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HomeMy WebLinkAbout034-1012-60-000 ST. CROIX COUNTY ZONING DEPART AMN AS BUILT SANITARY REPORT 4 Owner t. Property Address City /State LPL.' r c Legal Description: Lot a-- -Block -- Subdivision/CSM # ` 1 /4 ' /4, Sec. 4, T4`N-RAW, Town of .' SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION i Tank manufacturer �� e Size ST/PC 0 / / Setback from: House 4 Well 6 / P/L /t 2 t:) Pump manufacturer Model L-5 Eon 41 Alarm locatio (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM i Type of system: Width .3/ ,� Length Number of Trenches Setback from: House -W Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark o - S�� .r j OW,_ Elevation iao_� Description of alternate benchmar o a Elevation _ Ls ; Building Sewer ST/HT Inlet A 05", 7 ST Outlet 16 � PC Inlet a PL Bottom . Header/Manifold 63,17 Top of ST/PC Manhole Cover 91 ss Distribution Lines Bottom of System Final Grade Date of installation c$ /w /f Permit number 7�s`a /_ State plan number Plumber's signatur License number a?��°� Date , 4/ 2 0 Inspector Complete plot plan l� 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. U- ip PLAN VIEW POO Cam; -5,14t` emu' t 00o G� 7 INDICATE NORTH ARROW ,6 6S� I Wisconsin Department of Commerce Safety arfd Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) S N o-: IX Pers information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)). 344 4 Per rnik.Etolde,r's 9, JIM /STUCKEMEYER, RS vI Nf� Town State Plan ID N o.: Wl1�LlAM 3 a CST BM Elev - Insp. BM Elev.: 7BM Description: Parcel Tax No.: i CST 034- 1012 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �.� 12W Benchmark (A $ 2� � Ie70 •D� Dosing 170 Gt 8 .� �S'• Aeration Bldg. Sewer d • Z3 . Holding St /Ht Inlet CA 1O.g4E 057,91' - TANK SETBACK INFORMATION St /Ht Outlet A Ll- I J os - , 4':1L TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet 12.12 94. irl Septic Sa s c-6 > NA Dt Bottom (S " 3G Dosing , 2-00 lzap Z- Z,* NA Header / Man. Aeration NA Dist. Pipe 3. o* 40 3. D Holding Bot. System 3 .44 10Z.Yfi A0 TO PUMP/ SIPHON INFORMATION Final Grade * 2- Manufacturer De qd , C A R- t( (R. To cytLr Model Number (0c ' 0 GPM qg• s� TDH Lift 0 Friction System � TDH ,'Ft Forcemai n Length 'Ol' Dia. 2 " Dist. To Well 7 (f� . 65 'b -'P SOIL ABSORPTION SYSTEM eA / I (.- ° `f BED T�1;EAliEii Width I Leng h PIT No. Of Pits Inside Dia. Liquid Depth EN I N Z DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION TypeO � ' }fi Model Number: Syste M w D 7 � _ CHAMBER OR UNIT DISTRIBUTION SYSTEM 5 Header/Manifold Distribution Pipes) J \ t x Hoye Size x Hole Spacing Vent To Air Intake Length .� Dia. iZ Length 35- L oo' ) - 'a. I �� Spacing _ A J -O / 5 • o —' 6.tZ SOIL COVER x Pressure Systems Only xx Mound At rad ys ems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Ce'h 'r C`Akk . ` LOCATION: SPRINGFIELD 06.29.15.91,SW,SW 1113 CTY RD D ��ifa"" >Dsd's•(N�� /4` L �ao.VB t ,,� - 4� �t`4' a�2or . i s Sit- l r`•. ts.utq� -�f• 99, n t o ) a D •sew. Sf8' Cover c.s— A4-f 011- At e%�, di dQ�� -(9 Plan revision required? ❑ Yes No Use Qt side for a i F ® �b -6710 (R.3/97) ector's Signature Cert. No a Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 2 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. o ,, Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst $. paper ot�les>~, ' my than 81/2 x 11 inches in size. CROIX • See reverse side for instructions for completing this appy n S4xf Sanitary Permit Number _s m Personal information you provide may be used for secondary purposes 4 I 0 5 j Ch 3 4 / 1 /& x` k if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. - ' Gif)( ftvt4PIan I.D. Number Site ID 177521 I. APPLICATION INFORMATION - PLEASE PRINT I&AkA j ns ID 237824 Property Owner Name Property Jim Williams & Angela Stuckeme er /4 1 T 29 r N, R 15 IV* W Property Owner's Mailing Address a Block yy umber PO Box 861 A N/A City, State Zip Code Phone Number Subdivision Name or CSM Number XWOX /01 Hudson WI 1 54016 ( 45 N/A 11. TYPE OF BUILDING: (check one) ❑ State Owned o it Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ❑ Village ___L�_ -_ Town OF Springfield Co Road D I11. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 034 - 1012 =60 -0000 (o- 20� . 15 .`1 ( 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. U Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an ------ System -_ - - -_ S e _ TankOn�/________ _ Existing System System _____ xistny _- - -__ -- Exlsting ---X-st--m l ------------ 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 M 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 Irl VI. ABSORPTION SYSTE FORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 600 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 500 500I 1.2 N/A 101.92 Feet 104.22 Feet Capacit VII. TANK i Ca allo n Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank 1200 1200 1 Midwestern Precas ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1000 1 1000 1 IMidwestern Precas L 1 0101 01 ❑ 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) Plumb ' Signature: (No S MP /MPRSW No.: Business Phone Number: Bennie Helgeson 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip Code): W1229 770th Avenue Spring Valley WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fe (Includes Groundwater at ssu Issuin gent ign ture (No Stamps) Surcharge Fee) qa pproved ❑ Owner Given Initial �-� c � `- / ' 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 s INSTRUCTIONS A 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 S. 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 ou have questions concerning our onsite sewage system, contact our local code administrator or the State of Y 4 9Y 9 Y Y 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. Vlll. 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. i Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; ,streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410included 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 2226 ROSE ST LACROSSE WI 54603 -1905 - TDD M (608) 264 -8777 I sconst n www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda I Blanchard, Secretary August 02 1999 g , CUST ID No.268093 ATTN: Rod Eslinger ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/02/2001 Identifica' ers Transaction ID o. 237824 Site ID No. 17752 SITE: Please refer to both identification numbers,' Site ID: 177521 above,; in all correspondence wi&4h age St Croix County, Town of Springfield SW1 /4, SWIA, S6, T29N, R15W Facility: Jim Williams & Angela Stuckemeyer FOR: Object Type: POWT System Regulated Object ID No.: 482208 Replacement mound system The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this, correspondence may be made tome at the telephone number listed below, or at the address on this letterhead. is Sincerely, DATE RECEIVED 07/20/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 "Dennis nson BALANCE DUE $ 0.00 Wastewater Specialist (608) 785 -9336 dsorenson @commerce.state.wi.us INDEX SHEET , V PROPERTY OWNER: JIM WILLIAMS & ANGELA STUCKEMEYER P 0 BOX 861 HUDSON WI 54016 PROJECT NAME: JIM WILLIAMS & ANGELA STUCKEMEYER PROJECT LOCATION: SW 1/4, SW 1/4, S 6, T 29 N, R, 15 W MUNICIPALITY: TOWNSHIP OF SPRINGFIELD COUNTY: ST CROIX CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications Name: Bennie Helgeson Signe Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: RECEIVED JUL 19 1999 SAFETY & BLOGS ow - o OL v� - �3PC� Loeb y v `o GL �riJC S 1r1f 0 s¢e �2 �?lxKt Pc�ar r• TR 7y Q ra (Jed � C.T. N � Ctit�•..{�or� � ��o �i 4 Dos e- `( w `D sc a Jc I y c cp s' $� 9 m � C6,- %4cxu- Peo. 99. 9":) PRIVATE SEWAGE #YSTEM Conditionally sfi APPROVED SEE RRESP )NDE-NCE -- T ►LUA S'` Aiij mot e Of r Page _ vt� � ►n u h1L' 4 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe oy a um Sand H G Topsoil F _J l; 3 D E � � u % Slope- gq,g3 y M Bed Of Ji — 2 2 Force Main Plowed Aggregate From Pump Layer D a Ft. E eQ.3� — Ft. Cross Section Of A Mound System Using F �U Ft. PRIVATE SEWAGE SYSTEM A Bed For The Absorption Area G Ft. Conaidonally A �_ Ft. H /. S Ft. A ficis ' e RUV ned• B 7� Ft. K / 3 y Ft. NII�It�N OF SAFETY AND BUILDINGS L � �� Ft. Da e: j Ft. SEE CORRESPONDENCE T /'7 Ft. Force Main W 3/ 7 Ft. — L ► Observation Pipe J 8 K A �o - - -- ---- - - -_ -- ------ - - - - -- Distribution Bed Of 1 2 1 1. — 2 z Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area r,elr5 ; Tim W I 1.1 1 n nt q 4Qe n' ��e_ryi Pllar New Perloroled Pipe Oololl � CJ End Vlew ) Porloraled End Cap b �: PVC Pipe ( j Permanent End Markers ` s Holes Located on Bottom are Equally Spaced Q .a" PVC Force •Main From Pump PVC CND / Manifold Pipe CAP 1 A/c oiel ibullon..• Pips Loci Mole Should Oe Nett To End Cop Distribution Pipe Layout P 3�5 R S, PRNATE SEWAGE SYSTEM X S Conditionally y � s Hole Diameter Inch Sig — Lateral � Inch (es) Li N mb Late � a�. NOW Manifold " a Inches SEE CORRESPONDENCE jls rorce Main " a Inches (/iyrl r5 ; .1im 0111 fAms 1' is � em 4r PAG, -:F PUMP CHAM?j R CROSS SEC -!C!j DKJE SPECIFICATICkiS VEAIT CAP i 4 "C.I. VENT PIPE WEATHERPROOF APPROVED LOCAIMG JUNCTION BOX MANHOLE COVER L3' = 20.M t300R. 12 "MIU. WIQCOW OR FRESH I AIR INTAKE I GRADE 4" MIAl. I8" M'IU. COWDUIT -- ---- - - - - -- PROVIDE I — — IAILET AIRTIGHT SEAL APPROVED .JOINTS APPROVED JOINT A I I I ( Wf C.I. PIPE W /C.I. PIPE I I EXTEUDIU(s 3' EXTENOtWG 3' Q�gYgTEM I II ALARM ONTO SOLID SOIL. ONTO SOLID $011N ( I pft • l i O N . C � ELEV.aF PUMP - -j �� OFF CONCRETE BLOCK pND E =, c sa ft CK R1 €K EXIT PEKMIlrED O R HAS SUCH APPROVAL p.:Sz:22 -4'1 SPEGIFICATIOAJS CA� tua. 9�5� =1141 ANA E OOSE �J TANKS MANUFACTURCK: �`� `��r" Or' NUMBER MBER OF DOSES: PER OAS TANK SIZfi : I 6 _I, l. sca GALLOWS / DOSE VOLUME ALARM MARIUFACTURGR: V • � �SY,,I ��U�yf6ACKFLOW: o2 GALLONS MODEL WUMBER: ��� w_ - CAPACITIES: A= _IMC14ESOlt � GALLONS SWITCH TYPE' " � 'p J r ,� n r`'1 /0!A 8 ° — INCHES OR �1�-- OALLOUS PUMP MAWUFACTURER' �S ' � Gx C a INCHES OR �`S MODEL NUMBER: —LA) O� N � D = I - ) y f INCHES OR j2_2+11.§ GALLONS SWITCH TYPE' 1 -- 'o te r ,v' eK- ' MOTE: . PUMP AMD ALARM ARE TO DE INSTALLED ON 5EPARATE CIRCUITS MIUIMUM DISCHARGE RATIE � GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MIAIIMUM NETWORK SUPPLY PRESSURE . . . . . .. . . . 2.5 FEET + FEET OF FORCE MAIN X _ /oo ►tiFRtc71ou FACTOR. ,, - 7 FEET TOTAL OyNAMIG HEAD = .243 .± FEET f rl // 1( IAITERNAL DIME)JSIOMS OF TANK: LENGTH . 710 ; ;WIDTH — LIQUID DEPTH Q 6, 3 6,1. T .r.wc4, 51GUED: LICENSE LIUMBER: DATE: - dik ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■MEMO■■ � i ■M■MEMEMEM■ ■EM■■■ as ■M■ ■E■ ■E ■ ■ ■■E■EEEMEM■ ■ ■ \�\ ■ ■ ■ ■ ■ ■ ■MEM ■ ■EEEE■■ i■mom \MO\n \ ■MO ■ NONE ■ NONE ■■ ENIMMEEMOMEM '"Emmmam\■ ■sue ■ \B ■ ■ ■ ■E■ ■ ■ ■■ w"Tm \M\■■► \ NONE MME ■EE■ '■ ■MM MEM■■■ 1 ,K \ ■E ■ ■E� ■ ■MI.MEMO ■MME ■M ■ ■■ \�mmm. M E■EE \E\ \■M \M ►EM■ ■E■ ■ MM—M \ ■MMO ■EEM ■VEME ■ME■ ■EMMEMMEa m "Ella M\E■\E\ :MEN i.� ■O ■EME■EEEE\mmm ■MOO ■MM■ ■MM■ ■ ■■ ■ ■ \E \��� \���lE■■ ■M ■ ■ ■ ■ ■ ■ ■ ■ ■M ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ 1 1 1 , •1 1 .1 1 :1 •1 11 1 1 D � ,SEEM ■ ■EE ■ME ■ ■ ■ ■ ■M■ M ODEL 3 88 5 NONE ME MEMO No ME■■MEEEMENOEEE■ ►� ■ ■ ■E■EEEE■ ■ ■ ■ ■ ■■ ■FEE■■ , ■E■ ■M■EEEM■ ■■MME\ ■EM ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■E■ ■E■ ■E■EMNNEEMEM■■■ME■EEMMMMM■ ■EM■■MM►MMEEMEEMEM ■E ■EMEEE ONE EEEEEME ■EM ■EEmom EEO MENEM ■�� ■ ■ ■ ■■ ■MME ■ ■ ■MMOE■ ■M ■ ONE ' MO MM■ ■EM■ ■ ■ ■■MEMEEMEM■ 'O■ME■■\WME■■■\MEMEEEM■OMEN 1 , ■■ME ■MEIOMMEM ■O\MEMMEEEMME■ �.______. .,....�E ■\ ■FEMME ■EM■ ■EEEMEEIIMM\ ■ME■ENEMEEEEME■ OEEOMEEI �E ■ \�MEE ■ ► \EMEEE ■FEE ■ ■ ■EME ■IIE ■E\ ■EMO�EM■ ■DOFF■ 1 1 ■EE ■ ■EEI ■E ■E ■ME ■FEE ■E ■EE ■ ■■ 1 1 1 1 •1 1 ., 1 :1 •1 11 1 1 1 , , 1 Wisconsin Department of Commerce SOIL AND SITE EVALUATION rc.4 F' � 49L ,, 040 S Division of Safety and Buildings, k1fto ` Page _J_ of _ Bureau of Integrated Services �� in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 5 + C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ,.. 03 - Iala -� t oo - APPLICANT INFORMATION - Please print al � o"Otipn: Re ' wed y vat Personal information you provide may be used for secondary pu r se �Psivacy Law, s. 15.04 Property Owner Property' ocation ►� �w � RF-f`r - Govt Lof � S (,� 1 /45W 1 /4,S T.q ,N,R j 5 E (orffl� Property Owner's ailing Address t # ! lock# Subd. Name or CSM# Ciiy � C> State Zip Code g, Number'�NTy ❑ , ❑ village ® Town Nearest Road �L �{° t?I ( �7 sn a ❑ New Construction Use: Residential / Number Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 1 gpd Recommended design loading rate • a, bed, gpd /ft i trench, gpd /ft Absorption area required 500 bed, ft f D© trench, ft Maximum design g loadin g rate j bedgp , d /ft I j t� trench, gpd /ft Recommended infiltration surface elevation(s) ,1b/ . 7 a a ft (as referred to site plan benchmark) Additional design /site considerations Parent material I n e w 41 CL e — Cw c Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound X K1,t In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S [59 U �& E ❑ U ❑ S ®U I ❑ S 54 U I ❑ S EZ U ❑ S A U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots `` in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 1� -15 - 7, 6kff- I) """°° L � it'I� � � h 1 F� C W � � � � ; 0 elev. Depth to limiting factor V3 in. Remarks: Boring # a J049 t ca l{ L a� , sbk � F .5 A 3 ty116 7.5 1 ) 'q C. F , 5 ' Ground l�o'r+� • �A / / .2m . k rvi Ft' I uF * , • to Depth to limiting factor alD in. Remarks: ' 'r- �° �« + tt CST Name (Please Print) Signature Telephone No. v f Address Date CST Number PROPERTY OWNER �p 11rr� SOIL DESCRIPTION REPORT age u g _Q_ of PARCEL I.D.# 3 7— 101 D� —L O — o o o Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench � � -►� Io`1Rs �� 5;�.. �m�b►� �ir Cw .5 Ground 3 a -�7 `7 5y(Z /,� - 7. 5 4 Keh L iPSbk ro Fr Cw q l a ff. I7Q3 7.5`4 Ry F 7.5 40 SL_ 1;,56V.. t 4 , 4 w l ip ► � ►� 519- F /1$ Depth to � y��/ L.. d"� ��t �' f ' .„3 � '7 limiting factor in. Remarks: f Boring # ........................... ......................... ........................... .......................... Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ........................... ........................... ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) r 6 -6 -99 To: Rod Eslinger St. Croix Co. Zoning D g P 1101 Carmicael Road Hudson, WI 54016 From: Donna J. Stark 276 200th St. Star Prairie, WI 54026 CSTM 221746 Subject: Request for revisions of Boreholes 1, 3 and 5 for Betty Bloom perc Mr. Eslinger, On the above te, I hand dug (with shovel) review holes by boreholes 1, 3 and 5 per your request. I dug to a depth of approximately 18 inches per borehole and stayed within the proximity of the original. As you can see, the depth of each horizon on I and 3 have changed slightly, but I still disagreed with the SiL at the depths you found at each. This would be the 3rd horizon's that is in question. In this 3rd horizon, besides the color change, I could definitely feel the sand content pickup. I could not call this a SiL. I did compromise and called it a loam instead. In borehole 5, besides the SL texture change to a loam, I found my horizon depths to be just as I described on my 5 -27 -99 perc. I feel pretty confident with the latest changes for boreholes 1, 3 and 5. If you have further reservations about accepting my field study notes, I guess we ask Leroy Janske to settle it. If Leroy says that I am wrong, then it will have proved to be an educational experience and make me a better soil judger to say the least. Please call me with your decision. Sincerely, Donna J. Stark 515- 248 -3588 9 Cb t �. R�cEiv��J r SS CF'x �Flt'Ir i� inrlscdnsih DeppWantof Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau otintegrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and 1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # C 0.0000 APPLICANT INFORMATION - Please print allif, on. Ravi ed by Da Personal information you provide may be used for secondary r( lew, a� 04 (1) (m)). O! Property Owner (� , operty Location qa .Lot 6 1,t) 1/4 5 w 114,S ( Tag ,N,R /.5 E (odo Property Own &s Mailing Address ' -. Lot Block# Subd. Name or CSM# City State Zip Code Phone rS (t Village © Town Nearest Road Ga l�Jt S,o1 6 -x{5(071 �,n 5;e-la ��k9 0 F ❑ New Construction Use: ® Residential' ' mb r Pf E s 7 Addition to existing building (D Replacement F1 Public or comm - Code derived daily flow t7 O gpd Recommended design loading rate gi bed, gpd/ft • Z trench, gpd/ft Absorption area required S00 bed, ft2 501) trench, ft Maximum design loading rate I bed, gpd/ft � • A trench, gWt Recommended infiltration surface elevation 1 O 9 / (s ) It (as referred to site plan benchmark)' Additional design/site considerations Parent material f- H Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound t R. plot ►. `}n- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ s BU [Z is O U ❑ s O u I DS fZ u I EIS 5 1 171S 9 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /tt2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 0- (0 I o -1R 5; L a m R >r, Fr- � G s a lo- O'1R -- 5 $'L c?M ft c t,> F S ' .6 Ground 3 a -ia 7.5YW1 SL c M ' - ►hFr Cw IF .5 ; . ele 19e?�ft. y _1 ?.s`1 5L_ F S bW- "Fr 5 Depth to 17_ SIP01 1 F1 1 F2S`1 e/8 SL- 0 -M rnF; — :3 ; . , limiting factor 1'7 in. Remarks: Boring # 3 Jz � -10 104 IZ 5 / --- 5, L h.56 PL Ground y f -� 7. S`i(ZY ) q - 7.S�i `/ SL F5 r e lev. s -4 S`1 ' 114 F IF 7.S4 R t- 0 - M Depth to limiting to I or in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number a'7 t s -a - g a y 6 If 16 a 1, ztt- _�� SOIL DESCRIPTION REPORT PROPUM OWNER Jr2ScJ_� - +�L - Page -Ci- of PARCEL 1.D.# 3 y- 10 I a (r+ b- O O D D Boon # Horizon Depth Dominant Color Mottles Structure 2 Boring In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots ;. C Bed , Trench 5; L o7M b P, Fr Q a F 7 10 L MFr to Ground I b -1� ']. 5 'l Q 5/ y 5` Qrnsbw IM Fw- elev. IO 13 ft. Y 1 1.1 -A D 7. S y W yly ---- -- 5L- a M s 6 M Fr a w I j F Depth to - 7. M Fr limiting (, SIR Y/ F 7 `I �/ 5 L 0-M M F; ; , y factor -jiLin. Remarks: t,y a.-f e.- S C t Boring # :♦ t o -7 I Dlp,3j 5; L alM b R hnf r S OF . S'. y - 1 s/ - S:L .?r,SSk• ►.,Fr �w dF ,S , IV .,, 3 II - ►B 7, S y Ry/ F 1 F7,5 YR I '/ S�- I FsbK. S Ground 4 19_U 5 g%j /`l ,F y 1./ 5L a - M F,& . 3 ; • y g Depth to limiting f ac l r in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 0.1 1 b'I R 3 /2 5 L a m G rh Fr G S a F • 5'. b x 7• la o`12 — 5; L 2 Y"5 b K. ntFf c w a F .5 ' .b 3 3 /2 -1 7. 5jjZ' $ JY fW .5`f 2V SL k m F e- c w I F .`! :.5 Ground 4 17 -23 T OR -1 141 IF7.5`I M/ 'S If sbk w, Fe- taw 1.,F .y ,5 9R a f� +oa S Y F I f 75 %f KV9 SL- Q -Pv %F: ; .y Depth to limiting fa Remarks: -� � y - 01 Y i 1 Boring # Wes? Ground elev. Depth to limiting factor I "' Remarks: SBD -8330 (R. 07/96) Do yl 11 �34 q�rc pd rc.• -i C 5.� ►�-� a 17 Ll b i Uy l V 1 f v, I I I eS -10° lu 6 { IV 1 j 00 / - - a 1 0 ' e. c�1 p o,%+ a \ o r R bof- of 1e ,s 1 99�9a By 99. � w e TZ) 3 ! �sd�� nDe r,`- neiatw�t56y, SOIL AND SITE EVALUATION REPORT Page of Z 1 Dnrisimr of Safety s Buitdrgs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach comp site an on p ap e r not less than 8 1/ PI PI p Pe �n`�h�5•ize. Plan must include, but not limited to vertical and horizontal reference pgml:,( - &a* aT4'% slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and d artiratb neazetroad , • ; � APPLICANT INFORMATION- PLEAS�P-RINT ALPI,R�{ATION '`, R I D Y D E tlCCffll B4 1 PROPERTY OWNER: �� _. �� S PROPERTY LOCATION B�T `j gLOOr'1 f 6A -E0T S�- 1 1/4 S WI /4,S (, T Zq ,N,R 1 S E PROPERTY OWNER':S MAILING ADDRESS • X - LqT # BLOCK # I SUBD. NAME OR CSM # AUNTY ._ CITY, STATE ZIP CODE v ;PHONE NUMBER CITY VILLAGE (MOWN NEAREST ROAD G L�ZVWC)(lD Cll'1,Wf S �L6L3 ` �t )' bS,_�Z: 7 S NZIiV G P ( [) New Construction Use [xJ Residential / Number of bedrooms L/ [) Additign to existing building Replacement [ j Public or commercial describe Code derived daily flow 6613 gpd Recommended design loading rate uY- bed, gpd/ft IJA trench, gpd/ft Absorption area required ti w bed, ft tig_ trench, ft Maximum design loading rate t--s k bed, gpd$ ►JA trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Nu �.o t w Z kc \Z� h — r� 1 ty - Z S oo < •-t- -r Parent material c)U% T1L( Flood plain elevation, if applicable t. A ft S = Suitable for system cONVINfIONAL MOUND IN-GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S N ❑ S O U ❑ S ®U p S (RU O S ®U WS ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmrich }i \p Prrs w v Ground elev. F1 1 F sblz - - ft Z Nf�� ►n Pt �S_ - ,Z 3 Depth to 3 \S -Z3 S tR 3/y C\ Sop 3L3 S, O YnU�1•- �-5 " 'Y limiting ; factor L{ 23 _ 38 S `'l2 Remarks: -2 PITS Boring # I� Cct�1Tf�'t 'U r.t t..i 7 I i Ground elev. ft Depth to limiting factor Remarks: T Name —Rease Print Phone: Arthur'L. - We erer 715- 425 -0165 g e erer ,So it Testing & Design Service -P.0 Box 7 - 4 :River- Fa11s,WI 54022 g S` nature: j Date CST Number: . C,��2 �: �. 0[9 - 1 5 - Z- 22025 PLOT PLAN Page Z of • Z t I SCALE 1 "= YO ' i L4 Bbd 16 : � I GRR X x x � \ 00Vtir�1 G Lo C.,gT�ry 9 I 1( 1K s VA = 6bo z q z zo z s ( 715 ) 425 -01 65 CST Signature Date Signed Telephone No. CST # Wisconsin Department oflndustry, SOIL AND SITE EVALUATION REPORT P e \ of Z Labor and Human Relations a9 — Division of Safety & Buildings in accord with ILHR 83:05, Ws Adm. Code / COUNTY • Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 6AV --L-OT Sw 1/4 S W1 /4,S (, T Zq ,N,R 1 S E ( PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD G L1wc)()O C1T`/,t�f s�[at3 (CIS) zt,S -Z3� SP2lry G FL [ J New Construction Use [xJ Residential / Number of bedrooms L{ [) AdditiQn to existing building Replacement [ J Public or commercial describe Code derived daily flow tJO gpd Recommended design loading rate MK bed, gpd/ft NA trench, gpd/ft Absorption area required t i ra bed, ft va A trench, ft Maximum design loading rate tJ A bed, gpd /ft 1.tA trench, gpd* Recommended infiltration surface elevation(s) ti •A • ft (as referred to site plan benchmark) Additional design /site considerations 'tA� L-o I w G � r� \Z2t� n — r�1 1 tv - - Ls oo GA t_ Gfmfl t `ice r Parent material o c>v%�- GLA t-k f cc, - PL-t- Flood plain elevation, if applicable tJ A ft S = Suitable for system CONVOMONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDWG TANK U = Unsuitable for s stem ❑ S RU ❑ S ®U ❑ S ®U 1:1 S ®U ❑ S ®U WS ❑ 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 Tmrich 10 P l S >-j — v Ground elev. _ – ft Z 9-\s .1 l R y 1 �( 5`l2 Depth to 3 \S -21 -1,S'I c \ S4L3L S or., "A u1) limiting. ' factor q Z3 Remarks: Z -'VtTS ® Rr4 `i�� z: �h /bL? �1 NoT Boring # R tvllT "I U h) ),^j G. •: sv Ground elev. ft Depth to limiting factor Remarks: T Name: Please Print Pte ;Arthur•L. We erer 715- 425 -0165 g rex 7Soil Testing & Design Service-P.0—Box 7.4 .River Falls, WI..54 _ Signature: <— Date: _ CST Number $ _ 2 Lis �.-� �9 Z g 220254 PLOT PLAN Page Z of Z 4 ' SCALE 1 "= 40 43bV —" I j �i -or1� I � kw� /� LU c •►*C'�l UTv I �Ru I x x PtP\�uy- . 7 Lo c_v��uvu 4 Q v � x � K x qq- Z zzc (715 ) 425-0 - 1 h 5 T'I CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer JIM WILLIAMS & ANGELA STUCKEMEYER Mailing Address P 0 BOX 861, HUDSON WI 54016 Property Address 1113 CO ROAD D, GLENWOOD CITY WI 54013 (Verification required from Planning Department for new construction) City /State. GLENWOOD C TY WT Parcel Identification Number m4- ini2- rn —nnpn LEGAL DESCRIPTION Property Location SW 1 /a, SW Y<, Sec. 6 , T 2 9 ) , N -R Town of ,PgT;rgT - Rj - D Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 4 e f3 a 0 , Volume 35 . Page # Spec house ❑ yes ® no Lot lines identifiable E9 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, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 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 days of the three year expiration date. NATURE OF APPLICANT 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 the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. S NATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1 V(';_ 1435PAGE 453 605309 STATE BAR OF WISCONSIN FORM 2 - 1982 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. RECEIVED FOR RECORD Betty L Bloom, a single arson 06 -21 -1999 8:45 AM WARRANTY DEED EXEMPT 8 CERT COPY FEE: COPY FEE: conveys and warrants to Angela L_ StuckQm a gi 1 a person TRANSFER FEE: 330.00 and James G Willi a si ngl P per,�on RECORDING FEE: 10.00 PAGES: i THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St Croix County, Return To: State of Wisconsin: Edina Realty Title 400 South 2nd Street Suite #115 )A Vson, WI 54016 034- 1012 -60 -000; 034 - 1012 -30 PARCEL IDENTIFICATION NUMBER 034- 1012 -50 All that part of E� of SWJ lying Westerly of Railroad; South 10 rods of NW- of SWT; East 11.428 rods of NwT of SW's, EXCEPT South 10 rods thereof and all of SWT of SW- all in Section 6, Township 29 N, Range 15 W. St. Croix County, Wisconsin. This is homestead property. (is) Exception to warranties: Easements, restrictions and rights of way of record, if any. Dated this day of A.D. 19 -��• (S L) �- (SEAL) * Betty L. Bloom (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, - 'T' ss. (`/� Count}. authenticated this day of 19 Personally c4a before me this day of 1942_, the above named D � >> tty L Boom, a single person TITLE: MEMBER STATE BAR OF WISCONSIN tai 10 4v�O� — (If not, v c 1S G authorized by §706.06, Wis. Stats.) Ok to me known to be the person who executed the foregoing Sta instru and acknowled' the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland , Hudson, WI 54016 Not ublic, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, ate ex 'ration date: necessary.) / 9 iw��) ' Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. 'I WARRANTY DEED Form No. 2 — 1982 Milwaukee. Wis.