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HomeMy WebLinkAbout012-1051-00-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Q p r Address I c1 ° L QA G City /State N D 1 7 Q Legal Description: M j4 Lot P A_ Block Al Subdivision/CSM # N F4 '/. N'V-- '/, NC . Sec. , T_3 -RAW, Town of fir, 'PIN # S / -c>o -00 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: I r j Tank manufacturer ` e Size ST/PC WCO/ Ivy' Setback from: House Well Co I PAL (00 Pump manufacturer, QOL Model �R k 5 WC D 3 It L Alarm location 9 " ' U jM , (HOLDING TANKS ONLY) p Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: w Width a a • L Length Number of Trenches Setback from: House Ct a_ Well to 1 PAL lO Vent to fresh air intake (p© ELEVATIONS Description of benchmark oc� w� �, S cl, Elevation / Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet/ PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover 9 4 1. J c Distribution Lines O q I O ( ) see rv+-E-- ae�-- Bottom of System () C N S ( () () Final Grade Date of installation Log / ermit number O 7 7 State plan number 17 S Plumber's signature License number Date / (/ � Inspector complete plot plan 1 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 , t- 1 #s 9 1 N �Z) VV 3 qs, INDICATE NORTH ARROW d aNiscoi3sin Department of Commerce PRIVATE SEWAGE SYSTEM v Safety and Buildings Division Count INSPECTION REPORT sT. CROIx GENERAL INFORMATION (ATTACH TO PERMIT) SanitariPOnitcNp.: Personal infor you provice may be used for secondary purposes [Privacy L s.15.04 (1 )(m)]. / '' yy�� ANDERSEN , PAUL ' M I I4Wn of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T�iDllo_:10 jdo o v df/� o�si ll� 0A., dalclin U TANK INFORMATION ELEVATION DATA A9800202 TYPE MANUFACTURER CAPACITY STAT ON BS HI FS ELEV. tic WG PiaS­j' Ida C) Bench D mo- /D lab Dos' 431 A CL4d1i1 r 9 4 , 10-0 Aeration Bldg. Sewer Holding t Inlet ��. p �a ? TANK SETBACK INFORMATION / t Outlet TANK TO P/ L WELL BLDG. vent to ROAD Dt Inlet Air Intake plic �♦ 5'` (, p ° 1..j , NA Dt Bottom 1 - 1 D Ing u /1 N 7 ? l NA Header / Man. 9� Aeration NA Dist. Pipe 17f�� Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer 6 00a Demand V Y % Model Number 41 Ea 3 //L 7a GPM e_ojjel TDH Lift q,7 Lriction , �g SVstem� TDH /a t Forcemain Length v Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED Width f Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 1 N S ? DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM L HING Manu SETBACK C AMBER INFORMATION TypeO Mo um er: System • ( O IT DISTRIBUTION SYSTEM Header/Ma old ji DistributionPipe(s)+ a x Hole / ze x HoleSp dig oAirintake Length Dia. Length � Dia. Spacing `� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Q� �� Depth Over xx Depth Of „ xx See / Sodded x Mulched Bed /Trench Center ��� O Bed /Trench Edges Topsoil 1131, 1 41 Yes E] No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 20 �8 �1 S�Z LOCATION: ERIN PRARIE 23.30.17.349A,NE,NE 1 8 CTY RD G 0 eo*41 5 ;L)(1a( rat a (evM41� 67 k s l 01 p3in r `t�irb -I � Plan r Ye N��1 l�v q o Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Sig ture /f - SANITARY PERMIT APPLICATION 201 ashingon�Ave �� ♦� Isv In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County n than 8 1/2 x 11 inches in size. �� IL C • See reverse side for instructions for completing this application State Sanitary Permit Num er 3d Is The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION 81 '75 Prope Owner Name Property Location tr G 1 N E.1 /4, S T 3 a, N, R j E$W W Propert y Owner's Mailing Address l Lot Number Block Number d W A- City, State I Zip Code Phone Number Subdivision Name or CSM Number tv IL OF BUILDING: (check one) ❑ State Owned ❑ : age Nearest Road u Public 1 or 2 Family Dwelling - No. of bedrooms .3 ❑ v OF n` P rIc, I t ; &If V III. BUILDING USE (If building type is public, check all that apply) P rcel Tax Number(s) 2 � O 3 4G r1 1 [] Apartment / Condo 0 1.) J b,Js -! ­00 _ OTC f� 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 % Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - ------ System -------- System ------------- Tank Only --------------- Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 [] Specify Type 41 ❑ Holding Tank 12 [] Seepage Trench 22 In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/d y /sq. ft.) (Min. /inch) Elevation 37S 37 /V qQ.$ Feet 10J..5 Feet Capacity VII. TANK i Ca allons n Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank x ( b W Q Y` ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl 1 &00 1 E ❑ 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: (Pri tX MP /MPRSW No.: Business Phone Number: ,� Plumber's Address (Street, City, State, Zip Code): t � O C IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee [includes Groundwater ate slue Issu g Agent Sig ture (No Stamps) �L K Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SB66M (R t tom) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber I WiscoaVn Department of Industry SOIL AND SITE EVALUATION Labor and (iuman Relations ---- F Page of 6ivisio6 of Safety and Buildings $ i& accc7rd�nce with s. ILHR 83.09, Wis. Attach complete site plan on paper not � an 8 1�� AM es in size °.Plan must County include, but not limited to: vertical an rEF{pnt (BM), detection and 5 � �, h o 1 x percent slope, scale or dimensions, �, n g ontal rrow, and location and distanca)lp nearest road. Parcel I.D. # go i APPLICANT INFORMATION k Please ptMt1AUWorma>, 0, Revi ed bA Date NTY Personal information you provide may be us Y9r secon Z a *0 UFTt ac s - . 15.04 (1) (m)). � ♦ , Property Owner Property Location r , , �. (, Govt. Lot N � 1/4 �� 1/4,S .93 ,N,R A(or) W Property Owner's Mailing Address ' "" Lot # Block# Subd. Name or CSM# � G 01 N/ ^yp *A City Atate Zip Code Phone Number Nearest Road ❑ City ❑ V' ge � Town lG W.r / � �,�) pZ — 5597 V ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ;Replacement n Public or commercial - Describe: Code derived daily flow � 0 gpd Recommended design loading rate 1 5 bed, gpd/fe — t - A L--trench, gpd /ftz Absorption area required 97 5 ed, ft .175 rench, ft Maximum design loading rate k S bed, gpd/ft jv trench, gpd/ft Recommended infiltration surface elevation(s) 97,-5 C.:ayj:6w`• L rl:A, ft (as referred to site plan benchmark) Additional design/site cons id rations Parent material Flood plain elevation, if applicable A ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S X U S❑ U ❑ S Q4 U ❑ S X U ❑ S EM U El S 14 U SOIL DESCRIPTION REPORT P r .B Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 " in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I I a Se M .27 J 4/41 :5 �� sblc M 5'1- 's 4 Ground '/ 3 O f3 SI R M 54k e S & S b �� elev 1n o R S Xvt 5VY Depth to limiting facto, � 0in. Remarks: Boring # a z -? R s/ a rrrn 5 bk M I i- j 3. A - 0 !o — K m Q,M . s ' Ground R$ S a m S K 1 —' elev. Depth to limiting fact r .�in. Remarks: CST Name (Please Print) S* at re Telephone N 7 �s�a y6 Address V Date CST Number i f SOIL DESCRIPTION REPORT ` 3 PROPERTY OWNER �►�A �'Rd�I'S� Faye PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -� 6 f SDK M w ,. ;:.. o- o S/ 02 rn S 1K S ,. + C 4 � Ground 1- k'16 �—' , ✓ , elev. 9-71a.ft. Depth to limiting factor >Wn. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. 8z: Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) /'� •_ r SOIL DESCRIPTION REPORT' j PRQPERTY OWNER QA.I '�J1 tao--t-w Page __Q_ of _3 PARCEL I.D.# a -405 / - OO — Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots r Bed , Trench a- o 0 3 f sa U r W 3r- r tS o o s/ amS�k Sr ccz elev. 3 E----' 1 .5 ; Depth to limiting f act fato or r Remarks: Boring # 13 Ground elev. n. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft2 Texture Consistence Boundary Roots in. Munsell Qu. S�z: Cont. Color Gr. Sz. Sh. Bed ,Trench Boling # Ground elev. ft. Depth to limiting factor 'n Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I _ See -4P.3 J - t�'�'Yt_ � r �• r�1 u � I I I L i - _ i I I i i I � , I I i I i I � � I I { _ _ I OF i II it Sx I I , I ' — '0 ' 3 I ' Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 N visconsin Tommy G. Thompson, Governor Department of Co mmerce William J. McCoshen, Secretary May 18, 1998 CUST ID No.273085 CALVIN POWERS POWERS EXCAVATING INC 1969 185TH AVE NEW RICHMOND WI 54017 RE: CONDITIONAL APPROVAL Transaction ID No. 81751 APPROVAL EXPIRES: 05/18/2000 SITE: Site ID: 8574 ST CROIX County, Town of ERIN PRAIRIE NEIA, NEIA, S23, T30N, R17W PAUL ANDERSEN FOR: Description: MOUND DWELLING 450 GPD Object Type: POWT System Regulated Object ID No.: 21464 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • Existing system to be abandoned as per chapter Comm. 83. 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. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerely, DATE RECEIVED 05/15/1998 FEE REQUIRED $ 180.00 RYAN M BOEBEL , PLUMBING PLAN REVIEWER 1 FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)261-8504, M -F 0745 -1630 F RBOEBEL @COMMERCE. STATE. WI.US co, API DEPART OIIIA�IN Q WE Q nog x1 w t Sy of 7 WORKSHEET - MOUND SYSTEM! DESIGN ( yy N E y - 3 73 o N A 7 81 7 75, PROBLEM: Design a mound system for a_ The site characteristics are: qq Depth to grounNater or bedrock r in. Landslope _ Z Percolation rate Distance from dose chamber to distribution system _Q fit• Elevation difference between Dump and distribution systern � ft. Step 1. WASTEWATER LOAD - s� aal Step 2. SIZE THE ABS0PTION AREA A) Area required - t/Sp ), Z 3 2�7 sq. ft. B) Bed or trench length (B) 5�5 ft. 9 3 C) Bed or tr 3nch width (A) S _. S ft. D) Trench spacing (C) r r Wastewa er load .24 (,al /f * /day trF r � es Step 3. MOUND HEIGHT A) Fill depth (D) - ft• B) Fill depth (E) - D + slope (A)+P) �•�, ft. C Bed or trench depth F ,F3 ft. OAT-86 D) Cap and topsoil depth j� ;tsott � 1 ft. E) d topsoil depth cnOVE O ,s ft. PENT OF COMMERCE SAF Y ANIP 1U4WNW `t.___ ZRESPONDENCE Step 4. MOUND LENGTH C- A)' End slope (K) _ C D + E 1 + F + H x 3 ���� ft. \_fir/ 1� �-+l,/ �,�3 tl B) Total mound leng h (L) = B + 2(K) z 95,E ft. 7 -t . (16, ; - qs, y Step 5. MOUND WIDTH Al) Upslope correction factor A2) Upslope width (J) - (D + F + 0)(3)(factor) _ ft. (/ t,Y3-�- 9y B1) Downslope correction factor B2) Downslope width (I) - (E + F + G)(3)(factor) _ 9 ft. C/1l�, W311)r3 X /, 06 = g.3/ Cl) Total mound width (W) for bed - J + A + I = ft. 1 94 5 f94 �a�� C2) Total mound width (W) for trenches - J + A + (no. trenches -1)(c) + A + I _ JA ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil ,�,� gal. /ft /4ay B) Basal area required - wastewater flow 1 natural soil infiltrative capacity = ?-5 sq. ft. ,4 /c5o CI) Basal area available for bed for sloping sites = B x (A + I) - 1V1,4 sq. ft. C2) Base are avail le for trench for sloping sites = 8 W �J + / sq. ft. l 4 s� : s 9 a , 5 C3 Basal area available for trench or bed for level i es - B x W = sq. ft. _ r D a t. :. r 2 3 1 3 "r-p�! iJ Step 7. DISTRIBUTION SYSTEM 7A; SIZE DISTRIBUTION SYSTEM 1,) ,Hole size = in. 2) Hole spacing = � in. 3) Distribution pipe length a_• 4) Distribution pipe diameter _ in. 5) Spacing between distribution pipes = in. 6) Distance from sidewall to distribution pipe 3 0 in. 7B) DISTRIBUTION PIPE DISCHARGE RATE 37 ft. 1) Number of holes °r pipe A _? 2) Flow per pipe : a .23 GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length a 11 /o -3 1 Tie. � _ ft. 3) Number of distribution lines a o? 4) Manifold diameter 3 in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = ' y °y6 GPM r 2) Force main diameter Q 3 in. �4 3) Friction loss �'�` �� , • �y ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = .� ft. 2) Friction loss = •1 ft. 3) System head 2.5 ft. ft. Total dynamic head ,� ft. .. _ �C7 GO 1F) PUMP SELECTION 1) Pump selected will discharge GPM a f� ft. total dynamic head. 2) Pump model and manufacturer 7G) DOSE VOLUME 1) 10 times void volume of distribution lines gal. /cycle 2) Daily wastewater volume 4 doses /24 hrs. 11,AS gal. /cycle 3) Minimum dose volume z 3 e � :/x ' gal./cycle a� -6�-i, Lam. 7H) DOSE CHAMBER ,S 1) Minimum capacity required = 3 'gal. P(o--j Da Le -- -- ------- .4 _ 114 LA l I ' I I� I I I I _ � .� -. t2 Lb - I - I I I I --- -' � � i I I I � I I I �- Ay t Im AA - 14 4� 'Po- Qw�c�ewse ri Pays Of • a . • /9�I l� µ G Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Top smell i I r % Slope Bed Of 2"— 2 %2 Force Main Plowed Aggregate Layer D Ft. Cross Section Of A Mound System Using E l,/ Ft. t o'Bed For The Absorption Area F . Ft. G / Ft. A s Ft. H /_ Ft. gned: g L Ft. tense Number: 4 0,53 K 0, Ft. te: S' -- // -- 9S E 95, Ft. j Ft. Alternate Position I . 9,� Ft. of Force Main W a Ft. A l Observation Pipe 1 1 `Force Main Distribution. Bed Of 2 2 2N Pipe A99regate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area A; ent �J l;v� S b1 > page R Ic Z q Perforated Plpe Detail End V1ew Per fora led End Cop \' PVC Pipe o �,o ic e Holes Located On Bottom, c Are Equally Spaced .r X �,b : e ., pry • Er b ns f ;bw1, Lail Hole She l'd Be _ ,�• . Neal To End Cap Dictrib.ulion Pipe Layout P - 3 7 Ft. R S - -> X Inches Y lc-. Inches ,� Signed: Flole Diameter '�. Inch License Uumber: Lateral Date: Manifold Inches Force M a i n 3 Inno; # of holes /pipe Invert Elevation of Laterals_q3,_0 Ft. / S EPTIC TANK !; PUMP CHAMBE CROSS SECTION AND SPECIFICATIONS / / ��_ 9 or 4" CI VENT PIPE 12" MIN BOVE GRADE & WEATHER ROOF' 25' FROM_DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE 4 CI RISER W/ PADLOCK >; WARNING LABEL 6 MIN. ABOVE G ADE — �w__ -4" MIN. 18" IN. 6" MAX. • �� INLET , �� WATER TIGHT SEALS GAS - TIGHT i A SEAL ; APPROVED 4 " BAFFLE CI PIPE --�— , ALM JOINTS W/ CI 3' ONTO B i PIPE 3' ONTO SOLID - ON SOLID SOIL C SOIL PUMP OFF ELEV. FT. -- I pF ** RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE lI TANK MANUFACTURER: G8'O &)1,0, WUMBER DOSES PER DAY: TANK SIZES SEPTIC 1 6V0, GAL. DOSE VOLUME INCLUDING DOSE 1 po GAL. FLOWBACK: GAL. ALARM MANUFACTURER: CAPACITIES: A = INCHES = GAL. MODEL NUMBER: SWITCH TYPE: / CL f- B = 2 INCHES = .3 3 GAL. PUMP MANUFACTURER: G�rulA, C = 7. INCHES = Q4, /L GAL. MODEL NUMBER: SWITCH TYPE: D = g INCHES = /►O GAL. REQUIRED DISCHARGE RATE - 26 GPM PUMP 6 ALARM WIRING AS PER I 16.23 WAC .I VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 9 EET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . % . FEET + O FEET FORCEMAIN X __,Yi FT /100 FT. FRICTION FACTOR . .13 FEET T.OTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER LIQUID DEPTH ,,3G �� �� /44 a SIGNED: LICENSE NUMBER O ::t .O S3 7 DATE: S // — 9� 1/88 t I S. \ <. \ ;. AV) ip �DULDUBfiDL� �r . {��U ,�, '1� � � +F MADE A. D EFFLUENT Pump*s OJtmEP0311 142 EPO311 - - — �� � t 7 i >ti t 1./3 FP 115 V Efflua,t Putto 1/2" Solids 1 256.80 � 172. I ' :.n MODEL EP0311 • .r�1 a�•',,� 4 ' Effluent:. trump . SIZE IN' SOLIDS METERS FEET 1 < dnti 25 tai' •r . ,.:: • 1 ' 1 .r < 0 0 0 4 a 12 15 20 24 28 32 36 40 • l_ L GPM 0 2.S 5.0 7.5 m CAPACITY e� r .G °t Performance 't Curve MCMAS rut • ' MODEL WS SIZE ' /4" Solids WE •. 1 •}, b A �•• � wcox _ _ _ i J1 fit, iO t .•,, o 0 r.ti::?' ?•^ o to p x .a ' w w 'ro oo to loo tto 120 or•ut . 70 warn\ r. 1• � ' ' CAMCI77 LIST DISC. `'t•'�''• 0XIPKFA3111. 142 WE0111L 1/3 i1P lIS V LAW N 3/4' eolids X91.55 329.3S r ti r a. d 00 142 ' WE0311M 1/1 IT 115 V ma A 3/4•' loolids 491 .55 329.35 ' + 1 ,. "'1`:•'•ti'• •'�' ' 1 00LnrrM1131 142 WE05'1`1N 1/2 10+ US V fucli R 3%4 .oblids 704JS 4 3.85 -?'• ' i t s A OXNT0712t1 142 XE071i1i 3/4 1tp 230 V Rlgh 113. 3/4" solids 841.65 565.25 �� � I i i ° "•' "SEE F UJOWIM PAM FM PE1U) f1W= AM WMFICMUl4. � R�• MIL 10%88 30 PAGE 07u Wisconsin Department of Industry SOIL AND SITE EVALUATION `Lataor and Human Relations Page of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 5 -1 G r o \ X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i Property Owner Property Location a Lk O r Govt. Lot /V e_ 114 A) 6 1/4,S a3 T3O ,N,R 7 Jj(or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# £>' l G R ,- , l `G N A 1,4 n/ A city Atate Zip Code Phone Number Nearest Road lG W= 1 —5397 [:1 city 1:1 Vi ge Town �\ ^ N Z I­ .n V I ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ,Replacement M Public or commercial - Describe: Code derived daily flow 45 o gpd Recommended design loading rate 1 S bed, gpd/ft A! trench, gpd/ft Absorption area required 97 S bed, ft 7, trench, ft Maximum design loading rate i S bed, gpd /f1 • I6 trench, gpd/11 Recommended infiltration surface elevation(s) 9 Z n:A. ft (as referred to site plan benchmark) Additional design/site consid rations Parent material Ge.[./ Flood plain elevation, if applicable Q _ft I Mound In- Ground Pressure AT -Grade System in Fill Holding Tank S = Suitable for system Conventlona o d y U = Unsuitable for system El S X U S❑ U ❑ S CK U ❑ S U El S �I U ❑ S U SOIL DESCRIPTION REPORT P 7 le .B Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l v Q /o a S b k rn c,J 3 4 - 5 ................... 1 1 z -27 Joug Y/4 s .�,�. sbk rn 5)- ,,) a %-- Ground elev. 9�? Zft o /o R S S 51 V rn SW I< Depth to limiting fact°q�,r Remarks: Boring # 1 o y /o I ! Sb rn� S' 3 ; .S a z -� L) it 5/ a m Sbk r 31-m 2 /D K 171 -m ,S ' 1. Ground "� /0 R S S / SbK rA f elev. ft. Depth to limiting �� fact r in. Remarks: CST Name (Please Prin S' t e Telephone No. 0Z CJ 0 r _.) y6 512S Address Date CST Number /9/0 w S' - / /-- Plr *�' ;L2 0-r-? SOIL DESCRIPTION REPORT PROPERTY OWNER ��� Y1��hS� Page — a of --3 PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 - g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench f 5 r W 3m i7 �S o y / Ove il, S/ a M S, k S ,. CGO Ground 3 Sty- elev. 9Za-n. Depth to limiting , f actor fa n• ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # d i s Ground elev. n. Depth to limiting factor ' Remarks: Boring # u , Ground elev. n. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) lit i _� I I v ; I I - - C - i - - I _ I - I � - - I ' I I t I I I I I I I I I I I I I I I I , I I I I I I IL �vr A-'- 6P I i - i F I I I I I I I I 3 f �- I I I � I r - - � 39 � ��� � i GA O •o /` ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S Mailing Address Property Address (Verification required from Planning Department for new construction) City /State C�w� onc�� P arcel Identification Number LEGAL DESCRIPTION Property Location AX ' /4, Pj=' '/4, Sec. Q T_3Z�_N -R'W, Town of C ', -. r �r� •�, Subdivision 1 , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # o - 7 , Volume - aZ , Page # 3 Spec house ❑ yes no Lot lines identifiable I 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 expiratio date. p� SEYNATURt 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 property lescribed above, by irtue of a warranty deed recorded in Register of Deeds Office. - to e AlAvAtiqsal SIGNATURE OF APPLICANT A DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** i ** 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 DocumtNT NIU. STATS BAR or WISCONSIN roxx 1-190 v"IS *P*At MUW4= Von secom"Is DATA 3 ",1 WARIRAMTY 4120 wls� ? W.- ftk' U 44 'tft O"Ict This Dead, made between ... ST. CROIX Co., WI& Andersen also known as al ............................... ....... . wte ......... An PAC'CL fix Record #is ..........•....• ..• .• ........ .......................................................... ................ ........ .................................................................... .................... . Grantor, NOY 0--XQ1L_AA 19_$S 1:00 P ............................................ I ................................................ ......................• .. .................. ............................................ .. . .............. .......................... .............. .................... ............................... , Grantee, Witnesseth, That the said Grantor, for a valuable consideration County. State of Wisconsin ........... conveys to Grantee the following described real estate in ..... St.. CrojZ.­ 119mot" TO HAROLD D. OLSON ATTORNEY AT LAW I BALDWIN- Vil SAQQZ-- I West 396 feet of the North 224 feet of the East Half Tax Parcel No: . ......... ..... of Northeast Quarter (1h of NE%) of Section Twenty- three (23), Township Thirty (30) North, of Range Sev- enteen (17) west, St. Croix County, Wisconsin. This ...is. not ............. homestead property. ")-419-nou Together with all and singular the hereditaments and appurtenances thereunto belonging; And...... 1 4AAC.Q.r ................. .............................. ............ ........... .................. ----------------- ------- ----- ��Ve warrants that the title is good, indefeasible in fee simple and f-,,-e and clear of encumbrances except that t described real estate is subject to the highway, easements of record and oil, gas and mineral rights reserved by The Federal Land Bank of Saint Paul by Deed dated June 13,1 d reco4fid in Volume 291, page 62 in the or- of the Register of Deeds for St. Crej Uri w1hyJarran the same. 21st November 85 Dated ............ . ....... ... day of ---- -- ------ ­­ ------- .......... ..... ....... ....... 1 19 ......... (SEAL) - -­-------- (SEAL) — ------------ H arr y dersen .....• . ......... ........ •.....• .• ...... ...... -- ------- ­ gb epps onq ....... ........ ........... ........ ...... ............ ............. ...... (SEAL) h - ---------------- ------ -------- ------------------------------ . .Walter- -E... Andersen ......... ...... ...... I F AUTHENTICATION ACKNOWLISDOMBNT Signature(s) ............................. ... ............................ STATE OF WISCONSIN •.....•........................•...•.•................•. •..•................... St. Croix County. ........ ............ ........ I t authenticated this .__.....day of ----------------------­-- 19...... Per,.-,nally came before we this .-_ ..1s - - -. - day of Mov er;�,-ex- . ... •----- ­­ ........ 19_. S the above ramed ---------------------------------------------------------------------- -------- Marie B. Johnson Walter E. Andersen also -- .................... ­2 -------- ------- -------- I ---------- --- ..• ..• ... ---- ­.. . ---- ..... as Walter Andersen. and.Ha ry_-An -------------------- .... ............ .... .......... ............ ................ .............................. ..... �r _-der TITLE: MEMBER STATE BAR OF WISCONSIN sen ------------------------------------------------------------ ------ (If not, ........ ........... ­ ... ........... ­ .......... ........... ........ ­­ ---------- ........ ------ - ------- �� a uthori z ed , . , , , by 1 706.06, Wis. Stats.) to mp. known to be the person .!� --------- who executed the ins rum e7 ff foregoi t ent and acknowl d ' e the same. THIS :NSTRUME WAF DRAFTED f'Y !� ' ------ .. WY� ..................... Harold D. -- Olson ---- --------- ----- ---------- ---- ---- Ba)6 54002 St. Croix .. . ...... ............ r ------------------ --------­----- ...... Nota-v Public ....... .... ....... County, W:--- (Sign4itpreso VIAY he_ A tithenticated or acknowledged. B permanent. My Commission is (ff -e --mt,­Aate- - - ----- - ---------- ------------ C lyre nok necessary: - 1jM1 In any capacity should he type or printed Kalov their xirn.tures- 7 STATE BAR OF W1SC0 Fli FORM N.. I — 1942 Stock No. 13001