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HomeMy WebLinkAbout034-1048-10-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANIT PORT Owner Property Address 5? L+j-- City/State WO)OaVi LL t. Legal Description: Lot - Block - Subdivision/CSM # PIN # 1 14 1 /4, Sec. LL T2LN-R-& Town _ TANK INFORMTION: HOL SEPTIC TANK - DOSE C H AMBER - !L� ) Tank manufacturer M,�,j CI Size ST/PC from: House j WellZaL P/L, Pump manufacturer ALio A//c" Model Alarm locat (HOLDING TANKS ONLY) Water Line Setbacks: Service road _ Vent to fresh air intake Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width I; Length _2-,5- Number of Trenches Setback from: House l h Well 1Y P/L Vent to fresh air intake ELEVATIONS: Description of benchmark I'Do Ili C A- Elevation Ir Description of alternate benchmark Elevation Building Sewer L 2 ST/HT Inlet- Inlet A.44 -6� L r r �-,/�,ST Outlet PC PC Bottom Header/Manifold IV,4 Top of ST/PC Manhole Cover AO 5:-- -9 Distribution Lines Bottom of System /0' 7• 7 Final Grade 7* I Date of installation 5 9 Permit number State plan number L—L6 9b63 / 4��L / Plumber's signaturp �c e �us e number Dated Inspector Complete plot plan A lcusu PluYlut; flue following; 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. _P_ LAN VIEW ;. I . f T rr` I s A 4 - \� A4 ro c t \ INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No ST CRO X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338926 Permit Holder's Name: ❑ City ❑ Village X Town of: State Plan ID No.: MALLET, MARK SPRINGFIELD CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: 034 - 1048 -10 -000 TANK INFORMATION ELEVATION DATA 900201 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia, Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD 21.29.15.330,NW,SW 840 292ND STREET . /�v Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert No s Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION P 1 B Wa 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 8 112 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State S anitary Permit Number , 6 - 1 Personal information you provide may be used for secondary purposes [0 heck if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number SiteID 164063 I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Trans ID X $$ 191074 Property Owner Name Property Location MARK MALLET NW 1/4 SW 1/4, S 21 T , N, R ) W Property Owner's Mailing Address Lot Number Block Number 840 292ND STREET City, State Zip Code Phone Number Subdivision Name or CSM Number WOODVILLE WI 54028 1 (715 )772 -3453 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cit Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms I Town o f SPRINGFIELD 292nd Street 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 034 - 1048 -10 I • Z9t • 15. X 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 - _____ System________ System_____________ Tank Onl�r______________ Existing System ________ Existi gSystem 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 SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 375 375 .5 N/A 107.7 Feet 110.04 Feet Capacit VII. INFORMATION in gallo Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper New Existing Tanks concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank 1000 1000 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 650 650 1 MIDWESTERN PRECAS ® ❑ El ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb 's Signature: (No tamps) MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 220292 1 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) IV Approved E] Owner Given Initial 0 r Surcharge Fee) I Adverse Determination O 77-9 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber DSO G-- C Mo a✓ J goo S / � L( NS le LK '[ e I i ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT fCO vEp Owner MAY Property Address Z Z do ST C 1999 - City /State W c)o a v i hL� (o i �v 8 Coin"` S' 20NffVG OFF►CF Legal Description: Lot Block -- Subdivision/CSM # AW '/4 S(A) '/4, Sec.L, T2 �N -RAW, Town of F PIN # O3Z1– , S/d� `/U SEPTIC TANK -- DOSE CHAMER -- HOLDING TANK INFORMATION: Tank manufacturer ie' ST/PC/ from: House ;L3 Well /P/L Pump manufacturer C- Model D SP 3 3 Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width S' Length 7 5 Number of Trenches Setback from: House 4, Well /Y P/L 110' Vent to fresh air intake ,t1w ELEVATIONS Description of benchmark o ke Q) Po ,-) c �- Elevation � o Description of alternate benchmark Elevation Building Sewer 10 ST/HT Inlet /Di3b Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover /D /,:!!) r6/, �� Distribution Lines ( ) ( ) � ( ) l o �, , (/-� Bottom of System () /C 7• 7 () 107, 7 () l d 2 , ,Z— Final Grade Date of installation 5 51 g Permit number -? State plan numbe 34 t), Z6 6 63 Plumber's signatur cense number Date L31 Inspector Complete plot plan � III � II � I - 100 feet of the system. Z plan vievy sketcf showing, evetything within • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW ---------------- S1P I- -_ -- i � 3 �3 /t/,5 7 r L. ( /.CC) \ `\ INDICATE NORTH ARROW a i a L t Wiscons, +n Department of Commerce PRIVATE SEWAGE SYSTEM y Safety and Buildings Division Count ST . CROI X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,Permit,�VA.: Personal information you provice may be used for secondary purposes [Privacy UkW, s.15.04 (1)(m)]. -PxrrriS "er'sdarj& [:Sift 1�1,1ft flown of: State Plan ID No.: CST BM Elev.: M01 Insp. BM Elev.: BM Description`: [1VGr i L�LJ Parcel T d ' 3V - 1048- 10 - 000 0 /00,00" at�3r °r 't •''? TANK INFORMATION ELEVATION DATA A9800621 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � �.� Bench m° �4 110 . G9 J D t7 Dosi n 5 3 t i 9 u � -7 , Sb D.�'6 l0. G� ,J Aeration Bldg. Sewer 9, 9 161.6.7 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 105 ' 3' s NA Dt Bottom 1 3.3 L 99, 7 S Dosing o . S' 02 , 1 , S NA Header / Man. a Sq Ubo q; Aeration NA Dist. Pipe ' SA / Uy Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand S`�° u. 7c.0 rr� �G �+1 C.� 9 o5,z S Model Number P33 ;1A•f GPM TDH Lift Friction $ �� System _r TDH Ft Head Forcemain Length /,d' Dia. oZ � Dist. To Well - /�0' SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of T riches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � s I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O � � CHAMBER mod Number: System: /`/O $ �/� OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length (13-6 • Dia. �" Spacing 6 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over � xx Depth Of xx Seeded /4edded- xx M ched Bed/ Trench Center �� Bed /Trench Edges a — � 6 Topsoil /P les E] No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD 21.29.15.330,NW,SW 840 292ND STREET fv. C f lswi�'l 51j'LV77 Utec'5 5a-d 1041.`7` 5 ­j7- Brit "//0.94 , Plan revision required? ❑ Yes [�rNo Use other side for additional information. SBD -6710 (R.3/97) Date a 's Signature Cert. No. Safety and Buildings Division 201 W. Washington Avenue 1* 6 consin SANITARY PERMIT APPLICATION P 0 Box 7302 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 8112 x 11 inches in size. ST. CROIX • See reverse side for instructions for completing this application State Sanita ry P Number Personal information you provide may be used for secondary purposes ❑ Check If ►evision JOK application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number Site ID 164 I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Trans. ID # 191074 Property Owner Name Property Location MARK MALLET S NW14 SW 1/4,S21 T 29 , N R 15 F/ ) W Property Owner's Mailing Address Lot Number Block Number 2095 WAUKON AVENUE Cit State I Zip Code Phone Number Subdivision Name or CSM Number 5T PAUL MN 155119 1 (651) 730 -5653 11. TYPE OF B ILDING: (check one) ❑ State Owned " arest Rod Public 1 or 2 Family Dwelling r292 - No. of bedrooms 3 r Town OF SPRINGFIELD ND Street 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 034- 1048 -10 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 I 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. [3 New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System System Tank Only 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 E] 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 SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 375 375 .5 N/A 107.7 Feet 110.04 Feet acct g VII. TANK in Ca pact Total # of Prefab. Site Fiber Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks e tic Tank mg a ❑ ❑ ❑ ❑ Lift Pump Tan berj 650 650 1 MIDWESTERN PRECAS ❑X I ❑ I El 1 ❑ 1 ❑ ❑ VI ONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: (No S mps) 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 (IncludesGrou ter ate ssue issuing entSign ture(NoStamps) '4 A roved surcharge Fee) pp ❑ Owner Given Initial C�L r6 � /07-) Adverse Determination UU �U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings ., 2226 ROSE ST LACROSSE WI 54603 -1905 *iSconsin Philip G. Thompson, Governor lip Edw. Albert, Acting Secretary Department of Commerce November 18, 1998 CUST ID No.268093 ATTN: POWTS INSPECTOR ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL ' APPROVAL EXPIRES: 11/18/2000 Identification Numbers Transaction ID No. 191074 Site ID No. 164063 SITE: Please refer to both identification numbers, agency. IC I Site ID: 164063 above, in all correspondence nc with the g en _cy . St. Croix County, Town of Springfield NW1 /4, SW1 /4, S21, T29N, R15W Mark Mallet FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 436849 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. Stats. • Inspection of the rivate sewa e system installation is required. Arrangements for inspection shall be made with p p g Y q g the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. • The well must be a minimum of 25 feet from the tank aJa minimum of 50 feet from the mound area. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 11/12/1998 FEE REQUIRED $ 180.00 FEE RECEIVED 180.00 Cera k r i d M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 e 41 ov 2 INDEX SHEET 199 PROPERTY OWNER: MARK MALLET 2095 WAUKON AVENUE ST PAUL MN 55119 PROJECT NAME: MARK MALLET PROJECT LOCATION: NW 1/4, SW 1/4, S 21, T 29, N, R, 15 W MUNICIPALITY: TOWNSHIP OF SPRINGFIELD COUNTY: ST. CROIX CONTENTS Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Pump Chamber Cross Section & Specifications Page 5: Pump Specifications Name: Bennie Helgeson Signe Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: November 10, 1998 )NIED S ip P ` �f COMMER ►NHS «� � Sf� .G _ CO NGE 5t PIC31 Pl U�-- = 1LA�v►ti b e r a � v► a H e L e so — C y3o I s '�ro oS HO rq 9 "P� _ }� j Q�Ci��,SQ Covn�o j Qi b o MO 5 b eJ Grac9� I ` 133 10 Pei. I OL, �CCx � Q I U As ShoC�J� r �LJN�R_ Nlr�rk YYl Page Of Cross Section Of A Mound Using A Trench Fur l'lie ,Lj>urption Area O H Medium Sand Fill F _ — 6" To so i l r eu (ASTM C33) 3 E Trench Of '2" - 2 z" Aggregate, Sly - FIB_ /040 Plowed Layer 6" Below Pipe, Covered With D 1 Ft. Straw, Marsh Hay Or Synthetic Fabric [ /, •� Ft. G � Ft. F H /, S Ft. Plan View Of -Sound Using A Trench For The Absorption Area Force Main Distribution Pipe Permanent Markers Observation Pipe W B I K I \ Trench Of ?" - 2 Aggregate I L I L A -S Ft. I /lj.5� Ft. 1: 0..3 Ft. W �. Ft. B 75 FL. J 7. Ft. L L-L Ft. License Signed: Plumber: Date: '�e• mR rn a I I e,t- _ -- Pa Distribution Pipe Detail For Lateral Network PVC Force Main Holes Located On Bottom A e Equally Spaced End Cap y I Y i� f X'i . PVC Distribution Pipe P * Last Hole Should Be Next To End Cap ! First hole to be from manifold end of bed P 73, Ft, Hole Diameter Inch X Inches Lateral Diameter 2 Inch(es) Y ! Inches Force Main Diameter �_ Inches # Of Holes /Pipe a S , Invert Elevation Of Laterals /o, 3•,= Ft. ,�, < �lpak YY1�.tlet •. Page Of_. — .. -COMBINATION SEPTIC TANK /PUMP CHAMBER 4" CI Vent Pipe with (No Scale) Approved Cap, +25' ,Approved Locking Manhole Cover From Buildings With Warning Label Attached Weatherproof Approved _ abel Junction Box Vent Cap �� g 12 Minimum Final Grade --� 6" Minimum 4"Minimum 6" Maximum 4" I • • C ; Quick Disconnect 18" Minimum Insp. Pipe `- -- 1/4" Weep Hole Baffles n r I Approved Joint A w /C.I. Pipe Alarm Extending 3' g Approved Joint Onto Solid Soil On 6; w /C.I. Pipe I C Extending 3' S U ' Onto Solid Soi Off D Conc. Block 3" of Beddinq Under Tank—/ 4 1 Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day / o - Doses: //a,s Gallons Volume of Backflow:....... + ,s y Gallons Tank Manufacturer: IAC10- ei �re « 5 Total Dose Volume: ........_ ,a G �"� allons Tank Size - Septic /Pump: iG0o/ g5 s'v a o � Alarm Manufacturer: S S f 5< 1 - Gallons Model Number • lo H �e> Capacities: A I —inches or�_gallons + B inches or Switch Type: Me r�u+r t=t ��i" - + C _�- _ i nches or 1�2� al 1 ons Pump Manufacturer: T ve x �, - + D nches or_$2__ Gallons _ Model Number: S 3-3 inches or - Gallons Minimum Disch ' Discharge Rate: q a Total.....= - Vertical Difference Between Pump'Off and Distribution Pipe: /3.2 Feet Minimum Required Supply Pressure:....... •••••• + eet _ Feet of Force Main x ,j, %a _ Friction Factor /100 Feet: _ Inch Diameter Force Main Total Dynamic Head: ... = / 7j Feet w� Internal Tank Dimensions: Length S ; Width 5 Liquid Depth Signature License Number Dates_ i . • � Il : al • M ODEL: • SP33 SUBMERSIBLE SUMP PUMP -MAX. SOLIDS V SPHERE - 1750 ., e■■■■ ■■■■■■■■■ ■■ee ■ ■e■ - • - ■ ■�����■�� ■■■■ ■ ■ ■ \' \■ ■ ■ ■ ■ ■ ■ ■ ■ ■! ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■ ■■■■■ ! ■■■■■■ ■ ■ ■■■■�� ■ ■ ■ ■■ ■ ■ ■■■■■■■■■ •■e■■■■■■■■ ■ ■ ■■■ ■s■ ■!■►� Millis •• ■■■■■■■■ .... ..... ............................... C • - . Wiscontin'Departmentof Industry SOIL AND SITE EVALUATION -Labor ah*Human Relations Page of Division of Safety and Buildings ': in rdance with s. ILHR 83.09, Wis. Attach complete site plan on paper not)eSs n 8 1/2'1 inche? p'sI . Plan must County include, but not limited to: vertical and h int (B -d action and s percent slope, scale or dimensions, north arrow, 1t5'c i and dis to nearest road. Parcel I.D. # NOV 9 "} 3Q 7 3� � /o ,� - %e APPLICANT INFORMATION Please P�i� l in rma "' Rev' wed Date Personal information you provide may be used for secondar06 (Privacy w, 15.04 (1) (m)). Property Owner p r o Property Location _ + Govt. Lot l,) 1/4 � /4,S T.2 1 1 N,R � tiler) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# �, _ City State Zip Code Phone Number Nearest Road [:1 City , ❑.Village e Town .2 Y All( s � If V (� New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow g ! 0 gpd �i Recommended design loading rate � �bed, gpd/ft trench, gpd/ft Absorption area required -- bed, ft 2 3 / � trench,; 2 Maximum design loading rate.4_bed, gpd/ft :f trench, gpd /ftz Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations 42 "'o F .SA' d 1. N de, R S S re M Parent material A Lj / A L �� /C� Flood plain elevation, if applicable IV ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system EIS X U I COS ❑ U I ❑ S LZ U ❑ S Do U ❑ S U ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench D K M M I Ground s ,S .S, Z Y6 x m iv >J elev. Depth to limiting factor .2 4� in. Remarks: Boring # , i M s ZAe .S e. 2d - e/ Ln Ground elev. Zd k-e- to limiting factor ly—win. Remarks: CST Name (Please Print) Signature Telephone No. 6= NI ' f /� - l >, /A: Address Date CST Number PROPERTY OWNER �LrM I ! i4 a >v y SOIL DESCRIPTION REPORT Oage PARCEL I.D.# ID L,/ r z© Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench O- S M - C x o - 6 L .t C- Ground - ,�- Se. 6 y ele � v. ,,�, Depth to limiting fact r & n. Remarks: 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 # �o Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) ' vv - -Y - RJAW w---- - J oo __ -� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer MARK MALLET Mailing Address 2095 WAUKON AVENUE, ST PAUL MN 55119 Property Address - 7 (Verification required from Planning Department for new construction)_ City /State Parcel Identification Number. LEGAL DESCRIPTION Property Location NW 1 /a, SW ' / a, Sec. 21 , T 29 N -R 15 W, Town of SPRINGFIELD Subdivision , Lot # Certified Survey Map # . Volume , Page # Warranty Deed # 56 7 3 7 Volume f of % , Page # -, Z 3 Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber 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. SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 VOL 12 7? PATE 9 73 STATE BAR OF WISCONSIN FORM 2,- 1 982 56 7397 WARRANTY DEE6 DOCUMENT NO. REGISTER'S OFFICE James T. Mahoney and Keri S. Mahoney, ST. CROIX CO, WI husband and wife R4g4 far Roce;4, OCT 2 4 1997 conveys and warrants to Mark E. Mallet and Katherine 3:30 P M A. Mallet, husband and wife Re ratan or O.eds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in C r oix County, /Yf Jq / State of Wisconsin: S p A -` /yJN- 034 - 1048 -10 PARCEL IDENTIFICATION NUMBER The North Forty (40) acres of the West Half of the Southwest Quarter (Wk of SW4) of Section Twenty -one (21), Township Twenty -nine (29) North, Range Fifteen (15) West. l/ 7FEE This is n o t homestead property. XX (is not) Exception to warranties: Easements and restrictions of record. Dated this day of 0r�Po A.D., 19 97 (SEAL) / ' (SEAL) fames T. Mahoney (SEAL) (SEAL) Keri S. Mahoney AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix Count . authenticated this day of 19 h Per came before me this Dy day of (� , 19 9 7 , the above named James T. Mahoney and Kari S. Mahoney TITLE: MEMBER STATE BAR OF WISCONSIN (If not, t A authorized by §706.06, Wis. Stats.) to me known to be the person S e instrument and cknowledge the me. o THIS INSTRUMENT WAS,DFIAFTED BY /! r) ' "'• i ; h Thomas A. McCormack •3 W. Bald W 54002 Notary Public, S` '• � s. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, star `K ;„ tign. date: necessary) 19 ) ' Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee. Wis. SURVEY MAP FOR MARK MALLET Survey of South line of North 40 acres of West 1/2 of the Southwest 1/4 of Section 21, Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin. W 114 COR. SEC. 21, r29N, R 15 W, /COUNTY SURVEYOR'S MON./ S 88. 47'2/ "E 1312. DO' — i I I 1 f I 3 I �I �5 R 3 N ? I 2 SE i J I ^ , c ^ V ^ 4Q W M N n 2 zt ev VV � 0 3 I Q I: LAURE E b _ m .W MUR HY o Z I m a em $ w J W Z : RIV FALLS, J FALLS, .- h � : I Q WISc. C J Q ` LAN o I ,,` H b I \ /S LINE NW 114 SW 114 N 88 42 '37'•µi a 616' I vJ /3/2. 12' -- 234.06' 2 ' -- –� N 88' 42 / "W 7' 297,33' j I 53' �I 274.2Z State of Wisconsin) a County of Pierce) NI ti 1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that 1 have surveyed the above described and mapped line according to official records and that this map is true and correct to the best of my knowlege and belief. SW COR. SEC. 21, T 29N, R /f W, /couNr r SuRVEroR'S MON./ o Indicates I" x 24" iron pipe weighing 1.13 lbs. /lin. ft. set. ZFL DEY , -28 _97 EY 1ilLl�1� R �� 10 -28-97 " r 200' M r �1 15_42,9,9@ // 11 o 2 Y 1 29 - / 5 _ /? 7 LL > W a� S b �" ¢ c Q E El T1 .. ■ ■ ■ ■ O �' c ;, " ■ ( I ■ I E T T 3 i 7 ; W M N I Z cm 10 tot ' I � ��11�� I,I ,I � I. �p i I O CD X T c Go n r F,e _ J (\ C N OD 9 cc f { 1► j — _ W fit ;\' '; {� , ax cr) 1 I r T ` of r z ` X a 1 I ts aQ CW) We T r , . N { •�_: F ' i Zvi /VN ` x