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HomeMy WebLinkAbout004-1040-20-000 I _ i ST. CROIX COUNTY ZONING DEPART ,N)[ AS BUILT SANITARY REPORT ; `.,. %� /� � C '` Owner !J Gt C CL /t ,S A 00 Address 2 Y10 r 98 City /State I�t/, San l,�/ S 1, s cR x tits ; Legal Description: Lot Block Subdivision/CSM # L 1 Z� t�, PLArA Sw/ Sec. a, T-gfN -R I r W, Town of 6 A PIN # o - - 2.p - SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer V /� d k/astt�h Size ST/PC - Setback from: House � l Well P/L f 4, Pump manufacturer 8.0 [I't pe Model / 4 3 Alarm location h of y H if /+1, (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm lotion SOIL ABSORPTION SYSTEM: Type of system: Gu A 0/ Width v Len gth 2 Number of Trenches Setback from: House Q(& Well P/L 1s ^7 Vent to fresh air intake ELEVATIONS Description of benchmark N I / q / l 3 /-/ G G' Elevation Description of alternate benchmark Elevation Building Sewer �rl ST/HT Inlet ST Outlet_ W 4 3 — PC Inlet PC Botto Header/Manifold A — IS - Top of ST/PC Manhole Cover 7 S", S i Distribution Lines () y Bottom of System ( ) gy q () ( ) Final Grade Date of installation /. / d Permit number 3� 7 State plan numberj/ Plumber's signature D-�'. License number 9 S"' Date 5 /3 Inspector /?Gd ('omplele plot plan Q x I 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 % - N N �� t`v► 7' I O. �g0 4 k A 9 t ss INDICATE NORTH ARROW Wisconslfi Department ofCommerce PRIVATE SEWAGE SYSTEM y: � Saf�,y and Buildings Division Count INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 320204 �rplttLQ , r s W R C ' H ❑��t�[] Village Town of: State Plan ID No.: CST BM Elev.; Insp. BM Elev.: BM ' Description: (� , e, Parcel Ta o.: g rJ�>�J4- 1040 -20 -000 TANK INFORMATION ELEVATION DATA A9800392 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ p eptic I (/ln - Bench m r IaZ3S Boa Aeration _. _._�.. ,.�. /` Bldg. Sewer - 7 0 "9� '75_ 1 Holding ...._. _,., ., , ....._.. (P-01 Inlet �`I lS /0,3 — 7 5 ?Z:, TANK SETBACK INFORMATION (Jt/ utlet . i 10, 73, TANK TO P / L WELL BLDG. vent to Airintake ROAD Dt Inlet �� ,' 1 1. 3 - 7 72 Septic v - t — N 2 NA Dt Bottom 5f 44, /5 1 3 67 D 3 Dosing I i 1% 35 �b' NA Header / Man. - �7 �, E '' •."' Aeration _ A Dist. Pipe Holding Bot. System ,Z g- 3L�cl.�, PUMP / SIPHON INFORMATION Final Grade Manufacturer ��r^~ l l Demand 54 K52l - 7 S� Model Number GPM } /} L& JJy TDH Lift 25 Friction yetem ;tA TDHFt 9q C5 [ Forcemain Length Z30 Dia. 1 �7_ Dist. To Well SOIL ABSORPTION SYSTEM BED TRENCH Width s Length e* No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N? DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LACHING purer. SETBACK CHAM INFORMATION Type Of t ' umber. Systern: l✓cR. Z�j '"j�_ — OR UNIT DISTRIBUTION SYSTEM Header/Mani fold Distribution Pipe(s) x Hole Size x Hole Spacing 'Ster►t To Air Intake Length Dia Length G. J Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center I; Bed /Trench Edges i - I Topsoil I?j Yes ❑ No ® Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Ij5 _ /I 63,Z LOCATION: CADY 17.28.15.268C,NW,SW 2810 CTY RD N o 1 Plan revision required? ❑ Yes 0 No Q Use other side for additional information. ° ! c / ►t�S�Y SBD -6710 (R.3/97) Date Inspector's Signature Cert� ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E E e a e ; ; e t F f s E e e e e .e ee e , t I e e t ; t E Safety and Buildings Division V SANITARY PERMIT APPLICATION 201 W. Washington Avenue sconsn In accord with ILHR 83.05 Wis. Adm. Code P O 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 , than 8 1/2 x 11 inches in size. •�'rD1X • See reverse side for instructions for completing this application State Sanitary Permit Number dp Personal information you provide may be used for secondary purposes ❑ Check it revi 3 iozc i revision to previous a lication [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION PLEASE PRINT ALL INF MATI N R 1� 3 2�1Z Prp Owner N 'XA T GYl ate Q U. T 1✓ r N W /4 S L oc a tion W 1 /4, 5 17 Tag . N, R 15 E (or)�@ Pro erty Owner's ailing Address Lot Number Block Number C Rd N I — ' City, tate Zip Code Phone Number Subdivision Name or CSM N �!U ►� tm l,u �4 van ( ) I1. TYPE F BUILDING: (check one) ❑ State Owned It� NearesfRoad p Vil age Publi 1 or 2 Famil Dwelling No. of bedrooms Town OF a d C Rd N III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 6 `l - /0 v - U - v (? V 2 ❑ Assembly Hal[ 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. M New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5_ ❑ Repair of an - __ - __System ________ System_____ ___ _ ____Tank Only Existing System - _ -_____ Ex)stln�S� stem 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 [SMound 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 13. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation c 5 5 '7` t . I l� g�� Feet ��0. Feet ut VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks r� Septic Tank ) /A0D I MI' (,Ue er [A ❑ ❑ ❑ ❑ ❑ Lift Pump Tank of600 I 1 I d LUC`j r 1 ® ❑ I ❑ I ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit for insta tion of the onsite sewage system shown on the attached plans. Plum er's Name: (Print) Plum er's Signat r o Stamps) MPRSW No.: Business Phone Number: Plum � , 3y 5 1- s : egg lo / Plumber's Address (St eet, City, te, Zip Code): 5 010 W 1 f o' DP . oc"AU, I lc, W2 IX. COUNTY / DEPARTME USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ® A pp roved ❑ Owner Given Initial �� AV. Surcharge Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: < w`rl1 Y'��vt✓'.G Gc. �ohhg 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 S. 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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 manufacturers name, indicate prefab or site constructed and tank material. Complete for all septic, pumpisiphon 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 modeI, 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 and Buildings 2226 ROSE ST ` IA CROSSE WI 54603 -1905 AA Isconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary July 17, 1998 CUST ID No.220499 A7TN. POWTS INSPECTOR BRUCE ALLEN WEBSTER N3659 CTY RD C ELLSWORTH WI 54011 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 07/17/2000 Identification Numbers Transaction ID NQ 113292 Site 1" SITE: P a bo a tin numbers, Site ID: 13906 ox all c d the.agency. St. Croix County, Town of Cady NW1 /4, SWl /4, S17, T28N, R15W Butch Sauter i FOR: a ) ' ' t,, C Description: Mound a Object Type: POWT System Regulated Object ID No.: 29483 �\ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, d� DATE RECEIVED 07/08/1998 FEE REQUIRED $ 180.00 ( M SWIM. PO TS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JS WIM @COMMERCE. STATE. WI.US State P(an # 113292 Parce( I.D, # 04 J ul -, S EIY BUTCH SAUTE CADY T ❑WNSHIP s. G p,p o rially �>>z d NW 1/4 of SW I/4 �g ��ED Section 17T 28 N R 15 W� ERCE 1 MIENT OF GOMM LDINGS.... pF.PAR SaFE1Y AND St Croix County ptv ►oN -e COPSE ENCE Page 1 Title Page Page 2 plot Page 3 cross section and plan view Page 4 Distribution Pipe detail Page 5 Pump chamber Page 6 Pump Curve owo ulufful little � !!! '1l sNO3a�� ' a� Jim r PC�,ar" n C + o �G c O o Q A � 3 Q N Z 0 c Q � 3 Q 3 * < m �0 t a'�1Z 3 3 O 2� ?0� C3 p _ J? P 3 N c V D N 3 A � C 3 A n .+ O 3 N ` �' O� C hIeF ! -4m P A 9 rF 03 N H A YI A O %0#4 W3 l o B ee 88.7 ti �mm Opp e st fen ' lot line , = '+ 0 X33 y � 3 a N N �O I� cl - o o 0 D �x W - fop 3 �Sp1YflMlp1/ +�` 1 5C � NSj 0 ` ro 3 s rr�N < $ ' 0 0 f0 a O < - O - 5 a o gin_ coo 0 0 �o ��� 5 I G� �. Q 1 - Straw Marsh Hay, Or i is. :YSynthetic 'Covering Distribution Pipe Medium Sand G r 6" Topsoil = _ = -= =- ` F p.� „ d� `\````a`a uqununuanq�p i � P °/, slo �. Plowed Bed Of 2 _ 2 Force Main 2 ° . �E Aggregate Layer C a,.o z (6" Below Pipe) V i : &B8 . D V Ft. `�.. s q y E Ft. Cross Section Of A Mound System Using Q Ft. A Bed For The Absorption Area G l t Q Ft. ,,n L q I ® Ft. H �5 Ft. Sign d: r� ,+l2 ��lr,�'� B �`� Ft. License Number: I /`�I K I Ft. L 1 IT Ft. Date: I f 7 Ft. _ I 1 Ft. ' W: Ft. Observation Pipe- - F A Force Main W° - -- - - -- - - - --- - Distribution Bed Of 2 2 % Pipe Aggregate Observation Pipe Permanent Markers ' View Of Mound 'Using A Bed For The -. Absorption Area PAGE GF v PUMP CHAMP,ER CROSS SECT IOW AfJG SPECIFICATIOMS — I VEIJT CAP j Y ✓ENT PIPE WEATHERPROOF F APPROVED LOCKING — T y "c � -' JUMCTIOU BOX MANHOLE COVER 25' FROM DOOR, " WINDOW OR F ESH 12 M1U. AIR INTAKE I " I _ f GRADE COQDUIT -- 18 "Mlnl. _ l v,�quuunn�rrnnp'" I — — — `��� pi�4 PROVIDE - - - -- INLET ��15�'ONs+l pi��% AIRTIGHT SEAL I ( I -.. '\ I A � � IaRU��u.EN = I I ELLSWORTH q N I ( ALARM 4 C D �� S WITH I I- LEV. ' APPROVED PIPE L, {5 3' ONTO PUMP OFF D SOLID SOIL Dp i;'w M� MvMJM COAJCKETE BLOCK RISER EXIT PERMITTED OiJLH IF TAUK MAULIFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFI'CATIOKIS ` DOSE- TA W KS MAMUFACTURER: wes�ev PJeck51_ NUMBER OF DOSES: PER DAS TAkMK SIZE GALLOWS DOSE VOLUME ALARM MAMUFACTURER: t e ,e INCLUDW6 BACKFLOW: - GALLONS MODEL IJUMBER: L✓ CAPACITIES: A= °� � MCHES OR � G� 5 SWITCH TSP[: rl�rcur B= INCHES OR "' GALLOMS PUMP MAMUFACTURER: 2 � ` ` �� � � �` C= IAICHES OA GALLONS MODEL MUMBER: 0.S �° 3 D - INCHES 0R GALLOWS SWITCH TYPE: M�2C MOTE: PUMP AMD ALARM ARE TO BBE �. 5'1' 1A MIWIMUM DISCHARGE, RATE z) 3' GPM INSTALLED O SEPARATE CIRCUITS_., VERTICAL DIFFERENCE BETWEELI PUMP OFF AMD DISTRISUTIOW PIPE.. U. FEET - MINIMUM NETWORK L PR SUR ETW RK SUPP ES E FE. ♦ 0 FEET OF FORCE MAIN X... 'i._ 10 FLF RICTIOW FACTOR.. 3' 3 FEET :fa r -- - TOTAL 0SL AMIC. HEAD = �$' FEET I r INTEFt1JAL DIMEIJSIOMS: OF TANK: LEIJGTH II ' P _•WIDTH = LIQUID DETH 51GNED: C U�I LICENSE UUMBEC �� �) DATE ; fjL 7 — � Distribution Pipe Detail For A Four Lateral Network A •. � �a6R Jt �tJt -.. 3 f. IRW 9•fF'Y .0 ... ••s Alternate _Pos'ition Of ,,End .Cap Force Main PVC Distribution Pipe PVC Force Main P Holes Equally Spaced PVC Manifold Pipe On Bottom �. X X 2 * Last Hole Should Be * IY P�L� F S Ft. x Inches Y 3 Inches (i� !Signed : ✓ZGGC�: Gti/ -- 9 � Hole Diameter Inch License Number: ,�/ ! Lateral Diameter t A Inch(es) - Date: Manifold Diameter Inches ��,a 1gCO�r Force Main Diameter Inches ER t "" / Holes Per Pipe to w s Invert Elevation Of Laterals 0' Ft. tom,... �..._ i a� l HEAD /CAPACITY CURVE TOTAL DYNAMIC NEAOXAPACITY PER MINUTE EFFLUENT and DEWATERING EFFLUENT AND DEWATERING i C WARNING: Model 185 should not be subjected to „ ' less than 30 feet TDH. I1 1 TOTAL DYNAMIC NEADAa►ACrtT►ER MINUTE 32 EFFLUERTANDDEWATERING 100 33 36 93 SERIES 37-61 N 13744 10 tp to its 1K IN IN 2e 1r. M' 0t U9 an L": at t n :: at Lw " ua : 0t :ui at l rc of L► ` of if i 90- s 1A2: N tb n Sit fa >tl: tN 16i:: tt tlf: tl ::xtt N `M:. 155 Iti: 153 26 10 3os: H :12U 61 :,Z3 V 70 301 104 371? 61 .2 31 M :2u x xx> 1a ice:: 151 :rn SS 1s tat:- 19 > tt 1 43 :1116. 44 llti: 01 . 34C N : t. so N 142 q2 la #M:: 24 20 iti. 23 ;: pS A x lw S2 :310:: so t2t: N :227 N Y2C 1N 1111!: la ?370: 75 b . >S2: t ' >0: 74 2a: 37 llt. x :M N 2SC: 129 AN: 133 46.: 8 22 e6 30 a4 a xi: SS . W N:us so sa 54 :x:121 a1:: t27 0 1 y z 7 a 112110 a Y71: a In': a Zla n :.2p:, x : 103 207;: 11443 } 20— 65 N SAt4 21 :10: u txi: S1 >tN N 4%. N : 120' N mt. 100 170: 3 16 N it2! 1! S7: a ;tit x ,{%t 14 .U6: 71 :w a :a: i 30 4 10 .4k. S2 - - 10:: 31 :1 v » ;.20: i 55— a 2U0:: 14 : `St a A70: 24 :M:: 34 >2M 0 16 0 100 '3Na : i N `: i i 21 .i V ,• s no 3200 7 17 ` LMcVM U2!' D' 2t' %' 0r tr n'. .. 113• N' 11Y j e 33 to NXI 16 a 6— 0 161 IS lee t 2 le HEAD /CAPACITY CURVE 3 3 o 57:5 SEWAGE and DEWATERING y � 70 30 4 60 70 Sol 90 100 1110 120 >0 t10 SO 160 �\ ea ,60 2 40 320 4 60 460 560 6w WARNING: Model 293 should not be subjected to 0 FLOW PER WNUTE less than 15 feet TDH. TOTAL DYNAMIC HEAOXAPACITY PER MINUTE SEWAGE AND DEWATERING SEMES 212 24 4 297 211 212 294 212 213 201 2Q 411• FT. M. G61 Lts G61 LIn Gal LYs Gd U G61 Lts G01 Los G01 Lts Gd La Lts Gig I tt Gal I" S 152:> 90 3115; 126 Idt': 121 ': 121 /d4:; 130 %a92 160 611 140 t E90 196 71l: 22S a7 100 1513::'. G 2 3QS::: 60 .T2T 69 .337. 89 137' 19 977:: 95 160:': 1Sd : 491:. 124 161 .;.414 ZOS ;`714. $50 fY : 15 225 . _ts SO 769:; SO .164:; s0 119:: 63 236,: 135 tii #' X01 130 Y92 165 :624` 115 >t0�. 300 ,1196: 20 619;: t0 JA _i' 10 '.!6 `: 10 33 126': t 1. N : 119 : I50 : tsG .;666:. 168 :_676' s TS >: .: 22 76 ::j11: 66 106 ; 40.1: 136 $t¢ 153 '.::. 200 "' 30 .1kI 47 ,1.Td 90 :.710'' 121 ;146- 140 >iwii: ISO :541 TO t214; ':: 5 19 s0 1d9 94 ':966 115 :195: ,s so ss 60 1x29 1L 04 59 :Y21 ,s 4 70 2151 2S Y -4- LockVsW 16• 215• 215• 21 26' 1 35• Q' SO' 62• T7• 40 2 .0 7s r ,0 o 291 `+ s J » s 70 7e7 s 2e. ,0 2 262 292 29. ]91 .OS 0 ..c c.•,...c .n 1 ,n .nl ti •nl >a ,nl 9n ,mli,o ,m I, JO ,m hs0 ,eo hm,9n, >m >ir1 »n >�J >.n w>Ixn >m h... �... i...,. .,, .1. ..,. ...1 ..,, ..a .... ......... ..... i... .. .. - Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page / of Labor and Human Relations Divis;.on of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code -" • COUNTY 1 1 , 11 0) 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 PARC t Q Y; 5� � dimensioned, north arrow, and location and distance to nearest road. —] Q a / A 1 1/ -9- C) REVIEM � BY r. DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION A a � 1 � f rr%r PROPERTY OWNER PROPERTY LOCATION 6, GOVT. LOT 1 /4 , , ( S � 1 E PROPERTY OWNER':S MAILING ADDRESS f LOT BLOCK SUBD. NAME 0 ' ; CITY, STATE IP_CODE PHONE NUMBER ❑CITY ❑VILLAGE MWN NEA _ROAD: =% New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow Y50 gpd Recommended design loading rate bed, gpd /ft — trench, gpd /ft Absorption area required � b , ft 7"e & tre en nch, ft ximum design loading rate .- 5 bed, gpd /1`1: trench, gpd/ft Recommended infiltration surface elevation(s) 9a, b ft (as referred to site plan benchmark) Additional design / site considerations j s C X r K Y7 EP S Parent material t ��- ©c� ��a, '� : t Flood plain elevation, if applicable ft S = Suitable for system CONVENTgISN L MOUyD ❑ U IN-GROUND P SSURE AT-GS DEE S M IN�FILL HOLDING T U = Unsuitable fors stem El [�'S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench v W l , 6 1c Ground 1�s 7- C I 0 kS� 3 elev. �. c _ ft. c © n Ll t Depth to limiting factor -p Remarks: Boring # -Ps 11-17 s vim. �_j I U Ground 11ii elev. ft. Depth to limiting factor �t Remarks: CST Name: — Please Print Phone: j Address: S r i UJ I -e1- Si ature: t Date: CST Number: PROPERTY OWNER l ''��"" b SOIL DESCRIPTION REPORT Page c"�of 3 PARCEL I.D. # �C5 q — /O `t — - �O . Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground - Cj ! elev. Depth to limiting factor e if Remarks: i Borin # 3- . Ground © ~ elev. ft. Depth to limiting factor ff �� Y Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) Jl�Vl.2 r' � r Gl C",c -1 L Qvvt b C. S,T z corl4cur r/-Co Q3 h 99 O 14 ve ,, _ r Ac , V loo.00 5 p , lc. /e r R , 6i oark v\ {�CUi C t VCA-e- 3 A rad�e- Al Y_ Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3— Labor and Human Relations --- Diviskn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY, �— Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but r not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ; dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R& IEWEDB? ^s t_ PROPERTY OWNER PROPERTY LOCATION s y <'., Fla u Q GOVT. LOT �� j 114 SUI 114, "1 J F a �! PROPERTY OWNER':S MAILING ADDRESS f LO03 t 13LOCK�I SUBD. NAME 0 /V f{ 'fJ CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE WN NEA ^ / u %118 i V (`1) 5y & - � QSG 3 <f / V New Construction Use [ Residential I Number of bedrooms 3 (] Addition to existing building j [ Replacement Public or commercial describe Code derived daily flow gpd� Recommended design loading rate 1 � _ _bed, gpd/ft _ (( trench, gpd /ft2 Absorption area required 92 r bed, ft 76 0 _ _ trench, ft . aximum design loading rate �� bed, gpolft _ Uench, gpolft Recommended infiltration surface elevation(s) J'. , cA-� *6 Ric l ft (as referred to site plan benchmark) Additional design / site considerations c ( S( X' X 'Y e Parent material :51 ©c ai _ - t ( (. Flood plain elevation, if applicable ft S = Suitable for system CONVENTION M IN- GROUND P SSURE OGS DE S I L H❑OLDING K Fix I U = Unsuitable for s stem El S LA'S ❑ U ❑ S EKLI SOIL DESCRIPTION DEPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxl k 67 Ground C �F, O elev. s - q .j ft. - O n v t r Depth to limiting factor Remarks: Boring # �- ; .:: 1 Ground elev. _y S 1 S- 92q- ft. Depth to limiting facto J � Remarks: CST Name:— Please Print Phone: ddress: I 0(7 ' Signature: Date: CST Number: �d l'S PROPERTY OWNER 6.LA L-01" SOIL DESCRIPTION REPORT Page c 3, PARCEL I.D. # 1 b - lO Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground - b < v yl C wt - - elev. ga ft. Depth to limiting factor � q Remarks: Borin — # 3 F O 1 to Ground elev. Depth to limiting factor s Remarks: Boring # ................ Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) I C. S.T �i w - I , B► Sp,1;.� �iGr R� �bc;n :3 A I j " N ST CROIX COUNTY - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P) U + C �'l S Q Udt- r Mailing Address a g I D C d N Property Address 2 D C 4/M N (Verification required from Planning Department for new construction) City /State W I'5Oh Parcel Identification Number 00q - Ot40 - o)Q LEGAL DESCRIPTION Property Location NW %4, SW Y, Sec. I q , T N -R 15 W, Town of Ca d V Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # ? ; Volume j 2 Page # 3 O C Spec house ❑ yes U no Lot lines identifiable 0 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 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 a thre year expiration date. SIGNA F APPLICANT 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 describe above, b virtue of a warranty deed recorded in Register of Deeds Office. IGNA F APPLICANT 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 VOL D ocumen t Numbe WA P NT Y DEED This Deed, mate betw en Paul Lamb and V�cir--A FICF- Lamb, husband and wife, Grantors, and Laren W. S bT. 4 V ,o "�+ W1 and Kay L. Sauter, husband and wife as survivorship rr �: JUN U 2 1998 property, Grantees. Witnesseth, That the said Grantors, for a va#��e 1: ° p M consideration convey to Grantees the following des; , 4e-J- real estate in St. Croix County, State of Wisconsin The West Half of the Northwest Quarter of South 'r4 /, 1 Recwdl r�r <_a _ Quarter (W of NW of SW %) EXCEPT that part iy Name and Return Address South of County Highway 'N" in Section Seventeen (17),, Laren W SSquf-P-Y' Township Twenty -eight (28) North, Range Fifteen (15) �1i8'y Ave, West, Town of Cady. .5& 004-1040-20-000 (Parcel Identification Number) 4 o FER This is not homestead property. Together with all and singular the hereditamerts and appurtenances thereunto belonging; And Paul Lamb and Violet Lamb warrant that the tide is good, indefeasible in fee simple and free and clear of encumbrances except easements, ccr enants, restrictions, and rights -of- way of record, if any, and will warrant and defend the satrt Dated this —64— day of June, 1998. 'Viok!t Larrib AUTHENTICATION ACKNOViLEDGMFNT Signature(s)_ STATE= CF WISCONSIN _t��t COUNTY / Pefsc,;.aky ante before me this L,�L ` day of 1998. t+e zbove named Paul Lamb and Violet Lamb to me authenticated this _ day of _, 1998. kn Nns Sx be the persons who executed the foregoing instriu -rC and acknovtedge the same. Signature � Type or print name TITLE' MEMBER STATE BAR OF WISCONSIN ll' !eP � L t r-5e , Notary Public (If not, County, State of ^ W � onsin, authorized by §706 06, Wis. Stats.) M cxr>�ion expires � — THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord, Attorney at Law River Falls, Wl 54022 n5 5 ni d kl be y, o« w ted $—km k+e+r oen,ares. IR`p tee. =0-r. (Signatures may t.e autll�nticated or ack - -d By;° are, nec .sary.) x,h:;:..zx:T ar.:es.:enas :or,.pany Fcnd du max, W.sca s;n 900- ?53:021