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HomeMy WebLinkAbout191-1011-30-100 f Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No X y ou rovice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) 3 3 8 8 9 7 P information Y P Y rY P p I Y Perlra,iif Holt' N i'' F ❑City_ fl V Town of: State Plan ID No.: t ri l ll T Wrj, 1V .2I1 = - Hams. /D.* CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: t,o U e� B 191- 1011- 30 —Q4e TANK INFORMATION ELEVATION DATA ae , a9.Is, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r �opo �o"D Benchmark 7. 3t o ?, 39 /CZ , d Dosing �j c1 / �j/I.l �.og �� /, 30 Aeration Bldg. Sewer 0,2. q& 36 Holding (_SV/ Ht inlet TANK SETBACK INFORMATION utlet TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Dt Inlet � Septic ' / NA Dt Bottom 11 Dosing > j�`p' Z NA Header / Man. 3.60 Aeration NA Dist. Pipe 5... 3. aC' Holding Bot. System PUMP / S HON INFORMATION Final Grade Manufacturer & IeIt I 4 Demand Model Number 06 o3 [( (_ �.`'� GPM TDH Lift,k,lb Friction0 u System � TDH 13.9 Ft e - Forcemain Length Dia. i� Dist. To Wel SOIL ABSORPTION SYSTEM Width / Len th PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS KO I DIMENSION SYSTEM TO P / L BLDG I WELL LAKE/STREAM LEACHIN M acturer: SETBACK CHAMB INFORMATION Type O n � / O IT odel Number: System: /v� l DISTRIBUTION SYSTEM Header / Ma i - Id Distribution Pipe(s), u x Hole Size x Hole Spacing Vent To Air Intake Length a. 2 Length T� Dia. 2 Spacing j SOIL COVER x Pressure stems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over/ ve xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed / Trench Ed es Topsoil ❑ Yes ❑ No []Yes ❑ No COMMENTS: 0nciuk e-rgd � epancie , persons present, etc.) LOCATION: VILLAGE (QF WT .29.15.89,W,SE 1600 JOHNSON STREET Plan revision required? E] Yes No Use other side for additional inform tion. o:� /`f 79�kJ� SZ X SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION Safety and Buildings Division Vi sconsin 201 W. Washington Avenue In r . A P O Box 7302 Department of Commerce acco d with ILHR 83 05, Wi s dm Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 vi x 11 inches in size. - 5 , t � - c ✓ n; • See reverse side for instructions for completing this application State Sanitary Permit Number 3 34a�c � 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 I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N I -'D-1T5 Property Owner Name Propert Location u� f�� i 3 t� t L t /a, S F T L `3 , N, R ���-" H (orC Property Owner's Mailing Address Lot Number Block Number 1 , City, State Zip C de Phone Number Subdivision Name or CSM Number ��'os- . TYPE F BUILDING: (check one) ❑ State Owned p Cit rest Road 7 � �SG Public 1 or z Family Dwelling Village - No_ of bedrooms `� 'Town OF Tea 111 BUILDING USE (If building type is public, check all that apply) Parcel T 1 ❑ Apartment/ Condo I '� — /O /l ' � 0 2�0•�• �5• g 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..® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________System______ - _TankOnl�r__ ______ ______ ExistingSystem _____,__ Exlstin 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 JA 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 -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 Req (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 1 G✓ 2. /(I ��'� • �' Feet Cap acity VII. TANK in Ca allo s Total # of r Prefab. Site Fiber- Exper INFORMATION g Gallons an Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank k lee"o j;? ' _7 L�c�l t?, Y' ,® ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank i*e4Qjmber [ rC i, f u �,�.;n r. ❑ ❑ ❑ ❑ ❑ ❑ 11. RESPONSIBILITY 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 Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, Sta te, Zip Code): f V 7 r r� Wit. `-'.� l /7I �: t . z-Lr , �'�;�✓ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate I ssued Issuing Signature (No Stamps) App roved E] Owner Given Initial Surcharge Fee) Adv erse Determination �S vp)) /�4� v''C X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (11.11/97) 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 www.cornmerce.statemi.us ksconsin Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary April 15, 1999 CUST ID No.6306 ATTN: POWTS INSPECTOR BOLDTS PLUMBING AND HEATING INC ZONING OFFICE 820 MAIN ST ST CROIX COUNTY SPIA PO BOX 87 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 RE: CONDITIONAL APPROVAL I I Identification Numbers APPROVAL EXPIRES: 04/12/2001 Transaction ID No. 218521 Site ID No. 169500 SITE: 9 , Please refer to both identification numbers, Site ID: 169500 ✓ ( // �fC G( , /i j50 above, in all correspondence with the agency. St. Croix County, 6f SpFingfie}d S26, T29N, R15W Facility: Jeff Hintz FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 459486 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 ermit must be obtained from the coup where this p roject is located in accordance with the rY h' p J requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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(2)(d), Wis. Stats. .Note: See the soil test plot plan for additional dimensions that can also aid in placement of the mound per the approved location. 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 03/31/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us r 1 a t t '� r "' a ` " ° "' inlis PRIVATE SEWAGE SYSTEM vi S and tar /dlrrgs OWlydon REVIEW APPLICATION BMW of kdWAsd SWAM .Hayward Office LaCrosse Of5w Madison Office Shawano Office Waukesha Office 209 W. let St. 2226 Rose Street 201 E. Wasl tgton Ave. 1340 E. Green Bay St. 401 Pilot Court, Ste. C Rt 8, Boot 8072 La Crosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone ( 608) 785 -9334 Madison, W153707 Shawano, WI 54166 Phone (414) 548 -6606 Phone (715) 634-4804 Fax (606) 785 -9330 Phone (608) 266 -3151 Phone (715) 524 -3826 Fax (414) 548-8614 Fax (715) 634 -5150 Fax (608)267 -9566 Fax (715) 524 -3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill In all applicable data and submit this form together with fees and plansludormation. Your submittal must be received at bast two working days prior to the appofnLnent at the office where your review was scheduled. Please call any of the fisted offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form Is on the reverse side for your reference. Personal information you provide may be used for sec ondary purposes [Privacy law, s. 15.04 (1)(m)]. 1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the infomuWon requested below to save time. Reviewer Name Plan Identification Number Appointment Date Rev 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Project Name County /e-F� A "iZ E) City ��Ilage Town of: Project Location `J GOVT. LOTS,�,f 1/4 I/,� 1 /4,SZ T 219 N,R /5 (or)o 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTE( System Type (check one): System Type (include new and existing tanks) co A ❑ At -Grade Up To 1,500 gallon septic tank .... ............................... .$110.00...................... H ❑ Holding Tank 1,501- 2,500 gallon septic tank.. ... ............................... $120.00 ...................... M Mound 2,501 - 5,000 gallon septic tank .... ............................... ..$160.00...................... N ❑ Non - Pressurized In- Ground (Conventional) 5,001 - 9,000 gallon septic tank .... ............................... ..$200.00...................... P ❑ Pressurized In- Ground 9,001 - 15,000 gallon septic tank .... ............................... ..$300.00...................... O ❑ Other: Over 15,000 gallon septic tank .... ............................... ..$500.00...................... 00 Up To 1,000 gallon dose chamber . ..............................$ 70.00...................... Building Type (check one): 1,001 - 2,000 gallon dose chamber ............................ ...$ 80.00...................... D Dwelling, 1 or 2 Family 2,001 - 4,000 gallon dose chamber ............................. ..$100.00...................... P ❑ Public Building 4,001 - 8,000 gallon dose chamber ............................. ..$120.00...................... S ❑ Stat @-Owned Building 8,001 - 12,000 gallon dose chamber ............................. ..$140.00...................... Over 12,000 gallon dose chamber .............................. .$160.00...................... Up To 5,000 gallon holding tank .... ..............................$ 60.00...................... Code Derived Daily Flow Soo gpd 5.001 - 10,000 gallon holding tank .. ............................... ..$100.00...................... Over 10,000 gallon hokruV tank . ............................... ..5150.00.:.................... ❑ Check if Replacing Existing System Experimental System (additional one time fee) .............. ..$300.00...................... 2 Revisions to Approved Plan $60.00 ...................... Petitions for Variance: Setback .. ............................... ..$100.00...................... ❑ .Petition for Variance Site Evaluation ....................... ..$225.00...................... Plumbing... ............................... $225.00...................... Revision..... ..............................$ 75.00...................... ❑ Groundwater Monitoring Groundwater Monitoring - Per Site ......................... 60.00 ...................... (other than a subdivision) ❑ Site Evaluation in Lieu of Graamdrtriter Monitoring Site Evaluation in Lieu of Groundwater Monitoring ..........$ 60.00 ...................... Subtotal :................... Priority Review Enter same amount as Subtotal:................... 00 MAKE ALL (NECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Tota Fee :......... ..... ..... _O &: SUBMITTING PARTY INFORMATION - Telephone No. ( incude area code b m tension) Company Name Contact Person X-el -3379' 3of S 7 �' No. 3 Street Address or P.O. Box City, Town or Village, a Zip Code <7 Z- D ,' / l� ►�, S�> 3a /�U, �'r li Si�ODZi Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. Z Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. OVER S130-6748 (R. (R. 07/96) I - RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET !fc,&PEO APR 15 Project Jeff Hintz s �� 19 99 Owner Jeff Hintz Address 2010 Dahlberg St Wilson, WI 54027 Legal Description SW %, NE %, Section 26, • �� ++x3f County St. Croix Subdivision Name Gene Larson Lot No. 1 c0 - E RCE Parcel ID Number llilki Of Co,1Mp1�p►NGS pEYPR so Plan ID Number ptiv�s►aa pENGE EE COR INDEX SHEET PA ONE MOUND CALCULATIONS PAGE TWO MOUND DRAWINGS PAGE THREE PRES. DIST. CALCS. & LATERALS PAGE FOUR PUMP TANK DRAWINGS PAGE FIVE PUMP CURVE PAGE SIX SITE PLAN OF MOUND SITE PAGE SEVEN SOIL TEST PAGE 1 PAGE EIGHT SOIL TEST PAGE 2 PAGE NINE SOIL TEST PAGE 3 PAGE TEN Designer Dale Hudson Lieense Number MP220853 Signature �G �' Phone No. 715 - 684 -3378 Date 3{24199 Notice: Tsunpera« pttaicl ile!►yored{�srsonsispr�hibi�ed. Deliberate nwditation will result in disciplinary action under s. 145.10, Wis. Stats. SBD- 10462 -E (R 04197} Page I of 10 RESIDENTIAL. MOUND DESIGN Eight Bedroom Maximum Complete information in lied framed boxes as necessary. (y or n) I n Is the system over creviced bedrock? Slope 4 % Number of bedrooms 2 Wastewater flow rate 300 gpd 1135.5 1 Lpd Depth to limiting factor 24 in 61.0 1cm In situ soil infiltration rate (code) 0.5 9Pd/ft 20.4 um Contour line below the upslope edge of absorption cell 102 ft 31.09 m Use standard fill depths? OR Designer speed depth I in 1 cm Place X in box to use standard depths (12, 24, A+4 inclusive) OR specify design fill depth. Center or end manifold a (c ore) Estimated hole space 4 ft Not a final calculation. Latest spacing 0 1Vlirrimum dose >= 10 times - void'votume Use a o lateral spacing for trenches. Pump tank elevation 93 ft Outside bottom of tank. Number of laterals RoRft Force main diameter 2 in Force main length Force main actual dia. 2.067 in SYSTEM SOLUTIONS inch- pounds Metric -Ce f media "x" one only. Estimated daily flow F 300 gpd 1136 Lpd x Aggregate and pipe Chamber and pipe Absorption cell Design load rate & area 1.2 9PC` 250.0 fe 23.23 m= Linear load rate 6.0 gpd/ft 74.4 Lpd /m Design width (A) 5 ft 1.52 m Cell length (B) 50.0 ft 15.24 m Depth of cell (F) 9.9 in 1 25.1 1cm Sand filter Upslope fill depth (D) 1 12.0 lin 30.5 cm Downslope fill depth (E) 1 14.4 lin 36.6 cm Basal area required (gpdfinfiltration rate) 600 ft 55.74 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 , in 30.4 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length.(I) 10.3 , ft 3.14 . m Upslope toe length (J) 7.6 ft 2.32 m Downslope toe length (1) 10.3 . ft 3.14 . m Total mound length (L) 70.6 ft 21.52 m Total mound width.(W) 22.9 . ft 6.98 _ m Project: Jeff Hintz Plan I.D. Page 2 of 10 • I MOUND PLAN VIEW observation pipes (typal) T W= . 9 ft A2 A= 5.0 ft 1.52m 6.98m — B= 50 ft 15.24m B K > J= 7.6 ft 2.32 m I= 10.3 ft 3.14 m K= ft 3.14m � = 70.6 ft _ I 21.5 m typ. obs. pipe A X B refers to absorption cell width and length (anchored securely) J = upslope width I = downslope width K = end slope dimension UA 6" (150 mm) T MOUND CROSS SECTION T D = 12.0 in 30.5 cm lateral topsoil G H subsoil cap E = 14.4 in 36.6 cm invert 103 5 ft F = 9.9 in 25.1 an elev. 31.55 m see note F G = 12.0 in 30.4 cm H = 18.0 in 45.6 cm D E ASTM C33 sys. 103.0 ft / sand Fill elev. 31.39 m 102.0 ft contour 4% �y 31.09 m slope Note: Absorption cell media will D = upslope fill depth plowed layer consist of aggregate and pipe E = downslope fill depth or leaching chambers and pipe F = absorption cell depth as specified Aggregate MChamber G = subsoil + topsoil depth at cell wall at right H = subsoil + topsoil depth at cell center Designer notes: If aggregate is used, it is covered with code compliant material. Project: Jeff Hintz Plan I. D. Page 3 of #110 r PRESSURE DISTRIBUTION CALCULATION Absorption cell Inch nds Metric Width (A) 5 ft 1 1.52 Im Length (B) 50.0 I ft 15.24 m Lateral specfcations Number laterals 1 Holes/lateral 12 holes Lateral length 46.8 ft 14.3 m Perforation dia. 0.25 in 6.4 mm Lat. dis. rate 13.98 gpm.- 0.9 Us Sys. dis. rate 13.98 gpm — 0.9 Us Hole spacing 51 in 129.5 cm Lateral diameter Pipe diameter Design options Design chafe Designer must 1 in/25 mm P/ac Wo one choice 1 1 /4in/32 mm X box from the options 1 1r2irv40 mm X x dial provided. 2in/50 mm X 3in/75 mm X Manifold diameter Pipe diameter Design options Design dwice Designer must 1 in/25 mm 'V one choice 1 1/4ird32 mm Non from the options 1 ilzr 40 mm Nog provided. 2ird50 mm 3in/75 mm 4in1100 mm Distribution system contains 1 lateral fs) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram i. Laterals centered over the A & B dimension end oap P Last hole dlriled next to end cap 14X- -� I Laterals & Force main of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 84.30 -6) equA spaced . = permanent end marker Inch -pounds Metric Lateral length (P) 47.0 ft 14.33 m Lateral spacing (S) 0 ft 0.00 m Manifold length 0 ft 0.00 m Hole diameter 0.25 in 6.35 mm Lateral diameter 1.5 in 40 mm Number of holes per pipe 12 Invert elevation of laterals 103.5 Ift 1 31.44 Im Project: Jeff Hintz Plan I.D. Page 4 of 1 r Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = 9.20 ft 2.80 m Are laterals the highest point in the Friction loss = 0.30 ft 0.09 m system? Yes W here. Total dynamic head = 12.75 3.89 m If no, what is the highest elevation Dose Volume downstream of pump? I� Lateral void volume = 5.0 gal 18.9 L Force main drain Minimum dose = 75.0 gal 283.9 L back to tank? (Y one) Drain back = 13.9 gal 52.6 L x Yes Dose volume = 88.9 gal 336.5 L No Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover T weather proof wMaming label and padlock grade levels junction box ^� grade levels quick disconect aftemate 4" vent pipe electric as per NEC 300 and outlet Comm 16.28 WAC location 18" (46 cm) min. wad of pump L- — approved chamber or outlet combination 7 ,/ joint tank A 1i4• weep Grade levels alarm on hole as pump tank mantwle . C min. above finished grade pump on B rwcessffy pump tank man. -100 mm mkt above fnistred grade vent - 12' min. above finished grade pump 94.3 ft C y vane - sera mm min. above nnWW grade off elev. 28.7 m —�— D 3 " 5 mm of bedding under tank and anchor tank as necessary Mrn ft Pump tank elevation bottom of tank Tank specifications: Weiser combina 1000/600 Pump tank = 14 gal /in Pump tank volume = 600 gal Capacities Inches Gallons A= 22.5 315.1 Pump manufacturer. JGoulds Pump B = 2 28.0 Pump model number: WE0311 L C = 6.4 88.9 D = 12 168.0 Project: Jeff Hintz Plan I.D. Page 5 of 10 MONSON suggsomom ' '.■■■■■m■■■■■ bm ■i1MENEM ■ ■r ■�■H�/M■M■M■E■■■■■ ON monmMEN I nommem NEMES noose OMEN 0 qhbqaqu MENNE sc Nor t s on IMMISMISM ME mm D ■t�a�H��t ■rte =�� ■ ■■ ►� � � ■■irk0M EME 1■■■■tEN■E■ ■ ■ ■��►�HM■l. �t■■ ■t■■■■■ ■■<EH NOON Hm■■■■■ommommM■ MEMO ME ' ■ ■■■H■■■�tlHNN ■ ■H ' ■cT!* ■tea ■NN ■ ■��■ t■ MEMO H►aINNE■W►■■■M■■E■■■■■ MEMO MEmom om ■t■■o■■■■■■■ ■ ■■ 'NOME H��� ■� ■1 ■ ■� ■ ■1 ■ ■t■ ■t■ ■ ■ ■ ■H■ ■■ ■tea■ ■ ■ ■ \ \ ■ ■ ■ ■t ■ ■t■ ' NONE H■ ■t ■ ■��t ■ ■ ■�i ■ ■ ■■�■��■ r SW/4 N9' /y SOMON 27, T28N, R17W St. Croix County, WI /� p �) . Page 7 of 10 C of Wi /SD W 4 ° / a { sl9pe S hlrQ $a ``�G•� ORRES�� POO p w�t2 11 i , TG $3 StTbhC�( rGC�U��c fillnT) .�v ©Q W V% D G Ot !3� { Gas c o� t�,ne }ice. �l l oo ' 6M 2 4 asle o �' ?..,,_ ic e Eke gs•80 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Pape 1 of 3 won of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Fuvkanmanal BY Des Attach complete site plan on paper not fees than 8% x 11 ink In size. Plan must County include, but not Inked to: vertical and horizonMl reference point (BM), direction and St. Croix percent slope, scab or dimensions, north arrow, and location and distance to nearest road. Paroel I.D.# APPLICANT INFORMATION - Please print all Information. PwoonW kftrmadw you pwide may be used for secondary p.posss (Privacy t sw, s. 15.04 (1) (m)). Reviewed By Date Property Owner Property i ocaabon Hin Jeff Govt tot SW 1/4 NW 1/4 S 26 T 29 N,R 15 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 2010 l)ahlberb St 1 - Gene Larson City State Zip Code PhoneNumber [] City ® Village [;Town Nearest Road Wilson W1 54027 772 -4436 Wilson I CTH W Z New Construction Use: Residential / Number of bedrooms 2 ❑Addition to existing building IJ Replacement Li Public or commercial describe Code Derived daily flow 300 gpd Recommended design loading rate 1.2 bed, gpolfP 1.2 trench, gpd/ft Absorption area required 250 bed, fF 250 trench, ft Maximum design loading rate 1.2 bed, gpd/ft 1.2 tr ench, gpd/fF Recommended infiifration surface elevations) 103.50' ft (as referred to site plan benchmar Additional design / site consideration Parent material loess over till Flood plain elevation, ff applicaW Na ft S - - Suitable for system Conventional Mound I In -Ground Pressure I AT -Grade System in Fill I Holding Tank U= Unsuitable for system I u S 0 U 0 S 0 U I u S E U ❑ S Ixni U I ❑ S 0 U u S El U SOIL DESC RIPTION REPORT Depth Dominant Color Mottles I Structure I GPD/ft Boring# Horizon in Munsell Qu. Sz. Cont Color Texture I Gr. Sz. Sh. lConsistenc� Boundary I Roofs I Bed Trench 1. 1 0 -6 10yr4 /4 - sit 2msbk mfr cw 2f .5 .6 2 6 -19 10yr5 /6 - sil 2msbk mfr cw if .5 .6 Ground 3 19 -32 7.Syr4/6 - sit 2msbk mfr cw - .5 .6 elev I I 102,16 it 4 32-421 7.5yr6/4 c20.5yr98 sil I imsbk I mvfi 1 - - 1 .2 .3 Depth to factor 32" i Remarks: IOyr 4!4 - sit 2msbk mfr cw 2f 5 .6 2 6-22 10yr5 /6 - sit 2msbk mfr cw i f 5 6 Ground 3 22-40 7.5yr4/6 - sl 2msbk mvfr I cw = .5 .6 elev 101.62 ft 4 40-44 7.5yr6/4 c2d7.5yr5/8 sil imsbk mvfi - - .2 .3 Depth to Arrritir� factor 40" Remarks: CST Name (Please Print) Sgnature: Telephone No. Thomas C. Nelson 715- 246 -2454 Adder Environmental By Design Date CST Number Ref # 1432 120th Street, New Ric3nnond, WI 54017 3/24/99 227387 227 PROPERN OWNER- Jeff SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL IAA ErvitOMMtol By D Dominant Color Mots Sftlure GPD/1e Horizon Munsell Qu. Sz. Cont Color Gr. Sz. Sh. �o nsiste Boundary Roots Bed : Trench 3 1 4-6 1Oyr4 /4 - sil 2msbk mfr cw 2f .5 .6 x � e 2 6-26 1Oy+r5 /6 - sil I 2msbk mfr cw if .5 i .6 Ground elev 3 26 -32 7.5yr4/6 c2d7,5yr5/8 sit lmsbk mvfi - - .2 .3 96.89 ft Depth to limiting �9 factor I 2s I I I I Remarks: Ground elev I I I I I I { I IDm factor I Remarks: Ground F 7 1 elev f Depth to I I limiting factor { I i I I I Remarks: v+ Ground Depth elev I to limiting factor Remarks: n JEFF I INTZ — Lot SW %<, NEYA, SECTION 27 T 28 N, R 17 W St. Croix County, Wisconsin ��i� x,150 ut 3 a - 3 3 To,a n koC f iq7 s T 7 r 0 P e Y 1 n e SCALE 1" —40 BM 1. BASE OF PINE TREE ELEV. NOT BM 2. BASE OF PINE TREE ELEv. 95.80' t d of io i Wisconsin Department of Commerce SOIL AND SIT VSA{.trp►TIQN Page 1 of 3 Division of Safety and Buildings in accord with Co 5, WisAdm R����� 11 Environinental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Qn ust �dnty inc lode, but not limited to: vertical and horizontal reference point (BM), bdn and St. Croix percent slope, scale or dimensions, north arrow, and location and dista nel" fpa4t g 4K ? Parcel I.D.# APPLICANT INFORMATION - Please print all info C,crOx Personal information you provide may be used for secondary purposes (Privacy �a�)S 04 (1) (m*WNT`/ Rev ate Al 1 Property OwnerP Location , fi /� Hintz, Jeff t _ g 26 T 29 NR 15 W Pr Owners Mailing Address Lot # # Subd. Name or CSM# 2010 Dahlberb St 1 - I G ene Larson City State Zip Code PhoneNumber ❑ City Z Village [:]Town Nearest Road Wilson Wl 54027 772 -4436 Wilson CTH W {A New Construction Use: Z Residential I Number of bedrooms 2 L_l Addition to existing building LJ Replacement U Public or commercial describe Code Derived daily flow 300 gpd Recommended design loading rate L2 bed, gpoff 12 trench, gpd/fP Absorption area required 250 bed, fP 250 trench, ftz Maximum design loading rate 1.2 bed, gpolff? 1.2 tr ench, gpolfF Recommended infiltration surface elevations) 103.50 it (as referred to site plan benchmar Additional design / site considerations Parent material loess over till Flood plain elevation, ff applicable b) Ar it S= Suitable for system Conventional I Mound In -Ground Pressure ! AT -Grade System in Fill I Bolding Tank U= Unsuitable for system , DS NU I i� S u U I u S NU i Ei S 0 U u S Z U 1 u S 0 U SOIL DESCRIPTION REPORT Horizon I Depth I Dominant Color I Mottles I Texture I Structure I Consisten I Boundary I Roots GPD/ft2 Boring# 1 in. I Munsell ( Qu. Sz. Cant Color I I Gr. Sz. Sh. I I Bed Trench 1 1 0 -6 10yr414 - siI 2msbk mfr cw 2f .5 .6 2 6 - 19 I 10yr5 /6 sit I 2msbk I mfr I cw I if I 5 6 around 3 19 - 32 7.5yr4/6 - sit 2msbk mfr cw - .5 .6 elev { 102:16 It 4 32 -42 I 7.5yr6/4 I c2d7.5yr5/8 1 sit I lmsbk I mvfi - I - I 2 3 )epth to irr�iting I I I I I I I I 'actor 32" I I Remarks: 1 0-6 10yr4 /4 - sit 2msbk mfr cw 2f 5 6 2 6 -22 10yr5/6 - Sit 2msbk - mfr cvv if 5 6 G round 3 1 22 -40 1 7, 5yr4/6 I - sl I 2msbk ( mvfr I cvv I - I 5 6 101.82 ft 4 40-44 7.5yr6/4 I c2d7.5yr5/8 sit lms I mvfi I - I - ( .2 .3 ]epth to limiting factor 40" I I I I I I I Remarks: CST Name (Please Print) Signature, Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental 13V D n Date CST Number Ref # 1432 120th Street, New Richmond, W1 54017 3/24/99 227387 227 PROPERTY OWNER: Hintz, Jeff SOIL DESCRIPTION REPORT I F - 2V -- 1 Page 2 of 3 PARCEL LD.# Environmental By Desi Depth Dominant Color Mottles Structure GPD/W Horizon I in. I Munsell I Qu. Sz. Cont Color I Texture I Gr. Sz. e. onsistence Boundary Roots Bed Trench 3 1 1 0-6 I 10yr4 /4 I - I sit I 2msbk I mfr I cw 2f .5 i .6 2 6-26 1 10yr5/6 I - I sit I 2msbk I mfr I ew I if I .5 .6 Ground elev 3 26 -32 7.5yT4/6 c2d7.5yT5 /8 siI lmsbk mvl'i - - 2 ; .3 98,89 It I I I I I Depth to limiting factor I I I I f I 1 26 f I I 1 I I I I Remarks: I I I I I I Ground elev I I I I I I I I I Depth to limiting I I I I I I I factor 1 l 1 I I 4 l 4 Remarks: I I 1 I I I 1 Ground I I I I I I I elev Depth to I I I I I I I limiting factor I I I i 1 I I I I Remarks: I Ground I I I I I I I I 4 eiev I I I I I I I I Depth to limiting factor I I I I I Remarks: I 1MV �Y 0[5 131120 STREET, NEW A+ A00, W600K U1Sl �4vfD BYT�On�!S NE1.S4N �3 - ?9b- ?979 TO NO SOIL MIQ 22M7.-•RC6M Q0 "AM M71) JEFF HINT? -- Lot SW/4, NE I,, SECTION 27 T 28 M, R 17 W Springfield Township, St. Croix County, Wisconsin Page 3 Q�� 5 l� Trio h kurj t9� 5 r P e Y l 4 e SCALE 1" =40 Tom Nelson BM 1. BASE OF PINE TREE ELEV. 100' BM 2. BASE OF PINE TREE ELEV. 95.80 to of to r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND nn n OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 2 O o h\ e r O n Property Address n YS n 3 (Verrfrcatroa required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION �� �" /'� .. �// /aye ��' /sOr•� Property Location V., %, Sec, W, Subdivision T ^:,:nii Subdivision Lot # Certified Survey Map # Volume _ . Page # Warranty Deed # -- a 1 g Q Volume Page It Spec house ❑ yes IR no Lot Lines identifiable yes ❑ no SYSTEM.MAINTENANCE Luproperase and mamtenaaceofy=sepdc systemcouldresvltia itspremaumfaff=to handlewastes. Propermamftaar= consists of pumping out the septic tank every drree years or sooner, if needed by a licensed prnmpm What you put into the system can affcd.the function of the septic tamk a tratnent stage is the v%ft disposal ryste:m Ile proietty owner agrees to submit to St. Croix Zoning Depart rent a certification form, signed by the owner and by a p Jo p dphanber or a licensedpamper that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pun4 ft (if ne=rvy). the septic - tankis less than 1/3 Full of sludge. yve, the Undersigned have read the above requirements and agree to maintain tine private sewage disposal system with the standards set forth, herein, as set by the Depatment of Commerce and the Department of Natural stating that your septic Resources; State of Wisconsin.. Certification system has bees maintained must be completed and redaned to the St Croix.Couaty Zoning Office within 30 days of the three year expi 'ett date. * F CANT DATE OWNER. CERTIFICATION I (we) certify that all statements on this form am true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, virtue of a warranty deed recorded in Register of Deeds Office. BSI F yl 1l� (WANT 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 601869 � I KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Eugene Larson, a /k/a Eugene D. Larson, conveys and 04 -23 -1999 9:45 AM warrants to Jeffrey A. Hintz, and Jeanne M. Hintz, husband and wife, the following described real estate in St. Croix WARRANTY DEED , State of Wisconsin: EXEMPT # County, CERT CORY FEE: COPY FEE: 2.00 TRANSFER FEE: 45.00 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address Se Cf hln_�z I bo o aHti ti ST 191-1011-30 (Parcel Identification Number) Beginning in the center of Section Twenty -six (26) in the Village of Wilson; thence East 660 feet; thence South 660 feet; thence West 660 feet; thence North 660 feet to point of beginning. All located in the West Half of the Southeast Quarter (W %Z of SE %) of Section Twenty -six (26), Township Twenty -nine (29) North, Range Fifteen (15) West in the Village of Wilson. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated this add day of 1999. * *Eugene . Larson * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY �� Personally came before me this �+ Cday of apt., 1999, the above named Eugene Larson, .afk/a Eugene D. authenticated this day of Larson to me known to be the person(s) who a cuted the L foregoing instrr and acknowledge the sa r signature signature type or print name type or print name TNC'Ata S 4 . IPICc4?01AC& TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin. (If not, authorized by §706.06, Wis. Stats.) My commission is permanent. (If not, state expiration date: .) THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or Thomas A. McCormack printed below their signatures. Baldwin, WI 54002 Information Professionals Company Fond du Lac, Wisconsin 800 -655 -2021