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HomeMy WebLinkAbout042-1079-50-100 ` ST. CROIX COUNTY ZONING DEPART, 0 AS BUILT SANITARY REPORT �. Owner TE , , 0' 1 z;h 4 p R 14 a c UL ,07 ) F Property Address - 7 7 s / Q 3 kb S7` 2 9 1999 ` City /State Pc 3 r te S LA J ( q s-T 0101, GQV'Pr`Ty 1 t 9 Legal Description: Lot ( Block ' Subdivision/CSM # to Co 1 /4&U- /e, Sec.' , T e , N -R Town of �0A 0- 4 I/ tSEPTIC ]F:Xt DOSE CHAMB HOLDING TANK INFORMATION Tank manufacturer ��� `� /e-- Size ST/PC 14 , f9 7.� * Setback from: House Well P/I. Pump manufacturer 2 o E Model S 2 Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location — Alarm location SOIL ABSORPTION SYSTEM C� U Wid th Leng f Number of Tr � Type of system: Sri h(� Wid gt .: Setback from: House //0 Well tie's t^-P/L fZ3 , Vent to fresh air intake ELEVATIONS Description of benchmark E Q S f ( HE rL. / = d Elevation �OC? Description of alternate benchmark -f e � f /i r Y" / 0 :;� Elevation Building Sewer. ST/HT Inlet r `� 5T Outlet ! PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover ^� T Distribution Lines Bottom of System O r6 Final Grade ( ) Date of installation `7 // 9 $ermit number 3 9 y State plan number Plumber's signatur _ License number = e3 6 Date - 7/ �/ �7 Inspector P� - Complete plot plan Or l 1 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. in32n�- — • Show alternate benchmark, if applicable. DRIVE PLAN VIEW - aRA (,j WELD zy`x3 �Z /T �s 0 0 (2So�o�L i ' 15a S o,LCp^ �vw� t{.dwbQ� 0 ? t x;;Ka,S 2ocK 8EA l LA T�QA L wlq,3 HOLF : rPA i NC KATE NORTH ARROW 1 , Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and Buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No: IX Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 344531 Permd6llftT.E � TERRY & SANDRA E] Cit 'W A village Town of: State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: AA � Parcel Tax No.: (00 (Cc c I� S 042--1079-50—t,00 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1D Benchmar 1 Dosing (�.Cy 5 b -, 9'p" �' 03 lv Aeration Bldg. Sewer ?, 6 Q ( Y 2 Holding 6/4k Inlet jo fe 3 �- TANK SETBACK INFORMATION (5/4Z Outlet `j. Y2 zo TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet �q� GG Q Air Intake a. [ O fl l - Septic ? I " , 3 Z! NA Dt Bottom Dosing 1 > 75 46 ' 1 r 9'2, r NA Header /Man. �a Aeration NA Dist. Pipe fZ �- Holding Bot. System /0 PUMP / SIPHON INFORMATION Final Grade Ni Manufacturer c L Dem M i f `} y X3,4 3. Tj l . Model Number - GPM TDH Lift Friction xZ Syetem;L TDH 1 oss Forcemain Length 1 1) 1 Dia. Z " Dist. To Well 46 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J M — DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER mod Number: INFORMATION Type Of 13 ( 0' -- OR UNIT a System: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) JlJ�� t « x Hole Size x Hole pacing Vent To A Intake Lengt y Dia. _ Length v -D LL Dia. Spacing _ �3 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 EANo 4 I COMMENTS: (Include code discrepancies, persons present, etc.)(' F. 5 ( t. '� (, LOCATION: JARREN 29.49%%8.452A,$t NW ZZ5 103RD STREET — LOT 1 5,g !� - 3Z - q &A — 4- *,Z,Q wv— ' 50U ckV {o Le— it or.: t+a oe pw —rwke rk��rteQQ L 4v� ' Plan revision required? ❑ Yes No c Use other side for additional informer 2 on. 7 L b SBO -6710 (R.3/97) Date 1 Ig�Pe�9� s Sign�t�/e JA Cert. No. V isconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 B 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 Count than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary PPermmi Number Personal information you provide may be used for secondary purposes ❑ Checvr�vi §ion co previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 9 Property Owner Name operty Lo ation (2 6Q0 E � 1/4 1/4, S ZQ T Zq , N, RI$ E (or0Z Property Owner's Mailing Address Lot Number Block Number ZI UTH D T City, State Zip Code Phone Number Subdivision Name or S f� Z M Number s D T W 1 2r 3 (7 Z0 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Nearest Road ❑ VII age Public 1 or 2 Famil Dwellin - No. of bedrooms Town OF (. AK E O e o <4 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) na ly L 1❑ Apartment/ Condo 6 y 2 — 107 S /00 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 Ik New 2. ❑ Replacement 3_ ❑ Replacement Of 4. ❑ Reconnection of 5. ❑ Repair of an ____ystem ________ 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 E] Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22� Mound 30 In-Ground Pre 42 Pit Priv ❑ [] ou d essu e ❑ y 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade t Required (sq. ft.) Proposed (scyft.) (Galstday /s -ft.) (Min. /inch) Elevation c2 D 0 . �0 S'C> CD , Z O 110 Feet 0 Z f WFeet Capacit VII. TANK in Ca g Total # Of Prefab. Site Fiber- plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st ti Steel glass App. Tanks Tanks Septic Tank an I Lira I w E tz 2 ❑ El El 1:1 El Lift Pump Tank 4Wuo"4,w!er x - 7 SO I I W 1 (L 1 24 1 ❑ ❑ 1 ❑ ❑ 1 ❑ Vill. SPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St a s) MP /MPRSW No.: Business Phone Number: M1 46 =e LI- I Zzso3b 3g4P Plumber's Address (Street, Cit State, Zip Code): v _70 �k1�E2. 116 E v So H Lt.) a Ira IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved �; 1497 _5 ry Permit Fee (Includes Groundwater ate ssue Issuin gent Signature (No Stamps) F� Surcharge Fee) pproved ❑ Owner Given Initial , Adver se De termin X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) - DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 04, 1999 CUST ID No.225036 ATTN: Kevin Grabau ZONING OFFICE MICHAEL P MC DONELL ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/04/2001 Identification Numbers Transaction ID No. 228210 Site ID No. 173118 SITE: Please refer to both identification numbers, Site ID: 173118 above, in all correspondence with the agency. St Croix County, Town of Warren SE1 /4, NW1 /4, S29, T29N, R18W Lot: 1, Subdivision: CSM vol 12, pg 3263 Terry & Sandra Goulette FOR: Object Type: Mound System Regulated Object ID No.: 470583 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. Adm. Code. • 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(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 05/19/1999 � FEE REQUIRED $ 180.00 ennis R. '!!on FEE RECEIVED $ 180.00 Wastewater Specialist BALANCE DUE $ 0.00 (608) 785 -9336 dsorenson @commerce. state.wi.us WiSMART code; 7633 TERRY GOULETTE REC EIVED MOUND SYSTEM DESIGN MAY 19 1999 Residential Application INDEX AND TITLE SHEET SAFElY & BL ors oiV Project Terry L. & Sandra J. Goulette 4 bedroom residential mound Owner Terry L. & Sandra J. Goulette Address 211 South Division Street Roberts, WI 54023 715 - 749 -3542 Legal Description SE1 /4NW1/4, Sec. 29, T.29N., R.18W. Township Warren County St. Croix Subdivision Name CSM Vol. 12, Pg. 3263 Lot No. 1 Parcel ID Number 042- 1079 - 50-100 Plan Transaction Number Index and title sheet Page 1 Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Pump performance curve Page 6 Site plan Page 7 Attached soil evaluation report Page 8 Designer Mike McDonell License Number 225036 Signature Zj Phone No. 715- 386 -8692 Date 5/05/99 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Slats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10462 -E (R.05/98) Page 1 of 8 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 6 % Wastewater flow rate 600 gpd 2271 Lpd Depth to limiting factor 32 in 81.3 cm In situ soil infiltration rate 0.5 91d/t` 20.4 Lpd/m` Contour line elevation 100.2 ft 30.54 m Use standard fill depths? x OR Design epth? in F___1cm 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 F in 0.125, 0.156, 0.188, 0.219, 0.25, 0.281, or 0.313 inch oniv. Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 3.50 it Not a final calculation. Number of laterals 2 Pump tank elevation 96 It Outside bottom of tank. Forcemain length 30.0 ft Forcemain diameter 2.0 in 1.5, 2 3 or 4nnch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 1/8 = 0.125 1/4 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9/32=0.281 Estimated daily flow 600 gpd 2271 Lpd 3/16=0.188 5/16=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpdW 500.0 ft 46.45 m` Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd /m Design width (A) 5.00 ft 1.52 m Cell length (B) 100.0 ft 30.48 m Depth of cell (F) 9.5 in 1 24.1 lcm Sand filter tii�� � a 1y F° dVATE SEWAGE SYSTEM Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 15.6 in 39.6 c t. i1rt Basal area required (gpdAnfiltration rate) 1200.0 ft 111.48 m 4 Supporting components k M . Topsoil depth 6.0 in 15.2 � cm Subsoil depth at center 12.0 in 30 m ` Subsoil depth at cell wall 6.0 in 15.V ON O F IIIIJILD 6S End slope toe length (K) 10.33 ft 3.1 Up slope toe length (J) 7.10 ft 2.W: ' --� Down slope toe length (1) 11.30 It 3.44 rtSEE CORRESPONDENCE Total mound length (L) 120.66 ft 36.78 m Total mound width (W) 23.40 ft 7.13 1 m Project: Terry L. & Sandra J. Goulette 4 bedroom residential mound Transaction Number: Page 2 of 8 I .. MOUND PLAN VIEW observation pipes (typical) J 23.4 ft r q A = 5.00 ft 0�1 m L_r 7.13 m 7i : ::::• ....... ................ B= 100.0 ft m W �-- B J = 7.10 ft m K I= 11.30 ft m K= 10.33ft m L _ 120.66 ft F - 36.781 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AAB) J = up slope dimension = plowed area (Lx1N) K = end slope dimension 6' (152 mm) T MOUND CROSS SECTION subsoil cap D = 12.0 in 30.5 cm lateral topsoil G H E = 15.6 in 39.6 cm invert 101.70 ft F = 9.5 in 24.1 cm elev. 31.00 m :: JF G = 12.0 in 30.5 cm • ASTM c 33 H = 18.0 in 45.7 cm D y sys. 101.20 ft and Fill elev. 30.85 m 100.20 ft contour 30.54 m elev. 6 % ---� 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 cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: P RIVASE SEW SYSTEM nuj — W 1 jt P Project: Terry L.. & Sandra J. Goulette 4 bedroom residential mound Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 1 5 Ift 1.52 m Length (B) 100.0 ft 30.48 m , Lateral specifications Number laterals 2 Holesilateral 14 holes Lateral length (P) 48.38 ft 14.75 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate gpm 1.03 Us Sys. dis. rate 32.62 'pm 2.06 Us Hole spacing (X) in 109.2 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) - Place X in red X' one choice 1 114 in (32 mm) box of chosen from the options 1 1/2 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 1/4 in (32 mm) None required. from the options 1 1/2 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 2 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. P _ I end cap I<- X I<- 02 02 - > Laterals & force main of PVC Sch 40 Last hole drilled next to end cap (per COMM Table 84.30.5) Holes drilled on the bottom of the lateral, • = permanent end marker equallg spaced Inch-pounds Metric Lateral length (P) 48.38 ft 14.75 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 43 in 109.2 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 MITI PWA�GE SYSTEM Lateral diameter 1.50 in Forcemain diameter 2.00 in 5 m Project: Terry L. & Sandra J. Goulette 4 bedroom residential mound Transaction Number: PAP ^ DIVISION Of SAFETY ND SUIIflINGS SEE CORRESPONDENCE TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 4.80 ft 1.46 m Are laterals the highest pant in the Friction loss 0.54 ft 0.16 m system? Yes °x' here. Total dynamic head 7.84 ft 2.39 m If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 10.2 gal 38.6 L back to tank? (°x" one) Minimum dose 150.0 gal 567.8 L x Yes Drain back 5.2 gal 19.7 L No Dose volume 155.2 gal 587.5 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 —� grade levels disconnect afters 4" vent pipe electric as per NEC 300 and outlet ate Comm 16.28 WAC location 16'(46 cm) min. wall of pump Lam approved chamber or outlet joint combination tank PRIVATE SEWAGE SYSTEM A Provide 1/4" weep hole or anti - alarm on siphon deivoW®nally pump on B pump 96.9 ft C - puni n fe E D off elev. 29.5 m D BUILDINGS D - - cm) mini finished g, 96.0 kQNDENCE 3 " (75 mm) of bedding under tank 29.3 m bottom of tank Tank manufacturer Wieser 750 gallon concrete Pump tank capacity 20.28 galrn Pump tank volume 760 gal Pump manufacturer JZoeller Inches Gallons Pump model number 53 o A 19.8 402.0 B 2 40.6 Alarm manufacturer JS.J. Electro systems E C 7.7 155.2 Alarm model number 1101 HW 0 D 8 162.2 Project: Terry L. & Sandra J. Goulette 4 bedroom residential mound Transaction Number: Page 5 of 8 HEADICAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 18514185 should not be subjected to less than 30 feet TDH. TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE N tr t3 ff W �.J ERIES U 41 $1.59 11 1".139 "40140 I6114111 161041/ 16101115 11114161 1149114 10114116 llqm11 q is I '+- 7T. M. Cal. L17: Got Lim Cal. 1.17 GaL Lrs Gal. Lki Gat W Col. Us Gal. Lim Cal. tim Gal. LK Gal. Lin. Gal. un. Col. 107. Cal. L►s 1 40-- S IA2 11.1 12 : 21 Ile A 113 72 272 17 .112 94 131 106 411 61 221 it ilt 11 221 in Sir tfs Sol B : its 42 _ 47 . J A 111 21 17 H 121 61 211 11 30 90 211 lee. 3" 61 lit 61 221 so no 148 $60 tit lit 41 : 171 1 35— IS 4.17 1.9 34 Is 07 19 11 of in 04 lit 11 i . 4 11 w so ny 60 lit so W 112 J# NS Pt 43 i 20 110 2.5 f 2 11 25 13 21 121 13 71/ 82 110 59 :323 60 225 A .221 521 111 111 $so 43 Ile 40 130— 2s IA2 1 : 20 12 %U1 it 204 If :210 59 227 N M 124 111 172 101 43 .111 30 9.11 $I 201 65 . 716. 56 . M 51 221 f0 204 it 220 121 .40 121 401 R Ito . 40 tLIS 31 .114 11 Ili :. 46 : 172, 13 209 15 ..211 fl 220. 101 211 114 171 II II 38 — 12 5-- so I&u 21 N 33 175 31 111 31 211 $1 921 90 241' IN 211 of ::111 - 60 1011 1! 131 p 111 76 - .126 $l ,221: 71 :211 -: Is > 74 13 1 20— 70 2131 10 111 if i1 It .111. sl .lit to Its as ::121 36 191 80 2411 11 u 45 111 26 101 5+ it11 a Sri 1 1 5— fo 27AI 12 121 2 1 31 110 of 111 too 20.01 u W it it ae 1111! 34 110 21o0 r 2e 1 70 70 :111: 1 1 (F _ 120 7631 32 105 I)o ».a Lock Vat": 21.5 21' 192r it if• K' R' K' IT /r 115• fr ttr qT 100 30 95 — 28 90— 186, 26--- 4186 85 80 165, 24 4165 75— 1 22 70 — x v 20 65 - } 0 1 60 163, 4163 189. 0 55 4189 l 16 50 45 — 14 - 12 40— 140, 188, 35 4140 4188 10 30 8 137, 185, 25 139 4185 6 20— 15 4 i �3. ZG 10 X_ Elk- 2 5— 43 4 8 5 98 161, 7,59 4161 0 US. GALLONS 10 201 30 401 50 601 70 80 1 90 100 1110 120 0 140 1150 160 LITERS 80 160 240 320 400 480 560 640 [� 0 FLOW PER MINUTE P 009922 0 T 0 . 3z •GZ G Pnj M' 1. re �/, d,' Sd c r1� fr U Note: For Head Capacity on Mode�112, industrial column - explosion pr000f pump, see FMO219. 3/ �• WnGr: 7:er�ry �-' Sanalr'a Gou. LeEEe • .7.1 / J e . �i d��Si'p1 -1 SZ� • 5 / J = 4 �o 6u�b5, c�7 /. S y f723 ■ J`o va�;oY, �Loc a�i rm : *-Y- e,rjs& nj Pence lei ✓o C. It, ��• 3243, 6 c e, 5C • cro;)c Q., Lo(. PRIVATE SEWAGE SYSTEM Prr KSCJ y 6 tam,6m tv res�denct Conditionally " APPROVED D i� 250 DI VISION IF �GY AM 8"-Q �!lIiLDINfS SEE CORRESPONDENCE b 3alf(AA eCp/uenf bwo . Propsw 76 j'ad/an parnp cJia.hbu: AJ.C, fe ,-cem . ■ � `bar � � � 6 -1 ��►- 106 S4,4 Assumed eIle II Wisconsin Department of Industry SOIL AND SITE EVALUATION , Labor and Human Relatlons Page of .; : Division of Safety and Buildings In accordance with s. Mill 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale of dimensions, north arrow, and location and distance to nearest road. Parcel I.D. M r ��GS J APPLICANT INFORMATION - please print all information. Reviewed by Date Personal InlormA16 you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) Property Owner Property Location /¢tif��jS'fo� Govt. Lot SE= v4 i(/�1y4,s 2y T L/` .N,R i F (nrs -w Property Owner's Mailing Address Lot 0 B ll Sulxi. Herne or CSMN City State ZIP Code Phone Number i Nearest Road �o �pi? T S �v /. SYo 2-3 S )7yf- 3 35L ❑ city %� llla'a Town i �0 3 ,PO ST. LTj New Construction Use: LEI Nesidentlai / Number of bedrooms 3 Addition to existing building - -- . ❑ Replacement ❑ Public or commercial - Describe: -- -- yS'O — Code derived dally now O 9Pd Recommended design loading tale • � bed, gpd /It� _^ __french, gpollh t--" Absorption Area required — .� bed, ft 7 � trench, It Maximum design loading rate ' ! bed, gpd /ft _trench, gpd /1t Recommended Infiltration surface elevatlon(s) S� 1— 3 CL1 • i 5 Il (as referred to site plan benchmark) h /yoU— S SrLi`� 5 Additional deslgn/slle oonsld ons �— Parent material �,PE� Flood plain elevation, II applicable — r / ___.___1 1 S = Suitable for system Conventional ,�M,ou�nd In Around AT- Grade L j em in / III I folding Tnr LJs ❑U ❑S LIdU ❑S Lrlu S CI U ❑ U = Unsuitable for system El [� >� — SOIL DESCRIPTION REPORT - Horizon D Dominant Color Mottles Structure G ('Uli Boring # p Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trr In. Munsell Ou. Sz. Cont. Color Irlwam l O - io 3/3 L . _ Ifsht' / .I cs 1 7f - y ' A 1fsd,C Ground ��. �z -- _ L � — �i y� / C � - - - - -^ -- - - elev. �, C Z Depth to --- -r- - - - -- - - - - -- - --- - - - -- 1 Ilmiting factor In. SSS Remarks: S'¢7`u"t, Boring!! l 1 6y"e J13 L- 7 K t� — '7 Around S 7 S low G�fsGv ,o [f e s 1 (� S l ' S ' s Depth to ' y� limiting V J p�,� factor ,p Q 57PI `- Q- � '� -�tiL/ F � 4N S h //� / ✓ & Itin. Remarks: _A70 y p y Signature Telephone No. CST Name (Please Print) A o �3 L 2 T ?1t. /3�r'� - 71 Date CST Number Address y zo crST�vo�.y�' 1_'Ibrlcht & Asnoclatwi Private Sewage Consultants 655 O'Neil nd. Hudson, Wls. 54016 ORIGINAL a ' PROPt.RTY OWNER SOIL DESCRIPTION REPORT Page ?_ of 3 PARCEL I.D./ GO Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots In. M Qu. Sz. Cont. Color Gr. Sz. Sh. / Bed , Trench 3 / 0 -1 10 y/L 3/ G 1 7 4 5 h /A4 -6e C S /0 VI ? V I 9- z 1� 3 ____ s Ground �'7 I � ft. �O S G C� 27"S!7 /�n e7o l N N Depth to limiting factor 3,!a y' Remarks: Boring 9 (around elev, ' It. Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. P13ad Boring If _ IN Ground elev. ft. Depth to limiting factor In. Remarks: Boring # i Ground alev. ft ' Depth to _.. limiting factor In. Remarks: SBDW -8330 (R. 08195) � i�� A 0 ID m m o° C to ) (� > 0 w CA c l c N � I 1' Q O y � r ° o 1 � 1 fi • O� ti v i Wisconsin Department of Industry SOIL AND SITE EVALUATION 3 Labor and Human Relations Page . _ of ;L Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 112 x 11 Inches in size. Plan must county S �^ C�0 •� Include but not limited to: vertical and horizontal reference point BM direction and / percent slopd, scald of dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ey.2 /0 71' -S6 .� APPLICANT INFORMATION - Please print all Information. Reviewed by - Date Personal Informfi lon' you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). Property Owner O L n Property Location . I D NA �� /� �N��/pf0'!) Govt. Lot 5 5 1/4 / AA14,S 29 T Z/ G ,N,R E (oiCW Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 7.5 lea ,elz sT• / City State Zip Code Phone Number ,�,/ Town Nearest Road �'o,dEh'TS 4J/ 'rya 13:1( 7/5 ) Alf- 3352- ❑ city F-1 Village u /p A ST L O New Construction Use: [BResidendal / Number of bedrooms 3 Addition to existing building ❑ Rdplacement ❑ Public or commercial - Describe: Code derived dally flow gpd Recommended design loading rate bed, gpd/fl trench, gpd/fl Absorption Area required _ bed, ft 7 � trench, ft Maximum design loading rate - ( bed, gpd/ilz trench, gp&V Recommended Infiltration surface elevations) s- p_l /O 1 i S�� it (as referred to site plan benchmark) Additional design/site consid ons S /'TE so /7 -,fd /&-- o u z_ y foie 6i DU .vp S. y S7��y 5 Parent matertal SGS G �iQF -E4i11 Si /f dui¢,, fi /�$ Flood plain elevation, If applicable S = Suitable for system Conventional M In- Ground Pressure AT -Grade System InnFi /ll Holding Taqu U = Unsuitable for system ❑ S t� u g s C1 U ❑ S L+� u ❑ S U ❑ S L ,� U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD1tt2 In. Munseli Qu, Sz. Cont. Color Gr. Sz. Sh. Bed , Trench !. o -q /0Y 3/3 L . /f'shk 4-P -G_ cs /f - f Ground /© y L .i 14ol 160 . e A0 0e S Ce -; � GG 2 40 � � S Depth to Ilmiting f actor Ss s Remarks: s'¢�2 /VW Boring # 1 -25 5 iv ,e 1 — L / IM -6e s l- IM cs /0A36 L / ff,� �,� C-5 Ground 7 5 I? y �!wD� L S 14n fe Depth to Ilmiting W ' fact r W-1 n. Remarks: /� ,�e�• zo,� y— C-P�.. -twY a CST Name (Please Print) Signature Telephone No. �'o/3�R7r ZIL/3Rl�rn' 7 /S- 3L56 -0 /65 Address Date CST Number y 20 l� CST,4ioz JO Z- Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL y 1 M 1 PROPtATY OWNER 10Oiy � �"f SOIL DESCRIPTION RE PORT Z J Page of PARCEL 1.01 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 In. Munseli Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Z 92 /0VX 3 Ground LS elev. q ?-eft. /o YX s G CZ Depth to limiting + 4 factor _In. ; Remarks: Boring # , Ground , Slay. , n. Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed GVDJTr • Trench Boring # Ground elev. ft. Depth to limiting factor In. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. • Remarks: SBDW -8330 (R. 08195) i .. d �. a�mQ C C� 7- m o ° o D CD fn fa c y c � C1 Z � O o 'Ilk N a° Q 0 y � o y l r - LA o o .-- N -47 � - W w v i r � 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Slu Lt J�F Mailing Address ` j ) U D V / " S / D Property Address ZL A d e S l (Verification required from Planning Department for new construction) City/State ,8D S Parcel Identification Number ra 7 O LEGAL DESCRIPTION Property Location SE '/4) ' /a, Sec. TT - /0 , ,Town of subdivision , Lot # Certified Survey Map It �" , Volume Page # 'Z. 40 Warranty Deed # 3 S , Volume / 3 74— , Page # a-3 Spec house y yes ❑ no Lot lines identifiable ( yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensedpumper 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 St. Croix County Zoning Office within 30 days of the three year expiration date. °� / / F SIGN TURE OF APPLICANT DATE R CERTIFICATION .1 {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 pro : , described abo , by virtue of a warranty deed recorded in Register of Deeds Office. GNATIJRE ` PLICANT 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 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED This Deed madr, hotween Steven J. Friedrich _ a sinfzle Derson and_ Terry L Goulette an d Sandr J Goulett h uab a dranlor, and wife Wit nesseth Thal the said Grantor, fora valuable consideratio Grantee, conveys to Grantee the following described real estate in_ __ St. Croix RETURN TO County, Slate of Wisconsin: Part of the SE1 /4 of NWl /4 of Section 29, Township 29 North, Range 18 West, St. Croix County, Tax Parcel No Wisconsin described as follows: Lot 1 of Certified Survey Map dated February 29, 1997, filed May 28, 1997 in Vol. "12 " page 3263. Doc No 56006. , This is not h omestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And — warrants that the title Is good, Indefeasible in fee simple and free and clear of encumbrances except any possible claim of adverse possession or proscriptive easement by the adjoining property owners to the North, or their successors in title, as to the Northerly 32 feet of the above- described propert and will warrant and defend the same. Dated this 5th day of November 19 . (SEAL) �, ' (SEAL) • Steven J. Friedrich (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 5 f C. P16 f " �( ss. County. authenticated this day of , 19 Personally came before me this 5th day of November , 19--9-ELthe above named YP �((j even J. Friedrirh, a singlpnPrston O TITLE: MEMBER STATE BAR OF WISCtSI p�gUREEN K. (II not, R tone known to be the person who excuted the authorized by § 706.06, Wis. Slats.) ft going Instrument and acknowledge the Sam . THIS INSTRUMENT WAS DRAFTED BY % LAW SON, MARSHALL, McDONALD.& GAL 3880 Laverne Avenue North r i A A _ Lake Elmo, MN 55042 (651) 777 -6960 Notary Public T C titer; V (Signatures may be authenticated or acknowledged. Both My Corpmisslon Is permanent. (If not, ;fate linty, t i s. are not necessary.) y— fir_ 9'c/ date 19 . ) Names of persons signing in any capacity should be typed or printed below their signatures. SB1 NTF 17020 WARRANTY DEED STATE AAA ne wl"Auelu DOCUMENT NO � $7A (E BAR OF LJi5CON5lN FORM t -198 WAflftANTY DEED YO - This Deed, rnadrt , nlwpe Ste J' Frj -1 _ ST. CROIX M., W _ sirt le_persoq_ 111 r" c NOV • -- - Grantor, t a-3— Terry L_ Ooulette sad S andr a J G�- w_ette_hus8and 8 and wife L ata. d Ohda �a - Grantee, •' W That the said Grantor, fir a valuet'�: c.:ns,deration RETuAN To a conveys to Grantee the following described real estate in — St. Croix County. State of Wisconsin: t Part of the SE1 /4 of NW1 /4 of Section 29, Township 29 North, Range 18 West, St. Croix County, Tax Parcel No; 042- 1079 -50 Wisconsin described as follows: Lot I of Certified Survey Map dated February 29, 1997, filed May 28, 1997 :.. Vol. "12 ". page 3263. Doc No. 56006. t �L aTt T �ISF��t Y This is not homestead property. x (is) (is not) Together with all and Singular the hereditaments and d 09urtenances thereunto Lelonging; And warrants that the title is good, indefeasible In fee iimple and fre9a r!J:!earoiencuirbrancesexcept any possible claim w of adverse possession or proscr - ,)tive easement by the adjoining property owners to the North, or their successors in title, as to the Northerly 32 feec of the above- dFib property scred ;~ and will warrant and defend the same. ` Dated this 5th day of November _ 19 13 a - I SEAL) n- ^K ""''�- /'tom'? -C' •!SEAL) ..; t Steve J. F_edrich — (SEAL) AUTHENTICATION ACKNOWLEDGMENT a. Signature(s) STATE OF WISCONSIN x authenticated ibis _day of 19 _ Persr is Ily cane before me this 5th day of + I 4 `�. �`:`�`Z s• Nave bgL.r_ 19- ..2B_.lheabeve named Y t3�i taven T Frjedr - ic1 -a i1pg ' TITLE: MEMBER STATE BAR OF WISC, 51 `v Z7 PAAUF,LE^J K (it not,-`- Ki�E;FI fo a t »own !o be the person _ — wh;, excuted the 1 authorized by § 706.06, :".ris. Stats.) 2t going instrument and acknow'edge thv sarn THIS INSTRUMENT WAS ORA FTED BY LAW SON, MARSHALL, McDONALD S GAL 3880 Laverne Avenue North Lal Elmo MN 55042 (651) 777 -6960 Notary Public_ T C _ = ' Y S.�_ 2 V _County, Wis. (Signatures may be authenticated or acknowledged. Both My Comp issic.i is permanent. (If not, state expiration are not necessary.) date —__4 'Names of pwsons signing ,n any ^apa[dy should be typed or pr; nled b the., s gnatu ea WARRANTYDEFD STATE BAR OfWt3CO S81 i N81N r 0020 FOAM ?.� _1 962 Nrko. Forms P O. &:_ !x3299, Green Say. Wt SsJCyO ^i`= .�.: � : :. a ,. :_�- , .. ,�.a .,,,, dam• ,�•, a .. �*� =.. r ar.:x �� �=�::» CERTIFIED SURVEY MAP DONALD AND EDIE ANDERSON Part of the Southeast 1/4 of the Northwest 1 /4 of Section 29, Township 29 North, Range 18 West, Town of C� Warren, St. Croix County, Wisconsin. 0 Indicates 1" x 24" iron pipe weighing 1.13 lbs./ N CDR. SEC. 29, r29N R /8W lin. ft. set I CO(/NTYS!/RVEYOR's NON.1 Indicates driveway location. o 27 , UNP r LED LANDS 0 �N LINE SE 114 NW 114 S 89. 38'16 'W .0�2 � 390.00' � I 423.02' 32' 734,91' M -� 1-100'ROAD SETBACK LINE .h ° I I L0 J w y 0 2.107 ACRES c W „ „ N , N %09,208 SO. Fr. ` p, V ' 2.3 /ACRES EXC. R.O.W. N M � /00, 6B4 SO. FT, I I 3 N 89.38'16 "E 423.02' \ Z 1 4 J,p '„ ' 390.00' h v W W W I• 1 M GOT 2 N a to o O 2.2/3 ACRES b O ` O O � \ 96, 393 SO. FT. O % IR ¢ � o i 2.040 ACRES EXC. ROAD R. O, W, ty h 4i N 88, 869 s0. FT. H ? Q , j ; Z' 1 390.00' I W N T 29N R/ B W 4 "� ♦ S 89 38'16 "W 4 23. 02' b /COUNTY SUgvEYOR'S. JI o v I sJ- dI LLANDS e H MON./ I b V .89 . 38' 56 "E 351. 72' 33:82' 1 3 18. 70' , — This l instrument drafted by i LET 3 Laurence W. Murphy I �'D 3 Ib .403 ACRES v SCALE 1" +110' 14 "C A 300 ' 400 F T. 3. 126 q y O 10' /00' /10' p00' I ' N I N 140, 515 SO. FT, SNEO ❑ ►. Q I i DWELL INC h Q I 3 vl Dated: February 29, 1997 S 89 • 38' 16 "W ^ n, ~ \\ \ /� , �TII A N GE ~ �� / 33,02' GARAGE G `L AURVNC JI W RP ac CD 0 13 1 RIV ALLS,.. * J � WISc. Q. • S 89' 38'16 "W 318.70' ��' I�� �J � U NPLA rrED LA ,'�•L AOFJ % % ,0 , \ \, Owner's Address: r 759 103rd St. Laurence W. Murphy Roberts. WI 54023 Registered Land Surveyor SHEET 1 OF 2