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HomeMy WebLinkAbout014-1028-50-000 ST. CROIX COUNTY ZONING DEPART 1 10 AS BUILT SANITARY REPORT � Owner ,�,�:q Property Address S !o O City /State Gc t :x 5 qO o? O E r' co uovry OPFACE Legal Description: Lot Block Subdivision/CSM # S6:'/a �' /a, Sec. f 3, T Town of -F PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC I 7,, CSetback from: House 3 O Well / NO /L >F E o Pump manufacturer Mode 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 Length C9 3 Number of Trenches Setback from: House lo? s Well 7�_ P/L OV Vent to fresh air intake ELEVATIONS C � Description of benchmark S Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet 33 ST Outlet SS 0 PC Inlet PC Bottom �3 Y Header/Manifold - (o a Top of ST/PC Manhole Cover �.�•�'L d, Distribution Lines O ��/. Cv o� O f q• ( ) q < Bottom of System Final Grade ( ) () ( ) Date of installation RAW/ggPermit number 5- 33 State plan number Plumber's signature OA number Re? Date l l Inspector -1 ,?7L%V`4.QA- I Complete plot plan a 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. I PLAN VIEW I w I INDICATE NORTH ARROW 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 J c/ INDICATE NORTH ARROW Wisconsin Department of Commerce SYSTEM Count Y YS PRIVATE SEWAGE S Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you rovice may be used for secondary purposes [Privacy Law, s.15.04 (1 515933 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ONES, SHANE M. FOREST CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: 014 - 1028 -50 -000 too 1 0 � (,7 rp,o� a e..'t G Go.' n er 5 h eo TANK INFORMATION ELEVATION DATA A9800322 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic PO ft IZS© Bench rrgi k, ge ) 1016r 1 0D Rosin olu(pa 758 1F 3,0 (o�,•co C 0­0 Aeration Bldg. Sewer 1 P Holding /}* Inlet 1 F' R3•s �l S 3 TANK SETBACK INFORMATION 1 S4 Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic Sp pt 3 d v�� NA Dt Bottom ` 1316 f 3.21 p Dosing �• •� '� 3 5'' NA Header / Man. /V 3 x, 3 4' C1 1 .10 Z Aeration Dist, Pipe 103 a3� 9q & � Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer t Demand 17 Gi3 r� I -e, I --► s/z 7 7 9 S ;L7 Model Number 3 ? Z�G ' PM TDH Lift I L oss 3.D Systtem3'2 TDHas, Forcemain Length 5� Dia. H� Dist. To Well SOIL ABSORPTION SYSTEM ,- K EW TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid th EN I N r DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER IZ I.,, I t 75 �/ OR UNIT I N er: System + ) DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length -- Dia. Length , �� Dia. L Spacing 1 1 2 1 y 7 " 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 l g'' Bed /Trench Edges r Z" Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: FOREST 13.31.15.196B,SE,NE 2156 320TH STREET S:z�/ �i�•58 9�•b'$' "I %.`1g S 5 e Plan revision required? ❑ Yes �Z No Use other side for additional information. 7F-� SBD -6710 (R.3/97) Date Inspector's Si ature Cert. No r SANITARY PERMIT APPLICATION s afety and Buildings Division I SA PE 201 W. Washington Avenue Nl iscons i n In r ILH m. P O Box 7302 Department of Commerce acco d with R 83.05, WIS. Ad Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County � than 8 1/2 x 11 inches in size. &- CrotX Ccun • See reverse side for instructions for completing this application State Sanitary PermNu Personal information you provide may be used for secondary purposes ❑ Check if revision to previous a (cation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION ?— b Property Owner Name c� Property Location ••n ant, M • Sc)ne' S 5t 1/4 N E. 1/4, S 1 3 T 31 , N, R V5 E (or W Property Owner's Mailing Address h 15+ Lot Number Block Number City, State Zip Code Phone Number Subdivision Name SM um er OtCm L1(-- w I $3 00 ( ) 3 PE OF BUILDING: (check one) ❑ State Owned It� Nearest Road Public 1 or 2 Family Dwelling - No of bedrooms ° Town OFbrE -' S'� III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 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 j6 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 0 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/da /sq. ft.) (Min. /inch) Elevation 500 ° Sc> 4 Feet Feet Capacity VII. FORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New Existin Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank 1250 —' 17 H uqc u ❑ ❑ ❑ ❑ ❑ II, ift Pump Tank '1 — - 1- u I 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ V NSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: $rocl :r U Ard - 745t, 7]15 - ZoG9 : J Plumber's Address (Street, City, State, Zip Code): P .O. Sox 2 2 11 A-mey w ) '640 0l / IX. COUNTY/ DEPARTMENT USE ONLY / ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued ss g Am ent Ugnature (No Stamps) I I...1 1�� Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination / 7 X. CONDITIONS OF APPROVA / REASONS FOR I ISAVROVAL: ' 0 SBD- 6398 (R.11 11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET Project SHANE JONES Owner SHANE JONES Address 452 260 TH ST. OSCEOLA WI 54020 Legal Description GOVT. LOT SE 1/4 NE 1/4,S 13 T 31 ,N,R 15 W Township FOREST County ST. CROIX Subdivision Name Lot No. Parcel ID Number Plan ID Number S97 -21079 INDEX SHEET PAGE ONE MOUND CALCULATIONS PAGE TWO MOUND DRAWINGS PAGE THREE PRES. DIST. CALCS. & LATERALS PAGE FOUR PUMP TANK DRAWINGS PAGE FIVE PUMP SPECIFICATIONS PAGE SIX SITE PLAN PAGE SEVEN Designer BRADY UTGARD License Number MP 7456 � .w.T.s. Signature Phone No. 715 ally Lol Date 8 -28 -97 AP p R WED TMENT of COMMERCE DEPAR pl ION Of SAE 7Y AND BUILDINGS Notice. Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. SEE C ESPONDENCE SBD- 10462 -E (N.05M) Page 1 of 7 S 21 07,9 RESIDENTIAL MOUND DESIGN Eight Bedroom Maximum Complete information in red framed boxes as necessary. (y or n) n Is the system constructed over creviced bedrock? Slope 7.5 % Number of bedrooms 4 Wastewater flow rate 600 gpd 1 2271 JLpd Depth to limiting factor 32 in 81.3 1 cm In situ soil infiltration rate (code) 0.5 gpd /ft 20.4 Um` Contour line below the upslope edge of absorption cell 98.4 ft 29.99 m Use standard fill depths? OR Designer speed de 0 in cm Place X in box to use standard depths (12, 24, A +4 inclusive) OR specify design fill depth. Center or end manifold a (c e) Estimated hole space 4 ft Not a final calculation. Lateral spacing � ore) Minimum dose >= 10 times void volume Use a 0lateral spacing for trenches Pump tank elevation 90 ft Outside bottom. Force main length r 85 1 ft Force main diameter 2 in Force main actual dia. 1 2.067 in SYSTEM SOLUTIONS Inch - pounds Metric Cell media "x" one only. Estimated daily flow 600 gpd 2271 Lpd x Aggregate and pipe Chamber and pipe Absorption cell Design load rate & area 1.2 gpdW 500.0 ft` 46.45 m` Linear load rate 9.5 gpd /ft 117.8 Lpd /m Design width (A) 8 ft 2.44 m Cell length (B) 63.0 ft 19.20 m Depth of cell (F) 9.7 in 24.6 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 19.2 in 48.8 cm Basal area required (gpd /infiltration rate) 1200 ft 111.48 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.4 cm P•�•' Subsoil depth at cell wall 6.0 in 15.2 cm Conditionally End slope toe length (K) 10.8 It 3.29 m � � ��� � D Upslope toe length (J) 6.9 ft 2.10 m Downslope toe length (1) 13.2 ft 4.02 m DEPARTMENT OF COMMERCE Total mound length (L) 84.6 ft 25.79 m ION OF SAF 7Y AND BUILDINGS Total mound width (W) 28.1 ft 8.56 m Project: SHANE JONES SEE C RESPONDENCE Plan I.D. S97 -21079 Page 2 of 7 MOUND PLAN VIEW observation pipes (typical) T I W= 28.1 ft q A= 8.0 ft 2.44 m .56 — �-- -- B = 63 ft 19.2 m B K J= 6.9 ft 2.1 m I 1 = 3.2 ft 4.02m K =Fl ft 3.3 m L _ 846 ft 25.8 m typ. obs. pipe A X B refers to absorption cell width and length (anchored securely) J = upslope width I = downslope width K = end slope dimension 6" (150 mm) T MOUND CROSS SECTION D = 12.0 in 30.5 cm lateral topsoil r N subsoil cap E = 19.2 in 48.8 cm invert 99.9 Ift F = 9.7 in 24.6 ern elev. 130.45 m see note F G = 12.0 in 30.4 cm D E As H = 18.0 in 45.6 cm TM c� Sys. 99.4 ft Sand Fill elev. 30.30 m 98.4 ft contour 7.5% 29.99 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 x 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. P.O.W.T.S. Project: SHANE JONES Cpl2dtt1012f1�1y Plan I.D. S97 -21079 Page 3AP P ROVE D DE ARTMENT OF COMMERCE D!yo OF SAF Y AND BUILDINGS SEE C ESPONDENCE PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch -pounds Metric Width (A) 8 ft 1 2.44 Im Length (B) 63.0 Ift 1 19.2 Im Lateral specifications Number laterals 2 Holestlateral 16 holes Lateral length 60.0 ft 18.3 m Perforation dia. 0.25 in 6.4 mm Lat. dis. rate 18.64 gpm 1.2 Us Sys. dis. rate gpm 2.4 Us Hole spacing in 121.9 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in/25 mm Place X in red "X" one choice 1 1/4inr32 mm box of chosen from the options 1 12in/4D mm X diameter. provided. 2irv5o mm X Pin/75 mm X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in25 mm W one choice 1 1/4in/32 mm Place X in red from the options 1 imnl4o mm X box of chosen provided. 2in150 mm X x diameter 3in/75 mm X 4n/1 mm X LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A & 9 dimension Last hole drilled next to end cap en F P AM laterals are identical I¢ X—}I Holes drilled on the bottom of the lateral equally spaced S • Force main connection via tee or cross to mankM at any point. Laterals & force main of PVC Sch 40 • =permanent end marker (per COMM Table 84.30 -5) Inch-pounds Metric Lateral length (P) 60.0 ft 18.29 m Lateral spacing (S) 3 ft 0.91 m Hole spacing pq 48.0 in 121.9 cm Hole diameter 0.25 in 6.35 mm Lateral diameter 1.25 in 32 mm Number of holes per pipe 16 Invert elevation of laterals 99.9 ft 30.35 m P.om.T.S. Conditionc€ly Project: SHANE JONES Plan I.D. S97 -21079 Page 4APPROVED D PARTMENT OF COMMERCE p ION OF SAFETY ND BUILDINGS SEE COR SPONDENCE l S t7 �o a 17 / Sa Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = 9.00 ft 2.74 m Are laterals the highest point in the Friction loss = 1.97 ftv 0.60 m system? Yes "x' here. Total dynamic head = 14.22 l 4.33 m If no, what is the highest elevation Dose Volume _ downstream of pump? C� Lateral void volume = 9.3 gal 35.2 L Force main drain Minimum dose = 150.0 gal 567.8 L back to tank? ( 'Y' one) Drain back = 14.8 gal 56.0 L x Yes Dose volume = 164.8 gal 623.8 L �No Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per COMM 83.20(3) WAC. approved manhole cover weather proof wNvaminq label and padlock grade levels junction box -� rade levels quick disconect g aftemate 4' vent pipe electric as per NEC 300 and outlet COMM 16.28 WAC location 18" (46 cm) min. wall of pump 0 &-- approved chamber or outlet combination ,1 joint tank A 1/4 "weep Grade levels alarm on hole as pump tank manhole = 4" min. above finished grade pump on B necessary pump tank man. =100 mm min above finished grade C vent =17' min. above finished grade pump 90.9 ft vent = 300 mm min. above finished grade off elev. 27.7 m D IE] \V I 3 " 75 mm of bedding under tank and anchor tank as necessary 90.0 Ift Pump tank elevation 27.4 Im bottom of tank Tank specifications: HUFFCUT Pump tank = 17.07 gal /in Pump tank volume = 750 gal Capacities; Inch G A= 24.3 414.5 Pump manufacturer. ZOELL B= 2 34.1 Pump model number: N98 C= 9.7 164.8 D= 8 136.6 Project: SHANE JONES Plan I.D. S97 -21079 iP.OMT: S . Conditions fly PP R"OVED DEPARTMENT OF COMMERCE DI N F SAFE AND BUILDINGS SEE CCWESPONDENCE 3 7. o U� f'IEAO CA Cmr CURVE p - Ya.M 20 iO0 ' r � 4 a , 2 0 u� 10 30 a yo ao �o so l -- — r -- �- r / C 40 240 F P ER ~E TOrY CRMMC FOR 4imp" mown n ew�uwrawoetvrT�aaro i — _ - -- - -• >riao �t+k pAC nr t? _ Lim +0 306 1 4% 237 7s 4s7 ab 170 20 etc 25 ss CONSULT FACTORY FOR SPECIAL APPLICATIONS • Efettrieal affematocs, for duplex sYslems, and eveilahk and Vmnm*e k�vet Rost suppffaa w ilh aft afaren. smut WBS are available Mr conva" single MW ft @* phase 1: ems. - WMMM fin+ ��, W aiup+ex systems. are available with or oouok pw warm** level am swkhn are avamw for vm'M* WON " eyrie Controls. ftnt rd au sELECT"o;L M n40defs - We1M 39 RM. -' M.P. t k4 wal 0 � aw~ 2 PC* nrOWWAI swfth ne s.yw►r operro� r e a !a ?. & na k wrtallr f�7b1C kfra! 4pfil k�l'110r mWl! ��Ck rawOb ktral, Caafssl 230 fl0af a� 1S fialar>eFglp177 a�M IN 3, Mac�aR+ca►akornafa taoon or T10_0075 73 t 1 9 a 1 f i r — 4. SMF00712 forCOMOCf 11 1 �" S lM . Conr fawleft 104225 utae at • aenlrat -E -- acswtor, apaoay dupkts t]) or ty Ove t wrap a T t or 1 49 7 boat soften E9a 270 T f 2 i 3o,4 i 5 s Few (4) hot - J.aak - . rrneo n. on o, far aN ovow CaJn aeft of aarad.n A s+n0 a 01 el- 4090 lion. 104002 Tw 7 o (2) ke►'J -Pak'. ror.ra»r1iged W j pM a. For wltp"wm� on soft~ alma l sa�alfl. r1 , arm b u rte- raahawcal pkaNar Hlewstd MM•wawMa Jrreflet.lw C a>«eaa awe om'ws owulOM dent er • aai iarOTj2 +/� Osns. rarpaar ar,rSnNy lCaassese nrx rataM Nat.onp fhelr c tes. ( [C1 a a Occv " be f onft"o iwuu�+ny tow nOSNAJ S•r•r► away MlaMN AGt RESERVE POWERED DESIGN For unusvat conditions a RESERVE satiety factor is sngineermd into the design of every Zoenr p ump ro mar NMI -- sr7nr aafp avMrwscrN � !/M1' !D. +se►�n r ,rits�ue, �6 rrAam ,afar , • SF - /vE - S /,3 - 7.3 5 7 - ly h r7 �N '' b � M t 11 t t t � � Fi �Y�ad ARIMENT OF CONir," -RCE � p� N *SAFE Nth 6�tlUI�iOS t SEE CONDENCE _ i :'.' Depanment of Commerce SOIL AND SITE EVALUATION :.!vrsior. of Satety and Buildings page- In accordance with s. ILHR 83.09, Wis. Adm. Code _)jlVac, of inl!graied Services Aeach complete site plan on paper not less than 8 112 x 11 inches in sizo. Plan must County nclide, but not limited to: vertical and horizontal reference point (BM), direction and percen[ SIOPr scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D_ _a - - - - - - -- _ - - ` -- - APPLICANT INFORMATION - Please print all information. Reviewed by -� Date Persona• information you provide may be used for Secondary purposes (Privacy taw, s. 15.134 (1) (m)). Property Owner j Property Location_ -- Govt. Lot ✓L� 1144/f 1l4,S� ?j T j / ,N,R ! �� t (o Pr.rty pe Owners Mailing Address Lot * Blocklt Subd. Name or CSMaY City State Zip Code Phone NNumber (( ❑ Cit _ ❑ Village Town Nearest Road / J Naw Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑Public or commercial - Describe: Code derived daily flow , _ gpd Recommended design loading rate I: bed, gpolft` _trench, ypo Absur twn area re uired � (L _- bed, If` ri 1 'i tr ench . n p q - L_ tt Maximum design loading ratel._�` - bcd, gpd /ff Z_v`- _:renCh, gpd. /ft� c:: 7 � - � r� Hecommended infiltration surface elevation(s) • _ _ f1 (as referred to site plan benchmark) Xruui,.r,.a oeSrgn /sile eDnsiderations i',ur nt maleual - % �' �/ �� i Flood plain olevatial, it applrcablo .!� // tt - u �- - � - - - - -- �-- - 1 - �' -- - - -- - - -• - Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill bolding Tank Unsuitable for system Q g U S❑ U ❑ S /`-; U ❑ S U ❑$ - ❑ S SOIL DESCRIPTION REPORT riUr,zon De th Dominant Col-_)i Mottles Structure - 1 nn(� ar p Texture Consistence Boundary Rr:,ts GPD.'fw in. Munsell Uu. Sz. Cont. Color Gr- Sz. Sh. lbea Trercr Grcurta .�i _,6 / 'S'% 7 L� �' �✓ T C �y ` fp !�' �/! �„ !i . Depth to - - - —/ -- 3 liimi it t ti ing ui Remarks: �A Depth to -- - — -- ,rnitrng C �in. Remarks: CST Name (Please Pint) i Signature Telephone No r i.Jaress Date CST Numtxar- SOIL DESCRIPTION REPORT page _-- of PWPERTY .PARCEULD-111 Structure GPDftl 2 Boring;4 Horizon Depth Dominant Color Mottles Texture Consistence Boundary Roots — in. Munsell Qu. Sz. Cont. Color Gt- Sz, Sh. Bed , Trench .7 Z ` y GrGround -2 j tt Deptr I to factV Remarks: Bering # elev oepth to — — - -------- ---- luniting tactof in Remarks: Horizon Depth Dominant Color Mottles Toxlur(., structuto Curlsistence Boundary Roots GPC)Ilr" in- Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed Trorict, Borw.g 4 Gfouno L - )eptn to TliClOf - . Remarks.- Gfoulio Depth to 11tilisting I J Izi-1101 Remarks: qP'I.Qq'in fm n-7,Qf;i - ar age -a�� ' J . Soil Test Plot Plan 'Project Name S hane ,tones d-Xfe1G6< G Byron Qird Jr. Address 452 280th St. '7�3 Osceola Wi 54020 CSTM #3479 Lot ------ Subdivision --- -------- Date 8/1 3/97 SE 1 /4 NE 1/4S1 T 3 NIA 1 5 W Township Forest Boring O VVe)l PL Property Line County ST. CROIX IL BN1 or VRP Assume Elevation 100 ft. at Shed Systern Elevation 98.85 *HRPSame as Benchmark 86' him - B -3 22' Mound Arcil B -1 � 15' j3 30' B.M. B ' 32 � �� , Well 1 48' S)lei) 66' Overflow 60' �~ Existing 4 Bedroom House x' ST 20 �tV Pro )eny Line i Wiscosisin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Jntegrated Services in ac nci wits s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 / h inc es i�size. Plan rnu County include, but not limited to: vertical and horizontal fe ce po VOIRction dn� J� / C� r a r /r percent slope, scale or dimensions, north arrow, rye ation and distance to near"! ad. Parcel I.D. # r r ,: I R �w — c2_ So APPLICANT INFORMATION - Please all infqr►ggdqn. a Reviewed by Date Personal information you provide may be used for second p ses Pv� s. 15.04k(' Property Owner rty Location qtio dh vt. Lot �Li 1/4� 114,S1 T 3 ,N,R IS (o Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# �o �`/ S4 $- �lo1-3 . b City State , Zip Code Phone Nu mber ❑ C ❑ Village Town Near t Road 06 e o /41 - p(/ y> 4 7 r ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building []�- Replacement ❑ Public or commercial - Describe: Code derived daily flow � gpd Recommended design loading rate 1 bed, gpd/ft 7� trench, gpd/ft Absorption area required 3�9.0 bed, ft Maximum design loading ratel�_bed, gpd/fl U nch, gpd/ft Recommended infiltration surface elevation(s) �.� ft (as referred to site plan benchmark) Additional d gn /site c nsiderations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional I Mound In- Ground Pr ssure AT -Grade System in Fill Holding Tank U = Unsuitable for system El U S❑ U [:I S XU [Is u ❑ S u ❑ S �t_u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench G , 5 Ground Depth to limiting factor Remarks: Boring # ohm / r,•i , S J„ Ground ,. CnI 4 1 14 Depth to limiting - Ct in. Remarks: CST Name (Please Print) n Signature Telephone No. Address , �D Date CST Number 7 s,,� SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Moftles Texture Structure Consistence Boundary Roots 13 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground r .SCi 122 eef � Depth to limiting factor Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # MI z. Ground elev. ft. ' Depth to limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor 'n ' Remarks: SBD -8330 (R. 07/96) �, • . • ••- Dominant Color Mottles . �-� ',��)� -iii i�WM ©El�!�M=/1.� Dominant Color Mottles Structure Doi a Soil Test Plot Plan Project Name Shane Jones Byro Bird Jr. Address 452 280th St. Osceola Wi 54020 CSTM #3479 Lot ------ Subdivision --- -- ------ Date 8/13/97 SE 1 /4 NE 1/4S 13 T 31 N/R 1 5 W Township Forest Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Grade at Shed System Elevation 98.85 * H R P Same as B 86' 20' B -3 22' 80' Mound Area B -1 0 15' 33' 30' * B -2 32' 2 ' 1 ,Well 48' Shed 66' Overflow 60' Existin g 4 Bedroom House 8 9 ST Overflow 0' �\ t � Property Line STC- 105 SEPTIC TANK KAINTENANCE AGREEMENT St. Croix County OWN'ERIBUYEIt __S a✓oir/c MAILING ADDRESS 21S `g 2_ rl ST. e- L-c PROPERTY ADDRESS (location of septic system) Please obtain from tltc Planning �M CITY /STATE PROPERTY LOCATION _ 1 14. 1 14, Section , T N-R a W TOWN OF ST. CROIX COUNTY, W1 SUBDMSION LOT NUMBER CERTIFIEDSURVEY MAP VOLUME __3 PACE 4 &I LOT NUMBER 1 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system_ St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1. 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than It3 full of sludge and scum LAVc. the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth. herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to tic St Croy County Zoning Officer .within 30 days of the three year ex ration date SIGNED:_ ._ St Croy County Zoning Office Gove niii1C111 Comer t 1 01 ( - - an1111hact Roa f tullsn 1l'i )1016 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house) , then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property j V\0-nf- nn ` 1(3i`1fe:;, Location of propertyaF1 /4 1J E 1/4, Section _ I ,T �31 N -R i5 W Township Tore S,t Mailing address X15 or4� ar /� k= t., -t�`.Z ALA Address of site Subdivision name Lot no. Other homes on property? Yes K No Previous owner of property R* %!2jna'-yJ U ate, (1 t Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X _ Yes No Is this property being developed for (spec house)? Yes --- - No Volume IzCv and Page Number 5-59 as recorded with the Register of Deeds. - - - - -- ------------------- --- __ ------------------------------------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. �7 Signature of Applicant Co- Applicant 09/23/97 09:23 $7156842393 'THOMAS MCCORMACK Iij001 l • 565313 DOCUMENT NO. State Bar of Wisconsin Form 2 -1982 WARRANTYDEED REG ISTER'S OFFICE ST, GROIX CO., WI Raga 1w Raord Leona. M. Aamodt, formerly known as Leona M. Rudesill, and SEP 12 1997 11: 5 A adt wife and husband, and warrant to M Richard O. Aam d, cony 14 k 446t Melissa e Jones the following described real � R � estate in St. Croix County, Wisconsin: NAME AND RETURN ADDRESS & r L AJW OFFICES P. ox ew Richmond, WI 54017 014- 1028 -50 (Parcel Identification Number) Part of Southeast Quarter of Northeast Quarter of Section 13 -31 -15 described as follows: Lot 1 of Certified Survey Map filed September 5, 1978, in Volume "3 ", page 677. TRA F fER ro This is homestead � pro perty. Exception to warranties: municipal and zoning ordinances, easements and restrictions of record Dated this 'day of August 1997. L66ha M. odt f/k/a na sill o Ric *d O. Aaniodt AUTHF.NTIC,ATION ACKNOWLEDGMENT _ I Signatures) STATE OF WISCONSIN ) authenticated this day of 1997. ST. CROM COUNTY ) Personally came before me this A &�lday of August # 1997, the above named Leona M. ASOdt 'f/k/a TITLE: MEMBER STATE BAR OF WISCONSIN Leona M. Rudesill and Richard 0. — = E to me_ (authorized by Sec. 706.06, Wis. States.) known to be the persons who execyted *d'iuQrego instrument and aclmowledge the same. ; •; ; THIS DOCUMENT DRAFTED BY: 7 A. Remington -• . '` Judith A. R emingM N Public St. Croix County, Wis. ..... e REMINGTON LAW OFFICES My Co mmissi on is permanent. P.O. Box 177 New Richmond, WI 54017 f 35 Is 8 SEP a 19 co 78 Liu l 84 04 4d, +�rf r �. ST. CROIX COUNTY SURVEYOR'S RECORD z 1 W '�s 2102. /(o • .oy �3.oq � � 4t WO� LOT 1 z �v J A 7 76 8 AC2E ± O• ,h o 77, yo / Sa. FT. `O a o h 4j N 4j h °N (P "j3 I I 0 = //Ro PIPE W i13 LB.ILF •o 's � s /o 13 18 CERTIFIED SURVEY Y 13 18 PVR aF THE SE %y OF ThT NE SECT/Olv /3 , TN 3/ , R15W, APPROVED TOW/v 0F FOREST, Sr. CROIX 6 C O UN 7 P l W J Oil/. 51A1.. AU G 2 3 1978 APPROVAL OF THIS MINOR SUBDIVISION DOES NOT M'6AN APPROVAL FOR COMP.;EMENS;V 5T. �.:o:x c.;u ; r : PAicKS PUN:44G DESCRIPTION BUILDING SJ_ OR SEPTIC aY.,TEM. AND ZONING COM WITU REFER TO H62.20. Part of the SE- 4 of the NE4, Section 13, Township 31 North, Range 15 West, Town of Forest, St. Croix County Wisconsin described as follows: Commencing at the East 4 corner of said Section 13 and this being the point of beginning of this survey; Thence N 86 55' W 33. feet to a point; Thence continuing N 86 55' W 262.16 feet to a point; Thence Due North 295.20 feet to a point; Thence S 86 55' E 262.16 feet to a point; Thence continuing S 86 55' E 33. feet to a point; Thence Due South 295.20 feet to the point of beginning. This parcel of land contains 1.7768 acres more or less and 77,401 square feet more or less excluding land released for highway right -of -way purposes. SURVEYOR'S CERTIFICATE I, Richard D. Booth, being a duly qualified surveyor, do hereby certify that by order of and under the direction of Jerry Cormican, I have surveyed and mapped the property described. The plat shown on the sheet is a true and correct representation of the exterior boundaries of the land surveyed and that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes to the best of my knowledge and belief. CSC O r o t �L . e . Richard D. Booth ®� Registered Land Surveyor RICHARD D. Clear Lake, Wisconsin BOOTH Z S•1413 May 2, 1 97 8 CLEAR LAKE, WIS.r _ CA r • V '' 9� O S U RJR �� -�� 10 Volume 3 Page 677 _ i'