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HomeMy WebLinkAbout038-1177-20-000 r ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORT �`, �► P`�. F Owner l _N Iv I S SLR -t I LTS 4 Property Address Z3B il1)TR, �4J City /State 111Eti0 i�. k1t�►�L , 1 1 5'ID1 �, cou" ZONING OFFICE Legal Description: Lot 1-5 Block -- Subdivision/CSM # MI ALL N t /4 NE t /4, Sec. , T 1, #N-R /g W, Town of RAIRfE PIN # I>3f�- i1�7 -Zn �cx'jD SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer YIELDED Size ST/PC 1 M0/ ,801) Setback from: House q3 Well Z 5 P/L T 5C ) Pump manufacturer Cam LXJLDS Model :32571 E an 4 Alarm location 2 " PZLW ' fJJS co e Q/1M t / Al'RO X )S " 1 BTM,. i) iytiP fll, (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: MDUQ Width L7 Length Z-S Number of Trenches Setback from: House °7L Well P/L t S[? Vent to fresh air intake ELEVATIONS I ,f f C) F - ,SF - C� ko n1z K Elevation Description of benchmark �— tion of alternate be nchmark 577Y� b F �I� ILL IS E LnUC-2 C f- a S 7f p � St` Elevation I) Building Sewer l6q, ST/HT Inlet MZ..Z6 ST Outlet AOZ 5 PC Inlet I6l- ttS PC Bottom 9,35 Header/Manifold J D 9 Top of ST/PC Manhole Cover Distribution Lines () J011. 9 () ( ) Bottom of System Final Grade ( ) ( ) ( ) Date of installation )D 16 / Permit number 3LN State plan number 2SWL---1,L) Plumber's si natur !/' W License number �7.3ZL Z Date g Inspector Complete plot plan e 1 s �IaUS£ A AL gllx' +IkR�li2t� (,ARAL D tM np 1J� �.cQnlE2 d� flh�s� 143` 0 in PRDP L S + ST. CROIX COUNTY ZONING DEPARTME ' } ' AS BUILT SANITARY REPORT Owner I _N N i S SLA I LTS Property Address 23B l M 7 1+ , G,, s7 Nt I 5&00 ct, - City /State v►/ iCNk1t�►�� , V zon, OCOU $CE Legal Description: Lot 15 Block — Subdivision/CSM # Al ALL HE '/, NE ' /,, Sec. q , T 3 /# -R 1g Town of `STAt- 7ZAIRL PIN # IJ3�- il�7 -Zc► OCX�D SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer V�Lf-KS Size ST/PC jam / Setback from: House `3 Well Z 5 P/L T _5D Pump manufacturer aLVLDS Model :3z5ll F pn q t^' ivtif' 1�1, Alarm location 2 A&WE ON ,C'oe RIM /IpROX 13 F, (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: )M ML Width L� Length Z-S Number of Trenches Setback -- ck from: House `7L Well PIL t �D Vent to fresh air intake ELEVATIONS Description of benchmark 1D1 r)r 5E C� S P nRu TAKE Elevation _ Description of alternate benchmark RlM bF � 51 �, PE 0-nCuE G r Eu5, ` Elevation 113, 7P- Building Sewer IN, A ST/HT Inlet IDZ,Z6 ST Outlet 1,0 Z•n 5 PC Inlet IOJ• AS PC Bottom `72'5,35 Header/Manifold i D 9 Top of ST/PC Manhole Cover — Distribution Lines ( ) % ( ) ( ) Bottom of System Final Grade () () ( ) Date of installation )t/6 Permit number 3'NSIf Z State plan number - Z / Plumber's signatur (/'�� License number Z. Z- 329 Date / Inspector Complete plot plan a � I z M 1Jti -f .n LU 4� \r C4 w 2 vi 4 W r � �n 0 �p � � o � A � �2 AZ M W Q v Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT -GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: CIR0 r X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344582 Permit Holder's Name: ❑ Cit ❑❑ Villa e Town of: State Plan ID No.: SCHILTS, DENNIS STAR IRIE o2 CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: (� O loplo ) Al 038- 1177 -20 -000 TANK INFORMATION 0 ELEVATION DATA 0. 9` TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( ,, 5 J Benchmark DTI ; C7 Dosing 1,0 /! 3- ! - b Aerati Bldg. Sewer IV oS� (d �. 8 6 Hol St Ht Inlet ,r,( (02 -2-4. TANK SETBACK INFORMATION St/ Ht Outlet s•� �rZ -- TANKTO P/L WELL BLDG. Air to ir I ntake ROAD Dt Inlet (o. j0 14V 1 , 8S A Septic 4 3 1 NA Dt Bottom `) 6 0 3 S Dosing > S 60 NA Header / Man_ 3. a S� 6 q. c), 0 Aeration NA Dist. Pipe 3.O r Holding Bot. System Jay. tS^ PUMP/ SIPHON INFORMATION Final Grade S 3 Manufacturer 4 00 3$�I emand Model Number �p�P 2 � 0 GPM TDH Lift Friction System .� TDH p,(► Ft Forcemain Lengt I Dia. _ u Dist. To Wel SOIL ABSORPTION SYSTEM BE / 11 @NC-H Width Length f o. Of Tomes PIT No. Of Pi EN I N 3 1 l c I DIMENSIONS _ SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI INFORMATION Type O _ CHAMB► System: >S r — OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) � x Hole Size x Hole Spacing Vent To Air Intake 0 I.S S 5 t u N � Length 3.5 Dia. � Length 3 Dia. p g � 2 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 g �— Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) a {�h U ' LOCATION: STAR PRAIRIE 4.31 18.877 2, 8 110TH ST - MALLARD RUN ti ts i l Lf L `� 6m p � Rd� AS - 61-'rf le �-IP) Plan revision required? ❑ Yes No Use other side for additional information. (3 ey J Z SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division N*6consin SANITARY PERMIT APPLICATION 201 Bo 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 Couunnty than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 3 yyz Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04(1) 2 3 8 / (a / r State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION O Prqaerty Owner Name Pr Location /U� � i E 1 /4, S T , N, R E (or )p Property Owner's Mailing AcWress Lot Number Block Number Ste- City, Stat Zi Code Phone Number Subd ision Name or CS ppqq Number CH f1i 1 1 /01 7 ( > AILLWO K II. TYPE OF ILDING: (check one) ❑ State Owned It Nearest Road E] Village Public M 1 or 2 Family Dwelling - No. of bedrooms g Town of RI / III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numb s 6 -3 g- �Nr - 2- 0 -0 c)0 1 ❑ Apartment/ Condo G Y. 3 P 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. kNew 2. ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an - _____System ________System _____________ Tank Only______________ Existing System ________ Existing 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 2 t)n Mound 30 ❑ SpecijV Type 41 ❑ Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pr sure 42 ❑ Pit Privy 13 ❑ Seepage Pit t l0 3 43 ❑ Vault Privy 14 ❑ System-In-Fill 03 ,Q (14� VI. ABSORPTION SYS M INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp-Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (s q. ft.) Pro ed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation J, 7 Ad Feet ._3 Feet VII. TANK in Ca gallo Cit Total # of Prefab. Site Fiber- Exper_ s Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks e tic ank o MvtdTmjt -,k- /nno 13 10 1:1 0 ❑ ❑ El Tan B�D 6 1 ❑ 1 ❑ 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) Plumber's Si ture: (No St am s) MP /MPRSW No.: Business Phone Number: TEFr /, z - 7 715 -Z91- �lV PI er's Address (Street, City, tate, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY []Disapproved S nitary Permit Fee (Includes Groundwater late Issued Issuing nt Signature (No Stamps) DO Approved ❑Owner Given Initial ? v,rSurchargeFee) Adverse Determination J Z (J 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 t 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary July 08, 1999 CUST ID No.223242 ATTN. POWTS INSPECTOR ZONING OFFICE JEFFERY V FOX ST CROIX COUNTY SPIA PO BOX 295 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 07/08/2001 Identifica ' n hers ' Transaction ID No. 54660 Site ID No. 175920 SITE• Please refer to both identification numbers, Site ID: 175920 above, in all correspondence with the;agency St. Croix County, Town of Star Prairie E1/2, NE 1/4, S4, T3 IN, RI 8W Subdivision: Mallard Run — lot 15 Facility: Dennis Schilts Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 478057 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 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(2)(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 to me at the telephone number listed below, or at the address on this letterhead. Sincerely DATE RECEIVED 06/28/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)795-9348, Mon - Fri 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiS1vIARfiiode,„ f MOUND SYSTEM DESIGN '�Fc Residential Application ✓(/� ` /�� INDEX AND TITLE SHEET F� 6) <V 4 9 ,9 Project Dennis Schiits ys40 Owner same Address 130 Stardust St New Richmond Wis. 55017 Legal Description E. 1/2 NE1 /4 sec 4 T31,N,R18 W W fina Township Srar Prarie r County St Croix C.011 1 vC,D Subdivision Name Mallard Run Lot No. 15 NS D O pMMERD gt�►1.D NG� D FS E Parcel ID Number p ►v►s► pE NGE Plan Transaction Number SEE 00RRES Index and title sheet Page 1 Mound calculations Page 2 Mound drawings Page 3 Pres. list. calcs. and laterals Page 4 TDH and pum tank drawing Page 5 Fu Ill► i� m -'fa b E Z' fkt-) - M - AK) 66 7 Suit e- r A 71I�G4e'�hs Designer Jeff Fox License Number 223242 Signature - Phone No. (715) 294 3141 Date 8/28/98 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. 8tats. Personal information you provide may be used for secondary purposes (Privacy Law, x.15.04 (1 )(m)). sBD 10462 -E (R.05198) Page 1 of I MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric Residential or commercial? r (r or c) (y or n) Replacement system? Creviced bedrock site? n (y or n) Slope 9 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 24 in 61.0 cm In situ soil infiltration rate 0.4 gpd/ft 16.3 Lpd /m Contour line elevation 103.0 ft 31.39 m Use standard fill depths? x OR Design depth? L - �in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold c (c or e) Hole diameter r 0.25 1 in 0.125, 0.156, 0.188, 0.219, 0- 25, 0.281, or 0.313 inch only. Lateral spacing 3.50 ft Use 0 lateral spacing for trenches. Estimated hole space 3.50 ft Not a anal calculation. Number of laterals 4 Pump tank elevation 93 ft Outside bottom of tank. Forcemain length 55.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only. 2.067 in Actual I. D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch-p 01 Metric 5/32=0.156 9/32 =0.281 Estimated daily flow 450 gpd 1703 JLpd 31`16-0.1 51`16 =0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpd/fe 375.0 ft 34.84 m Linear loading rate (LLR) 7.14 gpd /ft 88.5 Lpd /m Design width (A) 6.00 ft 1.83 m Cell length (B) 63.0 ft 19.20 m Depth of cell (F) 9.5 in 1 24.1 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 18.5 in 47.0 cm Basal area required (gpd/infiltration rate) 1125.0 ft 104.52 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.69 ft 3.26 m Up slope toe length (J) 6.60 ft 2.01 m Down slope toe length (1) 13.70 ft 4.18 m Total mound length (L) 84.38 ft 25.72 m Total mound width (W) 26.30 ft 8.02 m Project: Dennis Schilts Transaction Number: Page 2 of MOUND PLAN VIEW observation pipes (typical) J 26.3 ft A l A= 6.00 ft 1.83 m 8.021m 1 0 B = 63.0 ft 19.20 m W �E ----- B J= 6.60 ft 2.01 m I K I = 13.70ft 4.18m K = 10.69 ft 3.26 m � � 4-3- .38 ft 25.72 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LxW) K = end slope dimension 6" (152 mm) T MOUND CROSS SECTION D = 12.0 in 30.5 cm lateral topsoil G H subsoil cap _ E = 18.5 in 47.0 cm invert 104.50 ft - - - F = 9.5 in 24.1 cm elev. 31.85 m - - - - - - F G = 12.0 in 30.5 cm ASTM C33 H = 18.0 in 45.7 cm D Sand Fill E Sys. 104.00 ft y elev. 31.70 m 103.00 contour 31.39 m elev. 9% — slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The ceh H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: Dennis Schilts Transaction Number: Page 3 of PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 6 ft 1.83 m Length (13) 63.0 ft 1 19.2 Im Lateral specifications Number laterals 4 Holes /lateral 9 holes Lateral length (P) 29.75 ft 9.07 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 10.49 gpm 0.66 Us Sys. dis. rate 41.96 gpm 2.65 Us Hole spacing (X) 42 in 106.7 cm Lateral diameter Pipe diame Design options Design choice Designer must 1 in (25 mm) Place X in red OV one choice 1 1/4 in (32 mm) x box of chosen from the options 1 112 in (40 mm) x x diameter. provided. 2 in (50 mm) x 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) "X" one choice 1 114 in (32 mm) x Place X in red from the options 1 1/2 in (40 mm) x box of chosen provided. 2 in (50 mm) x x diameter 3 In (75 mm) x 4 in (100 mm) x Distribution system contains: 4 Lateral(s) LATERAL DIAGRAM - CENTER CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area, Force main connection via tee or cross to manifold at any point. • Laterals are identical typlCel E p end cap • If- X— '1IEx/2 I x12 Laterals & force main of PVC Sch 40 Last hole dnikd next to end cap (per COMM Table 84.30 -5) Holes drilled on the bottom of the lateral e a permanent end marker equally spaced Inch-pounds Metric Lateral length (P) 29.75 ft 9.07 m Lateral spacing (S) 3.50 ft 1.07 m Hole spacing (X) 42 in 106.7 cm Manifold length 3.50 ft 1.07 m Hole diameter 0.250 in 6.4 mm Lateral diameter 1.50 J in 40 mm Forcemain diameter 2.00 in 50 mm Project: Dennis Schilts Transaction Number: Page 4 of TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 10.90 ft 3.32 m Are laterals the highest point in the Friction loss 1.59 ft 0.48 m system? Yes "X" here. Total dynamic head 14.99 4.57 m If no, what is the highest elevation Dose Volume downstream of pump? C � Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.6 gal 47.7 L back to tank? ("x" one) Minimum dose 126.0 gal 477.0 L Yes � — �No Drain back 9.6 gal 36.3 L Dose volume 135.6 gal = L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with IF I weather proof warning label and locking device grade levels junction box - � grade levels disconnect ------ - N� r 1 aRemate 4" vent pipe electric as per NEC 300 and F-- outlet Comm 16.28 WAC location 18" (46 cm) min. wall of pump ' approved chamber or outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 93.6 ft C pump tank manhole = 4" (10 cm) off elev. 28.5 m minimum above finished grade D - vent - 12" (30.5 cm) minimum above finished grade 93.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 28.3 m bottom of tank Tank manufacturer Weeks Pump tank capacity 20 gal /in Pump tank volume 800 gal Pump manufacturer 19oulds Inches Gallons Pump model number Model 3871' EPOS o A 27.2 544.4 . u) B 2 40.0 Alarm manufacturer Tank Alert E C 6.8 135.6 Alarm model number 1101 o D 4 A 80.0 Project: Dennis Schilts Transaction Number: Page 5 of M ODEL DV-03 ­,M 3871 Vertical Sump Pump -0- -0 Submersible Eff luent Pump CDS I >> r 6 Y 1 * k Pump Specifications YiHP METERS FEET Up to 40 GPM '9 30 MODEL: 3871 Discharge size 1'/: NPT Solids: �� maximum 6 Motor 7 25 Single phase: 115V� Materials of Construction ' = 5 20 Brass/thermoplastic 1 5 Features and Benefits > 4 EP05 0 *Top suction eliminates 3 10 impeller clogging. 2 EPM 5 • Corrosion resistant , construction. 0 00 10 20 30 40 50 U- GPM •Float actuated switch. 0 2 4 6 6 10 12 m3ft CAPACITY METERS FEET ' 25 MODEL DVP03 Pump Specifications Features and Benefits 6 20 ! 4 /i0 and 72 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM with pump out vanes to protect 1 6 _ mechanical seal. Maximum head to 32' 3 ,o - - -: Discharge size 1 NPT • EP05 impeller - enclosed design - - - - t Solids: 1 /4" maximum for improved performance. • Rugged lass- filled thermoplastic 5 l —1— Motor 99 9 p I All motors feature ball casing and base design provides 0 0 bearing construction. superior strength and corrosion 0 5 2,0 ,5 4 zo 2 30 a iomM Single phase: 115V •resistance. CAPACITY Materials of Construction Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. ',is^onsin Dopa- tmontof Industry SOIL AND SI I +_ ':VAL:1A i iQiV ' Lpbor anO Human Relations Page —/ of Division of Safety and Buildings in accordance v. s, I LHR 83.09, Wis. Poach complete site plan on paper not less than 8 1/2 x 11 incho: in size. Plon n .,;I County ;tc,,ude, but not limited W vertical and horizontal reference point (W), dreclvnr ,, � ��T. k percent slope, scale or dimensions, north arrow, and location and distance to rear „ road. Parcel 1 0. # APPLICANT INFORMATION - Please print all information. Heviewed by Personal Information you prewde may be used for secondary purposes (Priva _y Law, s 18 04 Property Owner ry� 4A.J Prr,ertyLocatior; - - - -- --' 1 _ f , h✓ Go Lot f / bill ��1 /4,S 7 1 ' N,R p E (or) W 1 - 4 Property Own s Mailing Address Lo; Block# I Subd. Name or CSM# City State Zip Code Phone Number _ , n/ i — '1y Nearest Road 1 y. �/�a, iilr+� /�� l*�i `�Oe' d 7 /.S )yf►J " >;� L !.. El lla ge Town New Construction Use: Residential / Number of bedrooms L" Addition to existing building _ — ❑ Replacement ❑ Public or commercial . Describe: Code derived daily flo ). gpd Recorrr nded design loading rate =_- __.bed, gpd /ft trench, gpd /ft Absorption.area required !-..,• bed, tt2 / '____trench, ft Ma :in um design loading rate =_bed, gpd /ft trench, gpd /ti Recommended Infiltration surface elevation(s) _ _ __. ___ - - -. ft (as referred to site plan benchmark) Additional design /site considerations y Parent material Flood plain elevation, if applicable S = Suitable for system Conventional Mound In C - and Pressure AT-Grade System in Fill Holding Tank U = unsuitab:e for s ❑ s (� u a's ❑ u L$ u ❑ S E. u EIS K u ❑ s K u S %DESCRIPTION REPORT Borin ff Horizon Depth Dominant Color IIOlotlles Str J ucture GPD,ft` y i �ture � Consistence Boundary foots — in. Munsell Qu. Sz. Cont. Color Gr z. ter,. Bed Trench �'4 1 7 J Ground J `moo � /� ��� ���— v z _l /f�t�� 7"/ �.S —' ' Z . • _ ` >✓:�!. ter... - - - -- A� _ � Depth to iimiting factor -- -- — -- Remarks: Boring #1 _ ,6'r Ground •' rr..�.�. � - elev. __ r,�; ✓ �_ l..J � ' F �il v _ �— ^ _ -- Depth to limiting factor Remarks: CST (Ploase Print) Si r afore Telephone No.. ' ' _ ))�� 7 Addr s l� Date / CST Number -, - 4 � �� c� SOIL DESCRIPTION REPORT ? 'PROPERTY OWNER Page � of J PARCEL I.D.0 Boring # Horizon Depth Dominant Color Mottles Texture Structure 2 Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Ground Depth to ! / i Y- / rz l.S 1 S/ 8 ��' -�-� - "W1 ✓'r` limiting fact r - - - j in Remarks: Boring # Ground — Depth to - -- - - - - -- limiting factor __ - - in. Remarks: Horzon Depth Dominant Color Mottles f . xt ,rc Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tren Boring # Iii -- — _ - -- _ -- - - -- _ _ - - --- - - - - -- — - - Ground elev. Depti: to ' -- _ - - -- - - -- -- — - 1 miting f factor -' — _ - -in. Remarks: Boring # -- - -_._ - -_ Ground -- elev. Depth to limiting factor in. Remarks: _. SBDW -8330 (R. 08/95) Ci 4 O p I I P. s i h 1 t I I / O r0 O i I * Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordancP,Wlt]1 1 7) ttiR $3.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inche r must County 1 include, but not limited to: vertical and horizontal reference poin diregilfbn /, d / k percent slope, scale or dimensions, north arrow, and location a d i of t roi r rcel I.D. # w ; .; , APPL.ICANT INFORMATION - Please prinf all in or afi u w d b Dat Personal information you provide maybe used for secondary purposes( w, s. 15.03,11 ..< \ { if 'V Property Owner (r,� £ PC_ L 0__ q� cJ L ,zi /4,S T 3 � ,N,R f8 E (or) W Property Own s Mailing Address ck# Subd. Name or C# lob/ ,a'1 �T, �c� /c�.� 14 City State Zip Code Phone Number .0 / Nearest R oad ❑ Cit ❑ Village Town '&New Construction Use: KResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft ' 3 trench, gpd/11 Absorption area required rJ bed, ft trench, ft Maximum design loading rate — bed, gpd/ft 33 trench, gpd/ft Recommended infiltr ce elevation ft (as referred to site plan benchmark) Additional desig its considerations y d - / f c? 6 / cSa Parent material Flood plain elevation, if applicable ft S = Suitable for system A nal Mo und In Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for systeE5 U U ❑ S R U ❑ S a U ❑ S 9 U El S KI 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 13 a Q d f �� �"� �� �� S Ground 3 3 a © yt, q .s; r' I elev �p Depth to limiting factor Remarks: Boring # o _ E3 �- /0 Y/ 1 15., / 113 IK a3- --' - 2- 3 Ground j'3- .� /'S �� rn-+r S� / ✓ i C ' P. �l Depth to limiting factor Remarks: CST (Please Print) Si nature Telephone No. d C C? F �7d w 1�i',v.T 13 7a V Addr s Date , CST Number i C?/ �'` �— SOIL DESCRIPTION REPORT PROPERTY OWNER Page of 3 PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground t ` 3 Z v` �� �/ 1 Y �ri�s -�� .Si I F.6t T /mo ft. y v 7 21A Sc o?„.� ,�6K ��c w , Depth to limiting factor Remarks: Boring # Ground elev. n. 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 # ; K< �t , 1;f Ground elev. n. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBDW -8330 (R. 08/95) c �� Ile a 0 w i I ,, i �. `�� �'� i ,� I i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer De N N s 5 ; I t s Mailing Address 1311 5 2 us K Va ) e w Ri c A m o i d .c 1; . 5 Q / Property Address a 3 is (C) ) /07 ' (Verification required from Planning Department for new construction) W, JS y 0`-7 City /State L) 6 W K1CMD dt)0 Parcel Identification Number 'j30 /J7 7- 2L LEGAL DESCRIPTION / .� 3` �` P -7 Property Location _ lF '/4, �lJ� '/4, Sec. �, T-ZLN -RjLW, Town of 5tAA A ');? i e__ Subdivision ,/'14 I [A P_d PU � , Lot # Certified Survey Map # 54W , Volume Page # Warranty Deed # , Volume , Page # Spec house ❑ yes [q no Lot lines identifiable f0 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. �'�'r`� / 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 DroDerty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI 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 VA 146PAsE 72 60 1L s6.1 STATE B AR OF WISCONSIN FORA z - 1998 KATHLEEN H. JALSH 131STER OF DEEDS Document umher ST. CROIX CO., WI This Deed, made between Michael J. Germ and Michelle M. RECEIVED FOR RECORD Germain, husband and wife, _ 04 -20 -1999 8:00 AM , Grantor, and Dennis A. Shi:.s and Laura L. Shilts, husband and wL s survivorship marital property, Wf>RRAIITY DEED EXEMPT ! Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the ftallowing described real estate in `t. Cr County, State of' Wisconsin (The TRANSFER FEE: 89.70 "Property "): RECC.;DING FEE: 10.90 PAGES: 1 1 Rtcaxding Area Name ;nd Return Address First National Bank of New Richmond 1 09 East 2nd St., Box C New Richmond, WT 54017 038 - 1177 -20 Ptrccl Idcntrticauon Nurnbe''PIN) Thi, is not homestead property Lot 15, Mallard Run in the Town of Star Prairie, St. Croix County, Wisconsin. TOGETHER WITH A 66 foot private easement for ingress and egress over Ou'lot i o1 said Plat of titallard Run. Exceptions to warranties: Easements, restrictions and rights - of - way 1tf record, f any. Dated this _ day of April, 1999. :Ftstd J: fier*nain -- — -- * * Michelle M. (,erimain AUTHENTICATION ACh.NOWI EDGMENT Signature(s) Michael J. Germain and Michelle M. Germain, STATE OF WISCONSIN i husband and wife, ) ss. t Aienticated this v —_ County f of April, 1999. Pcrsu :ally came hefi,re rite this hna ___day of the above named * Kris glan —_ _ - _ - -- _ - - - - - -- _ to one kno'.vn u) be the person(s) who TITLE MEMBER STATE BA: OF WISCONSIN --cute the foreeoing instrument and acknowledue tlr_ „tne. (If gut, �_- -06,W,, — -- authorized by § 71�(i. . Stats. i THIS I"+STRUMENT W NS DRAFTED BY Notaiv Puhh— ante of Wi,con,in - -- — -- Attorney Kristina Ogland My Comrvi n is penmancm. (If not. eta.e ctpiration date: Hudson, W I 54016 ,Signatures may be authrnncated a.knosiied ,, ed Both are not necessary.) pers.,ru s -piing in an) ca:,acits should he tyi - 1r prints 1 their signar:•cs 'A ARRA:,TY L_._? tiFATF BAR of •,Pt ,(Y7. :;L it FORM So. ! - ,'>')A i NFJRUA%T -`N Pk . 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A� OUT 89�iN- PRIVi1tE O " l fO - -€ FOR IN& b° 200100 8 rO tors 0 0 - �, O w S.9 1 200 , 4 0 ,- / --T- -- ... o 25 25 r o a I 1 E EL. � - - o c POND 2 r of � W. = 985. �T .W. L =989 O 8� �c 2T4 705 SO. FT. :' 6.3/ AC Z y ° o .o i' S.90 °00`00 W. 781.40' rri w x .%1 89 �I SO. 3.92 AC r POND ' oa W. EL.= 1009.1 r� POND W. EL _ - 993.5 \�\ )� ��H1 W. EL.= 1010.3 1 HI. W. EL.= 994.6 S.90 "w. POND I` W. EL.: 980.6// \�HI W FL.= 982.2,, I