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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JASON J & GLORIA M SLOAN O - SLOAN, JASON J & GLORIA M 292 TOWNSVALLEY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH I Legal Description: Acres: 4.180 Plat: 3415 -CSM 12/3415 SEC 21 T28N R19W PT NW NW FORMERLY PT OF Block/Condo Bldg: LOT 3 LOT 1 CSM 4/1107 NKA LOT 3 CSM 12/3415 EZ -UT- 1450/200 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 09/21/2004 774938 2660/292 WD 03/13/1998 5749880 1305/331 WD 03/13/1998 574987 1305/330 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.180 66,000 284,600 350,600 NO Totals for 2006: General Property 4.180 66,000 284,600 350,600 Woodland 0.000 0 0 Totals for 2005: General Property 4.180 66,000 284,600 350,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 1 ST. CROIX COMM ZOMNG DEPARTMZNT �! AS BUILT SANITARY REPORT Owner / Property Address < City/State Legal Description: i �bdivisonlCSM #t � / f 37 _ mss s.- ; 3 �I �� Town of PIN # s � _,.. PTY 'TANK — DOSE� CHAMBER — HOLI TANK INFORMATION Model qtr u r Size Setback from: House Well P/l. Tank manufacturer Pump manufacturer ,Zp! /�^ �. Alarm location 6..j (HOLDING TAMU ONLY) Setbacks: Service road Vent to huh air intice Water Line Meter location Alarm location SOIL ABSORP'fI SYST'E'M Type of system: 1hyvNdA Width / Length. Kumbw of Trenchas Setback from: House ti Well f P2 f-5'v Venn: to fresh air intake 2y IE1iLEVATIOI~l'S Description of benchmark �� his 4 J� (/G _ _ _ Elevadyon o Description of alternate benchmark Elcwation 1..2-4�.G Building sewer l.�- y n s'TIHT inlet Ae S'1' Outlet I ZtJ- 91 PC Inlet e t� ©2 PC Bottom `f `�! d Header/Manifold LCt. Top of ST/PC Manhole Cover 7 1 Distrilsution Trines Bottom of System Final (Trade Date at installation Permit num r State plan number Plumber's signature I kease ,cumber 3;} ,; [6 Date cmWift pta AM • _ f La V 1 T j ui i 3 I -i,�t i I L - _ q -i - : _ t ' s � � : . � I r f Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION Sanitary Permit IX (ATTACH TO PERMIT) 33886 9 Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)]. Per er's ba�n�C El City � Town of: State Plan ID No.: UPA ttSS..KK �'11�� yy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: t oo /00 3 /► 040- 1082 -60 -000 TANK INFORMATION 'q' ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic U, er- Z p Benchmark 1 6U Dosing -� vfw 1 Z� n Bldg. Sewer 3.� Z Hol � V Ht Inlet 4 3 2 2 TANK SETBACK INFORMATION / Ht Outlet �� 0 p �j�2� TANK TO P/ L WELL BLDG. VAenuake ROAD Inlet 6 �� Septic >5 / z7 l NA Dt Bottom Dosing > 50' 71661 �I � NA Header / Man. A le - ID2_SS A r Dist. Pipe - `� 02, j O Holding Bot. System �• /� b�.fl� PUMP/ SIPHON INFORMATION Final Grade Manufacturer Z Z U � �✓ De T 0 Model Number 4" y4,F1 GPM Z 0 - 4 1 17 6 0 - 71 16 DH Lift A� L n System. TDH ('1 Ft b P d 1 73'. Forcemain Length ` Dia. Z N Dist. To Well S� _ _ '~ SOIL ABSORPTION SYSTEM 4 4� f w BED/TRENCH Width 6 / 1 Length 1 N Of s IT No. Of Pits Inside Di id Depth DIME N I N D N SYSTEM TO P/ L I BLDG WELL LAKE/ STREA RING manuf acturer: SETBACK CHAMBE INFORMATION Type Of 7��' mber: System: > I > /� OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipets) , 1 ( x Hole Size x Hole Spacing Vent To Air Intake Length 7 Dia. Z Length Dia. `� Spacing � a 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 I ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 16, / 4 f 3 Z. Z 0 . w LOCATION: TROY 21.28.19. 5C,NW NW 292 TOWNSVALLEY ROAD — LOT 3 U �l (,f. �u✓ - �,� , v ih p�pc 41a.5 �O�cs e�• 5.`F� Cj l- 30 7 yZ'' Cv�/�r M,s.a -� ,,,sue 18` c�•x,. oe �•-'�. door sif Wt1kow� Plan revision required? []Yes f No I t 6 OD / Use other side for additional informat on. d M7 SBD -6710 (R.3/97) Date Inspector's Sig re Cert. No. Safety and Buildings Division ` ,• SANITARY PERMIT APPLICATION 201 W. Washington Avenue isc onsi n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application. State sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION I c9" l"7 S0 O PropeA Owner N me Property Loci/ $ T , N, R E (Of w c w l Property Owner's Mailing Address Lot Number Block Number City ate Zip Code Phone Number S am CS ,4 'cf Gam' ��z V15 ) %;-s 147 IL TYPE OF BU ILDING: (check one) ❑ State Owned ❑ Cit Nearest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms C] Town OF rV III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 []Apartment/ Condo �-2- 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. ?Mew 2. E] Replacement 3. [:j Replacement of 4_ ❑ Reconnection of 5. F] Repair of an ______System - - - -- ___System __ Tank Only_______ _______ Existing System ........ ExlstlnqS�fstem 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 r 42 ❑ Pit Privy 13 [] Seepage Pit �3 43 ❑ Vault Privy 14 ❑ System -In -fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17 1 Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 0 1 zli 3 r , ' (O2_- C Feet p 3 Feet Capacit VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks �1 ep cT ank K �le C fv — ® El 1:1 1:1 1:1 0 IftPump a ipgenfhSmber ("� fUPCJ ❑ ❑ El 1:1 13 VIff. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Na : (P nt) Plumber's ture: Stamps) TN"AUS4LAIC: Business Phone Number: • 13 2 ������ /t7C> V Plumber's Address Street, City, State, Zip Code): �(� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee 0nc1udesGroundwater ate ssue Issuin Agent Signature (No Stamps) Surcharge Fee) pproved ❑Owner Given Initial �� C o J� � Adverse Determination / X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (8.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings . - 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 iscons n Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Department of Commerce April 01, 1999 CUST ID No.267341 ATTN. POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 04/01/2001 Identification Numbers Transaction ID No. 217500 Site ID No. 169020 SITE• Please refer to both identification numbers, Site ID: 169020 above, in all correspondence with the agency. ST CROIX County, Town of TROY; TOWNSVALLEY RD NW 1/4, NW 1/4, S21, T28N, R1 9W BROCK WISE TOWNSVALLEY RD FOR: Description: MOUND SYSTEM FOR BROCK WISE Object Type: POWT System Regulated Object ID No.: 457852 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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. 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 03/24/1999 ` FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 KEITH A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US WiSMART code:7633. - - - ST CROIx `3 COUNTY Z(y, lGF • T I ILF- S 11E- 1 Page of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE . Z1 LOCATED IN THE NW 1/4 OF THE N T rd N w Z 1/4 OF SECTION , R 1 9 W , TOWN OF COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN -PAGE 3 of 6 PLAN VIEW +CROSS SECTION ; Off' MO PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER C2.osS lLmoN E S P£L5. PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR C YK- W ISE, N ces l B Z 9 11S -4 ST. PT03PAIM BY s1 2 47999 WEGEF�ER AC] = L TESTING: C®N ; '.t ��.'�".�. DES 2 Cl•! S>E�V = CE ��r •''"»«.'''S,�� 1 •�' ll � C,n di tlo o a y F.O. BOX 74 421 M. MIN ST. ARTHUR R WEGERER El) RIVEF. FALLS. 8I 54022 � � EuswoRni, 115 - 42°x-014 rs' RTMENT OF COMMERCE � DE ? N DpliSION OF SAFETY ON BU I N•..N d► ® O � e C/ �S I C�� SPONbEN SLE CORR� JOB NO. 9� -3g Page Of 6 Approved Synthetic Covering Rs�'w► c 33 Distribution Pipe Medium Sand Topsoil F Elev - 10 Z . O� E D tip % Slope Bed Of 2- 2 %2 Force Main Plowed Aggregate From Pump Layer D 1 Ft. Cross Section Of A Mound System Using E Ft. A Bed for The Absorption Area F o Ft. G 1.O Ft. A ° o Ft. H t Ft. Linear Loading Rate= c.•5 GPD /LN FT B 6 Ft. Design Loading Rate= o- 4.GPD /SQ FT j \1, Ft, J `1 Ft. K Ft. e�- L 85 Ft. Fes,= ec-;,T W 31 Ft. L Observation Pipe —, 8 K � A ( - - - - - -- - -- ` r- - -- -------- - - - - -- - - - - -- --'� Force Main W ._ - - - -- Distribution Bed Of 22 2 2 $ ` Pipe Aggregate 1 Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption. Area Page y Of 6 Perforated Pipe Detail 0 / End View ) Perforated End Cap. o `i PVC Pipe Install p ermanent marker .4 oQ at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC force Main Q PVC Monitold Pipe Distri ution Piee Last Hole Should Be Next 7o End Cap ` End Cap / P z8 S Ft. Distribution Pipe Layout S y Ft. X 3 Inches Y 31a Inches Hole Diameter 1 �� Inch Lateral " 1 Inches Manifold Z Inches Force Main Z Inches # of holes /pipe to Invert Elevation of Laterals lo Z.5 Ft. IOY- .- l 'l — I \.- may = 44 G .bo QV+1 Place lst hole lb " from center of manifold with succeeding holes at 3 6 " intervals. Last hole to be next to the end cap. ' PUMP CHAMBER CROSS SECTION ACID SPECIFICATIOMS ' PAGE S OF 6 NT P VE CA 4' C.Z. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE JUUCTIOU BOX ' 10' FROM DOOR. COVER WITH WARNING LABEL WINDOW OR FRESH 12�MltI. f AIR WTAKE GRADE >pL L D l s f a NON. COWDUIT PROVIDE ( — — -- IIJLET —T AIRTILHT SEAL. I ( v APPROVED JOIN A Tank construction shall comply � �'� APPROVED JOINTS with ILHR 83.15 and ILHR 83.20 ALARM 1 C 1 i ON CLEV. FT. PUMP - ' J M OFF 0 c Z�4 , OD 1 CONCRETE aLOCK 3" APPRWED R15ER EXIT PERMITTED OMI-tl IF TANK MANUFACTURER HAS SUCH APPROVAL gFpplµ� SPECIFICATIC)US DOSE w rs Liz CUB c2 3 �-�- 5� TANK MA1JUfACTURCR: NUM6ER OF DOSES: PER DAy TAWK SIZE: �OOb GALLONS DOSE VOLUME t � �, GZ ALARM MAIJUFACTUILER: 5.� , L5L<3Cjj2Cj SLISt S•` INCLUDING 5ACKFLOW: �`"`� ALLONS MODEL WUMBCR: `�� �� I "� CAPACITIES: A= 1611 z WCHES OIL !!22'' GALLOUS 4SZ. SWITCH TUPC: L�CV� 8= Z INCHES OR 4LLOLI5 PUMP MANUFACTURER: ���'�- C■ 6 INCHES OR GALLOW5I(o51V MODEL NUMDER: Q$ D= \Z INCHESOR GALLONS SWITCH TYPE: IJOTE: PUMP AND ALARM AR TO 5 MIWIMUM DISCHARGE RArE GPM INSTALLED ON 5EPARATE CIRCUITS 'VERTICAL DIFFERENCE DETWEEN PUMP OFF AUD.DISTRIBUTIOIJ PIPE.. " FEET + MIMIMUM NETWORK SUPPLY PRESSURE , 2.50 FEET , S S FEET OF FORCE MAIN X u___ _F to fT.TRICTION FACTOR Z �' FEET --- TOTAL_ OyIJAMIC HEAD = 1Z Z�FEET DIAMETER I IIJTERLIAL OIMLIJSIOIJ� OF TANK: LELIGTH ;WIDTH - ;LIQUID DEPTH . BOTTOM AREA - 231= GAL /INCH AS PER MANUFACTURER -- s T-T GAL /INCH REZ e-vzvE P %G e b atr - HEAD CAPACITY CURVE 3 7 f s 6 1 4 — MODEL "98" 4 5/8 0 2 o 3 5/8 i 6 ® O i O I Q 1 5 4 lL'Z 4 3/16 10 2 y6-so - 5 1 1/2 -11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 I I 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENTANDDEWATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 - 4 3 f 16 20 6.10 25 95 Lock Valle 23' i L. SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and - Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Wei ht 39 lbs. - '/: H.P. 2. Single piggyback variable level float switch or double pi ggyback variable level, 9 9 98 Series Control Selection float switch. Refer to FM0477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical atemator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4) D98 230 1 Auto 4.7 1 or 1 & 7 — float system. 6. Four (4) hole J -Pak junction box, for watertight connection or wired4n E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. 7. Two (2) hole J-Pak, for watertight connection or splice. CAUTION ForinbrInabononadditiomIZcellerprodudsreferlo catalog onCombinationStarter ,FM0514;Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable Level Switches, FM0477; Electrical Aftemalor, FM0486; Mechanical Alternator, FM0495;Sump / licensed electrician. All electricaIand safety codes shouldbe followed inclu ding themost Sewage Basins, FM0487; and Single Phase Simplex PumpControl/Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. r _ r MAIL TO. P.O. BOX 16347 r Louis0e KY 40256-0347 Manufactaersof.. D SHIP TO. 3649 Cane Run Road _ Louisvdle KY 40211 -1961 - M u4urr revs nvcE / � Q P S 99 PUMP CO. (502 ne2>31.1(aon�szs PUMP FAX(502)774 -W4 Wisconsin Department of Industry SOIL AND SITE E V A L U A T I S P O R T Page of 3 Labor and Human Relations — ` Division of Safety & Buildings in accord with ILHR 83. COUNTY lJJ"'/ , � S • Cf�U Attach complete site plan on paper not less than 81/2 x 11 inches in an ntust`clpe _\ � T' , but not limited to vertical and horizontal reference point (BM), direction of s ii it CEL I.D. # dimensioned, north arrow, and location and distance to nearest roa ALT ^ , - ,.t;MU APPLICANT INFORMATION- PLEASE PRINT ALL INFOR �- N „': �" wf y PEWED BY DATE PROPERTY OWNER: PROPE %-Q 11/4,S , � u; Z I T$ ,N,R l 9 E (or PROPERTY OWNERS MAILING ADDRESS NAME OR CSM # Z., t 3 PU'tf,v U l ew D CITY STATE _ ZIP CODE PHONE NUMBER tAGE ®TOWN NEAREST ROAD lM0Q!ZFnLS, Lj1 S�LozZ (CIS) - $6- 007 t (� New Construction Use [x} Residential ! Number of bedrooms t{ [ ] Addition to existing building (} Replacement [ ] Public or commercial describe Code derived daily now 60o gpd Recommended design loading rate o • 1 1 bed, %xW - trench, gpdtft Absorption area required _ -SO 0 _bed, ft SO trench, ft Maximum design loading rate o, S _ gp d 2 b trend, god/ft Recommended infiltration surface elevation(s) l O Z. p ft (as referred to site plan benchmark) Additional design / site considerations W / $'x 6 3� S Qt� > `f 11A.►, 1 oi= i=1 LL Parent material 5 t L_Tti -S t�_ 1 n k jT Flood plain elevation, if applicable 1ti- A , ft S = Suitable for system CONVENTIONAL MOUND IN-GROLIND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system 11 S tau 5d S U 0S o U [i s ®U [is LR U ❑ S ® U SOIL DESCRIPTION REPORT vk.,svXr�; L 1+ i� Su tT�ir f'f12.'�A C1= < Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bound3y Roots. Red Trt ctt in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. S � 1z wl'F>^ C° S o. S ° . s Ground 3 s3 -�S 16­1 2 3Ib �n -SLI2 V/V S ds elev. 01 Ill. D,", ID limiting factor S Remarks: Boring # c -(Z tio`1 2 3!3 St, Wit" �bk 1+1'C1� GS `0`1fL S1 w ltit�1- cS o.S 3 uz_l, g pmt lZ 3�� t -,. S rz V/y S t', o•� f't- - — Ground I elev. , R9.0 it Depth b limiting j factor (1 Zti �r Remarks: CS T Name:— Print Arthur L. We erer Phone: 715- 425 -0165 Me Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signabire: r a Date: G_ `� 6 CST Number: 5 7 6 PROPERTY OWNER S-MA LeZ-T SOIL DESCRIPTION REPORT Page ?`•of 3 PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends K o -L� tU`t2 X13 _ Si 1 Z" sbk �1- �S o• S n_L t. Z 16 -�{ S Low 2 316 s �) Zw► gbh w `ft- c s Ground Z 1Z y 3�6 � 1.S `1 R VIV S ts, elev. � V OL. b ft. 'i Depth to limiting factor ` Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 3 Ground elev. ft. Depth to limiting factor Remarks: cnn- a��nrtn nSi�� PLOT PLAN Page of 3 SCALE 1 "= 4 C ' I � G FS.1 ZS' i r� y � ,,,, r roT C y, z -LT O � - Ttt1 I , B•3 � 1 0 3r- z Ccw�ou{t lJt , 1p 1. p , �iT• aF ebb � �, lo`L. u • 6.1 Z fL99 Nv `To a t'T L Q- z FiUM M 0 �Z I ( 715 ) 425 -0165 14 00576 Sig n T C 5 ture Date Signed Telephone No. CST # a t Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Divisiorrof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S � CCU lX 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 S'7t�ti I FZ BST GOVF E6T-^ NW 1/4 N W 1/4,S Z 1 T Z ,N,R 19 E (or)�o PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # Z [3 PttnuU Ltd D12 — CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD [� New Construction Use [x] Residential / Number of bedrooms y [ ] AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 60e gpd Recommended design loading rate o bed, gpo1ft - trench, gpd/ft Absorption area required SO O bed, 11: _ S O U trench, ft Maximum design loading rate o S bed , gpd/ft b• 6 trench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations w 8 ' x 6 3' R `r'i lti, 1 oI - s D FI Parent material s t L'r-Y S k1-1 Flood plain elevation, if applicable 1� -A , It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE A I SYSTEM IN RLL HOLDING TANK U= Unsuitable for s stem [is ta u [WS El U I ❑ S IOU ❑ S ®U ❑ S [$ U CIS ® U t�Kel.l� 'COX tU SOIL DESCRIPTION REPORT Lir 5� 1 Z�L 01= < Z,p oJ Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots Bed Trench in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 4'.....,, �` O -`� 1,0`11? 3 / 3 � S t � Z rrt S � 1Z �n-i �1- �S o. S o • b . 3l L s s - wl v Ground 3 S3 -LS �C1` 1 2 3)(� - j.S�1IL V/ S n elev. q o ft YZ. U Depth to limiting factor S Remarks: Boring # o _ l v m'�� cS o.S o. L o.S L Ground 4 elev. R9.0 ft Depth to limiting 1 factor Ll Z" Remarks: CST Name:— Please Print Arthur L. W e e r e r Phone: 715-425-0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signatwe: V Date: CST Number: 9 M00576 PROPERTYOWNER S`tLUF Q�ST SOIL DESCRIPTION REPORT Page ?of 3 r PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Y ^ t� -q S lost 2 316 s j) Z vn s��T V" `f 1 s o- S �. b Ground 3 US -)2 y1.1 Z 3/b � ;.S `1 R Vl S gs� " ,, N1" _ 1 elev. l ots ft. Depth to limiting fa S Remarks: Boring # •.Yv ¢v - Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: cr;n- Aiio(p PLOT PLA Page 3 of 3 SCALE 1 '= Q ' 1.� t� G i - VL. M'r) ON ll�lll(;H 3 / ° Ulq, I t � 012 O�S1v1'��3 w °l I B'3 � I p I � � zSA_J Z V) 31- L � O f�-Rg 1 W kT'LL adI14,Y �? �� ( 715 ) 42 - 0169 1400576 CSTSignature Date Signed _ Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer T L F Mailing Address N S k2 275—A 64,1P 5 Property Address d q b W h 6 V (q- l (Verification required from Planning Depa nt for new construction) City /State Tcw Parcel Identification Number. LEGAL DESCRIPTION Property Location Sec. T �� N -R�W, Town of r Subdivision INa . Lot # _3 Certified Survey Map # 3 1 S , Volume Page # Warranty Deed # 5 MS� , Volume <% Page # Spec house )ff yes ❑ no Lot lines identifiable K 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 wastewaterdisposal system less 113 full of sludge. r ' and pumping if necessary), the se a than g is in proper operating condition and/or (2) after inspection n p p g ( ry), tic tank is p 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 se ' system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 s e year expiration date. •.t SlGiVHRE OF APPLICANT DATE OWNER CERT ,ICATION jibed hat all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th ro Fd esc above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNXVM 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 VOLT 0e. 574988 STATE BAR OF WISCONSIN FORM 2 — 1982 WARRANTY DEED Y� ; I DOCUMENT NO. I c Steven M. Best and Paule M. B est, husband REGiST '$—bF10E' and wife ST. CR I br �, WI MAR 1 S 1999 conveys and warrants to RvocJf T Wise a Singl e ' .sk �. q t THIS SPADE RESERVED FOR RECORDING DATA+ ? , NAME AND RETURN ADDIRESIL the following described real estate in At - t^rn i x — County State of Wisconsin: r , Pt 04n- 1082- 6n -00n PARCEL IDENTIFICATION NUMBER .3 ". Ni Lot Three (3) of Certified Survey Map in Volume Twelve (12) of Certified Survey Maps, page 3415, as Doc. No. 574158, filed in St. Croix County Register of Deeds Office on March 2, 1998, being part of the Northwest Quarter of the Northwest Quarter (NW1 14 of F NW1 /4) of Section Twenty -one (21), Township Twenty - eight (28) r; North, Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin. I r TRANSFER FEE ' This iS 130t homestead property. X� wx (is not) ;.x Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this F day of March A.D., 19 98 _(SEAL) .� %— (SEAL) i !` • gtpvpn M_ Best � wEAt) ��. Y 1 m / . ISEAt) Y Paulette M. Best tiff }J . y M1. AUTHENTICATION ACKNOWLEDGMENT # > Signature(s) State of VXi*X9M , GEORGIA ss. 8d County. authenticated this day of 19_ Personally carne before me this _ day of x Na rch Iv_.�$_, the above named S M lest and Paulette M. — -Best - == .=vim -a Fl ! — and wife - — t TITLE: MEMBER STATE BAR OF WISCONSIN — (if not, — — - - -- authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing 't ins[ nt and acknowledyR'ihW sactr••••. .. P , ,; y. THIS INSTRUMENT V,AS DRAFTED BY Att K Ogla __ g� -lrc * k471 Ca •� _ Hudson, WI 54016 Notary Public, �� : ' h EtluntY: u GA (Signatures may he authenticated or ack: oHled ed '4th are not MN comnusslo is p� rp�nt ` S ., e date w t Y g Netiry PU_1'', Cdbt COy�jt O�or9 `. neccsstry) �� —• 19_ —� l _ - -. mr �,yra1111 *.Rpli'Lt 7int�,16 . u, d Names of prisons .igmrg m ink . pa,o) >hou;d ix ped or prmied lxloH ;hey s: {cs.: ,s W s K'ARRAN IY DC 19S2 I E B kit OF N: IX ON SIN .Y'sc:'.yn tec III I9S2 M+wa:.ea ; '� t _'_.'t r,.' +. -_ 1:. � ..•� t +�W •�A h, �. .!" �:'�.• =� do � �- ♦ll+"�Y' aT .Y 1. , .4 •. _ I FILED MAR 0 2 1998 ► 11 KATHLEEN H. WALSH lR of Deeds 574158 SLcm1xco-.w1 CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 21, T28N, R19W, TOWN OF TROY, ST.CROIX CO—WI. (BEING PART OF LOT I OF THE C. S.M. VOL. 4, PAGE 1 107). PREPARED FOR: STEVEN BEST OWNED BY: MAX SALZMAN NOTE: BEARINGS ARE REFERENCED TO THE NORTH L i NE OF THE NW 1 i4. NW CORNER OF SECTION (ASSUMED), 2 I. ( COUNTY MONUMENT 2 FOUND). C. S. M. VOL. 4 ...•.. "".•...."" NORTH LINE OF THE NW 114 N 8 8 0 44 ' 3 (R E C. N ° 4 5 X 31 " E) S 88 495. ►2" .I 2154. 18'_ - - - -�_- - - - ` S 000 00' 00' w PAGE 1 107 � r i 22.6 !' • 3�4' RE —BAR FOUND 114 CORNER OF SECTION 21, (COUNTY N 86 589- MONUMENT FOUND). 554.40' 34.76' \ UNPLATTED LOT 3 �N. LANDS , 4.18 ACRES m cn m : ro l 182,251 50. FT.) 3' �' \ of '� 4. 03 AC. EXC. R/W ° � V M f 175, 494 SO, FT. ) —k OD W w 66.64 699' 87 2 f. 4 0 0 LOT 4 a 4.58 ACRES f 199, 369 SO. FT.) N• 4.28 AC. EXC. RiW f 186, 598 SO. FT.) v'. c C Z 770. 02' m: 35. 17 S 88 14'W 805. 19' \ \ 314 RESAR FOUND'- 621 ° 27'35 "E 10. ;2 \ �•a": FROM CALCULATED NOTE: THIS MAP IS A RECONFIGURATION POSITION. OF LOT I OF THE C. S.M. VOL. 4, PAGE I ;< 1107 TO CONFORM WITH SUBSEQUENT �1 SURVEFROMDODEEDNRECORDS. N O RECORD APP7,- 11,17D N C. S.M. VOL. 4 „PAGE ! 157 'asu � C aly O " SET I* X 24' IRON PIPE WEIGHING , JAMES M.�'d 1. 13LBS PER 4 " �f WE 4 LINEAR FOOT. BER " 8-1804 • - I' IRON PIPE FOUND UNLESS OTHERWISE P> c SPRING VALLEY NOTED. WIS. �� � v tio.1►`� 150 0 150 "3 p 450 U R �h�mmm�eo�m�� GRAPHIC SCALE —FEET JAMES M WEBER S -1804 NEL SEN -WEBER LAND SURVEYING SHEET 1 OF 2 DATED 40 -'S i REVISED 11 - 20 - 96 96 -141 THIS INSTRUMENT DRAFTED BY JIM WEBER I Vol .12 Page 3415 0) •A O rggNl N b R+ -7i o N a) •Q a 4-) j to rd C to tv y2l • v U tL 3 TJ r G Zia :� a ti •H -)UM � r U O H Q) cd k U 1 a ro ° aa �'° A 4a td t 4J 0 4 a. s ��� $��; �Q)3r-i( V� 2 o - 0 4 � . En � ¢, 0 ° rd •r � � • -J 0 3 O 0 to o h1 a) 4 td • Q •I-) e) � � U P ul O td to Q) = f + ( .k �4 —7 �r � a r-I z N WHHU)�pQ A tQ � ' g 0 ' o o 2 1;9 n �- 1 I 01 N O W ,sa c N 1 r Sul 0 e� y !L v i i I i � m I T � J to