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HomeMy WebLinkAbout004-1028-30-000 r i NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. Two horizontal reference oints to center of septic tank manhole P ep cover. • Show alternate benchmark, if applicable. PLAN VIEW "V } 5 7 7 { 7 1 INDICATE NORTH ARROW 3 � i' C 4 ST. CROIX COUNTY ZONING DEPARTMEN . AS BUILT SANITARY REPORT Owner z 0 U _S 2 u e l I''! c 1 ,C ccy r Address 4/2 City/State W S -1 99/2 _ ��� s� 0 4 X ; c Legal Description: g P Lot Block Subdivision/CSM # '/, , %. ,mil✓, Sec. � T2fN -RAW, Town of 4 PIN # ��f- /ems - 30 -�� SEPTIC TANK -- DO CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer r �d c.. e dC Size ST/PC �/L � G Sv Setback from: House 1 3 Well P/L��3G Pump manufacturer 00 t Model S Alarm location A ti 4.5 � at e r V (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: ma k 4 C Width Length � / � Number of Trenches Setback from: House t Well A- P2 Vent to fresh air intake ELEVATIONS Description of benchmark P, ,n t.. Elevation U 0 Description of alternate benchmark ? a � e a z- 4 a 0t ; •, c Elevation of 2. /G Building Sewer q3- 2 �- STMT Inlet g 2, G 7 ST Outlet' PC Inlet PC Bottom 7 GI Header/Manifold G l Z Top of ST/PC Manhole Cover g q i Distribution Lines( C/4 . 5' 1- () ( ) Bottom of System () Final Grade O O ( ) Date of installation P _ ermtt number State plan number Plumber's signature �'"°`''� License number Date � /•? / Inspector ►1 i h e ('ompiete plot plan � ' Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM •Safety and Buildings Di Count INSPECTION REPORT • GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information ou rovice maybe used for secondary p [Privacy Law, s.15.04 (1)(m)). a i y ❑ Village ❑ Town of: State Plan ID No.: 004- 1028 -30 -000 CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel Tax No.: 1&6 . UU s A9800172 _ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark v7, Dosing b,�rla -t_. GSU a-� / _a er _4..M. Aeration Bldg. Sewer 1513 9 3 - Holding St /�ff Inlet �`�9�' �a•�"7 TANK SETBACK INFORMATION St/ brfE Outlet TANKTO P/L WELL BLDG. AirI to ntake ROAD Dt Inlet irl NA Dt Bottom - Fs' 4 7 Dosing j NA Hjjadm/Man. 5 9(0,( Aer NA Dist. Pipe 56b Sr 1 7 -5�z 4 Holdi Bot. System G -/o c-/ - �1(,-p6-' .oa PUMP /SPHON INFORMATION Final Grade Manufacturer ,J`,�_ Demand n Z4, . 6/' 9 � Model Number V 5� 21 -ftPM 6AA o e 4& TDH Lifts �� Friction 52 System2,s TDFVO.?�t Forcemain Length �Jr Dia. .2" 1 Dist. To Well S ABSORPTION SYSTEM s� BE / TRENCH Width Length ' No. Of Trenches PIT No. Inside Dia. Liquid Depth MEN 1 N DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER IN Type O Mo umber: System Dvd 4I� �Z N OR UNIT DISTRIBUTION SYSTEM Header/Ma ifold Distribution Pipe(s),, i x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length �� Dia. � Spacing ��¢ 8 rz 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 1C/ Bed/ Trench Edges 11! I Topsoil (ij ,Yes ❑ No Yes ❑ No COMMENTS: (Include.code discrepancies, persons present etc. LOCATION: CADY 12.28.15.190,SE,SW 422 J254H STREET J an revision required! ❑ Yes ❑ No Use other side for additional information. H � 4et SBD -6 710 (R.3/97) Date Inspe or's Signature o I � 1 pp ppp" ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: It Al SANITARY PERMIT APPLICATION 20 eE Waashinilgt isconsin P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, Wl 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less Countj than 8 vZ x 11 inches in size. Y. • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide may lie used by other government agency programs ❑ Check it revision to previod§ application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFOR ATI N - PLEASE PRINT ALL INFORMATION Pro PL ©0 , � ��Name ' C r ��p�o4ert /4, S I,� T �� , N, R I S W Property Owner's Mailing Add�ss Lot Number GJ Block Number �lz 3 3 2.0 I City, State Zip Code Phone Number Subdivision Name or CSM Number k r� W 3 q ?q c X1,5 > 772 Ys'3s ll. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it� Nearest Road _ [] Vil age C � S Public 1 or 2 Family Dwelling- No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) Cr 1 ❑Apartment/ Condo - G O ` - /(2,?e- 3 !� 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 / Cat 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_ [] E] Replacement of 4 Reconnection of 5. E) Repair of an --- _System ____ - _ System ------------- Tank Only_____ ___ - ____ Existing System _ ___ _Exlstln System B) ❑ A'Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -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 Re uired (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) / '7 , Elevation � U ? � /, 2 G Feet k Feet Capacity VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tan Tanks Septic Tank or Holding Tank 1 00 0 / W ¢ sit e T x ❑ I ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber LI 50 ( < < ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility foy)hstallationaf,,the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb �gnature: (N Sta ps) PRSW No.: Business Phone Number: fo S t cc <, Plumber's A( dress (str Gt State, Zip Code): 5 0 ( ! [ G PA c o �✓ l G.�/ : s '�(a 1�� IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San tary Permit Fee (includes Groundwater ate ssued Issuing Agent Signature (No Stamps) Approved [I Owner Given Initial Adverse Determinati Surcharge Fee) on X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (A.11/96) 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. 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.), 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 8 1/2 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 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. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce ' � REcE�v ,; August 11, 1997 ' rslaaicc- ti WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 II I RE: PLAN S97 -40931 FEE RECEIVED: 405.00 2UPANCIC, LOUIS SE,SW,12,28,15W TOWN OF CADY COUNTY OF ST CROIX MOUND SYSTEM PETITION FOR VARIANCE TO CODE SECTION(S): Comm 83.23(1)(e)(1). The Department has reviewed the above- referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All of the statements and supporting documentation included with the petition were considered. Since your request is similar to other petitions approved by the Department (e.g.s93- 00901),• Y'lriant&e requested Man to allow a This petition approval is granted conditionally with the understanding that all of the petitioner's statements included on the variance application form and any other documents submitted to the Department will be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. All permits required by the city, village, township or county shall be obtained prior to installation. SBD -7997 (R.11/96) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce WEGERER SOIL TESTING Page 2 August 11, 1997 PLAN S97 -40931 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Slnce � t G and M. Sw Ian Reviewer Section of Private Sewage (608) 785 -9348 5056L/ 2 cc: ST CROIX Leroy G. Jansky SOD -7887 (R.111%) I - r S97--40931 Page I of b MOUND SYSTEM R ECEIVED FOR JUL 2 5 1997 A 3 BEDROOM RESIDENCE SAFETY & BLOGS. DIV. LOCATED IN THE SE 1/4 OF THE S 1/4 OF SECTION � Z , T Z N, R 1 S H1, TOWN OF C,P�" ST- C�LX COUNTY, WISCONSIN. 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 .•�nu�ly o• . � :c- • dti 0 y.Z"3 3zo `Rt _ ST, Cori OP. O O SES � PREPARED BY WEGEE;tEFQ-- SO I L TESTS NG !t ' AND . ' DIES = GtV S�l4�V I CE AlS /�Y P.O. ROI 74 421 N. RAIN ST. : ARTHUR L RIVEN FATS. N1 UM WFGERER i o•s , • 715 -42. -01Z EtI ::WORTH, • Wis. SIG 1 JOB NO. 9 . ,. -� t , � �������c� ;� s., � , . sW�d� . 3 �re � e�.,f,� ���� '# sie �''�'� ��. #rte r 4. .�. „� 5� #; f - PLOT PLAN Scale 10 js. r Cowlvv�, tR, as.o' � t4 D t -E �21Ut�v �- a.y So of �. Q►�l i C3. Z �' t/1 Do NOT CtMPA UR 0 ` 1STU�B Slj�S Pit LcA P?v L E V� ST ZS' 4=um ) OUK.)> . Z. W. Zr u__ �_ $�j' �. PVC `PtiT LET Z s' Fjz_� Tft7.,, S. - - 3 . Qtti► - __L�... ton. 0 ' o�., � 4 N � H � 31 y'` Lit t�< Qv e - .l''_t1� -: !U��N�1-- �'�# M pM _BF FjL.l;JM>_ 5_ D�S!tm "I _ B l D _'t'jfE w►ou+�,o t►vTo `rti �X1ST :��t v� S C- T'? - NOTES •l. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( q required) 3. Install .4" observation pipes with approved caps. ( Z required) 4. tank to beIbm / 0 gallon capacity manufactured by �llp►tiJC3`T�JV � - �RSTa I�vC• S. Bench Mark Ste' i'n30 OE. 6. Divert surface water around system to prevent .ponding at the uphill side. Page � Of 6. Approved Synthetic Covering 1 prs - rm c 33 Distribution Pipe Medium Sand :sa H �t G Topsoil Elev'. q 6• �1' - F iJI - - -;; D 3 E e 15. % Slope Bed Of 2- 2 %2 Force Main Plowed Aggregate From Pump Layer D 't.o Ft. ' Cross Section Of A Mound System Using E Z•Z Ft. A Bed For The Absorption Area F o -8 Ft. G 1.0 Ft. A $ Ft. H 1 - Ft. Linear Loading Rate = R-(- GPD /LN FT B Ft.. Design Loading Rate= o.12GPD /SQ FT I Z2. Ft. J 6 Ft. K 1Z Ft. L 11 Ft. ef- F-orc-e -Main W 3 Ft. L Observation Pipe A W I• - - - -- --------- - - - - -- ----------------- - - - --- Force Main 0 « oppu��T Distribution Bed Of i � « i - 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchb= securely) Plan View Of Mound Using A Bed For The Absorption Area Page L4 Of b Perforated Pipe Detail \0 End View ) Perforated End Cap . cam` a PVC Pipe Install permanent 'marker ?' Joa at end of each lateral Notes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe Distro ution Pipe Lost Hole Should Be Next To End Cop End Cop P zZ Ft. Distribution Pipe Layout S ^ Ll Ft. X 1 19 Inches Y LIIInches Hole Diameter 1��1 Inch Lateral Inches) Manifold Z Inches Force Main Z Inches # of holes /pipe Invert Elevation of Laterals -'S' Ft. Place lst hole - 2- 4 from center of manifold with succeeding holes at Ll $� intervals. Last hole to be next to the end cap. Combination Septic; Tank and r PdMP CHAMBER CROSS SECTIOU AAIO SPECIFICATIOIJS' PAGE `� .OF �o -NEWT CAP WEATHER PROOF JUUCTIOLI BOX 4"C.I. VENT PIPt APPROVED LOCKING 10' FROM DOOR, MANHOLE COVER 601'11'{ :iIUIDOW OR FRESH WRR�IIUJ�. L.aeEl. ALIIIJTAKE a CoraputT r a� t' I ffL, 9.S _ T Cam- ° l"1 * K,RJS 'i" MIN. f � PROVIDE I - - - -- IfJLET AIRT16HT SEAL 30.rt �L�S A I I I APPROVED JOINTS APPROVED JOINT I I I W /C.I. ? W /C.Z. PIPE aR Tank. construction I II shall comply with . II ALARM ILHH (83.15 and 83.20 d I I ON C I I LLEV f Y PUMP--_ - -� OFF D COUICKETE $q.00' `� e>.00K 3" APPRcvE RISER EXIT PERMITTED OMLy IF TANK MAIJUFACTURIER HAS SUCH APPROVAL B6DDINfi SEPTIC f SPEGIFICATIOKIS DOSE 1r'tt0 JV 112 Uf3T IJUMBER OF DOSES 3. S'Z PER DAU TAWK MANUFACTURER: TANK SIZE: 6$O GALLOAIS DOSE VOLUME I ALARM MANUFACTURIR: 4 S �-� �CRA �-1S`T% IIJCLUDIN BACKFLOW: �3b GALLOIJS MODEL U UMBEK: ,0 N w CAPACITIES: A= 8 I Sot° GALLOUIs SWITCH TUPE: I't cUR-L( B = Z I U CHWOR 34 G(►LLONS PUMP ) WANUFACTURER: ZdQ"-SEZ C: a IUCHES OR GALLOU5 MODEL 1JUMBER: S D- , INCHES OR GALLOWS SWITCH TYPE: ��ZC� MOTE: PUMP AMD ALA RC TO BE � MIUIM DISCHARGE RATE 2 4. 0 ? GPM, INSTALLED ON SEPARATE CIRCUITS • 6.61 VERTICAL DIFFERENCE DETWEEU PUMP OFF AUID.DISTRIBUTION PIPE.. FEET + MIA.IIMUM NETWORK SUPPLY PRESSURE .: .. 2.510 FEET + SO^ FEET OF FORCE MAIN X I 61 F 00ftFKICTIOU FACTOR_. D ' a I FEET .._ TOTAL DtJUXMIC HEAD = x'26 -FEET DIAMETER Pump chamber 38k IUTEItUAI. OIME.1Jfi%OIJt OF TAUK: LENGTH ;WIDTH LIQUID DEPTH BOTTOM AREA '"� 231'= GAL /INCH AS PER MANUFACTURER = \�. "O GAL /INCH F w 3 15/16 -6 5/32 TJe OFO W HEAD CAPACITY CURVE l_ "53 - 57" - "55.59" SERIES ' 4 5/8 1 1/2 -11 1/2 NPT zs TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWATERING 3 15/16 6 50SERIES ° 4 1/16 Ft. Meters Gal. Ltrs. x U 15— 5 1.52 43 163 Z 4 10 3.05 N 129 p 15 4.57 19 72 F 10 p Lock Verve: 59.25' O 2 5 Z8 -O 10 1/16 0 U.S. GALLONS 10 20 30 40 50 ( 3 3/32 LITERS 80 160 -� 0 FLOW PER MINUTE 3KNS SKM CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Available with special cord lengths of • Variable level long cycle systems available. 15', 26, 35' and 50'. • Alarm systems available. • Duplex systems available. SELECTION GUIDE Standard cord length - automatic 9 It 1. Integral float operated mechanical switch, no external control required. Standard cad lerKffi - non - automatic 15 t 2. Single piggyback variable level float switch or double piggyback variable level float M53/55 and 57159 Se ries Control Selection switch. Refer to FMO447. 3. Mechanical altemator'M -Pak" 10 -0072 or 10 -0075. Model Voles Ph Mode Amps Simplex Dup 4. See FMO712 for correct model of Electrical Alternator, E-Pak. M53155 & M57159 115 1 Auto 8.0 1 or 1 & 7 — 5. Variable level control switch 10 -0225 used as a control activator, with E -Pak (3) or N 7 4 (4) float System 4 7 — E53155 & E57159 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 wined -in simplex or 2 Pump operation, PM 10 -0002. 53 Series - m 22 Ibs. 57 Series - Mk 27 lbs. 7. Two (2) hole J-Pak, junction box for watertight connection or splice, 55 Series - WL 24lbs. 59 Series -1M 30 Ibs. PM 10-0003. CAUTION For information on additional Zoeller products refer lo catalog on Cornbination starter, FM0514; All Installation of controls, protection devices and wiring should be done by a qualified Piggyback Variable level Float Switches, FM0477; Electrical Alternator, FM0466; Mechanical licensed electrician. All electrical and safety codes should be followed including the most Alternator, FM0495;SumpfSewagefiasins, FMO487; and Single Phase SkrgkxPumpConhoVAlann 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. MAY. TO. P.O. BOX 16347 1xidsville. KY 40236-0347 Mam/aduers of. . SIRP 70. 36/9 Cane RralRGred Loinft KY 44211 -1961 iiu r P S�cE /939" ® f'L//I) L O (502) 778 -2731 • f (600) 928PUMP FAX(542)774,W4 :. Wisconsin Department of Industry SOIL AND SITE EVALUATION REP 0 Page 1 of _ Labor anti Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. a Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must i J ��) x not limited to vertical and horizontal reference point (BM), direction and % of slope, r .i; EL I.D. dimensioned, north arrow, and location and distance to nearest road. ..+ APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION f U IN � M � BY DATE 11 r. PROPERTY OWNER: PROPER TION - t y rt r Zv QZ ,N,R 1S E( W PROPERTY OWNER' MAILING ADDRESS LOT # BL CITY, STATE ZIP CODE PHONE NUMBER []CITY 1 NEAREST ROAD 1�CPP w - S L4 (NISI -1-1 2 - Ll S 3 S I 4 1 '3 [1(] New Construction Use [M Residential/ Number of bedrooms y [ J Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate o •3 Z bed, gpolft - trench, gpdtft Absorption area required bed, ft S tYu trench, tt Maximum design loading rats O - S bed, gpdrlt a 6 trench, gpd, Recommended infiltration surface elevation(s) CI L �" O It (as referred to site plan benchmark) Additional design/ site considerations }'1bufqp b w / 8 `X 62 Li ft . WI 1 Aj . 1 o F 3" F-1 LL. S ; Z 2 Parent material $ r V4 S g\ I m ��ooT ov QR Q\ T t t-t_ Flood plain elevation, if applicable fy • A . It S = Suitable for system CONVENTIONAL �c MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem 0 S U ®S ❑ U ❑ S ®U 0S 21 U EIS ®U ❑ S Eau r SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxtdary Roots GPD /ft <,,. - ts. in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Red tench ti " 0_6 LO `12 �(3 — Std Z `� 5�1t my �M 0.,S - o•S 016 S t S Z Ground 3 19 -39 7.S `212 Sly _ S u S 5 elev. g 3°! -c(S tU YlL I� _ �•S `tfZ sly �� oti,, r�'�i Depth to limiting factor 5 Remarks: Boring # , o- L - 3/3 s L � Z� S b k )- NN j "1- OL '1 3 LO � `t R- wy S 2 S� wl u T1- C S a. S o. L 3 Z9 -3 lu-t 2 vj/ � y s C )i \114�; i Ground elev. 1 - ft Depth tD limiting fa Remarks: CST Name: - Please Print Pho ne. Arthur L. We e r e r 715-425-0165 e'gerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: Date: T Number: 9 6 - I'ZO - SU)"JE is L`�:t CS M00576 PROPERTY OWNER ZU�'fr1�1 C SOIL DESCRIPTION REPORT Page L of 3 ' PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence eourrdagr Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.. Bed Trench O -`V W -1 1'Z 3 l 3 S 1 2 1 h wr L"• S u • � 3 .. Ground bLl fZ S d- 6 elev. Ott. 3o -�fi S`?f23ly - ) \ i=SUk M `f't^ CS'' _ o�y c,.S Depth to `7 IL y /.tv S O S y I — o '� u. limiting factor Remarks: Boring # I o -1 10` 313 St Z�' Sbk mv `��. Z '� - 10 `1VZ Yl — S1 2w►gUk Y�'FL- Ck, ° ' S ' ° ' 6 cw - �•�/ c� Ground elev. Z -S 7.S `tR YID 1 `1iZ 3/1 Se.\ 1 es�k �►� �>^ — — — 9 2.0 ft. Depth to limiting factor Remarks: Boring # Ground elev. I ft. Depth to limiting factor Remarks: E3 Boring # f Ground elev. ft. Depth to limiting factor Remarks: inn o•»nin 01 In" PL V P LAN Page 3 of 3 SCALE 1 "= Ll ' r` i - v "o l h • PU C W /woub L g�? " I , a.y Ln - -� �O 1vuT I�LSIU1'� -t3� �^ 300 @ \ o qb 6 , Do NOT C -,Pft- 012 N n) wF Pr t_.e T Zs' mov►. W�ELL 4e •.. h i. Su L. k q6 -IZV SU1.J ( 715 42q - 0165 M 0 0 5 7 6 CST Signature Date Signed Telephone No. CST # fawn inDep o�� SOIL AND SITE EVALUATION REPORT Page ofd Division of Safety & Buildngs in accord with 1LHR 83.05, Wi 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 I.D. 0 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER. PROPERTY LOCATION L u v X S Z. v P t*r" C I C SF 1/4 SW 1 /4 ,S \ I T 7-8 .N 1S E( w PROPERTY OWNERS MAILING ADDRESS LOT I BLOCK if SUBD. NAME OR CSM to �I Z. 3 3 ZO ` — CITY, STATE ZIP CODE PHONE NUMBER [:]CITY []VILLAGE ®TOWN NEAREST ROAD �►JPcPP >N S C)lS)771 4S3 S Gib 3 Z S T* 'ST. [1Q New Construction Use IM Residential/ Number of bedrooms y [ I Addition to eAsting building I I Replacement I I Public or commercial describe Code derived daily flow VDO 90 R=nmended design loading rate bedg01t . Absorption area required Soo bed, 2 Soo trench, 2 Ma)dmurn design loading rale o • S bed, g pd* 0 - 6 trench, gpdV Recommended infiltration surface elevations) CI L ( 14. 1 3 ' ft (as referred to site plan bendurlark) Additional design / sit- oortsiderations }'1o yNtb w / 8'x 63 ' Belo. flit 1 rv . I � o F 3" H L�L. 1 Z Z 2 r Parent material %L t_ Vy S Km rt ka r*r ou CM 0-k T t Lt Flood plain elevation, if applicable lV - S = Suitable for system CONVENTIONAL MOUND qJ GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system El 0 U ®S ❑ U ❑ S ®U ❑ S ®U O S ®U 0 S Ea * 4u SOIL DESCRIPTION REPORT 0 Boring # Horizon Depth Dominant Color Mollies Texture Structure Consistence Bolnday Rests in, I in. Munsell Chu. Sz. Cont Color Gr. Sz, Sh. Bed Pjad si mv'(`M O' - M.S o -_6 Z S -t9 W`12Y - S l� Z$ Sb6C yrffl- Cw Ground 3 1a - . S `t 2 NY S b S g �„� � � _ a• � a- -� elev. L ,� C Uga tt. �} 39 -�5 ►u�2 ylL �•S Utz sit; rn I' Depth b limiting facia 39 y Remarks: Boring # �16\-iz.313 s ° - o -S o 1 .� Z Z 6 M Lo `1 R v wi U Ti, C S l a.s a L Ground 3 29 -39 t Opt 2 V/ 6 I elev. 1 -5 tt Dep th b limiting j Z9 Remarks: T11ane:- Please Print Arthur L. We erer Pf,one. 715- 425 -0165 V e " g w e ' rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Sgnabre: Date: - ...CST Number: -, - -- - - C) t20 Su>v 8, -lqft6 M00576 1 PROPERTY OWNER ZU \�PrIV C 1 C SOIL DESCRIPTION REPORT Page?- of 3 PARCEL I.D. # 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 Q)- W -t 1z. U a 5 U. } . " Z - �� `� �z y/y s ►) Z- ` s k wt e � o , s u. L Ground 3 �'1 -3u lb`i fZ 3A. o• S ei- 6 elev. M-Zft. 3/y \ C..3Uk MUii- Depth to (3 S Y4 — o o• t limiting factor Remarks: Boring # 1 0 -� 10`t12 3!3 St Z'�Zbk WA a.S Z 'I -Z.3 v) , q2 y! _ St 2 to g U k yn C Lv 3 i 3 Z9 �•S`1R 3/y — S� �m S1�k >n �l- cw - o•u c� Ground 9 zvo ft. Z9 -sy �_ S `%rZ y16 Depth to limiting factor z°f'' 1 Remarks: Boring # Ground elev. ft. Depth to limiting factor i Remarks: Boring # [3 Ground elev. ft. Depth to limiting factor Remarks: nn n nnrn nr n �. PLOT P LAN Pa 3 of 3 SCALE 1 "= I ON -- 7 HI G u , . • S oVo � ' w /wou� l f} tom- c1b / 8. y e-L -cL 0 DV 1VUT ►�lsTUl'`t3� �^ / •c 3oa` —�—� 8.1 0 ot6 N � cF a c'z �►► S - Do NOT C0m p hcT Olt N I ' ovSE �U BF PrT l.QNsT zs' t-►zei 1 Y"iau►.A, W�TLL 4 ,, slj' e, 4'6 -IZO 15 42A-016 Gsf Signature Date Signed _ Telephone No. CST #-r- __. r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ll OWNERSHIP CERTIFICATION FORM L Owner/Buyer / s a ( A f c �' Mailing Address n 77 Property Address 010 (Verification required from Planning Department for new construction) OF City/State Parcel Identification Number LEGAL DESCRIPTION Property Location- '/., S y Sec. �, , T N - 1 5 W Town of Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # `l KG L Volume at/,7 Page # `l v Spec house ❑ yes M Zno 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have-read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. NATURE OF ' L DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. -5/ 1 '�- � § IG14ATURE OF A&LI 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 ` OOCUMENT NC. WARRANTY OM TWO sracs Itas€an.D •on a Re DATA STATZ BAR OF WISOON31N PO- l---2l SIERS G WAL for Rid ab 1 �T2itua. #auj�eeman and Jean H. Hauserman ........... ..................................................................................................... 830 ............. ............................................ ....... ...................... ......... lc eonveya and warrants to ..... L ............ ouis ... u anc ................... ............................... ........................................ ...............•.............I. asTVeeN TD ... ........... I • ................................................................ ..•- •- ........................ I _ the following described real .state in ......... St.. .- .Croix .................CwDty, 00 State of W iseensln . 0 0 yc — 10.2 $ 3 s7 Taa Farad No; The Northeast Quarter (NEk) of the Southwest Quarter (SW%) and the South One - half (Sh) of the Northwest Quarter (NW %) of the Southwest Quarter (SWh) and the South One -half (Sl%) of ':he Southwest Quarter, all in Section Twelve (12), Township Twenty -eight (28) North, Range Fifteen (15) West. i 4 � � „ .FE This ........1. .............. homr_tead property. (i:) (is not) Exception to warranties: 28th ( � Dated this ................................................ day of .... may , 19.... fi ............. (SEAL) �1�x!u!11i1-�^� (SEAL) • ........................... • Pl 11`L1V It:'.l) __.......------ f ...... ........ -•---• .................... .........................(SEAL) ....... .......... .......................(S -:AL) �i ........................ ----- -._... •-- •--- •- •-- •...--- ........ ............. i' AUTURNTICATION ACHNOWLBDOMENT I! Signati re(s) ------------------------------------------------------------ STATE OF Maine i� ss I f ...... Cumberland Cou authenticated this ._..-.-.day of__-.-.-_-••---•_-- -- ......, 19.....- Personally came before m., a this ... 2Bth_.day of „ .......... ....... ... may - - - - --- -- --•- -, 19_,,.7. the above naiped •.. ... .....---- ••- ••- ••-- •- •- •- - - - - -- - - -- -Will ar�fiouseman..and..3ea�n _ .:�``� I P l TITLE: MEMBER STATE BAIL OF WISCONSIN FIQUSB?A 'Q (If not, ............................................................ a W --- . -- •-•.._ ..-• -- •- - -- ---•----------- -•- authorized by 0 706.06, Wis. Stats,) vd i f to me wn to be the perso* ............ who exeertt fo ing natrument and ackn wledge the same. THIS INSTRUMENT WAS DRAFTED FTED 9Y _.(!__ _ •�, 8tvanson and Loberg ----_----------------- ------ •----------------- ------ - -- --- Robex:t- L _.-- Lobexg--------- •- ••-- - - - - -- ................. Notary Public ... ............................... (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) My Ct'UNiZVOtA E)ARO. date. ...................................... . 19_..•• - - -•) •NSEWS of Verges sienlnu In any capuity should be. typed or printed blow their signatures. STATS BAR OF W ISCONSIN Stock No. 13043 FORM No. I -- 1982