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HomeMy WebLinkAbout022-1067-80-000 ST. CROIX COUNTY ZONING DEPARTMENT / AS QUILT SANITARY REPORT / Owner K wr S� t.e Address 2 fie/ SA-e4_4V062 ,�iP�, Z /0 /� . '� City /State /� S G>/ • SYo Z Legal Description: cp k h Lot Block Subdivision/CSM # /9lV7 O 40 /�G+�Cf ` - ' V . t /. 5 % N W . Sec. TV', T Z 9 N -R I ft, Town of 'PIN # e Z Z - D SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC / / f ° Setback from: House Well P/L 7 Pump manufacture_ r_ Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM f��SA Gg� 3� X 12 y 13EP , Type of system 4 Width 5 Length Number of Trenches Setback from: House >.�O Well > /da PAL rlaV Vent to fresh air intake ELEVATIONS e57 Description of benchmark /V Elevation Description of alternate benchmark -r nQ Co vC�L�2 Elevation Building Sewer 3 ST/HT Inlet 2 D ST Outlet g l 9 PC Inlet sa . 2 ` S PC Bottom 9(o-30 �' 30 Header/Manifold / Top of ST/IC-Manhole Cover S� (��saj Distribution Lines () q () ( ) Bottom of System () �! • �0 () ( ) Final Grade ( () ( ) p, b Date of installation b / Permit number 30 7 � State plan number Plumber's signature License number 2 37 5 Date Inspector _ 'Pop Complete plot plan * r 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 I I INDICATE NORTH ARROW i 1 b rN �t o I _W M ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM v Safety,and Buildings Division Count • INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 5r�jVT Pe information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)). 3 / // J 4 Permit Holder's Name: it V T wn of: State Plan ID No.: KERBER, KURT & BETH ��ylacK� C T CST BM Elev.: Insp, BM Elev.: BM Description: Parcel USG lax Q'!- :1067-80 -000 UL7 (6th r TANK INFORMATION ELEVATION DATA A9800184 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I e + -- Benchmfrk a loa.9� j, v� ng `) I e S e AL +, Aeration Bldg. Sewer Holding St Inlet [ TANK SETBACK INFORMATION St/ Outlet ?0 TA to ROAD D TO P/L WELL BLDG. AirI t Inlet lZ � p Airintake Septic j 1 NA Dt Bottom 41 (p a6 7 Dosi >✓t!a 3 NA Header/ Man. ?_ Aeration A Dist. Pipe Bot. System Holdi(9 2- PUMP % S1PH 'INFORMATION 2 �y� Final Grade Manufacturer c ;v Demand�� �g Model Number �� � GPM E lk olk4k TaH Frictions � Systems TD FLength oss q5 Dia. F2 1 Dist. To Well SOIL ABSORPTION SYSTEM B REN Width I Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D h DI QN S DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING anu acturer: INFORMATION Sy WI f � � � C> � ] G 4L OR UNIT DISTRIBUTION SYSTEM l ---- CHAMBER Model Number: Header / Manifold i Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length I Dia. Length Dia. _ / Spacing I 6 �)" 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.) 1 -�4 LOCATION: KI 24.28.18.375,SW,NW 261 SHERWOOD FOREST Plan revision required? ❑ Yes [ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's ignature ert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I /�� nsin SANITARY PERMIT APPLICATION ��S' 201 E'w Bu ildi n g s A ve . V1.4 co Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code P.O. P.O. ox 7969 Madison, WI W707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. J • See reverse side for instructions for completing this application State sanitary Permit Number 30 The information you provide may be used by other government agency programs ❑ Check if revision to previous 5pplicationr [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION- PLEASE PRINT ALL INF RMATI N 796 Property Owner Name Property Loc tion / U A 6t � AILS W 1/4 i /4, S Z T 2g , N, R / E (or) W Property Owner's Mailing Ad ress�� P O Lot Number Block Number Into J City, State ,!� S Zip Code 2 Phone Number Subdivision Name or CSM Num e r C �D Z- (yz 2 T o �4L�1 S . TYPE OF B IL NG: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o own of ~ / � 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 244A9. 012 - / &7 -t?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. TYPWOF ERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ,______System ________ System_____________ Tank Only______________ Existing System ......... ExistingSystem B) C] A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressuriz Distribution Experimental Other 11 E] 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: /0 2, 0 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re uired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation �b `� -5a'V 4 L ' � Feet Feet VII. TANK in Capacit Total # of Prefab. Sit Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks / Septic Tank or Holding Tank COil7�+.L ❑ ❑ 1 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I 5K ❑ 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) r Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: �71 � , Plumber's Address (Street, City, State, Zip Code): / Aol ;2 r - C - #V psev Z Z IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater MIssued wing A gen Signature (No Stamps) h ` e fee) Xj,Approved [ Given Initial /'` ;'�� Adverse Determination uv �� ff X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-63M (R.11)" DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plunder ` INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteriz 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 installatior: 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 S..ate of Wisconsin, Safety and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address !provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ili. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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. VIII. 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 81/2 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 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; and F) all 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 contamination investigations and establishment of standards. • Safety and Buildings 1 A PO BOX 7162 MADISON WI 53707 -7162 v Tommy G. Thompson, Governor Department of Commerce William J. Mccoshen, Secretary May 15, 1998 CUST ID No.271184 ULBRIGHT & ASSOC 655 O NEIL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL Transaction ID No. 78656 APPROVAL EXPIRES: 05/15/2000 SITE: Site ID: 7317 ST CROIX County, Town of KINNICKINNIC SWl/4, NWl /4, S24, T28N, R18W KURT & BETH KERBER FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 17958 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 Comm 83 and 84, Wisconsin Administrative Code. This system is not reviewed for the code requirements set forth in chapter Comm 82 or in chapters Comm 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire in 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • On page 3, P = 95 feet. There shall be 20 holes in this distribution pipe. The required now ratw is 23.3 gpm. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID No. in the regarding line. Sincerejv, DATE RECEIVED 05/15/1998 FEE REQUIRED $ 180.00 PAGEL , P LAN REVIEWER II FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (608)266-2889, M - , 0745 - 1630 HRS PEPAGEL @COMMERCE.STATE. WI.US ULBRICHT, & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # 7 9 5'0 Date AffV /57^/ff Owner if "W T ? 194 V4t, 1( As;e Phone 7/S • y�. S 93 3 2- Address 3d( JO H 4 -3 -_ 1p%GOP 10 �lf 411 -5 Z Z Legal Description !fp 44aS . l ) / -* 02 z -- /067— �O . Town of /C%{��v %G� /.IJ�tJ� County x - -- - - -- _ - -- -- - _ ._. - - - - - - - -- -- - -- —_ _. _.... _ .. C.S.T. t f Ogj!5R7 21 /,�if <�i7 OS7T ?. fZ Installer 7 - 63 G T Local Authority/ Supervision 577 C/Pp��aC GTy zeA-7 ;3 - PROJECT DESCRIPTION Ae Co,'S 7,;VOCT7o,�� /3u 7 G �til F_.v 7'm 4 T J�O s j . Co di io I . ROVED C ORRECTION NEEDED MENT 4ENCE �� GS �ECEIVEp SEE CORRESPONDENCE E SAE E G0RR MAY ) 5 1498 - 7 `6 8094 8nd BUIldinp Pg.l PLOT PLAN VIEWS tr` & P �4 °�s y� ts P9.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS p ,kqA P9.3 PIPE LATERAL LAYOUT AAAA R S 2 Pg.4 DOSING CHAMBER CROSS SECTION P9.5 PUMP PERFORMANCE SPECS This design for installation is based entirely on measurements, elevations, la'nAscape conditions (slopes etc.) and soil suitability The accuracy of his specs, as reported, shall remain the sole CSTM of the csTm. res po n sibility Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, sub§titution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. Z� Q O Q Q tp I o-4 0 �D yam- � _� - -- ---- - - - - -- ' C n � � � I I O o` o com c ..o c o >� e o � CO � = C'i a � vi ev ■� p 1 0 fs n y v m P o CR OSS 'SECTIOJ O NIOUAjD — wi rti 'f3 ED Bev OF ro �istR�(�uTlo� t 2. AilecSATE' G , Tk pi 6- sysreM of Y °P soiL E IEVA r ioo % r 0 "' FoR M TOE K to 99' S'o RATIO T- �I 1 d uu FO ( % 51oPE F ORCE" EiWN IOO uu�E1Z MAW f3ED 99.0' Fr F /&0 Fr. IM VE,Rr OF z �! IATIERM S F: ' PV FT. To O F R ock / 0O.3-� C, �• Fr. P N /.s T Top o �.� �ATERAIS / Old . /0 F i PLAN VI EW OF MOujjD - wi rtt 13E D F oRc E MAW A � FT• B /0 F r K 12- F r F w 1 ' ---- _____ - - FT �� w � w 30 o Fr Bev OF To I!-" PVC cAppEp '- 0135ERVArIO0 A 93REIATE PipEs PERMAuEAuT MARKERS REC.2V f3AS At_ A ReA - `D APcy tv h S rE' F'! ow 90(L Ix)'fi ITPA - r)0E C APAci 1, 7 s Fr, r PRopoSEd BASM AReN = '� ( A + _ /Ov �GN�fz ^�. Maul t-D DiSmiBOT1O� - . Plp� uErwaa k TOTAL— v G d F LA rLz2N(— �tSTR1t3uTl�i• LATERAI. EN CAP X X X Y z PvG F O R GE M L Vole s HA II 13E ►JEf-r To ENb CAP � VOID VvlutA FOR -tuvERT U Ir VAr10A-) V MAW 12 jhls, /o CORRECTION NEEDED SEE CORRESPONDENC E f ERFvRAT - CD PIPE DETNi L U F {olEs IrscATFt� o� GOTtOm SHAII 13E Y vnR�nr3�� y Ec��hlly sp�cED. bfSTANCE 9(o r r Nnle Di /EKE T E R fN . rrod MAUI FOLD " tN. X fNChf s r MAik) -- Co0 - Y _____ f ►u c (, t; S # :- o r Ii of e s/ ; / p PE�- DISTRi t3uTIoN pISCHARC e RATE PER LATERAL- s7 Ga I/ TOTAL, - Dl5GtAAR C,1; BATE / IJEt'WOR k Z .,s GA L / PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 �j of rj VENT CAP 4 ° C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOP., w /tv^R ,# IA) &- /AAE� WINDOW OR FRESH 12 MIU. AIR INTAKE l�tr�1 - 40 Al GRADE - T I 4" MIIJ. - 7 1 /LI'Q 18 "MIAI. CONDUIT - - 0 ---- - - - - -- � fT D . �O .O INLET PROVIDE I - - - -- 1 -_-+- A ) AIRTIGHT SEAL i I APPROVED 01 T A 5 I I I I APPROVED JOINTS Iv/ C.I. PIPE � I I W /C.I. PIPE EXTENDING 3' 0 ` I I I ALARM EXTEN61m(, 3' i OqTO SOLID SOIL B 1 I I II OUTO SOLID SOIL O N ELEV. FY __� PUMP -� OFF Z�SE 3 o f i D /, �1o�P - OF io d I BLOCK �� c v�1 f GY�iit1 C' RISt EXIT PERMITTED OUL-9 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFICATIOUS DOSE �� TANKS MANUFACTURER: IS �� � (DUMBER OF DOSES: PER DAH TAWK SIZE: / 9 2� GALLOMSS DOSE VOLUME /s ALARM MANUFACTURER: o4ay_ Z A� C Q INCLUDING SACKFLOW: 2 / GALLONS MODEL 1JUMBER: PV L CAPACITIES: A= IS INCHES OR 7� GALLONS SWITCH TSPE: y )c/od T 8 = Z INCHES OR 5/ GALLONS PUMP MANUFACTURER: ` C= �' INCHES OR 211 GALLONS MODEL NUMBER: _ c l a. r 1 r iLH P. ' 7 D= ..C INCHES OR J GALLONS SWITCH TYPE: ?(jjY&Az l • FI CAC - IJOTE: PUMP AMID ALARM ARE TO BE MINIMUM DISCHARGE RATE-- - 3 0 .3 -GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BE PUMP OFF AND DISTRIBUTION PIPE.. I FEET fiAA) L !9 P C'S ' + MIIUIIMUM NETWORK SUPPLY PRESSURE . . . • . . . 2.5 FEET , I 0� V + _.`L FEET OF FORCE MAIN X ` ` F o'FT.FRICTION FACTOR.. / �' L FEET tr��rIs Z 5. C.(/ Als. TOTAL DyIJAMIC HEAb = s `� FEET ga 39„ INTERNAL DIMEMSIONS of TANK: LENGTH ;WIDTH - ;LIGIUID DEPTH F HEAD CAPACITY CURVE 3 7/8 MODEL "9H" 6 �/4 4 5/e 25 g i 6 3 5/a + 15 O + it 4 4 3/16 e to ... 1 1/2 -11 1/2 NPT 2 5 0 U.S. GALLONS 10 ZO 30 40 50 UTEAS 707 a0 80 160 240 0 FLOW PER MINUTE TOTAL DTNAMIC NrAVOLOW ►ui ,urn N . IMUENT ANO oewATEAnNO CAPACITY 12 HEAD UNITINTAIN • L10 METER{ GALS LTRS v , 1.52 7! 913 O.Ob el 131 IA7 Ib 110 110 2b OS 3 6/16 sWe 29' CONSULT FACTORY FOR SPECIAL APPLICATIONS e Electrical alterna Mercury "oat switches are available for controlling sin tors, for duplex systems, are available and • M le and supplied with an alarm. g *; Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. Standard all mode Willght 39 lbs - - / H.P SELE ouloE r t. S i n g l e l Nora operated 2 pole mechWca switch, no external Control required. 1M Series -• � 2. Single Piggyback rrler , Contro Selection Y 1100 swWah or double PlaWback mercury, Moat Model V he -Ph Mode Am • switch. Rotor b fM0177. M" 116 Sim lex Du lex 3. Mechanical Alternator 10.0072 or 10-0076. 1 ulo 9•0 1 or 6 7 _ 4. Sea f M0712. lot Correct model of E1seWA Ahernslot. "E-P oee 23p i o 1.1 sx d *l" $Ofww 11001 switch 10-0R26 ; raid N a control activator psc N 1 or 1 a 7 -- d (3) or N) float system +' •E96 230 1 Non 2 0l. R 6 4 6 or 16 6 :. 6' Fpu,(4) " "J• Pak ". June" box. lot VidIs111ptd conrNMbn or wked•In ski l, cr duplex operallon, 10.0002. t 7. Two hole "J.Pak ". W waledigtd scnnv.__ w Optic, . fa kdorrnsllw on RM110n4l Z «•N products r@ lot to ut CAUTION P -.k L+srewy 6wIldws, R401�1; Ebr:kkal AAern� FM O488; eon **1 fMO or, AN kls+aNalloa N controls, prdaclbn'�a6bss end wk L-1 Alarm Pwckapa, FM0613' t flim lex ANsr &M Ned Ncenaad abdrbbn AN deolrbd s 6 s*1 N/ should w dons by • dwN• fMOT32 ' bcmPl6ewy* 6ulns, fMOYT; *nld Aimplex C4nbd 6os, Mb pit sled *seat N Beside Cods E *odes shaNid be %Nowed k,dud NasNh Ad tOfNAt MW ow COOYWNowal Salty srW RESERVE POMPED DESIGN For•unusual conditions a reserve safety factor 1a dngineered into the design of 04'61y Zoeller pump, -- .� MAIL r' r.0. Box 16317 O " O l0dRiFf.iKY Manu/acturtirS of.. . ZAOTZZZ ' 8H/P r0; 3 8o ov Millers lane N w labs e. KY 40.116 j eWYA'!'/ wpf X WC.- (502) 778.2731 ;e FAY 1502) 714.3624 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page Y of Labor and Human Relations 'Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 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 ARCELI.O. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Pr GOVT. LOTS 1 /4N 1 /4,S T ,N,R E (oo P ROPERTY OWNE (LING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CF, STATE ZIP ODE PHONE NUMBER []CITY (]VILLAGE P50WN N ST ROAD (/] New Construction Use[/] Residential/ Number of bedrooms 3 [ ] Addition to existing building j) Replacement ( j Public or commercial describe Code derived daily flow J o gpd Recommended design loading rate bed, gpolft , trench, gpd/ft Absorption area required 9 ,pP_ bed, ft 7 S­o trench, ft Maxi um design loading rate . S bed, gpd/ft . ` trench, gpd /ft Recommended infiltration surface elevations) 91 / x / ft (as referred to site plan benchmark) Additional design / site considerations — Parent material Flood plain elevation, if applicable ft F u = Suisuittable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK = Unable fors stem El S 121 U OS ❑ U ❑ S BU WS I] U [ IS 0 U .- I 0U.-I ❑ S [a U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles f Structure GPD /ft Boring # Horizon I Texture Consistence Efa.e•xiary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rrench Ground _ S o _ 7Z h, l Q s . S' elev. I Depth to limiting factor Remarks: 4 c e &4rA, 4Z j Boring # O 3 j f O -73 •3 < 3 — 0 Aq ' Ground elev. - d /o — 7 fZL a► a ft. c� Depth to limiting factor Remarks: - C �wr>! CST Name: — Please Print r° Phone: Address: /. o�P a z3 Signature: Date: CST Nu mber: r PROPERTY.OMER /Ge L SOIL DESCRIPTION REPORT Page _.?__of q PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourJary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. S Sh. Bed Trends . tip 3 Ground 3 o — o —' o g elev. P7•�/ Depth to limiting factor Remarks: Boring # OC Ground el ev. o .. d' L B j PLO ft. Depth to limiting factor , Remarks: 'r a,, c . Boring # w , VC :`:' s L — • s` — -�s o !tic / e— • S Ground XT o— ' o xt elev. o . o P7. ft. 7 G Depth to limiting factor II 9'3 2 Remarks: Boring # -AX Id ................. Ground "l► o T� o elev. ft. Depth to '� 3 limiting factor f no Remarks: t K A a � SSS T ega \\ V Q Irk +� N fd 1 j� N v 'C 1 ,. w It 0 S � a S '` R► Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749 -3656 /eS�+N 6coJ�6S ��9ft6�l�"ti+ wr' // by rwl�ra1 i 4 fm r'A // - 0 VLK 1s w . 9e IAIX la/ u,. VLt<2 so/ r / �• A `, e fri3�`rri�,►l�y �X�'� / rKr / t / � ,Pre"A4.)4 , 7./ , (�J l✓0' K ��" •t"i$;�i�iY/1 7's ` / �!'� Sr�'KSi)"I /!9 !'�P• / / ,�CCGe!✓ � 7 l �•- a�y/�11 ° oltlryLt u+ WY 6rlT ✓ ®l7 d�� w. `0+09 14 rrol' ,• jc Awwp-V a he Al- labo a Hu r. Relations Vr Mr`Irl Oi l c G V MLUM r IVr`I nerVn r raged of_, isron of Sa ty a Buildings in accord with IL s . Code COUNTY Attach complete silo plan on paper not less than 8 1/2 x 11 i e n size. P must i ut not limited to verlical and horizontal reference point (BM), d' i n and e o cale PARCEL I.D. I dimensioned, north arrow, and location and distance to no road.G d22 ^ 4 p 7' d O APPLICANT INFORMATION- PLEASE PRINT ALL � MATT }Ot�� REVIEWED BY DATE i PROPERTY OWNER: � R(APY L N GOVT. LOT 114 W 1/4,S2 T Zy ,N.R E (o� PROPERTY OWNER':S MAILIN ADDRESS LO NQ # SUBD. NAME OR A 3 o CI STATE ZIP COD5 v PHONE NUMBER QVILLAGE OWN NE EST ROAD � V <r O ( ) 2T- 9 L ° C (/J New Construction Use [ n Residential / Number of bedrooms 3 [ J Addition to existing building [) Replacement [ Public or commercial describe Code derived daily flow gpd Recommended design loading rate _ 7 ed, gpoltt f_ trench, gpdm Absorption area required y'y3 bed, ft 5�3 trench, ft Maximum design loading rate _, - _ bed, gpd /e . d trench, gpd /ft Recommended infiltration surface elevations) �(' I ft (as referred to site plan benchmark) Additional design /site considerations - " ce- Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I MDING TANK U= Unsuitable fors stem I EIS QJ U Cpl S O U ❑ S O U 0S O U [IS la U EIS O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft 3oring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Beurr>ary Roots Bed Trer Uj Ground elev. - I ?e ft. 2- Z 6 7. 5 - — s r, s _ Depth to - limiting factor 3 _ — 93d 6 s o s Remarks: ;9 I el«�°mirkt` - Boring # VtsL,�/ Ground d 7• elev. V_� it. Depth to `3 - 4 7 to - S o '„ S _ . 7 limiting factor ' / Remarks: CST Name:- ase Print Phone: Address: _ 11�rr r cv L - 5 - ye 2 _ Date: L .t fs CST Number:3� # [ Horizon Depth Dominant Color Mottles Structure in• Munsell Texture Consistence GPD /ft 4.. Qu. Sz. Cont Color Gr. Sz. Sh.Y Roots Bed Tnench Ground l elev. QZ.. �y ft. Ile Depth to limiting factor o - k7f Remarks: Boring # Ground L - S� ' Y4 `iE' / s — elev. 7 .,F ft. Depth to 3 - 7 limiting S _ — • 3 factor Remarks: -f r # Boring # Ground Z 33 - / elev. ft. Depth to 3 - ro ea _ limiting factor , 2- Remarks: Boring # 1 v s 2- _y Ground elev. Z. ft. Depth to 3 `� o - limiting factor Remarks: ` fi t J/f,�� f fc,L SBD- 8330(R.05/92) i1 I � ` - l o wl 1 �1 1 4 Z c 1 w 1 N v All n it A It 0 s w n o � R� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �3 V Ve " ZS Prop erty Address Z 6 CD s/ /It ? � P Y ,. (Verification required from Planning Department for new construction) r D 2 -2 —,�D — O City /State (� t'Q.! �� y 11L Parcel Identification Number LEGAL DESCRIPTION Property Location J &) ' /4, 1 4-1t4-) '/,, Sec. 2- tl , T 2 ' k N -R l " W, Town of Subdivision Nf,+ _ AV OF Lot # Certified Survey Map # N/ , Volume , Page # Warranty Deed # 5 ©� V , Volume ! Z � , Page # Spec house ❑ yes k no Lot lines identifiable 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 e p stag 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 wastewater disposal 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 s by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your se i system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three y ex it Lion te. � SIGNA OF APPL DATE OWNER CE RTIFICA T ION I (we) certif t at all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro descFib above i e of warranty d d recorded in Register of Deeds Office. S GNA F 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 • 530 State Bar of Wiscomis Farms 2 — 190 WARRANr DKILD _ DOCUMENT NO. VOL fxV 457 { , ^�, . -- . E;:... fsisCti ir: r:� _. Glean X. Bad and Dorm x. Bedie, JU 3 M5 �haba nd aid wife et 9:n AM . KeYhet and M � ,th A. � and- wife, TiNa V*= TASW. D FOP REC01101"O DATA %M4 AND MUM ADMIMS /Q w *a WowiaB &wdWd teat stale is St QrQJX Coofty. State Of WbOollisix r (Ps rod l ANksm. Nasaber) Tile SWi/4 of w1 /4 Section 24- 28-18, St. Croix Cowty, Visconsin. O �Sf� r� 71is is not haseatesd powl2. ]MCK (is go) axoeaim to watmbec Zasementa, restrictims and tights -of-W of record, if any. Dated this 7s/ tA - day of `ham _ (SEAL.) (SEAL) •__ a Glew K lie � 8 A (SEAL) t i j �---- (SEAL) e Dmus R. Bads AUTBENTICATION ACKNOWLIDGMENT 3 *tea) Glenn K. Badje, STATE OF WISCONSIN Dunne R. Badje aatbesticsted this dy Of -lime . !B_� P"30M fly caws 1 0 ose ass tbia day of .19 the above named • !Gris tine ggUM TITLE MEMBER STATE BAR OF WISCONSIN (N sot, astborized by 1706.06. Will. Stab.) to xse kROwn to be t!e pasos wbo executed the foresoisa iasv*nw t aad acksowiedse dte :,• :e. TWtS aWSTRUMENT WAS DRAFTED BY Watim 00ard • Notary PwAk COUaty, WiL (Si6natura may be aatbeaticased or acknowkdV& Bmsb we am Commission s pe+aaaest (1f sot, state expiration date: necessary.) , 19 —.) '� •lieies,/ pem. sigma, ie may aMeay should be lyp W e• p6ma' Riu. 00ir +iWlres. WARRANTY DEED sTATi aAa OF WISCOP11 W iconsin legal Blank Co- Inc. FORM 14o6 _ _ 1902 Milwaukee. Wis.