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HomeMy WebLinkAbout020-1330-60-000 ST. CROIX COUNTY ZONING DEPARTMENT i g i , AS BUILT SANITARY REPORT Owner Addres City /State d oso „/ ` 1 ? i l�� a >' Sr � f998 , RC)/)( UN � Legal Description: f, awNGopp ole '., ` Lot Xck Subdivision/CSM # -e � e -� - - ' / <' /. Sec. , TAN -R W, Town of ��/C��J PIN # D •- SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Jai , `Ad e _s 7`e Kd Size ST/PC , D /G 5�a Setback from: House a Well S4� P/L �SLl Pump manufacturer you 1d, Model Alarm location / s m- (HOLDING TANKS ONLY) Setbacks: Service road me Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: lnOa -arc Width •2 Length eZ Number of Trenches Setback from: House _6z:2 Well -5 ', - PAL Vent to fresh air intake 147 ELEVATIONS Description of benchmark � a,5 Elevation l Description of alternate benchmark Elevation Building Sewer 7 ST/HT Inlet ?4'• -a ST Outlet PC Inlet PC Bottom /?-107- Header/Manifold Top of ST/PC Manhole Cover &-V Distribution Lines O 93, (F O ( ) Bottom of System SS ( ) ( ) Final Grade ( ) O ( ) Date of installation Z L-1 number State plan number Plumber's signature ��� License number Date Inspector IF Complete plot plan I v 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 I � F -6 p I 3 INDICATE NORTH ARROW i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y' Safety and Buildings Division Count ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarl"" Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)). Permit BURBACK , s MI�E P A eb11 1�illage [] Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Descriptjt�n: Parcel Ti2bl- ;1330- - 000 ov 1 TANK INFORMATION ELEVATION DATA A9800124 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic M4 wfA +- V ��� �} 1 Benchma k �Oa, /op Dosing dv� �c� �� 44- BA4 I q(&. Aeration A Bldg. Sewer )11S 7 Holding Inlet Z TANK SETBACK INFORMATION St /dot Outlet TANK TO P / L WELL BLDG. Ai to ROAD Dt Inlet Air Septic ( �� t yA/, NA Dt Bottom �? 3 )Z Dosing 1 ( l / , I NA Header / Man. I w-eq TV q 3 • is Ae NA Dist. Pipe 10 8 1 1' °13, 18 Bot. System (D(_ q.j q2. PUMP / SIPHON INFORMATION Final Grade wx Manufacturer G ( .15 emand (7• kk.-,k v 6p ye /60 c' •5i ° j( - /Z„ Model Number �� 3�) GPM J3 x.0°1 X01 loci TDH Lift D,� friction System �' TDHI 2t Forcemain Length t 0 Dia. ' Dist. To Well SOIL ABSORPTION SYSTEM / TRENCH Width t 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Dep DIM N I N 7 DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA t ING Manufacturer: SETBACK CHA BER INFORMATION Type Of r75 p/3i 17- ► „_� OR UNI M a N System: DISTRIBUTION SYSTEM pb�rvc Header /Manifold ) Pipe(s) 't( �r x Hole Size f1 x Hole Spacing - Yent�fo Air Intake Length ef Dia. a Length � 5 Dia. � � Spacing 30 � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over �J Ir T/TrenchEdges th Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center `� IZ" Topsoil `/� ®Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 7. ?o LOCATION: HUDSON 23.29.19,SE,NW 730 WALDROFF FARM RD — EVERGREEN LOT 6 J qLA -ii� M — 6 }{tin � Sie1 m,bave. 514b 51� � ` 1 Uker (bz,k, :PLow % . -7 I� r j� - 7 ( 1 6 Plan revisio requlr , ❑ Yes JR No Use other side for additional information. b7 , SBD -6710 (R.3/97) Date Inspe or's Sig ure e . No. Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION Po E. Washin 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 8 112 x 11 inches in size. , <?!7 <Wd ` t K • See reverse side for instructions for completing this application State Sanita Permit Number 5 07 7 -3 C==, 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 0 7 Property Owner Name Property Location 7_2F 114,xW 1i4,5 gg T ,N,R /Q' E(or)W P roperty Owner's Mailing Address Lot Number Block Number �4 S G e City, State Zip Code Phone Number Subdivision Name or CSM Number 45'C a-o.tJ ( > -G .tJ II. P BUILDING: (check one) ❑ State Owned [I C Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 5 own of l(f 144 Oyo Aic /aV III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 1 d 3 Q - /.9 30 ' G A 3• • t9 . v 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 pNew 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 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 (s ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation d 9 ?3 3 7 S Feet � d Feet VII. TANK Capacit gallon Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glaze Plastic App New Existing structed Tank Tanks ticr pC 1 4 r?4p / ; tS �v,✓ � ❑ ❑ ❑ 11 El Lift Pump Tan Q < < B ..fJ � ❑ 1 ❑ 1 ❑ I ❑ ❑ VI11. RESP 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) P MPRSW No.: Business Phone Number: i l Plumber's Address (Street, City, State, Zip Code): .:�; 'CO' IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate s Issuling gent Signature (No Stamps) A roved �urcharge Fee) pp ❑Owner Given Initial Z�` e+c5' Adverse Determination 6 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD�&W (8.11/96) DISTRIBUTION: Original to County. One copy To: Safety t Buil6ngs Division, Owner ftwill SAFETY AND BUILDINGS DIVISION 2226 Rose Street La Crosse, VIA 54603 * AA , sconsin Department of Commerce Tommy G. Thompson, Governor 24- Mar -98 William J. McCoshen, Secretary i Wegerer Soil Testing & Desig RICHARD LA CASSE 421 N Main St PO Box 74 River Falls WI 54022 LA CASSE, RICHARD Plan ID 9820463 SW,NW,23,29,19W Municipality of HUDSON Inspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): MOUND 450 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wiscogr` i Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page 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. All permits required by the state or local municipality shall be obtained prior to commencement of construction /installation /operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at theJop of this page when making an inquiry or submitting additional information. ct' t Sincerely, Gerard M. Swim POWTS Plan Reviewer ., (608) 785 -9348 .J. SAFETY AND BUILDINGS DIVISION 2226 Rose Street ySCOIN LaCrosse, Wisconsin 54603 isconsin TonwW G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary Page 2 93 2U463 - 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, prior to installation. - 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. OVA LEfTER.DOC SBD 5524 -E (R. 2/98) File Ref: H: \STANDARD PARAGRAPHS APPROVAL Page of 6 RECEIVED MOUND SYSTEM 3 1gg8 : FOR A 3 BEDROOM RESIDEN % -,[y & BLDGS. DIV. LOCATED IN THE S E 1/4 OF THE N w 1/4 OF SECTION Z3,T7 - N, R 19 W, TOWN OF COUNTY, WISCONSIN. (V -- „ S ..0 OF INDEZ PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION: PA GE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE P Q I su ' lly PREPARED FOR cort ift� �O Ov MER� _ p o f r. t� tc �nZ LA C-hS&L pRCM� j� p oNO � N GE SEE GO PREPARED BY WEGEFREFt SO I L TEST I NG AND ,�► C p P.D. BOX 74 421 K. KAIK ST. = Wt ER RIVU. FNIS. MI 54422 = o-s15 P E .LSw0R7N, in 115 -4� r-0165 JOB NO. 98 -SS Page 3 'Of Approved Synthetic Covering Distribution Pipe Medium Sand H G Topsoil F Elev. °1 Z 5:)' 3 E b y % Slope Force Main Plowed Trench of k" -2-2" From Pump Layer Aggregate Undisturbed D • O Ft. Soil E Ft. Cross Section Of A Mound System Using F �•� Ft. 1 Trench For The Absorption Area G a Ft. A S Ft. H S Ft. B Ft. I \� Ft. Linear Loading Rate= L.P GPD /LN FT J , Ft. Design Loading Rate= a.3 GPD /SQ FT K \O Ft. L q1 Ft. --�\� W Ft. L Force B - -- K Main W Distribution \- Trench Of Pipe Aggregate l Permanent J Observation Permanent pi p eS (a°chbr securely) Mound Using 11 Trench For Absorption Area ' Page Of + i o Perforated Pipe Detail 0 End View ) Perforated End Cap ` PVC Pipe . 1 . .4 Cn �' as Install permanent at end of each lateral Holes Located On Bottom. Are Equally Spaced Q End Cap P R PVC Force Main Distnoution Pipe Lost Hole Should 8e Next To End Cop Distribut Pipe Layout P 3 k,.z5 Ft. X 30 Inches Y " Inches Hole Diameter 'IV Inch Lateral t l " Inches) Manifold Inches Force Main " Z Inches # of holes /pipe k S Invert Elevation of Laterals g 3 -bo Ft. \ S X �. 1`1 _ l S S A Z-=- 3 S 1 G P t+1 Place lst hole 1S from tee with succeeding holes at 30 intervals. Last hole to be next to the end cap. Combination Sept4c; and PUMP CHAMBER CKOSS SECTIOIU .MUD SPECIFICATIoMS _ PAGE S OF b - .VEA1T CAP J WEATHER rF-OOt` Jt3ucTfofs BO j H'C.I. VENT PIPE ti APPROVED LOCKILI6 10' FROM DOOR. MANHOLE COYER wl AAwDOW OR FRESH 3 wAAtass,G LP•BEL. ALltJTAKE t ca ►Duir 6� MA -X • bvM�N, raR1! � `i� J''11A1. i Ie' Ml u. PROVIDE -- --' . I/J LET �AlRTlGHT SEAL APPROVED .]OItJT 84��5 A I I I , APPROVED J0111T: W /C.Z. PIPE OR Tank construction i f w lC. I. PIPE Pic _ ( ALARM shall comply with ILH�- (83.15 and 33.20 a 1 I I f oIJ C I 18-2-S I LLEY. FT. OFF D COUCKCTC OLOC-K 5 3" APPR -! KISCR EXIT PERMITWCD OWLy IF TAIJK M AtJUFAGTURrK HAS SUCH APPROVAL 86001N4 SEPTIC f SPECIFICATIOkJS DOSE K'll fl1�tTI�RlJ ��' '�' UUh1f5ER OF DOSES: PER DAB TA,wK MA&JUFACTU TAWK SIZC lOpO 1 6S O GALLOAIS DOSE VOLUME Z ALARM MANUFACTURER: S,r �- � SAS S IMCLUDI BACKFLOW: S3 GALLOMS MODEL tJUM9ER: ��� ��W OPACITIES: A= I INCHCSOR 306 GALLONS SWITCH TAPE: 1`� `UU� -1 S= Z IIVCHES`OR _ GA LLONS PUMP MANUFACTURER: Gov \-.z S C= 9 INCHES OR � GALLONS MODEL IJUMBEIC D- 9 INCHES OR ZS 3 GALLONS SWITCH TOPE: �7' IJDTE: PUMP AND ALARM AR TO 5L MIu1MUM DISCKARGE RATE 3 5 ' , (;PM I OW SEP CIRCUITS yERTICAL DIFFEILENCE DETWLEU PUMP Off AIJO "DISTRIBUT(O PIP E.. FEET + mimIMUM METWORK SUPPLY PRESSURE , .. 2.51a FILET 10 5 F EET OF FORCE MMIJ X 2r�q3 F ooft.FRICT FACTOR -- I' SS FEET TOTAL O!JIJAMIC HEAD — V 34 FEET Pump chamber DIAMETER 35. . IUTERLIAL DIIALUSIOLIf OF TALIK: LEAIGTH — ;WIDTH DEPTH BOTTOM AREA -- 231= GAL /INCH AS PER MANUFACTURER - \ - GAL /INCH • Goulds �. Submersible Effluent Pump C� t EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and du'rabili'ty. following uses: • Effluent systems dry without damage to heat transfer. ■ MMor Cover. Thermoplas- • Homes components. Available for automatic and tic cover with integral handle Motor: and float switch attachment • Farms manual operation. Automatic Points. • EPO4 Single phase: 0.4 HP • Heavy duty sump models include Mechanical •Water transfer 115 or 230 , 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Water transfer RPM, built in overload with rated oil and water resistant. g automatic reset. preset at the factory. Bearings: Upper and lower RP M, SPECIFICATIONS • EP05 Single phase: , FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RP 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 • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal rotection. • Total heads: up to 24 feet. with three prong grounding P SP• CatladianstandaNsAssociation ■ EP05 Impeller: Thermo- • Discharge size: 1 I NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 1613 SJTW with plastic enclosed design for end in "F' or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. 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 • Capable of running dry without damage go s 30 components. Pump: EP05 8 • Solids handling capability: o 25 Y4" maximum. w • Capacities: up to 60 GPM. o s 20 • Total heads: up to 31 feet. 2 711 • Discharge size: 1W NPT. z 5 — - -- • Mechanical seal: carbon- 0 15 rotary/ceramic- stationary, Q 4 BUNA -N elastomers. o • Temperature: 3 10 i 3 104 °F (40 continuous 140°F (WC) intermittent. 2 5 t 0- 00 10 20 30 40 50 GPM - 0 2 4 6 8 -r )0 ;: 12 n*h CAPACITY O 1995 Goulds Pumps, hoc EtlecM May. 1995 83871 wlsconsin Department of industry, SOIL AND SITE EVALUATION ! 3 Labor and Human Relations par_ d Division of safety and Bundbgs In accotdance with s. ILHR 83.09, Us. Atiaoh complete sne plan on paper not less Oran s 112 x 11 kwhes in size. Plan must Cou nt' Include, but not "ad b: vertical and horzonlal reference poled (13M), direction and ST C RO I X percent slope, scale or dimensions, north arrow, end location and distance to neeresl road. Parcel 0 QL- AJbIA3 (�.. APPLICANT INFORMATION - P/else print ell lnformeflon, nevtewed by Date Persona' WwmMbn you MAde may be used br secondary rK poses (Advocy Law, s. 1504 (1) (m)). PFMmry Owner _ k (4 L)A ' ' rl,S`, Propery Location (fly //QV GA-,VP L sow. Lot .S/.J ` i /4 .3 Z 3 T 2 ,N,R ! / E Property Owner's airing Address Lot A I blocks Subd. Name or CSMif 3 k Sr • 37_ Nipje ' _ �' (o 4CvERG- .PF�•v EST ES City Slate zip Code Phone Number Nearest now 10 a s'r Pt4uL NIA.Iz1 55101 (�1z )tut 5555 Ovmage To� ems /t'e�l-y Ott} .' New Constnrction Use nasMennal /Number of bedrooms 3 - q Addition to exlstkp Mrpdkrg ❑ neplecemenl ySv - El rm Public or conerelM - Descrtbe: Code derived deny Now (O O D td Reemwnended design badkrg rate L bbW. gpd* _ ' -5 herrch gpollz Absorption eras required S b D Gad. d •std tre fl 2 Maximum design loading tale _ -,.L — bed. gpd* • S Wench. gpW Recommended InMttallaa surface elevations) SEE P1 ' 3 11 (as referred to bile plan benchmark) Additional deslgn/sne atlons TES S /TE /.PFS TV " j T V P`` S YST• Patent material 56S 8 woT T S f r rA /o--L'!s • Flood plain elevation If oppncaMe A' 1 f_ A r u Suftme for system Convenllonal f b� In- around Pressure AT-Grad System In FR Hddkkg Tank . Unsullable for system p S Cf Ch 0 u p s Bi ❑ s Ir u ❑ S [ ❑ S SOIL DESCRIPTION REPORT goring Il tiorzon Depth Dominant Color Mother Textur Structure Conslatence Baedery Roots �' M. Munson Ou. St. CoM. Color Or. Sr. Sh. Bed , Trendr / 0,•3 ioyR 3/3 10-4 , e�' 3 � /* s c .�; 0 - /o e Depth to — nmtnng . factor Remarks: Boring A 1__ -1 /o Ye 3 /z 4 11 lens s . 3 Ground �y-n. n e 3-0--in. nemarks: , CST Name (Please Print) Signature Telephone No ROBERT z(L(3Rcr_(4r— VA 7c.6 71,E 3 P4 - Pigs Address bate CST Nutrber tea 2- //� (i CST Z- yd�� Private Sewage Cons ante 855 O'Nep Rd. Hudson, Mlis. 540% r,, ( 0 ) PY PROM I V UWIJkN SOIL DESCRIPTION REPORT ? ' 01 3 / PARCEL I.D.! L �' Cp — Co l. ES"T -1'I • F S Page i I Boring N Horizon Depth Dominant Color Mottles Structure y in, Munsell Ou. St. Cont. Color Texture Conslslence Boundary Root Dr. St. Sh. Bed , Trench i 0-13 / 0 yR 3 1 /f Sh,E' ft C L 3- n o R 3/ ^---- / Y Y SG /�'S u Ground _.Zir? _ .toy. -3 2 -3 a S O. A0 QR. tJ c z c? S /CL Depth to tmlling lector - 3y__ln. Remarks: Boring / Ground slay. ' Depth to , Nmiling factor ' _._)n. Remarks: Horizon Depth Dominanl Color Mottles Structure In. MunseN Ou. Sz. Cont. Color Texture Conslslence Boundary Roots Boring S Gr. St. Sh' Bed , Trench Ground ploy. - - _._n. Dept, to tmlling factor , n. — � I Remarks: Boring p around elev. - - ,II. Depth to 11mlling factor _In. Remarks: ' SCOW 8330 (R. o&vs) r Y Wisconsin Department of Industry SOIL AND SITE EVALUATION j 3 Ldbor and Human Relations Page of Divislon of Safety and Buildings in accordan ce with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference int BM direction ST G /� °/ x po ( ), action and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. N PE�VD /iJ r!r- -• APPLICANT INFORMATION - Please print all Information. Reviewed by Date Personal Information you provide may used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location q VAf13 1, 0 1-4 ,vp 49 Govt Lot SW 114AU 11 23 T 2- 7 ,N,R / / E (or )(0 Property Owner's Mailing Address E $ Lot N Bloc$ CSMN L Subd. Name or 33 Z N i N,u esorh- S-r "'� C,-- . Co g 1/E RCriPEt �v 6 75 7 - City State Zip Code Phone Number Nearest Road //1V /1 Y. - IT PAUL NINA 5slo1 (CoIZ)22Z - SSss D +� Ovinage To� e�,i( k�-uY 1z7� New Construction Use: Residential / Number of bedrooms 3 - Addition to existing building ❑ Replacement ySo ❑ Public or commercial - Describe: - Code derived daily flow (D 0 0 gpd Recommended design loading rate • - bed, gpolft • S trench, gpdfif Absorption area required TA Q bed, ft 2 S� trench, it , S Maximum design loading rate bed, gpd/tlz trench, gpd/f1z Recommended infiltration surface elevation(s) $EE ft (as referred to site plan benchmark) Additional design /site con atlons TES ]- S/� /PFf� y /ip�s' /90LAA1 L T I /PeF - 5 Y r7 Parent material 5 0 8 l�/ Mo T S A 1-7 101( . Flood plain elevation, 0 applicable S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system D s p'U Ej s❑ u ❑ S Chi ❑ s B ❑ s p ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color MoRles Structure GPD1W In. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench z /o y/z Ground 3 )LO-3v loyA G S Z * S C . 7 elev. Depth to limiting factor 5—In. Remarks: Boring # - •I S /0 YR �✓/ z LDA 1��56 f' / �`` y ; . S loy l e Ground elev. Depth to limiting factor 3-0—In. Remarks: CST Name (Please Print) Signature Telephone No. R0 13ER - r '2AL6 2i C1(tT' 7 /,r 396- RIA - Address Date CST Number fates �2 - -/1� �o CST Z yeZ-- Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINA PROPERTY OWNER SOIL DESCRIPTION REPORT Page `�" ' Of 3 PARCEL I.D.# L r '- �( ��► �/l.O.?.b. E S j �! �� $ Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 .. 0 -13 lo 3 I / fe C s / , Y ; ,S L 13 • zs /o R V _--- -- 5L 1 1 56 Ground -3 ZS - 6 5 O, S , pp elev. et it � '" • 7 7. Syr Depth to limiting factor Remarks: Boring # L Ground elev. tt. , Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. tt. , Depth to limiting ; factor I " Remarks: Boring # Ground elev. F4- Depth to limiting factor , i " . Remarks: SBDW -8330 (R. 08/95) r UR 77 . � G b � o r �a o o � . w � l � � o 6� o � n c � � L �I Q I O P) 1° • v R � 0 - rlS �' XC It ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �, '��_Om- Mailing � Address /1 . �- 4a Property Address X30 U �a V m (Verification required from Planning Department for new construction) City/State dU j6&- ;, Lor Parcel Identification Number LEGAL DESCRIPTION Property Location 6 0 1 /4, N10 1 / Sec. Z3 , T ZS N -R!I W, Town of f4t,l6 Subdivision _ifd e y , 6 v t-r� �5 a�6 , Lot # 6 Certified Survey Map # . Volume 10 , Page # a S 07 Warranty Deed # , Volume . Page # Spec house ❑ yes M Lot lines identifiable ff yes ❑ 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 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. The 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less 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 days of a three year expiration date. 7 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 the property describedaove, b virtue of a warranty deed recorded in Register of Deeds Office. J " - Z , J i 7l 9 S ilbNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed WARRANTY DEED Document Number RE =R'S OFFICE ST. v' wl Return Address s Ord r a APR 2 3 1998 YIN d r �.xYtix:k.. °S� asa�. of Deeds Parcel I.D. Number: 020 - 1330 -60 Richard W. LaCasse and Grace J. LaCasse husband and wife conveys and warrants to Michael J. Burback and Sherri A. Burback, husband and wife, the following described real estate in St. Croix County, State of Wisconsin: Lot 6, Evergreen Estates in the Town of Hudson, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of April, 1998. ('Z — J,4 � SE ) \C' (SEAL) Richard W. LaCasse ra J. LaCasse ACKNOWLEDGMENT STATE OF WISCONSIN ) 1'RS' COUNTY ) FE Personally came before me this day of April, 1998, the above named Richard W. LaCasse and Grace J. LaCasse, husband and wife, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. ROGER D. nrw" Notary Public WI My commission expires AT° OF i � =OkW THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 I VERGREEN E PATES VWI /4 AND THE SEI /4 OF THE NWI/ '; =pF SECTION 23, T29N, R19W, TOWN OF RICfION clads met, pdnenor. Beer eor liaotee, eor other perioa dill ho p.d. Itghedy •12�, a ehery ad the plat; It being 141"slp p Iiod for the bedetit Of the public eccordiog to tectics the Inperwat of Tredeportetion. LOT C €RTIFIED .URVEY MAP I DE LIRED Su NOI.31'o2eWl IN VOL. 3 �`Pa. 622 I SOI.31 -02`E IN VOL. IQ, 19.22' 14. U.S HIGHWAY 11 12 ° _�— N89 0 262.36' ' N89.52'42`W 660.00' _ TO PUBLIC N89.52'42 "w 1371.61' THE 397.23' 384.6 413.16' r PONDING Eq SEMENT I O O NWL 933.3 'I\ O_ ..__._ . ___ _._ . \ ............... ...................:........... ............... .... ...... ...............:......................................... 1 LOT 3 s LOT 4 ti3 LOT 5 (THI. (THLI „"� ✓' 3,20 ACRES 3.01 ACRES C, ^ 3.01 ACRES 139,293 SO. FT. 131,116 SO. FT. I 131,116 SO FT. X6 9 .......... .. ... ..... 5 6 0 0 9' i - ' .......,.I ........, 230.90' L , 10 N ° 12'00 "W .___~20 5 / TO 4 36.93' . 364. 12 . 00 "E 1 24.11' 458.93' LOT 6 © H F - 237 .07'__ M \ 3.06 ACRES ' _ ..... ... .... 37.'3 ` '., 1 3 3, 10 3 SO. FT. 1 14 LOT 13 :\ 593° 21' 41 'W 5 LOT 12 : \ 400.56 FT. 2.10 ACRES n + 91,476 50. FT. 2,11 ACRES A �\ p N 92,114 SO.. FT. o n ' \ � LOT 7 n 7 2.50 ACRES \ 0 a 12 (0e.898 50. FT. M10 4 241.23' 239.30' y S89 °46'06 "E 480.53' 4 • 6 Ie > 09 0 0 4B3 Oa, -P P 6 A� LOT II m 0 /' �� LOT 8 D 2. 14 ACRES b ry' 2.50 ACRES + I g N 93,212 SO. FT. 3 0• '4 b 108,898 SO. 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