HomeMy WebLinkAbout008-1030-50-000 CROIX COUN 'I'Y ZONING DEE'AIZ "I'M
AS BUIUF SANI'T'ARY REI'Oltl'
FIV1-
Owner i C, h 4 e a
Address 1 . _�,
City /State `t�' P5, 4
( , cr� �
Legal Description:
Lot Block Subdivision/CSM II
VLC Sec. 11 , % N -R 1 � W, Town of C, PIN It AA-Cl d ��
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer M / =C'" hSize ST/PC )Uw/ `S' OSetback from: House j Well %10 P/L 12 0
Pump manufacturer 2c /e.2 Model 5
Alarm location _)R e- c. C-e d
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: *?o 44,41 C Width Length Number of Trenches
Setback from: House 1 L ' Well ?V p/L /10 Vent to fresh air intake
ELEVATIONS
Description of benchmark 26 t t u �... r �y ! / �' ` Elevation
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet �1 J , 7 "�-
ST Outlet- PC Inlet
PC Bottom 3 Header/ManifoldC Top of ST/PC Manhole Cover S �"
Distribution Lines
Bottom of System
Final Grade
Date of installation, U/, ermit number -- 31 State plan number
Plumber's signature °�`» ..�`.: License number r {. Date lZ /f./
� u
Inspector
Comploc plot plan •�
J
1
NOTICE Pleasc providc 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
r'
NS
�G v
3
INDICATE NORTH ARROW C t
1
r
AWisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y'
Safety and Buildings Division Count ST . CROIX
INSPECTION REPORT
P r
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar ,
Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)].
K IESOW , r R C iARD C'i �ftap� Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Dessc Parcel T dWai1030-50-000
TANK INFORMATION ELEVATION DATA A9800514
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ��
P,6 alpp 1000 Benchmark I.$ I I m
Dosing C Ovwlr�� (,
Aeration Bldg. Sewer G•'Z. GjS./
Holding S Imo, Inlet 8.1 9 3.72_
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Air to
I ntake ROAD Dt Inlet
ir
Septic
01S NA Dt Bottom I I Sv g0 3�
Dosing 41 / l'I ` NA Header/ Man. 3•g� g'� p �,
Aeration A Dist. Pipe ?qZ g7, q�
Holding t. System �,� �J,c�s 97.3( 917
PUMP/ S ATION 31qp., Final Grade
Manufacturer :7-ocI ).,,- Demand Sa - Yno,r Cc eA G.oZ �tr
Model Number J C? ] .c&GPM
THH ft'� Fric tion System, TDI-Voty Ft
Head Fin Length 5 I Dia. 2,�o Dist. To Well
SOIL ABSORPTION SYSTEM
AIEMTRENCH Width < ches / Length N 0.0 f Tren PIT No. Of Pits Inside Dia. Liquid Depth
QXAd NSIONS DIMENSION
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHING Manu
INFORMATION Type Of e Number:
System: 110 ` 87 OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold ►t Distribution Pipe(sl r x Hole ize x Hole Spacing Vent To Air Intake
Length Dia. Length�� Dia. � Spacing 0
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: EAU GALLE 11.28.16.156A,SE,NE 470 COUNTY ROAD B
�� 1�lew� - �v�zal 'a•7t. S•88 ,s• V»
gy.�� q S•�ry �)� � 8
Plan revision required? [:]Yes )E No
Use other side for additional information. l� y
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
1
Safety and Buildings Division
V SCO/1S %11 SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County D
than 81/2 x 11 inches in size. County - &,t o 1
• See reverse side for instructions for completing this application State Sanitary Permit Number z
Personal information you provide may be used for secondary purposes ❑ Check if JFFvious application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION lad s�
Propert wrier � y ! ame Property Location '/
l Cnl'1 r f' S o(.✓ 5,6 - t-114,S I( T A , N , R /� or)W
Property Owner's Mailin��ddre2 Lot Number Block Number
U ,` wh- /�
City, State Zip de Phone Number Subdivision Name or CSM Number
r.✓eo d vf 5 vz (ts'� G boy
II. TYPE 0 F 6 IL ING: (check one) ❑ State Owned it Nearest Road
Public or 2 Family Dwelling - No_ of bedrooms 3 D fiii Tow OF D G lit- C nq 13
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 Apartment/ Condo 60 1 0 3 0 0
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2 [A Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
------ System System Tank Only 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
11 ❑ Seepage Bed 21 Mound 30 E] Specify Type 41 [3 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
44 Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) Elevation
3 74 3 ?4 11/ 1 7 Feet Q . 2 Feet
VII TANK
Capacit
in g Total #of Prefab. Site Fiber- Plastic Exper.
INFORMATION New Existin Gallons Tanks Manufacturer's Name concrete strutted Steel glass App.
Tanks T nks
Septic Tan or Holding Tank C9 �JG I rn� w G tt r El El El ❑ El
Lift Pump Tan . iphon Chamber (,5'U t . ❑ ❑ ❑ ❑ 1 ❑
NSIBILITY STATEMENT
I, the undersigned, assume responsibility f9jr installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumbe Signature: ( S mps) PRSW No.: Business Phone Number:
x, S' 7/5 -� Irf -;2 2
Plumber's Address (Street, City, te, Zip Code): ,
5 L✓ D� ve'ud t , /
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
A roved Surcharge Fee) S
pp ❑Owner Given Initial (�
Adverse Determination 10b /
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
Safety and Buildings
15837 USH 63
HAYWARD WI 54843 -8107
Vi sconsin Tommy G. Thompson, Governor
Department of Commerce William J. McCoshen, Secretary
August 20, 1998
CUST ID No.267341
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST
PO BOX 74
RIVER FALLS WI 54022
RE: CONDITIONAL APPROVAL
i t
APPROVAL EXPIRES: 08/20/2000 Identieatin Nuutrs "
Transaction ID No. 121528
Site ID No. 16915
SITE: Please refer to WW denttftcatton numbers,
Site ID: 16915 above, in all correspondence w�th't11e "agency:
ST CROIX County, Town of EAU GALLE
SE 1/4, NE 1/4, S11, T28N, RI 6W
DICK KIESOW
FOR:
Description: MOUND
Object Type: POWT System Regulated Object ID No.: 37554
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
This plan approval is for a 450gpd mound. R
Condih
The following conditions shall be met during construction or installation and prior to occupancy or user
• This plan action is subject to designer comments on the plan
• Correspondence Note: DEPARTMENT o
• Maintain well setbacks per Comm. 83.15(4) & 83.10(1). DIVyip of SAFETI
• Per Comm. 83.23(3)(b)2, the area 25 feet below the downslope edge of the soil absorption system must remain ..
undisturbed.
SEE CORRcSI
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 a"he- telephone number listed below, or at the address
on this letterhead.
v
Sincerely,
r' !; DATJE RECEIVED 08/17/1998
FEE QUIRED $ 180.00
TOM BRAUN PLAN REVIEWER V EM CEIVED $ 180.00
Integrated Services 7`Y rJ;,',, ANCE DUE $ 0.00
(715)634-3026, M - F 7:45 AM TO 4:30 PM
TBRAUN @COMMERCE.STATE.WI.US ` '
.} l
- 1
A
Page of (D
MOUND SYSTEM
FOR
A I BEDROOM RESIDENCE
,
LOCATED IN THE S E 1/4 OF THE IS 1/4 OF SECTION )1 , T Z9 N, R b W,
TOWN OF Z v G> 0� � 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
' T.S.
\ZZ-Vc�A-A alb \--t G-S o w - onally
2S0$ '-11GHlvft 4 12-
w S q u zb )VED
COMMERCE
'AND BUILDINGS
ONOENCE
PREPARED BY
WEGEE�ER SOIL TEST S iVC-�
AND. 0 0 -W DES = GtV SEREJ I GE 4
P.O. 801 74 421 K. KAIM ST.
RIVEP FALLS. MI 54022 ARTHUR L.
WEGcRER
715 -4L r -0155 0915 P
i ELLS WORTH,
Z W(3.
•N-Q/NON y
r G I3 E
r+rrrr
JOB NO 98 -I8
PLOT PLAN
Page Z of
Scale 1"= 30 '
r-
�A Wr)'r CAM1�r� -? T ( 3R
N
)EL as
C)
�' � 700f= Z� PVC F:►'7.
of i
o►_ U "PUC se � - � PssYrvouti RS
EL , °t l .2 B , u� . Pc* h z
�T L CUO _
e►�+�a r�o ar�sE►�C�T N uT To s cnt�
o�
0, Z) OQ
01.1 G�civ1W Sv�Z FRCS .
Me,
NOTES
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be I 16 So gallon capacity manufactured by
VM lZKJ l j>N - Lk ST , ) N c •
5. Bench Marks SSEvt_
6. Divert surf ace water around system to prevent ponding at the uphill side.
I
Page 3 Of �?
Approved Synthetic Covering
mss- c 33 Distribution Pipe
Medium Sand
G
Topsoil = _ -- F Eiev. ° t — )- Z
—�� E D
3 `
b
3 % Slope
Bed Of 2 * — 2 2 Force Main Plowed
Aggregate From Pump Layer
D \.O Ft.
Ft.
�z�
Cross Section Of A Mound System Using F E 1 - Ft.
A Bed For The Absorption Area
G 1•o Ft.
A Ft. H t•S Ft.
Linear Loading Rate= Q - 5-7 GPD /LN FT B Ft.
Design Loading Rate= o GPD /SQ FT Ft.
Ft.
K Ft.
ion L (,9 Ft.
Fore . -M its W 3 z Ft.
L
-+' Observation Pipe
A -
�• - - - -- ----- - - - - -- --------------- - - - - -- •� Force Main
Distribution Bed Of 2 2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page 'A . Of �O
Perforated Pipe Detail
0
End View
Perforated
End Cop. �` PVC•Pipe Install permanent marker
at end of each lateral
S
Holes Located On Bottom,
Are Equally Spaced
S
PVC Force Main
P
PVC
Manifold Pipe
Oistri ution
Pipe
Last Hole Should Be I
Next To End Cap
End Cap
P Ft.
Distribution Pipe Layout
S y Ft.
X Ll b Inches
Y 14 b Inches
Hole Diameter Icy Inch
Lateral 1 Inches
Manifold Z Inches
Force Main Inches
# of holes /pipe
Invert Elevation of Laterals G Ft.
L--"A- V x - 2 - b. 08 Gib
Place 1st hole Z from center of manifold with succeeding holes
at 4Y' intervals. Last hole to be next to the end cap.
Combination Sept�l Tank and
- PUMP CHAMBER CROSS SECTIOW ARID SPECIFICATIOMS PAGE S OF E�
VE T CAP WEATHER PROOF
JuUCTIOU 80X
4 VENT PIPE APPROVED LOCKIMG
110' FROM DOOR, MAWHOLE COVER A011"
:iimoow OR FRESH u-'Ag tJ11JG L N EL.
ALP, IIJTAKE s oOt�DuIT
tj
n �k
b 'NPrK
� .� I8 MJU.
--
• 1
yIINSVt'tT1oFJ m PROVIDE I - - - --
IWLET AIRTIGHT SEAL I II
I
I
34P t I II
A
I I A PPROVED JOIUT
APPROVED JOIN
I I I w /C.I. �IPE�P'�c
construction
W C.I. PIPEa R Tank
/ I II ALARM
shall comply with
ILHR ('33.15 and 33.20 13 I i
I I ow
C I t
_
ELE I
V. OFF
-1 FT. Pump--, - -�
D COUCRETE
BLOCK
APPR9+c
Ll
RISER EXIT PERMITTED O►JLU IF TAWK MAWL)FACTURIER HAS SUCH APPROVAL. 1
SE,DDIN4
SEPTIC E 5PEGIFIGATI0tJS
DOSE
T,,IJK MAN UFACTUR ER: LJUMESER OF DOSES: PEII DAy
TAWK :,IZE: \O13z b Su GALLOIJS DOSE VOLUME i
ALARM MA►fUFACTURCK: S'� ���a SL1.�` 7�i IMCLUDING DACKFLOW: > S3 GALLONS
MODEL 1JUMBER: lZ� 1 ,l CAPACITIES: A= VJ INCHES OR 3 p b CALLOUS
SWITCH TAPE: I'1 �1Z� g = I NCHES`OR 34 G( LLOUS
PUMP MANUFACTURER: Z,U�Z� ' C r IAI CHES OR S GALLONS
MODEL WUMBER: S3 Dw INCHES OR 1 GALLOWS
SWITCH TYPE: Y�L2Cu� "y WTE: PUM AMD ALARM ARE TOBE
MIMIMUM DISCKARGE RATE "�' GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEREMLC DETWECIJ PUMP OFF AIJO.0I5TRIBUTIOW PIPE.. �''� FEET
+ MIWIMUM METWORK SUPPLY PRESSURE 2 SO FEET
-I- F E E T OF FORCE MAIN X " ) F/ 0 F i FRICTIOU FACTOR -. 1 '� 3 FEET
10
.= TOTAL OtIUAMIC. H-LAD = LO• Sb FEET
Pump chamber DIAMETER J �
ILITEKkIAL DIMLWSIOW� OF TAUK: LENGTH ;WIDTH ;LIQUID DEPTH „
I
. BOTTOM AREA - 231= — GAL /INCH
AS PER MANUFACTURER GAL /INCH
w w 3 15/16 - 6 5/32 c l_ p� O1
HEAD CAPACITY CURVE
UJ
"53 - 57" - "55 - 59" SERIES —) a s/6 1 112 - 11 112 NPT
2s
TOTAL DYNAMIC HEAD /CAPACITY
PER MINUTE
EFFLUENT AND DEWATERING 3 15/16
6 / _
50 SERIES — �
Q 4 1/16
1.1 Ft. Meters Gol. Ltrs.
x
U
15- 5 1.52 43 163
Z 4 10 3.05 34 129
0 15 4.57 19 72
F
to— `O , Lack Val 19.25
O
2
5
10 1/76
0
U.S. GALLONS 10 20 30 40 50 1 3 3/32
LITERS
O 80 160
FLOW PER MINUTE
wane Sasso
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Variable level Float Switches available. • Available with special cord lengths of
• Variable level long cycle systems available. 15', 25', 35' and 50'.
• Alarm systems available.
• Duplex systems available.
SELECTION GUIDE
Standard cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required.
Standard cord len th - non - automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float
M53155 and 57159 Series Control Selection switch. Refer to FMO447.
Model Volts Ph Mode Amps Simplex Dup 3. Mechanical aftemator'M - Pak" 10 - 0072 or 10 - 0075.
M53/55 & M57/59 115 1 Auto 8.0 1 or 1 & 7 _ 4. See FM0712 for correct model of Electrical Attemator, E - Pak.
N53155 & N57/59 115 t Non 8.0 2 or 2 & 6 3 or a & 5 5. Variable level control switch 10 -0225 used as a control activator, with E -Pak (3) or
D 5M5 & D5 7159 230 1 Auto 4.0 1 or 1& 7 __ (4) float system.
E53/55 & E57/59 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J - Pak, junction box, for watertight connection or wired - in simplex or 2
pump operation, PM 10 -0002.
53 Series - Wt. 22 lbs. 57 Series - N. 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice,
55 Series - Wt. 24 lbs. 59 Series - W. 30 lbs. P/N 10 -0003.
CAUTION
For information on additional Zoeller products refer to catalog on Combination starter, FM0514; All installation of controls, protection devices and wirinq should be done by a qualified
Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical licensed electrician. All electrical and safety codes should be followed including the
most
Alternator,FM0495; Sump /Sewage Basins, FMO487; and Single Phase Simplex Pump Control/Alarm recent National Electric Code (NEC) and the Occupational Safety and Health Act (OS
Systems, FM0732.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
` Louisville, KY 40256 -0347 Manufacturers of. .
SNIP v K 36 Cane Run Road qp
Louis KY 40211 -1961 Q U4L /TY PUMPS S NCE ��j�7
PUMf -
�' f
(502) 778 - 2731.1(800) 928 -PUMP
FAX (502) 774 -3624
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
'Latxu and Human Relations
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 include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. () () S - I b3 - SO
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION R I BY D TE
PROPERTY OWNER: PROPERTY LOCATION
w Sry 1/4 NE 1/4,S T ,N,R 6 E (or (W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
L Sog \-lkC'W'R r \ Z
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD
W1 ( 64�- 7 v of uJ 0-eU&A%1 , B"
[ ] New Construction Use Residential / Number of bedrooms 3 (] AdditiQn to existing building
P4 Replacement (] Public or commercial describe
Code derived daily flow qS0 gpd Recommended design loading rate • `F bed, gpd/ft - trench, gpd/ft
Absorption area required 3 S bed, ft 3 trench, ft Maximum design loading rate • s bed, gpd /ft • 6 trench, gpd/ft
Recommended infiltration surface elevation(s) °(1 • Z ft (as referred to site plan benchmark)
Additional design / site considerations I`'1 D'jt•%�) Lv/ S' X y �' L3� . H JN f "U w \ OF R LL .
Parent material Lo ass oy G vi c t t5t - N) Lt Flood plain elevation, if applicable ° fl • ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK
U= Unsuitable fors stem ❑ S N1 U I EIS ❑ U 1 ❑ S ®U EIS O U [IS IR U EIS RU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Bouxiary Roots
in. n II
.• • •....••_.. Mu se Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITmrich
3/Z - sib Z as
�o� \L3LL — s Z sbk wi cs — �
Ground 1'S4R- 3/y - 6� 5� \ esbk wtv �h �i _ , �l • S
elev. c tin
Cl ft. Z1 -37 . S `-/ 2 y f - 1. S `! 2 S /Y� 2° o w+`4' i
Depth to
limiting
factor l2c»,1 Z u ►Ct L 3bY�. i 1 u e S\ T wtTs
Remarks:
Boring #
- 1 b� t t1 3 12 S 1 Z T°11 • �vt�1� �S S
`{ �7 $ 20 to `I Iz- l L �sbk S
(�
2:::.•;:x:.:::::3:}
3 l L - s i ! cs bk h� '�� cw - . Z • 3
Ground
- 1 6• ft. 7' $ `1 t2 $ � �, C, � �Yv1 Y✓1 T1-- � � _ i...i. ! ' ' , � • • Z
Depth to \
t
limiting
factor
n
r
Remarks:
CST Name: — Please Print Phone:
Arthur L. We erer 715 -fit 5�'' b�__.. '�
e�gerer Soil Testing & Design Service -P.O. Box 74 River Falls, I
Signature: Date CST Number:
C ' mil. �- Z C� M00576
PROPERTYOWNER �cC�ESOw SOIL DESCRIPTION REPORT Page 2-- of
PARCEL I.D. # C�0'6 - Y030 - S0
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
} in. Munsell Chu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
o -v tio�t�Z3tz sit Z� 9v -�`F�• cs - ,s ,L
��1x yelTV cS • S
Ground 3 1L N, e sbk \M F �S - • Z 3
elev.
g4-3 ft. 4 Z -qD S `IrL y/6 i.S \4 V-' c� �� rK'�4-
Depth to
limiting
factor
Z1 L,
Remarks:
Boring #
Via:
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
w
4, p4
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
i
PLOT PLAN Page 3 of 3
SCALE 1 "= 7�
J
r —, ` ` I�1j ►��T CAM(�'PS cT OR
0 5s
,/ y
69
(� N 6'� /
� �z . a6•z' 6
of S �%
18 -Z g ,' X .r -Szwn c, r
�i^�itZ ti0 �3�E►�C�T NuT TO Scfit�; ] .
7 � 7
r
0
o' Z) orJ 8LTM" L)r SCDI/vC
T c�?'l�Z � . ° 1��0' c9►J GC�v)W SV \�-�.
CIF }^'loves StfE_ �R1u��.vnY I
rvST �?CwP R ttit
,
715 ) 42.5 —(17 h5 1400576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page :l of 3
Labor and Human Relations
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 include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. OOS - 1 - So
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION RIEWEDBY DATE
PROPERTY OWNER: \- PROPERTY LOCATION
I vnl' CL : }1 ��� `�s0 l o GOVUM S� 1/4 NE 1 /4,S l T Z-b ,N,R E (or( W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
L Sog \ kkQ4 wr-f \Z
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD
`✓JO�OV��`,� , 1 Syo = - 8 ( 6q� - ?9'o L } >v C. fl 'f L CoUn7M " $"
(] New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing !wilding
64 Replacement [ j Public or commercial describe
Code derived daily flow `-lS0 gpd Recommended design loading rate `f bed, gpd1ft trench, gpd/ft
Absorption area required 3n S bed, ft 3 trench, ft Maximum design loading rate s bed, gpd /ft • 6 trench, gpd/ft
Recommended infiltration surface elevation(s) °l -1 - Z ' ft (as referred to site plan benchmark)
Additional design / site considerations 1'-'1 U'�h /4� i v/ S' Y, �; �' t3E0 . }� 1N J wi v ►� �z „ o t- S r� r -,b Ftl_l.
Parent material Lo ass ova J_^ c P, _"D u Flood plain elevation, if applicable iv f) - ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem [is Ga U ®S ❑ U ❑ S ®U El ® U O S ®U ❑ S 1�aU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
.................
..................
.................
..................
3/Z
mil CS — -S
Ground 3 zo Z7 1 S IZ 31 0_Sbk wJ i h `k,
elev.
(2
Depth to
limiting
factor l�,U�.1 �- u t- f CL l_ v : ; w► S C Aserr-'T
Remarks:
Boring #
3 2iJ \O`1 3 L - si �CSb1C
Ground
elev. V 3o y S`� �� s yt� s/� �� o m`�� — tvp .2
o ft.
Depth to
limiting
factor
Remarks:
CST Name:— Please Print Arthur L. W e e r e r Phone: 715-425-0165
J�ege WI 54022
rer Soil Testing & Design Service -P.O. Box 74 River Falls,
Signature: c '�2.. � -, ') S - 3 Date: .� - Z C� �� CST Num ber: 0 0 5 7 6
C l i ZTvt �l. ti
PROPERTY OWNER SOIL DESCRIPTION REPORT Page L of 3
PARCEL I.D. # Oc)b - 1030 - S O
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 0_�, tio` Ut s Z� 91 0q
wt's cg • S
Ground 3 L-t nL 3
elev.
ON ft. Z, - BCD J `I rL Y/6 i .S 4 R S18 c 1 owe Y►a 'F1- - N \� . Z
Depth to
limiting
factor
Z1 �
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD. 8330(8.05/92)
PLOT PLAN Page 3 of
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(715 ) 425-0169 14 00576
CST Signature Date Signed Telephone No. CST #
r �
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner l I t e'z '-' /' / /�, "L s o L.✓
Mailing Address 2 F lq v W,, c w .'s 5 vG
Property Address L 19 0 to
(Verification required from Planning Department for new construction)
City /State Lilo, �✓ ���� Parcel Identification Number 6 0 , q ,- l v 3 62 '�' U
LEGAL DESCRIPTION
Property Location ��� I /4, N L- 1 / a, Sec. , T 2 N -R 16 W. Town of 4
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # _��� j , Volume 2 Page # 2 05
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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.
I/we, 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
ys o the three year expiration
SIGNATURE F A f1k ICANT 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
roperty described above, virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF 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
T
State Bar of Wisconsin Form 3 - 1982
QUIT DEED
esn
DOCUMENT NO. � � SPACE
R_ cn C FESE
$ I CRW C1Y, WI
Sylvia Kiesow, is single woman __ �Ibtlaar8
- -- - MAR 19 1997
quit - claims to Richard M Kiesow, a s ingle man
me 9:45 � , M
' - M +ya1r d oMea
any inte s he may have in _
the following described real estate in St. Croix _ County. "'a SP ACE RESERVED F OR RECORDING DATA
State of Wisconsin: NAPE AND *WrURN ADDRESS
Robert V. Mudge
MUDGE. PORTER, LUNDEEN A SEGUIN, S.C.
110 Soatn Second Street
Hudson, Wisconsin 54016
Part of the Southeast Quarter (SE's) of the
Northeast Quarter (NEB) 11 - 28 - 16 described (Fliumsl96=615catmaNumber)
as follows:
Beginning at a point 10 rods South of the Northeast corner of the South One -Half (Sh)
cf the Northeast Quarter (NE4) of Section 11- 28 -16; thence South 20 rods; thence
West 32 rods; thence North 20 rods; thence East 32 rods to the Point of Beginning.
** THIS DEED IS MADE PURSUANT TO THAT DIVORCE JUDGMENT GRANTED FEBRUARY 9, 1990
AND IS FEE EXEMPT PURSUANT TO SECTION 77.25(8). **
FEE
EXBRPT
i
� i This / to net homestead property.
40 (is not) 1
Dated this day of
li
i (SEAL)4L_ (SEAL)
• Sy via Ki esow
�! (SEAL) _ (SEAL)
ii
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WtsC0%W%*
SL
�� ��►_ •,
ounty.
authenticated this day of ' 19- Personally )dote me this — �/t -� day of
19 T4 the above named
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, - -- - -- -- _ __-
authorized by §706.06, Wis. Slats.) to me known to be Ac person who exet:640% s.
forego) tnsiruwa ask wled tldsai . _ • : K
THIS INSTRUMENT WAS DRAFTED BY
Robert Y, dge.
110 Sou nd Street
Hudson, W i- scoris -i 54016 Notary Public -_ �,h County .
(Signatures may be authenticated or acknowledged. Both are not My commission s permanent. (If not. tQ1
necessary.) -
*Names of Nr.)n, signing in am capacity ;M7uld hr typed ur prnnted Nh6 :h— - ignaiture, `
` IT CI..AIA1 DEED STATE R. -.R OF WISC"OfiSK W,scoos legal °,lank Co. Inc 1-
FORM %o.3 — 1"2 Mdwa.Aee W's C'