The URL can be used to link to this page

Home My WebLink About030-1040-20-300 S'I'• CROIX COUN'T'Y ZONING DEPAR`T'MEN` ' 8 � AS RUILT SANI'T'ARY IREI'OIt 'I' M,I t r 'Llelme s ta y x Address i?o x 13& City /State 1-/ d ra r, LAl i . t yo 1 G r N90 a sr C— Legal Description: -" Lot _ Block Subdivision/CSM it 5 - 5 y,5 J vv� 12 '/• -SI✓ '/, S t✓ , S ec. Lt, T N -R 1 j W, Town of c c o e. J - PIN it SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer 4-19165 t Size ST/PQ GS USetback from: House 4 13 Well 44- P /L Pump manufacturer Model .S 3 Alarm location _ 13 t l t ` t ; 13B (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: M& h d Width Length Number of Trenches l Setback from: House 3 U Well P!L 2 U ' Vent to fresh air intake ELEVATIONS: Description of benchmark _Ct � I H 5 �. 3�`( p k , A /' v c, / Elevation / 6 Description of alternate benchmark t &4 6 1.3 /c G !( Elevation Building Sewer ! o l , ST/HT Inlet 6 1 ?- S U ST Outlet- PC Inlet PC Bottom 9` ._t S- Header/Manifold t' 1 Top of ST/PC Manhole Cover ,l 4 S , v s Distribution Lines ( ) )U k 7 ( ) ( ) Bottom of System( Final Grade ( ) ( ) ( ) Date of installation fb 00/ Permit numbcr 3 9U 2 2 r State plan number 1 3 3qs r� Plumber's signature ..`t,.,, License number _2 21 c1 D S Date Inspector )?"d conipicic plol (hail a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitaPerr2$t2No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3 Permit Holder's Name: p City ❑ Villa e Town of: State Plan ID No.: ILLER, SAM ST. JOSE CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 1040 -20 -300 9� Z 0 / 1 7. Z tf Z 030 TANK INFORMATION ELEVATION DATA A9800418 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Y►�GCa�- Iowa Bench !� Ij% ?OIS lo$ 1 q?. Z_ Dosing OYw6�� GSa .414.6m. f .�8 106• Aeration Bldg. Sewer 6a /. Holding t 0 Inlet °l • G/ g$; TANK SETBACK INFORMATION St /Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake eptic , 50'� A 3� ` u NA Dt Bottom / - 6 S Z e in rr - b ' NA Header / Man. 3 e'oi. 7 - C ation NA —Dist Pipe ( -y ( (p - 7 Holding Bot. S stem 'j, p(o Ci�� pc, PUMP/ SIPHON INFORMATION 3o N, Final Gr e Manufacturer Demand oc> S/. yy/,* Model Number 2S' GPM TDH Lift ( L �� System2� TDH Ft j oss Forcemain Length �� ' Dia. HH �� Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � L I7 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man f SETBACK urer: INFORMATION Type Of CHAMBER Mod um Systern4ma ,w +/ v 12 N 6t � OR UNIT DISTRIBUTION SYSTEM +' Header/Manifold Distribution Pipe(s) / x Hole Size x Hole $pacing Vent To Air Intake Length Dia - IL Length 22 Dia. Spacing 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.) 7, �f•oY 8'• q.67 67 ,7.o(, l Dp. 0!; �'an ,✓ LOCATION: ST. JOSEPH 19.30.19,SW,SW 1425 CTY RD V — LOT 5 g lLf-O A- C It n0f ; rg >a et � � �, p --- O *� YrG U! r'G�r S� r�J � b v jars ° � y I Plan revision required? ❑ Yes OdNo Use other side for additional information. SBD -6710 (R.3/97) Date InspectoA Signature ert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Asconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attaeh complete plans (to the county copy only) for the system, on paper not less County 4 r . than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application o fate Sanitary Permit Number Personal information you provide may be used for secondary purposes (� 1 i E] Check it revision to pFevious a pplication [Privacy Law, s. 15.04 (1) (m)]. q a 5 cly •` V • State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 1335 Prope y Owner Name r Propert Location czN? ✓�/ l�e e C� r��R Koh.cS $ w/ Zia, S /� T 3U . N, R � g r) W Property Owner's Mail' Address _ Lot Number Block Number W. � s City, St i Zip Code Phone Number Subdivision Name or CSM Number 4ClS6n �J. 3 4161 & ( > 1 3Z II. P F B ILDING: (check one) E] State Owned !t I Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 in Town of St �J use Cz` V III BUILDING USE (If building type is public, check t all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 1q 30 . ` ` lt. 14 t o- 1 d 3 V —1 U U Z v goo 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 Ig New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 M Mound 30 C] Specify Type 41 ❑ Holding Tank 12 E] 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.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation S v '� ? ( � 7 (P / , G Feet 1 Feet Cap acity VII. TANK i Ca allo n Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanksl Tanks eptic Tank or DGV c d c..� r-n ❑ ❑ ❑ ❑ ❑ Pump Tank 65 ❑ 1 ❑ 1 ❑ I ❑ ❑ VI11. ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb s Signature: S mps) PRSW No.: Business Phone Number: 7 S'd � a G q /5" G ff - 2 2 �L Plumber's Addretreet, City, Sta a Zip Code): S X1 S 1 2Z G 4-11 '#, PAZ G C d u c ��l &"/"S- j eto 2 S/ Jr IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee (Includes Groundwater ate I ssued Issuin gent Signature (No Stamps) roved Surcharge Fee) q pp ❑OwnerGivenInitial 2�0 q A Il 6B Adverse Determination /OCR X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to county, One copy o: Safety & Buildings Division, Owner, Plumber Safety and Buildings 15837 USH 63 HAYWARD WI 54843 -8107 isconsin Tommy G. Thompson, Governor Department of Commerce William J. Mccoshen, Secretary August 15, 1998 CUST ID No.267341,` .' A WEGERER SOIL TESTING & DESIGN 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 Wn - RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/15/2000 ��• Identifica azt Numbers. Tia saction ID No. 133546 Site ID No. 157450 SITE: 'Please refer to both idedtifietzon nunxb, Site ID: 157450 above, in all correspondence," th the:ageney ST CROIX County, Town of SAINT JOSEPH; CTH N SWl /4, SWIA, S19, T30N, R19W SAM E MILLER RES MOUND SYSTEM CTH N FOR: Description: MOUND Object Type: POWT System Regulated Object ID No.: 416784 P• Con The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes AP P and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in DEPAR M chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. DIVISI This plan approval is for a 450gpd mound. SEE COF The following conditions shall be met during construction or installation and prior to occupancy or use: • This plan action is subject to designer comments on the plan • Correspondence Note: • Maintain well setbacks per Comm. 83.15(4) & 83.10(1). • Bury sewer per Comm. 82.30(11)(c). 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 08/05/1998 Get FEE REQUIRED $ 180.00 TOM BRAUN, P N REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ . 0.00 (715)634-3026, M - F 7:45 AM TO 4:30 PM TBRAUN @COMMERCE. STATE. WI. US Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE S W 1/4 OF THE SW 1/4 OF SECTION 1 ,T 30 N, R W, TOWN OF %r. Sr. e-mlx COUNTY, WISCONSIN. INDEX PAGE 1 •of 6 TITLE SHEET ).W.T.S. PAGE 2 of 6 PLOT PLAN lltionall - PAGE 3 of 6 PLAN VIEW -CROSS SECTION. ROVED , PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PA GE 5 of 6 PUMPING CHAMBER -NT O COMMERCE PAGE 6 of 6 PUMP PERFORMANCE CURVE AFETY A* BJWD INGS f� .RESPONDENCE PREPARED FOR c l o � � L��Z �'vx -► � S L�1QJO7v, w� 5yot6 PREPARED BY WEGEFtER SO = L .TESTING . DES I GIV AN I CE �� \scO F.O. BOX 74 421 N. KAIN ST. : •• .s L RIVU. FALLS. NI 54022 ARTHUR L WEGERER T15 -42`, -0165 s DA15F WJ • E °1MORTM, •, �� t � f hMNis�' JOB NO. C t 9- la3 - S PLOT PLAN Page - Z- of Scale 1 "= �jp ' LvT LI n w\ \ LIKX or Sw "q- SW I 1,f G� G co�+slRu e`nutiv 1�ME O w� tv 2 3 w 'M \aE AT LeA So ' � I o � J I� i f- n I 13. V 3/q �p ►v0�- tPrteT o1Z ti r„� a.l da y 1 �F B� \a�vRn S Et. NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (__q_ required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be \ OOp16so gallon capacity manufactured by 5 . Bench Marks S � "DU F 6. Divert surface water around system to prevent ponding at the uphill side- Page Approved Synthetic Covering C- 33 Distribution Pipe Medium Sand Topsoil :- F Elev. . 1 p \. O —�� D 3 E " � - f„ „ b 6 % Slope Bed Of J %2 Force Main Plowed Aggregate From Pump Layer D \•o Ft. Cross Section Of A Mound System Using E k -Lb Ft. A Bed For The Absorption Area F 0 - Ft. G \_o Ft. • A 3 Ft. H S Ft. Linear Loading Rate= q- GPD /LN FT B C� Ft. Design Loading Rate =a -y .GPD /SQ FT Ft. o Ft. K Ft. Ai ee Position L 6 9 Ft. of Force Main W 3� Ft. L n � Observation Pipe $ �, K � ---------------- - - - - -- -------------------- W 10 -- 1 ------- ----- --- - - - - --I Fin Distribution Bed Of 2" 2 2 Pipe Aggregate I Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page y Of _b Perforoted Pipe Detoll 0 End View ) Perforated End Cap � PVC Pipe 1. n Install permanent marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S P PVC Manifold Pipe PVC Force Main Distn ution Pipe Lost Hole Should Be I Next To End Cop End Cap P 1 Z Ft. Distribution Pipe Layout S y Ft. X Inches _ Y u Inches Hole Diameter. /1 y Inch Lateral Inch(es) Manifold Z Inches Force Main Z Inches # of holes /pipe � Invert Elevation of Laterals lttl•S Ft. y Place lst hole --4 from center of manifold with succeeding holes at " intervals. Last hole to be next to the end cap. Combination Sept4c; Tank and • PUMP CHAMBER CROSS SECTIOU AMD SPECIFICAT101US ' PAGE S . OF VE T CAP WEATHER PKOOF JuUCTIOIJ BOX . ti VENT PIPE APPROVED LOCKMIG lO' FROM DOOR. MAWHOLE COVER rv11M �iIUDOW OR FRESH LR wA1r2 rJIIJG LI46EC.. A IMTAKE s cosacutT �. x,03 � rG M161, IGttl� i L.. . I ,� le•Mlu. fj PIPt PROVIDE I - - -- I/JLET AIRTIGHT SEAL 3 e�FFL�S A I III APPROVED .IOIWT: APPROVED J011,1T W /C.I. PIPE "C W /C. PIPEOP'm Tank construction I' II ALARM shall comply with I II ILHR 133.15 and 33.20 B I I I I Ow C I I ELEV. q y_�1S FT PUMP � _ _J OFF D C0UCRETE 5LOCK APPRC61 RISE EXIT PERMI'TT'ED OULy IF TAUK MAIJUFACTLIR�R HAS SUCH APPROVA1 gCQp SPEGIFICATIOKIS SEPTIC f DOSE M A�IUFACTURCR: IJUMESER OF DOSES: 3 ' Z IO PER D" TAWK SIZE : ��UO 1650 GALLOWS DOSE VOLUME I ALARM MAW U FACT URC.R: S J )MCI- UDIMC, OACKFLOW � GALLONS MODEL IJUtABER: �O Hw CAPACITIES: A= 1 I OR 3 0 GALLOU5 SWITCH TYPE: ��' �� 9 = � IUCHE5 OR G(LLOUS PUMP MAWUFACTURCR: - 04- C= 9 IUCHE5 OR S GALLOWS MODEL NUMBER: S3 D- INCHES OR S 3 GALLOWS SWITCH TYPE: WEE- cuitLf MOTE: PUMP AUD ALARM ARE TO 5E 6 MINIMUM DISCHARGE RATE 2'f3 k)b GPM INSTALLED ON SEPARATE CIRCUIT5 VERTICAL DIFFERENCE DETWEEU PUMP OFF Au0..D15TRIBUTIOU PIPE.. 6.1S FEET H-- MIIJIh1UM ►NETWORK SUPPLY PRESSURE ; .. - 2-SO FEET + � FEET OF FORCE MAIN X �'� F � FRICTIOU FACTOR.. �,�5 FEET 100 F i. TOTAL 09VJAMIG HEAD = ' FEET DIAMETER Pump chamber I&ITERLIAL. DVALWStOFJ� OF TAWK: LEM&TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231= GAL /INCH AS PER MANUFACTURER = X 1.0 GAL /INCH rn 3 15/16 6 5/32 6 �~ BEAD CAPACITY CURVE "53 - 57" - "55 - 59" SERIES a s/a 1 1/2 -11 1/2 NPT 2s TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE } 15/16 EFFLUENT AND DEWATERING 6 — 50SERIES � — Ft. Meters Gal. Ltrs. 4 1/16 x U 15 S 1.52 43 163 Q 4 to 3.05 3s 129 15 1.57 19 72 I I F 10 LxY V•Ne: .19.25' O F 2 5 70 1/16 0 U.S. GALLONS 10 20 30 40 50 I 3 3/32 LITERS 0 80 760 FLOW PER MINUTE 5 sK•se 1006 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Available with special cord lengths of • Variable level long cycle systems available. 15', 25', 35' and 50'. • Alarm systems available. • Duplex systems available. SELECTION GUIDE Stand cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required. Standard cord leng - non - automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0447. M53155 and 57159 Series Control Selection 3. Mechanical alternator "M -Pak" 10 -0072 or 10 -0075. Model Volts Ph Mode Amps Simp Duplex 4. See FM0712 for correct model of Electrical Alternator, E -Pak. M53155 & M57/59 115 1 Auto 8.0 1 or 18 7 — 5. Variable level control switch 10 -0225 used as a control activator, with E -Pak (3) or N53155 N57159 115 1 Non .0 or & 6 3 or 4 8 (4) float system. D 53155 & D57/59 230 1 Auto -4.0 1 or 1 & 7 — E53f55 & E57/59 230 1 Non 4.0 2 or 2 & 6 3 or a & 5 6. Four (4) hole J-Pak, junction box, for watertight connection or wired simplex or 2 pump operation, PM 10 -0002. 53 Series - Wt. 22 lbs. 57 Series - Wt. 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice, 55 Series - Wt. 24 lbs. 59 Series - Wt 30 lbs. PM 10 -0003. CAUTION For information on additional Zoeller products refer to catalog on Combination starter, FM0514, All installation of controls, protection devices and wiring should be done by a qualified Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical licensed electrician. All electrical and safety codes should be followed including the most Alternator, FM0495; Sump/Sewage Basins, FMO487; and Single Phase Simplex Pump ControVAlarm recent National Electric Code iNEC) and the Occupational Safety and Health Act (OSHA). Systems, FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Zo OELLEf� ill KY C ane Ru 347 Manufacturers of SHIP IP TO T0: 3 3 649 Gane Run Road r Louisville, KY 40211 -1961 Q/xu /TY PUMPS S NCE �9JJ - PL/MP !O. (502) 778 - 2731.1(800) 928 -PUMP FAX (502) 774.3624 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY F Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST, X' not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O 30 ZCj APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: E , wtl LL PROPERTY LOCATION T SW 1/4 SW 1 /4,S '°1T 30 ,N,R 19 E(or W� PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # P.4. 3ok XSl S — CSr1 Vot "Z V9 3 ZSS CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD 6J I 54o1� (l LS) ��6 -z, S, �SCp1`I C,� ''V [�, New Construction Use [� Residential / Number of bedrooms 3 T [ ] Additi.Qn to existing building L ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate gi bed, gpd$ - trench, gpd /ft Absorption area required 3-1 S bed, ft 3Z S trench, ft Maximum design loading rate • 5 bed, gpd$ - � trench, gpd/ft Recommended infiltration surface elevation(s) ti o\ . p ' ft (as referred to site plan benchmark) Additional design / site considerations M" )U r-A� �► �,'x. �l7' 8� . 'M tw kimum �Z SfP-� F:) LL- . Parent material u'C S ovQZ - i kL Flood plain elevation, if applicable M.A • ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable for s stem ❑ S R U ®S ❑ U I EIS O U ❑ S W U [I S EAU EIS RI U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Botx>daly Roots In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer>ch :<K � o _ � Z l0 `1. �- 3 ! Z � s l � 2..`Fs b 1� w�.'F �S � . S . t Z YZ -35 LO `11Z 3l 31 1 11") Sb1T WL '�` F C S • s , b Ground Ni. elev. G $. - 1 ft. I Depth to limiting factor Remarks: Boring # _ -1Z �O\-AV- 1Z — sL� z- 'FsUIc k2`�H C S lO � ... 31L .rLl P- 3) 1 I l o�, I- CS ►'� -2 Ground elev. o - S � 2 3/3 - rJP N Depth to r' limiting i 'I factor - 3 Remarks: C004 CST Name: — Please Print " •' ' ti Phone: Arthur L. We e .i^; : - {`�`. 715- 425 -0165 Ad dress: Soil Testing & Design Box 74 River Fa11s,WI 54022" Signature: i ate CST Number: �r8- 143_ Date -� -�� M00576 PLOT PLAN Page 3 of 3 SCALE 1 "= tA` ' \, ,X or SPi I Iy- sW 1l%f G� coW�s�1�.0 eY�o,� 1�oME y NOtir ' J � 3 W CLL - \Z, %qE cv I u � a J cu r 3 � i E \oZ a.'L _LOl 3 aw►�z- e�.,a�.z' .X o� „ +'n��1, 31 4es a 1�1� • PvC Pt PQ' � \ i I D d ti0 T 0 - 01 `1 ? ra c-T olZ �4s _ Ot —`) ( 715 ) 4L-0165 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Pag 1 of 3 -Labor and Human Relations g — Division of safety a, Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must include, but T_' C-AZ-O `x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O 30 - 1040. ZQ_300 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: � f'\M F , 1 1 LLB PROPERTY LOCATION -"1 ;3 �► L lrl� vM M ZS seur44eT S W 114 &W 1/4,S ) P\ T 30 ,N,R 19 E (or W) PROPERTY OWNER' :S MAILING ADDRESS LOT # I LOCK # SUBD. NAME OR CSM # P- 4. �3ux lSl S — CSM Vot- Q- V4 3Z S S CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD `c�vDSo>J W 1 54OL6 ( , I LS) aS 6_z�69 �• �s�p� e,� v'` [)4 New Construction Use M Residential / Number of bedrooms 3 [ ] Addition to eAsting building I I Replacement [ I Public or commercial describe Code derived daily How AS 3 gpd Recommended design loading rate _ bed, gpd/ft trench, gpd/ft Absorption area required 3-1 S bed, ft2 3-1 S trench, ft Maximum design loading rate • S bed, gpd/ft � trench, gpd/ft Recommended infiltration surface elevation(s) 1 O\ • p ft (as referred to site plan benchmark) Additional design / site considerations w1 ov11.� w l °, �x �-�' g� , M t N tmu m \Z"oy S fP-b F:-'I « • Parent material Flood plain elevation, if applicable N A • ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S [4 U ®S ❑ U ❑ S O U ❑ S O U ❑ S U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdaly Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTrench > : >:': \ v _� �0 1�31Z sit 2�sb1� wl�'� �S •s _b Nz -1S do Ground S `1 (z 3 ! 3 - L Csw�m v` i _ f�►P tvP elev. 4 Ci $.1 ft. Depth to limiting factor 3 S'' Remarks: Boring # Z � Z 1Z - 3� LO`1 \t 316 s ' Zwt U � S •� ::.. � cS - +w . 'Z Ground elev. o A S 2 l3 - A- 1D 0 ft. W - 0'� I Depth to w�`Akl�f C 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 Falls,WI.54022 Signature: Date: CST Number: 1 1��L Z12� ��2 � �r8- 143 5 - `4 _�F M00576 i P L OT P LAN Page 3 of 3 SCALE 1 "= U� ' \.uv�-- ov sue, `Iv- Sw Icy G� I C-oA1 S�.0 eY�ura Lv m rrvE l I � � !J i 7i 6 - ��\� t110zo a.'L - - x LIL. 100, p' 7J w/ \ I D o r 1 n bQb l (715 ) 425 -C7 65 _ 1400576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S Mailing Address S& / Property Address S C'T M tel (Verification required from Planning Department for new construction) City /State N tJ I Parcel Identification Number LEGAL DESCRIPTION Property Location W %4, S W 1 /4, Sec. \ , T 3 N -R 9 W, Town of - ST- So 4")4 subdivision C - • S 9 So T Lot # Certified Survey Map # SS 9 S o s- , Volume , Page # 3 S� Warranty Deed # '7 6 c o z / , Volume I z � � . Page # Spec housed yes O no Lot lines identifiable yes no SYSTEM MAINTENANCE Impibper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or , a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards.. set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating that your septic system has been maintained must be completed and returned to St. Croix County Zoning Office within 30 days of the t e year expiration date. 2 / 15 / S s/ StCAATUA OF APPLICANT DATE „;N P_LVNER CERTIFICATION I'!(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the propthyApscribed above by virtue of a warranty deed recorded in Register of Deeds Office. §RRATuRE F ' ;L .:.r4T 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 warm :d from the Register of Deeds office a copy of the f survey map if reference is made in the warranty deed ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer S /� sg-t {/12 ll ? �� lc :2 ��o e Mailing Address 12, �� 1' � 3 /-�� clsc L✓,' S��( �� Property Address ` S� Li (Verification required from Planning Department for new construction) City /State Parcel Identification Number 3 U - LEGAL DESCRIPTION Property Location S '/4, S G/ % a, Sec. 1 , T 3 O N - R �l W, Town of Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # , Volume _ , Page # Spec house ❑ yes ❑ 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 stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S C A F APPLICANT ATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. J SIG TURF OF APPLICANT / ` DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed � S.ATE BAR CF WISCONSIA FORM 2 1982 WARRANTY DEED 560021 41 DOCUMENT NO. VOL Fw5,14 F F%'els IN ^ husband and wi fe. Y --_ � to --'_ . --------------'---�� -~a s "^s�n"mFOR "eCu"a'^:DATA � A ~�� -*~^on^,vo � t following �scribeu teal estate m St. Croix ____C,un'» State "/wis'"v^m. � m30-1040-20 NUMBER____ Part of the Sgk of 5gk of Section 19, Township 30 North, Rartge 19 West, St, Croix County, Wisronaln, 6eyocilxy] py follows: Lot 5 .[ Certified Eumma,y Map filed 'r in Vol. '"12", Page 3255, Dnc, No. 559508. IYXGFnIER WITH an easement for ingress and egress over Owtimt 'I= of said Certifie,�, Survey Map. and Part of the SWk and SA of Section 19, Toune6ip ]O North, Rarize- 19 West, St' Croix ' County, Wisconsin, described as follows: Imto 1 and 3 of Certified Survey Mop filed May 8, 1997 in Vol. ''11'", Page 3351, Doc. 0m. 559126. - Ih,,_ is not "^o°y'"u property. ^~~~^ (is n Easements restrictions and rights-of-�my of record, if any. c,,,p""nm°,,,"".'s , Dated this 27th -_--_-_u,r"/ .A 19_4J_ ` --------'- esxu , William A Hendrickson _---__' ' (ScAu ______-_'6cxL) �. . ' AUTHENTICATION ACwc~AOWLsmGausNT Signature(s) - Is ---_-_ Coun . � aut icated ibis da a .��_ Personallyorw aw this -' ay~ May �*�GL- the above named ~ ' n/uc MEMBER STATE BAR nrWISCONSIN ]0,eodu Poulin (if not, ------------------'' Notary authorized �' uroomo v/." y'u` ~� ^ ` �m,"^x"uu /m, ,°m."� ' ��u�� n� �Viocouxio � e- the Rime �Ume rm o o/wu`nvwswrw^�ox^�,�o , �� Attocoev Kciotioa 0 /aod ccn da Pmc � 559508 CERTIFIED SURVEY MAP Located in part of the SW1 /4 of the SW1 /4 of Section 19, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; being lot 2 of Certified Survey Map recorded in Volume 11 Page3251at the St. Croix County Register of Deeds office. / / I OWNERS I II66' William & Carol Hendrickson N UNPLATTED_ , 1405 County Road v S I I Houlton, WI 54082 C LANDS d.2w w� Of WJSC o N III °�� moo 00U0LAS I �; Z L71 G+j ZAHL R ; a S 1 w a� 0 E I H QI L N o North l i n e of the +' L- I� >I SW1 /4 of the SW1 /4 a l QI N E N C 7 88 0 51 1 15 - -E 650.81' a m 3 r 507.16' � �I � OD LOT 5 0 66 CD / AREA OF LOT S 132,618 SQ. FT. Lni 3.04 Ac. �•.. AREA OF OLITLOT 1 1.0 I 20,370 SQ. FT. OUTLOT:' 1 r-11 001 0. 47 Ac. 161.73' E S86 0 12'25 "W I CDi E � VII -I U- w I N 1t C 0 \ � I N LEGEND Q r !9 Aluminum County Section Corner W N v - Y Monument Found H y & ° 2 Iron Pipe Found N - D a cu ,`�� • 1" Iron Pipe Found U N N N O 1 x 24" Iron Pipe Set, weighing /� � 1.13 lbs. per linear foot J - - — 4 Existing Fenceline L y N v - F- 1 Wa u: 3 ° ........ • • • 100' Roadway Setback Line ��// a, 111 No water in pond a, � r as of 8/23/96 GPI o N Q1 o m ZI </1 ¢I NOTE: Outlot 1 is reserved for future Qi use as a public road. 1 II Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 315930 $Rft l-�q�Cjer's Qldtr�g: ❑S,ji<y ❑JO arc e Town of: State Plan ID No.: CST BM Elev.:- a[jt1 Insp. BM Elev.: BM Description: 1` ��; Parcel Tax No.: 030 - 1040 -20 -300 TANK INFORMATION ELEVATION DATA A9800318 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ H utIet TANK TO P/ L WELL BLDG. Ventto ROAD Dt In Air Intake Septic NA Dt Botto Dosing NA eader /Ma Aeration NA DI t. Pipe ; Holding Bot. ystem PUMP/ SIPHON INFORM TION Final ade Manufacturer Demand Model Number GPM TDH I Lift Friction S etem DH Ft L oss Forcemain Length Dia. Dist. To ell SOIL ABSORPTION SYSTEM BED/TRENCH th Length No. O nches Pyt o. Of Pits Inside Dia. Liquid Depth DIMENSIONS bIMEN I SYSTEM P/L DG WELL LAKE /ST M LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Sparing SOIL COVER x Pressure Systems On 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 E] No ❑Yes E] No COMMENTS: (Include code discrepancies, person present, etc.) Q LOCATION: ST. JOSEPH 19.30.19,SW,SW 1+:- 5 CTY RD V Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ^� Safety and Buildings Division �. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 0 , Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. f c '' ` V • See reverse side for instructions for completing this application State Sanitary Permit Number jSq�o The information you provide may be used by other government agency programs El Check it rev sion to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name C Pro erty Location 1. .,E J �S'Uj 1 /4,S ! T v,N,R E( W Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision N me or CSM Number u]l 7-;; CS -4i, ss s o WA. Rn ,325 ,5 11 . TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Ro d E3 Village r 0.5� N ❑ Public or 2 Famil Dwellin - No. of bedrooms own OF -st.! Cm r V III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 6 3 a �d q4D _ ®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. TYPE OF PERMIT: (Check only one box on line A. Check box on 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 - ------ ___ExistingSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ffSeepage Pit =I /Nf/L7Xi # ?A /L 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) I Elevation, SO 7:5-0 - 1 . ( / 073 Feet / (0 r Feet acit VII. TANK in Ca altos Total # of Prefab. Site Fiber- Ex p er INFORMATION g Gallons Tanks Manufacturer r s Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank r El 1:1 El 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ 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's Signature: ( Stamp) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): A 1A, 1070 t~ A04 No ftsn 14 LV r IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Dissung Agent Signature (No Stamps) � roved Surcharge Fee) pp ❑ Owner Given Initial / n�� , �� ! / /// Adverse Determination 3 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398(R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Divi. ion, Owner, Plumber SAAR MILLED LoT g <.S M, a sst sog' TAY* to Yo Z-a ZAD A L+ T3. w� - - z--�p F ►tit Ala rt'rM &oT J.i AIF S' ®7,1�,',;t/ottwfl�� 118 ' t 1 4 A L l� V � h ' At Sa Se - A LE 11 0 y�� . M, A Tor -oF LT STsIk� 1: loa,o Til.m. °loP of fc4:T E i s I I I. too N6144-7. _ M T - I L TU'To IL z T2 we-HF 5 I Z S� DE k1triD�rt� E#4c.N 1- 44 a H y � s E c0 E t6 ' C co cn _0 X cz -a � � g >. (C CV a) Q (b Q. cn i C7 E ' O Q � N O (d � }• G O O 0 O N j, co U (0 1� ► 3 _ C , p 'a O p O a 0) o x a N E CO o >= co c• �.Z) x -� U U ` M m 2 C O C U N G C — U O N N O) Q �� Q - 0 j RS N> 0 0 ; O J N LL E O 2 U "O U) 4 • • • • ck �J4 I L� J y, g w �� W N 4Z 44 ® o ® a N a v U m aO E Y t� .MQ 3 -0 O M �. L � 3 �p UJ o rn C W CO (h CWO n- 00 h U • U O 0 � T V W a 3° N a w D CO v � 6 cn �° �r H g 7 6 Wiiscorlsin Department of Industry SO� i;L U AT I O N REPORT Page 1 of �_ Labor arA Human Relations `Division -of Safety & Buildings ccord HR 83.0 * Wis. Adm. Code R r' ,r�,E�v COUNTY Attach complete site plan on paper not les� than 8 1/2 x 11 it h ,t ize. PW must include, but St. Croix PARCEL I.D. # not limited to vertical and horizontal refere' ce pointm, arAbti ' of d % of slope, scale or dimensioned, north arrow, and location an di ance to gVrSl�K?t�ad. 030- 1040 - APPLICANT INFORMATION PLEASE T AT REVIEWED BY DATE PROPERTY OWNER: , , , �_.,_, r PROPERTY LOCATION E , William & Carol Hendrickson GOVT. LOTS S 1/4 1 /4,S 19 T 30 N,R19(or) W SW PROPERTY OWNERS MAILING ADDRESS LOT # LOCK# SUED. NAME OR #� c c, 3 _ of h Fourth St. na csm J CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN N Stillwaer, MN. 55082 (612) 549 -6063 St. Joseph Ct Rd. "V" [x] New Construction Use [X ] Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft • trench, gpd /ft Absorption area required 90o bed, ft2 7cin trench, ft Maximum design loading rate 9 _ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 107.30' ft (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND 71N-G PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S El U ® S E] U ❑ U ® S El U ®S El U [3 S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. .................. ................. .................. ................. .................. 1 0 -12 10yr3Z3 none sil 2msbk mfr CS 2f .5 .6 2 12 -28 7.5 r4/4 none scl 2msbk mfr CfW if .4 .5 Ground 3 28 -78 7.5 r4 4 none sl 2csbk mvfr na na .5 .6 elev. l O ft. Depth to limiting factor +78 1 , Remarks: Boring # `<' 2 2 12 -30 none sicl lcsbk mfr 9W .2 i .3 Ground 3 30 -56 7.5 r4 4 none sl 2csbk mvfr aw na .5 i.6 elev. 1 10.4 ft. 56 Depth to limiting factor +8 2" Remarks: CST Name: -- Please Print G L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ve. New Rich and WI 54017 Signature: v loo f Date: CST Number: m02298 4 -24 -97 STEEL'S SOIL SERVICE Gary L. Steel Wm, & Carol Hendrickson 1554 200th Ave. CSTM2298 WIWI S19- T30N - R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 OV�i CSm /al3ass N 1 =40' BM.= top of NE lot stake @ el. 100' Alt. BM.= top of steel fence post C el. 111.60' z ► zo` 20� l a 7 00 _ Q Gary L. Steel 4 -24 -97