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HomeMy WebLinkAbout004-1017-20-000 \k § ( o a 0 a � \ � ƒ � Ll ƒ - e � � $ � k c o U) § ƒ k 0 _L 2 k L « 2 w z E ) 7 z § \ \ } CD OD R z q � ) z / 2 / U) § 7 { ) = E . 2 7 M ^ ) / & }_ $ / o c j z % ) h k ) � g § ) Q (0 0) 2 # / \ o 0 a = 2 m■ ■ §\ $§ E= a+ z CD \ § § 2 a Pa j \ k k 2 _ _ zz » =R \\ b tƒ §oc g 2 m M co $ t $ J»m R � » . , \ \ E k§ } D\ 8 LO C L § L o ® & f § 7 2$ L6 d k / © 7 3 { f a/ -� o= o ;e n o z_ ■ n 2 � ' « $ z / ® � � k CL % / 4) k E e , 0 a 0 2 2 f ? Parcel #: 004 - 1017 -20 -000 01/11/2005 04:48 PM PAGE 1OF1 Alt. Parcel #: 8.28.15.114 004 - TOWN OF CADY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * TROY E, &JEANNE M STUART SEBION SEBION, TROY E, &JEANNE M STUART 2865 50TH AVE WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 8 T28N R15W NW NE EZ -U- 1369/097 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 08- 28N -15W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1237/598 WD 07/23/1997 856/18 07/23/1997 851/39 07/23/1997 838/341 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 55188 Use Value Assessment Valuations: Last Changed: 0512412004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 13,000 126,700 139,700 NO AGRICULTURAL G4 13.000 1,200 0 1,200 NO UNDEVELOPED G5 1.000 100 0 100 NO PRODUCTIVE FORST LANC G6 21.000 14,700 0 14,700 NO Totals for 2004: General Property 40.000 29,000 126,700 155,700 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 29,200 126,700 155,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 0411712001 Batch #: 511 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ' Wisr'oron Department oflndusby, SOIL AND SITE EVALUATION REPORT P age of Labor and Hum Relations Human 3 Division of safety a Buildngs in accord with II-HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must indude,.but S� 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. 0 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY c�u AT L I ;Z� PROPERTY OWNER: PROPERTY LOCATION Bv`t �F\z ' -- V - 1z0 St33 zs1J 98V°�tt71` NW 1/4 k 1/4,S 8 T Z.a ,N,R 1 S E (orFJW PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # X 33 3h Sr. " I*-- z T - — CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD I�vouDV���F ►v) sVo (GIs) 648- Boa© C'F'�DY Sc-) Tit r}te. pQ New Construction Use [04 Residential /Number of bedrooms 3 [ j Addikn to existing building ' j Replacement [ j Public or commercial describe Code derived daily flow USO gpd Recommended design loading rate bed, gWR ' 3 trench, gpd1/ Absorption area required 1 bed, ft 1 S trench, ft Mabmum design loading rate _ - S bed, gpd/ft trench, gpol(K Recommended infiltration surface elevation(s) k 0 o - S ft (as referred to site plan benchmark) Additional design / site considerations w/ 5 'Y- l S TRt cl} • M IAA . 1 t o F - SI)fvb FI Lt- Parent material sl t ` S tIm*J aLa: ok.)k4_� S 1 1 LL Flood plain elevation, if applicable N - _ It S = Suitable for system CONVENTIONAL MOUND &GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem ❑ S 1@ U 21S ❑ U [IS O U [IS 0 U [IS ®U [IS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu, Sz, Cont. Color Texture Gr. Sz. Sh. 'Roots Bed rRtaldi o_$ 10`12 ! Z 3 — si Zh►S b� ( l _ 31 y Z In S l b�t. M 'F1- �S • 5 Ground 3 lq -31 '1•S`i P-Y/ - s 1 GS Ilk muf;- c-S ' `S a � fL L{ 3) - s `t R Y! s ti cZ 13 S ►-n Depth to limiting facto Remarks: Boring # b `-ttZ31 i S� 1 1'q S10 S — Z z MAd % w►`� 3 23 3S lS`tR S� Ground elev. 4 3S-Sy CZ SKZ S1 1 •S ft. Depth to limiting factor 35" • Remarks:' ' CST Name.-Please Print Arthur L. We erer 715 - 425 -0165 Ve Soil, Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Sillnatwe: Date: CST Number: ,l C1 —X17 —) 1 ") ��- l l? , [ `� `7 M0057'6 Q `-1. PROPERTY OWNE Ste) O1V SOIL DESCRIPTION REPORT Page Of 3 PARCEL I.D. # O U ZO Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxx* Roots GPD /ft in. Munsell Ou. Sz, Cont. Color Gr. Sz. Sh. Bed Trench 3 , 0-9 31Z - it 2Mab ' rn cS -- "s , 6 2 9 -?- o `12 3/y S,') IWI AV M �� CS - -S .6 Ground 3 ZZ -3� -•Sy L!/ v u MU`Ft- CS elev. q q. - I ft. y R y/ C 13 Depth to limiting factor Remarks: Boring # 13 { Ground ' elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to — — - limiting i factor Remarks: E3 . Boring # i , Ground ` elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) PLOT P LAN Pa 3 of 3 SCALE 1 "= L�Q' IE �cey h9 S Ito I-jt-j S C) - M P 1vs. { O -ZS hA I TO Z `Rt ST, WDOD'� 1 oP��7 B 1 z \S ' gri 3t-1 J eq' - / i el ��SSU�2t3 `C1j -'lS A�R1�'A �� / a.Z 2S d`� a 1- g.3 Q �� Z- . loz.7' o►J -op op vnit - Fovc(� TRUST 1S' I.)oIZTn__4E 7ZJ�E V W F-rLL 4 +� 4 Sc o' 44 ', 7 L " �-t. A )A k l r 1 1 `l -7 (Z15 ) -0165 M 5 7 6 CST Signature Date Signed Telephone No. CST # I "nsin Department oflndustry SOIL AND SITE EVALUATION REPORT Page ", of 3 Labor and Human Relasons Division of Safety & buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must indude,,bA S not limited to vertical and horizontal reference point (BAH direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 — - 1 O l7 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION B T1�0 5 3 1 ON t3m'f'Cm NW 1/4 h)Lr 1/4,S g T _2Z ,N,R 1 5 E (o�jw_ PROPERTY OWNER . - S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # � S r. »�r z '- - CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE ®TOWN NEAREST ROAD bv) S\lo ZB CWS) 698- 3o8o (- So `nt A(�- pQ New Construction Use [M Residential / Number of bedrooms 3 [ ] Addht n to ebsbng buikfing j ] Replacement [ I Public or commercial describe Code derived dally flow yST� gpd Recommended design loading rate bed, glxW ' 3 trench, 9pdlt Absorption area required 3- )S bed, ft S trench, ft Ma)amum design loading rate • S bed, gpd/ft trench, gpd1ft Recommended "infiltration surface elevation(s) I o a . S It (as referred to site plan benchmark) Additional design / site considerations !'l OV)vp ►.v/ S 'Y- l S �t� C1} , ►") Ilv . A h o F- Shhib El Lt Parent material Flood plain elevation, if applicable N - A - ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSl1RE AT -GRADE SYSTEM IN FILL HOLDING TAW U= Unsuitable for fain O S M U Jz S O U O S ®U ❑ S (�IU [IS ®U O S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxl3y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed qiench .3/ z — s i Z tv, s Z $ -19 1 oti tz 31 y sI 1 Z »��t- �S - S b Ground YI y C- 2 's el ev. a tL 3) -14 s V R VI s ti Iz 3 13 S } owl Depth to limiting factor 31 ', Remarks: Boring # S t J 2m S b `r`� `��^ L S Z Ground 3 23 3S - ),S `t R_ Y7� - S) , C SM \w y\\j . CS • �I `•. • S elev. 4 3S -S� �.S`TR y/ C �Skz 3/3 sl o`"� m`Ft- I oo.s ft ` Depth to limiting factor 3S w . Remarks: CST Name = Please Print Arthur L. We erer 715- 425 -0165 egerer Soi Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 sgnature: Z q7 - (4 7 -' Date:�,�MZ 1Qr [�cl ,7CSTN 00576 - S V�r�Z PROPERTY8WfM 5 31 ON SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D4 O O L/ - Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 o -- 31Z — Si Zmab ' rn , 2 9 -Z Z, l � `1 3 / "• S , 1 Z.r�t S � N'I T � C S — • 5 . � �Z Ground 3 Z1 - Syfz L//v S) \ csbk Mull O-S - , `� •S elev. c1 - ft. �( 37 - 7.S �a V/ c 5yR- 313 S) OWN to `F4 Depth to limiting factor Remarks: Boring # 13 i Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground ` elev. ft. Depth to limiting factor 1 Remarks: Boring # [3 i Ground ' elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) PLOT PLAN Pa 3 of 3 SCALE 1 L4 C) ' �x -c��T h S�towN S O 71+ PfUQ _ I o •ZS>M i lv Z `fi+ ST. moo } w�oD� Oo N3DT e oM at� e1 - oR , a. � Il{ r / oG C g.3 NS7 _ EL. LOO w 7oP of ) 6 ` N#�GE� ��� -i3PrR N�PSTZ l8 " Dl8_"T1 �• h QZ Bm* Z- LSL. 102.7' a+J Ton Ul='1'chfit -�fi .F?(uT 1S' I;iuIR7N -_4F `P i - t�, VS F "U BF f'1 L.EM T IS ' FrZOPI M OLIA b . U y lv ALL 'r `• c SU '� q� -y7 -I On ) 42.5 -oi6s m 00576 CST Signature Date Signed Telephone No. CST # S'I'. CROIX COUN'T'Y ZONING DEPAR'I'Jk r AS BUILT SANITARY REPORT' p S Owner 0 .� �c Address ss ,. x Cit /State FFICF Legal Description: Lot Block Subdivision/CSM It _..__. Sec. �_, T 2Z N -R 1S �W, Town of L' PIN # - SEPTIC TANK - DOSE CLAMBER - HOLDING AN INFORMATION: Tank manufacturer Size ST/PC /`22 t,-'J Setback from: HousePP /L n Pump manufacturer ' 7� � r` � -� -�� Model �; Alarm location �- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: /1 3 Width Length > - 6-- Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS: Description of benchmark j% ✓� --f �.,�, u��/Z L. /,.,% x Description of alternate benchmark , ,7 Elevation Elevation /e)I / 7 Building Sewer ST/HT Inlet 2S- Outlet PC Inlet PC Bottom -- � Header/Manifold © Top of ST/PC Manhole Cover Distribution Lines( r.�Lr ® cv /14 '14 l e 1,, ) � ( ) Bottom of System ( ) () Q © ( ) Final Grade- ) m Date of installation /l/ ermit number 3 45 i / State plan number Plumber's signature_,___ ��' �, License number f / � �` _ Datc to ll% Inspector_ f } o c— / Comploc plot plan — NOTICE: Please provide (lie 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. PLA VIEW y 3 elk 5 if J it , U INDICATE NORTH ARROW i Wi!:constn Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 315994 PQ i,r's NA -mg CADYC] village Town of: State Plan ID No.: CST BM Elev.: U Insp. BM Elev.: BM Description: Parcel Tax No.: to o 1 1 ro / " a4-n — 0 41 004- 1017 -20 -000 TANK INFORMATION ELEVATION DATA AQAnniRq TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S ptic y �- C POO Benchma j. 67 0 osing �irlk �%ha -��h X00 Aeration Bldg. Sewer Holding �Js4f[ Inlet 2 -P ?k2— TANK SETBACK INFORMATION St/ W Outlet TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet Air Intake eptic flu 3� 3 SOT NA Dt Bottom H-21 '7 1/- .t d Dosing �/� 3S� •3 SGD T NA Header /Man. $•ic/ /00- Aeration NA Dist. Pip s`.�' s 0 2. a P r. •e o Holding Bot. System >ry PUMP/ SIPHON INFORMATION (,� �x inal Gr a 2- ��� 1 / Manufacturer �� IIemand 51- MCI"" /0/•!7 Model Number 75 ZD GPM T Li ft, L Sy _ TDH� .37Ft Forcemain Length 41p Dia. H Z r ' Dist_Towell SOIL ABSORPTION SYSTEM BE REN Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 3 DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING facturer: INFORMATION Typ 1 MBER el Number: - Sy eruEtt(Ven+iu- '� --�t OR UNI DISTRIBUTION SYSTEM Header/Manifold e ll Distribution Pipe(s) „ / x Hole Size x Hole Spacing Vent To Air Intake Length 1ZT Dia Length Dia. Spacing rO 115Vj4 SC Z72 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: CADY 8.28.15.114,NW,NE 2865 50TH AVENUE 1•bDge loc a.-W ,Was wi tej vVer 3o p(uS -;uef -Frvm S - 1 n. t� GIectq - ov s Fe-Z'ct. © � W / e f l lVf T k6A10 04 ; >1r,rer,+,j U 1 � VY'GGf • U'vLI� _ iLj cow Plan revision required? Yes ❑ No l Use other side for addition information. SBD -6710 (8.3/97) Date Inspector's Signature � P�I-� ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I , a - - , a a b - e a , , a a. e a f ` a e r 1 1 2 m,3 3 t e e.� i a 3 i f S I a a 7 s ' z i x i _ ) E � e r' t � t` E 2� P e v a v a c 3 t - a ry P d Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue I Lconsin In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County �S,T�aQB l X than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number lT Personal information you provide may be used for secondary purposes E] Check it re6;s on to previous d plication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pro a ner ame r r ert LpEation p / 1/4, S T 2_ N, R /,J E (or Prop rty Ow is Mailing Address Lot Number Block Number (9,4 1) City, State Zip Code Phone Number Subdivision Name or CSM Number 4> mva(u, GC .o ( �> 6 5�36�' . TYPE I DING: (check one) ❑ State Owned it� Near st Road 0 VII age / f � � � Public 1 or 2 Family Dwelling - No. of bedrooms Town OF(�Z III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 Apartment/ Condo 6 — i O r 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. p 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 1PEF] eepage Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank 1 eepage Trench 22 ❑ In- Ground Pressure �� _7Sr 42 ❑ Pit Privy 1 eepag e Pit v 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: g5,5_4n_ y$ 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade L/ Required (sq. ft.) Proposed (sq. ft.) (Gals/day /s . ft.) (Min. /inch) r Elevati/ rd 1. it ! Feet X40 - Feet VII. TANK TANK in Capacity s Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass App. New Existing strutted Tanks Tanks Septic Tank orMeFdif3g�enie� f ❑ ❑ ❑ ❑ ❑ Pum Tan - ' )Si �r O ❑ ❑ ❑ ❑ 1 ❑ VIII. 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 Si nature: ( o Stamp MP /MPRSW No.: Business Phone Number: �/t is L r l J �$ 7 l S� 3 �3a Plumber' Address (Street, City, State, Zip Code o , `l 7� 3 0 s �� ,� tfJ �'s 3� o IX. COUNTY / DEPARTMENT USE ONLY 11 Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Is ent Signature (No Stamps) N Approved ❑ Surcharge Fee) Owner Given Initial �V 7t Adverse Determination V X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS a 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 pumperwhene3er 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. II. 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 manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and 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.j,' 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) cr055 section of the soil absorption system if "required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. t� 11:i 7156845456 _;Y;i E t,, Pr: at L�J PLOT PLAN po e SCALE 1 r -ac C- �Y��.,`cy `N �•J ` t Q w pvp� 0 7 J 4 -44 i R � q °► 1 F ECI see_—' r � �M i► ,l �. / � � � yeti i o � °- --'� - �� r 1 . 8r1k► t -fit. jor�.p or., ?.2�' DOH tcs� -Ca en , )(;i L' r" ,/, O f So�.�Otiritil.,l. 6 • y "PuC o�4T2tg�boN PtPr Z.'' pvc � 6' LI``v�r/T P►p� w/ P►PPRO� �'P F- attc�; r�q•,� S 11vv tx5z. -T �- . 10 0 c�, s ry y "vim Pt PE w / "P1 u ft C" ��ST t Z � � t�0 U F 4=t �v t Stt� Gtt.Y�'� I? (a2, zoo FI LL, 4RP�.ovNA Sy1.Tf1�TIC y'� av ` ✓ eo v E N G b�g`1R 1t1��1D►J Ptptr ` -, Cr ' `- , � r G" O F ' J Z "lU Z l I z, Pr6 R�5 h B u �J A L�R Fo R Pc'CL�D 1� t P TO ��S`�( B� j10►� �ip�S PmJD Z `� H134uE R uTTb" OF G-V �1' r PUN'\P CHAMFER CROSS SECTIOIJ AUD SPECIF ICATIOf1 —VEQT CAP `I VENT PIPE WEATHERPROOF APFROVED LOCKIAIG 25' FROM DOOR, JUIJCTION BOX MAIJHOLE COVEF_ WWDOW OR FRESH 12 "MIU. AIR IAITAKE GRADE i I 4 ° MIN. I COMDUIT 18 "MIN.v ---- - - - - -- \ )10 PROVIDE ( - - - -- I►JLET AIRTIGHT SEAL i I * A I I I I I I ALARM B I 11 I *APPROVED I o q C JOINTS WITH ELEV. _ r _ FT. APPROVED PIPE 3' 3' ONTO PUMP -� ` OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED O1JLy IF TANK MAMUFACTUREP. HAS SUCH APPROVAL SEPTIC E SPEC-IFICATIOUS DOSE TAWKS MANUFACTURER: L l (.!UMBER OF DOSES: _ 34 -PER DAy TANK SIZE: _ .4O GALLONS DOSE VOLUME ALARM MANUFACTURER: SIT INCLUDING BACKFLOW: GALLONS MODEL NUMBER: CAPACITIES: A= 2 INCHE5 OR ` 32g GALLOAl5 SWITCH TYPE: $/P G y/t Y B c .Z IMCNES OR GALLONS PUMP MANUFACTURER: O I- Z_ 'e C = INCHES OR 1-{— GALLOWS MODEL NUMBE : .S (o O R D= INCHES OR GALLOIJS SWITCH TYPE: "/ --A V iz NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE�GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 17 FEET + MINIMUM NETWORK SUPPLY PRESSURE T✓. . . . . , , . . --5 -FEET F + _ �O FEET OF FORCE MAIN X " 1 00 FzFRICTIOW FACTOR.. ') FEET = TOTAL OyNAMIC. HEAD = �L a I �FEET L t P ' INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH 31GUED: LICENSE NUMBER: ApZq yy DATE' 7 P f � 1 4' W W HEAD CAPACITY CURVE j- 4.1r 6'/4 —� "53-55" SERIES 25-1 - - -� TOTAL DYNAMIC HEAD/ U `` FLOW PER MINUTE , /0 . \ 47/e EFFLUENT AND DEWATERING �- - t- _ CAPACITY � 20 HEAD UNITS/MIN - - 1' /z - — N la 6 FEET METERS GAL LTRS ; 43/ 11 /z NPT = 5 1.52 43 163 10 3.05 34 129 ' V 15 4.57 19 72 15 19.25 5.87 0 0 Z 4 y . D Q 10 o 2 - 5 I 0 I _ US 10 20 30 40 50 3 GALLONS v y LITERS 0 80 160 FLOW PER MINUTE 4 CONSULT FACTORY Kim SPECIAL APPLICA - f - i� NZt, • Piggyback Mercury Float Switches • Available with special cord lengths of 15', available. 25', 35' and 50'. • Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non- automatic 15 ft. M53155 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts -Ph Mode Amp Slrn IeX _ _ Duplex 2. Single Piggyback wideanglenie.rcury fl-if swilchur dr,uble piggyback mercuryfloat M53/55 115 1 Auto 8.0 1 or 1 & 7 switch. Refer to FM0477 N53/55 115 1 Non 8.0 2 o 2 & 6 3 o 4 & 5 3. Mechanical alternator 10 or to 0075 D53/55 230 1 Auto 4.0 1 or 1 & 7 _ _— 4. See FM -712 for correct model of Electrical Alternator, "E Pak E53/55 230 / Non 4.0 2 or 2 & 6 _ 3 or 4 & 5_ 5 Sensor mercury float switch 10 -0225 used as a control activator, with E -Pak (3) or (4) float system. 53 Series - Wt. 23 lbs. -.3 H.P. 55 Series - Wt. 25 IbS. ­3 H.P. 6 Farr (4) hole 'J Pak tunc'.0 ,, box, for w,Uarbyht connection or wired m simplex or duplex operation. P/N 10 -0002. 7. Two (2) hole "J -Pak', junction box, for watertight connection or splice, P/N 10 -0003 For information on additional Zoeller products refer to catalog on Combination Starter. FM0514. Piggyback Mercury Float Switches. FM0477: Electrical Alternator, FM0486: Mechanical Alterna- A.; ,,,. -, Ned nator, FM0495; Alarm Package. FM0513; Sump /Sewage Basins. FM0487. and Simplex Control „, ,,,­ l,.rte,,;,,,,,,,; non in the Box. FM0732. , � — , m NaMl' l e.,, ,.,� i, i: tNl , .,.,: c,.., u�..i „� S..taefy ..nu 11 Act i ` RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 3280 Old Millers Lane Manufacturers of ... p Z Z7ZZ-ZZj_ff D P.O. Box 16347 • Louisville, Kentucky 40216 (502) 778 -2731 • FAX (502) 774 -3624 Qva� /ry PuMPS SHCF /939 VfmoonsinDepartmentofIndustry, SOIL AND SITE EVALUATION REPORT P of 3 Labor and Human Relations — DK*jon of Safety & Buildings in accord with ILHR 83.05, VVis. Adm. Code COUNTY 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 (BM), direction and % of slope, scale or PARCEL ID. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Q f) GGVF -60T- N w 114 NE va ,S 8 T Z ,N,R VS E (�Ow PROPERTY OWNER MAILING ADDRESS LOT / BLOCK # SUBD. NAME OR CSM # 3 3 0 12 sT. Pm-r f� t — — CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD + +�`� �• � Sy0 2.3 ( 64 ?. 30 $1 cf� tj�_T s0 T�+ t'}Ue. New Construction Use Residential / Number of bedrooms 3 [ ] A" tD existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 'A S O gpd Recommended design loading rate bed, gpo1ft trench, gpdtft Absorption area required — bed, ft2 11 Z S trench, ft Maximum design loading rate bed, gpd/ft • S try, gpd/ft2 Recommended infiltration surface elevatiom(s) S� N tvuT oN P 3 ft (as referred to site plan benchmark) — ur Additional design / site considerations or-t rat IlLtl yl ft C-S IVMVl S 'y- 1 s ' LwvG Parent material % t t_ `Ili( D41 Mi i Oven Rood plain elevation, if applicable ly . 1) . It r su ❑ = Suitable for system qqNv MOUND l N- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK = Unsuitable fors stem US U 0S ❑ U ❑ U R] S ❑ U EIS W [IS IM U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence BwxJ3y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jrends I. O -►o ID�2lZ 312 s+ LMSID � c- S S • ) lo ut - 31 y Sl) 2 w, A T h, C.S Ground 1.- S71Z VA fn U Tj_ • q S elev. �b ft Depth to limiting fact 3 � Remarks: Boring # 0 -8 �om-L 3tZ zm gbh W., a.s _ • s 6 Z Z � -2 l�� 3t S J Zx� sbk rn �►� cg _ - S Ground 3 2 S_6 i's L, IZ X116 — �s� ��a )n A, (_-S •q -S elev. 60 70 I .�\1 2 31 Y m - �N g�,ft Depth to limiting facV Remarks: T Name: — Please Print Phone: Arthur L. We erer 715 - 425 -0165 _ V e m g% rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 mature: S9 f �� �� .� -� �- Date.1����Z I C'.+ I 1 `2 "l .7 CST Number: 0 5 76 PROPERTY OWNER IOiJ SOIL DESCRIPTION REPORT Page ?•of PARCEL I.D. # 0 CJ - 03 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Board3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch a - 1O ` - I R 3 /Z s • ZmS Wt l- �S 3 � .s •b 5 Ground L elev. �? ft. Depth to limiting factor Remarks: Boring # I o — 1 b"11Z 31 Z S _ 13 Y � l Z ` n .fs rvl Ground S 3 y - 5S elev. y SS 1s �u ti � 1 L I — s 1 ` 1 s �� X2. 5 3 ►n v ft. Depth to limiting fact Remarks: Boring # o-9 loy si �. Zri.s�k m`F►- ctS - •S , 6 S Is L 3 36 S2 �•S 3 — G►-s I ��s�h Hn u �'� �S - � • S Ground Z e o ft. `� SZ - � 8 . s v 2 Vl6 _ F S c,,^ vn v ��. LL s Depth to limiting factor j > �$ Remarks: . Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) PLOT PLAN Pa 3 of 3 � - SCALE 1 "= L4D ' s � `�+ • v -s M' Yo J r 0- � 1 0 7 11. . Z J I �+ .O r pl L '2iv ag ,,, N 0'Te TO 11� ► SQL l2 TNtwr.c *e Z--NQIA SXIS %M w L o t- ?�_ `�i Owt�.i s Lod l30�* r ',/. f,01 1N S1v lC: R �fo 'P�RMt 8.4 E1- gc0 X210 t 5 I - N • TLS, -(3 RR VQ/ Llt'T)J . -- Oil - T - %V2' of ►" 1IfM F-EWC.,�j P0,27. -- 3 CST Signature �! Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT P I of 3 latbor and Human Relations — Division of Safety & Buildings in accord with IL.HR 83.05, Wis. Adm. Code COUNTY Attach complete site an on �j'• C� U 1 pl pl paper not less than 81/2 x 11 inches in size. Plan must induce, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ID. # dimensioned, north arrow, and location and distance to nearest road. 00 - -10 t1- ZO APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 13 'Nlti�;11 S l Q�N G99-LOT -- M w 1J4 Ne 1 /4,S g T 2 ,N,R S E (oW PROPERTY OWNER' - S MAILING ADDRESS LOT BLOCK# SUED. NAME OR CSM # 3 3 3 o•+Pc� ST. PI'PT '� Z = — CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE MOWN NEAREST ROAD wOt�OUtLLl,1.v I Syo 2.8 ( IS) 69e. 30 $D C_ f�D` -r 50 T>+ Aoe M New Construction Use j,>4 Residential / Number of bedrooms 3 j ) Adam to existing building j ] Replacement j ] Public or commercial describe Code derived dairy flow y S O gpd Recommended design loading rate bed, gpdM • �_ trench, gpdAl Absorption area required — bed, ft2 Z S . trench, ft Maximum design baling rate • y bed, gpW S trench, gpd/ft Recommended infiltration surface elevation(s) sew NuTI cv J 1" 3 It (as referred to site plan benchmark) � g�"'I Additional design / site considerations �►" M C 3 `hZ t1t5 - �H S 'x I S ' 1_oxX . ��C"'� r� W Parent material S t t- ` "I SI&I MQC l p j. ef2 - n UL_ Rood plain elevation, if applicable 1­5 . A - It S = Suitable for system cONv MOUND IN- GROUNO PRESSURE AT -GRADE SYSTEM IN FILL. FIOLD1i�IG TANK U = Unsuitable for sys ® 11 U !� S ❑ U Oa S ❑ U )a S ❑ U ❑ S (ffU 1:1 S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3N Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tertd� 13 4 cs -1 ID`1p_ 31Z - S Zrixsb W1'FI- GS Z 1 D -�l3 10 ti 31 y S) 2 w, S b Jri CS Ground 3 X1 7 3 �- S Y l ��� _ S O /rl v' f'}, • q S elev. \lo Z It Depth to limiting factor Ll Remarks: Boring # o -� �o�tz 3 1Z — st1 zit gbh W -. a. .s •6 Z sbk 111 �� Cg . S - G Ground 3 2-746 - ).s ylz VIC - d.., mv��, cS -- elev. 6b 10 Ion 2 3! 9h1 fl. Depth to limiting factor Remarks: CST Name: - Please Print Arthur L. We e.rer Phone. 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Date: "PM- l e ll 09 ,7 CST Number- 0 5 76 PROPERTY OWNER SOIL DESCRIPTION REPORT Page_Z.of PARCEL I.D. # 00 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bour>dy Roots Bed Tn� 3 o - ° f 1 b �-t 3/ 2 S 2. n1 S � bvt `Ff- aS _. , S • � 3/ S') Zm Sb4 wt�h �S - S Ground !. - s i C,S h cyt v �'�. , S elev. f ft. i Depth to limiting factor , ? Remarks: Boring # 2-0M S m `fir- C4_ '13 - • s • (, t Z °1 �3 �/ i o �1 fZ 31 �/ - s 1 1 Z M S b )rz Yn `Fh �S f-S 42-s )Dk- Groun s w� u ' , , d vh '� c,T l .5 elev. y SS 15 10 `11Z 3 L 1. S ft. S �-S X12 Wl u .5 Depth to i limiting factor j »$ , i i Remarks: Boring El # 0-9 3 L Z S l). Ztin 3 b12 7+ `f h Z 9 -31. 1�`11Z 31y — s� J Z►v, s1� � �� CS — , S , le Ground 3 36 -S2 � . s ti2 S ly — G�-S I �� - tivl0'n C-S , S el 1 O ft. SL -�$ • S v 1 YA - FS Owe 11n V , `�l . q S Depth to limiting factor 8 M Remarks: Boring # . 1 Ground elev, ft. Depth to limiting factor Remarks: SBD- 8330 (R.05 /92) PLOT PLAN P age 21 of 3 SCALE 1 "= yD ' S , _ ITV E �`5in� lv J LA w ovp�j 0 7 ly y Z J �o Z N Z - q °t B. �ti t ih - Z y i� 11-� 0"e TD 10 3)fLL - 1�3R % 3 mac" Z, WA S S LZ. , h1N• 6' wr ft it t!bGe . acAC. olo l�w�E Or-- cnusncv�ruN, e •3 - � 3 B•4 �t,qg� ttl�t 5 Z. 9YI V Z- C2, 161 •Z" O>.l 1�S' of �thYtt ��wcE PosT. s lU E 'R'f' L."-ST ZS - lit Q, 0-fts , W FELL. so `� K a P� JZ 10, LgOI7 (715 ) M 00576 z PT Signature Date Signed Telephone No. CST # s y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyec , R0 (r s -e 6 , o 7 Mailing Address Property Address (Wrificatioa required from Planning Departrneat for aew coasftucdoa) Cit3atate a 4u t L? er—' Parcel Identification Number – D I – 70 LEGAL DE SCRIPTXON Property Location - %, �� ' /<, Sec. . TN R lJ W, Towa of Subdivision Lot # Celli ed Stctvey Map # Volume . Page # Warranty Deed # / / a Volume �2 3 Page # S Spot grouse ❑ yes ❑ no Lot lines idcntifiableAyes ❑. no SYSTE>VI��IriAIl�1�NANG'� . ofy= sy*MCouldrCSuttiaitsp tohand[ewastes.Pcopermai oeaanee consists of! ' I oat the septic tank c=Y throe yt= or sooner, if aee&dby � U=sodpmmp m yh2t can. affecttbe of the septic taalcas.a stage is ffie vrastedi po aisystem. Mae_ P?oPertY owner sv= to WMIk to St CM& Zoning Department a :cafficatioa form, signed by the -owner and by a . : �? �' Piplambertrst< idodplumbaoriS +oeasodpcauper�reafyinggiat(Ij t5e on�itaR�stcdislxualsystcai is m Proper opemdag eondifim and(or (2) aft= boa and p=ging.(iif aeecomy), the septictank"is iess than M "fie adudge. Ywc, the andeaknod have-rad tiro above rogaicraicaft and agree to Mild-ii, the private sewage disposal system wi& the standards Get fork berein.a set by dw Department of Qwnneroe and do Dot of Nattaal Rmuroes, State of Wisconsin.. Ceromfin statingthatYM ups 9stem has be= maiatained mast be completed and rebmned to &c St Crojx.Cmity Zoning Officewittua 30 da of ttre three year expi7 - J�& /-( 8 i si a SI&U TURE OF APPLICANT DAZE OWNER C _MMCAWQN I (WO) Certify that all statemeats on this fora are tine to the best of my (our) knowledge. I (we) am (are) the owner(s) of &e described above, by ' of a wamaty dood recorded in itegister of Deeds Office. — R"Ie ) " TiJRE OF APPI:ICANT ''L DATE 9 s « « « «« Any information that is mis ««« «« - reprxentodmay rcarit is the sanitary pemrit being revoked by the Zoning Depactimeat «« Include with this app[icaUon: a sumpod wamnty doed fiom the Register of Doody office IL Copy of the ccrtifod suncy map if rrfcreace is made in the warmaty deed 559 1a STATE BAR OF 'AiSCO \StN FORM 2 - 1982 WARRANTY DFED DOCUMENT NO. - - -^ — J 1. IX C 0., v i I t Ra J Baker - - - -- t. ovPoaft , MAY. 8 - -- 11:45 A M t conveys and war: nts to - Seb and Jeanne M. t Stuart, _ as point tenan _ -- h,,,1Syi V ttJbbay TR.s SP..CE RESERVED FOR RECORDING " _ %AjJE AND RETURC_ ADDRESS Croix _ the following described ". I estau in C ounty State of Wisconsin; ...� ! • l .. �.. � vI' i�u.,::+. 16 ! i!n A ve. BaldMn. W; 54002 004- 1 017 -20 PAPCEL 10F%TIRCATION NUMBER A Northwest Quarter of Northeast Quarter (NWT of NE'k) of Section Eight (8), Township Twenty -Eight North (T28N), Range Fifteen West (R15W) TNAti EP 00 ..0 W This is not homestead property. 1 O&X (is not) Eceptiontow•arrannes: Easements and restrictions of record. . " 97 Dated this day of — — --(-� • A D , 19 Erb. J (SEAL) !!1 /s Y (SEAL) - , " " RRaaymon J. Ba ker (SEAL) _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT i State of v'isconsin, a Signature(s) ss. ...-; county. St. C _ _ �y 19� Perso Ily carne tvflme tite th ` is S day of authenticated this day of -- 19 9 the above named _ R a+m�n r TITLE MEMBER STATE BAR OF WISCONSIN - - -- - -- � Of not not -- - _arar -_ .k •. —__ —_ - - --_ —�— Of not au t hor ized by §706 06, AA'is. Stats.)y ow me knowii to tx 's' Prx n ; _ who executed ttte foicgomi; JCR Ja-r ^;t instrumrnt , ack t /+ same. L •* THIS tNSTRtititENT WAS GRAFTED BY -- Thomas A. McCormack — .___.�.�. -�. _. _— ____.— _ —_,_.— �. .. -.__ ...r4• x.10 YT "���� SG • .. . , �t Cr O1X C. ?URIC �1�. Baldwin, WI 5 4002 _ Not Publ' _. - -- \l ctt au„tor tY a� ent(It not, state erpiraur�p ate (`ilnatutes may be authenticated or a.knowlcdged &1th arc not )' / C'r nece»ary.) V - ViSC Xsn _O9W 9tyk l;J