Loading...
HomeMy WebLinkAbout002-1053-40-000St. Croix County Planning and Zoning Tuesday, July 03,2007at11:zS:16AM Page I of I Detail Sanitary Information Computer 0: 002-1053-40-000 Sub/Plat: 40 acres Section 22 Parcel #: 22.29.16.331 Lot: TNIRNG: T29N R16W Municipality: Baldwin, Town of CSM: 114 1/4: SE 114 SW 114 owner: Erickson, Leonard 2442 801h Avenue Woodville, WI 54028 State Permit: 218925 Issued: 0710611994 POWTS Dispersal: Mound County Permit: 0 Installed: 10/12/1994 POWTS Detail: NA POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Mary Jenkins Yes Stang, Joe Jim Thompson /1 Yes Maintenance Scheduled Pump Date Pumped 1st Notification 10/12/1997 5/10/2006 04/20/2006 5/10/2009 Other Requirements 2nd Notification 3rd Notification Permit: Replacement Bedrooms: 3 WI Fund: yes Additional Notes owner awarded $2612.84 by WI tuna records Money Owed $0.00 h STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L e on /A±<j L-!? @ /[ t a ri ADDRESS . [-/ L-/ 2 L AVk l,/edd 'Ile, li,'c SUBDIVISION / CSMJ I LOT 0 SECTION Tri iN-R__L(`W, Town of a4 ! w It ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Flo "se' J ya" �vk u O I I INDICATE N TH ARRO Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK. I �11 r ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well S y House / i Other Pump: Manufacturer Z , //C&p Model#_ Size Float seperation 6 �Z Gal.lons/cycle: /? Alarm Locat SOIL ABSORPTION SYSTEM Width: S Length 7 Sl Number of trenches Distance & Direction to nearest prop. line: 2 5 Setback from: well: R U House 2 / V Other ELEVATIONS Building Sewer �� ST Inlet. / �• S�z ST outlet PC inlet l gL� PC bottom S� Pump Off Header/Manifold Bottom of system 3 Existing Grade �5, Final grade e,— DATE OF INSTALLATI7,t-,-ft74, r PLUMBER ON JOB: ,,, , LICENSE NUMBER: P INSPECTOR: 3/93:jt wiscpnsin Department of Industry, PRIVATE SEWAGE SYSTEM county: ST. CROZX Labor and Human Relations INSPECTION REPORT sidety andtu,ldmgs Division Sanitary Permit No.: ���� �cLtcowt rwCnRMeTIAN (ATTACH TO PERMIT) -117 City ❑ Vi age Town o : [Pa te P an PerEr2LHQ � meLEONARD O lilC ce Tax C T BM E ev.: r Insp. BM E ev.:�,BM Description: 0 / Od . Ca l 'a TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' Dosing Aeratio Holdinq T,&MW IkETRACK INFORMATION TANK TO P/ L vent to WELL BLDG. Au Intake ROAD Septic s0' S5 ) n¢} NA Dosing >56 Aerati NA Holding --- PUMP /$WR"FORMATIUN Manufacturers D er Model Number .� 5,3 'TDH Lift a I FrictionC S to Forcemain Length � Dia. , Dist./67� ELEVATION DATA STATION BS HI Benchmark r - 1 i 4% Bldg. Sewer St/,Ht Inlet St Outlet Dt Inlet Dt Bottom Dist. Pipe Bot. System Final Grade SOIL ABSORPTION SYSTEM BED !TRENCH width 5 ' Lengt_ r No. Of Trenches PIT I SYSTEM TO P / L BLDG WELL LAKE / ST M ). 01 Pits Inside Dia. LEACHING as SETBACK CHAMBER a Numcer: INFORMATION YPe d System: i o DISTRIBUTION SYSTEM x Hoes7:e x HoeSpacing Vent ToAhlnta e ani o Distn ution Pipe s ,/� length _ Di Length_ Dia L Spaang SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only =I/Z#e4ER=tL.Uges xx Depth Of xx Seeded/5odded xx Mulched Depth Over /� s No E Y []No Bed / nter B /v Topsoil ❑ COMMENTS: (Include code discrepancies, persons present, etc.)* / 17 LOCATION: BALDWIN 22.29.16.328B,SE,SW BOTH ( QO�'/9v97�f� fir. /`w�/a,z Plan revision required? ❑ Yes L� ryv �� a Use other side for additional information. Cent No SBD-6710(R 05/91) Date Inspector's Signatur ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �1 CAUIITAQV 011=112BAIT ADDI IrATInN ��■ V.COONr�In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ,��9� S 8% x 11 inches in size. Check if revis to previous application -See reverse side for instructions for completing this application. STATEPLANI.D'./NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER l{Sc PROPERTY LOCATION Ser%.SW'4,S 22 T 2Q,N,R E or W PROPERTY OWN R'S MAILING ADDRESS LOT# BLOCK # CITY. STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY ? / NEAREST RkAD If. TYPE OF BUIL ING: (Check one) ❑ State Owned VILLAGE: 4 a�w � (� t ❑ Public ❑ 1 or 2 Fam. Dwelling,# of bedrooms 3 PARCEL1 I III. BUILDING USE: (If building type is public, check all that apply) U r 2 _ F d — O G O 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. ❑ 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 # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 El seepage Bed 21 L0 Mound 30 El Specify Type 41 ❑Holding Tank 12 ❑ Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER 72. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 16. SYSTEM ELEV. 17. FINAL GRADE REQUIRED (sq. ft.) PROPOSED ( . ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION tj / 5-4;31 5 3'-)S� i'3 I q �f Feet C157 4 Feet VII. TANK INFORMATION CAPACITY in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- Steel Fiber- glass Plastic Exp. App. New Tanks Tanks strutted Septic Tank or HoldingTank 100VI 1 ,1 Lift Pump Tank/Siphon Chamber ✓ SZ t - Pr Fj 1-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' ignalur mps) PRSW No.: Business Phone Number: JC t; SL C, n L Plumber's Address (Street. Cftslillate. Zip I ): 7 L L k/. g& � 0i WC.v v� ��e � S f �( e Z_ IX. COUNTY/DEPARTMENT USE ONLY Approved Dapproved jHow,ner Given Initial Sanitary Permit Fee (Includes rFuunndwater �j ij y� QAdverse DateIssuedGf lasuino Agent Signstur Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buiidmgs urvision, Uwner, riumoer W INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5 Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served, B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump d performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; anF) ail sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11188) PLOT PLAN Page 3 of 3 SCALE O"Jv�% m. L"VCitD Cit l ucSON p � p ..w, oOL IOS3- Oc X. wc+v- ��. �o tuoT COMPh4-T- OR Ott sNy \r D1sry 3 T1tls hRCA ly N o p 6tuc9 s F" m �ra�rcR.ersT`_ �I1tit OF 9o_ryc. PMtCtc�t> a o. ►ni To I 2 %4 p T►F ST. 9-80`* Hue. _ v_M - eL. wo-o" ON NA "I%b" I iy Y",,. Svc smpw w/1-g1w a 4v_ 133 (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # SAFETY • BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations JIIII, ^R, 199.1 WEGF.RER SOIL TESTING PO 74 RIVER FALLS WI 54022 RE: PLAN S94-40633 ERICKSON, LEONARD SE,SW,22,29,16W TOWN OF BALDWIN MOUND SYSTEM 2226 Rose Street La Crosse WI 54603 FEE RECEIVED: COUNTY OF ST CROIX The Department has reviewed the above -referenced submittal. 180.00 Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, dof ard Swi■ Plan Reviewer Section of Private Sewage (608) 785-9348 4517R/ 1 80D4= 411.61AU �1 2 REMNEO Jul 5 im S T CRax COUNTY MNINGOFFICE ', Page I of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE S94-4O633 LOCATED IN THE S1? 1/4 OF THE SVJ 1/4 OF SECTION ZZ,T29 N, R 16 W, TOWN OF p1ti. n1^juJ , ST. C�2c1 p( COUNTY, WISCONSIN. INDEX PAGE 1'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION: PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CRAM3ER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR �RLGra.SOn7— z. y Y Z 90 `M F}v e- W�OViL�.C, WI 5qDZ$ WEC3EFtEF2 3C3 I L . TEST I NO AND . DES = (Sr4 SEFZV I CE P.O. 30174 421 M. IW1N ST. RIVER FMIS. V1 UM 715-4254165 JON 2 2'994 S %Fgy & BU)GS. W 4-439t/ JOB NO. q 4 - 13 3 PLOT PLAN Page 2 of Scale 1"= yo ' S y 4= 4063 3 I ,, wC.L 9 @DRM Sp. I >z�Iee��r S o a O. 4 M i iM . . 24O 'r* ST. own. - l �on>�8 D tM1 cLe30N V.X%+moo. 0ot_Ios3_eo PRIVATE SEWAGE SYSTEM Conditionally APPROVED oER. OF p10I1f71M�. Lno i HUMAN Rrauno" DIVNiM W &*M 6WLOINNS ` EE SpONDrVCE tiN.�O. qt ,�ti D1sTv�$ `�T►/S hltM e c� Vr A,• \ �s.Z\ez.s99 S p�G \o 6tu�44 � F�rlp • Cr.��T'_ Lp►�t OF 90 �. PMI.cIcTt.> AEL.toc.o' or., ��°HIsq,3/y•AIr,- �?vC FIPW w/c RTH 9-_ 80T* mue. _ NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted.. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be ZOoO gallon capacity manufactured by %A I n 4 I ►rt��l a 121� AAA. Uv C. - �vM P %Tftjh 'ro B� � I D►�E3 T>z R� � S 0 �+M • i� 5. 6. Divert surface water around mound to prevent ponding at the uphill side. Approved Synthetic Covering 894-40633 Page 3 Of i Medium Sand As &A a L.rra 6 s. t a(a,Xb) . Topsoil —� \D % Slope Trench of ',"-2k" Aggregate (undisturbed Soil Distribution Pipe F D u Force Main From Pump Cross Section Of A Mound System Using I Trench For The Absorption Area A 5 Ft. B 7 S Ft. I \ S Ft. Linear Loading Rate= 6.0 GPD/LN FT J -- Ft. Design Loading Rate= o.3 GPD/SQ FT K ► 1 Ft. L c1�1�— Ft. Position of Force Main —�_I W �_ Ft. r L G ._ Elev. 014.0 Plowed Layer D \.b Ft. E Ft. F Ft. G N a Ft. H )• S Ft. J� Free' K IGf01�' _--------_--_— - W — - - - - - - " Trench Of - 2 z - Distribution 2 Pipe Aggregate Permanent J 'Observation Markers (JWn es ssecurely) . , c SWAGE SYSTEM Conditional Y APPROVED s Wium paY" Mound Using I TUMp OF _ roll"n," SEE Page a Of End Perforated Pipe Detoll n End View 'erforoted / 'VC Pipe S94m4O633 Install permanent marker at end of each lateral Holes Located on Bottom. Are Equally Spaced Q End Cap p;�i'v ATE SEWAGE SYSTEM Conditionally OVED + � PVC Farce Abn �ppFl HUMAN RELAMW pm, OF fN NIA WILDINGE DislrttMion ` Pipe Lost Hole Should Be ESPONDENCE Next To End Cop E C Distribution Pipe Layout P 3�{. S Ft. X 3b Inches Y 36 Inches Hole Diameter JLV Inch Lateral I ILY Inches) Manifold — Inches Force Main " 2 Inches # of holes/pipe 1Z Invert Elevation of Laterals "NSO Ft. Place lst hole 1B4from tee with succeeding holes at 3 6V intervals. Last hole to be next to the end cap. • PUMP CHAMBER CRO55 SECTION ARID SPECIFICATIONSPAGE S OF to VENT CAP s94,,40600 ti C.I. VENT PIPE fr WEATHER PROOF 7 APPROVED LCICKING MANHOLE JUNCTION BOX COVER WITH WARNING LABEL � 10' FROM DOOR, IL•MIU. WINDOW OR FRESH AIR INTAKE I GRADE I Y• MIN �L gt4f I I � IB'nlu. CONDUIT------------ I6"MIN. `� \---------- s�(SOVIDE I ----- INLCT � r •,.Tt: SE�JAC'E 1�TIGHT SEAL f �y� 1Y I V APPROVED JONT/ A Tar filtiWActio 1 comply I III APPROVED JOINTS with approved wi H 8 HR 83.20 I III pipe extending If ALARM vt 3 feet onto B1 mop g N�tNpb ` I solid soil. , I, D I I ow Both sides of 0 OF IK�s�pF tank. per' ptV151 LLC1C 89•ZS FT. PONO�'v PUMPS --� OFF ID SEA ' COMCRETE CLOCK I 3" APPRovEp RISER EXIT PERMITTED ONLY IF TAWK MANUFACTURER HAS 5UCH APPROVAL I UDDIµ4 SPEC.IFICATICIMS DOSE K PR. rST MANUFACTURER: MRER 3 8 NUMBER OF DOSES: PER D" NUMBER TANK bIZE: -)so GALLONS DOSE VOLUME r \Z6. ALARM MAWFACTURER: S•5. QL.I?C.`= S`f5T>�tS INCLUDING BACKFLOW: GALLONS MODEL NUMBER: NW CAPACITIES: A= wcHE50R 331 S GALLOWS SWITCH TYPE: "e_zc-uV_Y B = Z INCHES OR 39- O G(LLOUS PUMP MANUFACTURER: �S't'� C0)"l1E'(T1u'"( C■ %/17-IWCHESOR 2-6'46 GALLONS S3 \S z IZ.SGALLOUS MODEL NUMBER. Du OR INCH�ES� SWITCH TYPE. 1`n `31ZCUR Lf MOTE: PUMP AND ALARM ARE TO DE Z C93 INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE _GPIA VERTICAL DIFFERENCE BETWEEN PUMP OFF AND_DISTRIBUTIOM PIPE.. 5' ZS FEET t MINIMUM NETWORK SUPPLY PRESSURE .. . . . .. 2.50 FEET •+- ZS FEET OF FORCE MAIN X L'6\ FYoFtFRICTIO1.l FACTOR. 2•42 FEET TOTAL DYNAMIC HEAD = e ' 1S FEET DIAMETER — INTERNAL DIMENSION OF TANK: LENGTH ;WIDTH _ iLIQUID DEPTH AO BOTTOM AREA — 231= GAL/INCH AS PER MANUFACTURER = 19.5 GAL/INCH _ ° W W in LL 2 W Q 6 20 LU U_ 15 a Z 4 0 J 10 H O ~ 2 0 6 US GALLONS LITERS 0 HEAD CAPACITY CURVE "53-55" SERIES TOTAL DYNAMIC HEAD/ FLOW PER MINUTE EFFLUENT AND DEWATERING HEAD CAPACITY UNITS/MIN FEET ETERs GAL LTRS 5 1.52 43 163 10 3.05 34 129 15 4.57 19 72 19.25 5.87 0 0 ZS.ob I 10 20 30 40 T 80 1 FLOW PER MINUTE pf,�GIP 6 or- 6 I S94 40633 CONSULT FACTORY FOR SPECIAL APPLICATIONS is Piggyback Mercury Float Switches • Available with special cord lengths of 15', available. 25'. 35' and 50'. is Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non -automatic 15 ft. MVW55 SERIES Control Sidecdon Modal Vohs -Ph Mods Amps SknDIOX Duolex M53155 115 1 Auto 8.0 1 or 1 S.7 — N53/% 115 1 Non 8.0 2 or 2 3 6 3 or 4# 5 D63M 230 1 Auto 4.0 1 or 1 S 7 — E53/55 230 1 Non 4.0 2 or 2 a 8 3 or 4 8 5 53 Series - WL 23 lbs. -.3 H.P. 55 Series -Wt. 25 lbs. -.3 H.P. 11h - 111h NPT SELECTION GUIDE I. Integral float operaaad rlwUanical switch. no adiw" control ra0uifed. 2. Single Piggyback Wcaangla lnarcurytklal 0w4teh"doubleftilybul<lnamuryfloat snitch_ Refer to FM04T7. 3 Mechanical anernow 10-0072 or 10-OOM 4. See F W 712 for correct model of Bactrfetl ANwndw,'E4'ak - fi. SWak r der c iry Oort twitch 10-0225 uaad as acontmlat dWdr. wMt E4'ok M W (41 Goat ayaMm. 5. Four M ho%.j4 . heatbn bo, for wdwtlgm corafection or Wre64n simplex or duplex opers"M PM 104x12. T. Two (2) hoi,-J4%r. Jwlelbn WK.Icr watenight corxncWn or 8OiCe, PM 10-OM For kdo nytlon m IddtlaW Z061Wpioducy rowto atatd0 on CombirUtbn SwUr. FMMI4: CAUTION Piggyback Mwcury Float Bapehes.FM0/T7, EWMIt:il AWnWor, FM04M Mechanical Ahem,- All Inataeatfon of Controls.prulecilon rNyl,",ndwiring Mould be done by er♦ualmed radd r. FM04W Alarm Package. FM051; alwp/Sarage 9aalm. FM0457: and Simplex control Iloonsed eloctrlclan. AN electrical and "lely codes ahotad be tollewed In W dltlon to the Sm FMU732. most ncwrt National Electric Code (NEC) end Ile Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL TO: P.O. BOX 16347 Louhv0e, KY40256-awl Manufacturers of ... OfLLfi'P O. Loufs .KY40216 w ® (502) 770-2721 e 1 (epo) 9284WP QruLlrr PavPS SAcE /91F.9 FAX (MV774,W4 •, wriconsinDeparwentolIndus". SOIL AND SITE EVALUATION REPORT I..Mr and Human Relations Page of Division of baTsW a Isw"FVs in ac cora wnn ILMrt w.Uo, rvia. r+ul ll. wup TY ST. CCio lJC Attach complete site plan on paper not less than 8 12 x 11 inches in size. Plan must include, but . anot limited to vertical and horizontal reference pant (BM), direction and %of slope, scale or FPARCELLD p0 Z- LO S3 - 0dimensioned, north arrow, and location and distance to nearest road. DATE WED BY APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION • SLr 1/4 SW 1/4,S2Z T Z9 ,N,R )6 E(Q LN,1:0►3MM> IEM(Ckr SOti PROPERTY OWNER'S MAILING ADDRESS LOT tt BLOCK # SUBD. NAME OR CSM Z. 7 80 `� R� • CITY, STATE ZIP CODE PHONE NUMBER I NEAREST ROAD ❑CrrY QV LLAGE ®TOWN �30 PNE:. wooOv� wl S\jrW6 (-IIS1648- zb31 OPc�- tN l 1 New Construction Use QQ Residential / Number of bedrooms 3 I I Addikn to e):isting building pd Replacement l I Pudic or comneraal describe code derived daffy lbw y SO gpd Reomnended design bading rate bed, gpolR2 0.3. trench, gpdrtt2 Adsorption area required Y) S bed tt2 3-1 S tenCh, 112 Maldmm design baring rate o'S bed, gpdIRZ o L trench FW Recommended infiltration surface elevations) cl q . O R (as referred 10 She plan benchmark) Addilionel design / sib oaaiderelm 1-\W "JO W % S K i S' �iSZ@+C S hAjb Parent material W Asa o'j vtt S)t -n plain elevation, R applicable tom. fi - R S a Suit" for System CONVB4r1oNAl ❑S 0U MOUND IKS❑U 11N.& IND PRESSURE ❑ S OU ATGRADE ❑ S ®U SYSTBYt N PLL ❑ S ® U =SWJT U- Unsuitable for Boring # 113 Ground elev. q1.2 It. b inviting tads y5,` nwu ne&n01D1r11%a1 DFDnRT Horizon Depth in. Dominant Color Munsell v mom Cu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Cortsistertoe Bou<t�r)' Roots GPD/ft Bed tt3rtdu 0_8 1o"llZ 3/3 sil Z. Sb\-t V^i�_ 2, 8-ty \oKR 3Ib - si1 5)tik �- cg - o•S o.L 45-S\f 3/y 1.9�1R S115 s o '^ ll" 0-w Ow% J bring# 1 Z►,Sb1� rn E4 CS Z Z I t%v•c VA f} CLu o. s o. 3 ly-1B i.Stitt *I/y — alll lcsb�t u�� CS — o.y o.S _ elev Z8-$O 10` tR sly -t.S�t¢ s lib- 17 — 17711 1 Sp-l� �•S yR YA' — S o S c mtbono - - b linniti"g Ileft `3 rl" w. 715-425-0165 Ar� hur L. We erer Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Date: CST Number: Qy-t33 6-)3-`3� M0057 PROPERTY OWNER —CM LC -Yu SOry SOIL DESCRIPTION REPORT Page Z o6 73 PARCELI.D.ar t�)OZ.- 1053-&0 Ground elev. 7.0 ft. Depth to limiting factor Z-1 ' Ground elev. ft Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. CortL Odor Texture Structure Gr. Sz. Sh. Consistence Roots GPD/ft Bed rerrh C; Io`1p 3/3ZmSb>z 1_n`Fti CS - p,$ 0-6 Vl s )1 Z'F S)orL whit- tS - o. s o.l. Z-)_69 lo`1r2 v/ �.s�cR 3jy f S`1%?- v — � n-S 7R s/fb s 1 alscl 1 csbtir ©' ` wkk.. *, �h - _ — o.s , nemarKs: nemarKs: Boring # 1-3- Ground elev. ft. Depth to limiting factor Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: _ SBD-8330(R.05i92) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE j , PROPERTY LOCATION `✓ 114,1�c� 1/4, Section .n 2 T sZ N-R��W TOWN OF 1 it: A'_, ST. CROIX COUNTY, WI SUBDIVISION ✓f/ ft 1 , LOT NUMBER ,t CERTIFIED SURVEY MAP , VOLUME_, PAGE , LOT NUM 3ER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: --- DATE: St. Croix County "Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC-100 'this application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec Douse), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------ i owner of property Q ,v;.a Location of property cr- 1/4 >_ 1/4, Section Township ^Lj rJ . -,3 Hailing address `/5%t.., Address of'site Subdivision name_ i%' Lot no.--, 4'4n4-- other homes on property? yes 9- No Previous owner of property i -,a /i; C_ Total size of parcel Zd ii n S _ Date parcel was created Are all cornors and lot lines identifiable? Yes No xe thio property -being developed for (Spec house)?_Yes 2.�,_140 VolumeeYS--and Page Number % 3_'�t as recorded. with the Register of Deeds. INCLUDE WIT11 THIS APPLICATION THE FOLLOWING: A WARILMITY ULL:D which includes n DOCUMENT NUIWER, VOLUH9 AND PAGE 1IUl1UE11 It THE SEAL OF THE REGISTLR OF DEEDS. In addition, a certified survey, if available; would be helpful so as to avoid delays of the reviewing process. If the deed description reforencea to a certified Survey Nap, the Certified survey Nap sliall also be required. PROPERTY OWNER CERTIFICATION I(wc) certify that all statements on this form are true to the best of ny (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded i the office of the County Register of Deeds as Document 11o._ 4V ? U 2- , and that I (we) presently own the proposed site for the sewage disposal system or I (wo) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. yg6-40 2, Sig" -nature of ap¢l cant r Date of signature Co -applicant pate of —signature