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HomeMy WebLinkAbout018-1068-20-000 . . o ? 0) 0 / , q $ $ r k � CD - « ƒ m■ 0 z£ 0 °< E ±/ o ¥ E k c ° # = § / 2 + f to / \ . § 2 $ k PL § 3 G CD } \ / § \ CL . - e (n «; c / EE /; 2 e c y ® e $ E G m @. 10 0 C F \ \ 3 E 2$ d ca o/ . _ = a § F 2 / 0 o o I' / j j j j 0 > § \ § } o § G . ° .&_ , 7 (D 5 ) e \ 7 2 z 2 7 g .. § 0 § § E . � 0 � . C) 7 , CD art � � [ § 2 w ca K . . \ . g w � q § @ . 0 k c ° q & / 2 » $ ® . > 0 � G n �. 0 R ƒ ) \ . � / \ � � e C / \ . )o \ k = k � \ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT ST. CROI GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryP 324674 ermitNo.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1) (m)]. beer's�ljkme ,;., [1 City_RYillage Town of: State Plan ID No.: CST BM Elev.: 17 Insp. BM Elev.: BM Description: li � MMPPiIUUNNDD Parcel T x No.: �18- 1068 -20 -000 o ✓6 4 TANK INFORMATION ELEVATION DATA A9800562 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Gee � Benc mark g 1_4q Dosing 6 Sp Aeration Bldg. Sewer Holding S Inlet 1D J, L� TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet Septic 9 IJ /4, NA Dt Bottom / g 7 , 7 Dosing Zb NA Header / Man. 2 7� qj. Z Aeration NA Dist. Pipe 2'•�) 2• G /� J Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 02 1 � ?.t 10Z. 1 00 Model Number 2$°4rPM TDH I Lift/ 1 Friction SystemZ TDF /; ff Loss Forcemain Length Y & Dia. Z N Dist. To Well SOIL ABSORPTION SYSTEM 1 �/ ED / NRI N H Width Length , l / No. Of Trenches PIT No. Of Pits Inside D Depth C / DIM SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manuf>aarer INFORMATION Typeof I CHAME Moe Number: System in'` DISTRIBUTION SYSTEM G Header / Manifold Distribution Pipe(s) V x Hole Size x Hole Spacing Vent To Air Intake '. Length 4 Dia. Length Z Dia. / Spacing 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: HAMMOND 30.29.17.467A,SE,SE 714 160TH STREET t �,igll8 U4 Wt 3. - 7q q7. 5 5 elegy, IS: a�` okt-w wt l ( �f ` </1 eel, - 4,rru rar 3 � b lo� 5���. � � �'l4a�er' �' A P revlsIon rejuird "Yt o Use other side for additional information. 3 a 1 5G SBD -6710 (R.3/97) Date Inspector's Vignature Cert. Safety and Buildings Division - `V= • - In PERMIT APPLICATION 201 W. Washington Avenue �scons►n In accord with ILHR 83.05, Wis. Adm. Code P 0 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 8112 x 11 inches in size. Sc y , • See reverse side for instructions for completing this application State Sanitary Permit mber Personal information you provide may be used for secondary purposes [I Check if revisi( A, NN er ous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Num er I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 1`��7v Property Owner Name Property Location u e L, Q rvasf 1/4, S ,?p ;2t7 T e ? , N, R E (or� Property Owner's Mailing ddress Lot Number Block Number S ea e,da(- sr' City, State Zip Code ` hone Number Subdivision Na c W S- SM Number Y S �� - 1 'Yo'� r TY PE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest Road Public 1 or 2 Family Dwelling /'T Town OF - No. of bedrooms E] vil lage / / A. 7-11 isr ,r� .S T III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo (,/ / F ` l 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. W New 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an _System ________System __ _________ __ Tank Only______________ Existing System ___ - _____ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ff 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/day /sq. ft.) (Min. /inch) Elevation ySQ ? � _T_ - A_ 947` T Feet l da.,Z Feet VII TANK Capacit gallo Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks tr��ff Septic Tank k h7 ,'duJ 6 s e- 1-N Ldl ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /5 ber ❑ ❑ 1 ❑ i ❑ ❑ VIII. 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) PRSW No.: Business Phone Number: �� .S'cL,a e/lC I��G ?G+ �,3/2! Plumber's Address (Street, City, State, Zip Code): 7 c o la - IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) )(A pp roved ❑ Owner Given Initial loll Surcharge Fee) �G� po. . Adverse Determination U ! D GLY X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber I Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 isconsin Philip G. Thompson, Governor lip Edw. Albert, Acting Secretary D epartment of Commerce October 02, 1998 CUST ID No.267341 ATTN POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL 9J Identification Numbers APPROVAL EXPIRES: 10/02/2000 j�, ransaction ID No. 149770 r� ai:lo � ID No 161147 ... SITE: se refer to both identifichtton numbers,: in all correspondence with the Site ID: 161147 --� (� "j a en St. Croix County, Town of Hammonds rP CROIX SETA, SETA, S30, T29N, R17W : -,' COUNTY Dave Langer '/ ZONINGOFFICE ti FOR: Description: Mound] Object Type: POWT System Regulated Object ID 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. Slats. • 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 09/28/1998 FEE REQUIRED $ 180.00 OcrardM. W Swim FEE RECEIVED $ 180.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.us " Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE l/4 OF THE S 1/4 OF SECTION 30 ,T N, R W, TOWN OF COUNTY, WISCONSIN. "T e.s�j v o L 0 i V C'�D o��_ ►o be - 2,0 INDEX S Sep � PAGE 1 •of 6 TITLE SHEET gFFt 2 1 998 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 'b Av E L 1'C►vG�'1Z woo�v N Lv l s 14 C ED P COMMER CE DEPARIMEN� of B 10 " Dl ON PREPARED' BY S E C ORRES 0 CE WEGEE�EF2 SQ = !._. .TESTING ab ,�� ! _ AND. �{► '�Y 13E13 z CE;N ` Sco)v F.O. BOX 74 421 K. KAIK ST. z RIVET FALLS. V1 54022 WE:"E ER 715-4 D- SLWORTW se's �N�N ct- Zy JOB NO. ��� ST. CROIX COUNTY ZONING DEPARTMENT,, AS BUILT SANITARY REPORT i < Owner i 1 A ' �Ze� e ��z,u�Gr Aa Property Address /-/;, City/State Legal Description: ,✓ Lot % Block Subdivision/CSM # 6);' %, %4, Sec. 3 -- a - , TAN -RAW, Town of A w�, u c� PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer &,, d wes' *r.N Size ST/PC / °v 1 Setback from: House - P 7 Well P/L , Pump manufacturer tea.. ,rd_� Model t Po Alarm location /%I. s I (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: ' PZae A- Width 3a Length , Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark ._/d, ;a Elevation 14 °r Description of alternate benchmark ya �, -d d y , Elevation Building Sewer 1, 7 ST/HT Inlet `le ST Outlet PC Inlet PC Bottom 7.74*r Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () Y9 2 J () ( ) Bottom of System () 7, () ( ) Final Grade () () ( ) Date of installation 11- Permit num State plan number IVI - 77d Plumber's signature =- _ License number Date Inspector Complete plot plan �+ AO . y 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 v o� a V cc/ �V INDICATE NORTH ARROW PLOT PLAN Page Z of Scale 1 "= yp ' �EL - k .p' ono \ krZ 'Q di N�'Rr _ Pv�wr� CdCK►'�8�1t U�,T 'b �� H'f �-�T I � � ' �RO►'1 ttUv3@ o F y'` pt, c pis Ld 8.Z zs , `t)z Ivor WY's P P� - tT o R !- 2 � F t�? . 98. V I NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( �4 required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be 10 0 16S0 gallon capacity manufactured by 5. Bench Mark SQ7 V 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of �? Approved Synthetic Covering Fts C 33 Distribution Pipe Medium Sand G Topsoil _ -H. F Elev. 99.1 3 b Z % Slope Bed Of 2— 214 Force Main Plowed Aggregate From Pump Layer D \. Ft. Cross Section Of A Mound System Using E x, �b Ft. A Bed For The Absorption Area F 0 Ft. G 1. Ft. A B Ft. H 1• S Ft. Linear Loading Rate =4• � GPD /LN FT B L_Vl Ft. Design Loading Rate = O,V .GPD /SQ FT j Ft. J _ Ft. K 1p Ft. ni +or n ;i t A a„c; +inn Ft. W 3 Z Ft. L Observation Pipe F g K - - -- ----- - - - - -- - - -- -- --•I Force Main Distribution Bed Of 2 "— 2 2 Pipe Aggregate I Observation Pipe Permanent Markers LL (Anchor securely) Plan View-Of Mound Using A Bed For The Absorption Area Page Y" Of Perforated Pipe Detail 0 End View Perforated End Cap. d�6�e PVC Pipe Install permanent - marker at end of each lateral �' ar Holes Located On Bottom, Are Equally Spaced S PVC Force Main P PVC Manifold Pipe Distri ution Pipe Lost Hole Should Be I Next To End Cop End Cop P Z Z Ft. Distribution Pipe Layout S y Ft. X L IS Inches Y V Inches Hole Diameter '1y Inch Lateral I Inch(es; Manifold Z - Inches Force Main " Inches # of holes /pipe Invert Elevation of Laterals 9 q-Z Ft. Place lst hole Z V from center of manifold with succeeding holes at L/V intervals. Last hole to be next to the end cap. - Combination Sep.t:ic- Tank and PUMP CHAMBER CRO55 SECTION AMD SPECIFICATIONS ' PAGE S OF �o -VENT CAP WEATHER PROOF JuUCTION Box 4'C.I. VENT PIPE APPROVED LOCKIPJG 1. lO' FROM OOOR, MAUHOLE COVER w .NOOW OR FRESH rI T wAAIJIWG LPsOEL.. A!K IAITAKE co�pulr t NR-X . - .� i b 4 MIIJ. ---------- L -- 14 1"SIe'c:nw ptPt ' PROVIDE I — --- JIMLE�� T AIRTIGHT SEAL 8 4FPLsS � APPROVED JOUIT A I I APPROVED JO11JT: I III W /C.I. PIPE W /C.I. PIPE OR Tank construction 1 I� shall comply with ' I I I ALARM ILH ()3.15 and 83.20 e I I l 1 ou C I $x:15 CLEV. FT.-- PUMP - -� - � OFF 0 COSICRETE BLOCK 3" AVPRorea K15EK EXIT PERMINED O►JLy IF TAIJK MANUFACTURER HAS SUCH APPROVAL• BbD01N4 SEPTIC f SPEGIFIGAT101�15 OOSE }'I � )�5 �1�. .PAST' NUMISER OF DOSES: 3 ' PER Do" TAWK MAN UFACTUR ER: TAWK FAZE: 1 %00 Sly GALLOWS DOSE VOLUME t ALARM MAIJUFACTURCR: S S ` �`- S \ t S 'T )a'•1S IWCLUDIWfo OACKFLOW: S3 GALLONS MODEL NUMBER: �S3 N(Aj CAPACITIES: A= IAICHESOK 3 06 GALLOIJ5 SWITCH TYPE: y- ELCAJ" B= I 3� 4LLOL15 PUMP MANUFACTURER' Gov - ,ts , 5 S C= q �IUCHES OR S CALLOUS MODEL NUMBER: 3 X04 D- __L_ IMC HHESS�O�R b y b GALLOWS SWITCH TYPE: MOTE: PUMP A)JD ALARM A TO 5E MINIMUM DISCHARGE RATE `'g'b$ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD..DI5TRIBUTIOW PIPE.. ` y S FEET + MIUIh1UM IJETWORK SUPPLY PRESSURE . . .. . . 2.50 FLET + FEET O F FORCE MAIN X 1 F Yo►r.FRICTIOU FACTOR.. �` FEET TOTAL 09UAMIC. HEAD = � 9a FEET - � - Pump chamber DIAMETER IAITERNAL. DIMLWSIOIJ� OF TAUK: LF-KI&TH ;WIDTH ;LIQUID DEPTH 3 $ BOTTOM AREA = 231= GAL /INCH AS PER MANUFACTURER GAL /INCH . � . • • Goulds Submersible Effluent Pump r EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specificall y designed for the stainless steel. grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. •Effluent systems ■Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle Motor: and float switch attachment •Farms manual operation. Automatic • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewaterin g preset at the factory. RPM, built in overload with rated oil and water resistant. , automatic reset. ■Bearings: Upper and lower RP 115 V, 60 Hz, 1550 RPM, SPECIFICATIONS ' EP05 Single phase: , FEATURES heavy duty ball bearing construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design 3 /; maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING r - • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Co. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding 111111 EP05 Impeller: Thermo- * Discharge size: 1 NPT. plu O , p i o l 20 f oot with p end in o lastic enclosed design for eliste model I numbers • Mechanical seal: carbon- improved performance. ) rotary/ceramic- stationary, three prong grounding plug p BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 I • Capable of running dry without damage to s 30 -�;F- components. y Pump: EP05 a !"? • Solids handling capability: o 25 %" maximum. Q W. i • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. 6 20 • Discharge size: 1 NPT. z 5 ` . • Mechanical seal: carbon- 0 15 rotary/ceramic - stationary, -+ 4 BUNA -N elastomers. o Temperature: 3 10 j 104 °F (40 °C) continuous 140OF (60 °C) intermittent. 2 j - - -EPO4 _- 5 I I i I l 0 0 0 10 20 30 40 50 GPM L L 0 2 4 6 8 .10 12 m' /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 —.1. sdonsinDepartmentofIndustry SOIL AND SITE EVALUATION REPORT Page/ of 3 Labgr ary� 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 8 1/2 x 11 inches in size. Plan must include, but 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 INFORMATIO ASE PRINT A MATION REVIEWED BY DATE PROPERTY OWNER: / �-? C GL PROPERTY LOCATION ,Sc' GOVT. LOT 1 /4 S,1_7- 1 /4,S 3 o 7-7 7-7 T ,N,R /7 (or) W PROPERTY OWN R':S MAC G ADDRE POI K ... BLOCK >r SUBO. NAME OR CSM ar w �t - CITY, STAT ZIP CODE PHONE NUMBER VILLAGE /TOWN NEAREST ROAD 4 . S / (7W) ( Oew Construction Use Residential / Number of bedrooms 3 (] Addition to existing building ( J Replacement (j Public-or commercial describe Code derived daily flow 60' gpd Recommended design loading rate 5 bed, gpd/ft trench, gpd1ft Absorption area required 37 5 bed, ft 375 trench, ft 6 Pximum design loading rate __ bed, gpd /tt ' 6 trench, gpdm Recommended infiltration surface elevation(s) 9B ft (as referred to site plan benchmark) Additional design / site considerations Parent material ( (i4�c '* � dt�r 1 Flood plain elevation, if applicable d/ /� ft S = Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem O S � U �S O U O S X11 S U ❑ S ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPO /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rFa1� f ni 'fin- S , Ground - t) 7. 7,+ 7, S `f 1 11 07 -i c- SL - n'I /S !r� d . - S 6 elev. . 5 �s /� E S /S /t'1d �J •vet S , e � 7, syrt. �/z 5 �.►ds � Depth to _ , 5� s2 G /g' , 5 rL - r /vis= f'rs limiting factor = Remarks: Boring # t °S Z � z:17 /o , S�/ >_. ,S � � - •� ism lei _ 46 - I:>. .s ►� 0 ec) . s Ground z P 77z N = Depth to limiting factor 7 B'� Remarks: CST Name:—Please Print n� L Phone: .1 5 Address: _ _ Z L -'?o0 Signatur Date: CST Number: Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations Division. of 5'afety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference int BM direction and /o of slope, scale or PARCEL I.D. # Po ( )� P dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT �C 1 /4SG 1 /4,S 3o T Z� N,R /7 ,B (or) W PROPERTY OWN R':S MAILING ADD�R BLOCK # SUBD. NAME OR CSM # NEAREST ROAD CITY, STA7 ZIP CODE PHONE NUMBER []CITY VILLAGE/QOWN [ New Construction Use V+ Residential / Number of bedrooms 3 [) Addition to existing building j [ Replacement [ [ Public or commercial describe Code derived daily flow 5 ; U gpd Recommended design loading rate 5 bed, gpd/0 . trench, gpd/ft Absorption area required 37 5 bed, ft -- trench, ft _Maximum design loading rate - �5 bed, gpd /ft 6 trench, gpd/ft Recommended infiltration surface elevation(s) �B 6 ft (as referred to site plan benchmark) Additional design / site considerations Parent material (p f r & n-� dv+) Flood plain elevation, if applicable ^ 4/ 1 ft S = Suitable for system CONVENTIONAL I MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem El 1 tJ �S C1 O S ZU ❑ S U O S ❑ S EZU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITirench o rL �/Z /20-7-7 e �- a i�nis n, fin- s Ground V7, Z 7, 5 `¢/ h 0 7- 2 6- !ate elev. "F - ft. _ 7, `1 �.S /S �ti�- 0 WA S - >z �R 7, s 7/ 5,4„�ds _ Depth to _ . 5' r2 & /,E -rzff limiting factor ,r Remarks: Boring # Ground -ZL S-/ C z P 7 s 71 Depth to limiting r + "' factor ST c NX Remarks: -, t IC* CST Name:— Please Print S4 5 Phone: Address: _ Signatur : p Date: CST Number: p( L°S zz a PROPERTY OWNER AA1IE13w. I s SOIL DESCRIPTION REPORT Page -"-of 3- PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Z z YLa� -lam /miss L s. !o �-i 1, S ; - z�r,� /s� M4 k) y Ground a It /n ip .S elev. C .tip IVA Depth to limiting factor z8 „ Remarks: Boring # 4;r..h \ice ki:: Ground elev. ft. Depth to limiting factor Remarks: Boring # Z: Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 988 N. Shore Drive C.S.T. 2298 New Richmond, WI 54017 MPRSW -3254 ` a� S (715) 246 -6200 .s� .s ,3a fz9•v •17a t IV N'L ' 30 v �a 3 Z► y 1 isconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page — of 3 Labor and Human Relations Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code . COUNTY / sue` � �O / Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference ARCEL I.D. # n and % of slope, scale or e int BM direction P point ( ), dimensioned, north arrow, and location and distance to nearest road. • REVIEWED BY DATE APPLICANT INFORMATION-PLEASE E PRINT ALL INFORMATION PROPERTY OWNER: / /� / PROPERTY LOCATION �dl ;/ S GOVT. LOT SG" V4 SL' 1/4,S 3o T Z f ,N,R /7 .f3 (or) W PROPERTY OWN R':S MAC G ADDRES LO # BLOCK # SUBD. NAME OR CSM # W 1t W �- CITY, STAT ZIP CODE PHONE NUMBER OCITY VILLAGE�tOWN NEARE�uD pi - f New Construction Use V+- Residential / Number of bedrooms 3 J Addition to existing building (J Replacement J Public or commercial describe Code derived daily flow 5_0 gpd Recommended design loading rate 5 bed, gpd/ft 4- trench, gpd/ft Absorption area required 0 37 S bed, ft 375 trench, ft �ulaximum design loading rate �? bed, gpd /ft ' 6 trench, gpd/ft Recommended infiltration surface elevation(s) 99 6 — ft (as referred to site plan benchmark) Additional design / site considerations Parent material l ( mac d7^ f Flood plain elevation, if applicable AZ It S = Suitable for system Pa NVENTIONAL MOUND IN- GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S JEW IBS O U ❑ S 1J El S U ❑ S ! ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed I Trench t:: 8• /7 /a I// now e_ ,•C. '?L 4t 1 6 I , 5 � Ground 3 7. Z+ 7, SL elev. 5 , Z oar 7,sym- / / 54045 4 Depth to _ , limiting I factor Remarks: Boring # rYl f t 3 z.z 17 /4 � f�/ � S � ,C • .� /S� Yyi �v N . Ground z P 7 sy ,/z AM el e v . /.5 - e , y . � .r �- s o Depth to R ECOW c� limiting factor 191/ SP 1 5 1993 ST CROIx e� Remarks: Print Phone: �ONINGOFFIC� CST Name: — Please P +q L s Address: Signature: Date: CST Number: /y I_ - roWNER I�i(t: ��� ��S SOIL DESCRIPTION REPORT Page —of 3 by ARCEL• I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trencfi Ground 11 zp /� / off! �C �- /rr� /S/�/ rl1 �i�— •� •S 1 8 0 lGs Z . 5 � e NA Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor I 1 j j j I -TI Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 988 N. Shore Drive C.S.T. 2298 / / New Richmond, WI 54017 MPRSW -3254 /u S (715) 246 -6200 .7LZ 9ti . /7 4-d _t 2.17 7' � = . A �,2 3� �b 3 Z� b ` s ,C. zys " �- ®� // -53 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ,,/:f L/0 l AI( — j�� Mailing Addres �/�/� .% L2- %L_L� Le-) Property Address 16o -TI-1" - (Verification required from Planning Department for new construction) City/State 6? Q c Lc 2 I Parcel Identification Number LEGAL DESCRIPTION Property Location ' /,, SL %, Sec. 30. T2�_N -RjZW, Town of 0X D . Subdivision h lA- L Lr )i 1-/ c -2 S Lot # Certified Survey Map # S Volume Page # 2 Warranty Deed # / Volume Page # e- i49-_ . Spec house O yes 0 no Lot lines identifiable QI yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three yeas or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is lea than 1/3 full 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 returned to the St. Croix County Zoning Office within 30 the three year expiration date. Cam- I � lwl SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of pr rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. �- a, ll i lOi y SIGNATURE OF APPLICANT DATE *sass* Any information that is mis- representedms,y 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 - 561286 1- .7raGEb - 49 DOCUMENT NO. State Ba of %aiconsin Form 2 -1982 WARILkNTY DEED S?. Cnix CTY va r .JUN 2.0 1991 `+ Halle Builders, Inc., a Wisconsin corporation, conveys and M ,$ warrants to David A. Langer and J.'nelle L- L.a�er, husband and 11 ' q5 A '> wife, as survivorship marital property, the fotloming described emu"' 4k 1".41 real estate in St. Croix County, Wisconsin:. NAME AND RJ IURN ADDRESS J HALLE BUILDERS, INC. fi A 1113 Hwy. 64 ? New Richmond, WI 54017 Tax Parcel No.: 018 - 1068 -20 i Part of the SE 'h of SE '/4 of Section 30, Township 29 North, Range 17 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed September 15, 1993 in Volume "9 ", page 2684, as Document No. 505545. This is not homestead property. 3 -«- ^ Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. } Dated this A�day of June, 1997. t HALL UIL RS, INC. *Wesley alle, President *Linda R. Halle, Secretary AUTHENTICATION ACKNOWLEDGMENT Signature(s) ' STATE OF WISCONSIN ) ". authenticated this — day of ) ss. 1997. ST. CROIX COUNTY ) Personally came before me this �`� of June, 1997, the above named Wesley W. Halle • and Linda R. Halle as officers of Halle Builders, Inc. to me known to be the persons who executed the TITLE: MEMBER STATE BAR OF WISCONSL% foregoing instrument and acknowledge the same. (authorized by Sec. 706.06, Wis. States 1 THIS DOCUMENT DRAFTED BY: 1lpi,� pLE Remington Law Offices d* MAN of •- P. O. Box 177 Notary Public St, Croix County, Wis. New Richmond, WI 54017 My commission expires: i / FILM SEP1 5 7�9� JAMES d'MKfg& J' Reamer -� 505545 CERTIFIED SURVEY MAP APPROVED Located in part of the SEa of the SE4 of Section 30, T29N, R17W, in the Town of Hammond, St. Croix County, Wisconsin. SEA i ; ly N S1 . C:ROIX COUNTY LOT I LOT 2 LOT 3 LOT 4 :omprehensive Plannai.-; . co M 11 28.84 5.00 ACRES INC Zoning and . R/W 2 2.11 N pl Pa;':3 Commiiteo SQ.FT.INC. R/W 91,799 91,T99 1256308 217,749 CD m ACRES EXC. WW 1.90 1.90 27.92 4.75 a If not rec orded w '.v -h C SQ.FT.EXC. R/W 82619 82619 1216100 207024 v ithin 30 days of doe CD M 0 rt � `-+, f— E HAR d .30MIM sball h C/) *4— 0 (S E� ?III ggii11 ppII 00 a oo SURVEI�OMOR 0 o 0- c m CORNER TIES.) " 'ry O v °' N 0 Q NE) LA T T LD ! ,aidQS O 0 = rt s m r• co r• , 0 N � NORTH LINE OF THE SE4 OF THE SE V4 L 33 Jr rt a N89 48'30 "E 1315.69' J I 12e2.ss' rt 33.00 0 6d eD -s w -+� rt 0- I w .c r O O! C) rn w Ic m Z � 0 1� �o LOT 3 :m 0 . > I� 0 1y Z N N8Aa'O9'E 0 r �� 1J —1 rn 330.0d 297.00 z l = t —I C- I -1 O �rj rn N89 1 -1 v '58'O6 'E 33.00 o �U 2 2 325.00 N NNi — I i1� N _ i m LOT 2 •��I� _= I—I I li rn F- W N N 00 I ll i' I> z N89 58'06 "E 11 rn I m � -•P �) W O 330A0' -P � I m I. 1 'n o ' o o _o 297.00 N I_ 1 LOT 4 N °' 33.00 N I–� o �J) 0 -� 171 W m o m LOT mm 33.00) 29zoo' S89 o 58'06 ° W CL SMALL NI 330.00 - - - -- w �, - -S89 ° 58 '06 "W 987.02 TRACT 6 ;89 W 325.0 33.0 662:02' 33.00 710 /392 * _ I 325.0 �� X6205' 0) \_ ;69 "W A PSE CORNER OF 1317.06' -�— S89 987.05' Off' \ 330.0 ' SECTION 30 I SY4 CORNER OF w SOUTH LINE OF THE SE V4 0 , „ SECTION 30 ;0016 04 E r. 70TH AVENUE 198.o ' UNI'LATT`D LAnDS LEGEND G6 . ,��7 9 Aluminum County Section bit D30N." Monument Found O 1 x 24" Iron Pipe Set, VOLUME 9 PAGE 2681+ weighing 1.68 lbs. per OWNER linear foot SCALE IN FEET Halle Builders, Inc. 100 Roadway Setback 1767 115th St. M-- r Fence Line 10050 O 150 300 New Richmond, Wi. 54017