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HomeMy WebLinkAbout008-1063-20-000 0 cn o n fn O 3- n d rte. o (n m z N z ° w O z m m z ° RI N °O O. fl. O c A a O N C2 '� j. C N y.r CD Ca (D �_ N Q � O r p O N O N (D 7 01 N O co O N O 8 cc 0 0� ( N 3• CD co 6 (D N N p O B O G th N n N (D CD n A O o y 3 a o 7 a o " -4 f ° �+ !� O co R to < D m a w t? z D (e 4 D CD A L-• y N G ° ° y G < N C M c > W (D ? ° _ D z< N 0 3 O o o r, O N p C, L -"�'.' O Ut ���` N O a CD (o m° o cD m n r to oo m °- o ° N a lrl ° z 000� 0000' -' N cn o 0) —1 o ° N 3 o_ n N N N y O Q fn fn fA N N ^ Q 0 W O' 0 (a ° O 0 (D M (D (A (D N O d N < N V N 3 ° to m a o Z `•' � o 0 _ z z z m o N n D D (D 7 �1 N1 N "0 O N (v A O N CD w • (D 2 CD x S N N C =r (D C (D w m n a a O. N 7 3 7 OZ CD CD C6 III a a '� A 7 Z N N W m W m OD CL a , z c 3 c 3 A� o - o " z-' y D N CD A N p� N CD c D7 a CD a N (D am a * a °' m a � T m O- T 3 D _ m c c m m z a � o z a 3 ° v °-< ° CL ° 'p y Z ', N N Cn u) O N 0 CD A ° O 'O 'o (D O (O n N y 7 N j (D H 77 a A CD p A CD p C O O . O 7 O N 7 ? N N N b (D N CD V A O� O� ! O O A O (D (D Op Op c., c� O cfl O V CD CD 0 0 i o a Wisconsin Department of Health and Social Services Plb. #67 10/69 Division of Health PERMIT APPLICATION for PRIVATE DOMESTIC SEWAGE SYSTEMS s { / - R",4i ? A. OWNER OF PROPERTY AIM In TYPE OR USE BLACK INK Name /S >1' Address (Street, City Zip Code) County B. LOCATION OF PROPERTY WHE1 SYSTEM'WILL BE CONSTRUCTED ALTERED CA EXT ENDE13 Check One: CITY VILLAGE GAL DESCRIPTION: / I LLJ u TOWNSHIP ' Zy T�s� /4 Qek �i. C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES . NO W1 PERMIT NUMBER D. SEPTIC TANK CAPACITY �� [% Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Coner;te Poured in Pace Steel Other NUMBER OF TANKS TO BE INr1TALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commeroial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETCt Food Waste Grinder YES _ NO Automatic Clothes Washer YES X NO Dishwasher YES f NO Automattc Potato Peeler YES �_ NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM EW TENSION ADDITION REPLACEMENT Tile Size *o.t,in.i eet �` inc Width �� /. Depth 4 1-P Number of Lines Seepage Beds Length Width Depth Tile Size No. Lines -;f Seepage Pitt Inside diameter . Liquid Depth P E R C O L A T I O N T E S T Test Depth Character of Soil Hours Water Test Time Drop in Water L evel In Minutes Number Inches Thickness in Inches ISince Hole in Hole fInter:al Secaad to — Next to Last To Fall gh 1st Wetted Overnit in Minutes Last Period Last Perioe Period Ore Inch Example P- 0 36 T12 Soil 10" Clay 26 25 yes or no 30 2 1/2 1 2 60 - T - 77 T - 7 i p_CORD DATA FROM MINIMUM OF 3 TEST HOLES i Compute size of absorption arev in accord with H 62.20 Wis. Adninistre%ive Code. S 0 I L B 0 R N G S- Minimum 36" Below Proposed Absorption System oring Total Depth Depth to Ground Water Death to Bedrock umber Inchfls Observed Estimate:: Obsarveu* Estimated Character of Soil with Thickness i Inches xanple - 0 72" 72 Black Top Soil 12 ClaX 18 Sand 18 24 RECORD U ATA FROM MINIMUM OF 3 BORE HOLES COMPLETE OTHER SIDE I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision '_n ° -cc ^r3 with tLi pr".-dures and metho(' specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and l( of test holes are oorreot to the best of my knowledge and balief. NAME J r' .i /= :t 1. / 7 TITLE "�i�l /S <<� t:� �• ?� i� ' Type or Print) REGISTRATION NO. or MASTER PLUMBER LICENSE No. ADDRESS r .!> .7 ^ >' ��/ . �,���' C , C� > T �/ ✓� DATE / r , " i 4 SIGNATURE MASTER PLuIvE R MAKING APPLICATION / MP Signatures / �� �^ License Numbers u MP RSW (To a Comp eted by Issuing Agent) �1�� Date of Application // �� 7 r Fee Paid Permit Issued (da e) l .� 6 C Permit Number Agent (name_% ' -i _ `��I l_ For: Town, Village, City, County, etc. _ (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below — FOR DEPARTMENT USE ONLY DATE RECEIVED �� °Z ACCEPTED BY 11LI/ RETURNED (Initials) / /[� (Date) (S / e / Corres. FEE RECEIVED VALID. NO. `� 7 PERMIT NO. (Yes or No) REVI04ED BY APPROVED DATE (Initials) (Yes or No) CON. LENTS e 7gy 3 AI 33 i ''EA GALLE T, 28 N.— R. 16 W 21 , SEE PAGE 33 IL f e h riders �` d C He /end 0 o D� Qd azr� - � ,.E 6 �. a y. 1 911 F C • {/cz />dc - `� C '� y L. y. so Gasse 9 /ta Jen BB anso w q C q o. T� d 1J 0 C �e,\Q v o�a�f e� o� U � s �/ Tfie es f/ Oe in as /zo ° / 4/6.3 • vY,`� � � � V+ a . � • % o `� 4 �Q /74. s Lee • � ¢mfr / „ °,SS ct k o r/ o .�� 9 �• ��" •Cia?. c..v/ di• 3 iso `� /i�zJ .Ea. Hw. 4r7o /y Tharwo% N �� s � B F ff • ,P �sf /4S.r7s r , 94 OscarfCe //- t/iur C 4 /ora 17. B,,k6efh ,Moen /n SO • en /m.7s oi�< .� k_ Jhn Owi7 /e C G ` ° Leon °� <r sari /ye %Fe r /oe� woii � �� r/ -obi° `sar tiv •847s zo /90 n cs cr 64 �A 136.is s /o< 6o e/o/ zo.zs • 8779 c�C 2 .�/ � en X .Pl+! �o . `r! C/ias. 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Oi r�o /ds Rye s so Zb /e h; Go ' C e a C' /ate at/ �ufii wl Maw. o /lmoi� U � cTO ce F ccs o.� VI l • � � � U '1 0� 07son f h/lso/7 p s mo Gera /d F kenl '°• z R G�c 0 //! f � B sf om 6y Baron Pudcsi // des // L¢✓e /% in cr o B y-° go /so 9 Bp ton ftnde.aon 90 so, so so Bo • o (ac/ John /( .h • /`(f/"°n • /'70�cc/ .� qnd ew �!�'erh d C6. a a /_¢✓e //E � � pobcrY E. so f5' fe�, Lyi✓U/n ��� F /o'e w� W F/ndersor/Le cS° /be /sr¢ ne 80 • 80 2 ,Q de // f L /O O `✓ n `�4 H/o /far- .Da✓c s vo a Bis 0 Harrvc% 9 / ■ Hrr UV a ayde/ ne / /ffon� 0 ,C ccs 4 Z7e %ris s �e�sor� O /o ° M be 0� .S¢m / /efsw " :� ./rs 9�de 5k, yanson AC- t e C Gi /sfad h � loo Bo g yo U � /oo sio / :z.7s oo'e- tl C 170 Eo / 7,zo /as! Mar n f • o /o �.c C John G. a B r //, Loris / Swam so.� .S wh en b�u ce R F/nde son <s • V V �o ¢o i snus 4o B /ad9cf�Bo /o tl0 si s �1� tl 4o n 90 ® �Poc�o a u6 ,T c PIERCE COUNTY t Cro i Co✓nf/ /s. )ORG£NS£N'S MADSON , - SKELL GAS LUMBER CO. Jacobson's Skelly BULK & BOTTLE GAS BUYERS OF LOGS, COMPLETE SERVICE STATION, TIMBER & TOWING AND ROAD SERVICE New Richmond TIMBER LANDS & Baldwin SPRING VALLEY, WIS. 698 -2438 WOODVILLE, Phone: 246 -4633 TELEPHONE: NITS - 698 -2630 WIS. 54028 after hours 246 -5134 778 -5533 ' ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT RFc Owner L e��Izz Property Addres -30 City /State 00' Jb /' f W, S"-f0 Z IF �� sT CR 1g9 Legal Description: 3}, CE Lot _ Block Subdivision/CSM # t/� 4 F, '/4. Sec. Z�k, T O N -R 6 , Town of PIN # �zz /6 3z /r3 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer 4 1 ,w fl Wh Size ST/PC lX Setback from: House q Well r P/L L 70 Pump manufacturer Q ioM�ie- Model 51V zr Alarm location /3ii�fPl�r (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: W64,L �l Width Length S v Number of Trenches Z Setback from: House '17,- Well 12Z P/L / o 9 Vent to fresh air intake 7 P ELEVATIONS Description of benchmark X% ©/-- Elevation 106 Description of alternate benchmark 15A5 f- a .5r AIW Elevation f L Building Sewer 93- / 7 ST/HT Inlet ST Outlet PC Inlet PC Bottom e ?d?, 5 Header/Manifold 9 G gS Top of ST/PC Manhole Cover Distribution Lines 73 ( ) Bottom of System ( ) / L1 , o () ( ) Final Grade ( ) 9 ( ) ( ) Date of installation�4 / �Permi umber J /� State plan number �- Plumber's signature License number Date Z/ � Inspector 0 Complete plot plan r ` NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW � SI�C�• j i INDICATE NORTH ARROW t Wisconsin Department of Commerce Safety a0d Buildings Division PRIVATE SEWAGE SYSTEM Count bT . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitalfiegilbo.: Personal information you provice may be used for secondary purposes [Privacy s.15.04 (1)(m)]. Permit EDATUS , Holder's BRIAN IiAU 1 2 A VA Town of: State Plan ID No.: CST BM Elev.: �l Insp. BM Elev.: BM Description: Parcel WQ- 1063-20-000 TANK INFORMATION ELEVATION DATA A9800503 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic rd Ben q. Z ) oq7 Dosing > � , Aeration Bldg. Sewe d Holding St 41� Inlet TANK SETBACK INFORMATION S It Outlet TANK TO P / L WELL BLDG. t I to nt ake ROAD Dt Inlet NA Dt Bottom / C,, &/ NA Header/ Man. 7• ZS Aeration NA Dist. Pipe , Y -0 Holding Bot. System / U D s wi 41 ,/S I PUMP/ SIP FORMA ION7 Final Grade �? Manufacturer Demand Model Number 7 j � GPM TDH I Liftq, Friction Systems TDHB Ft Forcemain Length 7 o ' ia. Dist. To Well SOIL ABSORPTION SYSTEM 2 -C BED R N Width ! Length r No. Of enches PIT No. Of Pits Inside Dia. Liquid Depth DIM N DIMENSION SETBACK SYSTEM TO L BLDG WELL LAKE/STREAM LE C CA BER INFORMATION Type / Mo e N er: Syste (0 O DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake Length Dia Length 'am. Spacing 0w, �/f / �� — 7 E 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 22.28.16.321B,NE,NE 2475 30TH AVENUE All e -F j kAA I 0 Plan revision required? ❑ Yes �No Use other side for additional information. 1( ?� / �° SBD -6710 (R.3/97) Date Inspector's nature Cert. Safety and Buildings Division.,,.,..,.... - SANITARY PERMIT APPLICATION 201 E. Washington Ave. onsin In accord with ILHR 83.05, Wis. Ad m. Code P.O. Box 7969 t of Commerce Madison, WI 53707 -7969 complete plans (to the county copy only) for the system, on paper not less county 112 x 11 inches in size. St. Croix .verse side for instructions for completing this application Spate sanitary Permit N um b er .nation y ou p rovide may be used b other overnmenta a gency p rograms ��e( y p y y g 9 y p g ❑Check if revision to pre ous application Law, s. 15.04 (1) (m)]. State Plan I.D. Number kPPLI TI N INFORMATION - PLEASE PRINT ALL INF RMATI N perty Owner Name Property Location Brian & Sheila Gedatus NE 1/4 NE 1/4, S 22 T 28 , N, R 16 XR90t) W Property Owner's Mailing Address Lot Number Block Number 2475 30th Ave. City, State Zip Code Phone Number Subdivision Name or CSM Number Woodville, WI 54028 (715 ) 698 -2678 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It� Nearest Road Public 1 or 2 Family Dwelling - N f bed ro o ms 2 ❑ vil age Eau Galle 30th Ave. e o o bed oo s Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 008 - 1063 -20 -00 (22.28.16.321B) 1. ❑ Apartment/ Condo 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. ff Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an ------ -------- System Tank ank Only Existing xisting System -- - - - - -- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE Of SYSTEM: (Check only one) 14 ,a#Y9.6^ t9f (!q,Pr �ST&d 3!•a, �,/ Non- Pressurized Distribution Pressurized Distribution ExperimentM Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 2(F3 Seepage Trench 22 ❑ In- Ground Pressure / 2 1 42 ❑ Pit Privy 13 E] Seepage Pit .2 '� 7 43 ❑ Vault Privy 14 ❑ System- In -FilI 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 300 375 381.6 0.79 NA 94.0 Feet 97.4+ Feet TANK Capacity VII. INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Fiber- plastic Exper. Gallons Tanks Concrete Steel glass App. New Exist in strutted Tanks Tanks eptic Ta Ing T ank 1000 A1000 1 Midwest Precast X ❑ ❑ ❑ ❑ ❑ a i 650 650 1 " (Combo) I M I ❑ I ❑ ❑ 1 ❑ ❑ ESPONSIBILITY STATEMENT I, the undersigned, assume responsibili f ation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu A MP /MPRSW No.: Business Phone Number: Todd Sinz MP 139462 715- 235 -2644 Plumber's Address (Street, City, State, Zip Code): E 5612 708th Ave., Menomonie, WI 54751 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Lee (Include, Groundwater D at - e - T s — sued Is ent Signature (No Stamps) Approved []Owner Given Initial Surcharge fee) Adverse Determination dul X CONDITIONS OF APPROVAL/ REASONS FO q DISAPPROVAL: 0 SBD -6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber r i .......\ N M ' �1 r 3 1 i '' f Aol 9 y ¢ r G � y o � a ` Z I f d i fj ^' M l.� o cj 4 y r 1 � N V � LA ci LA �' 2 d C O �.� �w 940 JQ S • , (7�.fi„ ti.n�s Y�.�.� � « G�yO 0.� �1 i • ;. i I I •: i � � i . i I IIIIiiI j I i I I I ( �•. ' i I I I I I .� I � i .I I ► I j i I I i I i i I j i 1 i I 1p eR .1C . , WEAT11E0.pRO0F LOCKING�COVER JLnItTION W/A 4NAW ,cA6E�l. QUICK D"wA "Acl ---\ G� 4 C.T. %*A%pGia 4ps"m* fro 2. PIPEi, 3' O wOIbTupuD SDtt,. Yi11JT .t10W MIN. �r I ��wccv Zj. 2 A C.S.pw SKLT tetra BAFFLES X o•Wo hwecriopM —�– GROUP L!v , S6 5 • �S� osR PIMP D b� CoNCaEnE . L.�r, 6�oCrC SEPTIC � AT L�s 0051 T_S MAMUFACTURCR: �ILWOER Of OOSfS: PE0. DAy TANK SIZ C : `� - b O `ALLOWS , 00St VOLUME AL RRA MAbAWACTYlL S , � • I LNOIIJ(s SACK/I.0 M/: ( (iALLONS AODCL WUPOCRZ e1 ~ �'`� CAPACITIES: A = Z wCNES DR 4 2 " b ' ¢ C,ALLOIJS SWITCH TNFZ: d = I u GNES OR 34 GA LLO NS PUMP MAUUFACTURCR: `"�"��" µ °"'` C �'� IIJCHES OR GALLOWS MODEL WUMSCR: S "` �'� D� INCHES OR A � Z GALLOWS SWITCH Tun:.�,:"�''"" � NOTE: PUMP AND ALARM ARE TO Of NA K a KARGC RAn INSTALLED ON SEPARATE CIRCUITS G1M / VERTICAL DIFFEREM" KTW[CN PUMP OFF AND OWTRISUTION PIPE.. FEET + MI el UM MC6TWORK SUPPLY PRtSSURC ........... �_ FCET i ♦ FE ,T, OF FORCC MA X _._. *00 K FACTOR.._ FEET TOTAL ID JAMIC NEAP s ET r ' " INTERNAL. DIMILMUONS ; ,� TAWK: LEAI6TN �; LIQUID DEPTH All 8 In Mai TPFL- f Perfor Data 32 Pump Characteristics PW P /Motor unit SubalerAk Manuel Models SW25M1 SW33M1 u Automdic Models SW25A1 SW33A1 113 HP Horsepower 1/4 1/3 18 I'd Load Amps 8.0 10.0 1/4 HP Motor Type Sboded Pole (4 Pole) R.P.M. 1550 e IN Phase 0 1 Voltage 11 S 0 — — — 1E_ Hertz 60 0 10 TO 30 so 60 CAPACITY -U.S. Operation Intermitted G. Temperature 120 °F Ambient Total Nood (foot) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1 1/4 NP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 1/3 NP 47 4S 43 40 37 34 30 26 22 16 10 Dlsdmrge Size 1 -1/2" NPT � � �- sows Hoo&" I/r Dlmenslonal Data Iwt W41 30 6L i. w (1111101WOM in wo Power Cord 18/3, SJ W, 10' at 3-1/2 sure 1. ( wWormi dimensions nwy (20' optkm) 4"1R vary = i/s wo 3. IM far werw s m Wpm 1 - 1/2 NPT unlessarAW A31,2 DISCHARGE 1 Dimensions and wighls are Materials of Construction e HomBe Stool S. On/ off level 6. We reserve else right to LA" Oi) 1N retrlc 011 make (ovum our �_ products and their Motor Housing Cost Ira spedfKOW WWOW NOW PUM COSIN Cat ka 1 Shaft 7-- stow ,.. Medanicul Sod Faces: Carba /Ceramic Sbah Sod Sod Body: An &W Steel SMing: Stainless SNeI Iele Mlf: Baa-N PUMP 11 -1/8 r 10.1/8 ON 9 -1/2 Uppor 110011 (cool, $lewe DISCHARGE HE Lower bw $a HEIGHT 3 - Strainer /Base Pblstk 3 _.... UM 1/2 P Fasteners Stddess SW OFF AYRORA /NYpROMATIC Pumps, Inc. 1840 Banmy Rood, Ashland, Ohio 44805 —' (419) 289 -3042 ;r,-7- , i-- Wisoon�i01` Department of Commerce SOIL AND SITE EVALUATION p I of.-.-3 Dvision of Safety and Buildings _* Comm 83.05, Wis. Adm. Code certi Soil Testing Attach complete site plan on paper not less the X;11 lze. Plan must IFLA County include, but not limited to: vertical and direction and St. Croix percent a", scab or dimensions, north V ind dMance to nearest road. Parcoi " RA.1063-20-00 (22.28.16.321B) APPLICANT INFORMATION - P 01p rint all Inform4don. locbr" 0b1WMh1vW*, Reviwed Date Personal intimation you provide may be v. 15.04 (1) (m)), Property Owner Location Gedatus, Brian & Sheila QUA. Lot NE 1/4 NE 1/4 S 22 T 28 N,R 16 W Property Owners Mailing Address Block # I &-1hrl. Name or CSM# 2475 30th Ave. ON state ZID Code El CRY F V liar XTown Nearest Road Woodville W1 5�4028 lr5lft tau 8 le 1 30Th Ave. ❑ 2 Now Construction Use: Number [:]Addition to existing building X ResklentW I Num - I Public or mninerclel dwribe Code Derived daily flow 300 gpd Recommended design loading rate .7 bed, gpd/W trench, gpd/W Absorption area requ 429 bed, fr 375 trench, ft- Maximum design loading rate -7 bed, gpd/W -8 trench, gpdffl Recommended Infiltration surface elevatits) 94.0 ft (as referred to site plan benchmar Additional design / site considerations . 1 2 - Yx 36' Sidewinder, Hi-capacity "turtle-shell" trenches for 2 br (2 - 3' X 54' for 3 br) Parent material sandy/loamy outwash Flood lain elevation, if applicable- NA ----- -ft M� S for system Conventional Mound in-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system 0 01.1 X S n U X S C i U X S S X U I : S X U OUIL ULUU111IFTFUN Kk:rOKT Depth Dominant Color Mottles Structure GPDM jConsistenc� Boundary Roots Boring# Ho in. MunsoU Qu- SL cant color Gr. Sz. Sh. Bed Trench 1 0-8 1 OYR 3/2 A 2 f sbk dsh cs Ivm .5 .6 2 8-36 10YR 4/4 SH 2 m dh cW I m/c .5 1 .6 Ground 3 36-40 7.5YR 4/4 0s 0 sg dl cs if .7 .9 elev 93.0 ft 4 40-52 IOYR 516 0 sg ml Cs .7 .8 Depth to 5 52-56 7.5YR 5/9 0 sg ml cs .7 .9 limiting 6 56-76 IOYR 5/6 0 sg Ml cs 7 8 factor > 7 76-94 I OYR 4/6 s 0 sg ml .7 i .8 Remarks: amtified2.5Y614s5&76-,'E;ZIMS/6130��52,ggt7,74-76 1 0-6 10YR 3/2 sl 2 f sbk dsh cs I f/M .5 .6 2 6-31 i 10YR 4/4 1 m sbk dh gs Ini .7 .8 Ground 3 31-76 10YR 4/6 JIM I w sbk dh cs IM, .7 .8 dev . . 97.4 it 4 . 76-99 IOYR 4/4 0 s dl cs 7 9 Depth to 5 90-95 IOYR 4/6 0$8 ml .5 .6 limiting factor >W L�p Remarks: - ----- CST No= (Plem Print) Solahm j o n Telephone No. Henry F. Grote 715-665-2681 Address Certified Soil Tesfing CST Number Ref I D1 P.O. Box 57, Knapp, Wl�,4749 1 2/11998 222774 1036 SOIL DESCRIPTION REPORT p PROPERTY OWNER: Ged" Brian & Sheila e 2 of . PARCEL LU 008-1063-20-00(22.28.16.321B) ® Certified Soil Tes6nz , Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots _. _ GPD/fe• Horizon in Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed 'Trench 1 0-12 10YR 3/2 - s1 2 f sbk dsh cs 1 f/m .5 .6 2 12 -28 10YR 4/4 - lmcos I m sbk dh gw lm .7 .8 ��� 3 28-67 10YR 4/6 - lcos 1 m sbk dsh cs lm .7 .8 elev -- - - -- -- -- - - -- - 99.4 ft 4 67 -102 1 OYR 4/6 - hncos 1 m sbk dsh - - - - _7 _8 Depth to limiti -- factor Remarks: - - - -- - - -- - - - - - -- -- - -- - _ 1 0 -7 10YR 3/2 sl 2 f sbk dsh cs t f/m .5 .6 4 - 2 7 -27 10YR 4/4 - sl 1 m sbk dh gs lm .4 .5 Ground 3 27-41 10YR 4/4 -- -- - - - - is I m sbk dsh cs IM .7 .8 elev 98.3 ft 4 41 -100 10YR 4/6 mom 0 sg dl - - .7 8 Depth to limiting - — -- — -- factor l > 100' Remarks• Ground elev - - -- -- - - - - -- t _ Depth to i limiting -- - -- - - - - -- factor Remarks: Ground elev Depth to limiting - -- factor I ,N M M � N • , 2 v �f 4 3 cj r/11 r ✓ P Iry 4 0 0 t � v • 0 .A d d A 1 op 1 � Zo ALA Wiscensin Department of Commerce SOIL AND SITE EVALUATION Page 1 of _ 3 Division of,Safety and Buildings mm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not les = reference as i ize. Plan must F __ nty include, but not limited to: vertical and horizontal point ( ), direction and St. Croix _ percent slope, scale or dimensions, r sions, north arrow, a 1. 4100 and distance to nearest road. el I.p# 008-1063 -20 -00 (22.28.16.321B) APPLICANT INFORMATION - P/eapi p ,ni all Information. — - - -- -- Personal information you provide may be used for ndary purp0e4(p Law, s. 15. (t) (m)). Reviewed By Date Property Owner Property Location Gedatus, Brian & Sheila {L0t NE 1/4 NE 1/4 S 22 T 28 N ,R 16 W „± Pro perty Owner's Mailing Address Lot Bloch # Subd. Name or CSM# 24 75 30th Ave. = °' �iy oodville WI State Zi Code Phop 3 I6 city Village ®Town - -- Nearest Road W 5 1 - - 678 Eau Galle 30Th Ave. ❑ New Construction Use: ® Residen uh>b�r rooms 2 []Addition to existing building ® Replacement ❑ Public or commercial describe Code Derived daily flow 300 g pd Recommended design loading rate .7 bed, gpd/ft' 8 trench, gpd/fN Absorption area required 429 bed, ft' 375 trench, ft' Maximum design loading rate .7 bed, gpd/W 8 tr ench, gpolft' Recommended infiltration surface elevation(s) 94.0 ft (as referred to site plan benchmar install 2 - 3' x 36' Sidewinder, Hi capacity "turtle shell" trenches for 2 br (2 - 3' x 54' for 3 br) Additional design / site considerations NA Parent material sandy /loamy outwash Flood plain elevation, if applicable ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ® ❑ U X S❑ U S! __! U X S U U C S U ❑ S X U Depth Dominant Color Mottles Structure GPD/ft' Borin Horizon Texture Consistences Boundary Roots -- 9# In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed ;Trench 1 1 0 -8 10YR 3/2 - sl 2 f sbk dsh cs 1 f/m .5 .6 2 8 -36 l OYR 4/4 - sil 2 m sbk dh cw 1 m/c .5 .6 Ground 3 36-40 7.5YR 4/4 - lcos 0 sg di cs If .7 .8 elev - -- - -- -- -- - -- 93.0 ft 4 40 -52 l OYR 5/6 - Is 0 sg ml cs - .7 .8 Depth to 5 52 -56 7.5YR 518 - s 0 sg ml cs - .7 .8 limiting 6 56 -76 10YR 5/6 - s 0 sg ml cs - .7 .8 factor > 94 — 7 76 - 94 10YR 4/6 - s 0 sg ml - - .7 .8 Remarks: strati t •5Y 4 s S an is @ S 7, 74 -76 1 0 -6 10YR 3/2 - si 2 f sbk dsh cs 1 f/m .5 .6 2 6 -31 10YR 4/4 - lmcos 1 m sbk dh gs lm .7 .8 Ground 3 31 -76 1OYR 4/6 - Icos 1 m sbk dh cs lm 7 8 elev - -- - -- - - -- - -- -- - - -- - 97.4 ft 4 76-90 l OYR 4/4 - s 0 sg dl cs - .7 .8 Depth to 5 90 -95 IOYR 4/6 - fs 0 sg ml - - .5 .6 limiting factor > 95' Remarks: _- CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715- 665 -2681 Address Certified Soil Date CST Number Ref # P.O. Box 57, Knapp, Wl" 54749 814/1998 222774 1036 PROPERTY OWNER: Gedatw> Brian & Sheila SOIL DESCRIPTION REPORT ® page - 2 of :3, PARCEL I.D.# 008-1063-20-00(22.29.16.321B) Certified Soil Testing _ - Depth Dominant Color Mottles Structure GPDIft' Horizon Texture onsistence Boundary Roots - -- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T Trench 3 1 0 -12 10YR 3/2 - sl 2 f sbk dsh - cs If/m _5 _6 - 2 12 -28 1OYR 4/4 - hncos 1 m sbk dh gw lm .7 .8 Ground 3 28 -67 1OYR 4/6 - lcos 1 m sbk dsh cs lm .7 .8 elev 99.4 ft 4 67 -102 10YR 4/6 - hncos 1 m sbk dsh - - .7 .8 Depth to limiting factor >102' - - - - - i Remarks: --- - - - -__ ..__----- - - - - -_ -- - -- - ___- —_ _ _ - - - - 4 0 -7 1 OYR 3/2 - sl 2 f sbk dsh cs 1 f/m .5 .6 1 F2 7 -27 10YR 4/4 - sl 1 m sbk dh gs 1 m .4 .5 Ground 3 27-41 10YR 4/4 - is 1 m sbk dsh cs lm .7 .8 elev 98.3 ft 4 41 -100 1 OYR 4/6 - s/mcos 0 sg dl - - .7 .8 Depth to limiting _ -_-- - -- - - -- - factor > 100' — -- -- - Remarks: - -- -- - - - - - - - - -- -- Ground elev Depth to limiting _ -- - - - - -- - -- - - - -- -- - - factor Remarks: _ , Ground elev 1 Depth to -- -- - - - - -- limiting - - -- - -- - fi factor j Remarks: - N M ' J 9 N a , 1 � � � ✓1f �J e� co cl i 9 N i � y ., e _ Cl ✓ ,� N cr 7 a c o J 1 O •� b g di go �- 9 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer JCS'/ 4 le( Lk C —TJ S Mailing Address Property Address _ �E (Verification required from Planning Department for new construction) City /State '00 l/l O Parcel Identification Number �� ' oo LEGAL DESCRIPTION Property Location & %4, '/ Sec. I T 9 N -R" Town of Subdivision `— Lot # Certified Survey Map # Volume , Page # Warranty Deed # ` , 5 OgZ y , Volume 7 q , Page # O Spec house ❑ yes W 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 days of the three year expiration date. ZiA SIGNA OF 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 roperty de cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. 101 SIGNATURE OF AIMPLICANT 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 10Z06'/98 - 14:55 CLOPAY HR BALDWIN 3 9P17152352592 10/00/98 TUE 13:38 PA 715 388 468 r� REGI STET{ OF DEEns NO.055 902 grwTr- aS or W18.omarv1 P o .- 2 . _ ,` °� ea�cax na a n• _....Ctgig �. Mohn, 3 /k /a Craig '• . �-. Wig, re 'E'Kes�i'' 9 S• Holm and �.•.. Mo?+19 ": "tiiti#B�[ila 8�F9d Sri �t� aa .......... .... . . . . .. 1W+L for R tea► t . :4 ri4AK ...:::......:':::: ......._. - .,.... -- - -_• �a nor. `�.�.' - -... _ ,,..X 19 s7 auawy� sac a tt► ..$t ri. -- :......,. ...... .�- ........_ ........_............_....!.... :1 ............ ........ . �_/.�,�... .. ..- .- ..... ..... ,• --...- ...uw.- ..._.�.`..•_ - -.iw_ ---------- -­ .r- -..,, '_...... Ilf►Y.MI .-A ! ..mG�WW O , -....K /�...y.T —�-1.y - w.__._ —... w•..••} ate,..— ..,�,.� �Ib: di_ ............ ..w_r.1.YGi�� Ott The West Eight Rundred Seventy six (878') feet of thy! East Ntnetdea Hundred Twenty Four t19241) feet of the Korth Two Yivadr.ed (200,) feet Of the North Na1P of Northeast 0uarter (N of 1vE) . Section •iweAty -tvo (22) Township Twenty -eight North (T28N), Range Sixteen We (RiBW). This deed in given in futfillinent, of that certain land contract betveen the above parties, dated July 31, 1983, and recorded in wig Office or the liegieter or Deeds for St. Croix County, Wisconsin, in Volume 717, at Page 499, as DOcum too. 404040. ..................... Revd plp�•(y. (!e} (*.7fi"X Iftell 011 to waeram�3p; Easements and restrictions of record, and except any liens or eoc=a created or sufrered to be created by the acts and defaults of the thew heirs, successors. or assigns j Dieted daft ... _....... "- Ls. ... ........... .. der of .._...... ._.... LT��...........__._.... . , 1#. H 7... I k� (SE+IL) : ". (S . ISAL) • ................. — . —...---- --...........--- .......__.... • 4_, a..,�'392�t!7. ......... • ......... .1, .......... tS$wL} �, '.,� �"r..4 C_.... `.' f.. . ........_.lSrFwwL1 • .....,- ........ ,..-- ..• ------- - ..._....... • .. 1"i11E�eaa..Aw- ..Mrshta ....._.....,._......., •9TUTA TICATIOM ACa:MQ* zMM10lrM* ...-... .--_ ..................... ..�. - .— ...... STATIC OF W"CONalr ..r....— .._ ....... -- �.......__ `5t �- Croix .... __CaaA�r. I es. H .. wy came we its .— _1-.:�...day of ca ...., vi. ..... esaE� s ---- nag. . ... _ _... aril _ - - -- T ... ?rier�sa�.A : .K[ohi% - -�` -- -......_�.. M• 1 J b b 7oau6, W L. Si1 - .., - -- ....- - .._ ....... - s° •.. +'Mes �.rs►yu�ae.rr w,�p tikwt�a 9T P Tomas A. MCC !_ I* low knewu ..:.....----- ..__....._..r blots Poblie .._ A (S�peaWras 1o7 be aPtbEOt tE01 �IFit .... qty; +� m gomowled Do* MY ComriY99+on is a� . . ', vet aW �eeesan*7•) tS�• psr rnG C f vot. rtaLC esgirst:Io . • *.mi1 •f nemw **saw is w' ••Pialb .1ka10 D. tpee .r P1ao .N below mcM