HomeMy WebLinkAbout042-1102-50-300 ST. CROIX COUNTY ZONING DEPARTMENT,
AS BUILT SANITARY REPORT
Owner Oe r ✓} S1 M p a So Al .....
Properly Address 60" ;
City /State Ra 4 e -C r
Legal Description:
Lot _ Block Subdivision/CSM # f% t Vo r � 1! 3003
s �✓ t /a X /�V ` /., Sec. 3, T jjN -R„LW, Town of t.-/e, e r c, *-N PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer M i `d k- r y size ST/PC koy Setback from: House 3.� ' Well q / P/L
Pump manufacturer 2&4( t2 Model i �l
Alarm location 13w
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: 14& g d Width 5� Length l U Number of Trenches
Setback from: House 11 G r Well 955 P/L Vent to fresh air intake
ELEVATIONS
Description of benchmark /2- Elevation C
Description of alternate benchmark Le 41 P F8 4 Elevation 9:2 / G
Building Sewer Cl / �G ST/HT Inlet `� ST Outlet PC Inlet
PC Bottom KY 1 Header/Manifold q 9• � Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System {) ? O ( )
Final Grade
Date of installation il /o / `) Permit number ���.� s"' State plan number
Plumber's signature 1 License number � 2.3 q? 5 Date/ Z!AV / f
Inspector h�
Complete plot plan R
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.
• Show alternate benchmark, if applicable.
PLAN VIEW
rM
A / G •
b w 3�
3G �
I
w
2
y
5
INDICATE NORTH ARROW U t L7
r
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX
Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 344505
Permb it jgftw & LINDA ❑ Citti V�11Ne Town of: State Plan ID No.:
trlrly WAl�I� 33
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
�1 �8 9i_ - +5 CST- A j, , B 042- 1102 -50 -300
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic LW Benchmar Z 5, 3
Dosing � � D. :7-a
Aeration Bldg. Sewer LA) 1,6
Holding St /Ht Inlet (A� 1 0, 8 8 $9,�8
TANK SETBACK INFORMATION St t Hvo
TANKTO P/ L WELL BLDG. Ventto ROAD
Air Intake
Septic
> Lo i �� 31 NA Dt Bottom A) $pr 92 ,6�
Dosing >/t:,V �� t` T 3 NA Header /Man. z, e-) Z1 / C t g'-
Aeration Dist. Pipe a 8S �• S�
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer tqc De�m�a Dr d ] �,S 4�•l(,
Model Number `��' GPM d �( Zgj f oo,6,( 3T
TDH Lift \0l't Friction * Syestem 5 TDH `� Ft 5`r �
FHi
Forcemain Length„ i Dia. z" Dist. To well >
SOIL A SORPTION SYSTEM
BPM RENCH Width Length I No. f renches PIT No. Of Pits Inside Dia. Liquid Depth
DIM EN I N S DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type Of
r i r Model Number:
System: lF >90 > 300 OR UNIT
DISTRIBUTION SYSTEM k2 q
Header/Manifold Distribution Pipe(s) I 4 x Hole Size x Hole Spacing Vent To Air Intake
Z ' a
Length' Dia. �- Length �(�"• Dia. 1 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.)
LOCATION: WARREN 36.29.18.567A- 30,SW,SW 1414 60TH AVENUE - LOT 3
0 "zr - � qt, w � (� �- �` I 8'" S-m•i � Cotes o-vv �-
IrY - I I TL-L` S+A
Plan revision required? ❑ Yes No
Use other side for additional information. [ 0J3 ZZ O
k SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
Safety and Buildings Division
201 W. Washington Avenue
Vi scons i n SANITARY PERMIT APPLICATION P O Box 7302
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 County -
than 81/2 x 11 inches in size. Gva 'x
• See reverse side for instructions for completing this application State Sanitary Permit N umber
Personal information you provide may be used for seconds purposes Check if revision fo previ secondary P p oses ap plication
❑ P PP
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION
Property Owner Name Property p Loc do S T 2 , N, R (or) W
G L N G G ,V �k/
Property Owner's Mailing Address Lot Numb Block Number
5 . 0" .s t 5
Cit 1 State Zip Code Phone Number S bdivision ame or CSM Number ' 1) z Q
I , 14kft #"e, d w� ��7 v [ �— ( ? /)- Olc U.Q /� Vti . 1 cJ J0
II. TYPE OF BUILDING: (check one) ❑ State Owned !t� Nearest d
❑ VII age / t 4
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF L/41 "'o C !o G
Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ;;t 2A. I g. Sb7 p' 3a
1 ❑ Apartment/ Condo U 2 /lox - 5 0 —
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. a 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 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fi I I
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 o Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) G Elevation
U - 6 - 0.0 S - O v �,� 7 �� 2 V Feet j Q, Z Feet
VII. TANK Capacity in g allons Total # Of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tank Tanks /
pticT r ngTa I I2�U ] h'Ir a/a,cr ✓7 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank YUU ❑ 1 ❑ 1 ❑ ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility f r installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumbo Signature: N mps) /MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, Wite, Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuin ent na re (No SLamps)
Approved E] Owner Given Initial �2, �-E� Surcharge Fee)
Adverse Determination ✓� vo a ��
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: toe
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
Safety and Buildings
2226 ROSE ST
LACROSSE WI 54603 -1905
TDD #: (608) 264 -8777
Nvisconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
June 10, 1999
CUST ID No. 223475 ATTIC POWTS INSPECTOR
ZONING OFFICE
JOE STANG ST CROIX COUNTY SPIA
506 WILLOW DR 1101 CARMICHAEL RD
WOODVILLE WI 54028 HUDSON WI 54016
i
RE: CONDITIONAL APPROVAL
Id r 4 a ' ers
APPROVAL EXPIRES: 06/1012001
Transaction ID .229333
SITE: ST CROIX COUNTY, TOWN OF WARREN Site ED No. 173606
SW 1/4, SE 1/4, S36, T29N, R18W Please refer to both identification numbers,
DEAN & LINDA SIMPSON 1414 60TH AVE I above, in all correspondence with the agency.
FOR: OBJECT TYPE: POWTS MOUND SYSTEM REGULA TED OBJECT ID NO.: 472126
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 05/26/1999
A `' ' FtE,REQUIRED $ 180.00
FEE RECEIVED $ 180.00
J eroy G. J -ky, `JJast ater Spec= ist BALAJ E DUE $ 0.00
Field Oper 'ons Bureau���1 t C (715)726 - 2544 Voice
3,$ code: 7633
ljanslcy @commercestatewi.us ���i� 'l � ,
it . .
I. _
MOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project Dean & Linda Simpson 4 bedroom residential mound
Owner Dean & Linda Simpson
Address 754 160th Street �►�,
Hammond, WI 54015 2 999
L eg Description tion SW114SE1/4 Sec. 36 T.29N., R.18W. cS DIV.
p
Township Warren County St. Croix
Subdivision Name Lot No.
Parcel ID Number 042- 1102 -50
Plan Transaction Number 6`
y
P.O.W.T.S.
Conditionally Index and title sheet Page 1
Mound calculations Page 2
APPROVED Mound drawings Page 3
DEPARTMENT OF COMMERCE Pres. disc. calcs. and laterals Page 4
D!vISl#N OF SAFETY AND BUILDINGS TDH and pump tank drawing Page 5
Pump performance curve Page 6
Site plan Page 7
E CO ESPO ENCE A Attached soil evaluation report Page 8
Designer Joe Stang License Number 223475
Signature Phone No. 715 -698 -2266
Date /21/99
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Ms. Stats.
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
L
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) ri Replacement system?
Creviced bedrock site? n (y or n)
Slope 6 %
Wastewater flow rate 600 gpd 2271 Lpd
Depth to limiting factor 33 in 83.8 cm
In situ soil infiltration rate >> 0. gpolW 24.4 LpdJm
Contour line elevation 96.2 ft 29.32 m
Use standard fill depths? x OR Design depth? in cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
Center or end manifold c (c or e) Hole diameter r 032 57 in 0.125, 0.158, 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 2.50 ft Not a final calculation.
Number of laterals 2 Pump tank elevation 87 ft Outside bottom of tank.
Forcemain length 160.0 ft Forcemain diameter 2.0 in 1.5, 2,3 or 4 inch only.
2.067 in Actual I.D.
HOLE DIAMETER CONVERSIONS
1/8 =0.125 1/4=0.250
SYSTEM SOLUTIONS Inch-pounds Metric 5/32=0.156 9/32=0.281
Estimated daily flow 600 gpd 2271 Lpd 3/16=0.188 5116=0.313
7132 = 0.219
Absorption cell
Design load rate & area 1.2 gww 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 24.1 cm
Sand filter
Upslope fill depth (D) 12.0 lin 30.5 cm
Downslope fill depth (E) 15.6 lin 39.6 cm
Basal area required (gpd/infiltration rate) m2
Supporting components i i W
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) 10.33 ft 3.15 m
Up slope toe length (J) 7.10 ft 2.16 m
Down slope toe length (1) 11.30 ft 3.44 m
Total mound length (L) 120.66 ft 36.78 m
Total mound width (W) 23.40 ft 7.13 m
Project: Dean & Linda Simpson 4 bedroom residential mound
Transaction Number. Page 2 of 8
MOUND PLAN VIEW
observation pipes (typical)
E23.4 ft .... q A= 5.00 ft 1.52 m 7.13 m :;:: ;::: ;: ;:..•:.:.... B = 100.0 ft 30.48 m W B J= 7.10ft 2.16m
K I= 11.30 ft 3.44 m
K= 0 ft 3.15m
L _ 120.66 ft
36.78 m typ. obs. pipe
(anchored securely)
I = down slope dimension = absorption cell (AxB)
J = up slope dimension = plowed area (LxW)
K = end slope dimension 6'(152 mm)
T
MOUND CROSS SECTION
D = 12.0 in 30.5 cm
lateral
topsoil G H subsoil cap E = 15.6 in 39.6 cm invert 97.70 ft
F _ 9.5 in 24.1 cm
elev. 29.78 m F G = 12.0 in 30.5 cm
T ASTM c33 H = 18.0 in 45.7 cm
D Sand Fill y
Sys. F 97.20 ft
elev. 29.63 m 96.20 ft contour
29.32 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:
Project: Dean & Linda Simpson 4 bedroom residential mound
Transaction Number: Page 3 of 8
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 5 ft 1 1.52 Im
Length (13) 1 100.0 I ft 30.48 m
Lateral specifications
Number laterals 2
Holes/lateral 19 holes
Lateral length (P) 47.79 ft 14.57 m
Hole diameter 0.250 in 6.35 mm
Lat. dis. rate gpm 1.40 Us
Sys. dis. rate 44.28 gpm 2.79 Us
Hole spacing (X) in 78.7 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) Place X in red
X' one choice 1 1/4 in (32 mm) box of chosen
from the options 1 112 in (40 mm) X x diameter.
provided. 2 in (50 mm) X
3 in (75 mm) X
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm)
X' one choice 11/4 in (32 mm) None required.
from the options 1 112 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 s I end c
0
IE ?f —� If xr2 I
w2 41 Laterals & farce 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
equally spaced
Inch-pounds Metric
Lateral length (P) 47.79 ft 14.57 m
Lateral spacing (S) 0.00 ft 0.00 m
Hole spacing (X) 31 in 78.7 cm
Manifold length 0 ft 0.00 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 1 1.50 lin 40 mm
Forcemain diameter 1 2.00 in 50 mm
Project: Dean & Linda Simpson 4 bedroom residential mound
Transaction Number: Page 4 of 8
r
TDH and Pump ank Drawing
9
Total Dynamic Head
Operational head 2.50 ft 0.76 m
Vertical lift 9.50 ft 2.90 m Are laterals the highest pant in the
Friction loss 5.10 ft 1.55 m system? Yes 'W here.
Total dynamic head 17.10 ft 5.21 m If no, what is the highest elevation
Dose Volume downstream of pump?
Dose is > 10 times lateral volume Forcemain drain
Lateral void volume 10.1 gal 38.2 L back to tank? (") one)
Minimum dose 150.0 gal 567.8 L x Yes
Drain back 27.9 gal 105.6 L No
Dose volume gal 673.4
177.9 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
�► alternate
4" vent pipe electric as per NEC 300 and < outlet
Comm 16.28 WAC location 16'(46 cm) min.
wall of pump Lam" approved
chamber or outlet joint
combination tank
A Provide 1/4" weep We or anti -
alarm on siphon device as necessary
pump on B
Grade levels
pump 88.2 ft C - pump tank manhole = 4" (10 cm)
off elev. 26.9 m minimum above finished grade
D -vent= I Z' (30.5 cm) minimum
above finished grade
IL
F 1259 1 ft Pump tank elevation
3 " (75 mm) of bedding under tank m bottom of tank
Tank manufacturer Midwestern precast concrete 12001800 combination
Pump tank capacity 21 gal /in
Pump tank volume 861 gal
Pump manufacturer Zoeller Inches Gallons
Pump model number 1137 _�. a A 19.5 410.1
N B 2 42.0
c
Alarm manufacturer JSJ. Electra system C 8.5 177.9
Alarm model number 1101 HW 'p D 11 231.0
Project: Dean & Linda Simpson 4 bedroom residential mound
Transaction Number: Page 5 of 8
HEAD /CAPACITY CURVE
EFFLUENT and DEWATERING
WARNING: Model 18514185 should not be subjected to less than 30 feet TDH.
TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE
N
M S15S
W SERIES 43 41 $7.59 f1 131 -139 16014160 161MI61 163M163 16SN16S 11944S 1164146 IW4161 MIMI III
2 FT. M. G61. Lb. Got Ws. G.I. LSD Gal. Lks 0.1. Lt. GA Un G61. l4 G.I. LIm WI. Lln. U. Lim G11. LIM G41. Lim GA Li ". � urs
1 4 S 132 16.5 62 21 101 43 163 72 273 03 -352 $4 3% 106 441 61 234 61 131 $6 220 1S$ 617 155 $17 45 . 111
42 to 2A6 131. 50 23 17 34 121 61 231 11 300 " 341 100 ITS 61 131 61 131 $I 220 146 160 1S1 .672 43 `170
1 35— Is 4. 42 IS 15 7 45 14 63 14 $1 60 7 60 7 54 220 142 1 US 45 17 '.
20 $,to 23 1 3 11 35 IS 36 136 73 '276 12 .310 $9 223 60 227 S1 220 136 $I5 140 S30. 4S 171-
40 2S 7A2 1 30 63 -:131 74 210 67 216 59 223 SI 220. 111 - 414 133 103 IS IM
1 3 30 9.14 53 291 63 244 $5 2" SI 220 f0 '14e 51 210 121 40 127 401 4S 170
40 .12.19 30 114 46 M. 46 :111 SS 206 75 .,263 so o 105 397 114 ::431 45 IIIe`
38 125 so Iku 21 60 33 125 51 111 50 219 56 220 If $41 100 370 45 _111
60 1119 IS U 43 111. 36 ' 136 $0 ME. 71 241 45 - -A2 45 <111
12 70 21.31 30 114 10 L S1 111' $1 1111 70 rig 45 171
36 191 40 24.31 _ 14 63 65 ne 26 to $4 - 204. IS '171:
1 1 90 27A1 32 111 2 6 37 140 45 170
100 34.40 11 u.._ 21 19 40 '
34 110 32A0 7 A 1 30 30 '1141>
110 Izo x36 20 76
105 of 59.19 1f u'.
32 Lock Valm 21.1 1 21' 1 1925• 2I• 26' 46' S6' ft' sr 117 T 1]7
100
30
95
28
90
186,
26 4186
85
165,
24 80 4165
75
0 Q 22
lal 70
r
U 20
M 65
z
0 18 60 16,
4163 189,
,a - 55 4189
0
1- 16
50
14 45
12 40
40 188,
� � � • 6b 35 40 4188
30 185,
25 137,139 4185
j 20
ova
15
4
' 10
2
5 43 48 3,55 98 161,
57,59 4161
0
U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 1110 120 0 140 150 160
LITERS 80 16@ 240 320 400 480 560 640
0 FLOW PER MINUTE 909922
•W...z4f� orq- 111;4. r � o% al;3tr, "6"''M rake .
Note: For Head Capacity n Mode! 112;' industrial column - explosion pr000f pump, see MOM- ri
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• '�`�— propostd well
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Wisconsin Department of Industry, SOHO E VALUATION 3
Labor and Human Relations 'I / 4 2 - •. Page of
Division of Safety and Buildings in a O With (, k 3.09, Wis.
^�,�'•
Attach complete site plan on paper not less than 8 112 x 1 i pies In sl���st \ County
Include, but not limited to: vertical and horizontal referen nt (BM), direction and �' ST' CjP01 x
percent slope, scale or dimensions, north arrow, and loc t�r't land A cep - teal [pad. ; �� Parcel I.D. # C"44.Q� fL Z
1 / Y 5
sr "HOix !� ay2
APPLICANT INFORMATION - Please print = , _torm j I P ,,TY f. %di ew oat
; cc y Personal information you provide may be used for secondary purPrivacy Law, s. 15.04 Rfirn)).
Property Owner ,I,f /,,d Prope ovaattion /''
� /i� �� Gov'f' Lot 7U) 1/4 5W 1/4,S 3� T ,N,Fl E (or W
Property Owner's Mailing Address It7o cUz* -t°e2 Lot If Block# Subd. Name or CSM#
'70 (,gym- svoE yEu)305 'Ttt %L 1 3 i CSM AEIUJQ vo r --
City State Zip Code Phone Number Nearest Road
' STS V/. 5yD23 (11f ) yi5 030 ❑ City D Village IdTown
[ "New Construction Use: 15 Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
y f6 -
Code derived daily flow 6101* pd Recommended design loading rate ` bed, gpd /fl trench, gpd/ft
Absorption area required 3�s J bed, N 2 3' S - %1 trench, ft 2 Maximum design loading rate • S bed, gpd/ft' ' G trench, gpd/11
Recommended infiltration surface elevation(s) s Q e e - p � • 3 ft (as referred to site plan benchmark)
Additional design /ssItte considerations s� T� �` EQ V �'�ES vA.70 7�60_p S ST
Parent material _A wt tt A 5 A' 4 T; R(fo Flood plain elevation, if applicable 4 1 1 4 — ft
S = Suitable for system Conventional ,MMou�nd In-Ground Pressure AT-Grade System In Fill Holding Tank
El 10 L1
U = Unsuitable for system S 'U S El El I
U S -P U S U � 1 ❑ S 2 ❑ S
SOIL DESCRIPTION REPORT
Boring # rHorizo Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /112
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
l ° 0-/2, /oY21 13 L 2f s6 /c e(l Cs 3f S: • �
fY4 4i� Awfl G' S • s ' G
Ground 3 33 - S /b %/'e 'V L
elev.
Depth to
limiting
factor
3-1-In.
S,sS- Remarks:
Boring #
3 1 �Xr W57 e5
� Ground S'�f �� $- y` G 2 SL �� /P /Lvf l /T� N
`�• L ft. 7.
sss ;
Depth to
limiting
factor
1 3 5 in. Remarks:
CST Name (Please Print) Signature Telephone No.
FOGERr uLaR�G(�i �� 7is 3e6- 81g5
Address Date CST Number
2 _ _
Private Sewage Consultants
855 O'Neil Rd.
Hudson, Wis. 54016
ORIGINAL
w
PROPERTY OWNER �' SOIL DESCRIPTION REPORT 2- 3
Page of
PARCEL I.D.tI
Boring Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 0e. u n a- h d u ; ' , S /, '
Mailing Address s / L O C h S �t 14 CJ
Property Address 1 j q D�
(Verification required from Planning Department for new construction)
City /State / min a n d i-f. Parcel Identification Number �' cr - 1I c:Z 5 - O
LEGAL DESCRIPTION
Property Location � %., S er %., Sec. 36 . TILN -R 1 W, Town of U14 n
CSM
Subdivision Lot # 3
�s
Certified Survey Map # S 2 , Volume Z , Page # 3 3 0 3 .
Warranty Deed # J 7 2 �' , Volume 3 S,� , Page # 2 �l
Spec house ❑ yes Elkno Lot lines identifiable 13 ❑ 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 syexp** artment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
Wing that yur ept been maintained must be completed and returned to the St. Croix County Zoning Office within 30
s of the yea4te.
AT t O PLICA DATE
OWN ER CERTIF ATION
I (w certify at all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
th property describe bove, by virtue of a warranty deed recorded in Register of Deeds Office.
.r—
o
IGNATURE OF APPL NT 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
'/n`�
uxxm�m��c
John T. anoa_!oboa and Arlene M So-cyanhpn
husband
-and wife, Lester W. Sno Jr
husband ,
JudiLh-C. 3oueyeubus b�uban� a a'.� S R S S OFFICE
warqarut Ann--Cave-and William S'' c Wife,-and
huo�and, _ _- _ _ __- a- witia_aud
APR 15 1998
Deaow'_aimpson and Linda morcby
Simpson, husband and wife,- - - - ~
- - ---- -- - - ' -
L ter of Do"
"='°zm* "Vi ", Off Ill ",.°*o^n
-- - - -- - — ------- ~"°"^"`",`" |
m _3 - t.�� .c �z '---�'^°�
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Lot 3 of Certified Survey Map filed July 73, 1 997, in Volume lJ
page 3}0] of Certified Suzvry map lu�a�ed io par� n{ tbp SW]/"
'
of the _`W1/4 of Sec�i-n 36, To-1110nip 2e mni-I h. 2aug* 18 west
7two of w`vrcs. 3t. Croix county. wincouo�n. '
This deed ia given in fulfillment of that certain Land Contract '
"=t°ecu the parties hereto dated December 5,
1997 and recorded
December
ner 2, 1997, in Vol. 1282, page 201, Doc. m 569775' U
"
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_-A-5 -not--- �"=m^ r`�'^ - EXEMPT
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Easements, restrict ions and rights-of-way of recocd '
if any. " `
98 _
Arlene- p-1. 1 3poeyenbZ7
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retAo/uc ' (oEAL)
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John'T. Gnoeyobos Arlene 8. '
;»meyenbon Leccez q Snor bo
� (xw^. _ _ Jr. ^uu`tn u s
Ann Cave o will
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�Attorney �Kcisti:a oqland
Hudson, �I �4Ol6
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562'729 0
CERTIFIED SURVEY MAP`; ti
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MARGARET CAVE, etal.
Part of the Southwest 1/4 of the Southwest 1/4 of Section 36, Township 29 North, Range 18 West, Town of
Warren, St. Croix County, Wisconsin.
Note: An erosion control plan must be submitted to the St. Croix County Zoning Office
prior to construction on these lots.
_UN_P_L_ATT_E_D _LANDS_
140th STREET ^ WEST LINE -SW1 /4 SECTION 36
(66 W %DEJ - -- N 00° 12' 00 ° W 2637.44-- -
^roc 'I _ - -- 89 (R= 809.2) - -- ,' � � -- 1829.55-- •�
It I I �\ --- NOO°1701 "E 741.67--- 't \ �9 � �c"iv"
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2 2 ( -- to --- NOG °20'24 "E531.67' --- - r Owner's Address:
rn
t to I �a 6q r� C/O William Snoeyenbos
u , �� �� oy 1 Coulee Trail
ro W I o0 eo (O A �v �^ Roberts, WI 54023
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I :Z / BEARINGS REFERENCED TO THE WEST
n �� p IW . �O LINE OF THE SWI14 OFSECTION 36,
^ `p b ti r(O RECORDED BEARING N 00 12'00'W.
W I n n ��. V ti
- - -- N 00° 20' 24 - E 453.03
(n WV t 414.23' u) -•
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poi I'- 330.94 -- EAST LINE- WI 12- = z
:z I SW 114 SECT /OIY�Iltlttttr� If o n.
o � fi n. UNPLAT TED LAN A C N � o Q) "' o
a w --- - - - - -- LAN
'LAUREN
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Laurence W. Murphy `\ 10 J �: Dated: March 22, 1997
Registered Land Surveyor 0•. 10 LANG S�.•`, "Revised this 2nd day of _
i�
81A6116 July, 1997."
This Instrument Drafted by Mark W. Peavey SHEET 1 0,
V ol.12 Page 3303