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CROIX COUN'T'Y ZONING DEI'AIU'M N"I
AS BUILT SAN[T'ARY REPORT' ft `-r
Owner
Address
City /Blatt -- 4-- Pt --�4 4 C
Legal Description:
Lot � Block
Subdivision/CSM It
Sec. Ik N -RAW, Town o c cM. PIN #
SEPTIC TANK — DOSE CHAMBER -- 7,
HDOTMG TANK INFORMATION:�� /�
Tank manufacture d eS e✓ C, p Size ST/PC/ 7Sd Setback from: House Well P/L SeO
Pump manufacturer Gv Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: 1 azA Width Length Number of Trenches
Setback from: House l6 Well 16 G P/L 3k Vent to fresh air intake
ELEVATIONS:
Description of benchmark ' '
/A " 7 `�``� Elevation
Description of alternate benchmark
EIevation
Building Sewer ST/HT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines ( ) ( ) ( )
Bottom of System( ) ( ) ( )
Final Grade ( ) ( ) ( )
Date of installation /1D !4 Permit number — 549 " L I State plan number IL 16�d
Plumber's signature -= `V / +.ri 4.
License number r %'� s 1'v Date '/ /id /?"P Inspector Vi
turn pletc pia( plan
4 •
A
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
Al l
1'
INDICATE NORTH ARROW
Wiscor Department of Commerce PRIVATE SEWAGE SYSTEM y .-
Safety and Buildings Division Count
INSPECTION REPORT ST. CROIX
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)]. 320215
Permit Holder's Name: [] ty VilVq L EY n of: State Plan ID No.:
WENGELSKI, CHRIS P IPT A
CST BM Elev. Insp. BM Elev.: BM Description: Parcel TVA.: 1019 -95 -100
TANK INFORMATION ELEVATION DATA A9800404
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic I f 2!1 > Fl, ,, Benchmark
K�
Dosing
Aeration Bldg. Sewer �J
Holding St/ W Inlet �� X41 /
TANK SETBACK INFORMATION St/ Ht Outlet -
TANK TO P / L WELL BLDG. Ae Intake ROAD Dt Inlet 9 1'
Septic NA Dt Bottom
Dosing NA Header /Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH I Lift Friction Syestem TDH Ft oss
Forcemain Length Dia. nFFii F Dist. Towel) r 1
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSION 1 15 DIMENSION
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/ anifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Len th Dia. 1 r � ,1
g g � /Spacing �t,!" J Len th /,�, %`,% Dia. /
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over I 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.)
OCATION: P LEASANT VALLEY 16.28.17,SW,SE 1766 30TH AVENUE — LOT 5
Plan revision required? ❑ Yes No
Use other side for additional information.
3BD -6710 (R.3/97) Date Inspector's Signature Cert. No
Safety and Buildings Division
%!;cbnshi SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue
In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 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 E] Chock if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N 1 15
Property Owner Name P pert Lo ation
f J �la 1 14, S /b T , N, R / 74 (or)
Property Owner's Mailing Addcgss Lot Number Block Nu er
o e 7 to fti AUC
City, State Zip Code Phone Number Subdivision Name or CSM Number
01 (_21 �S ( Y1i� S7 32o D / Z 3 !,f
. TYPE OF BUILDING: (check one) ❑ State Owned ❑ It Nearest RoAd t Z
Public 1 or 2 Family Dwelling - No. of bedrooms W Town OF
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers)
1 ❑ Apartment/ Condo �° /4)/? F5 – /loci
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, x New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
_System ________System __________ ___ Tank Onl�r _____________ ExistingS)ttem ________ ExistingSyrstem
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 Dd Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
6elo /f�78 /5' ., S/ ' �I S Feet /v/ Feet
Capacity VII. TANK in Ca allo s Total # of r Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks Im
Septic Tank o Ingo ank /Zsv — IZ40 w ,� ❑ ❑ ❑ El E] Pump Tan on L1 7 / 11 El 11 11 El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum is Name: (Print) Plumbe ' Signature: (N tamp MP /MLR .: Business Phone Number:
7/.:!� 77Z 3Z
Plumb is Address (Street, City tat Code); / ' - / �' /^ 1)►
o� �
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issu7ngen t Si gnature (No Stamps)
® F1 Owner Given Initial Approved Surcharge Fee) w
y 3 �
Adverse Determination ��� 6
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety a Buildings Division, Owner, Plumber
x . Safety and Buildings
2226 ROSE ST
LA CROSSE WI 54603 -1905
i sconsin Tommy G. Thompson, Governor
Department of Commerce William J. McCoshen, Secretary
August 28, 1998
CUST ID No.226524 ATTN: POWTS INSPECTOR
ROGER L TIMM
3128 20TH AVE
WILSON WI 54027
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 08/28/2000 Identification Numbers
Transaction ID No. 121590
Site ID No. 16953
SITE: Please refer to both identification numbers,
Site ID: 16953 above, in all correspondence with the agency.
St Croix County, Town of Pleasant Valley
SWI /4, SE1/4, S16, T28N, R17W
Chris Wengelski
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 37632
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Adm. Code.
• 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.
• For additional site details see page 3 of the soil test report.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely,
DATE RECEIVED 08/26/1998
FEE REQUIRED $ 180.00
&ERARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE $ 0.00
(608)785-9348, MON - FRI, 7:15 AM - 4:00 PM
JS WIM @COMMERCE. STATE. WI.US
Chris Wengelski - Mound
Transaction # 121590
Location: SW 1/4, SE 1/4, Sec. 16, t 28 N, R 17 W
Town: Pleasant Valley
County: St. Croix
A 28, 1998 �, lel
Date: g 9Xe <116 FQ
Owner, : Chris Wengelski �& 1998
OC
s
Address: 740 Evergreen Drive, # 112 40/`
• Burnesville, MN 55337
Plumber: Roger Timm
Signature:
License # MPRS 126524
Attachments: 6748 -Plan Review Application
SBD 8330
1P•0 �P4 vn tly
c�at`��ti
• COMM�RC GS t
page 1: cover E�aRZMtNtE Y B
2: calculations
3: , plot plan ESPO CE
4: system cross section EE GpRR
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
page 1 of 7
Goulds
Submersible
Effluent Pump
3871 EPO4
EP05
NiP
f .;
�IPPLi `IONS • Fasteners: 300 series • Fui. 'y submerged in high ■ Motor Housing: Cast iron
v OIL.,Y"
a ~ stainless steel gre de turbine oil for for efficient heat transfer,
peciEi es igned for the . Capable of running lut 7cation and efficient strength, and durability.
g �� �OIIOwin arses:
°� fflu8tlt ystems dry without damage to he..'* transfer. ■ Motor Cover. Thermoplas-
omes
h a • x components. tic cover with integral handle
H „ Avai:able for automatic and
ph • Motor: man;tal operation. Automatic and float switch attachment
u!'Sump EPO4 Single pease: 0.4 HP, mod ►Is include Mechanical points.
'11 +
ate fer 115 or 230 V, 60 Hz, 1550 ■Power Cable: Severe _.. t s Floa Switch assembled and duty ---RPM built in overload with
DeWatblitg " pres at the factory. rated oil and water resistant.
a ... automatic resit. pp
■ Bearings: Upper and lower
•' [ P05 Single phase: 0.5 HP,
ECtFICpYlON3 FEAT heavy duty tY ball bearing
$P 115 V, 60 Hz, 1550 RPM,
hump" EPO4 built in overload with w EPO4 Impeller: Thermo- construction.
+ Solids.handling capability: automatic reset. plastc Semi -open design
914" maxi mum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
• CapaciVes: up to 55 GPM. standard length, IN SJTO mec �anical seal protection.
• Totat40ads up to 24 feet. with three prong grounding p CP' Canadian standardsAwaslstion
" ■ Ei B5 Impeller: Thermo-
Dlscti�ltge siae:l' /x " NPT. plug. Optional 20 foot p p g (CSA listed model numbers
Mechirtical seal carbon- length, 16/3 SJTW with last'c enclosed desi n for end in "F" or "AC ".)
rotarylceramic stationary, three prong grounding plug impl:�ved performance.
BONA -N elastomers. (standard on F P05). ■Casing and Base: Rugged
,` a •.Temperature: thermoplastic design provides
104 °F,( 40 °C) continuous superior strength and
140°F (60 0 0) intermittent. corresion resistance.
•.Fasteners: 300 series METERS FEET
f staln steel. 10 — -- - - 1 -- T -
t Caps bf running
dry without damage to 9 30 _ - _ __ �. __ — 8 GPM
' Ornpononts. -- -
Pump EP05
' ' " Haridling capability: 0 7 25
�_Capaoles Up to 60 GPM. _
ry k TOtal,l�i�s�is:.up to 31 feet. s 20
+pisCli08
PT.
Mechanical -
Z -
Mechanical seal: carbon-
5 �-
Jotary/cel'amic- stationary, 4 1s
BUNA.N Rlastomers. ; --
`' 4 temperature: ° 3 10
>` 104 °F (40°C) continuous
140 °F (15") intermittent. 2 - — - - - - - - — -
1
a o f 10 20 30 40 50 GPM
0 2 i 6 8 10 12 m
CAPACITY
ttg 1998 'Pumps, Inc. ~` ` Effective May, 1995
83871
System Calculations
one family residence bedrooms
Loading rate CU '4 gallons /sq ft per day
Depth to ground water �' �° in
Depth to bedrock > in
Cross slope L %
Force main length drc> ft of Z in
Manifold /header length 4 ft of in
Drainback �'Z- gallons
Lateral length �' @ �' ° ' O ft of " J in
Lateral elevation R Cc ` ft (bottom of pipe)
Lateral hole size `16 in @ t9 " " in ( f t) spacing
1'� holes /lateral, 26 holes total
Lateral volume r gallons
i
Total lateral discharge rate 3 `° Ar -L gpm @ �'� ft head
Elevation difference V ft
Friction loss ft @ gpm
Total dynamic head C1.6 ft
Pump /si't%gon - gpm @ ° ft of head
Manufacturer Model # �` 1/
Dose voluxge gallons
Lift /sioon tank* `'"''°'t�" gallons
Septic tank , 12 j � gallons
Measurement pump on & off "� in
Height alarm from tank bottom in
Reserve capacity 4 Z°t } gallons
calcs page Z of
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A
M�►ih
i
VCWT CAP
4 "C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKIAIG
JUUCTIOIJ BOX MAMHOLE COVER
25' FROM DOOR, w4it*►%w G.
WIIJDOW OR FRESH �Z I
AIR IMTAKE
GRADE
Q�w• .,ag•� I 4 „
COUDUiT — —
PROVIDE I - - - --
AIRTIGHT SEAL I r �/ T
4 •� II v
t•' P • 0.BS �a� �3 2�' �� I I i I APPROVED JOINTS
I I II I W /C.I. PIPE
W I I i ALARM EXTEWDIWG 3'
12.t A... I ONTO SOLID SOIL
1% 1 4� ow
T pump—, -
OFF
FLOCK
w n �
406 &g_
j I
I
1.
latu Performance Data
Pu Ch aracteristics
Pump/Motor Unit Submersihle
Manual Models SW25M1 SW33M1 12 z4
Automatic Models SW25A1 SW33A1 1/3 HP
x
Horsepower 1/4 1/3 16
Fell Load Amps 8.0 1 10.0 11 HP
Motor Type Shaded Pale (4 Pale)
R.P.M. 1550 o s
Phase 0 1
Voltage 115
Hertz 60 0 0 10 20 30 40 50 eo
CAPACITY -U.S. G.P.M.
operation Intend""f
Temperature 120 °F Amblent Total Nead (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 NP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 NP 47 45 43 40 37 34 30 26 22 16 10
� Discharge She 1-1/2 NPT � -
Salids Handling 1/Y Dimensional Data
Unit Weight 30 IbL 1. Al &nmm in rdin
Power Cord 18/3, SM,10 std. b our
3.1/2 5.7/8 2. ( wWowd linemim mq
(20 optional) 4 -,/2 Tory t 1/e kd
3. Not for wsoudim purpose
1 - 1/2 NPT VOWMdlW
A 1/2
DISCHARGE + Oiormioos and are
M ateria ls of Con structio n op
S. On/ON 64 d4wa6M
Handle Steel 6. we nspw 16 60 to
Lubricating Oil Dielectric 09 1 mo6e graions
productsoad 10
Motor Housing Cast Ira � ailiaa0 """" I o0
Pump Cuslog cat Iron
Shaft Steel
Mechanical Soo) Fags: Carbon /Cw mk
Shaft Seal Sed Body: Anodized Steel
Spring: 5tahless Steel PUMP 11 -1/8
gws: Blma -N
1a1re
ON s -u2
Impeller &
Upper Bear DISCHARGE
HEIGHT
Lower Bearing , Row Bell
3 -1/2
Strainer /Base Phlstk 3 PUMP
OFF
Fasteners Stainless Steel
AURORA /MYDROMATIC Pumps, Inc. -
1840 Bony Road, Ashland, Ohio 44805
(419) 289 -3042
Wiscgnsin Deparbvent of Industry SOIL AND SITE EVALUATION REPORT Page of 3
Labor and Human Relations
DivisionpLSafety & Buildings in accord with ILHR 83.05, W� Code
l ,�{,,,�- ' too►. oo,,B COUNTY ST. G1�1ac
Attach complete site plan on paper not less than 81/2 x 1lints �ize. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. If
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION 1, oS- R�I��D� 9 ATE
PROPERTY OWNER: PROPERTY LOCATION /K( /
G L E t�l 4GVT._9T S �'3 1/4 SE 1 /4,S ) T Z�, ,N,R L7 E( W
PROPERTY OWNER MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
W \Zqq I 890 Tt+ t)v�, S CS)1 03L 1,Z l 4 341 ,
CITY, STATE ZIP CODE PHONE NUMBER CITY []VILLAGE ®TOWN NEAREST ROAD
- vlzLue�t FMlS, wl S(IoZZ DIS) 425- 5619 \j L_J ' 30 Tit RUB'.
P'4 New Construction Use Residential / Number of bedrooms t 4 [ ] Addikn to existing building
I I Replacement [ ] Public or commercial describe
Code derived daily flow tW3 gpd Recommended design loading rate q bed, %xW trench, gpW
Absorption area required SClO bed, ft S C trench, ft Mabmum design loading rate' • S bed, gpdjft ' b trench, gpd/It'
Recommended infiltration surface elevation(s) 9 8 • S It (as referred to site plan benchmark)
Additional design/ site considerations Vn w/ 8' b 3'.BAD - f - INtN1v>11 �Z" 0r- sAAJt) V +ul
Parent material - __ G L p, t fL T1 1__L Rood plain elevation, if applicable �- • A It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN Ffl L HOLDING TANK
U= Unsuitable fors stem ❑ S O U ® S ❑ U ❑ S O U ❑ S ®U EIS Q U ❑ S RU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rw&
y a •�.. x 1 0 1 rj `l Vz- 31 - 4 Ti 77777 7 7 7 7s
10 1 L - s I I Z sdk w► fi C S - S
Ground 3 2 6 -Y - I-SYrz wy � i H R S /a S► c � � � s bk wt F1- _ Z 3
elev.
It.
Depth Depth to
limiting
factor
Z 6''
Remarks:
Boring #
` 8 z g -ZZ 10 �'I li 3!� S l Z�S�Ir Yv►�h eS 5 s . L
.... 3 Zz� ,.s�tz.�1 — Grsl �,csb� ��� �S � •� •s
Ground
elev. 14 3 ? - 1 '12 yl is `ttZ S/?' Sc[
1.5 ft
Depth to
limiting
factor
Remarks:
TName:— Please Print Arthur L. We erer Phone. 715- 425 -0165
egerer Soil Testing & Design Service - P.O. Box 74 River Falls,WI 54022
Signature: �� .� 9 - - Z3) Date: 3 Z;7 ` � CST Numb 00 5 7 6
PROPERTY OWNER if SOIL DESCRIPTION REPORT Pagej!� of 3
PARCEL I.D. Jf O z,4 — 1019 - `q p "
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tn3nch
o-$ 1O`i 31 st(. Z v►�` - a, •S �,
-
Ground 3 Zb 38 '7 S`t yl y 2 S)g lVj - Qj- Ll -S
elev.
q $ ft. Ll 3$ -�l � , S 4 a-VI ti S
Depth to '� �►„ nr Lv - Tvv o
limiting
factor
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
PLOT PLAN Page - -'--, of
3
SCALE 1 "= LJ (3'
�4T fig Sl�UW N
X11 - $L.IOV.O' ON �'ttl6VA, 3h4 Dit) . P\3 p
�O ►nor o f to j Q)
Ln �tY� • B -9 6 0 10
85'
9 -6
31
@ � ' T Z o►�! o f
�.• X18. �
la s
Zs • zs �
�t qS°
_-
2
6'Y- 6 3 ' $C'D \s R*cO N M iwk') k?b f 1) 3 E -ww1 �'11
y. Fu NRE LbT L1fues `M V3E RM Le*S`T" S ' r-j? -o m M OuhA
If
Qy��F sw
. st)r
x IWtlz,-
sW -sE
x
� 3 `S 14 1�Ut.
v• s3 w t 7v
bo '
o
I )T ( 715 ) 425 M 00576
CST Signature Date Signed Telephone No. CST #
Wisconsin Oepertment of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor.and Human Relations
Division of Safety 3 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ST. (:'vzoIX
an 81/2 11 inches in size. Plan must include but
Attach complete site plan on r not less than x i
limited to vertical and horizontal reference
po int direction and % of slo pe, not po (Bfut), scale or PARCELID.#
dimensioned, north arrow, and location and distance to nearest road.
6
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
G 1.. EtJ LV � F$s t9T S �'3 1/4 SE 1/4,S T Z8 ,N,R E *W
PROPERTY OWNER`:S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
W \1 4q 1 890 Tt+ flVE. S Cs 1-z' L V l 4
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD
- RtueTc { W 1 S(4 ozz 01S) 4Zs- S& P\_N�lSf K. - V L.LE _ao `f?t RUN`.
PQ New Construction Use W Residential / Number of bedrooms Y [ J Add' ' to existing building
j ] Replacement [ ] Public or oD mmerdal describe
Code derived dally flow t gpd Recommended design loading rate _ bed, gpd/tt trench, gpdAt
Absorption area required S00 bed, ft2 S L0 trench, ft Ma)dmum design loading rate' • S bed, gpd/ft ' 6 trench, gpolft
Recommended infiltration surface elevation(s) 98-S ft (as referred to site plan benchmark)
Additional design / site considerations I' N ov rv� w/ B' Y- .(, 3' .BZ'r_> . 'f'1 KA" QM � z ° OF- SA &A) 1 L-L .
Parent material G L Pc 0 Flood plain elevation, if applicable ti A , ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK
U= Unsuitable for tem ❑ S O U p S ❑ U ❑ S O U ❑ S ®U [IS Q U ❑ S 1?U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncby Roots GPD /ft
in. Munsell Ou. Sz. Cont. len
Color Gr. Sz. Sh. Bed d
<° z `Fs b W" TV
:° Z - ►v �1z �/ - s I Z '�sdk m fi Cs _ s •�
Ground - )-SYR yl ��. yR s/S sic 1 s b1 y��� _ z • 2
elev.
Z�d.oft
Depth to
limiting
factor
Z WI
Remarks:
Boring #
8 8 -Z 10 '1 11 3C. - SO 1 Z �-3 1 0W Yl
.M L
cZ -.
3 2-Z3 - I.S 'If R /y C Sb12 ven QS •S
Ground
elev. L( 38 -q5 7_ S vi yl �g `tR Shy, se-1 0_ Sbk VA `�t, ' Z • 3
7.5 ft.
Depth to
limiting
factor
3$"
Remarks:
TNanw— Please Print Arthur L. We erer Phone 715- 425 -0165
eg rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature: 9 - � $1- Date: 3 _ Z..73 —�8 CST Number
01 �� y M00576
f
PROPERTY OWNER SOIL DESCRIPTION REPORT 1 Page l 3
PARCELI.D.# oZ- y— LOt9 -«jp
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoundW Roots GPD /ft
In . Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
q o - $ 1 O �t VZ 3 / Z _ S Z- `FS b ►n`�t- c" S t -� - S
Z S -Z.(o .. t O 4 R - 31( — S i I Z bn S 6 k m CS - .% . 6
Ground 3 Zb 3a; • S KR yly 2 SJ `�s 1 � sb� tin Ll .S
elev.
q$_4, ft. -- 7, S Lf ft VI L/ S
li m iting
0% �►�► N t v 0V%,/' 0 �— zlt
factor
I
Remarks:
Boring #
13
. i
Ground
elev.
ft.
Depth to
limiting i
factor
Remarks:
Boring #
Ground l
elev.
ft.
Depth to
limiting ;
factor j
i
Remarks:
Boring #
i
I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
PL PLA Page 3 of 3
ar
SCALE 1 " = L J O I Jv
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aa� .B -9 bolo
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37-
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y. FvTJRE L.oT Utoes - m A't' L �rts`T S ' �►ZO►�t �u -
O I
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SE�Sw X
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L1p T- ST- SO•Pcl,� 1� =800'
( wkly ( ) 14 00576
c� 715 42.5 —nl c,5_
CST Signature Date Signed Telephone No. CST #
Wisconsin Deparbrent of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor aqd Human Relations
Divisionof SJ1bty Eit itdngs in accord with ILHR 83.05, VVi dm. Code
�6' t 'lt�iKvt (k I Z{}-5� COUNTY I K
Attach complete site plan on paper not less than 8 112 x 11 i hes in 'ze. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. Ir
dimensioned, north arrow, and location and distance to nearest road. P9rvj I w G
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION S
r IEWEDBY ATE
�viS�d �fb � Gv� 3 ��a8
PROPERTY OWNER: PROPERTY LOCATION
G L E,IJ 1^j GA�T S .,3 1/4 SE 1/4,S It T Z$ ,N,R L7 E (qnw
PROPERTY OWNER':S MAILING ADDRESS LOT #f BLOCK iF SUBD. NAME OR CSM ✓r
W vZg91 890 TH l)vF, S — cS )I Vu L_ VZ
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD
(Z I ENt FM-Q, k31 s (l uzz D I S) 14 S 6z9 PA S T \W-uVr I 7a 0 - rn A ut__ .
[q New Construction Use (>Q Residential / Number of bedrooms y [ ) AddfiQrt to existing building
[ I Replacement [) Public or commercial desaibe
Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpdm trench, gpd/9
Absorption area required S '�' O bed, ft S 00 trench, f1 Maximum design loading rate S bed, gpd/it • 6 trench, gpd/ft
Recommended infiltration surface elevation(s) 9 8-S It (as referred to site plan benchmark)
Additional design/ site considerations o� �,� w Q�' K _61 ' .BZT�, • ►'� I�J1►�1 vM � Z " Ot= SA & 1 =1 t_t _
Parent material G L t%v I Nct T t_ _ Flood plain elevation, if applicable �- - A ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system [IS O U [as ❑ U ❑ S ®U ❑ S ®U [IS EJ U [I S CCU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baz Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rmrch
-� 1 v -� �>,� -ttZ 3/z sit z`Fsl, w. ►- o' • s •�'
2 R_ 2 6 l v `� ts_ /` - sit Z 'F sdk yr► f�- C s - S
Ground 3 2 - yo - )•SYrz Wy Litz sly sic
elev.
�0 fL
Depth to
limiting
factor
Z6"
Remarks:
Boring #
o _$ by,
m�H a, ) • s ��
2 10 `� IZ 3!C S l 1 Z FSb yvt�y. cS s . L
3 ZZ3 1• S Yl2 y Gr s l \ c S�1z Im� �S `l ' S
Ground
elev. �l 38 -�[S �.s �II2 yr F I g `tR s!� Sit C_Sbw wi I- • Z 3
7sn
Depth to
limiting
factor
Remarks:
CST Name. Please Print Arthur L. W e e r e r Phone' 715-425-0165
egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022
Sgnature: L1 q - Z$1- y Date: Z .� CST Numb 00 5 7 6
PROPERTY OWNER SOIL DESCRIPTION REPORT Y Page of 3
PARCELI.D.X _0 I0t9 -'q0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourx:13y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
9 0- $ 1 w -i �Z 31 Z — s i ( 2 - `Fs b ►+�` - \ P, - , 6
' Z g - zt o IotiFZ 3/(. — T I I Zw,S6k m C-S - . % .�
Ground Y! (/ l y R Sig `�s csbVz 41 'qt- Gw • Ll _S
elev.
3$ -V . S 4 fL y/y
Depth to '� w ►„ ti Lv �v v T Z6 ` 3
limiting
facctor�
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
1 3 1
Ground
elev.
It.
Depth to
limiting
factor
Remarks:
Boring #
�n
Ground
elev.
it.
Depth to
limiting
factor
Remarks:
SBD•8330(R.05/92) - --
. PLOT PLAN Pa of 3
SCALE I"= LI
EL- IrW,0' - ) " Vi1 OA, 31 PvC \ 01E w /LtM
✓ � s�vc _ �o ►no O 1 a 1��R )
FZ 4Y�S .s•9 6 ° �0
e,
B-
Cp n.lov � 2
BoZTom OF 8� gi
�t. 98•S
$S'
1 ms, 2s i
1 ; $•� _ _ _ _ - two NOT Cc" kcr O1Z
�. lioUSE 10 8E +'zT I.�RS Z S P�
Z. w tECt _ 4 �1 So'
3 . ri ��,.�,� ►,, L A 6' x 6 3 ' 8 Qb \s 2Cxco Pmt 3 �C�P cxs►�t Nv ►'-s�
y• F tT-) � t E LuT LfNes hi BE Rfi Lnrt3`T 5 ' �'1ZO►�l )j o Uk)� 3 . _
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�? �T1orJ stit� -N
4- 1— 3 -. Z 7- "l ( 715 ) 475- ()165 _ R 00576
CST Signature Date Signed Telephone No. CST #
JUL 23'98 11:05 FR CRAY 655F LOBBY EAGAN 12 683 5599 TO 917152735499 P.02iO3
Apr- Ot3 -Ol 07 - 31t� D. O1
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing AWress 740 2 ,0 0 - � ss'33?
Property Address .—
(Verifiation required from Pla WO9 Deparmmt for new const"Ictionl�
City/State � _ Parcel Identification Number
L KqAL D MPIMN
on
Property Locati SC Sec. _/ T -R W, Town of 1��' 41116f
Subdivision �� Lot #
Certified Survey Map # - 3t� _, Volume / Z _ Page #
Warranty Deed # — 57 D lv Volume _Z-3- — Page #
Spec house ❑ yes pia Lot lines identifiable P yes ❑ no
SYSTEM M !SCE
Improper use and maintenance of your septic system could result in its premature failure to haadlo wastes. Proper maintemaoe
consists of pumping out this scptic tank every three years or sooner, if needed by a Uomwd pumper What you put into the systean
coo affcct the function of tie septic tank as a treatment stage in the waste disposal system -
The pr perty own= agrees to submit to St. Croix Zoning Dcpara=nt a cettif cstioa fota, sigzsed by the owae r and by a
master plumber, journeymaaplumber. restricted plumber or a liccased pumper verifying that (1) the on -site wastewamdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the sepuc 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 Coatmcrce and the Department of Nattual Resou=. State of Wisconsin. Ce ff"tion
stating that your septic system has been maintained must be completed and returned to the St_ Croix County Zoning Offict within 30
days of c Ton date.
� I / DA__ TE QQ
A F APPLYC:
OWNER CERTIFICATION
I (we) c=fy that all statements on this fora► an true to the best of my (our) knowledge. I (we) am (arc) the owners) of
the pro "Z OVID y virtue of warranty deed recorded in Register of Deeds Office.
CSIC& AMUA F APPLIC DATE
asses* Any information that is Lois- tepsescnted may result iA the sanitary permit being revoked by the Zoning Department-
•• include with this application a stamped watraary deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
JUL 23 '88 10:37 PAG£.001
}
VOL 13213KU229
A. Lot 5 of Certified Survey Map filed March 4, 1990, in,
Volume 12, Page 3416 as Doc. No. 574320,. Register of
Deeds' office, St. Croix County, Wisconsin
B. A parcel of land located in part of the Southwest Quarter
of the Southeast Quarter of Section 16, Township 28 North,
Range 17 Nest, Town of pleasant Valley, St. Croix County,
Wisconsin, described as follows: Commencing at the South
Quarter corner of said section 16; thence N89056
655.48 feet along the South line of said Southeast =
Quarter; thence N00 °14 0 E 919.63 feet along the east
line of Lot 5 of Certified Survey Map, 'volume 12, Page
3416 as recorded in the office of the St. 'Croix County
Register of Deeds to the Northeast corner of said Lot 5,
being the POINT OF BEGINNING; thence N00 393_.53
feet to the North line of said'Southwest Quarter of the
Southeast Quarter; thence S89 0 55 1 46 11 W 560.04 feet along
last said line; thence S00 391.81 feet to the
Northwest corner of said Lot 5; thence "S89°53'43 561.44
feet along the North line of said Lot 5 to the point of
beginning. Containing 5.050 acres and subject to all
easements, restrictions and covenants of record.
t
_ i3
I
� a t
FILED
8 MAR 0 4 1998 ► 2
O KATHLEEN H. WAL
floplster or Deeds
® <C
7 I L L�
I„L, U S 3' U1)
I 4 tll o, - - - - - -- 1 D
❑ f 1
n -) WESI LINE OF THE SE1 /4 OF THE SWI /4 < __l
rY1
I � r - z z h_,, _u
r� J 1
N�.��J * 4 "� I �JO '�. OL5 ''''' FENCELINE (TYPICAL) --I ?j
ru FENCeUNE I5 fisT" 892.12' C', a• U ._
c_ I I Z 0.8' +/ FROM cur c; o � � - I�
V;
S2 67 (i a1 W t U) R __I " I 1- -i
I� iS `R • a e Hw I ►.) c aj 1:�r� (�1
cyl Cl U
r w Cu o q ( 0 u l Z �1
L7 892. /2' A A 0 W CA \ f'1
� O ^I +t-1 y 1T1 1 _j P Cij t�
31.80' ut5 i' 384.21'
rn -
_ 1
l 2 - - - -- r 5 -6"T- 9 0 4 , 33 - -'r-- — J n
y m _. _.. _ �`� 1 h 0 p 17
c) 31 508.21' 384.51 _'1m - 9
1. co 1 h-1
i 892. /2' w 1
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to Ib D�
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co
ra N00 *21'tw "E 923.46 `4� �� W I
� co 892.72' / rn
f c°
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Fri S01 1 39 E 595.36 D o g z° m
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p1 z ° c � mr, Z d �
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`i I - �o i� iV �7 ix yA �� n.
I� I U1 hl ; !�'I C) r 7 u 6 I C o
z A i� 1' 7 P LAS r INE OF THE IWl /4 r A '+ z
. z I +;� :1
o, (TI r l i W l T 1 v N c_ '20' 121 "E no
z c 52 � .32 ;u �_ z
WEST LINE ')F bit SE1 /4 --� ! z �
N — i N00'20'1 2 "E= 472.87'
rn
Cl (N01 "27'3U "w 4.,2:55') ' _j loll (A
V) c N01 �,51'u4 "I J� �.� r � W z
oi:; C
0) r� Z�+y
r> c D _ _ - -.... UU c7
r 1� i 29.1'2' 113.36 ��1 1
r rTI
c
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it m �r
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19.0 >' i 1 Z 1 + >Com
S00 1 4 1 5 IN 919.Q,5
t
n n FENCELINE IS Ktil, 0.6' +/- 1` D
z
f i FROM LOT CORNER
0, BEARINGS ARE REFERENCED TO THE
u) u. I- U.NPL 41 ED L.-1 SOUTH LINE O F THE SWI / 4 OF SECTION N
OL 16, ASSUMED TO QEAR S89'
volume. 12 page 3416