HomeMy WebLinkAbout002-1066-60-000 r-
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ST. CROIX COUNTY ZONING DEPARTMENT 4� �" } 9'
AS BUILT SANITARY REPORT
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Owner 4 t -
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Property Address 2 y� �j �U /� � sr c
City /State 1614L.0 , / ] t C✓ t` ti �iG Z s .., caa
.•� PIING OFFICE
Legal Description:
4
Lot Block Subdivision/CSM #
N&_ '/4 � '/4, Sec. a, T -aN -R 141 W, Town of 1? a l t^l w h PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
Tank manufacturer P4 4 iye4te. , q Size ST/PC 1 W/ � SO Setback from: House '1 Well 4./S— P/L ) 00
Pump manufacturer Za Model 9 S' 3
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: h 1I G u n d Width 3 Length Number of Trenches
Setback from: House 9Y Well 5 P/L ) Z ' Vent to fresh air intake
ELEVATIONS
Description of benchmark /fa r'/ 00 / w C. fi&pe- 4 K a,, o, d Elevation
Description of alternate benchmark Elevation
%!o
Building Sewer 'G 2 ` ' " ST/HT Inlet Z ST Outlet PC Inlet
PC Bottom �1 Header/Manifold q , f' - Top of ST/PC Manhole Cover
Distribution Lines(
Bottom of System
Final Grade O O ( )
Date of installation 10 /40/ 1 Permit number State plan number
Plumber's signature License number ?�'.���75"' Date
Inspector R ol' O 's �t
Complete plot plan
r
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
E
QI
Lot
AM i
INDICATE NORTH ARROW
' WAsco Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division ST . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar y324611--
Personal information you provice may be used for secondary purposes [Privacy L 2 s.15.04 (1)(m)].
SI T H; de � rr@: EL f1 CitySLill�ge Town of: State Plan ID No.:
CST BM Elev.: LL t1A Insp. BM Elev.: BM Description�3AL,DW iV Parcel TditlY - 000
I t ev f� 'e- e- L
TANK INFORMATION ELEVATION DATA A9800499
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Se Ic P AO ��Bessn ar ' j o2 1°5'.02- /CD Dosing ,� 2 m t
CO�� &W `-A 1 S f . / /OZ
Aeration Bldg. Sewer P .p Z 2.75 t. o • }
Holding
Q9 ,ft Inlet pp `�' •OZ =' 6-
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P / L WELL BLDG. Air i to ntake ROAD Dt Inlet
ir
Septic ° 7 !�' 32 ` t NA Dt Bottom IDSQ�" .0
Dosing It NA Header / Man. �(! . 32
14.9 Aeration Dist. Pipe 04. y.3g
Holding Bot. System D`F( I,cis 1 7 q.. Z
PUMP/ SIPHON INFORMATION — Final Grade
Manufacturer Demand (ps .b Q . (� / b�• C,/
Model Number "•D�GPM
TDH Lift 7 q, Friction System
� TDH // J t
L oss Forcemain Length Dia. Fi `� Dist. To Well
SOIL ABSORPTION SYSTEM
E ENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
IM N I N � I DIMENSI
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LE L ING Manu a
SETBACK CH
N ORMATION Type Of r b - �' i ORUNBER Moe Num e
System /J� 0
DISTRIBUTION SYSTEM
Header /Manifold r1 Distribution Pipe(s) if r x Hole Size x Hole Spacing Vent To Air Intake
Length _LP Dia a Lengt Dia. Spacing 14'
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded x Mulched
Bed /Trench Center Bed /Trench Edges �a'' Topsoil f? (54Yes ❑ No VYes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) %
LOCATION: BALDWIN 27.29.16.404,NE,NW 2449 80TH AVENUE
G) PCawl (� a G $Ss - '19.
Ucc g. Yr ys
5S•5 � ysa
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. CC'( ���GL �0
SBD -6710 (R.3/97) Date Inspector's Signature <= MEE>
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
a
Safety and Buildings Division
SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Vi s ' loonsin
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 8 112 x 11 inches in size. !34 C-69 j
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro a yOwner Na s Property Location
t cd l ,'� lj rl /4 N y✓ 1/4, S 2 ? T 2 , N, R /� E (or) W
Property Owner' 4 0wner's Mailin d dress 1 �� Lot Number Block Number
2 L / to /ffG. 7
City, St Zip Code Phone Number Subdivision Name or CSM Number
J3 114, w� s s " (d 2 c ?/s-) yy y2
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
❑ village
Public or 2 Family Dwelling - No. of bedrooms ja Town OF L?li
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/ Condo 0 0 Z L O – G U^ -0 0 C
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. I Replacement 3_ [] Replacement of 4. E] Reconnection of 5_ E] Repair of an
------ ` -- System -- Tank Only -------- - - - - -- Existing System -------- Existing
- - - - -- ----- - - - - --
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 M Mound 30 E] Specify Type 41 ❑ Holding Tank
12 C] 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
'1 Re uired (sq. ft.) Pro�,posed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) �} �j Eleation
`� S U L V S G U , 2 5 ( 1 Feet 16 t Feet
aclt
VII. TANK in Cap llo s
g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete . Con- Steel glass Plastic App
New Exist in structed
Tanks Tanks
Septic Tank or Tank �� l GC, G !'1? p� r� c c ac L 11 ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber i, ` S'U ) ❑ I ❑ ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility or installation of the onsite sewage system shown on the attached plans.
R Plumber's Name: (Print) Plum is Signature: amps) &VWPRSW No.: 2 slness Phone Number:
10 � St y tom, 2 31(7 s' /5 " G �l� -� :Z (o
Plumber's Address( Stre ett, Cit , tate, Z Code):
4 L � r //e .,+ /✓ ? G d / , , , (C t � 6 -/ /G z 1`
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent Si �(N )
ppro ved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination $. /a S
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, owner, Plumber
INSTRUCTIONS }
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4_ Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608- 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
li. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
f r i constructed an tank material. m l t for 11 septic, n d
manufacturer s name indicate prefab o site d Co e e o a s t c, a
P P P
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County / Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
n E it 1 form; n i
of the soil absorption stem if required b the county; ) so test data on a 15 or , a d F) all sizing information.
P Y q Y 9
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
i
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Safety and Buildings
PO BOX 7162
MADISON WI 53707 -7162
Visconsin Tommy G. Thompson, Governor
Department of Commerce William J. McCoshen, Secretary
August 24, 1998
CUST ID No.267341 ATTN: POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST
PO BOX 74
RIVER FALLS WI 54022
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 08/24/2000 Identification Numbers
Transaction ID No. 138482
Site ID No. 158315
SITE: Please refer to both identification numbers,
Site ID: 158315 L above, in all correspondence with theagency,
ST CROIX County, Town of BALDWIN
NEIA, NW1/4, S27, T29N, R16W
Facility: MICHAEL SMITH
FOR:
Description: MOUND DWELLING 450 GPD
Object Type: POWT System Regulated Object ID No.: 419032
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..'1
The following conditions shall be met during construction or installation and prior to occupancy or use: covtdi
• 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 AF?
required by the state or the local municipality shall be obtained prior to commencement of OEPARI MEN
construction /installation/operation. VISION OF SAI
i
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address SEE CON
on this letterhead.
Sincerely,
DATE RECEIVED 08/19/1998
FEE REQUIRED $ 180.00
AMES B QUINLAN , FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE $ 0.00
(608)266 -3937
"'A
J
L
Page of 6
5
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE M1 1/4 OF THE MW 1/4 OF SECTION ,T R
TOWN OF 53f�L��l1 iV , Ste. C,�yC COUNTY, WISCONSIN.
I
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER '
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
7-14 1 , 4 9 �o �vEtvv� �t�ally
0�V ED
T OF CO�MMER
E
�ppKpENC�"s
PREPARED BY
WECGEF::;tEF:q_-
AND'. �ptN
ZAN
P.O. BOX 74 421 K. KAIK ST. Vx
RIVEII FALLS. VI 54022 . ARTHUR �.
WECERER
715- 425-0165 SWO
_ (d,(.SWORTH,
w
JOB NO.
PLOT PLAN Page ?-- of (
Scale
z- so n3 sr.
8►^'1'� -I �' Q• � O,O' cy., *��SL� �6'� 'PrBov� G twuivD
W P P
E1.41 i� \\ tL
g
N Tip "r Cori p Ate oR
M 69/ �O 1slU\Z a Ty S
aF o \ \
6�P ��.
F ` nv C c� `P 2 g . IV
C�vTQ\. L tzrL, qg.o'
y or- sttED stro"C.
P
w�L
NOTES
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. { required)
3. Install 4" observation pipes with approved caps. ( 2 required)
4. tank to belwr3 I 6S0 gallon capacity manufactured by
W1 l Ow E'`J Pl? g�A 8T , ) tv e .
5. Bench Marks S � - Wrpouo -
6. Divert surface water around systeinto prevent.ponding at the uphill side.
i
i
Page 3 Of
Approved Synthetic Covering
rrs,7w1 c 33 Distribution Pipe
Medium Sand
Topsoil _- _- F Elect. c1q.0
3 E
b
6 % Slope
Bed Of 2"-2 Force Main Plowed
Aggregate From Pump Layer
D N -O Ft.
Cross Section Of A Mound System Using
E Ft.
A Bed For The Absorption Area F p.8 Ft.
G 1- o Ft.
• A Ft. H 1, S Ft.
Linear Loading Rate= cl GPD /LN FT B 1 4 - 1 Ft.
Design Loading Rate= b.y.GPD /SQ FT j 16 Ft.
J Qc, Ft.
K Ft.
lterna-te Position L i Ft.
of
Force Main W 3 2 Ft.
L
Observation Pipe
g K
A -- --------------
Distribution Bed Of -,"-2 2
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page ice. Of �6 I
Perforated Pipe Detail
0
End View
)Perforated
End Cop. on�6�e PVC Pipe
a ,S Install permanent
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
P
PVC
Manifold Pipe
PVC Force Main
Distn ution
Pike
Last Hole Should Be I
Next To End Cop
End Cop
P Z Z Ft.
Distribution Pipe Layout S Y Ft.
X 1 4 Inches
Y L / Inches
Hole Diameter 1 /y Inch
Lateral 1 Inches)
Manifold Z Inches
Force Main Z Inches
# of holes /pipe L>
Invert Elevation of Laterals aot.So Ft.
bY- n >e-
Place 1st hole �y from center of manifold with succeeding holes
at LIB 'intervals. Last hole to be next to the end cap.
- Combination Sept,,cc Tank and
PUMP CHAMBER CROSS SECTION. AND SPECIFICATIONS' PAGE 5 OF (�
- T CAP WEATHER PROOF
JuIJCTION 90X
H' VENT PIPE APPROVED LOCKING
�:. 10' FROM DOOR, MANHOLE COYER KXV
:/tAIDOW OR FRESH wA(itV1AlG S 146EL..
ALR 11JTAKE
T I f
Cor�Du1T
tj
• k, "MIN, Ksl;li I `(� MtIJ.
7 IB'MIU.
♦
y "tlus9tto� P1Pt ' PROVIDE I ----"
IAJL_E T ---- AIRTIGHT SEAL I I V
• � I I
APPROVED .JOINT 3hFF��S --A I I i ( APPROVED J RpTC
I I W /C.I. PIPE
wiC.T. PIP6flR Tank construction l' ((
1 with ALARM
shall comply Y I II
ILHP (33.15 and 83.20 a ( 1
I I Oli
C ( I
�tZ•�S I
LLEY. FT. PUMP --- —'�
OFF
D COMCKET
al BLOCK
3" APPt2os; .
RISER EXIT PERMIZTED QWL'J IF TAWK MAIJUFACTURER HAS SUCH APPROVAL SEW INf,
SEPTIC f
SPEC.IFICATI Old S
DOSE K llDkJ�s -1�1 p s ST !DUMBER OF DOSES: 3. PER DAU
TAM K MALIUFACTUREK :
TA S12C: W0 fb A SO GALLOAIS DOSE VOLUME r
ALARM MAUUFACTURE.R: SS.� � S�tS`��'} -1 IWCLUOI#J6 BACKIFLOW: S3 GALLONS
MODEL ►DUMBER: 1'Z0 Nw CAPACITIES: A= I 3 p 1 O GALLOy5
SWITCH TtSPC: ��ZCLJR $ = Z IWCHES`OR G�LLOAJS
PUMP MAIJU FACTURE: R: C= ILKHES OR 1cj GALLONS
MODEL !DUMBER: 53 D= J INCHES OR `S GALLONS
SWITCH TYPE: W'I�Z���� MOTE: PUMP AND ALARM ARE TO 6C
MIMIM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE CETWEEU PUMP OFF AUD.DISTRIBUTIOIJ PIPE.. 6 FEET
+ MIIJIMUM METWORK SUPPLY PRESSURE .. 2,50 FEET
6o F o•
+ FEET O F FORCE P4AlIJ X �• b� �oFI.FRIGTlO►J FACTOR.. CD FEET
1 ,2Z
TOTAL Oy1JAMIC NE:Ap = -�._. FEET
Pump chamber DIAMETER 3
It
IRITERGIAL DIMLWStOIJQ OF TA►JK: LEM&TH ;WIDTH — ;LIQUID DEPTH �.
1
BOTTOM AREA -- 231— — GAL/IN CH
AS PER ANUFACTURER = — )- - 0 - GAL /INCH
r
it 3 15/11+--6 5/32 OF
HEAD CAPACITY CURVE 4 s/
• - "53 - 57" - "55 - 59" SERIES 1 112 -11 1/2 NPT
- 2s
TOTAL DYNAMIC HEAD /CAPACITY
PER MINUTE 3 15/16
EFFLUENT AND DEWATERING
6 _
50 SERIES
Ft. Meters I Col. Lt..
4 1 /16
x
U 15 5 1.52 43 163
i 4 10 3.05 34 129
0 15 4.57 r9 77
to 2 Look Vol— .19.25' I 1
0
2
5
" 10 1/16 I
0
U.S. GALLONS
10 20 30 40 50 1 3 3/32
LITERS 80 160 -T
0
FLOW PER MINUTE
aKM VMS
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Variable level Float Switches available. • Available with special cord lengths of
• Variable level long cycle systems available. 15', 25', 35' and 50'.
• Alarm systems available.
• Duplex systems available.
SELECTION GUIDE
Standard cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required.
Standard cord length - non - automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float
M53/55 and 57159 Series Control Selection switch. Refer to FM0447.
3. Mechanical aftemator'M -Pak' 10 -0072 or 10 -0075.
Model Volts Ph Mode Amps Simplex Duplex 4. See FM0712 for correct model of Electrical Aftemator, E -Pak.
M53155 & M57/59 115 1 Auto 6.0 1 or 1 & 7 - — 5. Variable level control switch 10-0225 used as a control activator, with E -Pak (3) or
S & N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4
& 57/59 1 to a 1 or 1 & 7 (4) float system.
E53/55 & E57/59 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in simplex or 2
pump operation, PIN 10-0002.
53 Series - M. 22 tbs. 57 Series - Wt 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice,
55 Series - Wt. 24 lbs. 59 Series - VV'L 301bs. PIN 10 -0003
CAUTION
For infolmafion on additional Zoeller products refer to catalog on Combination starter, FM0514; All installation of controls, protection devices and wiring should be done by
a qualified
Piggyback Variable Level Float Switches, FMO477; Electrical Alternator, FM0486; Mechanical licensed electrician. All electrical and safety codes should be followed including
the most
Alternator, FMO495; Sua# Sewage Basins, FMO487; and Single Phase SimplexPumpControl/Alann recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
Systems, FM0732. ,
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO. P.O. BOX 16347
Louisville, KY 40256 -0347 Manufacturers of. .
SHIP T0: le Cane Run Road
LaLo , K Y 40211 -1961 QuaurrPut.PS S.vcF /9, F�
" ! f7�-2731 • f (600) 928-PUMP
��7 M, (502) 778
FAK(502)774 -3624
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
D'Nision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Sr, cQ.otx
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 007-- 1(J66_ 6o
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R VIEWED BY D TE
PROPERTY OWNERS : PROPERTY LOCATION
M1CMtfi1�_ po_b eew'tm NE 114 'N 1/4,S Z T Z.( ,N,R l E
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
Z.lj �L SO`-} IWe - —
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [afOWN NEAREST ROAD
woo�vt,u w 1 s y o zt3 (-) IS) L4 8 - Z 4 1_ 1" f 1 b
[ J New Construction Use [X Residential / Number of bedrooms 3 [ J Addition to existing building
bQ Replacement [ J Public or commercial describe
Code derived daily flow LA S l) gpd Recommended design loading rate - ({ bed, gpd/ft trench, gpd/ft
Absorption area required 3't S bed, ft 3 S trench, ft Maximum design loading rate 5 bed, gpd/ft - �- trench, gpd/ft
Recommended infiltration surface elevation(s) qq - O ft (as referred to site plan benchmark)
Additional design / site considerations W / B `x q 7 ' PM. YA V J ) 13 - ° or- SftAjb F1 LL
Parent material L..OtSg ouytt, Gl fy_-� `hLl. Flood plain elevation, if applicable Iv q ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK
U = Unsuitable fors stem cis ®U ®S ❑ U I CIS O U [IS IOU EIS ®U ❑ S RU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxkary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tianch
Ground 3 Z3 - 4 - 1. S '1fZ ( 1/y - s I l "—s 1 0 IT Vq \.3 � C °mil • S
°t el ev.
S ft. VA' ��.s�c�sl� • ��l on, wl - ►v1� -Z
Depth to
limiting
factor
Remarks:
Boring #
O' i1) L, /2 3 b1z ��t^ afs _ , •6
V f y .311
Ground 3 Z( -3 0 V/Y S
elev. 4 30 -52 -S `7R y/6 S`dtZ SIB
-A ,
Depth to
limiting
factor
_T_ M t
•,,: F es_ , ._
Remarks:
T Name: - Please Print Phone: `
Arthur L. We erer 715 -425 01-6,"5i'" J
Ad dress: Soil Testing & Design Service -P.O. Box 74 River Falls,W1 y
Signature: / �� A ,i R8 g8 Date: 1 � CST Numb 00 5 76
PROPERTY OWNER S`Pi1 V SOIL DESCRIPTION REPORT Page of 3
PARCEL I.D. # W - V)66- 60
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 0- tip` - v- 31 — z `� bk s s d
1
Z,
Ground 3 1� Z9 `z •s `f f2. _ G� - S� 1 S b12 Y4 V`F1- C S
elev. w�1��
Q3J- ft. zql "s \-I 2 y/6 - G 1" S J
Depth to
limiting
factor a
Z °t
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
lmiBng
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
PLOT PLAN Pa 3 of 3
SCALE 1
gw� *�-I �-' �� ° . cy ►-"�►� ���` 'PtBove G lwvw
6 9/
�D1SlU \z TVI S
by /
%6
s f
�Lqq y Cbu�nvR � 98.0'
'vim A- -?- L-L r) k fz' mi lzs arv�
} a o� o� e c�
y OF Sti'Lp SLPIn��'
P w�. L
- -98 ( 715 ) _ M 0 0 5 7 6
4 ?.5 �1 h5
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
D'nnsion of Safety & Builclings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
S. 'r
, c,Q -otx
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (Bfvq, direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 0()?_ _ 106(6, _ 60
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION R IEWEDBY DATE
PROPERTY OWNERS : PROPERTY LOCATION W .
M1CNff4u_ t'f?'� za- TJJ'}1 GeV K NE' 114 NW 1/4,S Z T Z.( ,N,R 1( E(
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
Z'4 q9 $O) IWit —
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (MOWN NEAREST ROAD
W(%�\) syoZl3 ( 648 -Zttz b `T-A Rv�.
[) New Construction Use [A Residential / Number of bedrooms 3 [) Additign to existing building
Replacement [ I Public or commercial describe
Code derived daily flow V - 1 S l) gpd Recommended design loading rate - q bed, gpd/ft j trench, gpdtft
Absorption area required '3) S bed, ft 3 S trench, ft Maximum design loading rate • 5 bed, gpd/ft - �- trench, gpd*
Recommended infiltration surface elevation(s) R9-- 0 ft (as referred to site plan benchmark)
Additional design / site considerations _`t'1ov W / B 'X U 7 ' pgb, h W I h um g ° o!= S>li� R U
Parent material Lots oyk�nt Gu' v prt. `' Iu_ Flood plain elevation, if applicable N )I ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem E] S ERU ®S ❑ U ❑ S O U [IS O U ❑ S IR U ❑ S IOU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rench
vh..w_ o _-7 I0 2- 3 L z — f Z,�sb w► a, s - , S . 6
<v> �- 3 -L. �c� ly - sff 2�sbk ohs 0-
Ground 3 Z3_ y - 1. S �2 V/y s I t` bk vhv'�'H Ct� °� • S
elev.
°l wl`Ft 1'�'� •Z
Depth to
limiting
factor
U. Z
Remarks:
Boring #
�....... : ) a -� t > 3t - si Z�sblrz
;;;.:;._
:- Z � �Z � • S ` 2 Y�Y s 11 Z� s bk � s e.S . S - �
3 Z1 -30 1 S`t2u/
Ground
. z
q , ft 4 33 -52 - �.s tiR VA � S -1R slb s �I OWN m `�l- - IJA
Depth to
limiting
factor
30"
Remarks:
CST Name: - Please Print Arthur L. We e r e r Phone. 715-425-0165
eg'erer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 '
Signature: !� l / _ R a T ) 9�8 Date: �, - 13 - C>'8 CST Num r 5 7 6
PROPERTY OWNER SlyycT( SOIL DESCRIPTION REPORT Page of 3
PARCEL I.D. OpZ _ 10 b — 60
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxby Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
Z.S Ll IL V/y — s;1 Z� sbh C. S
Ground 3 l Z9 `z •S `i R 3! 6�- S) i°_ S�12 Yn \)i — 0 -S , S
eleV. 0--: bk
C1 ft. z� � •S 4 2 y/6 _ G� s J l c��- ,e�anro
Depth to
Umiting
factor
. Z h
Remarks:
Boring #
Ground
e(ev.
ft.
Depth to
Umiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor.
Remarks:
SBD- 8330(R.05/92)
PLOT PLAN pa 3 of 3
i
SCALE 1 "= 30 '
6c) m4
•
% Z 7 7
o -ss m, - o i
• z.so � -
6►"1 �- a.. \0 0.0' Cy„ UM � �`� fTBov� 6 se.,,urv�,
^� � �p 1.lpT CA1h p A-t7- 01Z
6 9 1 �o t s - iv�z Q 'rv s
\ i
i
i
i
b
S�3
V)
'tee 3 Z -kr eavr*
y of stteo S �o,NG .
X18
'mac- ( 715 4 - 01 65 14 00576
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Bttye'r e. S M, t li
Mailing Address - V 4 1/4
Property Address S' -4 6�
/ Wltj (Veri required from Planning Department for new construction)
City /State 84 4'9- W, Parcel Identification Number U 2
LEGAL DESCRIPTION
Property Location fie ' /a, � W '/<, Sec. 22, T _aN -RjkW, Town of L?, � � PL .
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # L/ f 1 31 , Volume `f 3 , Page # U S
Spec house ❑ yes Cho 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, 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 fun 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 een maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiry ' date.
16 9S
SIGNATURE OF APPLI ANT DATE
OWNER CERTIFICATION
I (we) certify that all snts on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property des ribed above, of a warranty deed recorded in Register of Deeds Office.
SIGT4ATURE OF APPLIC 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
�4
DOCUMENT NO.
W AASAf ff DEED vMiS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF r W ii'' l l ; + /7 C �� IN FORM 2-190
481319
VOL 943 aoE 05
Eunice T. Hoolihan, for herself, and as attorney-in-
REGISTER'S OFFICE
faU� for"Bet tou Trahms VoskuTT; Pk i7Tp W� Trahms,
----- ---- - ---- -
ST. CROIX CO., WI
an -- Steven - W. Traliins, - es' tenants - in c peon . _• Reed for Record
>. _...- ..- _._ .... ........... .. -- -- -- - - -- _ ...................
.._
conveys and warrants to - - M ichael _A. - Smith and llsarilyn - - A. A I �gg92
_- ..Smith,..busban -d- ..... .and- ,�- ife---- - - -- - - --------- 10:30 li. M
... . .. ...... ... ...... - . -- . _ .......... a - ------ ------------ ------
noomw of 000&
_ ......... ...... . .. .. . . .. . ... . . . .. -
...... ... ...... .. .- -- - - - - -- -- -- - -- . - - - --
y i R[TUwN TO
the following described real estate in - S. t..- .GCQi_X- _-------- .- _.._.- ... -.- .County,
State of Wisconsin:
Tax Parcel No: ... .... .... .... ......... ......
Asg
Northeast Quarter of the Northwest Quarter (NE1 of NW1) of Section
Twenty -seven (27), Township Twenty -nine (29) North, Range Sixteen (16) West.
This conveyance is made in good faith by said Attorney - in -Fact pursuant to
the terms of that certain Durable Power of Attorney dated
and recorded in the offiCf ff the Register of Deeds for St. Croix County,
Wisconsin, on p 992, in Volume 943 of Records, at Page
01 , as Document No, ere!'y said attorney -in -fact was granted
' the power to transfer the above -d ?scribed premises regardless of the principal's
subsequent physical or mental disabili incapacity or incompetency. Said
Attorney -in -Fact has no actual knowledge of the termination of this power
because of revocation by the principal sr by the terms of the document,
the principal's death, disability, or incapacity.
is
This - 15 not homestead proT.ert }.
i, X6jX)X (is not)
Y Exception to %yarranti -s: easements an.1 restrictions of record.
(fated this ! dad of -rnR �G k I9
(SEAL- �.C�'Lt�f�COV l �t;EAL)
_ Eunice T. Hoolihan,for herself and as
attorney -in -fact for Betty Lou Trahms
k� Voskuil, Philip W. Trahms, and I�E.at.,
Steven W. Trahms
AUTHENTICATION ACKNOW LEDGMENT
U
Signature(s) . ---- ._.__ _- STATF OF WISCONSIN 1
ss-
---------------- - .......... - -- - -- - . - ------
-
r (Countx.
authenticated this -.___. day of_ -_.. -_ _- ._ -. -, 19- P-rsonally came before me this day of
19- 92 the above named
------ ............. Eunice T. Hool ihan
,
TITLF- NTF.'.ITBER STATF, RAI OF IX Imo( I)N,!N
author. zed by r .n� , W to } _ car ,n •i '
Thoma- A. McCerma,t r:
6a11:vin. tdI 7100 i
�Sicnat;ry n , v he
are not Weer <s;i ,
I
WARRANTY DEED
t �