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HomeMy WebLinkAbout012-1028-40-000 I artment of Commerce PRIVATE SEWAGE SYSTEM y 4afety and Buildings [Division Count ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryS &7itip9_: Personal information you provice may be used for secondary purposes [Privacy LaX, s.15.04 (1)(m)]. Permit GILLEN , f� rrlg: pLC#ytW VMI [A lE"n of State Plan ID No.: CST BM Elev.: DD 1V Insp. BM Elev.: BM Description: Parcel T® Rr1 1028 — 10c> O A wr Gp� S ( wl /C TANK INFORMATION ELEVATION DATA A9800158 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ept'c _ 1ZSb Benchmar " 3.��r �o3•fo /CO Dosing Cow►17a 7Su ZjWN S2 io5.v 1 �a Aeration Bldg. Sewer Holding 69(* Inlet 145>% 7 4 ? 5f TANK SETBACK INFORMATION (•m. Outlet T N K TO P/L WELL BLDG. Air to i ntake ROAD Dt Inlet ir Septi 1�o' �t 5 �-' / NA Dt Bottom I b3,( 1 1.69 . 4 ? osi $ NA Header / Man. Aeration NA Dist. Pipe �OS, ,/ O(• Holding Bot. System c PUMP/ SIPHON INFORMATION rr, >. Final Grade Manufacturer oY ti� Demand l 03 ?3r.77 �/q •�<o Model Number 37.28GPM r1 a r 105. :2•4 / p2 .s' 5� TDH Li ft -l� friction � System TDH I g Ft f (LQ� (, g l bt7 Forcemain Length $/' Dia. Dist. To Well SOIL ABSORPTION SYSTEM BEPARENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid pth IMEN I N �D DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC SETBACK r' C t INFORMATION Type O ,L pv-+' t �D� , -_ CH T ER Mo el Num System: DISTRIBUTION SYSTEM 3.M Header/Manifold Distribution Pi eW , x Hole Size x Hole Spacing I Vent To Air Intake Length �O Dia. Length �� Dia. Spacing �� 38'f� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of t , xx Seeded/ Sodded xx Mulched Bed /Trench Center IZ�'(j Bed /Trench Edges Topsoil t 2 Yes ❑ No es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.)5l.n /. gl2' f, f '7 �, �� ;• Z. LOCATION: ERIN PRARIE 11.30.17.161A,NE,NW 1941 170TH STREET /g /DD.�s f ) U44- =s I�cc ✓ i�cw K 5a wd/ Plan re'vlslon requ,0 No Use other side for additional information. I x i � SBD -6710 (R.3/97) Date Inspector'509 nature Cert. No. SANITARY PERMIT APPLICATION S a f ety Washi ngton Ave. �ton on �S resin P.O. Box 7969 Department of In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. $T • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope Owner me Property Location / F Zia M/ 1 /4, S // T 3© . N, R /? E (or X Property Owner's MailinaAddress Lot Number Block Number 70 ctv� City, State Zip Code Phone Number Subdivision Name or CS Number cw ;?A1isno%D W 7 S' o/ 11. TYPE B ILDING: (check one) ❑ State Owned ❑ Cit NearestBnad C] Village /� Public 1 or 2 Family Dwelling - No. of bedrooms Town OF o 1 70 wr ao4 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ��, �4 [7 411 fi J /0 1 ❑ Apartment/ Condo t - ) /z /a Z 'y0 / "U 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 online B, if applicable) A) 1 [] New 2 Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ------ -------- ________ System____ _________TankOnly______________ Existing System ________ Existing Syste 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 / Required (sq. ft_) Proposed (sq. ft.) (Gals/day /sq_ ft.) (Min. /inch) Z Elevation L oo S'Op 1 5zo o /, Z — Feet 100• s 3 Feet VII. TANK Capacity gallo Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanksl Tanks Septic Tank or Holding Tank 1 2S -0 v a ❑ ❑ ❑ ❑ 1 ❑ Lift Pump Tank /Siphon Chamber 75 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's S re: (No S MP /MPRSW No.: Business Phone Number: Plum is dd ess (StreeA City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY X rove ❑ Owner Given Initial c� E] Disapproved Sanitary Permit Fee (Indudes(Smundwater ate ssue ing Agent Signature (No Stamps) A Surcharge Fee) pp �© Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: 3BD (R t tM) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber I ST. CROIX COUNTY ZONING DEPARTME / AS BUILT SANITARY REPORT ��'� 1- � � Owner DCL-v-, / ' ► Address V IP City /Stat (,c/T s cc) 2 r c'g Legal Description: B oa , f Lot Block Subdivision/CSM # V V. '/, A, Sec. 1 / , T,ya_N R,(ZW, Town of l a PIN '�C SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC /zz /7Pjy Setback from: Housel " Well '7- P/L >S Pump manufacture_ r_ 2 Model U 9 3" Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width q Length S y Number of Trenches .�— Setback from: House 260 ` Well P/L '7 Vent to fresh air intake ? �a ELEVATIONS Description of benchmark Elevation A Description of alternate benchmark Elevation 92 J'jC Building Sewer /Of, 73 ST/HT Inlet 9 S; e(, ST Outlet- PC Inlet PC Bottom 9 y Header/Manifold Top of ST/PC Manhole Cover *4 Distribution Lines Bottom of System () /00. () ( ) Final Grade ( ) () ( } Date of installation �� ermit number 3o )7 - ? / State plan number Plumber's signat re W- License number /22jg71 Date Inspector comploc 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 G� I I i I INDICATE NORTH ARROW i I I 1 `I AL A � 7 r X .l7 w -.- JT Y' a I r RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET Project DAN GILLEN Owner DAN GILLEN Address 1941 170 ST. NEW RICHMOND WI. 54017 Legal Des+cdoon NE NW S11 T30NR 17 W Township ERIN PRAIRE County ST.CROIX Subdivision Name Lot No. Parcel ID Number Plan ID Number 75002 P.O.W.T.S. IND©C SHEET PAGE ONE Conditionally MOUND CALCULATIONS PAGE TWO AP ROVED MOUND DRAWINGS PAGE THREE PRIES. DIST. CALCS. & LATERALS PAGE FOUR MCDEPA NT OF COMM Er ,E PUMP TANK DRAWINGS PAGE FIVE DFETY AND L INGS SEE CORREYONDENCE Designer BRADY UTGARD License Number 7456 Signature Phone No. 715 - 268-6995 Date 4 -14-98 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.14, Wis. Slats. SBD- 10462 -E (R.04197) Page 1 of J RESIDENTIAL MOUND DESIGN Eight Bedroom Maximum Complete informat in r ed framed boxes as necessary. (y or n) n Is the s rstem over creviced bedrock? Slope 6 % Number of bedrooms 4 Wastewater flow rate 600 gpd 2271 Lpd Depth to limiting factor 21 in 53.3 cm In situ soil infiltration rate (code) 0.4 g 16.3 Um Contour line below the upslo e edge of absorption cell 96.9 ft 129.541m Use standard fill depths? N OR Designer speed depth 15 in 38.1 cm Place X in box to use standard depths (1Z 24 A+4 inclusMe) OR specify design fill depth. Center or end manifold E c ore) Estimated hole space 3 ft Not a final cak Wadon. Lateral spacing 6 ft Minimum dose >= 10 times void volume Use a 0 lateral spacing for trenches. Pump tank elevation 90 ft Outside bottom of tank. Number of laterals R60 Force main diameter 2 in Force main length Force main actual dia. 1 2.067 in SYSTEM SOLUTIONS Inch - pounds Metric Cell media "x" one only. Estimated daily flow ®gpd 2271 Lpd x Aggregate and pipe Chamber and pipe Absorption cell Design load rate & area 1.2 500.0 ft, 46.45 mz Linear load rate 12.0 gpd/ft 148.8 Lpd/m Design width (A) 10 ft 3.05 m Cell length (B) 50.0 ft 15.24 m Depth of cell (F) 9.9 in 25.1 cm Sand filter Upslope fill depth (D) 15.0 in 38.1 cm Downslope fill depth (E) 22.2 in 56.4 cm Basal area required (gpdfinfiltration rate) 1500 ft 139.35 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.4 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (In 11.6 ft 3.54 m Upslope toe length (J) 7.8 ft 2.38 m Downslope toe length (I) Z378 ft 6.10 m Includes basal adjustment Total mound length (L) ft 22.31 m Total mound width (W) ft 11.52 m Project DAN GILLEN Plan I.D. 75002 Page 2 of MOUND PLAR VIEW observAm pipes (t~ J = 37.8ft A A= 10.0 ft 3.05m 11.5 m F o B= 50 ft 15.24 m --— B K J= 7.8 ft 2.38 m 1 1 = 26 - 0 ft 6.10m K= 11.6ft 3.54m L = F - 73 - 21 ft 22.31 m typ- obs- pipe A X 8 refers to absorption cell width and length (andiored seat*) J = upslope width I = downslope width K = end slope dimension ir (150 M+) MOUND CROSS SECTION T D = 15.0 in 38.1 cm lateral topsoil G H subsoil cap E= 22.2 in 56.4 cm invert 98.7 ft--- F= 9.9 in 25.1 cm elev. 130.08 m see note F G = 12.0 in 30.4 cm H = 18.0 in 45.6 cm D E ASTM C33 Sys - 1 98.21 Saris Fit elev. 129.93 m 96.9 contour 6% - 29.54 m slope Note: Absorption cell media will D = upslope fill depth plowed layer consist of aggregate and pipe E = downslope fill depth or leaching chambers and pipe F = absorption cell depth as specified ex Aggregate G = subsoil + topsoil depth at cell wall at right. Chamber H = subsoil + topsoil depth at cell center Designer notes: If aggregate is used it is covered with code compliant material. Project DAN GILLEN Plan I.D. ### Page 3 of r e . PRESSURE DISTRIBUTION CALCULATIOW Absorption cell Inch -pounds Metric Width (A) 10 ft 1 3.05 Im Length (B) 50.0 I ft 15.24 m Lateral specifications Number laterals 2 HolesJiaterai 16 holes Lateral length 47.5 ft 14.3 m Perforation dia. 0.25 in 6.4 mm Lat dis. rate 18.64 gpm 1.2 Us Sys. dis. rate 37.28 gpm 2.4 Us Hole spacing 38 jin 96.5 cm Lateral diameter Pipe diameter D esw o pm - nest chor Designer must 1iM mm _ Plac 'C one choice 1 1 /4km mm box from the options 1 1/2wo mm X X than provided ZOM mm X 3N75 mm X Manifold diameter Pipe diam nesW ump*h— Chwe Designer must 10125 mm 'X" one choice 1 114int32 mm P lac from the options 1 mwu mm X box provided. 7mW mm X X dian 3W75 mm X 4iN1oo mm X Distribution system contains 2 lateral {s). LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram ever & �asthoredi�+�extteevx#ca;: r AStlatev9s art- identiaat 1� x-3f fiotesdndedantivebottamattitetaterzl eq�ai>! t�ace+r F(rrce it *- *e iW WLY L,,. lS I (onc=e mai. of PYG S,h 40 e : petmanew etM wwke? ow COMA Table 84.30 -5) Met ft Lateral length (P) ft 14.33 m Lateral spacing (S) 6 ft 1.83 m Manifold length 6 ft 1.83 m Hole diameter 0.25 in 6.35 mm Lateral diameter 1.5 in 40 mm Number of holes per pipe 16 Invert elevation of laterals 98.7 I ft 29.99 m Project DAN GILLEN Plan I.D. 75002 Page 4 of Total dynamic head Sysl em head = 3.25 ft 0.99 m Ver6Cal lift = 7.60 ft 2.32 m Are laterals the hill point in the Friction loss = 1.39 ft 0.42 m system? Yes W here. Total dynamic head = 12.24 3.73 if no. what is the highest ekn rafkm Dose Volume downweam of pump? Lateral void volume = 9.9 gal 37.5 L Force main drain Minimum dose = 150.0 gal 567.8 L back to tank? ( °x" one) Drain back = 10.5 gal 39.7 L x F: 3 es Dose volume= 160.5 I 607.6 o Typical Pump Chamber Layout In combination with state approved treatment tank. Tank conshuc ion as per Comm 83.20(3) WAC. approved manhole cover Weather proof w/warning lbel a and padlock grade levels junction box -� ` r graft levels quick � 4 _ al6ernate ° , r vent pipe electric as per NEC 300 and i � outlet Comm 1628 WAC location 18' (46 an) min. waY of pump - -- approved chamber or oUVOK combinalkm 1oint tank A I W rip Grade levels alarm on iroia as pump = 4- rain. abort tiwred grade pump on B rwcnmy wm tank man. =100 mm min above grade ,rat =12' mil above 1 ' -- grade pump 91.1 It C = aoo mm min abere s�iehee grade Off elev. 27.8 m D fl 71, 3 - (75 mm) of bedding under tank and anchor tack as necessary 90.0 ft Pump tank elevation 27.4 m bottom of tai* Tank specifications: huffcutt 1 277 7 5 � -7o Pump tank = 121ga Pump tank volume = 750 gal Capacities: Indies Gallons A= 37.1 445.5 Pump manufacturer [Zoeller B = 2 24.0 Pump model number 198 C = 13.4 160.5 D = 10 120.0 Project: DAN GILLEN Plan I.D. 75002 Page 5 of +•� 4i "'.i�i1T`r 1 l! • r' -3 7. -.#.— i T /a - -•l.l UAL anum �,'`Qi - .a#�JII�ePtta��A��ta�dMle• ►�>!� �""' a :� i •. ; S.L' •ter i ► e I iii��e..ti I r.aan�rrr t 19 ►tea surlsirA�,1Y -� I � �...1 �_ !!� ' ;••• W.T'Cw Asa s , s>t } >z to I i 1 L•� 1~- 16 305 all 221 1 I rl e+huran •rca�.,r -..RV R-.sr. R r•.rr.+a�• •ti+r ar►av+.�aan .� • ENCt►ks ?W'`f+rrgllas, for lk^G YsrillbFs ;ow+I IM It few :cher, ar• 8111kifib:e !r•: ton- trollino sink suR+Rli. wht, an darn.. :.n0 t � -•ut►i sr�sta�+s. - • ��CfIM'! -errtiRali. P?' 6-40"A fwflf*.rci. L• irrraitttba Val r, :]n"ble n1AA1 k Udwiopdw 1&--4 trust Awi/rwmr M �� �ya7�!►1� or w VWtt Warm mitcn. 1!x valor Iwlt bloc *406 corstrclb. *f'! =�YNY �u rr1 �� s•. • � �••s� lL � p ��:'r �. `::.- ::.�:�: i:: i wv t ". w.C�aLi4 .w �: �. �� ri'Z% ♦ t:�( 1 •.i 3�• Tr ,`. f .. �•qn , :W�i�y •�0111rR. alfldl trrf>QltfriLl[ • •tal aw.r N•St !`!••e A ► w. A. ral►!M� n.1r"N. Ic.1►ytaty •_••• —•_,•. � =- vlKlbtl ovRen poem tp r r7. Illtii i ty 1 "-�'--- lluTe •s t a t a t — �►+be:rtrw:w+ Mbrnrt towns o •,• tn•nmc t ►fO 1_� • • ! i m ? a 6 ..� J pf a ♦� !{ l 1 i GiUi f s., AR � . cl "'OVA W t'Vii "CA A dwiwVo1. 't •VNI Eii ?3D t ( 1. H ref :. s�_.1— _._.`_._�'� . -.1 a r�'w i•1 rou •1..N .VAc ltpt. ftv W41101t*l r0 ril fK,w 9.r w r•e t conMOOon or ephce ittrNNlltrtwewtteOUarllrAMf afrOCuti�Aiwcrttywa 'rwirwltp,wa.• iMalt., N GAy�tpN MertIMl f4� ".`..- -.:::..:- _ Iatadgrin e1 r t!iMetT YM.crtvm a► A4•n l• 1 .w + ZtIN1U4 /MenlrraaiRf --- r •:»•::•:••r wrn•�lrwea. me ra.fwMrre+.wY.r ut.dar _ 'n +l 9w^"0"'rllyd Room ;..�...o u, s• ►• •q KY.Y.�MIMeh ? <d ��Ai.Clew/rA.�t ~a *Mnwlr•t •�aRtawll AN wI th.mN.m w �•J;. Foru►.,;;;; . %.��:�IrKlrs�c a reserve safer, tactt:•- r. ± wj t� Mt tom. N 102fit!!q menulaeturi►e of. AW JIM w van JAW w A lltlFrl� !v lAtrs • . ih ?1 "'t•.irt w liag:nt•st;.v A AMWr Wisconsin Department of Commerce SOlL AND Page Divisi6n of Safety and Buildings Si' "E EVALUATION of � ,Bureau of Integrated Services in accordance with s. HR 83.09, WiC. Adm. Cade Attach complete site plan on paper not less than 8 112 x I 1 inches In size. Plai must ;ounty . r include, but not limited to: vertical and horizontal reference point (BM), directio and S ' ( ct'C K percent slope, scale or dimensions, north arrow, and location and distance to n arest road. -arcel I. D. # APPLICANT INFORMATION - Please print all inforM800n 3eview by Date Personal information you provide may be used for secondary purposes (Privaby law, s. t 5. {1) (m)). Property or 'roperty Location - / ��I f f (! _ iovt. Lot We 114 N 1/4,S f T 3� N R E (or) Property Owner's Mailing Addre of # Block# Subd. Name or CSM# State Zip Code Phone Number ❑ city V la [� Town Nearest Ro ty l7 tY !�.'.s sya �/S A -szio C1 n ;,• � i 70 mc,�e. ❑ New Construction Use: ® Residential / Number of bedrooms ! / Addition o existing building 9 Replacement / ❑ Public or commercial - Describe: / Code derived daily flow 61 Q Q gpd Recr nmended design Ic; iding rate L bed, gpd/ft S_Kench. gpd/f 2 Absorption area required • ,_,�a .. bed, f t 2 _ , Jt�,6 trench, ft Jaximum design Wading rate bed, gpd/ft _Z— trench, g Recommended infiltration surface elevation(s)_'2 t (as referred to site plan benchmark) Additional design /site co 'd rations Parent material - _ Flo: d plain elevation, it applicable lt S a Suitable for system Conventional Mound I •Ground Pressure AT - Grade System in Fill Holding Tank U Unsuitable for system ❑ S ©U Q S ❑ U ❑ S O U ❑ S 29 U ❑ 5 +� U IDS U SOIL DESCRI!' TION REPOR`i Baring # Horizon Depth Dominant Color Mottles Texture Stn, aura Consistence Boundary Roots GPO /f42 In. Munseli Qu. Sz. Cont. Color Gr. :i r.. Sh. Bed , Trench l5 --- a nfuF.P Ground 3g) P y/� elev. j�.5� Depth to ; limiting factor Remarks: Boring # k L r ✓ • s s/y air �4 —, .Z � 5 iP 313 rr L trW4 -� Ground fc. Depth to limiting � Actor in. Remarks: CST Name (Please Print) s ature Telephone No. Qate CST Number c Add; � � � - 9 SOIL DESCRIF 'ION REPORT Page _� of — 'PROPERTY OWNER � — PARCEL 1.04 2 Boring # Horizon Depth Dominant Color Mottles Texture Stru cure Consistence Boundary Roots in. Munseil Ou. Sz. Cont. Color Gr. S :, Sh. Bed .Trench :f s/y �FAP Ground eleV. Depth to limiting factor .L_. in. rl Remarks:, Boring # V" 5 Ground elev. ft. Depth to limiting factor in. Remarks: QPDfte Horizon Depth Dominant Color Mottles Texture Str lcture Consistence Boundary Roots in. Munseli Qu, Sz. Cont. Color Gr. >z. Sh. Bed ,Trench Boring # Ground Slay. ft. ; Depth to limiting factor In. Remarks. Boring # Sy ;M ,, l,' a°t% Ground elev. ft. Depth to limiting factor i " Remarks: �nn_n4aA fR n71Gti1 r PiaT A n .0 A �Q ih w Department of Commerce SOIL AND SITE EVALUATION .. i;sion Gf Safety and Buildings Page of eau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S 1 . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Plpr ht alllnfoC tion Revi ed by Date 1� Personal information you provide may be used s�eendary purp es (Privacyt s. 15.04 (1) (m)). Property er �'L I T E M Property Location t ._..lv� Govt. Lot NF 1/4 A( 1/4,S 11 T 30 ,N,R � � E (or)�N Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# I C) q 1 / ✓ 6 ST CROIX City State Zi ..0 Z ! r El ❑Villa ® Town Nearest R0 _ ❑ New Construction Use: ® Residential / Number of bedrooms Addition to existing building ® Replacement ❑ Public or commercial - Describe: Code derived daily flow � Q 0 gpd Recommended design loading rate Z bed, gpd/ft /' /—Z— trench, gpd /ft Absorption area required bed, ft s� a trench, ft Maximum design loading rate /. 2 bed, gpd /t1 gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site con 'd rations Parent material °' 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 EIS ®u El S ❑ U ❑ s & U I ❑ S ffl u ❑ s 4N U ❑ S O u SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground 3 Y 39 2. . ' eyly Sc: /�543 ' Move J�SLft. S Y5 SYk C Z D 7,S'd 25A St L 1 63,64' /n 1/. ,� r Depth to limiting facto] Remarks: Boring # G w . S� CA 3 1 - 31 1Z ; Ground elev. Depth to limiting factor ,fin. Remarks: CST Name (Please Print) i ature Telephone No. 61)n S 71 �rZ 6437 Address )X Qate CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER _ Page 1. PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 0 -13 ) rA,cs /l i„verP ar.,j IkI5 A 5� elev. nd -3 S a Y�3 3 ✓ S: c C ,�S/3� /►f/'FiP —" .2 Depth to limiting factor Ja in. Remarks: r (� Boring # x, Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; 13 , Ground elev. ft. Depth to limiting factor in ' Remarks: Boring # L3 Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) • � ,` � r ! s7 -. 3��a l/a 9 fV�y /�li/y5 / /7"3alye) 1� J 4 r ys' k S 7 era' �Qrh ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND n OWNERSHIP CERTIFICATION FORM Owner/Buyer - _ Da n Mailing Address _ - / '� 5/ / 170 57 A6,,�i =�c,�n Property Address -51t m -'�- (Verification required from Planning Department for new construction) City/State N4- (Al 444-yJ 1''J_ Parcel Identification Number LEGAL DESCRIPTION Property Location ' /4, %4, Sec. �� , T N -RjW, Town of z'i /Q 1r Subdivision , Lot # Certified Survey Map # Volume , Page # Warranty eed # 'y$ 2 g ty ,Volume � y� ,Page # 23 Spec house ❑ yes ff no Lot lines identifiable PS 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, restrictedplumber 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 the three year expiration date. /�;;� le'� y /"?r/• S ' SIbNATWVe 1 0F 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 property described above, by - virtue of a warranty deed recorded in Register of Deeds Office. SI NATURE O 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- 1 _ !, DOCUMENT NO. i' STATE BAR OF WISCONSIN FORM 16— im r -u SPACa assaavao roes acco.o+ -o DATA ASSIGNMENT OF LAND CONTRACT �I 482698 5 4 •'7 : - ��-- --=�,- VOL :�- REGISTER'S OFFICE ST. CROIX CO., %I II I I ) Assignor, whether one or more, for a valuable consideration, assigns t Reed for R I and conveys to . H.9g.1p ...Za arias Arnoid Zacharias APR3 01992 A and.nita..Xal.1 �t gxazx....s...IKt<X1AA. ... P. »common ............... y. ....................................................................... ............................... of 1o15a A M I ................................................................. ............................... (- Assignes whether one or more) the (Vendors or, fdtmi) Interest la a Land Contract �•�, �� ` dated the...... 31st .............day of ..... Djacambar . . 19..Q�.., ""ut•d by RrslaoEEieeds : : •Ediain . H » ... Zacharias ...`.In . w.. 1 . 90ANea j . ............................... V ndor to aerua- » . AX�iG�..A. � ...tjj.gD.�...T.axr� .�.t ..G111ent..�an eY �. „ Od rods „J Gi llen, *an urid'i "vlcYe� one:- ... ................... ................ , ,interest each as tenants fn comm a;�urchas•r I "r` ` on lands is Co nty, State of Wlaeoasla, : ; ; n , r ..... ......... .».. .. ».... »....................... _ . . I together with ( the indebtedness therein referred to and) all the interest of.ths i� ^r Assignor in the Land Contract Lad the lands described therein, which Land Coa- tract was recorded is the Office of the Register of Deeds of said County on SEE .DESCRIPTION ON .... ............. JAIIaxy...0 ...... 0 19.9.7.., as Document Number .....g.1 ;Q In REVERSE HEREOF xn= ) (=414 , , . . ... .. . ( Vol.) ......... Z b 5 ................ 9U on (Page) ......... ... The Assignor covenants that there Is now owing an ern a red �.aad Co r4cf,,tjle um o — ..T..�...�... »... - FortX,- two „;}�Qusapd Six X -}ine„ and„ 4, i �„ 1�0.. ,- , » ,,,,,,; » �, 44 „ �» =-. D ollars, ... I19 »� §96? . per cent per annum from .�,C �.,�-..2. �.� ... ... ........ and also interest at .... , . ... ........... that Assignor is the owner of the above described interest In the Land Contract and has good right to assign the same, and that the condition of the title of Assignor's interest Is the same as at the time of recording the Land Contract. PARAGRAPHS APPLYING IF THIS IS AN ASSIGNMENT OF PURCHASER'S INTEREST: (Strike either 1. or L) By accepting and recording this assignment, the Assignee agresal : ' ” -i �• . Xo�c�?(�4t7silsi?CYoBi?FiBK �.'t 16Xd6DI}QjUG1I[XX.� ' , IkDWI(�ilt Y�cXYs�L3G +�YXd�G�¢Yri�o'I+i(��SJU4� �X sdlli�aaxDcr�wa�acotdd o,X76 iiicaoYX1151'o24YpW4 Ifs74YXTil6a X XZAXVAXXraIL4 adX)0KX =K M 0AHIXIC3 W M LX&x�l=XjCYOX4 ;X3GCgXXX,aXX YoXx M XXXjq X ?i?;WX 7G7c)tflc7p]¢AQDt>}OriX SdG2rrXdf�CS aC�X1STdC?R7(oiGXxT saca�a] cac�d� cXbcaaaeDCCt�afcdeto�txacx udt • 'Cf . K PARAGRAPHS APPLYING IF THIS IS AN ASSIGNMENT OF VENDOR'S INTEREST: (Strike either L or C.) 1. This is a complete auigament of the Vendor's interests In the above described Land Contract. The Purchaser under the Land Contract Is instructed to make all further payments to Assignee upon receipt of a copy of this docu• meat. (OR) awcx�cf� uacxauu?c�r.�(?rp�xx��Ix dc�ctrr�aba�eXdiflasclt�bxeoxtimax: tncrcnEdsocxDr�maztixsa)cFncbaad x�t>titicac�c tgma�ax�axx�X�lxrtcdnla ��x;>bxaiac �xx 1 This .......t.4 T)9t....... homestead property. (is) (is not) D ated this ............. 3A.th ................ I......... day of ................... , APr. iI ................... ................. 19.9. ... ESTATE F N ZACHARIA$ ............. ............................... .........................(SEAL) By ............. .........................(SEAL) a He ........... Zacharias .( ..................... "• Personal Representative ............. ............................... .........................(SEAL) ............ ............................... .........................(SEAL) • ................................... ............................... • ..................... ................................. I AUTHENTICATION ACBNOWLY STATE OF WISCONSIN, Signaturs(s) ............................. ............................... + a '1 ; • r P '� ................................................. ............................... POLK .ZioSiS3 Y. �'` authenticated this ........day of .......................... 19...... Personally . came befcAus ;. this April.. .... ..... :� 1 M,p�92 - �: above naafecJ / ......................... . . ............. ............................... H�xb�X.t .Zaclara..e•???(.$� `gin "Is • ...... .�. ata.JxeY ..cf „ESt, o�-z n H. I •,�;�, TITLE: MEMBER STATE BAR OF WISCONSIN Zacharias,,,,,,,,,,,,,, ;w •- +,,,;� ,,,�a t>rla , (If not......................................... ........... ...........................�... fir' : ^i ��..� ................... .•: authorized by 1 706.06. Wis. State.) �• + +` � s to me knows to be the person . :. foregol instrument and acknow ���.tht,slroi: �� �J. 1.' ..�': THIS INSTRUMENT WAS DRATTED BY I ����� tttt • Daniei „M „BXrnes CWAYNA & BYRNES '• �_;'�'' .... e.. •. Charlene M. Ka tens � '(�t +1k . t lox 179 Amer WI 54001 +� A .:.... ...... ..... J............. �'1............................ Notary Public ........ ..PP.I.�4................... :.: County, (Signatures may be authenticated or acknowledged. Both My Commission Is permansnt.(If not. state espiraHon are not necessary.) dots: February 1 9,9,,5 • „) . ............................... I '^ •Na..ao at pana .Ignlae Is any a.patltr atluYld ►• trp•d or printad aluw t►.Ir a:anatura.. � rttiuer N E BAN Slock No. 9015 • a • `� � '1; ?' `�� "'�•, t� t • i 7Y 76 q .l 1.JV• —C: • _�1�, .,, "�1 D . !SCR�PTION OF REAL ESTATE The Lest halt of Northwest Quarter Sty NWk) h LJCCLNO one -hail sore in the Northeast corner' t e�eof used for school purposes the Northeast Quarter of southwest Quarter (WA SW%j in Scott 11 Townshipp 30 North t' • Rango 17 West LXCLPT a parcel of land'for'right - of - way p urposes located in the Southwest cornori of the North�y st Quarter of southwest Quarter (WL sW %) and described f as to11oVsi LQ,oavaoncin 'ho southweat corner 91 Northeast Quartar of Southwest Quarter $Wk of section, township and ranpof thence North li test, tho east on a 1Lne to a point li loot due Last to.placs of beginning thence Wast to place of boginning, said descrip- tion forting a trianglor the Southwest Quarter of Southeast Quarter ($W% ib�) c: r.;t:gr0 III ieF�G73ir.g li !Got W4:6 of tha ;;v:Lhe +tt car ;.er 91 the southeast Quarter of southwest Quarter (SL(t $Wk)f thence Last li toot, thence south li feet, thence Ina, Northwesterlyy direction to place of baginninq in Section III the southeast Quarter of southwest Quarter (SZk iWk) oft Section 2 911 la Township 20 Norths )tango 17 West. ;,' ' , The exception in the Last halt of Northwest Quarter (L WWh) Section 11 Township 10 Worth, Range 17 West for school purposes is more spsoifZ- cally dosoribad in Volute off p+qs 177 as Document No. 27001 in the office of the Register of Deus ial and for its Croix Countys Wisconsin. V� LP U ��J.Lv.�• '��'�