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HomeMy WebLinkAbout030-1006-40-000 "COPMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 - 715- 962 -3121 800 - 962 - 5227 ST, CROIX ZONING REPORT NO* *# 21155/01 PAGE �. ST. CROIX COUNTY RFPORT DATE. 4/20/92 COURTHOUSE DATE RECEIVED: 4/15/92 HUDSON, WI 54016 ATTN. THOMAS C. NELSON 3 OWNER. Kenneth & Verna Retherford LOCATION!: Hudson, WI COLLECTOR. M. Jenkins DATE COLLECTED. 4 -13-92 TIME COLLECTED. 2 PM SOURCE OF SAMPLE. Kitchen Faucet DATE ANALYZED. 4 -15-92 TIME ANALYZED. 2.00 PM Coliform Bacteria /100 ml *COLIFORM. 0 /100 ml INTERPRETATION. Bacteriologically SAFE Nitrate - Nitrogen, mg/L *NITRATE -N. 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. 9 10 LAB TECHNICIAN: Pam Gar►e Off. \NDEVENDFNT WI Approved Lab No. I7 Y V g < Means "LESS THAN" Detectable Level Approved by. ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ��.�/ i J g ) yti ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street C � Hudson, WI 54016 IV Telephone - (715)386 -4680 ~ C � The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private Completion of this form is essential 2 that the property can be located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. MATER TESTING--------------------- - - - - -- -FEE: $ 35.00 �✓�. O r7 (For nitr - --es and coliform bacteria) "ATER TESTING __._ FEE: $185.00 7 (For VOC' ! SYSTEM t'SPECTION ----------------- FEE: $25.00 ? 4 C (Determine if system is properly functioning at time of inspection PROPERTY OWNER'. NAME: PROP. ADDRESS: _ �,�,�� r��-L CITY Legal Desc i tion 1/4 of the . 1/4 of Section _!z T N Town of Lot Number Subdivision ZX FIRE NUMBER Z LOCK BOX NUMBER t 3l� � 106 - �� �?­ Color of house Realty sign by house ? so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A KAP j.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of resi::i =untial water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TE` "_ITNG: Many times water lines are turned off, or sill cocks a:. -•- - -,rued off, making access to the home necessary. 1 f this is .Case, please make proper arrangements with: ;ia office t. - °e time when entry may be gained. Firm or iaual requesting services: Telephone i <,zmber ___ -_ -- REPORT 1 1, , SENT TO: CLOSING^ ' EAST ST JOSEPH - PART , T. 29 - 30 N: R. I 9 W, ai 0 isorN I SEE PAGE 5 p /20 'hwi /eR Ne /ene A. p'\ d Ho. and . e/ i, •'O3' 9 90 • flav /e .p tl I F , �7°n F: a ci r/s. �a-, • 40 - Pua ran' Be !:, 4 V t � 13::::: 39aT 96.r �4R /GN f Tud fh eo!!qq/nG t7er y � w 262.42 VALI • e : N h urid 4 Edward o.�7 •79 S$ujeffe jr . s s d•� d h w oC_ onfa9 �7ohn r e N " n�h Hendnk d o Z• GEOry /ire y.. e n �a f t7ohn W k S '+ Schott /e elT� b /ib fb a y' 3vj� l/an Dyk e AS ars /40 L os. 5• 2 s f ro b ch j •' a os Ei'ic.Ewniff{ 94r �] ��n9 R, JJ.9 /9a W Da vdH,a o Q zoo p� h rank - a k s $Arks • R !sG¢cF Ce. rvffM Z C � y =� bo.d3 w t n 0 W A4 v `�....' . ie-.� SiiJi t:l �K. Rs / ✓f ./we Mary E. � yy t� t,7 .2.'.•CT3'T25.96 v TRrAC f - •1. w � K F� � �j � m/nett 9' E's ' ° J ar V E E / µq,zt & C e' K gQj �:0 Mgaret r /u. f9 Qti acv; n`� Ta ") w b 9ness A /SSO3 117 _N ®' a-hnf r N '9 h ` h en / e E /eanore Mur- tl t i I ,Ei - own E P y T c.' poN:nfvosc::. sK .Z - ! 1 9y�S F � 1 � Nv n$ / /v. JO i a• i"'� rw� :: ta'r .. Y y'S 4p 'oE>arx 'sG :::.:... i ... ♦ . :.R4: �o . yaii' �n moo. rd ass tV F Er tiara £Nancy amen _ E RJ is ' Mi /es Ha»�k %r+�sorr Durnin9 292 t W i 57 AS' 70./4 /YS •6B4 � � �, e� r ✓a/erie � eneP y�/ �7°t0 T. yam " Eb b ra. T Oy r R /chard 9 9S./2 rJ AA/ L. N. . 4o an Phi /ippiAe � • u �. N "��'Wrsccrifin, Beer /� { gf Nasrrrdgw fL PONa m tad v WILLOW, RI VER tr�nt,:, c %6, a SnC. /T4rn4S 4 STATE PARK s X c�'o� j URK 440.a3 o Hartinon W /2o b O ILLS L. cl ce O_ g� /c, z ,i �.s; /42� � , e I strucl ©/99/ Ro ord Mo Pub/sI c. SEE PAGE 27 l7" cSt Crox Corw'a�{tri6. i� 500 600 700 800 900 i `I • ,I i NEW RICHMOND PREPARE FOR THE Reinstra y GRANITE WORKS F rru , Van D k MONUMENTS - MARKERS I IN Xfl &Needham, S.C. BRONZE PLAQUES GENERAL PRACTICE OF LAW 246-20 L. R. Reinstra - Hendrik W. Van Dyk I Scott R. Needham NORTH JUNCTION 5 201 SOUTH KNOWLES HIGHWAYS b4 & 65 NEW RICHMOND, WISCONSIN NEW RICHMOND 246 -6806 i ., yt ,� ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET 0 HUDSON, WI 54016 (715) 386 -4680 Apr. 15, 1992 Kenneth Retherford 1114 Mound Dr. Hudson, WI 54016 Dear Mr. Retherford: An inspection of the septic system on the property of Kenneth and Verna Retherford, located at 1114 Mound Dr., Hudson, WI was conducted on Apr. 13, 1992. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Si,rely, Mar J. i Assis a t Zoning Administrator cj SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LAE40RATORY ANALYSIS REPORT NO: 21134 PAGE 1 04/27/92 St. Croix County Zoning DATE COLLECTED: 04/13/92 4th Street Hudson, DATE RECEIVED: 04 /14/92 !fudson, WI 54016 COLLECTED BY : CLIENT DELIVERED BY : CLIENT Attn: Mary J. Jenkins SAMPLE TYPE DRINKING WATER SERCO SAMPLE NO: 27942 SAMPLE DESCRIPTION: Ruther- ford ANALYSIS: VOC ------------------------- - - - - -- -- - - - - -- bromodichloromethane, ug /L <0.2 Bromoform, ug /L <0.5 Bromomethane, ug /L (Methyl bromide) <1.0 Carbon tetrachloride, ug /L <0.2 Chlorobenzene, ug /L <1.0 Chloroethane, ug /L (Ethyl chloride) <0.4 2 Chloroethyivinyl ether, ug /L <0.4 Chloroform, ug /L <0.5 Chloromethane, ug /L (Methyl chloride) <0.6 Dibromochloromethane, ug /L <0,4 ( Chlorodibromomethane) 1 ,2- Dic.hlorobenzene, ug /L <1.0 ( o - Dichlorobenzene) 1 ,3 - Dichlorobenzene, ug /L <1.0 ( m - Dichlorobenzene) 1 Dichlorobenzene, ug /L <1.0 ( p - Dichlorobenzene) Di chl orodi f 1 uoromethane, ug /L (Freon 12) <0.5 1 Dichloroethane, ug /L <0.1 1,2- Dichloroethane, ugfL <0.2 (Ethylene dichloride) 1 , 1 -Di chl oroethene, ug /L <:0.2 trans 1 ,2 - Dichloroethene, ugfL «.1 <. -. < 1 , 2 -Di chl oropropane, ugfL <0. 1 �:: '4/0 4L V � cis -1 Dichloropropene, ug /L <1.5 trans -1 ,3 - Dichloropropene, ug /L <0.9 < means "not detected at this level ". 1 mg = 1000 ug. Member SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 21134 PAGE 2 04/27/92 SERCO SAMPLE NO: 27942 SAMPLE DESCRIPTION: Ruther- f ord ANALYSIS: VOC ---------------------------- - - - - -- -- - - - - -- Methylene chloride, ug /L <5.0 (Dichloromethane) 1 , 1 , 2 ,2 - Tetrachloroethane, ug /L <0.2 Tetrachloroethene, ug /L <1.5 1,1,1 - Trichloroethane, ug /L <5.0 1 ,1,2 - Trichloroethane, ug /L <0.1 Trichlorofluoromethane, ug /L (Freon 11) <0.7 Vinyl chloride, ug /L <1.0 Benzene, ug /L <1 Ethylbenzene, ug /L <1.0 Toluene, ug /L <1.0 Trichloroethene, ug /L <:0.4 This sample's analytical results area {, below the U.S. EPA's SDWA Maximum Contaminant level of 1/30/91 for those requested compounds which are also on the SDWA MCL list. < means "not detected at this level ". 1 mg = 1000 ug. Member SERCO Laboratories 1931 West County Road C2. St. Paul. Minnesota 55113 Phone (612) 636 -7173 FAX (612) 636 -7178 LABORATORY ANALYSIS REPORT NO: 21134 PAGE 3 04/27/92 All analyses were performed using EPA or other accepted methodologies. Samples that may be of an environmentally hazardous nature will be returned to you. Other samples will be stored for 30 days from the date of this report, then disposed of by SERCO Laboratories. Please contact me if other arrangements are needed. This report may not ne reproduced, except in its entirety, without prior written approval from SERCO Laboratories. Report submitted by, Diane 3. Berson Project "tanager C means "not detected at this level ". 1 mg = 1000 ug. Member ST. CROIX COUNTY ZONING DEPARTMENT, AS BUILT SANITARY REPORT a 1 Owner - TI Property Address 11 14 M au N 2 City /State wb s oN w S1 U1 L � Legal Description: Lot Subdivision/CSM # Sw '/4 S U t /4, Sec. �, T 9 N -RA-W, Town of S of �, PIN # 0 30 - IUc - 140� � SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer � Q � k� Size ST/PC I o�u — / 80 0 Setback from: House Q'�T Well >S�' P/L 7S� Pump manufacturer Model �� w► .D c u J e_ Alarm location a A (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: 11� M1 ur` Width — Length � S Number of Trenches _ Setback from: House L' Well 756 P/L �_ Vent to fresh air intake S U ELEVATIONS Description of benchmark a^� °�► u °� �� S t b "" , S W Elevation Nu o Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet 0 $a PC Bottom ?fie -9 Header/M Top ofq�2C Manhole Cover Distribution Lines ( ) I — Y ) - W p S 1�. VO OrLu�+ l 'P it Bottom of System ( 0- O 3 0 u O Final Grade 1 7 . 0 0 �-) 7 U 0 ( ) Date of installation g /aa 9 $Permit number 31 S I S l State plan number - Plumber's signature �! License number Date 3 /( / 4 Inspector o a �S ` ►'� �4�— Complete plot plan � Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Box a�s N*6consin In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 63707 -7969 Department of Commerce • Attach complete plans (to the county copy only) for the system, on paper not less Count than 81/2 x 11 inches in size. State Sanitary P e!t Number • See reverse side for instructions for completing this application 3 t t m be used b other g overnment agency programs E] Check if revision to previo a lication. The information you provide y y 9 � J [Privacy Law, s. 15.04 (1) (m)). �► 1 State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pr y O er Nam Property Location A 1/4 1/4, S v2 T , N, R E (or Property Own r' ailing Add ess Lot Number _ Block Num I , Stat Zip Code Phone Number Subdivision NamQ o CSM Number ,fir ( -) i II. E F IL ING: (check one) ❑ State Owned - !t� Nearest Road ❑VII age ��11 Lj Public 1 or 2 Family Dwelling - No. of bedrooms — 3 Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a / 7 , 2 T .��. 7 7— G 1 ❑ Apartment/ Condo 10 2 [] Assembly Hall 6 C] Medical Facility/ Nursing Home Outdoor Recreational Facility 3 F1 Campground 7 _ E] 11 Merchandise: Sales/ Repairs ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ 12 Mobile Home Park ❑ Service Station/ Car Wash 5 Q Hotel/ Motel 9 ❑ office/Factory 13 ❑ Other: specify 1V. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) New 2. eplacement 3. [] Replacement of 4. E] Reconnection of 5 ❑ Existing o 5 stem '°`) 1 [3 New Existin S stem -------------- _ _g_y_ -__ - --- -- S stem S_stem -- Y ------------ - - - - -9 Y - - - -y-------------y--------------------- 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 Q Specify Type 41 ❑ Holding Tank k 22 In- Ground Pressure 19 1 . —t 42 E] Pit Privy 12ESeepage Trench '�;��.j � ab`�P/ ❑ 43 ❑ Vault Privy 13 E] Seepage Pit 14 ❑ System -In -Fill gj 1. rC, tC VI. ABSORPTION SYSTEM INF RM ION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Sys em %Iev. 7. Final Grade Required (sq_ ft.) Proposed (s . ft.) (Gals/day /sq. ft.) (Mi . /inch) �''f VY,0 Elegati r� (,,,/ ! u Z- �,GtJ Feet tt�ti t(� Feet VII. TANK Cap City Total # of site Fiber Exper. in gallons Manufacturer's Name Concrete Con- Steel glass Plastic App INFORMATION New Existin Gallons Tanks structed Tanks Ta Septic Tank r t a I�'�w ea J ❑ 11 ❑ ❑ ❑ ank C1, DQ �� ❑ ❑ ❑ Lift Pump T ❑ ❑ Vill NSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum is Name: int) Plu ber's Si at tamps) MP /MPRSW No.: Business Phone Number: J 1_ a -a 7/ -. � - 9oa d Plumber's Address ( treet, City, State, Zi Code): ,16 IX. COUNTY / DEPARTMENT USE ONLY sa Sanitar Permit (includes Groundwater ate ssue Issuing Agen gna re (No Stamps) [] Dilip rOVed � Approved []Owner Given Initial r & Fee) /`� �� it F Surcharge � � Adverse Determination l v X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: X � W . -to lie. aba�el on er✓t �' cc�c1, ` DISTRIBUTION: Original to County one copy To: Safety a Buildings Division, Owner, Pk MAW SBD -6398 (R.11 ' Safety and Buildings Division • SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. N ) L consin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box I 53707-7969 Department of Commerce Madison, W W • 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. f roi • See reverse side for instructions for completing this application State Sanitar'Perr�t number The information you provide may be used by other government agency programs El Check if revision to prevlou application [Privacy Laws. 15.04 (1) (m)]. ( f i (__/ State Plan L D ^ Numb�er ,_�„- L APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION yv0er N 1% / Property Location Pr y o ! T' j J0 1/4 $ 1 /a, S,( T v ? - , N, R E (or Property wn r•' ailing Add ess �r Lot Number Block Num C St at / 0) ]'' Zip Coe Phone Number Subdivision NamQo CSM Number y � 60 ( ) �r II. YPE 0 F BUILDING' (check one) ❑ State Owned 0 !t Nearest Road ❑ Wllage 'LL Public 1 or 2 Family Dwelling - No_ of bedrooms Town OF �.�T Jo III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 El Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant / Bar / Dining 4 ❑ Church/ School 8 F1 Mobile Home Park 12 E] Ser vice 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. ❑ New 2 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System ________system -- n — ly______ ________ Exl - -- - ___ - ___ p Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check,.only one) Non - Pressurized Distribution t " Pressurized Distribution Experimental Other 11 E] Seepage ~ Bed ' 21 F1 Mound 30 E] Specify Type 410 Holding Tank 12.fSeepage Trench Z S'l i tfui 22 ❑ ln- Ground Pressure • _ � � 42 ❑ Pit Privy 13 Li Pit / 43 ❑ Vault Privy 14 ❑ System - In - Fill 4 C / Si r It tj i n Gt ri �/'► a. Ts'1►�` a '"^ e'�'� VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. • Sys �r yev. 7. Final Grade t.J Requ'r� sq. ft_) Props (s . ft.) (Gals/ ay /sq. ft.) (Mi /inch) t1� El �Yat� Q U :4+� j 3.WFeet P e, i7 Feet VII. TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con_ Steel Fib ss Plastic Ex INFORMATION New Existin Gallons Tanks Concrete strutted g Tanks Tanks t Septic Tank —Re"""r- I p�u ! s� J ❑ El Pump Tank Qk' l V NSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. } Plu is Nam nt) Plu er's Sig�at tamps) MP /MPRSW No.: Business Phone Number. �� J]�f�{,�f Plumber's Address ( treet, City, State, Zip Code): /070 w Al 6A) Gtr / IX. COUNTY / D PARTMENTUSE ONLY El E D Sanitary Permit Fee (Includes Groundwater ate Issuing Agen gna re (NO Starllps) Approved ❑ Owner Given Initial /`� 00 Surcharge fee) Adverse Determination P V ov B � �u X. CONDITIONS OF APPROVALY REASONS FOR DISAPPROVAL: S��- w 4o b i cbOt. l ovi ec ( yeti is oc`) e DISTRIBUTION: Original to County, One copy To:. Safety & Buildings Division, Owner, Plumber SBD- 6396 (1111 A ,h L . r. •.. ra• • •....w w.w NA M E E ,S�11 R� StlNe Srh�'t 1...... NAM ION PL • � n' 1.:1 �'` �.�: 1 9..x._ .._.. _...._ • W e 11 iti f i n, ��u� • 3 • fu� '•• G f\ Soo Puw lr � � ys� c � >D • _ � 1 d � I iR( p �. • Ai_/ b Bo • �'T�L�c dal R�}} �'°"�' d 8 , of S;a�N k S W T 1 S I • _ -ate � Q w ,,. h p Syr P) NZ 1'u • i ; ;� cN G( P O ,. �_ Qa i FRESH AIR INLETS AND OBSERVAPIQH PUB CROSS SE CTION (� - Approved Vent Cap k Minimum 12" Above wp Gtc pw •' a s N Final Gra ��__ •_ 4" Cast Iron Above Pipe Vent Pipe To final Grader "" PRIVATE SEWAGE SYSTEMS - II PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4 "C.I. VE!UT PIPE WEATHER PROOF APPROVED LOCKING Z! ARCM DOOR. JUNCTION BOX MAWHOLE COVER � wuJCCW CR FRESH 12 "MIU. I AIR :PU7AKE GRADE ( 4 MIN. CONDUIT -- _____ - \ -- 18 "MIN. �� ---- - - - - -_ 11� INLET PROVIDE I - - - -- AIRTIGHT SEAL I I I I V APPROVED JOINT/ A I I APPROVED .;OINTS W/C.I. PIPE I III W /C.I. PIPE EXTENDIAIG 3' I II ALARM EXTENOIUG 3' OIJTO SOLID SCI L_ B 1 ONTO SOLID SOIL ON C ELEV. FT. PUMP -� -'� OFF 1 0 CONCRETE BLOCK RISER EXIT PEP.MITfED GNLd IF TANK MA.AIUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFICATIOUS OOSE I j `TANKS MANUFACTURER: ee NUMBER OF DOSES: PER DA TANK =•IZE: $Joy _ GALLONS DOSE VOLUME / INCLUDING BACKFLOW: �' ALARM MANUFACTURER: - J ���e���C —GALLONS MODEL ►DUMBER: 101 lair? CAPACITIES: A = INCHES OR Y4R'�D GALLCAIS SWITCH TYPE: h1 IL(4Anl B= INCHES OR 3!`�` GALLONS PUMP MANUFACTURER: �u��ICI� C= -- T iNCHESOP, f7 5 =y� CA_k.ONS .'MODEL NUMBER: © D = INCHES CR 7 L S GALLONS SWITCH TYPE: ` NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM rINSffT,,ALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE.. / -V FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET IF + _ FEET OF FORCE MAIN X 3 ZooiT.FRICTION FACTOR ° �' a S FEET T07AL OyNAMIC. HEAD — FEET INTERNAL. DIMENSIONS OF TANK: LENCaTH ;WIDTH ;LIQUID DEPTH W SIGIVEC: LICEUSE NUMB. R: �� DATE: Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance 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 point (BM), direction and ST- G R O I percent slope, scale or dimensions, north arrow, and locatiquand distance to nearest road. Parcel I. D. # 030 AoaG 4/0 APPLICANT INFORMATION - Pleas p,1►'a/l mrmation.. Re iewed b Date Personal - information you provide may be used fors oud pu aw, s.1,�,Qg 1) (m)). Property Owner arty Location • ', +.0 ' /f fT E'_I' . Lot s(,(, 1/4 S40 1 /4,S Z T Z! N,R �9 E (or W Property Owner's Mailing Address m � .? CROX L°ot Block# Subd. Name or CSM# City State Zip Code `, Phone umber °`• Nearest Road fjlU��D�J 4l / • Syo t(o �fir -��"'' CitYS . El villa e L"J Town M O!>OD :DP- El New Construction Use: L_I rtesidential / Number of bedrooms Addition to existing building �aplacement ❑ Public or commercial - Describe: ^/ /,� = /VOT /?, IGD14/lq Code derived daily flow gpd . 6 2 Recommended design loading rate bed, gpd /fi ? trench, gpd /ft Absorption area required n %x bed, ft 7 trench, ft . Maximum design loading rate bed, gpd /fl , ? trench, gpd 1ft Recommended infiltration surface elevation(s) S --40�0- • 3 ft (as referred to site plan benchmark) Additional design /site considerations s� T /P�¢U/ mss' L jCT o0Vi910 Gfc Parent material �(9�Wi¢� oy.Gt� l�ll lQ .�1 jJ�,�_ Flood plain elevation, if applicable N ft F U: Suitable for system Convent' nal _M,.oundd In -Ground AAT -Gra e System in Fill Holding Tank Unsuitable for system U Lrl'S ❑ U LA'S ❑ U L•-S ❑ U I ❑ S ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots 1 6 J/4 2,/3 Bed Trench 2 - 2 1 0YX 3/3 G S i f ,e s 1 40 Ground -3 � 7' O o z. /O yje S1 6 f�rJ s d r _ elev. q N. eft. Depth to , `�. mm F �d /y� E` �OU—v �� limiting p lf7 n } factor Remarks: Boring # / •/3 L10 3/ — LS .,� �wUfiE' S /� . 7 Z , ye G S / S f --2 .8 Ground —�P, G��P .tJ Q �d elev. 0 1G • ft. //o " } ev Depth to ! limiting factor 6' 0— in. Remarks: CST Name (Please Print) ROBLmR t ZfL82 iC r Signature Tole hone No. 17 Gt � 71 S • ��G Address Date CST Number � �b�d Si�1� �,r�T /,✓ �r NV O _ GD Mp if S ' �s ICE 2 TA . TMC ��fl ti° °cam �pNt� 33 lbv f k o, zo L 36 3 P6 16 IZ V) 02. FA 3 o a N // LY. m o c 5 1 o cv T RF'o f3, 0 /oOs T sZ!� T N Ftx) ct: Pos 7 �� lair = �-wi_ -I s-/ y y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer I Z Mailing Address I q M N D V�OS �O I Property Address �yyl (Verification required from Planning Department for new construction) City/State U o!JS(m) ( 1 Parcel Identification Number DEGAL DESCRIPTION Property Location r c l ,, � ,, Sm- T-QU N R 21 W, Town of Subdivision Lot # Certified Survey Map # Volume - Page # Warranty Deed # 1- l''. 3 2 9 7 Volume Page # Spec house ❑ yes ❑ no Lot lines identifiable yes ❑no SYSTRM:MAINTENANCE ooasistso use and maia nanoeofynursepticsystemcouldresultinitsPrematmfi ffunetohandlewastes. Pig oat the septic teak every throe years or Pmpermai�aanee can affea-dw fimc - on of the if needed by a Licensed pumper. What you put into the system septic tank as a treatmeatStage in this waste disposaisystem master The Pr'�P�Y owner agrees to submit to St C WiX Zoning Department a caffieatioa f the - owner. and a i °wm phmd ror a licensed �' P - Ply restricted hY is is Proper gating condition and/or (2) after inspecti�oa and brat ( the oa =site wastewaterdisposal system. P�Pmg.(if necessary), the septic tank is less than 1/3 `full of sludge. U ff the mdersigrLed have read the above regard and agree m maintain the private sewage t%APPUCA9T by Department of Commerce and the g System with fire standards o Department of Natural Resources State of Wisconsin Certification da of �� o b n maintained must be completed and to the St C� oix.Couaty Zoning Office within 30 / / 99 DATE O ERT ICATION I (gre) ce that all statements on this form are true to. the best of my (our) knowledge. I (we) the owner( of () P d above�b virtue of a warranty deed recorded in .Register of Deeds Office. am are q SIG OF CANT' 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