HomeMy WebLinkAbout018-1002-10-000 ST. CROIX COUNTY TONING DEPARTMEN � '� -k '
i ,' •,
AS BUILT SANI'T'ARY REPORT ''
y-
r
Owner
Address �43y / /O��` � c 0i
City /State 3.9/Q
Legal Description:
Lot Block Subdivision/CSM #
'�4 S + , Sec- I T ?Li N -RLLW, Town of NgmmeaD PIN # Q /$ 00d,
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
f,�,I, cs
IQU A�� J Tank manufacturer
CI-A. Size ST�rC O - Setback from: House. Well r O P /L w> 200
Pump manufacturer Model 4'3
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Lloa�— Vent to fresh air intake Water Line
Meter location
Alarm location -'n
SOIL ABSORPTION SYSTEM:
Type of
yp system: n7by jp s V 5 Width S - Length 7 S J Number of Trenches /
Setback from: House r m " We* y0' P/L } �O Vent to fresh esh au intake
ELEVATIONS
Description of benchmark _ 0n SP. K e, " A go U c Gree,-% a N IQ r k Elevation lUa°
Description of alternate benchmark on Tcp Rr CK rAC � 3 9Qc ,p Elevation toGi, o `
r,
Building Sewer G 7 ST/HT Inlet AT Outlet � �� - 7 '
PC Inlet
PC Bottom 2 1- , . Header/M � Top of ST/PC Manhole Cover Cq
Distribution Lines () ; - 7( () ( )
Bottom of System( 9e ( ) ( )
Final Grade ( ) 100.3 ( ) ( )
Date of installation 7 19 / / ermit number
Plumber's signature
0
�tate plan number
(, 1 6
g number�`�- �'�`��j' Date
Inspector A4
complete plot plan a
s �
NOTICE: Plcasc rovidc the f Ilowi
p 6 ng:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
G
\ �Pr
1
t
INDICATE NORTH ARROW /0 4C—
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y-
Safrtitjr and Buildings Division Count ST . CROI X
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanital 80.:
Personal information you provice may be used for secondary purposes [Privacy L I , s.15.04 (1)(m)].
9TEA ier's N�q,Q; L Village Town of: State Plan ID No.:
AtKC 1/� , t51 L 1V 1J
CST BM Elev.: Insp. BM Elev , BM Description: Parcel TftNn_1002-10-000
TANK INFORMATION ELEVATION DATA A9800276
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ! p� Bench J, 17 �b 1.17 j'oa
Dosing GlJ iGSGt� 7.5c> 13 (;vA I 2 fo2,8 1ch�>
Aeration Bldg. Sewer t°o 5Ab,
Holding (� Inlet
TANK SETBACK INFORMATION (�:{ jj't Outlet
TANK TO P/ L WELL BLDG. - Ventto ROAD Dt Inlet
Air Intake IM O S '
eptic 'LpO� r i ` Ict' ` Dt Bottom lam$ D.S� 4Z
Dosing 7x6t It 10$ 1 t s' NA Header / Man. la , t7 C fl ��
Aeration NA Dist. Pipe c�v cf. (
q. y .0q 9B.
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer e V Demand , p �;/ 9 0
Model Number Jr 7J 2516GPM S 10 - .8 �j•clD 10/ 4
TDH Lift 3 Friction Z System .Z TDF90.)
Forcemain Length $'V' Dia. 7" Dist. To Well
S ABSORPTION SYSTEM
BE TRENCH Width C Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
MEN I N J 75 1 DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH I Manufactu
SETBACK CHAMBER
INFORMATION TypeO f- / - f Mo el c Numb er;
System: p Zoo �� OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length "� Dia- �r Length-5-q.. Dia. NI Spacing if t' 3 "
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Onl
Depth Over Depth Over r De e MUM xx
Bed /Trench Center 1
Bed/ Trench Edges y Topsoil ("ji 4 Yes ❑ No es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 30 c�,i 7 Y-/'7 —7
LOCATION: HAMMOND 01.29.17.12,SE,SW 2034 110TH AVENUE
SCl/ J L d ✓'o v i ve, P ,, � 4-14-
vl of 46 d 3� a c��, t
1n4 I ���
Plan revision required. ❑ Yes J,;j No
Use other side for additional information. F-7 TI r
! '
Date In pector's Sig ure Cert No.
SBD -6710 (R.3/97)
i
Safety and Buildings Division
Visconsin SANITARY PERMIT APPLICATION 201 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. 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.
• See reverse side for instructions for completing this application State Sanitary Permit tN Number
Personal information you provide may be used for secondary purposes E] Check if revision'co previou3�applic3tion
[Privacy Law, s. 15.04 ('t) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Location Pro YO ner ame a, �� �j 4 S W 1/4, S T /Z �' , N, R E (or�
Property Owne Mal Ing Add ss Lot Number Block Number
01 r, ?A I 14 !f
City. tate Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms o Io w a n OF ®/1 /� r� �h*� p '
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number
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_ ❑ Reconnection of S. ❑ Repair of an
------ System _ _ System Tank Only 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 F2 Mound 30 ❑ Specify Type 41 [ Tank
12 ❑ Seepage Trench 22 ff In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 'r Elevation —
> / S l i .2 7 N Feet 00, (-'Feet
VII TANK Capacit Total # Of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks r e "-R
1 epti Tank a �® ❑ ❑ ❑ El E]
Pump Tank er j Z' fj 13 El El ❑ ❑
. RESPONSIBILITY STATEMENT
I, the undersigned, assume respons for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) " Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number:
C ,41 , f t �_ t k,0 e�� V Plumb ►t 's Address Street, City, State, Zip
7 — C h S/�w .1-
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issu g A ent Si ature (No Stamps)
(Approved ❑Owner Given Initial '1 GD Surcharge Pee) ' -7''79-�
Adverse Determination V` O
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber
Safety and Buildings
2226 ROSE ST
LA CROSSE WI 54603 -1905
Visconsin Tommy G. Thompson, Governor
Departm of Com merc e William J. McCoshen, Secretary
June 24, 1998
CUST ID No.267341 _ A7TN. POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST +R�.
PO BOX 74�',; ►'
RIVER FALLS WI 54022
`n� -
RE: CONDITIONAL APPROVAL ST CROIX g Identification Numbers
APPROVAL EXPIRES: 06/24/2000 COUNTY ti `
ZONING OFFICE , ansaction ID No 98321
Site ID No. 12849
SITE: (Z Please refer to both identification numbers,
Site ID: 12849 above, in all correspondence with the agency.
St. Croix County, Town of Hammond
SETA, SW1 /4, S1, T29N, R17W
BILLY R STEWART
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 26662
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
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. 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.
Sincerely,
" DATE RECEIVED 06/15/1998
FEE REQUIRED Q $ 180.00
GERARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE $ 0.00
(608)785-9348, MON - FRI, 7:15 AM - 4:00 PM
JS WIM @COMMERCE. STATE. WLUS
• Page of 6
• MOUND SYSTEM RECEIVED
FOR
A 3 BEDROOM RESIDENCE JUN 1 5 1998
SAFETY & BLDGS. DIV.
LOCATED IN THE S F 1/4 OF THE S 1/4 OF SECTION , T l N, R �7 W,
TOWN OF COUNTY , WISCONSIN .
INDEX ,, , 98 3 2 1
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
P.O.W.T.S.
gt i r�T -- Conditionally
bw;�-J,w S,4 0c) APPROVED
DEPARTMENT OF COMMERCE
DIVISION f� AF TY AN UILDI\NGS _
SEE CORRESE&DENCE
PR EPARED BY
WECGEFi;ER SO TESTING
AND .
DES I GN S1E =FCV I CE � M l
F. 0. BOX TS 421 K. KAIK ST. , ..«.• ».., ,�,
RIYEF. FALLS. KI 54022 $ r'
~~
715 - 422`.x-0165 i WFuE E"A
= U•915 P
EUSY1pHTM,
i t YYIS.
A .•r..u.N�� Q_
t✓ - q
JOB NO_
I —
PLOT PLAN Page 2 - of
Scale 1"= 4o '
1, 8r' *I- LTL. \00.0' OJ S�)112.E _ b64 MYU GT40VAb Uv 10'DJg:�1(20l�
2.- TL- %y. p` okv'1rJPoF 8P_LCFt MU1jr, 3' PceO�E G¢cl�rvi� W� L x
3 - - NEST OF t40 V- �ZZ pfrpCLL `S Sop �# w , p r-
�ST� G 1 k I `1'f(►�hzS �D 8E F1aPSl►bONeo pris PQ--Zcam
l
-
R u M OF Li. OCI S 3 8 U tt,t'1
(6
K11,v` (, C Rtrv�Z I
C� S
\` \\ _o' U
gg
�u SOT eo��fi�T oR L.+l•FZ
7M3
q,17 q f7
z
•N !
q1�
� o.1 � s 1—
zsl
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. ( _' _required)
4. Septic tank to be X000 gallon capacity manufactured by
TR "k P's 3C )so can L_ w iz -
5 . Bench Marks S Pca E
6. Divert surface water around system to prevent ponding at the uphill side.
Page 3 Of
Approved Synthetic Covering
19sT*'+ c 33 Distribution Pipe
Medium Sand
Topsoil F Elev'. q7.7 S tit —�� D -
3 E
- b
3 % Slope
( Force Main Plowed
Trench of 2 " -2 2" From Pump Layer_
Aggregate
Undisturbed D 1.O Ft.
Soil E WvS Ft.
Cross Section Of A Mound Systein Using F O -% Ft.
I Trench For The Absorption Area G 1•a Ft.
A S Ft. H I• S Ft.
B - 7S Ft.
I �S Ft.
Linear Loading Rate = b - O GPD /LN FT D Ft.
Design Loading Rate= 0 I GPD /SQ FT K V;�) Ft.
L o1S Ft.
4+ - ° osition of Force Main W - 1'3 Ft.
L
J + force
B K Mein-
----- - - - - - -
A- �Distribution W \, Trench Of 2 ' 2
Pipe Aggregate `
I
Permanent
Observation Markers
Pipes
(Anchor securely)
Mound Using I Trench For Absorption Area
Page u Of b
Perforated Pipe Detail
0
End View
Perforated
End Cop. ' PVC Pipe
-4 Dot
Install permanent
at end of each lateral
Holes Located On Bottom,
.� Are Equally Spaced
Q End Cap
* PVC Force Main
4
t Distrioulion
Pipe
Lost Hole Should Be
Next To End Cop
Distrib Pip Layou
- P 3y. S Ft
X 3-� Inches
Y 3 6 Inches
Hole Diameter ��y Inch
Lateral ) "V Inch(es)
Manifold Inches
Force Main Inches
of holes /pipe 2
Invert Elevation of Laterals Ft.
x . �� _ ►y . L)V x z- zg . og GPr
Place 1st hole from tee with succeeding holes at 3 6r intervals.
Last hole to be next to the end cap.
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE OF
VEIJT CAP
4'C.I. VENT PIPE f r — F
WEATHER PROOF APPROVED LOCKING MANHOLE
! O' FROM ODOR, JUUCTIOW OOX COVER WITH WARNING LABEL
IYMIU.
wWOOW OR FRESH
AIR INTAKE
GRADE
�- g S � I '1 MUJ.
� � Ie•Mlu.
CONDUIT -- --------
\ 11 ,
• PROVIDE --
IAILC7 � AIRTIGHT SEAL
APPROVED JOIN A Tank Construction shall Co mply I Ii� APPROVED JOINTS
with ILHR 83.15 and ILHR 83.20 I (�
I I ALARM
d ' I 1 1
1
I ow
LLEIC FT. PUMPS -j
ti OFF
0
CONCRETE DLOCK
T* APPRW9t>
RISER EXIT PERMITTED OIJL1 IF TANK MANUFACTURCR HAS SUCH APPROVAL SE-00 I NQ
SPECIFILATICIMS
DOSE
TAWKS MAN UFACTUR ER. w�Z'EiiZSt' C`Y1jC11v_t'Tt . IJUMBER OF DOSES: PER DAU
TANK SIZE: SO GALLONS DOSE VOLUME r �- O .4
ANU
ALARM MFACTUKEIZ: r ' . -`�� c � t S INCLUDING OACKFLOW: GALLONS
MODEL AIUMBER: tbl CAPACITIES: A= �S INCHES OR 101 GALLOIJ5
SWITCH TYPE: " 5= Z INCHES OR ' 4 ' 3-1 4LLOLJ5
PUMP MANUFACTURER: ZO�L!~TSZ C= 8 11 Z INCHES OR "D'y GALLOWS
MODEL NUMBER. S3 D- N -L INCCHE O 1 L b' b GALLOAIS
SWITCH TYPE:
'f'1�1ZCL�- ( MOTE: PUMP AND ALARM ARE TO bL �
MIMIMUM DISCHARGE RATE 2 ' a �� GPM INSTALLED ON 5EPARATE CIRCUITS
VERTICAL DIFFEKENCE DETWEEIJ PUMP OFF AUD_DISTRIBUTIOW PIPE.. S FEET
+ MwIMUM. NETWORK SUPPLY PRESSURE .. . . . .. .. . . 2.52 FEET
-F , FEET OF FORCE MAIN X �'�k F Y ofL FRICTIOU FACTOR. �� `3 FEET
. = TOTAL DyNAMIL HEAD = 8 FEET
DIAMETER
IUTERLIAL. DIME.UstOLIt OF TANK: LENGTH ;WIDTH - ;LIQUID DEPTH 3�1 I Zh
BOTTOM AREA - 231= GAL /INCH
AS PER MANUFACTURER GAL /INCH
+ . Cn F ��■ S 15/16— 6 5 PING b Q
HEAD CAPACITY CURVE 4 5/8
• "53 - 57" - "55-'59" SERIES 1 1/2 -11 1/2 NPT
2s .
TOTAL DYNAMIC HEAD /CAPACITY
PER MINUTE
EFFLUENT AND DEWATERING 3 15/16
6
50 SERIES
Ft. Meters Col. Llrs.
4 1 /16
x
U
15— S 1.52 4
s 3 163
Q 10 3.05 3 129
Z 4
J • p 15 4.57 19 72 I I
r 10 Cl lock Vole- 19.25'
O
H
•
2 p
' S �• V
10 1/16
0 I
U.S. GALLONS 10 20 30 40 50 3 3/32
LITERS- -
0 80 160 t
r
FLOW PER MINUTE
su2oa
suss.
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 length - non - automatic 15 ft. 2. Single piggyback variable level That switch or double piggyback variable level float
switch. Refer to FMO447.
M53155 and 57159 Series Control Selection 3. Mechanical alternator 'M -Pak" 10 -0072 or 10.0075.
Model Volts Ph Mode Amps Simp Duplex 4. See FMO712 for correct model of Electrical Alternator, E -Pak.
M53155 & M57/59 115 t Auto 8.0 1 or t & 7 5. Variable level control switch 10 -0225 used as a control activator, with E -Pak (3) or
N53155 & N 7 /59 115 1 Non 6 3or4
& 30 1 a t r 1& 7 — (4) float system.
E53 & E5759 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J - Pak, junction box, for watertight connection or wirecHn simplex or 2
Pump operation, PM 10 - 0002.
53 Series - Wt. 22lbs. 57 Series - WL 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice,
55 Series -'At 24 U. 59 Series - WI. 30 ibs. PIN 1041003.
CAUTION
For information on additional Zoeller products refer to catalog on Combination starter, FMO514; 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
Alkmator,FMO495;SumplSewage Basins, FMO487; and Single Phase Simplex Pump ControUAlakm 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.
JUX 70: P.O. BOX 16347
4T y Louisville, KY 40256-03 4 7 Marlulactlrers d. .
Z EL , SHIP TO. 3649 Cam
1-1 61 _
Lads2 KY (800) 9196 Quaurr s .F RIF
PUMP !O_ (5.72) 778-2 .1(soo) s26 PUIUP
FAX(502)774.3624
Wisconsin Deparbmnt of Industry SOIL AND SITE EVALUATION REPORT Page of 3
Laborhnd Human Reladons
Division of safety & Buildings in accord with ILHR 83.05, Wi Adm. Code
COUNTY -
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not fimited to vertical and horizontal reference point (BNI), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. (_�) 18 - 100 Z- I4
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R Y D TE
� T i
PROPERTY OWNER: PROPERTY LOCATION
12>1 >, 0_. �Z_ STzW1 - T - GOVT - L$T SE 1/4 SW 1 /4,S ( T 7 ,N,R 1 E(01@
PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
Z C_') a 4 1.10 rN AVEl — --
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD
B �wln� hi I sv ooZ UNO I 11 `n+ Avg-.
[ j New Construction Use Residential / Number of bedrooms 3 [ J AdditiQn to existing building
pQ Replacement [ J Public or commercial describe
Code derived daily flow q So gpd Recommended design loading rate bed, gpolft ' 3 trench,
Absorption area required 3 S bed, ft trench, ft Maximum design loading rate ` S bed, gpd/ft ' trench, gpd/tt
Recommended infiltration surface elevation(s) C M. 7 S ft (as referred to site plan benchmark)
Additional design/ site considerations w / S' X '1 S T) J Cy-, "I tu, 11 " 04= S A A lb fR L L
Parent material IZ L � MIMI 04 cSJe 2 S \TEL Rood plain elevation, if applicable It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK
U = Unsuitable for s stem ❑ S IR U ®S ❑ U ❑ S ®U ❑ S ®U [IS ®U [IS ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouridary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed kr&
> <: O-1 �O"t2 3 l 2 � Sl � Z,'�s w�. 'F1r eg Z�' • S . 6
i Z -iy �u`-t2 �1 — s,'1 Z'�sbk w,'f%- 1 ivy ,6
,s
Ground 3 tigf 30 - t. S `f 2 3l y — L \ e-Sbk YniF ci , • �l - S
elev.
0 0-t ft L/ 30 - SLi231y �L.Sti /g Ld S c� p►,� 1v1`FC u� • Z
Depth to
limiting
factor
Remarks:
Boring #
s ) o 1�`-1 tZ- 31 Z SL� Z'Fsbh Wt `Fh CS Z �' • S s
�� 2 � Z 8 -Zn 1o"1.1Z 316 _ sl l 2.'Fsb1t 117- eS ��'�- • S - b
::K..
3 zo Z-b � -S �t lZ � y — L � e-sbl m fit- ek, _ -- •��..>_ S
Ground
elev. y 2,6 -S2 S tt- y
q ft.
Depth to
limiting
factory ,, i
z 7 ', S CF?0lr
Remarks:
� �
CS T Name.--Please Print Phone:
Arthur L. We erer 715 - 425 -016 Z
egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WL 540 22
Signature Date: CST Ntmnber:
M00576
PROPERTY OWNER SOIL DESCRIPTION REPORT Page I of
PARCEL I.D.# O L`3- L00 Z-- 10
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxxiary Roots Bed rends
- Z�sb m' Z%--s 7.
Z 8 10 R 16 s i t 2 `� sbk y as
Ground 3 ?A -tfz Sly yt \ k Ct•u •�L , 5
elev.
eft. 3o - 7 S `IR- � .Sy RSlg C rn Yn�N — •3 i •
Depth to
limiting
factor
i
I
Remarks:
Boring #
I
,
round
elev.
ft.
z
Depth to l
limiting
factor
,
Remarks:
Boring #
Ground
elev. I
ft.
Depth to
limiting
factor
Remarks:
Boring #
i
I
,
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLAN Pa of 3
SCALE
'%M 1 0— 100.0 Ow s P I 1ZE 'L6"fMaO 6RSlk#A jrj :bIA- - R Cw
3' "OUe GvOU%.O_
I ST TTNE �F LIO 1 ° P R�Lsl tS 3�p �# W . Or- .1=1pV
, w, u z IEL 0 16, - ) S'
Oul�Or') OF LPL -0.'1 S 3 $ U tt,�
RttvRg
bzmk i
\ f
1� J LrL a'1
i
�o Ivor e��tt�rlea CSR
1�lS�l +iZ.j3 T3Y14 FYl��flfl I
44 % I
o�
v b
•IS hll 1�
zsont sr.
�; 1 ) — 1 ( 715 ) 425 -ni wi _ 14 00576
CST Signature �' Date Signed Telephone No. CST #
• V1wonsinDepart entofIndustry, SOIL AND SITE EVALUATION REPORT Page \ of 3
-tabor and Human Relations
Division of safety & Buildings in accord with ILHR 83.05; -Wis. Adm. Code
COUNTY -
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST • C � ?,p�X
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.
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REV D Y ATE
I km
[l
PROPERTY OWNER: PROPERTY LOCATION
$1 L L`( DP-, eeVF -E99 SE 1/4 SW 1 /4,S I T 'L9 ,N,R 1 E (o�W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM If
ZD 1 10 Th AVEt�IV —
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD
8�i� 1-J l SV OOZ
(] New Construction Use Residential / Number of bedrooms 3 (] Add" to existing building
pQ Replacement (] Public or commercial describe
Code derived daily flow V. So gpd Recommended design loading rate bed, gfxflft ''�' trench, gpolft
Absorption area required 3l S bed, ft 3 15 trench, ft Maximum design loading rate ` S bed, gpolft ' �+ trench, gpo1ft
Recommended infiltration surface elevation(s) c1- -) S ft (as referred to site plan benchmark)
Additional design / site considerations P1 Wh.; w / 5 ' X 1 S T1 �1 G`�.' M i ju, 1.1' SA A b f=I L L .
Parent material S l CV4 StblM i ov'Z s - n 1 0— Flood plain elevation, 9 applicable ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL I HOLDING TANK
U = Unsuitable for system ❑ S 911.1 [AS ❑ U ❑ S ®U ❑ S ®U [IS 1O U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerldt
{ .;rA �> 0� �o�t2. 3 12 � si l Z.'�sbk � �1r cg Z�' • s . 6
z
V64 _1 y 1 W L — s I'I - Li Sbk wl'Fi- CS bi
Ground 3 lqf 30 `1. S `f 2 w y - L e-Sbk w►'Ft- Ci., • %-L - S
elev.
%1 -9 tL L/ 30 -So SLtfZ 3IV 1 6 Ld SCI p►►� 1v►`�i ►.�1? - 2.
Depth to
limiting
factor
30�
Remarks:
Boring #
3 20 Zb �.S `i 2 31 y - L � �-sbli m fit_ ew - • �{ s t s
Ground
elev. _ N . Z
s s Y z6 Sz S `tiZ � ty� �.S.y R /g
q fL
Depth to
limiting
Remarks:
CST Name: - Please Print Arthur L. We erer Phone. 715- 425 -0165
egerer'Soi1 Testing & Design Service -P.O. Box..74 River Fa11s,WI.54022_
'Tonat re. 0 / g -1 L(O pate. 6 _ _ ` CST Number.'
PROPERTY OWNER S��PCR.T SOIL DESCRIPTION REPORT Page'?- of a
PARCEL I.D. # O L b- l t) o Z — to
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed lTmr&
-3 ) 0 -B tit3%A ZL 3! Z — T i 1 Z'Fsb YA `�� �S Z� , s . tQ
Z 8= to 1 z i it- �) 16 S; I 2 41bk ' -f�. es W4 - s "L
Ground 3 2z 30 R 31 - L�Sl l Zs
elev.
9_ ft. 4 3o - 2 �• S K(Z vl �A-S H R S /$ L 4 S m `F1^ — • 3 • �(
Depth to
limiting '
fa 3
actor
C'' '
Remarks:
Boring #
.13
elev.
— ft
Depth to
limiting
factor
Remarks:
[3
Boring #
I
z
Ground
elev.
ft. !
Depth to
limiting
factor
Remarks:
Boring #
�roi,rid
e1ev:
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLAN Page 3. of 3
SCALE 1 "= DLO '
' NOTES;
E:T— l00. oU S 112E Z b i'j3oUF 6RU A Pv _10.6119 1 )}
P We1.t_ X
q�vl1F 2- @Z. jtq r, ` 0f a'tvpOF Bzlcit EIS lir'. B ftBOVEGvmk"p_
��ST'Z.l IVOFO 1'�l° `S Sop . W 0.1iZtlu�O.
�rvtoanZ 12.. 9 6.1 S'
8 U'VI
IV
8.�
e .z - •
I
�� rvor et"M
1 1iS`1L�iZ13 �11S tY���1
41 t
o�
2
o.1S h1i 11
9L lwlz�-
zso�nt sr,
6 ( 715 ) 4 .s -ni 65 I4 050 76
CST Signature Date Signed Telephone No. CST #
3T CROIX COUNTY
A(3l?,EFl%4RNT
AND
OWNTS'PIS-HIP CURTIFIC'AT1014 rollu,4
rcqwrd fi-m Pliming Dcputm.mt f
fw;r': t #so u ��. a� rcrl 1,5)
ldcn6Fc2t;on Nuruber e e9 2
- Fov'm or - 11,4 e'7
Lot #
1Sluvey M,;p ff olume
Volume
Srcr, bowe- 13 Y'= no Lot Iincs id=611*1e no
yes 0
I I Me MAI N-mr-fm F m
Iran
yr-=
:d by it Tirm—
Mac tmk
.Ar' amxt dr, r= tw l or it= sq ftiftlad state fa wzo.
MrNT ft cubwit .61 m Qcfx zm*r, .. Dqqrhvcd it "xwkfi
'D
6e 'c
=m ravaVerwfinc AM M.4
"' SOM Vmlling =I&= =&042) dWrmq)wft ==dp=piug.(if ==my). the tcpfir'tm*-is 10"AmAtaof agr-
&c =&u4pahm-mad &c above wVk d to mandam &c Fmft ww
'd�betck u"
fadby&cDcpud m
Department t cDepunudaf AM�Qctics�
gbfi Y* 6 cPtk SYW= has lem"milftined mug W compldod and =Wm,:d to ft St Q Cmaty Zaft*wm wbbk 30
days of the dm-* Year =piration datr-
'n 119
7 17
SIGNATURE OF APPLICANT DAIZ
MON
(we) ca* that all statements on this form am tree to ft best of my (our) knowledge. I (we) am (am) &c owacKS) Of
dw pmpcqy dcscnlmd above.. by Vidw of a wananty decd rcoor&d in Regis6w of Deeds Office.
- 7 py
SIG APPLICANT DA j 71
IM
ssssss Axw infomssfion that i m MU& in the sanitary permit being revoked by the 7aft Dalotumt ssssss
ss ludfAdc "Uh this application: a cumped wu d from the RAgisw of Doody ofr
a copy of the =ffiod survey cup if mf== is Wade in the wamaty dood
r
DOCUM NO, WARRANTY UM THIS *FA C9 wtsenrw NIS atroeoeteo "TA
r7Q �� A c
TZ BAR OF WISCONSIN IRM ! —no
w
Richard 0. Rice and Frances A.E. Rice Reed*gRoccat
MiWbah anc 6 . .. .. . ..
11 . .... ....... -- ' - -- __.
.... APR 8 1
..... .........._ '` •-- •-- ------------ -- - - -- 8:34 A _,
........... .............. .. ............................... - — _ ........
Bi R. Stew an8 C� I L.
CORVlyi and warrants to
rl,
w�tee 0liRS �e�.. .LtS1J.tL11.1�__Alid._9�1�.f ....................•...- 4
... .......... . ...... ........... ..................... -- --- ------ ____.._.......
........ ....................»
the fonowing de- ,rtesd real estate in .........St _.. Cr 0�.... — _ — py h�✓ /s/ W� s .2
State of w iseonsia: _
The Southeast Quarter of the Southwest Quarter (SE1 /4 of SW1 /4)
of Section 1, Township 29 North, Range 17 West, St. Croix County,
Wisconsin.
fRAN
SAW V V
I
This _.._.._. -- --- • ------ -_--_ homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights -of -way
of record, if any.
Dates 4t - ••--- •-- - -•• -� ._. .......... day of April ................ -- .................
93..
19. t
..(SEAL) --X- k=es 1 1f! ..��K.K ..... ••.......... SEAL)
Richard 0. Rice A.E. Rice j
. WANDA fOLKE_......(SEAL) - - -- WANDA MWiRTS -• -- -- . -• - -- (SEAL) SIAL RX N D Pu i KOTA p
Nortixr Pvaut
SOUTH OIJCOTA -SEA
AVTRUNTICATION ACXNOWLEDOAI= T
$isaatwrs(s) --- --------------- _.._.– _..._-- ------------------------- 8 TA2`S OP I1
. ... .. _ ....... » ..... . ..... .._.._.._�. • 1 u �!Loi- --- -...--- Coanty
authenticated this --- _--- -day of -- ------------ it.----• Pmomally came before we this ___R�PZ�...day of
—AINILTik _ -___ - , 1933__ the above named f�
- -- ------------------------- - - - -__ ..•__ ... ------ ....--- -... -- -- frr�4�__lf:�!_ �t-
TITLE: K%Wazlt STATE BAR OF WISCONSIN ........... ....................
-------------------------•-•--.... ........._..._......•-.............
i by 706.06, Wis. Stets
to me known to he the person ------ who executed the
THIS INSTRUMENT WAS DRAFTED aY foregoes sstrumant and acknowledge the same. �+
Kristina Ogland ----------- - - - - -- - - - -- - - - - -. - - - - --
Ct f
--- •• ------- Anrn�
Y' at • Lew ------------ •-- •--- •--- •- - -• - --
-----------------------•-----•-•--••-----------------
- ------ --•-• °-------•- Notary Pie ..__r'1I`'1C�t�^A .... ......... ....County,
(Signatures may be authenticated or acknowledged. Both by Camendstiom is permanent. (If not, state expiration
are not necessary,)
date: _ A_ FOt! (EM_Nakv)r.k6lic.---- •- - - -._,
_ MD' Cenrr+ission E.xp;.es May 10 1994 ;
.—: Manwe of De+ vw slentiaff is WW wPa tp aiooW be t7Ded
i
, WA8.41,ANT$ DBED VrATa BAS OF WMC0ft8M Wisconsin legal Blank ro., inc.
CORM No, t— SRS Milwaukee. Wisconsin