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HomeMy WebLinkAbout040-1177-80-000 � § ) ci 0 Q . / c @ � K § £ � § � ts § ) I % §§ 0 22 . ( 2 = k §\ £04 ƒ A2 � /� f\ 2 3 2 ; % k $ % k 2 o 2 7 U. 0 — � 7n- E 2 $ $ Z 2 2 \ � k � n §\ a m a m j § I ) z V 2 C \ k k / } E / _ 2 E ) n k 2 ] [ j . 4) / f b a. 0 , < o k < } � zco f 7 � z w f t # z $ .. c / \ £ \ U) &\ \� k k c S 8 ) 0 2 a = E a o o a 2 °§ q w% \ k - 0 g j\ k :I ® ° _ z / a a a % m m m t I � IL '] �� ° § k k 4) , — z Q — — � * o § k ® g§§ 6 2 8 8 8 �R § % § \ 04 § § = / § S 2 / 9 2 o : 2 .0 § § -0 z m o 2 #» r . © £ -1 0 U) k E = b E 04 « r- 0 $$ a 8 a 8 8 8 8 / @ 9 / # E - m a ` k § / 1 c ca a R § / / \ CO ■ a 4) o • % _ 2 e o . $ $ c f 2 § § § ) §- n o' k a $' 1 5 '2 \ o z$ I z J/ o z$ z 2 s m ■ � � IL " 2 » E$$! k a§ k a§ k 0 a v v Parcel #: 040 - 1177 -80 -000 01/05/2007 12:26 PM PAGE 1 OF 1 Alt. Parcel #: 13/24.28.20.696A 040 - TOWN OF TROY Current 'X j ST. 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 JAMES L &DAYNA RUTHERFORD O - RUTHERFORD, JAMES L & DAYNA 285 COVE LA HUDSON WI 54016 ._ Districts: SC = School SP = Special Property Address(es): - Primary Type Dist # Description " 285 COVE LA SC 2611 HUDSON SP 1700 WITC I Legal Description: Acres: 2.800 Plat: 2491 -ST CROIX COVE 2ND & 3RD SECS 13 & 24 T28N R20W LOT 39 EXC S 66 Block/Condo Bldg: LOT 39 FT ST CROIX COVE SUB # 3 Tract(s): (Sec- Twn -Rng 401/4 1601/4) I Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 521/290 2006 SUMMARY Bill M Fair Market Value: Assessed with: 159094 308,700 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.800 92,400 189,200 281,600 NO Totals for 2006: General Property 2.800 92,400 189,200 281,600 Woodland 0.000 0 0 Totals for 2005: General Property 2.800 92,400 189,200 281,600 Woodland 0.000 0 0 Lottery Credit: C laim Count: 1 Certification Date: Batch #: 303 I Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 R�cz1'A1 i/6 -7a 1-4,b. #67 10/69 ( Wisconsin Departisent of Health and Social Services vu 2 r Division of Health • � ✓ ''`� "`" � 7 PEfd•IIT APPLICATION for PRIVATE DOMESTIC SEWAGE SYSTEMS De s� �Cl{or� ✓� g g S ," A. OWNER OF PROPERTY TYPE OR USE BLACK INK Name Address (Street, City, Zip Code) T L• E� - 9 ! <' X11. 0 i"5 o ma 4 County B. LOCATION OF PROPERTY WH RE SYST WILL BE CONSTRUED ALTERED ^R EXTENDED n j Check One; a C 1 ! Lr� f CITY VILLAGE LEGAL DESCRIPTIO TOWNSHIP 7 C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO 6 / PERMIT NUMBER D. SEPTIC TANK CAPACITY &J 1 ) Gallons NEW INSTALLATION ] REPLACEMENT -� ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: / E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other �.- _ Specify Number of Persons to be Accommodated -- Number of Bedrooms 35 F. APPLIANCES, ETCt Food Waste Grinder ^ YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatio Potato Peeler YES_ NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW X EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines r Seepage Beds Length Width Depth Tile Size No. Lines .( Seepage Pitt Inside diameter i' Liquid Dept PE RC 0LATI ON TEST Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inc Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Wetted Overni ht in Mi:mtee Last Period Last Peri Period One Inch Example P- 0 36" Too Soil 10 Cla y 26" 25 Yes or no 30 1/2 1/2 1/2 60 LO • CL'2 !lam(/ RECORD DATA FROM MINIMUM OF 3 TEST HOLES i C ompute size of absorption area in accord with H 62.20 Wis. Adninistra`ive Code. S 0 I L B O R I N G S- Minimum 36" Below Prop osad Abso. tion S stem oring Total Depth Depth to Ground Water Depth to Bedrock umber Inahn3 Observed Estimated Observed Estimated Character of Soil with Thickness in Inches xample 0 72" 72" Blaok To Soil 12"• Cle 18 Sand 18"• Gravel 24 2- / j 0 ,. , , J"7' a , RECORD DATA FROM MINIMUM OF 3 BORE HOLES COMPLETE OTHER SIDE r I,.the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3) Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME Q 6 4 1 , �1,7�� F�n� �L+L,LL �,� TITLE (Type or Print) f REGISTRATION NO. or MASTER PLUMBER LICENSE No. ADDRESS DATE TZ!2 SIGNATUFS MASTER PLUMBER MAKING APPLICATION � MP 7' signature: % '�✓ l� (� 4 4 License Numbers MP RSW r (To be Completed by Issuing Agent) Jf h z gh . ' Date of Application t7 GJ Fee Paid $ t Permit Issued (date) i - -�� Permit Number V Agent (name) i' For: y � Town, Village, City, tounty, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below – FOR DEPARTMENT USE ONLY DATE RECEIVED — G ! ACCEPTED BY �T �� RETURNED (Initials) (Date) See Correa. FEE RECEIVED VALID. NO. � g 0 / PERMIT NO. Yes or No) REVIEWED BY APPROVED DATE (Initials) (Yes or No) COMMENTS: r' I - - - ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT /3 Z q��P>� 6 9 4 Owner lit vn -CS 9 7q Q yam! Property Address Sr ' u c L A) City /State Legal Description: Lot 3 � Block Subdivision/CSM # g '/4 0 '/4, Sec. _D, T_29�N -R Z.y W, Town of PIN # TP_.p� SEPTIC TANK -- DOSE CHAMBER -- HO DING TANK INFORMATION: Tank manufacturer c l✓ Size S�'/�Q Setback from: House 3c) Well & P/L Pump manufacturer ra ,...,, /-%i Model Alarm location 14 s (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: �� ��" Width l Leng1h r Number of Trenches l Setback from: House /5 Well 66 -0- P/L Vent to fresh air intake —T o " ELEVATIONS Description of benchmark T.p &,e Elevation � a Description of alternate benchmark L-tv 94— ZAC 4Elevation Building Sewer G QUX-J. ST/HT Inlet ST Outlet ^ PC Inlet . PC Botto Header/Manifold F F3 Top of ST/PC Manhole Cover 9 0 Distribution Lines () () ( ) Bottom of System Final Grade Date of installation L/ / 7Permit number 3 `f A07 State plan number Plumber's signature License number 2 31 Vii"/ Date Inspector Complete plot plan 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 O r 4� J- 2/i INDICATE NORTH ARROW 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No . CR IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344607 Per El Cit Village Town of: State Plan ID No.: rk�A b, JAMES & DAYNA HUDSON CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: a (0M.0 040 - 1177 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic `"' Benchmark S 10 j 1 ,a Dosing 1 6 -0 ri6 2.f �°�•S/O Aeration Bldg. Sewer W Holding /, Inlet u TANK SETBACK INFORMATION 0/14 Outlet fir. Z TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 7;' 9 4-3 Septic Sp f >S-D 1 -- NA Dt Bottom ZZ.( , ?5 Dosing b > 2 �Sl NA Header /Man. r2'L; $$, 13 Aeration JSLA - 8�e Holding Bot. System 1 7 4 PUMP/ SIPHON INFORMATION Final Grade $; a " 9.7,,Sp Manufacturer �, Demand 57 18,E 9.P -.0 Model Number Eo GPM TDH Lift .11A Friction System TDH Ft L oss mead Forcemain Length (. 1 Dia. 2 `` Dist. To Well }40� SOIL ABSORPTION SYSTEM rr $ 6 A_ 0 , L 5 BED/TRENCH Width, Length i No. Of Trenches PIT No. Of Pits I d D Liquid Depth DIMENSIONS 2• s DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man fact reri SETBACK CHAMBER INFORMATION Type O i el Num er: System: P. S.Z� 9 7 60 OR UNIT _ DISTRIBUTION SYSTEM Header/Manifold t , Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length - "( �i Dia. _ length ing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 1 ?Y Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes El No [I Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: T OY 13/24.28.20.696A 285 COVE LANE — ST. CROIX COVE LOT 39 Plan revision required? ❑ Yes tg No Use other side for additional information. 1 0 13_ 00 1 Tf 526 X SBD -6710 (R.3/97) —Ml M cit, IS Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION d 201 W. Washington Avenue ' %IsIiionsin In accord with ILHR 83.05, Wis. Adm. Coe 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 8 112 x 11 inches in size. St. Croix • 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 raofsi cd p oL9 pplicacion [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location 1/4 1/4,S T , N, R 20 fa W SW Property Owner's Mailing Address Lot Number Block Number 285 Cove Lane 39 City, State Hudson, WI 506 Cod Phone Number Subdivision Name or CSM Number 1 ( 715 ) 386 -8075 St. Croix Cov d 11. TYPE OF BUILDING: (check one) ❑ State Owned [I !t Nearest Road Village Public x 1 or 2 Famil Dwelling - No. of bedrooms - i_ Town OF Hudson Cove Lane III. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s) I2�.a4 " . Zo (c 1 b 1 Apartment/ Condo 040 - 1177 -80 (13/24.28.20.696A) ❑ 2 ❑ Assembly Hall 6 E] 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 -- - - - - -- S�rstem ------- - - - - -- 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 ❑ Specify Type 41 ❑ Holding Tank 12 (gSeepage Trench 22 E] In-Ground Pressure f f 42 ❑ Pit Privy 13 ❑ Seepage Pit (Kjg1 � C� I � s 43 ❑ VayllrPrivy 14 ❑ System -In -Fill I -C a G;+ W ..��•. 't y a" VI. ABSORPTION SYSTEM INFORMATI 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 450 562.5 572.4 0.79 NA 86.2 Feet 92 Feet Capacit VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App Tanks Tanks Septic Tank o 1000 1000 1 ? x❑ ❑ I ❑ ❑ 1 ❑ ❑ Pum Tan ❑ ❑ ❑ ❑ ❑ Vff F - RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum Signature amps) MP /MPRSW No.: Business Phone Number: Tam Fisher MPRS 231491 715 -285 -5671 e Plumber's Address (Street, City, State, Zip Code): N 324 CTHW 0, Eau Galle, WI 54737 IX. CJDLINTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing ASinature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determination a�'S ao A .3 I 9r X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the �,,,, � 5 � Fp V residence located at: - ,a_ ;, Section /_ , T_�N, R a &_ W, Town of 7 dY Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. p Last time serviced: Did flow back occur fro* absorption system? Yes 'No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: J00 6 - A k� Construction: Prefab Cprete Steel Other Manufacturer: (If known} : Age of Tank (If known) : 2 7 XA- Yom` (Si ature) (Name Please prin (Title) (Lic nse Number) ,,= - "7 26 - 52 Date Fprm to be completed by licensed plumber (s.145.06,-,W sin s tatutes) or Licensed Disposer (NR 113 Wisconsin Adminlss VVe r -� Code) c::: � •-- - ---- ------------------ - - -' Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tah'k condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name T Signature zz MP /MPRS I Y -� cti . . . - O. iJ A U� ... Yom. 3 0 •+X � \ e �• J \ o... Z �� �.o v t. � o»� hg ��`MMM � Q� Sw- S'�►• \3; Nw.ty... -Z�.. to w t .. Ste. 1�4-►� ol.,,.A = »� Pvc •. 12' Z �` I s BSc,, 4-o *-ZK (t ct t. (.�R•q'� 4h A-IS Ism 4�s' Z. Lt q v �►' �"e" � r1 Cgo•sS' T � �, r ,�.,w� 1 w Ii• a1 w �3 �0•2 l ►2S� • I • C�� ���8 y 48�b,i N • . �J s � f G I � s I I , I \ Z AL z VEIJT CAP 4 "C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAJG JUMCTIOM BOX MAMHOLE COVER 25' FROM DOOR, N `A/ wAaW*NN C. WINDOW OR FRESH , Z I `AQ \-- AIR INTAKE GRADE I 4 ,, I CouoUIT PROVIDE I - - - -- AIRTIGHT SEAL �Z` } Crq\.l , �6S \?0.v ZJ •� I I i APPROVED .1010b I { II W /C.I. PIPE ` A., V I I ALARM EXTF 3' ONT SOLID SOIL I ON I I PUMP --�, OFF CAC.. ,(� 3.S Sw -Z_ BLOCK a�av . � Z . �• - I o� - �'6e U { , V it Performance Data 32 Pump Characteristics Pump/Motor Unit Submersible Manual Models SW25M1 SW33M1 l 24 Automatic Models SW25A1 SW33A1 < 1/3 HP i Horsepower 1/4 1/3 16 Full load Amps 8.0 10.0 1/4 HP Motor Type Shaded Pole (4 pole) a R.P.M. 1550 o a Phase 0 1 Voltage 115 Hertz 60 0 0 10 20 30 40 50 60 CAPACITY -U.S. G.P.M. Operation lntwlwnat Temperature 1201 Ambient Total Head (foot) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1A NP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class GPM 1 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Disc Sue 1-1/2 NPT Solids Handling 1/2" Dimensional Data Unit Weight 30 Ibs. 1. All dimemiom in i KW Power Cord 18/3, S", 10 std. 3-1/2 5 -Ire 2. (anponenl dimensions may 4 -1R Nor 11/8 inch 1120' optiond) � ( 3. No la nnstraoonn papese 1 -1/2 NPT on" certified 3.1/2 DISCHARGE 4 Dimensions and taights am 'Materials of Construction opproxim0le S On /OH Iwel odlmtahle Handle Steel 6. We rewve Nw right 10 3.1/2 make temp n to ow lubricating Oil Dielectric Oil products asd heir Motor Housinj Cost Ira speciliceoons edhow noon Pump Casino ClAt Ira Sha SW Mechanical Seal Foss: Cwbon /Cw=k - Shaft Seal Sod Body: Anodized Steel Sp*: Stainless Stow Bello Boma -N PUMP 10.1/8 � ON 9 -1/2 stir Upper Bearing Bronze Shtwe DISCHARGE HEIGHT Lower Bear' Row wad —� 3 3 -1/2 Strainer /Base Plastic PUMP OFF Fasteners Standess Steel AURORA /MYDROMATIC Plumps, Inc. 1840 B aney Road, Ashland, Ohio 44805 (419) 289 -3042 -- Wisconsin Department of Commerce SOIL AND SITE EVALUATION page _ I of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference Loin (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, a cati n ' ance to nearest road. - - - - - -- - - Parcel 1.p �-- 8 10- 1177 -80 (13/24.28.20.696A) APPLICANT INFORMATION - Plea *pi all infor*tfp ° - ,t 7 - - - - -- - - - - -- - - -- -- -- - Personal information you provide may be used for,deooridary pu se4Privacy LaV�_4, 34 (1) (m)). Re�pleyred,6y a q Property Owner ; rty Location Rutherford, James & Dayna (— v Lot NW -NW- SW 1/4 SW 1/4 S 13 T 29 N 20 W 4nnn Property Owner's Mailing Address ' o ock # Subd. Name or CSM# 285 Cove Lane , CRC�IX �' 9 St. Croix Cove # 3 City State Zi FWWNrJ aF l City ( Village XTown Nearest Road Hudson Wl 5 6 715 -386 - udson Cove Lane New Construction Use: Residenlw' M r rooms 3 1 ]Addition to existing building X Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate - bed, gpd /ft' • trench, gpd /ft' Absorption area required 643 bed, ft' 562 trench, ft' Maximum design loading rate •7 bed, gpd /ft' • t rench, gpd /ft' Recommended infiltration surface elevation(s) 86.2 ft (as referred to site plan benchmar Additional design / site consideration i nstall 2.7 'x 112.5' (nominal 3' x 108', 18 shells) Sidewinder, Ht- capacity "turtle- shell" trench Parent material sandy /loamy outwash Flood plain elevation, if applicable NA ft Holding Tank U= Unsuitable for Conventional Mound In- Ground Pressure AT -Grade System system ® E] U X S❑ U N S❑ U X S i- U lnhll ; S X U S Suitable fors Depth Dominant Color Mottles Structure Consisten Boundary GPD /ft' Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bounda Roots Bed Trench 1 1 0 -7 1 OYR 2/1 - sl 2 m gr mvfr cs 1 f/m .5 .6 2 7 -14 10YR 3/4 - sl T 1 m sbk mvfr gs Im .4 .5 Ground 3 14 -25 10YR 4/4 - sl 1 m sbk mvfr cs r 1 m .4 1, .5 elev -- - -- - -- - -- - - -- — 94.6 ft . 4 25 -30 ! 7.5YR 3/4 cos 0 m mvfr cw lm NP NP Depth to 5 30 -108 7.5YR 4/4 - cos 0 sg ml .7 .8 limiting- _ factor > 108". - Remarks: horizon 4 is tight, apparent iro cementing - - - -- ------- - -_ --- _ _ 2 1 0 -6 i 10YR 2/1 - sl 2 m gr mvfr cs 20 m .5 .6 2 6 -27 1OYR 3/4 - A 1 m sbk mvfr cw lm .4 .5 Ground 3 27 -44 r 7.5YR 4/4 1 Imcos 0 sg ml ! gs lm .7 .8 i elev -- -- , - — — -- - 92.5 ft... 4 44 -110 1 OYR 4/4,4/6 - mcos I 0 sg trill - - .7 .8 Depth to l imiting - -- -- actor f M - - � -- - ` S ' � - -- - - - - - -- j - '- -)1� r Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715- 665 -2681 CertTfiedS61l resfmg Address P.O. Box 57, Knapp, WI.54749 4 222774 1149 Re1f149 PROPERTY OWNER: Ruthe James & Da SOIL DESCRIPTION REPORT -] Page 2 of 3 PARCEL I.D.# 040- 1177 -80 (13/241 Certified Sol{ Tes&lle Depth I Dominant Color Mottles Structure GPDlftZ in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh, onsistence Boundary Roots Horizon Bed Trench 3 1 0 -7 10YR 2/1 - sl 2 m gr mvfr cs 2flm .5 .6 _ 2 7 -16 10YR 3/4 - s1 1 m sbk mvfr cs lm .4 .5 Ground elev 3 16 -51 7.5YR4/4,3/4 - s1 1 m sbk mfr cs lm .4 .5 91_8ft _ 4 51 -110 7.5YR4/4 - mcos 0 sg ml - - .7 .8 Depth to limiting - - -- - - -- - = -- - -- -- - - - -� - - - ._ factor tom- - - -- - - -- > 110" - -_ - - - - -- - - - -_ - - _ _ Remarks: orizon gra es LU MTK 414,416 mcos w increasing aep 4 1 0 -4 10YR 2/1 - sl 2 m gr i mvfr cs 1 f/m .5 .6 2 4 -15 IOYR 3/4 - sl I m sbk mvfr gs lm 4 5 Ground f ' � ro 3 15 -34 7.5YR4/4,3/4 - sl 1 msbk mfr cs I .4 .5 90.5 ft _ 4 34 -110 7.5YR4/4 - cos 0 sg ml - - 7 8 Depth to limiting - - - ` - -- -- - - - - - -- - -- - — -- — - 1 _ -f factor So > 110 " Remarks: orizon 4 gra es to mcos w increasing aep= -- Ground ---- - - - -- -- ----- - - - - -- - - -� I I - -- elev Depth to II t limiting -- - -- i - - - -- - -- - -- - - -- - - factor j I Remarks: I I Ground elev I Depth to limiting - -- - — - - - - -- factor I Remarks: ,} , Y ^\ D• 1.J A. r. � �. Yom. 3 0 �.X � \ e �" J \ o+.. � �� �o v t L wa � F1 1. o? wL� 10 6 /�. 1 Sw- Sw.�3; Kw.tA - -z4 �• � L9�:a5 tN a,�l ` � 1 � C (ctz Aol WQ W. KQ -, 3 0 � 3 s t • SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Aggregate Soil Absorption Systems Permit Number 7/18/99 Date x N X" Gravity Distribution only 1 Pressure Distribution ft Suitable Soil t in Aggregate Depth 2 4 in Nominal Pipe Diameter 450 gpd Estimated Daily Peak Flow 0.80 gpd /ft Wastewater Infiltration Rate 562.5 ft Minimum SAS Size 86.20 Ift Proposed SAS Elevation #VALUEI Soil Surface Acceptable r# nished Grade EL 3 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? #VALUE! 1 94.60 108 85.60 93.60 Yes #VALUEI 2 92.50 110 83.33 91.50 1 Yes #VALUEI 3 91.80 110 82.63 90.80 Yes #VALUEI 4 90.50 110 81.33 89.50 Yes #VALUEI 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10553 -E (R.05/98) • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer T Mailing Address 2 d V G zo -V s t /© /z Property Address ( required from Planning Department for new construction) City /State W d .S & _ 1 r S Parcel Identification Number k ° T 9 LEGAL DESCRIPTION Property Location S6J 1 / <, j� V., Sec. , TZLN -R W, Town of 3 Subdivision �L C/'0 1 X ��� [� C 3 . Lot # Certified Survey Map # , Volume , Page # Warranty Deed # s 2�� �,6� , Volume I , Page # 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 Orrice within 30 days of the three year expiration date. SI ATURE 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 orded in Register of Deeds Office. SI NATURE OF APPLICANT I DATES * * * * ** 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 DOCUMENT Nth, i i STATt RM OF WISCONSIN-P ORAL i + WJtRMTV ,' J 3261 t pYait fAMi�s+� 1 THIS Si+Ct *S& FUR CO01 DATA 1 u THIS DEED, made be, _Donald W. Moses Ind Ka N. MoseA, REGISTERS OFFICE husband and wife,, individually and_ as loin t - tenanfs S+ CROIX Co.. W;f,. i Rsc cbr Record thia_2 1 _rt It Grantor !E and _ afl(E',5_ L a Ruthe r f,o rd_ and _Dayna N. Ruthe r f o rd, 11 4 O "+&CYh_____ -A ri.1971 husband and wife as._1oint tens its___ t. __ r1i___.Pt_, _ �' W i t n e a s e t h , That the said Grantor for a vsl �ablc consideration ` 4sRlsfar o Deedtr conveys to Grantee the following desi .:abed real est ate in__._St. V r01k County, REttlA State of Wisconsin: Lot 39, St. Croix Cove Subdit-ision No. 3 in Township of Troy except the South 66 feet thereof. Tax Kes.g.__. __.-- _------ - -_ -_. Tkts is.--. -- homest -ad Property. TFuMSF'ER S —S-1 a qD FFE pop, ., Subject to easements, restrictions, reservation and esvenants of record Together with all and singular t',e hereditaments and ap urten��noes' ere belonging or in any wise apper!a.ning; And - Donald W. Mos'as and Kay �1. a`Ios('Z - - - -- _ - - - - - - -- — - - -- -- - -- - -- - - -- warrants :hat the title is good, indefeasible in fee simple and free and clear of encumbram_es except a �EOrt a t' Lo the Was hlgton__Federal_ Say iizgs. _a.nd !.oar,.soc_iation da,tec�_pr_i1.2Q,. t_4 ?�� ot_gna2ly in tht sum o $ 32,000.0�� recorded�Apri1 2 5 :_ 197?_ in office of Reg - of Deeds - and will warrant and defend the same. or sgtt CI•oix Coun i vvD1 483 gag- 231 -232, Document ko. 30084, , now redLLCe to 130,b�,.3 , which Grantee assurm. a nd a $ j� g res to nay. Executed at _ iUdSon - 11QQLLS lII_.._____ —_..�_ -this 31-at-- _ day of SIGNED AND SEALED IN PRESENCE OF `� '- �t 1 - -- ` ;SEAL) D_o ' Y. - '5 - .. r \ ,, ,, J, '' _(SEAL.) KaT N. Moses !SEAL) i SEAL) Signatures r,f Donald W Moses and Kay N. Moss -s, his wife authenticated this __._3.1 8t _.._ _ -day of - M a rc h ___.__ _..__ 197 Alex S. Kosa Title: Member State Bar of Wiscros,:t XF\ "44A Authorized under Sec. 946...6 vu _ _ STATE OF WISCONSTV t ss. County. Prrsone!,; came before me, this _._ --._- _..._.- _..._- -.--_ _ day of the above named_��__._--- --�_-_�...__ to me known to be the person ____ who executed the foregoing instrument and acknowledged the same, j' This instrument w:+ drafted by i . �£X_S- .__KQSa,- _._AttOrilCy .? t_. Law Notary Public County, Wis. 0 c! witnesses is c�,taonal. My Comma.ai ',Fxp rc ) t`!,) i'h use Names of persons OC-aing in any capacity should e i or printed below then a natur «s. ,`" WARRANTY DEED -STATE PAR OF WISCONSIN, FORM. NO" l - 1971 \ (9 LCER 5 fil c!t t" ( ! ,`.. ,:.. I I �• oo 0 1962 O ^ II 1 .,.,, ��.... 0/ 1 11 N � y/ I I 0l Z � Iol' IDZ 001, ti i J ���•re` o �/ o M 6 • O 14 10 42 °m 14% P P 0 1 4 0' . y V 9 ro Y Vb 3 N 8g•,36 ze � 40