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ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner LQ 9
Property AT,2 ess Z39 // 1 57" !'
City /State V iNfinmJQ tVl SWI —7
Sr CRc,,
Legal D scription: 2QN o PIC's
Z
Lot , Block Subdivision/CSM # IVILL RQ N N
t /4 ' /o, Sec. 4 1 , Tj-LN - R /� W, Town of )YAk kdR1,, 6 O�9
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer Vl�k:5 Size ST/PC/
� / etback from: House IL Well P/L
Pump manufacturer `MNt ;fC 7" Model 401
Alarm location
(HOLDING TANKS ONL
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SY TEM
Type of system: I1 Width Length "7 N umber Number of Trenches --'
Setback from: House Y 5 Well PA, 4 fP Vent to fresh air intake
ELEVATIONS
Description of benchmark I✓ CM/v S Elevation 100
Description of alternate be nchmark - roP &Dct Elevation 0'7
Building Sewer 9t 98 ST/HT Inlet 9S - 32 ST Outlet '7e, IS PC Inlet F9 4
PC Bottom q 11 ' 52 Header/Manifold /01.7 Top of ST/PC Manhole Cover
Distribution Lines () /0),7Z () ( )
Bottom of System O MY. 05 O ( )
Final Grade () () ( )
Date of installation L/— ZS/ — ? - ?P ermit number .3yy5 'y State plan number bey
Plumber's signatur �� License number Date
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.
PLAN VIEW
IC4'
�`✓ays� GFlR ® k1 , �I�li�r2� , To?
a r I3 L�C K � ��JDflT�c9lJ
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INDICATE NORTH ARROW
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar X
Personal you provice may be used for secondary purposes (Privacy L s.15.04 (1)(m)j.
Perm I ADEN ❑ Ci9 Villag Town f: State Plan ID No.:
CST BM Elev., Insp. BM Elev.: BM Description: AR t' Parcel Tax No.:
d� N 038 - 1177 -30 -000
,r s
TANK INFORMATION G� ` 3� - f ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �"fo Benchmark 0 ,90 Od
Dosing G� t3, () /6
'on Bldg. Sewer S
ing S / Ht Inlet 7d 3
TANK SETBACK INFORMATION ( �9/ Ht Outlet �- 5
TANK TO P/ L WELL BLDG. A I to ntake ROAD Inlet
Septic r NA Dt Bottom .713
Dosing / AJA ► NA Header/ Man. •'� ��
on A Dist. Pipe L 2 F e . � Z-
Holdin Bot. System
PUMP/ SIPHON INFORMATION ('e Final Grade
Manufacturer ojlz Te mand
Model Number �� L- , wPM
TDH Lift L oss A Syste TDH Ft
YO Forcemain Length Y Dlia.'ZH `r Dist. To Weil
SO ABSORPTION SYSTEM
'�` BlEqJARENCH Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. iquid Depth
I)M ENSIONS `f ZJ DIMENSION
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI nufacturer:
INFORMATION Type 0 f r / __ CHA Model Num er.
System: Q j /lf NIT
DISTRIBUTION SYSTEM
Header/Manifold � Distribution Pi�pe(s)� � ,/ � x Hole $ite x Hole Spacing Vent To Air Intake
L.. r II��G /
Length Dia. Len th Dia. Ti 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.) n
LeTIOr: PRASR 4.31.18.878 2394 110TH ST — MALLARD RUN LOT 16
�Z ♦ .St � Gtr � of
o{ ,h,� war / �r'� � 'I'°p ��w•��� o
' o t -P* G c4el►
e
Plan revision requi ❑ Yes ❑ No
Use other side for additional information. a
SBD -6710 (R.3/97) D e Inspectivs Signature Cert. No
f
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
�sconsin
Department of Commerce In accord with ILHR x3.05, Wis. Adm. Code Box 7302
P O o
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. p
• See reverse side for instructions for completing this application state sanitary Permit Number
3 y y�d> y
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. z3 q y /(dam 5{ State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Z 3 O Z
"A pp rt f y ' Owner N r me propertc;t�4 S T I, N, R 1A E (Or
if
rop rt )Owner's Mailing Address Lot Number Block Number
ST to Zip Code P�� ;umber Su divisi n N me r CS Number
�' 7 ( C�V 5
T YPE BUILDING: (check one) ❑ State Owned ' l NearestRoa�1
Village 7N
Public 1 or 2 Family Dwelling - No. of bedrooms v2rTown OF I /o
III BUILDING USE (If building type is public, check all that apply) Parcel Tax tubers)
03 I -
1 ❑ Apartment/ Condo , 0y 3r! /0 rQ
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable)
A) 1. k New 2. ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an
- - - - -- System -- - - - - -- System - -- Tank _Only -------- - - - --- Existing System - Existing System
---- - - - - -- --- - - - - --
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 E] Specify Type 41 ❑ Holding Tank
12 Trench
See a e 22 In -Grown Pressure 42 Pit Priv
❑ p d essu e ❑
9 � Y
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fi I I
VI. ABSORPTION SYSTEM INFORMATION:g C�fw : /O0�
1. Gallons Per Day 2. Absorp. Area 3. Abs or rea 4. Loading Rate 5. erc. Rate 6 System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Galstd /sq. ft.) (Min. /inch) Elevation
3 / 6 6 /i Z 1 Feet IN-T Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App.
New Existin structed
Tanks Tanks
e tic Orftef&MTTank J00Q IC60 ❑ ❑ ❑ ❑ ❑
ift Pu Tank 4*herrCtra A06 / ❑ 1 ❑ ❑ I ❑ ❑
W. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the�onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum ber's nature: (No St ps) MP /MPRSW No.: Business Phone Number:
%F E 2/, 2z3Z-llz y ?iI//
P ber's Address (Street, City tate, Zip Code): I j
a 2Oi5 RE ��z k
IX. COUNTY/ DEPARTMENT USE ONLY
E] Disapproved Sanitary Permit Fee (Includes Groundwater Surcharge Fee) ate ssue Issuing A ent Signature (No Stamps)
"K Approved ❑ Owner Given Initial Z ,�
Adverse Determination 3 Z �d d
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
15837 USH 63
HAYWARD WI 54843 -8107
TDD #: (608) 2648777
isconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
June 21, 1999
CUST ID No.223242
ZONING OFFICE
JEFFERY V FOX ST CROIX COUNTY SPIA
PO BOX 295 1101 CARMICHAEL RD
DRESSER WI 54009 HUDSON WI 54016
RE: CONDITIONAL APPROVAL Identificat>ii Nuiibers
APPROVAL EXPIRES: 06/21/2001 Transaction ID No. 230246
Site ID No. 174207
SITE: Please refer t6 both identification nunnbers
Site ID: 174207 above, 'in all correspon getscy'.
ST CROIX County, Town of STAR PRAIRIE; 110TH ST, STAR PRAIRIE 54026 C'(1rid tiona 1
El /2, ISMIA, S4, T31N, R18W
Lot: 16, Subdivision: Mallard Run A rI J K OVE D
Facility: ALLEN LUNDE MOUND LOT 16 1 LOTH ST, STAR PRAIRIE 54026 DEPAPTIVENi OF C04;,,oI R('E
FOR: DlV ' ON OF SAFETY AND BUILDINGS
Object Type: POWT System Regulated Object ID No.: 473780
SEE C ESpp
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Cod
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
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 06/02/1999
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
CAR?JPPERT, WASTEWATER SPECIALIST BALANCE DUE $ 0.00
Field Operations
(715)634-3484,
CLIPPERT @COMMERCE.STATE.WLUS WISMA T c�"
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 9P d maximum design flow.
Inch - pounds Metric
Residential or commercial? A (r or c) (y or n) �� Replacement system?
Creviced bedrock site? n (y or n)
Slope 8 %
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 100.0 ft 30.48 m
Use standard fill depths? J x OR Design depth? in cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
I
Center or end manifold c c or a) Hole diameter 0.25 in 0.125, 0.156, 0.188, 0.219, 0. 25,
0.281. or 0.313 inch orly.
Lateral spacing 4.00 ft Use 0 lateral spacing for trenches.
Estimated hole space 3.50 ft Not a final calculation.
Nurnber of laterals 4 Pump tank elevation 90 ft Outside bottom of tank.
Forcemain length 75.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only.
2.067 in Actual I.D.
HOLE DIAMETER CONVERSION$
1/8 -0.125 1/4 = 0.250
SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9132=0.281
Estimated daily flow 1 450 Igpd 1 1703 JLpd 3116 - 0.188 5/16=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) 8.33 gpd/ft 103.3 Lpd /m
Design width (A) 7.00 ft 2.13 m
Cell length (B) 54.0 ft 16.46 m
Depth of cell (F) 1 9.5 lin 1 24.1 cm
Sand filter
Upslope fill depth (D) 12.0 in 30.5 cm
Dowmslope fill depth (E) 18.7 l in 47.5 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) 10.71 ft 3.26 m
Up slope toe length (J) 6.80 ft 2.07 m
Down slope toe length (1) 13.80 ft 4.21 m Basal adjustment made.
Total mound length (L) 75.42 ft 22.99 m
Total mound width (W) 27.60 ft 8.41 m_
Project: Allen Lunde
Transaction Number: Page 2 of
I
MOUND PLAN VIEW
observation pipes (typical)
J
27. ft A A= 7.00 ft 2.13m
8.41 m 1 0 B= 54.0 ft 16.46m
W �-- -- B 1 J= 6.80 ft 2.07 m
1 K 1= 3.80 ft 4.21m
K = 10.71 ft 3.261m
L _ 75.42 ft
22.99 m typ. obs. pipe
(anchored securely)
I = down slope dimension absorption cell (AxB)
J = up slope dimension plowed area (LxW)
K = end slope dimension -7�6" (152 mm)
"I'
MOUND CROSS SECTION
H subsoil cap D = 12.0 in 30.5 cm
lateral topsoil E = 18.7 in 47.5 cm
invert 101.50 ft _ _ _ _ _ F = 9.5 in 24.1 cm
elev. 30.94 m F G = 12.0 in 30.5 cm
ASTM C33 H = 1 18.0 in 45.7 cm
Sand Fill E
SY& 101.00 ft y
elev. 30.78 m 100.00 contour
30.48 m elev. 8 % --_�
slope
D = upslope fill depth plowed layer
E = downslope fill depth Note: Absorption cell media " consist
F = absorption cell depth of aggregate and pipe with laterals
G = subsoil + topsoil depth at cell wall centered across AxB media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Project: Allen Lunde
Transaction Number: Page 3 of
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 7 ft Lim 13 m
Length (B) 54.0 I ft
Lateral specifications
Number laterals 4
Holes /lateral 7 holes
Lateral length (P) 25.46 ft 7.76 m
Hole diameter 0.250 in 6.35 mm
Lat_ dis. rate 8.16 gpm 0.51 Us
Sys. dis. rate 32.64 gpm 2.06 Us
Hole spacing (X) 47 ] in 119.4 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) x Place X in red
W" 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)
"?C" one choice 1 1/4 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.
F orce main connection via tee or cross to manifold at any point.
• •"—
r J Laterals are identical typical S
f P end cap % L
•
IE X— IE xl2 I W � Laterals & force main of PVC Sch 40
Last hole drilled next to end cap (per COMM Table 84.30 -5)
Holes drillled on the bottom of the lateral • = permanent end marker
equally spaced
Inch-pounds Metric
Lateral length (P) 25.46 ft 7.76 m
Lateral spacing (S) 4.00 ft 1.22 m
Hole spacing (X) 47 in 119.4 cm
Manifold length 4.00 ft 1.22 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 1.50 l in 40 mm
Forcemain diameter 2.00 in 50 mm
Project: Allen Lunde
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 1.36 ft 0.41 m system? Yes "x" here.
Total dynamic head 14.76 4.50 m I f no , what is the highest elevation
Dose Volume downstream of pump?
Dose is > 10 times lateral volume Forcemain drain
Lateral void volume 10.8 gal 40.9 L back to tank? ( "x" one)
Minimum dose 112.5 gal 425.9 L x Yes
Drain back 13.1 gal 49.6 L No
Dose volume 125.6 Hgal 475.4 1 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
weather proof warning label and locking device
grade levels junction box a — �
disconnect grade levels
afternate
4" vent pipe electric as per NEC 300 and E-- 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-
L11-11 alarm on siphon device as necessary
pump on B
_ C Grade levels
pump 9 0.6 ft - pump tank manhole = 4" (10 cm)
Off elev. 27.6 m A minimum above finished grade
D - vent = 12" (30.5 cm) minimum
above finished grade
90.0 ft Pump tank elevation
3 " (75 mm) of bedding under tank 27.4 1 m bottom of tank
Tank manufacturer Weeks 1000 S 800 P.C.
Pump tank capacity 20 gal /in
Pump tank volume 800 1 gal
Pump manufacturer Igoulds Inches Ga
Pump model number Model 3871 EPO c A 27.7 554.4
.N B 2 40.0
Alarm manufacturer Tank Alert E C 6.3 125.6
Alarm model number liol p D 4 80.0
Project: Allen Lunde
Transaction Number: Page 5 of
M ODEL DVP03 MODEL :
Vertical Sump Pump EPO4— EP05
Su bmersib l e Effluent Pump
GOULDS
,n
� ��. 4 "stn .':q "4 YES•"'^" �,�J. r R e ' _ � � S` , "
: �•
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Pump Specifications a
1 h HP METERS FEET
UQ to 40 GPM 10 MODEL: 3871
Discharge size 1 NPT 30
Solids: W maximum
Motor z 5
Single phase: 115V
s 20
Materials of Construction 5
CJ
Brass/thermoplastic Z 4 1 i epos
Features and Benefits o
*Top suction eliminates a ' '
impeller clogging. 2 e
5
-Corrosion resistant 1
construction. 0 o
0 10 20 30 40 50 US
• Float actuated switch. 0 2 4 6 8 10 1 AF"
2 mlihr
CAPACITY
METERS FEE, Pump Specifications Features and Benefits
25 � ' MODEL DVP03
o s 20 _ 4 /,o and 1 /2 HP • EPO4 impeller- semi -open design
W — Up to 60 GPM with pump out vanes to protect
5 15 - Maximum head to 32' mechanical seal.
d 4� Discharge size 1'/2" NPT • EP05 impeller - enclosed design
0 Solids: 3 /4" maximum p 3 101 -- �--__ __ _� for improved performance.
5 2 5 Motor • Rugged glass - filled thermoplastic
" 1 All motors feature ball casing and base design provides
0 0 bearing construction. superior strength and corrosion
0 5 10 15 20 25 30 35 40 11.S.GPM Single phase: 115V
0 2 CAPACITY 6 8 10�mr resistance.
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.
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_nsln D <pahrnent of ir.l ustry, SI 1 1. '; v ALUA i 10
`LA)Gr and Human Relations Page of -
1.
urvi�on of Safety and Buildings in accordance with S. ILHR 83.09, Wis.
County
i ich complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan rrt.st ty � ; .�
"
Include, but not limited to: vertical and horizontal reference point (BM), direction wvll
percent slope, scale or dimensions, north arrow, and locatiun and distance to nea.est rnad. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Roviowed by Da J( o
Personal information you provide rney be used for secondary purposes (Pnvacy i.aw, s I5 GI ( i it I'
)
Property Owner C?/ X t4 ,��/I: F'rc,periy Location r ,
�/ -� �• 1/4,S T -� ,N,R j
'? II C C. ( / o ^ �. Ica .-+'�T f — Govt Lot -- Z- N
Property Own is Mailing Address Lot n -- Block# Subd. Name or CSM#
__ _.._
Ci ry State S Zip Code Phone Number Nearest Road
( -� ❑ Village Q Town
`,� �.s� , a -C / /_s ; SY��� o c 7r� ) y�3 -• � S zh'
9LNew Construction Use: QResidantial / Number of bedrooms . Addition to existing building --
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow N _ gpd Recommrrded design loading rate _bed, gpd /t? -J - trench, gpd /ft
7� • !•�• 2 v � — trench, d.l'
Absorption .- ea required A " - . —bed, n __- trench, It 1,1a:.uYwm design loidiry rate _ .bed, gpd /ft � gP t`
Racomrnended infAraticn surface elevation(s) _ it (as referred to site plan benchmark)
Additional design /site considerations o!�. __ ..'` j �! "� -- - - - - -- - - - -- - - - - - -- - - - -- -- - -
`� n
Parent material -_ .____._ _ _ _ ___ _ Flood plain elevation, if applicable
S = Suitable for sy5rem - Conventional Mound In Ground Pressurn AT•Grade System in Fill Holding Tank
U - Unsuit for system - 1 9 U � S n U (.-� S a U ❑ S [2 U [Is ® U ❑ S � U
SOIL DESCRIPTION REPORT
r -
P mir.
oring # - ivrizon Dopth Dernt C ��
olnr et�s tt Structure GPD /ft
Tc�kue Consistence Boundary Roots
in. Munsell Qu Sz. Cunt. Color Gr, Sz. Sh. Bed Trenct.
Ground
Depth to - -- — --- - - - - -- — - - - - -- - -- -- - -- _.
limiting
I actor
j in.
Remarks:
Boring # s"
`/ .
Ground T ` Z. `J�f `� )! Y
Prev.,
Depth to — - -- - - - -- - - - - - -
limiting - --
factor
Remarks:
CST Name (.Please Print) / l / !�ignature Telephone No.
Address Date CST Number
do �������
-' Q A_J c� f_ SOIL DESCRIPTION REPORT
" . ATY OWNER Page of
.ACEL I.DI
Boring Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
( ?,J _ ft. 7 7/1 �� ` �� ✓ �i P, f',
I
Depth to ` - -- - -- - — - - — - --
limiting
factor — _ - - -- -
1/_19 in.
Remarks:
Boring #
Ground
elev. - -- - -- -- - -- —
ft.
Depth to - - - -- - -- - -- - -- - -- - -- - - - -- - —
limiting
tcrctx
in
Remarks:
ion ;on Depth Owninant Color Motllr_ -s Structure pD;tt
tw±ur• Consistence Boundary Roots
in. Munsell Ou. Sz. Cont. Coln( Gr. Sz Sh. Bed Trend
Boring ? —
a
Ground
eiEV.
ft
�epih to - — - - - -- - -- - -..._ - - - - - -- - - - --
- - - - - - --
limiting
factor
- ____ in. Remarks:
Boring #
Ground
elev. -- -
Depth to _�_-- _ -.___ __.__.___.... __---- _ -• - --
limiting
factor
i
-- n. Remarks:
SBDW -8330 (R. 08/95)
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Wisconsin= Department of Industry SOIL AND SITE EVALUATION
Labor and Human Relations of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. , k ` +.► �' \'
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ��, r j ,A, 1 � A �
include, but not limited to: vertical and horizontal reference point (BM), direction and y
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. R ed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
, c- .'
Property Owner .} of f.J f_ Property Locati?n
U (2 C S 1 C Govt. Lot ' t AV� 14,S F' j� ° E (or) W
Property Own s Mailing Address Lot # Block# Subd. Name or
/6 41 A JLl F � �° Ae — �r /arc Wit,�
city State Zip Code Phone Number Z d c2 i'L Nearest Road
7� El city U Village Town
New Construction Use: Residential / Number of bedrooms �" •'d Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow / 41) • gpd Recommended design loading rate t' bed, gpd/ft trench, gpd/ft
Absorption area required bed, ft trench, ft Maximum design loading rate ' ry bed, gpd!M trench, gpd/ft
Recommended infiltration surface elevation(s) —1 /' ft (as referred to site plan benchmark)
Additional design /site considerations r ! '7q 7 �d f✓ /,C- '_� ,' /
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound in- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system S R] U K S Z U EIS X U I E] S 4U ❑ S pt U I ❑ s & U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Con l olor Gr. Sz. Sh. Bed Trench
JIlk n Y, 7 d ,2 Z
a,S /v �' • S�
Ground .. - y �Y C �r►�-� .�sl+fC rwr T� d S Z- •.3 7. j 0_c "n o- 73'11'5 ; , C e ' S ' C '� �,-►✓ .- '`�P,;
Depth to
limiting
lentor
�CJ in.
Remarks:
'Boring # tJ
13 ,27 Al <pj
Ground S 7 3`1 K � / S (� .S
16 j • ft.
Depth to
limiting
factor
Y Z _; n. Remarks:
CST Name (Please Print) Signature Telephone No.
Addr ss Date CST Number
a+��'. u C k r �S3 l �/ / le �3 70
z
u V`y SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
g r Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground 3 " 7. StirR y� Sc f / abk .�., �,e d S • Z • 3
ele . D
�o yZ S`1R , S ys s� s ,�,� ,� p.
Depth to
limiting
factor
Remarks:
Boring #
ISO
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:
SBDW -8330 (R. 08/95)
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` Wisconsin Department of Industry SOIL AND SITE EVALUATION
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 81/2 x 11 inches in size A la mast -� % unt, include, but not limited to: vertical and horizontal reference point (BM),
i�tfo and �or
percent slope, scale or dimensions, north arrow, and location and dis a db nearbt reel. r D. #
APPLICANT INFORMATION - Please print all infor Afic `. Re by Date
Personal information you provide may be used for secondary purposes (Privac Lik s. 15.`0 pim)). .: %' f
j " 7
Property Owner �� � 4 ,�� A Property , , 0W-11 s, ✓ L / ?
7 6 +�+� 7a .rr E.S ,
Govt, pt "'' Y /��1 /4,S T T / ,N,R �8 E (or) W
Property Ow is Mailing Address Lo # Block #'':, bd. Name or CSM#
Iva A
City State f Zip Code Phone Number 8iC c?!f / Nearest Road
SyU20 (7 /.- )y�.3 - 33 City El Village Town //" Y�h s f
J!a�New Construction Use: g[ Residential / Number of bedrooms A� 59 Addition to existing building
❑ Replacement �) ❑ Public or commercial - Describe:
Code derived daily how ' C) ' gpd n W Recommended design loading rate i bed, gpd /ft `3 trench, gpd/ft
, ' , G �.
Absorption area required a bed, ft trench, ft 2 Maximum design loading rate bed, gpd/ft J trench, gpd/ft
Recommended infiltration surface elevabon(s) l ft (as referred to site plan benchmark)
Additional design /site considerations �7 /
Parent material Flood plain elevation, if applicable ` ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U Unsuitable for system El � U 0 S El ❑ S U EIS [R U ❑ s KU ❑ S , R 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
l c�2 �a /otief y � � /��S6k �-,.,, C c,,J / . ;•
Ground °� _ . �-
elev - S r -- s✓ .�
/ j ft. Y '._ 7
S 3 i�
Depth to
limiting
factor
T in.
Remarks:
Boring # / /o O YA V1`3 ,•, -„JbX .� -, 7�� C L.)
13 .3 d — � yh 4 %� mac' � abt �, ► c� S � . L .
Ground V 1 M T Y S Yf 4., Cpl ✓� /� N P
Depth to
limiting
factor
1 !?! in. Remarks:
CST Nam lease Print) gnature Telephone No.
A, S/7
Address Date CST Number
LL) ZU 1 ,9/ Q-"
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Borin g # Horizon Texture Consistence Boundary Roots Depth Dominant Color Mottles Structure 2
2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground ` �.f i 1 "-''r -e-� cab k °m � <2 S • L : • ,3
elev. ,3 Y� _ y, �i 5 1 -- N. ✓
9�ft. s V 7 syrs �! s� / p P,
Depth to
limiting
factor
m in.
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 # ;
211 »::>
'
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
' Remarks:
SBDW -8330 (R. 08/95)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ h' AC J L U;i d e—
Mailing Address --! 2 ,0, go), 6$( Cgo ix >�� 11-.5, Z k) i
Property Address a3cl I D fti 5_7L,
(Verification required from Planning Department for new construction)
City /State 148 t 6 manl0 .V( '5`{ Parcel Identification Number d 3$ l f 7 q 3d 4 0d
LEGAL DESCRIPTION
Property Locatio _ ' / <, 1Q ' / <, Sec. _ , T,�N- R Town of .>: - A,e BA i 2 i -:
Subdivision A/A / /,Q e POA) , Lot # A -
Certified Survey Map # J , Volume _ , Page # - ' 5
Warranty Deed # , Volume , Page #
Spec house LR yes ❑ no Lot lines identifiable N 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.
I/we, 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 f 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 prop ty describe bove, by virtue of a warranty deed recorded in Register of Deeds Office. 97
�!
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
it y 17/71
7 O3 $ /pap - S1� 8a
State Bar of Wisconsin Form 2 — 1982
526077 WARRANTY DEED
DOCUMENT NO. i l . ) REGISTER O � ICE�
ST. CROIX CO.. 1"
James K. Bryant, a /k /a James K.
/1
ryant, and Rec'd for R oc
Mollie A. Bryant, husband and wife, FE 2 0 1996
at 1:05 P.
conveys and warrants to Allen L. Lunde and Pamela E. 71 ` ,. • b)a!laX
Lunde, husband and wife, Reglater of Deeds
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
Allen & Pamela Lunde
P 0 Box 686
the following described real estate in St. Cr oix St Croix Falls WI 54024
County, State of Wisconsin:
(Parcel Identification Number)
E 1/2 of NE 1/4 of Section 4 -31 -18 EXCEPT part to Gregory V. and Mary T.
Germain in Vol. "514 ", page 128 and EXCEPT part to Eugene K. and Cynthia M.
Kobs in Vol. "491 ", page 554.
M IAN S V.
Joe
IUB
This is homestead property.
(is)
Exception to warranties: Easements, restrictions and rights -of -way of record,
�^ if any.
Dated this ` day of February 19 95
(SEAL) r` (SEAL)
J ames K. Bryant,
r ant aka James K. Bryant
(SEAL) 6 7 1 (SEAL)
Mollie A. Bryant
i
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Jaire K. Bryant, a /k /a James K. STATE OF WISCONSIN
ss.
Bryant . Mollie . A. Bryant
� ��j�, _ Count y .
authenticated this - I 4 day of February , 19 95 Personally came before me this day of
] 9 the above named II
Kristina Ogland it
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stalls.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland I
i�
Attorney at Law Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.) 19 )
'Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
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EAS EMENT O
• / FOR INGRESS 8 EGRESS .O O
200,00 8 TO LOTS 14 a 15
w S.9 °0000 30 0.00
200.00 W 40' ;--- ZOO'
25 25'
N
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