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HomeMy WebLinkAbout020-1337-20-000 0 (a G A r v 0 d o c m o c �� c ^' (n z O w a, z z O w a, 2: � J d p cn p y O to O N 61 a A N t C. O fD O X CD ICI girl .r A O d O N O 3 O y N N O "0 Q CD 7 O 7 O O CD CD O> N C A Cp d O O O 6 e-r N (CO O O c v c cn C D m . . < cn z D (p fl< e m rn a n D a f `� rn n W cn Q W c _ _ CD CD S ao O V=III c' �a CD co coo o a�OD N r CD c Z 000 000'i� 3 D3 N om! N @ I0 0 0 IQ T y N � CD N w U! - N m m m d m ro CL zaoz z= z ' N O D a O D M 7 i m m m m o U N O +I 0 I C CD N co 7. O 7. C (D c :r W (D O' p — Z ) CD (7 O- Z c �_ cn n a A Z n O p n CL 7 ?. c z W (D N ( T C A a a 3 A Z C ' z m z y z (D , A O (D \ O OL CD v c °—' v c C ° o 0 0 0 CL CD w c p CL 0) N OZ (D N r _ O N N < O O N � O 7 fi 0 3 3 O 'O C A N 7 N C 0 00 3 0 CY x o o ?� CD CD Do b to ts� a O O o CD o CD e y O Q. O L CD I r� ST. CROIX COUNTY ZONING DEPARTMENT ` AS BUILT SANITARY REPORT Owner i��o , �/ Property Address 98 20dEK T� . � ri ., �, City /State 75 WX EY016 C; ;(Nt: Legal Description: Lot Z Block -- Subdivision/CSM # ' /4 . A�-' /4, Sec. I Y' . TAN -Rf�W, Town of Ay&m -i PIN # I SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION Tank manufacturer 4 tIeX Af Size ST/PC/ / B� Setback from: House ! Well Pump manufacturer Model Z tl Alarm location Aai.tIl (HOLDING TANKS ONLY) Setbacks: Service ro Vent t a>r intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: d 470 Width IX Length Number of Tnaches 3 Setback from: House :r7' Well x1i,W PAL . 22 Vent to fresh air intake ELEVATIONS Description of benchmark - 7e o F Elevation /cy-,0 L Description of alternate benchmark Elevation Building Sewer 9 ST/HT Inlet ST Outlet Or PC Inlet F 77y PC Bottom Z Z11 Header/Manifold IM.d Top of ST/PC Manhole Cover /m• YJ' Distribution Lines () IQ2. D to () ( ) Bottom of System Z4 () ( ) Final Grade ( ) zy3 6 ( ) ( ) Date of installation -5 9 Permit numb State plan number Plumber's signature / License number 01 11,A Date Inspector /41- Complete plot plan s NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. i PLAN VIEW i 7 / Z � "S7 �c4te - 30 d ? / L� O i Ste' / l OP.' O (/Vo Gv,EGG INDICATE NORTH ARROW r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT S`E�C�ca ?X 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)]. 3a-'P? 3 O Permit older's Name: I� ❑ City ❑ Village -Town of: State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: t 6o I t0V 1 - 4ww I> L4 0,3-V -133 ca -vo TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic" c (Z pp Benchmark 7B /0&.7& OD Dosing goc� /N. 14 %F.1,� ZAi Aeration Bldg. Sewer $• 18 $, Holding (V/10 Inlet $ co l X./ TANK SETBACK INFORMATION Outlet .,�; TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet 97. Air Intake Septic 4_, NA Dt Bottom Dosing 4 >✓ �. � ZV � NA Header / Man. ` Aeration NA Dist. Pipe (0 -15 /aO.o3 Holding Bot. System 7. Ss5 q PUMP / SIPHON INFORMATION Final Grade Z'QS Manufacturer oAAds Demand Sr. d A C V_ Model Number &PPS OGPM TDH Li C / 4 71 L rictionj� o System/ TDH? Ft Forcemain Length I D Dia. .2 40' Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuacturer: INFORMATION Type 1 � i CHAMBER model Number: Syst I`/'fMlj ;V7 !ti OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ,i Length W/ Dia. ' Spacing � �rW 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.) 4 14. bin - Pao �law� ��alrr�� tw1�►�rtx `'�`^�- uJ U .� 1. &.eA 4 1 4 , M .4v �ro�- Plan revision required? ❑ Yes No Use other side for additional information. 62, 2,4ma I I i SBD -6710 (R.3/97) Date Inspector's Sign ure No r Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue P 0 Box 7302 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes Y 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 Property Owner Name Property Location 1 /12 1 /4, S TX , N, R E (o Prope; �wner' Mail Address Lot Number Block Number ;it , State I'Zip Code Phone Number Subdivision Name or C-tW tarn 2r ( 1 -777 ivy-w I. TYPE OF BUILDING: (check one) ❑ State Owned it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 4 o a n OF ��'P ,/ll� C`rT�NtOs1 III. BUILDIN USE: (If building type is public, check all that apply) IPa r cel Tax Numbers) 14.Z—%. lq, V1 gg 1 ❑ Apartment / Condo 7 — xd 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. 0 New 2 _ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System ________System Tank Only Existing System Existing System B) jg A Sanitary Permit was previously issued. Permit Number r A. t17�?d Date Issued /.t s.t V. TYPt OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ZSeepage Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank 1 ❑ Seepage Trench 22 ❑ In- Ground Pressure r f 42 ❑ Pit Privy 13 ❑ Seepage Pit tea' S� 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 oo I X$ d 0 p Feet /,0 Feet VII. TANK Capacity in g allons Total # Of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank oTTk 2010 41 ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon-eftwM*r ❑ 1 ❑ ❑ 1 ❑ ❑ VIII, RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio of a onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Sign: (Not ps) PRSW No.: Business Phone Number: • �! d 3 6S?o is Address (Street, Cit , State, Zi ode): ; � T3 Z 3 IX. COUNTY / EPARTMENT MMALY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A e I Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determination /Mitt{ 10 14� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 4t M 1 NvrZ_ P- EVI '7(D1 -- A�1 ��� �ur.np u+AVV► i3t=JZ_ AN PVft SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber r . w.44x a /-�/ A lly w� I 1 5 - 0 r CIA A C ys I i O = ied �poo x y X '� X PAGE (;F PUt'NP CHAMBER CROS5 SEC T IOIJ AUG SPECIFICA VEtJ7 CAP 4"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIMG JUAICTIOAI BOX MANHOLE COVE F., Z51' =RO."1 DOOR, S WINDOW OR FRESH IZ "MIU. AIR INTAKE G^ RA DE ' COIJDUIT 11� INLET PROVIDE AIRTIGHT SEAL * A I III I *APPROVED i ON . JOINTS WITH I I ELEV_ FT. APPROVED PIPE OFF 3' ONTO PUMP � D SOLID SOIL CONCRETE DLOCK - - RISER EXIT PERMITTED OULy IF TANK MAMUFACTURER HAS SUCH APPROVAL SEPTIC f SPEr-IFfCATIOUS DOSE TANKS MANUFACTURER: -IL4 X IJUMBER OF DOSES: 2 - PER DAy TAIIK SIZE: r GALLONS DOSE VOLUME C` 14q ) ALARM MANUFACTURER: -S i 'LECr INCLUDIMG BACKFLOW: AW - 14 1 - -307 GALLONS MODEL QUMBER: -/ / L - ?AiV1K A4OC 7- CAPACITIES: A= _L�IWCAES OR GALLOWS SWITCH TYPE: B= 2 INCHES OR �%Q GALLOWS PUMP MANUFACTURER: dj2u z- A C= Zk I►J OR 3a'o GALL0IL1S MODEL NUMBER ,D0V_ t' D =INCHES OR - / ® GALLOMS SWITCH TYPE: 'a'ALK /ltfxallz NOTE: PUMP AND ALARM ARE TO DE MIN DISCHARGE RATE - GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. IV_ FEET + MINIM NETWORK SUPPLY PRESSUR , . . . . , . FEET + 5 FEET OF FORCE MAIN X F loo FzFRICTIOLI FACTOR. - 1 FEET TOTAL 09MAMIC. HEAD = - -- FEET IUTERAIAL DIMEIJSIOMS OF TAUK: LEQ&TH ;WIDTH - ;LIQUID DEPTH j L T , ! - i MODEL 3871' • ' • '14 '1 Su bmersible Effluent ' • I i I GOULDS I I i I - ! ^ 3 i TV ump pectic "tions P. METERS FEET Up io 40 zGPM' 10- MODEL: 3871 Discharge size 1V NPT„. 9 Sofids '/a maximlim`�x, Motor '+ ; '�. i.;.+ °� 25 n z Single 11 5V =' ;3 �ta V ' Materials of C �istruction - % 6 20 I Brass/thermop4stic a S:2 5 ,6 Features and Benefits o EP05 1 • Top suction eliminates ¢ 3 10 i impeller clogging. 2 S l • Corrosion resistant 5 construction. • Float actuated switch. ° 00 10 20 3° 40 50 US. GPM 0 2 4 6 8 10 12 m a I METERS FEET CAPACITY ' MODEL DVP03 Pump Specifications Features and Benefits j C 6-20 4 /10 and 1 /2 HP • EPO4 impeller- semi -open design j = 6 Up to 60 GPM mechanical seal v anes to protect 4- 1 6 Maximum head to 32' 3 10 Discharge size 1 NPT • EP05 impeller - enclosed design a 2 Solids: 3 /4 " maximum for improved performance. s 5 Motor • Rugged glass - filled thermoplastic All moto ft bll casing and base design provides ° 0 1 1 superior strength and corrosion 0 5 10 15 20 25 30 36 40 U.S.GPM bearing construction. Single phase: 115V resistance. 0 2 4 CAPACITY 6 6 10 i /hr Materials of Construction efficient heat transfer, strength Cast iron Thermoplastic and durabili ty• j 1 Stainless steel • Corrosion resistant threaded j stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. s. Safety and Buildings Division SANITARY PERMIT APPLICATION 20 W. Washington Avenue ��isconsin P O Box 7302 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 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number ,? ?y;73v Personal information you provide may be used for secondary purposes heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location �- 14 — 1 /4, S c T , N, R E (or Property Owner's M aili Address of Number ) Block Number z City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned g C ity Nearest Road /� / Public 1 or 2 Family Dwelling ❑ Village - No. of bedrooms own OF / !� YI Crr Gr r I11. BUILDING USE (If building type is public, check all that apply) � Tax Number(s) 1 ❑ Apartment/ Condo - 2�1`� 11SS 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 [XNew 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ______System ________ System_____________ Tank Only______________ Existing System ________ Existing System B) VA Sanitary Permit was previously issued. Permit Number _7 L y7 _?" d Date Issued /-2/ z Z / 47 V. TYPO OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 QSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 0 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit i.�',k S D 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 , .7 99 Feet , o Feet Ca acit VII. TANK in gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanksl Tanks Septic Tank or wTk >- --- ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /SipberrEhemtrtr 7 ❑ ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation f the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Sign atur (No amps) ARWMPRSW No.: Business Phone Number: > /27 ty I Z 1 's Address (Street, City, State, Zip de): /f elZ/C-15 � IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Ag (n Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adv erse Determination 1VI/t'f l0 19r} w6 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: ct 1V�1Np(Z,. �(Ltl/1`71DN -- A�t�E�� I�uMP Ll ANJD Ptl SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber r V iscons in SANITARY PERMIT APPLICATION 201 E w shingtongAvesion P.O. Box 7969 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 in x 11 inches in size. _S,7' L • See reverse side for instructions for completing this application State saniti Number The information you provide may be used by other government agency programs ❑ Check:t' revidiion to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location va :! 1/4, T ,N,R E (o e Property Owner's Mailing Address Lot Number Block Number >G jgo :Z City, S ate Zip Code Phone Number Subdivision Name or CSM Number Awl- II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Road ❑ Village , - le Public 1 or 2 Family Dwelling - No. of bedrooms_ Town OF t �► .� 111. BUILDING USE (If building type is public, check all that apply) parcel Tax Numher(s) 1 ❑ Apartment/ Condo I V – I 17 �O 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 [Z 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 ,�',7 / Date Issued // /� —��' V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 KSeepage Bed 21 E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 ❑ Seepage Pit 0. g 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 P 5 1 9 m Feet 3 Feet Capacity VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper- INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete st ti Steel glass Plastic App Tanks Tanks Septic Tank Welelm7 0 El ❑ ❑ 11 ❑ Lift Pump Tank /Siphon Chamber I El ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of Oe onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Sta ps) MFYMPRSW No.: Business Phone Number: T 12 Plumber's Address Street, City, State, Zip ode): Zg f +V °` D2 IX. COUNT / EPARTMENT SE ONLY ❑ Disapproved Sanitary Permit Fee (includesGroundwat D ate Issued Issuing Agent Signal ure (No Stamps) Approved � pp E] Owner Given Initial Surcharge fee) Adverse Determination / 6��� X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD4= (R f tom) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber I Y � . v 2 1 i I f , ' s .� r /p IL i s a 'C/ � ..✓o .. _� %�a. -I _r 4I / r i t it � i CD j F i t kN Wissorjsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY f' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix 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. 020 - 1020 -90 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Kernon Bast GOVT. LOT NW 1 /4NE 1/4,S14 T 29 ,N,R 19 D(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 948 LaBAr a Rd. 2 na Grass Range Addn. CITY STATE ZIP CODE PHONE NUMBER ❑CITY [ PgOWN NEAREST ROAD l:iudson, WI. 54016 ( 71P 386 -7775 Hudson I McCutcheon Rd. 1c) New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 99.13 ft (as referred to site plan benchmark) Additional design / site considerations backfill to be to code depth or use of i nfi 1 tratorG rec4»i rPd Parent material outwash Flood plain elevation, if applicable na It E S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [2S ❑U ❑S f7U ERS ❑U ❑S ®U 12S ❑U 0 2JU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxtdaly Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends ................. .................. ................. 1 0 -32 10yr2 /2 none 1 2cbk mfr gw 2f .5 .6 6 2 32 -38 10yr3 /3 none sil 2msbk mfr gw if .5 .6 Ground 3 38-122 10yr4 /6 none co s Osg ml na na .7 .8 elev. 10 ft. Depth to limiting factor +122 Remarks: Boring # 1 0 -15 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 ?` 7 2 15 -48 10yr4 /4 none sil 2msbk mfr gw if .5 .6 3 48 -12 7.5yr4/6 none co s Osg ml na na .7 i .8 Ground elev. 10 ft. Depth to limiting factor' +120" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. ew Richmond WI 54017 Signature: Date: 12 -2 -98 CST Number: m02298 i PROPERTY OWNER Kernon BAst SOIL DESCRIPTION REPORT Page 2 of 6 PARCEL I.D. # 020- 1020 -90 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Gnu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .................. .................. ................. 1 0 -38 10 r2 2 none 1 2msb mfr qw 2f .5 .6 2 38 -48 10yr3 /3 none sil lcsbk mfr gw if .2 .3 Ground 3 48-122 7.5yr4/6 none co s Osg ml na na .7 .8 elev. 10 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. — Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Kernon BAst 1554 200th Ave. CSTM2298 NW4NE4 S14- T29N -R19W New Richmond, WI 54017 MPRSW -3254 town of Hudson (715) 246 -6200 f lot #2 -Grass Range Addn. N 1 =40' BM.= top of basement walk out foundation C el. 100 Alt. BM.= top of NE lot stake C' el. 94.90' tA i 1 c0 IS r 1 �CA ^J- 6 'e y, -� 30 97 2 � e i Gary L. Steel 12i -98 i ST CROIX COUNTY SEP'T'IC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O%Vner/Buyer Mailing Address 4& -t Property Address B'A'S^ _,I)Pe Ve �� • - - (Verification required from Planning Department for new construction) City /State . s /6 Parcel Identification Number d - — 737 -20 LEGAL DESCRIPTION Property Locativni ' / +, i!/E '/ Sec. T _2f_ N -R_ZLW, Town of Subdivision � /�i/t/�F ,Lot # Certified Survey Alap # , Volume , Page # Warranty Deed # 5 7' S ,Volume .Z _, Page # 8 Spec house Cl yes no Lot lines identifiable 1 yes ❑ no SYSTEM MAI Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by 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. "e property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth , , ein as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification ta s ' that o t septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ays of ee year expirati date. SIG OF AP ICANT DATE O` CER'T'IFICATION (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 pro y described abov , by vi a of a warranty deed recorded in Register of Deeds Office. SIC, A7URE O PPLICANT 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 DOCUMENT NO W fpb.l M DEED THI c►ACE RESERVED FOR RECORD+1/0 DATA 4 ! STATE BAR OF WISCON I Rai 2 —tse2 629'745 VOL1124pa E — ST. CFA. RAY, G. BROWN and. ELEANORE- BROWN . a/k a Elinor J Brown, Ile.d io, � ................ . . - - hugb�nd 1. wi f a . ......... ....... ... ....... . .. JUN 5 1995 _ ... - ------ --- -------------- -- - - - - -- _..._ ....... ............. ....... - - -- - -- — 8t 8:00 A.'.1 ;! 1 7 . conveys and warrants to .... QQI'.�A-1,�A. -a•_. SPEER- BAST, ......- •-- - -•• -- - - -- i ............ . . ......._........... K •,. -_ L I c �8=!- I. r r_r3 _ ............................ t I ...... _ ........................ ...... •................._....._ .._- ----•--- ....._......_...._.._.. --------- I llff _... . — i for �i1.00 and other valuable cunsldera o t .... in ' "" ° "" T° ......... ......... .•- •.... -• -- -- ....................... the following described real estate in .t. �rOiX� ............. State of Wisconsin: 020 1019 -40 ! !� Tax Parcel No:. QR97 APn90 NW% of NEk of Section 14 -29 -19 EXCEPT part to Hudvorth, Inc. in !' Vol. 604, Page 226. fl NEk of NWk of Section 14 -29 -19 EXCEPT part to Thomas Wiley in Vol. 958, !� Page 577. I Subject to toFn road right- of -vay along the southerly line of said landsf� �i '1 Grantee is responsible for payment of real estate taxes for the �J + year 1994, payable in 1995, and subsequent years. + _ Pte? ,! 1 ` VI ES j This -- .._ i.S...il(1L ......... homestead property. �) (is) %is not) E Exception to warranties: I' if j Dated this ------- 19..5 .-- _..._._- •---------- ------ - -- -- day of _..- ...... ... - -- - ..... June - ...... _ ---------- - tc�•- il I I E� 00 Ln v��F�a oW m Nl2 °55�� Y' O // 0 362 80- F r y o�y `� o N ro �• I N y m Q i • m v - N H i w °y � Fp 'cgTF Ss o3 „k• 6 (7) N rr 2� Ss rr v 0 — cn ;00 22 48_52 Aid '• \ \` ?• A ,yip Fao \ I ' Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count.:T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) San' pQr ATo.: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. L 44 b t31 P Hok si�l�ige: & DONALDA SPEER —BA � fiu && illage Town of: S to Plan ID No CS T TBBM Eleev.: Insp. BM Elev.: BM Description: Parce U 0 1337-20 -0 TANK INFORMATION ELEVATION DATA A980057 TYPE MANUFACTURER CAPACITY STATION BS H FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer [ I I I 0 Holding St/ Ht Inl abO v TANK SETBACK INFORMATION St/ H tlet TANKTO P/L WELL BLDG. vent to ROAD D let Air Intake Septic NA t Bottom Dosing NA , Header/Man. Aeration Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number i GPM TDH I Lift Friction Syste TDH Ft H Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS L g DIM SETBACK SYSTEM T P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typeof CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTE Header/Manifold istribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 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: clude code discrepancies, persons present, etc.) i LOCATION: HUD, N 14.29.19,NW,NE 985 DROVER TRAIL — GRASS RANGE LOT 2 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert No. A , Safety and Buildings Division SANITARY PERMIT APPLICATION Po ashington 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 81/2 x 11 inches in size. r • See reverse side for instructions for completing this application State Sanitary v Number Personal information you provide may be used for secondary purposes ❑ Check it rewswn to p lbus application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location BN S% R �a 1 ra, S T , N, R/,? E(0110 Property Owner's Mailing Address Lot Number ., Block Number ft p 2- -- City, State Zip Code Phone Number Subdivision Name or CSM Nu 7,775 J C Aol l ry.r— PE OF BUILDING: (check one) ❑ State Owned It � Nearest Road Public 1 or 2 Family Dwelling ❑ Vil age - No. of bedrooms Town OF u aA) Ilfc III. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s) 1 ❑ Apartment/ Condo O 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. 0 New 2 E] 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) /41,44 4 A^e A�k C a 4�; t h- •tS`ICIetO ;Ad Y. Non- Pressurized Distribution Pressurized Distribution xperital Other ��- 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit ,r— 3 ; Y 5W 43 ❑ Vault Privy 14 ❑ System -In -Fill r 7kc r 4E S LS T c1 , A wy% 6rjrc. VI. ABSORPTION SYS I ORMATIOI�� Ii TV. S_ 1. Gallons Per Day 2. A tr. Area 3 6. S ste�r�� Elev. 7. Final Grade Required (sq. ft.) P tj 8 I g� >90 Elevation DO I O Feet 9 Feet VII TANK Capacity in gallo ���� Site Fiber- plastic Exper. INFORMATION C Wu� ��i Con- Steel glass App. New Existin �l structed Tanks Tanks Septic Tank r+FtJtdiTRJT3TTR Z� -- El El 1:1 1:1 1:1 Lift Pump Tank r +,� El El 13 ❑ 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility 1 l// n on the attached plans. Plumber's Name: (Print) Plumber' 4 V� Business Phone Number: Plumber's Address (Street, City, State, Zi Code): jkr 3d v IX. COUNT / DEPARTMENT USE ONL' ❑ V Disapproved Sa uing A Signature (No Stamps) Approved E] Owner Given Initial 1 V 7� av� - - -" Adverse Determination (o ' � - X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11I97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber q � Amu Am w= &a� r 0 � G �t L i � �f O y IN to y PAC t (;F I ' PUMP CHAMBER CROSS SECTIOtJ AMD SPECIFICA'f 10ki I VCMT CAP `"C.Z, VENJT PIPE WEATHERPROOF APPROVED LOCKING IN 25' =ROM DOOR, JUIJCTIOAJ BOX MANHOLE COVER rs WINDOW OR FRESH 12 "MIN. AIR INTAKE GRADE I `1" MIM. COIJDUIT IB "MIM. - - - -- _ -- 11� IAILET PROVIDE AIRTIGHT SEAL I * A ICI � I I I I ALARM B I II I I c *APPROVED I I oM . JOINTS WITH I 1� ELEV. FT. APPROVED PIPE I OFF 3' ONTO PUMP -� --� 0 SOLID SOIL COUCKETE BLOCK RISER EXIT PERMI7TED OIJLy IF TANK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI'CATIOMS OOSE TANKS MAUUFACTURER: IJUMBER OF DOSES: 2 PER DA.4 TAWK SIZE: 4.100 GALLOAIS DOSE VOLUME ALARM MAUUFACTURER: S. \ ,r='/ TieO IMCLUDING BACKFLOW: - �� 2 GALLONS MODEL IJUMBER u/ 714/Lk )FK 7' CAPACITIES: A= 71 IAICNES OR s" I^-v GALLOU5 SWITCH TYPE: !fir Z-CG1jZe1 2 $ = IUCHES OR GALLO►JS PUMP MAMUFACTURER: 4- OUe-/7S C = t� INCHES OR �-� y GALLO►.15 MODEL MUMBER: �'� ©�t D- ° INCHES OR GALLONS SWITCH TYPE: f �= t1 MOTE: PUMP AUD ALARM ARE TO BE MIMIMUM DISCHARGE RATE _ GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. FEET + MIJU " IMUM ►NETWORK SUPPLY PRESSUR , , - FEET + _ �o FEET OF FORCE MAIM X� bZ F /Ipo FIFRICTION FACTOR.. l 5 7 FEET TOTAL 09MAMIC. HEAD = t3 J 7 FEET IIJTERAIAL DIMEIJSIOMS OF TAUK: LENGTH ;WIDTH - ;LIQUID DEPTH 51GUED: LICENSE AIUMBER: DATE: • •C.2 N X i ✓ N r i C2- c R _ C ^ E : m Otl3H DIWVNAO 1tl101 a CL C5 cn m Q 21., v;. CD J 12 4 2 O / a \ lJ l I to W CZ LO co �- • • ui R R A N is cn 0 4A ot LLJ d 4lQEta�2U UA __ •_._i$ _ _ .. I O M 0 cn r a E - I W a Lu o z _ C N c` C N C _ •.L LoE a� CL E L v' o.- o � s ., l R n a � EL. -• Otl3H 3IWVNAO IVIU T Q - 1 • i W O C O ' _. W - - _ L CD > ° y n E � a, E N — cl - .. U 1 w v mo + - r fp r-- i • j t r 1} j N C.) - ��, M N N N O N O CO = CL ` Otl3H 31WVNA0 1tl1O1 a ° .. a 5 C ul J � � -- W � V 1 ` Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor and Human Relations Division o'Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY .Attach dorrplete 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. 020- 1020 -90 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT NW 1/4 N 1/4,S14 T 29 ,N,R 19 : J (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 948 LaBarge Rd. 2 na Grass Rancle Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ ®TOWN NEAREST ROAD Hudson WI. 54016 (715 386 -7775 [x] New Construction Use [ x] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate • 7 bed, gpd /ft - trench, gpd /ft Recommended infiltration surface elevation(s) 95.60 -9 —93.60 ft (as referred to site plan benchmark) Additional design / site considerations na ` ' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem FJ S❑ U 0 S 1:1 U EIS ❑ U ® S LI C3cS ❑ U I ❑ S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bou Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 1 0 -9 10 r3 3 none s i l 2msbk mfr Q1W 2f .5 .6 Ground 3 124-5n elev. 97 ft. 4 150-60 10 r4 3 n • 8 Depth to 5 60 -84 7.5 r4 6 none cos os ml na na .7 ­ 1 : . 8 limiting factor +84 Remarks: Boring # 1 0 -10 lQyr 2 10 -24 10 r4 4 none sil 2msbk mfr c1W if .5 `:.6 Ground 24 elev. I I I 96 ft. Depth to p limiting., / fact + , 9 ' 9 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 20 . Ave. New Wmond, Wj 54017 r %' Signature: Date: 4 -30 -97 CST Number: -m02298 PROPERTY OWNER Krmrnnn Rant SOIL DESCRIPTION REPORT Page 2 01 ' 3 PARCEL I.D. # 020 - 1020 -90 �. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botnd3y Roots ,GPDM in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0- Ground 3 31-53 7 elev. 99 ft. 4 53- Depth to limiting factor +88" to� Remarks: Boring # Ground — elev. 99. ft. 43 Depth to limiting factor +RR Remarks: Boring # 1 0 -10 10 r3 3 none sil 2m bk mfr 2f .5 .6 2 10 -25 1 .5 1.6 Ground 3 25 -80 7.5 r4 6 none Cos osa m1 na na .7 .8 elev. 97 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) P STEEL'S SOIL SERVICE Gary L. Steel Kernon Bast 1554 200th Ave. CSTM2298 NW4NE4 S14- T29N -R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 t lot #2 -Grass Range Addn. N 1 =40' BM.= top of SE lot stake @ el. 100' Alt. Bm.= mid -lot survey stake C el. 97.80' 590 8` 35' Gary L. Steel 4 -30 -97 I