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HomeMy WebLinkAbout016-1059-50-000 S`I'. CROIX COUN'T'Y ZONING DEI'ARTME : AS BUILT' SANITARY IZI;I'UR' /' Owner Address __ 2g 41 � t,..T City /S(ate Legal Description: � lion: .. , Lot Block Subdivision/CSM # Sec. , T e) -RAW, Town of e - — �+ -� r�`' PIN 9 SEPTIC TANK -- DOSE CLAMBER — FOLDING TANK INFORMATION: Tank manufacturer Size ST/PC "r etback from: House 1 16 Well Pump manufacturer -- '-7. Z-/. Model - Alarm location ? -ti (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: & q ' Width �' Len Setback from: House Number of Trenches 1 X11 Well �-5 p/Z, Vent to fresh air intake i y ea ELEVATIONS: Description of benchmark / 1 �•; , f�� '- l�y L � , Description of alternate benchmark Elevation �' Elevation Building Sewer ST/HT Inlet bj, ST Outlet - PC Inlet PC Bottom 2 7 Header/Manifold ' Top of SUPC Manhole Cover 3 Distribution Lines Bottom of System Final Grade ( ) z 5 ( ) ( ) Date of installation /_� Permit number 2 0 State Ian number _ P Plumber's signature �� - >2 Z' z License number Date/ Ins pector � ��P r � ' Complete plot plan 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. ell t I 1� r 1 d i INDICATE NORTH ARROW HEAD(CAFACITY CURVE 411 MODEL 97 soy 8 N 4% 25, rD — 1 2a' 43V16 RJ 6 S ' V _ t5 ` 4 � to 2 �z s 0 us 10 tai so eo 70 G"ONs I . . j LITERS 80 180 240 „ I 10 ha FLOW PER MINUTE TOTAL DYMMC NEADIROW Ptll MINUTE lrrl„r1T AND DEri1TE1111010 CAFACtTY HEAD Umff$mw Sslie j20 METERS GAL LTRS kin 1.52 57 219 3.05 51 193 43 163 6.10 27 104 e 24.5' CONSULT FACTORY FOR SPECIAL APPLICATIONS . Electrical alternators, for duplex systems, are available a Mercury float switches are available for controlling and supplied with an alarm. single and three phase systems. . Mechanical alternators, for duplex systems, are avail- a Double piggyback mercury float switches are available able with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no extemal control required. Standard Ail Models - Weight 33 lbs. -'A HP 2. Single piggyback wide angle mercury float switch or double piggyback mercury float switch. Refer to FM0477. �• 3. Mechanical alternator 10 -0072 or 10.0075. ModN Volts -11 Moft Amp flAtrgr n 4. See FMO712 for correct model of Electrical Alternator, "E- Pak". M97 115 1 Auto 12-0 1 or 1 & 7 — S. Mercury sensor float switch 10 -0225 used as a control activator, specify duplex (3) M07 115 1 Non 12.0 2 or 2 & 6 3 or 4 & 5 or (4) float system. 097 230 1 Auto 6.0 1or1 &7 — 6. Four (4) hole "J- Pak ",junction box, for watertight connection orwired-in simplex or 697 230 1 Non 90 2 or 2 & 6 3 or 4 & 5 2 pump operation, 1D -0002. 7. Two 12) hole "J- Pak ", for watertight connection or splice, 10-0003. CAUTION For information on additional Zoeller products refer to catalog on Combination All Installation of controls, protection devices and wirlag should be done by a Starter, FM0514; Piggyback Mercury float Switches. FMO477; Electrical Alternator, qualified licensed electrician. All electrical and safety codes should be followed FM-04M Mechanical Alternator, FM0495; Alarm PacKage, FMO513; and Sump/- Including the moat recent National Electric Code (NEC) and the Occupational Sewage Basins, FMO487. Safety and Health AC (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 3280 Old Millers lane Manufacturers of .. . e � l f�7 �- P. 0. Box 16347 •Louisville, Kentucky 40218 N N {502) -2731 • FAX (502) 774 -3624 f�arurr *AIM r"cE /��� NOTE: No UL Noting for Extra Duty (ED) pumps. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,Pavfflol Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. 3G L BUCHITEr, N ame: BETTY ❑,,Cit��v�l]age Town of: State Plan ID No.: CST BM Elev.: Ins BM Elev.: BM Descri tion: CiL vL! Parcel T r p , p uf`8_ 1059 -50 -000 I 00 1 450 v r,7 TANK INFORMATION ELEVAilOh DATA A9800409 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic T I Db Bench , 2 lC70.21 f 00 , Dosing Aeration Bldg. Sewer -(N.'1 Holding (:g)Mt inlet ) � ' TANK SETBACK INFORMATION St / Ht Outlet TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic �� O /.� NA Dt Bottom 17.lq 8 , Z - 7 Dosing NA Header/ Man. 0 1a.1 Aeration A Dist. Pi •9S 4. 2+ Holding Bot.System j�•(� ��,s(p� h�� PUMP/ SIPHON INFORMATION Final Grade / Manufacturer Demand %1, Model Number A& 10 %PM TDH Liftq•67 Friction System 2 TDH oss e Forcemain Length6C) Dia. 2" Dist.ToWell SOIL ABSORPTION SYSTEM �s•is BED/TRENCH Width / Length No. Of Trenches PIT No. Of Pits Insid 5 Liquid Depth D IMENSI ONS 1 S� DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION Type Of ��/ ' / CH T CH Model Number: Systemmov DISTRIBUTION SYSTEM Header! Manifold ,, I Distribution Pipe(s) x Hole Size x Hole Spacjng ent o Air Intake Length T Dia. �- Length Dia Spacing ' _ 1 ' / �� 1 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: GLENWOOD 28.30.15.414,NE,NW 2943�C`TY RD O L U * & temp `I w 4 I ( ee l , 100S ()Vyl 0' (jeum at- 10�4.(1 5154,riiI WUS WoveJ do, 51op -e - 0 44. d�� C e j R � � * 4� Z I I Plan revision required? ❑ Yes xNo ' Use other side for additional information. � Date Inspect 's Signature.. - Sw SBD -6710 (R.3/97) �( q 11 v ` & Safety and Buildings Division Visconsin S ANITARY PERMIT APPLICATION Pa �X��hinngtonAve. Department of Commerce 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 8 1/2 x 11 inches in size. • 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 /. 053 Property Owner Name aj tJ Ip mope Lo ti t/ 4 1/4,S T -3 Property Property O er's Mailing Address / Lot Number Block Number Z (? 7 /) OL C, r City, State r ip Code Phone Number Subdivision Name or CSM Number 6r�_ .e,7 4Jood Gf 0 ".5 -5 (J/ ) �2 4 2 II. TYPE OF BUILDING: (check one) ❑ State Owned E] ut � Nearest ad « Public 1 or Family Dwelling - No. of bedrooms ° Town of L e�,G�Q �/ � 6- 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. Replacement 3_ ❑ Replacement of 4 E] Reconnection of 5. ❑ Repair of an System ystem 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 30 E] Specify Type 41 [ 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: 9. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re ulred (s ft.) Proposed (s . ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 2 /� 2 g .2,L Feet 1,41,41 Feet VII. TANK Capacit gal Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con - Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ©d� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber i (/� ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY 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: ( Stamps) MP /MPRSW No.: Business Phone Number: 4 Plum bass Addreu ( treat, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved []Owner Fee) Sa Itary Permit Fee (Includes Groundwater ate Issuing Ag t Sig pproved Owner Given Initial ,��� Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD•6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety 6 Buitdings Division, Owner, Plumber ilib. — SAFETY AND BUILDINGS DIVISION 2226 Rose Street WLaCrosse, � CON Wisconsin 54603 I sconsin • Tommy G. Thompson, Govemor Department of Commerce William J. McCoshen, Secretary Transaction ID No. 120153' ; >' _ Date: 8/12/98 Margaret Grummons NE,NW,28,30,15 W > ! Mound , System q I Town of Glenwood, St. Croix Count �s'`, sT ­po,x, ' r ZC?N� OUNTY / NG OFFICE Private sewage system plans identified by the abo tttc 3 raze a�ctlo�JD have been reviewed for conformance with applicable Wisconsin Administrative Codes and Wiscon Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters Comm 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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. Stats. • 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. Slats. 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. Sincerely, Gerard M. Swim Integrated Services POWTS Plan Reviewer (608 )-785 -9348 jswim@commerce.state.wi.us SBD- 5524 -E (R. 2198) Page of b MOUND SYSTEM RECEIVED FOR J U L 2 7 1998 A 3 BEDROOM RESIDENCE SAFETY & BLUGS. DIV. LOCATED IN THE NF 1 /4 OF THE P1k3 1/4 OF SECTION Zg ,T ' N, R u W, TOWN OF GLR�fJ W 00p COUNTY, WISCONSIN. i INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 . of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR Y Pr PCCZ kzT CG7-U 01V s � V O N VD � n AF cornr��� � OyAFt1Mf 'I pN g p1VIS�C Np �NCE ,,EE CCRFtE PREPARED BY W E G E F� E F2 AND I L .TESTING atBttNMp�� DES 00 . SCoNs P.O. BOX 74 421 K. RAIN ST. RIVE.. FALLS. NI 54022 ARTIiUR R = WEGERER 715 - 42 ' EUSWORTH, 1 W15. L�'��,f,.e G�h J �SIGN� 0 *w JOB NO. _' 9. PLOT PLAN Page Z of 6 Scale 1 " ='J40 ' r i ' c�, y,S 1�► i 1U '7 clev. 8.7.8r approx Ss' 9 ►,A.. I.—kad eom pft r Olt rV �� `IZt•ts A'R�+�A ' N/ r' 1 6 o'oFZ t pUC F.M. V CQ�1tov3Z l'1, g1.to � VL S I or r Gl FIWST S abeve y rd . /oca approk. y Olaf r,-y / //7C -f � /efdCr -y y" po s f. 1�oh E Nn = t�8�U4�✓� �J Pte.: coDE 2 , ►J tom' ?u>e: vq U►Ji lS S OO'.* _ P M OUM 3, W�Lt- lS > Lip' Soffit- o� - `t•{v�SN' , t NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( z required) 3. Install 4" observation pipes with approved caps. ( z required) 4. 'Septic tank to be \000 /boo gallon capacity manufactured by 5. Bench Marks sElIzz- "out b. Divert surface water around system to prevent.ponding at the.uphill side. Page 3 Df Approved Synthetic Covering �sT*�► c 33 Distribution Pipe Medium Sand .r.H G Topsoil F Elev:9Z. D - 3 E ' b 113 % Slope Force Main Plowed Trench of k"-2k" From Pump Layer Aggregate Undisturbed D \,V Ft. Soil E \,S Ft. Cross Section Of A Mound System Using F o.6 Ft. I Trench For The Absorption Area G N.a Ft. A S Ft. H i• S Ft. B 1 S Ft. I \S Ft. Linear Loading Rate= 6. GPD /LN FT J �1 Ft. Design Loading Rate= 0.3GPD /SQ FT K Ft. L X0 Ft . W Z Ft. L �- Force �-- —6` K Main_ A U�pOSt`T� W Distribution Trench Of Pipe Aggregate I Observation Permanent 1 Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area Page Of Perforated Pipe Detail i 0 End View Pertoroled End Cop b``y' PVC Pipe 1. (� J S ao • lY a Install permanent at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop * ti PVC Force Main 4 Distribution Pipe Last Hole Should Be Next To End Cop Distribution Pipe layout P 3y.S Ft. X 3� Inches Y No Inches Hole Diameter - -�-f-- Inch Lateral lit Inch(es) Manifold -- Inches Force Main Z Inches 9 # of holes /pipe \'Z i Invert Elevation of Laterals '134 Ft. 11 Place Place lst hole 18 from tee with succeeding holes at ' 66 intervals. Last hole to be next to the end cap. Combination Sept,!c;Tank and PI.IMP CHAMBER CROSS SECTIOIJ ARID SPECIFICATIOAIS PAGE S OF 6 . VtrAl7 CAP WCAT14EK PROOF • - JuUCTIOLI bOX ti C.I. VENT PIPC APPROVED LOCKING 1. 10' FROM OOOR, r ryj MAWHOLE COVER avtV ', INDOWOR FRESH WA(2tJ11J�e L140EC. A oiTAKE S - i S � b MF>L • ,�, °r.,id, , C,R11 I 'i' MIA1. I6' MIAI. L -- y�lu5�cct�a.� PIPC PROVIDE I --- -- IAl LE T _ S T AIRTIGHT SEAL 3 grrFL� I APPROVED JO A I I APPROVED J011411' I I ( W /C.I. FIPE�WO W /C.1, PIKbr_ Ik1T Tank r_onstruction I 11 I ALARM shall comply with I II ILH;; 1;3.15 and 33.20 8 I PIQM? OFF el C I I To 8�1.►oL� I CLCV. . FT__ P __� MP -� OFF D CDQCRETE Lev• 4.00' eLocK 3*' APPFov� K15EK EXIT PERMITFED OQLtJ W TAWK MAWLIFACTURCR HAS SUCH APPROVAL Br DDIN(: SEPTIC f SPECIFICATIOtiIS DOSE TAkJK MAkJUFACTURCR: k31zSE cwjc)r WUMISER OF DOSES: 3'� S PER DAy TAWK SIZE: lOt� O 1 U 00 GALL0US D05E VOLUME r ALARM MAIJUFACTURC.R: S• S , eL TSB jK �` x 1; IWCLUDIIVG DACKFLO 130 G ALLOWS MODEL kJUTABER: 1 W N1/V CAPACITIES: A= Z' IMCHCSOR r � GALLD►1g SWITCH TYPE: �_i F;?_ CJJVL 5= Z IIJCHES Z b G6LLOkJS PUMP MAQLIFAGTURCR: Z ���L -�� �'� C= �� Ik11HES OR `30'U GALLOU5 MODEL ►DUMBER: �3 D= V2- IMCHES OR ICI I' GALLOML SWITCH TYPE: ' MOTE: PUMP AND ALARM ARC TO 15L MIMIMLIM DISCHARGE RATE "D�i GPM INSTALLED OW 5EPARATE CIRCUIT5 VERTICAL DIFFEFVMLC DETWF,[U PUMP OFF AUD.D15TRIBUTIOIJ PIPE.. FEET + M11DIM um mCTWORK SUPPLY PRESSURE . . . . . . . . . . . 2.50 FEET bo ` FT. C).q + F O F FORCE MA►IJ X /Ofi.FRICTl01.1 Fl.croR_. FEET L TOTAL_ D9JAMIC HEAD = ` FEET DIAMETER Pump chamber SI " INTEK IAL. D(MEIJSIOW� OF TAWK: LEkI&TH - ,WIDTH 1 ,LIQUID DEPTH BOTTOM AREA - 231= _ GAL /INCH I AS PER MANUFACTURER = 11.8 GAL /INCH. 3 15/16 -6 5/32 P��IT 6 or-- L HEAD CAPACITY CURVE 53 - 57" - 11 55 - 59" SERVES --I 4 5/8 1 1/2 -11 1/2 NPT ` zs TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE / 3 15/16 EFFLUENT AND DEWATERING 6 --4 �.. 50 SERIES Ft. Meters Col. I Ltrs. 4 1/16 x U 15 S 1.52 t3 f W 4 19 3.05 34 129 11.5 14 19 n 10 Loci Vpva: • 19.25' I I O 2 Z.8 . 5 10 1/16 0 J L U.S. GALLONS 10 20 30. 40 50 I 3 3/32 LITERS 0 80 160 FLOW PER MINUTE slam SKIN CONSULT FACTORY FOR SPECIAL APPLICATIONS - Variable level Float Switches available. - Available with special cord lengths of Variable level long cycle systems available. 15', 25', 35' and 50'. - Alarm systems available. • Duplex systems available. SELECTION GUIDE Standard cord length - automatic 9 ft 1. Integral float operated mechanical switch, no external control required. Standard Cord leng - nonautomatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0447. M53155 and 57159 Se ries Control Selection 3. Mechanical alternator "M -Pak' 10 -0072 or 10.0075. Model Volts Ph Mode Amps I simpilex Duplex 4. See FMO712 for correct model of Electrical Alternator, E -Pak. M53/55 & M57/59 115 1 Auto 8.0 1 or 1 6 7 5. Variable level control switch 10-0225 used as a control activator, with E -Pak (3) or N5365 4 N5759 —U5 t N (4) float system. D53155 & D5 7159 230 1 Auto a E5:955 & E57159 230 t Non a.o 2 or 2 8 s 3 or a a 5 6. Four (4) dole J-Pak, junction box, for watertight connection or wired - simplex or 2 pump operation, P/N 10 - 0002. 53 Series - WL 22 lbs. 57 Series - VVL 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice, 55 Series - WL 24 lbs. 59 Series - WL 30 lbs. P/N 10-0003. I CAUTION For information on additional Zoeller products refer to catalog on Combination starter, FM0514; All installation of controls, protection devices and wiring should be done by a qualified Piggyback Variable Level Float Switches, FM0477; Electrical Allemalor, FMO486; Mechanical licensed electrician. All electrical and safety codes should be followed including the most Allemator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Systems, FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To: P.O. BOX 16347 Louisvile, KY 402560347 Manufachuers of. . SHIP T0: 3649 Cane Run Road �7 k Louisville, KY 40211 -1961 QLWIrr 0 11014 -V Slh'MF /999 %' PUMP l0 (502) 778 - 2731.1 (800) 926 -PUMP FAX (502) 774 -3624 / a •Wisconsih Department of Industry Labor and Human Relations SOIL AND SITE EVALUATION REPORT Pagel of ° Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY M 'Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but C RO IX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. — /� $ 6-0 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R D Y / E f PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT N - 1/4 • 114,S,�2 T 3D- ,N,R 1.5 10) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE ,MOWN NEAREST ROAD [ ] New Construction Use [X,1 Residential/ Number of bedrooms 3 _ [ j Addition to existing building LN Replacement [ ] Public or commercial describe Code derived daily flo gpd Recommended design loading rate _3 bed, gpolft _trenc' h, gpd1ft Absorption area required /S['o bed, ft / /as trench, 9 Maximum design loading rate _bed, gpdift _ S trench, gpd/9 Recommended infiltration surface elevation(s) 9 2 _ It (as referred to site plan benchmark) Additional design/ site considerations aa OL Pi ound Parent material la "�'c Flood plain elevation, if applicable N /A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT-GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable for system CIS o u .®S ❑ U ❑ S ®U ❑ S ®U 0S OR U ❑ S mil SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed terldl .{ gip: 1164° . .2 // - /0 Liele s/ Z rQ 5b fn ic s f' Z S Ground 3 , 5 Y c ! C -51 />?� F� ' /� S 17F . Z .3 elev3 �o �e 618 ) qq, ft. y- 0 p 712 p / U v� — P Depth to limiting factor .� a�cg r Remarks: Boring # 3 Z ry: 4 v z . s !� 3 3- s/ c� m. Ali M Fie '/tv y s Ground elev. /3 .s 0 /0 - SAD 2 8 Sin - 1 Depth to limiting LrG' if Y -� facto Remarks: C� a'9 J CST Name: -- Please Pri Phone: �, SO \ <; v e J ddress: A/ 30 no /& L 1 116 S e/ 7 S £ 1 Signature: K. Date: �" PROPERTY OWNER 4:�'!c'OMff OIL DESCRIPTION REPORT Page of �- PARCEL I.D. # /J/ , 105 - SZS Depth Dominant Color Mottles -Texture Structure Consistence Band3y Roots GPD /ft - Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends ft - s / k A. a - o LL /6 Ground 3 + - 10 E Wi q tt) l 3 elev. S eft. 9 / Q s - Depth to limiting fact Remarks: Boring # - r I i s �; Ground elev. ft - . Depth to limiting factor Remarks: Boring # I Ground eleV. _ ft Depth to limiting factor Remarks: Boring # a l Ground elev. ft. . Depth to limiting factor Remarks: ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Ad drCJ Cnficatioa required from Plaaaiag Dgwtrncnt fo construction) Gity/State x Parcel Identification Number 0 LEGAL DE SCRUMON Proputy Location A 4 J' '/. %, Sec. 2-JP Town of o i Subdivision Lot # Coed Saavey Map # Volume Page # Warnitaty Deed # �� '� 9 a Volume / 3 4 10 - . Page # Spoe Asa ❑ YCS ❑ no Lot Imes idcatifiable 0 - yes ❑. no ANCE �p�OSadm s�aocofyoot�ooald�urizmi�sp � tohandlewastcs.Pmper oat dw septic tank CVCry II y , = or sooner, if neoded by a lioeasod Pamper. What you Pert mto &c cyst m of tie septLC tank-as a toeatmcat stage is the vzstc disposaisysOcm. . Tx PWP=(Y ow= erg= to submit to St: Omk 7Aakg Dgiatmed iL certif=d()m faun, signed by the cwarz and by a rP jottmayntaaplumbet; rest<i Wdpinmberor :Iiocasedpamp=vcrWyingtbat(I)t eonaite� " � is m proper operatmg Condition and/or (2) after inspection and P.,q g CX y). septic- tank is less than I/3 full of d edge. YT"'- dIc wdeaigaod bave read tie abm requi runts and me= to maiut d private sewage disposal system wi& dr. standards wd fack b= 4 u set by dw Dgmtm d of Cbmmecee and the Ddurtmeat of Alatual Resoarccs State of Wi9oonsim. 0=60cahoa statrag that yoar septic system has boa maid must be eompldod and wturna to the SL Cmix County Zoning Office within 30 Of tie three � SI TURB APPLICANT / / ATE OWNER• TA�TCATTON I (vac that all statements on tins form art true to the best of m (our) knowledge. I (we) am (are) the ownc*) of �c descxibed abort by virtue of a wumnly deed recorded in Register of Deeds Office. SI(3riA t?F APPY.ICANT DAtE mis MR in the sanitary pgrmit being revoked by the Zoning Dcpartraerat. s «ssss ss Include with this appiicatfoa: a tamped warranty deed from the Register of Doody office a Copy of the Certified tucvcy map if rclemace is made in the warranty deed . . . 0 / VOL 134nW.042 i STATE BAR Of WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. 1E Margaret J. Gr_ummons_ a single person. CROiX JUL 1 1998 9:30 A conveys and warrants to Betty A. Buch te, a single person, THIS SPACE RESERVED FOR RECORDING DATA ; NAME AND RETURN ADDRESS St. Croix County. i A A the folio-rig described real estate in State of Wisconsin: 3 016-1059-50 & PARCEL IDENTIFICATION NUMBER 016-1059-60 E1/2 of NW1/4 of Section 28-30-15. TRANSFER FEE This 1 S homestead N .openy. XX1XXXXXXMX and rights-of-way of record, Exception to warranties: Easements, restrictions if any. Dated this 3 day of July A.D., 1 9 9 9 1 9 (SEAL) A@L. a Mr r7e!t� qJ. Gd r u Ymn m o n s (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, r. Signature(s) Ss St. Croix Cou authenticated this day of Personalty came before me this - r i t day of July --, 19 9 8 the above named - margaret-J. Grummons, a single persons TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706 06, Wis. Stats) to me krwwn to bt W PC who executed the foregoing tr.stru - wgit. the %me. x--A kno W THIS INSTRUMENT WAS DRAFTED BY SI , 4 Attorney Kristina Ogland S L_$ 0 Hudson, WI 54016 Notary P..bl!-, County, Wis. (Signatures may be authenticated or acknowledged. Both are not my c -W, is per ailell,'XIt not, state expiration date: necessary) - - . I - - -- -- -- -- - -.--= 7 • Names of lxruns vgr ig in any capacity should be typed or printed below their Signatures SIATF BAR Of WISCONSIN vi.scww 'Leo aank Co tnc WARRANTY DEED form No. 2 — 1982 M"aukft fts --c aN 3 y s "" • I I a o 1 S 14 y 0 3 ° It lZ Qj cr ed d M v 0 `C • u 'l► 0 G 11 m x 40 V NQ M_ _ d U j N f a � • � � � C U f Vi t� T � _ ,