Loading...
HomeMy WebLinkAbout016-1050-20-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner V ! Property Address cc) City /State Cq Lao LAJA 6d, Legal Description: Lot Block Subdivision/CSM # U2�% S ' /a, Sec. vim". T -R-ZfW, Town of C1 PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturerft eze ST/PC Setback from: House 3'�' ­ Well P/L Pump manufacturer WA 'M Model 311 l. /,Ijl Cw LA4 311 YYl 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 �� Number of Trenches `- Setback from: House 11 Well 11.0 P/L U& Vent to fresh air intake ELEVATIONS Description of benchmark Elevation 0 v LMO no Description of alternate benchmark 7 o Vo (4 pg;ud CAYZ-4 AVKe& 21 Elevation Building Sewer ST/HT Inlet In WST Outlet -� `2 PC Inlet PC Bottom Header/Manifold I Top of ST/PC Manhole Cover Distribution Lines Bottom of System () C1 () _ 0 � ( ) Final Grade O O ( ) Date of installation (d /W Permit number 1 �J State plan number 7 /' ((o Plumber's si nature �Jtm License number Dg Date Inspector 1ST � �`/ Complete plot plan R D u LL ' i 7 rn� do v1tlJ 'x 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 I I .Y r . m LqJ� O INDICATE NORTH ARROW 6' �a � 2� l 1' fir► 0 io 30 14 0 POVIA VV1, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT 34 j A, GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 31SM Permit Holder's Name: ❑ City ❑ Village jg Town of: State Plan ID No.: C_[A"e 6 V_ _� 1 C �� (Jbod CST BM Elev. Insp. BM Elev.: BM Description: 11 Parcel Tax No.: GAD C5D I Vo V\ P i k o (2- TANK INFORMATION ELEVATION DATA f�DOZS( GJ O TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic WW �� Be h ar �Z Iv .L tcs� Dosing l / �1 606 ?e� t3 w1 ! fit; 7 / ��/ Aeration -1/1 Bldg. Sewer g.q Y q?. ZJ [ Holding St/ Ht Inlet Ej(�,� 10.1-2- ,�� q�{ TANK SETBACK INFORMATION St/ Ht Outlet 6.(06 I ��qf TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet G `��o �V•bb I�(o • OHO Air I Septic r . �� /. S NA Dt Bottom ��i•( (� ��. �;-$ Dosing NA Header /Man. Aeration NA Dist. Pipe Holding X U Bot. System � L q a3•• y 9�r ! 3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer 9CU V Demand 6M 21 Model Number 11 IA 2'60 GPM TDH LiftQ .L` Friction Sy � TDH2p,94 Ft oss Forcemain Length C(b I Dia. a." Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width d Length ( No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `7 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O 11 CHAMBER mod Number: System:m 1 1f� l Q/0 !/tJ (�__ OR UNIT o°-- DISTRIBUTION SYSTEM Header / Ma fold Distribution Pipe(s� x Hole Size x Hole Spacing Vent To Air Intake Length T Dia. 1Y Length 1 Dia. 2~ Spacing 1 y y� z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center (g Bed /Trench Edges (y Topsoil tf! a R"es ❑ No ( .Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) `qa 3 7 `& p. cj�mwna 21 -�O-(S w I , P1,IWl.ww1kw 6M - u f vd- nw,-4 Cw"dt a,4 5Z. Coy - o,C,, �( , z► ��� �6 Gu� � l 6y�rx�t �•C iJ -r�.Q � (�. �� • �'�'��Y��; �e�LC��q� - ( �� o lui C, Pllfri e req�uirecf? v ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Sig ture rt. /0/60 10!3 0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM C ount y : ST. and Buildings Division Count INSPECTION REPORT ©� ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) (y` Sanitary Permit Personal inf you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 315863 Permit Holder's Name: ❑ City ❑ Villa e n Town of: State Plan ID No.: BEHRENDT, CHAD GLENWOO� CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r ib tffD ) I` TANK INFORMATION ELEVATION DATA A9800251 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� <w�•'t . T� r 2,0 Bench r g / �� s Dosi n �� 661 Aeratio Bldg. Sewer ^-� Holding St /yf Inlet ... TALK SETBACK INFORMATION St /,i Outlet TANK TO P/ L WELL BLDG. Air ir I to ntake ROAD Dt Inlet A Septic -t UV !,zi S� ' _ NA Dt Bottom Dosing }(jv NA Header if Man. , qS 7 Aeration °"' " NA I Dist. Pipe Holding Bot. System �,j.��I,, �( $� '7143. ? PUMI#►/N INFORMATION Final Grade Manufacturer Demand Bid v 3.53` (QJy Model N��L 0�,_caf�PM TDH Li Friction ( System S ' TDH t H u Forcemain I length Dia. C9 Dist. To Well SOIL ABSORPTION SYSTEM #E P � J4RENCH Width q ► I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN 1 N �� DIMC1 1 NS--L SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACN7NG' Manuact . INFORMATION SyP � r t, t OR RUNTER M Number: III ,A DISTRIBUTION SYSTEM if Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake a Length Dia- �_ Length Dial Spacing » y8 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 Gi ,r JR - .Yes E] No JA Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) S-irs LOCATION: t GLENWOOD 22.30.15,W,SW 1443 300TH STREET f r , � , v� 15� ° t ! � � X 16 X18 . 16 5. r b v•kc s S aid C'Nrkvt �•0 2. s. clev- �?q.oL Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division `� sconsin S ANITARY PERMIT APPLICATION 201 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce 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. • See reverse side for instructions for completing this application State Sanitary � l /Nuumbbber Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATi N - PLEASE PRINT ALL INF RMATI N 7 Property Owner Neme 7operty Location ! e r SG<1 i4, S Z Z T 3 4 9 r N, R Y (o PropertyOwner . Mailing �dress�� � Lot Number i7 � Block Number / 11 City State Zip Code Phone Number Subdivision Name or CSM Number r- rt ail IV, I t (7! ) -2S'yg 11. TYPE F BUILDING: (check one) ❑ State Owned It / Nearest Road ❑ Vil / Lo !11/ Public 1 or 2 Family Dwelling - No. of bedrooms -3 Town OF lage �/ l? Lr]r� 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.ANew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _System________ System______ __ Tank Only ---------- ---- Exlstin_System ________ Exl sting 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 MMound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 2 ❑ 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. 17 . Final Grade Required ( . ft.) Propo *ed (sq. ft.) (Gals/day /sq. ft.) (Mi h ch) Elevation 3 Z., Feet Feet VII TANK in Capacit Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks I Septic Tank or Holding Tank Zoo -- /ZaO t_. GY.S ,C]I �} El 11 11 1:1 ❑ Lift Pump Tank /Siphon Chamber /Zk!h7V /OOD l I 0 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb s Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: O le, e udso M� ,/6 z ZABS3 Plumber's Address (Street, Cit State, Zip Cod 1X. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (Includes Groundwater D ate Issued Iss ing Agent Signature (No Stamps) Approved []Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (8.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber _AA Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 Nvisconsin Tommy G. Thompson, Governor D epart m en t o C ommerce William J. McCoshen, Secretary May 22, 1998 CUST ID No.220853 ATTN: POWTS INSPECTOR DALE E HUDSON 1416 220TH ST EMERALD WI 54012 RE: CONDITIONAL APPROVAL Transaction ID No. 78667 APPROVAL EXPIRES: 05/22/2000 SITE: Site ID: 7322 ST CROIX County, Town of GLENWOOD W1/2, SWI /4, S22, T30N, R15W CHAD BEHRENDT FOR: Description: MOUND Object Type: POWT System Regulated Object ID No.: 17970 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 � I 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: i • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. 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, 9 DATE RECEIVED 05/14/1998 FEE REQUIRED $ 180.00 GERARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services AMOUNT DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JSWIM @COMMERCE.STATE. WI.US s RECE BOLDT's MAY 14 L A SAFETY 6 & 199$ PLUMBING A HEATING INC. LUGS G�V "Serving You For 40 Years" 820 Maln Street Baldwin, Wi 54002 (715) 684 -3378 Fax (715) 684 -3144 page Of g Date: Mound System For A -= ! — Bedroom Residence Located in the of the 1 /4 of Section 2Z , TLNT RLW; Town of , Sf� C ,-o;X County, Wisconsin. Index Page 1 of 8 Title Sheet Page 2 of 8 Plan View Cross Section Page 3 of 8 Distribution Pipe Layout Page 4 of 8 Pump Chamber Page 5 of 8 Pump Performance Curve Page 6 of 8 Soil Evaluation Report Page 7 of 8 Site Plot Plan P o.w.-r 8 of 8 Mound System Plot Plan P.O.W.T Conditionally A rr"PROVE D Prepared For: DEPARTMENT OF COMMERCE cA r U 131 -- h e e. d f DIVIS10 Y AND RMIL;4KCS /e7 -53 Ct, - 'Of T SEE CORRE DENCE Prepared By: Dale Hudson Certified Soil Tester / Master Plumber #220863 Page 7- Of Cross Section Of A Mound Using A Trench For.The Absorption Area A Medium Sand Fill � 1 ° F 6" Topsoil 3 E D Trench Of 2" - 2. Aggregate, Plowed Layer 6" Below Pipe, Covered With D /�O Ft. Straw, Marsh Hay Or Synthetic Fabric F Ft. H Ft. Plan View Of Mound UsiM A Trench For The Absorption Area A L;? Force Main icdM. Distribution Pipe Permanent Markers Observation Pipe A o ---------- - - - - -- - ----------------- W B K I \Trench Of - 2 Aggregate A I // Ft. K /D -5 Ft. W Z 3 Ft. B Ft. J 7,0/ Ft. L Ft. / License Signe �� �, L . :7 e i� Number: 2 209 :53 Date: BOLDTS PLBG. HTG. Fax = 715 - 684 -3144 May 22 '98 08:49 P.02 3 8 . 1 . Distribution Pipe Detail For Two Lateral fretwork Holes Located On Bottom /rf f erna�"�, Are Equally Spaced t Force 'lain L .' Y -1 z T PVC Distribution Pipe force. P X P �Q/ Last Hole Should Be Next To End Cap 7 P 9Z Ft. Hole Diameter I Inch X 49 Inches Lateral Diamete Inches) Y Inches Force Main Diameter Inches # Of Holes /Pipe Invert Elevation Of Laterals , OZ Ft. Signed: Oo4 License Number: zZ O �. Date: S— P 7 - 9S BOLDTS PLBG . HTG . Fax : X15 - b64 -6144 May 22 ' 9�3 U8:49 F.03 . L'' c r – c BCR C c...� _C_ IO�J Atilt �P[C!f 1'IVrf. VCW7 P CA `1 C -1. VE\:T PIPE WCATHCRPROOr APIROY[p _ 2s' = ROIL DOOR. JUA1C TIOW 5OX MA11HOL C COVE F WINDOW oft FRCSH It " MIU. AIR INTAKE I GRADE f MtIJ. COQDUIT WAIN. � - _ INLET PROVIDE AIRTIGHT SEAL I I f I i I APPROVEO JOIIJ7 A I I j I APPROVED JO I I I I II ALARM CXTEUDIU6 3' p i t I OIJTO SOLID Sc I 1 I I ON . q I I ELEV. y� FT. I PUMP .OFF t 0 I CONCRETE BLOCK 1 R1SCK CXIT PCR111717ED OWLM IF TANK MAIJUFACTURCR HAS SUCH APPROVAL- SEPTIC F SPEGIFfCATIOIUS �sIG • YANKS MANUFACTURER: � rSCr klUM9ER y OF DOSES: PER DAy TANK SIZE: 2 — GALLONS DOSE VOLLJME ALARM /'IMfUFACTURCR: INCLUOIN BACK FLOW: Z' t AttONS MOOCL IJUMBEK: 4 CAPACITIES: A /°/ IUCNCS OR � 3 GALLOu5 SWITCH YVE: l� r ur a g Z INrr„ES OR "� // t;AttOUs PUMP MAULIFACTURER: G Ool�f� C.b 1 UCIIE50R�z�� MODEL 1�lUMlD[R: !.t/�O3II �, �Z= INC GAlLOA15 MM - — D m _ZcHES OR gs' ALLOWS $WITCH TUPE: _ A; -e cu rl� IJOTE: PUMP AND ALARM ARE TO BE MIMIMUM DISCHARGE RATE $' �g� GpK IN5TALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEW PUMP OFF AUD DISTRIBUTION PIPE.. ''11'!rFEET + MIAIIMUM NETWORK SUPPty PRESSURE 2.5 . -�._ FEET + 150 FEET OF FORCE MIN X /' � — FT 40 0 YLFRICTIO" FACYO@t. 4 ? 7_ FELT l"OTAL Oy1JAMIC MEAD — L �•.1Lr FE IIJTE1tWAt, DIMEUSIONC OF TAIJK: LEIj(,'rm � y WIDTH �7 ,,pp ,IIQU DEPT► -I _ SIGtiSEO: LICEIJEF NUr+BER: 'ZZ�C �J S� pp DA7E. ZZ 70 Bulletin CL2 July 8, 1983 -- • For Homes GOULDS • Farms • Trailer courts Model 3885 • Motels (Supersedes Model 3870) • Schools • ' Submersible • Hospitals Emusncvumv Effl uent Pumps • Industry -- — • Eff luent Systems Pump Specifications anywhere effluent Solids Handling Capability to 1 4" or drainage must be Discharge Size 2'NFT disposed of quickly, Semi -Open Impeller quietly and efficiently. 3 vane riesign. threaded on Shaft i hrr.e units .;se irnneller locknut to prevent T I back- Pump out vanes on backside for protecting of mechanical sea! Casing Volute t;pe for maximum efficienc;_ Stainless Steel Fasteners Heavy —Duty Solids Handling Series 300 stainless steel for corrosi- Dependable Capability to 3/4" resistance Mechanical Seal Ceramic vs Carbon sealing faces. stainless steel spring and Buna N elastomers Maximum Temperature 1 h, 1 /2 H.P. 60 Hz 160 °F Capable of Running Dry Single Phase 115 230 Volt. without damage to components Motor Specifications 1 /2, 3 /4, 1, 1 H.P. 60 Hz Motor Fully Submerged in n c ^ turbine oil for perm Single Phase 230 Volt. Three uon o b= a!ings and mechanical seal and Phase 208 -230, 460 Volt. efficient !seat dissipation. Motor sealed frc: enviro! ^ by rugged cast iron enclos_: -•-- Bearings Heavy -duty all ball bearing construct nr. Stainless Steel Shaft Series 3J0 stainless steel for corrosior f :esst«' c_- ' i :leaded shaft Single Phase Units 90 Ali sin;.i._ - 'se units have built-!ii ;he: overloa,; pr, tection with automatic rese� 80 Three Phase Units Overload protection in starter unit. 208 -23: 70 460 volts Threaded shaft 60 Hz operation•. F- W Power Cord W Water and oil resistant. Epoxy seal on motor end 60 acts as a secondary moisture barrier in case of w damage to outer jacketing. Corrosion resistant Z 50 gland nut. U Single Phase Units a 40 ' /,. H.F. models equipped with 15' of 16 3 Z SJTO with 3 -prong grounding plug. t, t H P -- models equipped with 15' of 14!3 STO power J H Cord. F SPECIFICATIONS ARE SUBJECT TO CHANGE 10 WITHOUT NOTICE. 0 0 10 20 0 40 50 60 70 80 90 100 110 120 r^ GOU LDS PUMPS, INC. GALLONS PER MINUTE u SENECA FALLS NEW YOPK 13148 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divi &ion of Safety and Buildings Page �6_ of Bureau cif Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan.on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and s G >^o 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)). Property Owner / f /��- Property Location C A00 Be/7 r e nG� l Govt. Lot !!4_ eA) 1/4,S Z Z T ' N ' R l� (or W Property Owner's Mailing Address Lot # I Block# Subd. Name or CSM# City / State Zip Code Phone Number City ❑ Village Town Nearest Road //O m d "' e (715 ) 7 96 -25'18 1 300 57 ,E% New Construction use: .0 Residential /Number of bedrooms 3 Addition to existing building A6 ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow y5Q gpd Recommended design loading rate • Z bed, gpd/ft 3 trench. gpd/ft Absorption area required 375 bed, ft 37f; trench, It Maximum design loading rate • 5 bed, gpd* - & trench, gpolttz Recommended infiltration surface elevation(s) 9 .0 ft (as referred to site plan benchmark) Additional design/site considerations Parent material S', fV 5 c_ ot 47 Flood plain elevation, if applicable A� ft S = Suitable for system Conventional I Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system ❑ S ,� u INS El ❑ s .0 u I [Is I u [Is [9 u ❑ S u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench sE' / /oy� /Z- o c_ s,'� .2 r» s .-� �'.- q s - j Z i3 Z /o Y9 4� 2 s i» ->r'Y- L,) 2 - 5 : • G Ground 3 V JoyX z•nsbK ice✓- r� -r' - 5 , • to elev. / 93 5 fL •y� l o C Z of Z5" Yk S c rnsb r� �r •Z • 3 Depth to limiting factor `JZ in. Remarks: Boring # 1 a 9 /o� � /1�0,?o s,' Z,ns�7C' v� o s 3 cv • 5 ' •� O YR ' /✓o -K m4 C U-) 2 ' S :• 6 49 YX Y Y Non e 5 , - z,n Af., hA--� L.-) -�'� • 5 A V Ground - /D YK r C L od 7 s 5 8 5 G / r g,5 0 - Z;• 3 elev. 98 n Depth to Waiting factor 37 in. Remarks: CST Name (Please Print) Signature Telephone No. 6 7:>0 �e �. �.( SOw G�� G � /� 3379 Address Date CST Number PROPERTY OWNER ho of be- Areool SOIL DESCRIPTION REPORT ' Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munseil Ou. Sz. Cont Color I Gr. Sz. Sh. Bed , Trench .3 / 0 -/Z- /0)/ 3 3 A c , /7 c' s.'/ 2ryi- 05 3 co • 5 : , 6 Z A NY y n G' s:' 1*5b y- . C. w 2,171 5 ' Ground -`/j /D YR 4 o mS� /� ✓ r i,J to elev. 9 ft. .5'S' D y G2� '7.5Yk <'� �IS� m �Y Z ' 1 Depth to Writing fa in. Remarks: Boring # Ground elev. ft Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/f?- in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed , Trench Boring # ; 13 Ground elev. ft ' Depth to ; limiting factor ' Remarks: Boring # Ground elev. ft Depth to limiting factor ' Remarks: SBD -8330 (R. 07196) ' Wiscepsin Department of Commerce SOIL AND SITE EVALUATION Division of Satety and Buildings Page of Bureau of Integrated Services i etx�lence with s. ILHR 83.09, Wis. Adm. Code i Attach complete site plan on paper not less aQB X�/2 x 11 ' ches in s e an must County include, but not limited to: vertical and ho 'ntaf'refer M), f n and ��� G ,. - p ' percent slope, scale or dimensions, nort h,r gyti, and I and tlistanc arest road. Parcel I.D. # f 1 4 � APPLICANT INFORMATION - Pllease pril!ttah°�tifoii ions � Re ' ed by Date Personal information you provide may be used f r secondary purl3os�� Law, t (1) (m)). �� S '7 Property /Owner i ZCi`� N G �, Property Location l r �tQOI �/ r J?GT Govt. Lot l,�l�601 /4,SZ� T l5' d(or W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# ic) s., G-t y , R � r✓� City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road A/n m�� n (� LA,) -I' I 1(71� )7 - 2549 300 �! A New Construction Use: .Residential /Number of bedrooms 3 Addition to existing building NA ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4'50 gpd Recommended design loading rate ' Z bed, gpolfi 3 trench, gpdfft Absorption area required bed, ft 37� trench, ft Maximum design loading rate • S bed, gpd/ t trench, gpd/ft i Recommended infiltration surface elevation(s) 9 9 a Q Z ft (as referred to site plan benchmark) Additional design /site considerations �+ Parent material S i / fV S e, d,'✓ c n I Flood plain elevation, if applicable Nom/ ft S = Suitable for system Conventional Mound In- Ground Pressure ATA rade System in Fill Holding Tank U = Unsuitable for system ❑ S ,� U 19S ❑ U 1:1 S ,® U ► LYJ U ❑ S U ❑ S Piu U SOIL DESCRIPTION REPORT w+,►,. Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench SE". 14 r /cy� �L o 5.'� .2 r»5 mtY Qs 3co Z 1 13 Z lcylo' 4 / 2 m�'r 2 .n 5 •� Ground y hu Zi�?Sb /j:�t/f L.7 _ ' :16 elev. // 9 3. 87 ft. y� �}Z ' C 7 � SC Depth to limiting factor �in. Remarks: Boring # , /� s .. � 0 Y 0Z ' A or, c- .?� 5 6� hJ �,r C w Z M • 5 ; 2l l� 4 Alps e 5°% r Z m 5 k j . vy V- Y- L--> -FT ' S ' • Ground 7 �C� y1� CZo� �,� 5 8 5G r%'S 67� I Y ' z , ' 3 elev. 9& '•4? ft. Depth to limiting factor 37 in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number g o /�a�', a /041.1 ,,, Z o �3 C ho d be Are gol SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Ou. Sz. Cont. Color l Gr. Sz. Sh. Bed , Trench 3 / ' /Z / 3 3 N0 t' :n'/ 2m56 r- r a S c 0 • 6 2 z -1 Ir YK $ o 6! s;' a� - x55 _K - 179 Ty- c w 2.IY9 � 5 ; • +� Ground - yj /d Y1\ 4 0 s /r1sb h'I ✓�-- . ; elev. Depth 9 �l Q � `� G2� `7.5YR <- ir)s� m-�,r- � Z ' ►,3 to limiting factgr Remarks: Boring # 13 Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # E3 Ground elev. Depth to limiting factor in. Remarks: Boring # [3 Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) L l i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /ljQ( �, rc4a� Mailing Address /4'53 � • ?„J � , �,��, Property Address S ® 0i', i (Verification required from Planning Department for new construction) Q.i City/State G n '/e "'D 0 Lc;" , Parcel Identification Number LEGAL DESCRIPTION Property Locationl X 2d y., Sec. ZZ . T 30 N -R 15 W, Town of Cr�ei?�Joao! Subdivision AM pO Ac Lot # Certified Survey Map # Volume . Page # Warranty Deed # —S 3ez�' Volume Z—S 7 . Page # Spec house 0 yes 1' no Lot lines identifiable J9 yes ❑ no SYSTEM .BIArni MNANCE Improper use and maintenanceof your septic system could result in its premature-failure to handle wastes. Propermaiatmance 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 a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Department a ratification form, signed by the owner. and by a Platnbe4]4°meymanplumbez; restrictedplumheror a licensedpumpervetifying that (1) the on-site wastearaterdisposal system is in Proper Ming condition and/or (2) after inspection and pumping.(if necessary), the septic-tank is less than 1/3 dull 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 reWmed to the St. Croix County Zoning Office within 30 o three year exp' tion date. GNATCi1tE OF APPLICANT DATE OWNER CERTIFICATION ()Y that all Cements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the bed abov , y of a warranty deed recorded in Register of Deeds Office. 6 1 //9cq S NA OF APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « « « « «« ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed - 11 'S VOL 13?9plia'?W� State Bat of Wisconsin Form I ISW WAIMAN'FY DEED DOCUMENT NO. Clifford F. Anderson and THISDEED, inadebetween If REGISMR'S OFFiCE T C Jean L. Anderson* husband and wife AC ST. CRC CO-- W Roc'.''. f 1"Cord J UN 0 4 1998 UN 0 q Grantor. 10:00 A and Chad J. Behrendt and Katrina M. Behrendt, qL husband and wife, as survivorship marital property 'sk tfor of Its FOR AECOADMG DATA .. THIS SPACE +iESERV Grantee, NAME AND RETURN ADDRESS: WITNESSET11, That the said Grantor, for a valuable considetati"s Croix conveys to Grantee the following described real estate in St. 3 0 • County, State of Wisconsin: U)l 016-1050-20-000; 016-165 _PARCEL _MENTMCATION NUMBER W 1/2 of SW 1/4, Section 22, Township 30 North Range 15 West, EXCEPT the property described as follows: A parcel of land in the SW 1/4 of the SW 1/4, Section 22, Township 30 North Range 15 West commencing at a point on the West line of Section 22, 465 feet North of the Southwest corner of said Section 22; thence North 208 feet; thence East parallel to the South line of said Section 22, 241 feet; thence South parallel to the West line of said Section 22, 208 feet; thence West 241 feet to the point of beginning. NSFER y o EE This is not homestead property. M (is -0 Together wild all and singular the hereditaments and appurtenances thoeves"o belonging: And , Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except roadways, easements and restrictions of record. and will warrant and defend the same. Dated this 22nd day of May 19 98 CIL j j - ; (SEAL) tZ (SEAL) Clifford F. Anderson . ..... 4ean L. Anderson .... .. ...... .......... .. .......... (SEAL) (SEAL) • .......... ..... . .... . ....... AUTHENTICATION ACKNO jLNT 0 4T STATE OF WISCONSIN Signature(s) �! : St. Croix Ss. coukIlly 22n of 4 � ". ",�' day day of 19 pe cattle before we this authenticated this -may- 19 93 the•94ve named Clifford F. Anderson and Jean L. Anderson,_ husband and wife TITLE: MEMDER S I'ATE BAR OF WISCONSIN (If trot .. .... 10 we Lavwn to be die person s who executed (fie authorized by S,ction 706-06, Wisconsin Statutes) fo re kistrument id a no edge die same. I THIS INS rRUMENT WAS ORAFTED BY _�Cf' � Michael, H. F,:re4i, Attorney Kathleen R. Vi�een Eau Claire, Wisconsin Noul" rlvk4k Pol,k Comity, Wis (Signatures I may . be authent icated ­ ur a c . it itowledlied r Both are not Rcce ssafY) My CW%affMAL­iQ(T is permanent. (if lo state expiration date I • Na of persous s i any capIc s h ou ld be typed or pt;nted bch)w their signatures. June 24 J v G1C a a N Q` CIO � � N � v � 1 1=l a N N • N a b 0 \ I N v c � O`- _ u a b At p n r! i 3 c7 d o A a o a � � T 0 O .¢.S vv£ M _ 4— N --Z: L N o (2 �2, o N � o d 4� N S O p M 0 o, o-r v n of M b�j I � 3 w O ! `` d � V) �q a 1 1 w l `1 T m O 0 � u o � � Cal N N N Z J o Z a � Na 0 MLh 0 \ oo u O� v o �1 cz q to ' 3 041 Z � o o a K 14- � �C acY 0