HomeMy WebLinkAbout034-1032-95-000 i
+ A
ST. CROIX COUNTY ZONING DEPARTMENT
/ AS BUILT SANITARY REPORT
Owner A n Idd r e w 4A / S C,,
Address S u s ti' C 1Qr,
City /State G je k/p y d d
Legal Description:
Lot --I_ Block Subdivision/CSM # Va �, l a �. q 3
'�• S NC ,Sec. , T�N -R 1 W, Town of S Q t' 0 4C. J PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer we f e vi Size ST/PC 16601 ZS 1 Setback from: House 19 Well 1 P/L 0
Pump manufacturer Model 6',3
Alarm location _ ) 3 �, �, z —P &X
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: 1 U4 h Width Length f 7 Number of Trenches
Setback from: House Well i L&t P/LL Vent to fresh air intake
ELEVATIONS:
Description of benchmark t G J P G f d 7 e J3 k t /e IL Elevation U t3
Description of alternate benchmark "� o/ Elevation 4 0
Building Sewer ST/HT Inlet �s �? ST Outlet PC Inlet
PC Bottom 91- Header/Manifold �• �!i Top of ST/PC Manhole Cover oo
Distribution Lines ( ) R t ( ) ( )
Bottom of System( ) ( ) ( )
Final Grade ( ) O ( )
Date of installation /2t
Pcrmit number i s State plan number ' G
Plumber's signature
g r License number Date
Inspector
Complete plot plan K
Wiscortain Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
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)]. 315998
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
WELSCH, ANDREW SPRINGFIELD
CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.:
034 - 1032 -95 -000
r.
TANK INFORMATION ELEVATION DATA { �
A9800385 k'4''
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Benchmark1'
Septic
G' GtJ�.`., �r. r s) !. e C t-.�: �` / Cr �;�� -=, :•� ". �� �, . � , �',..r
Dosing
Aeration Bldg. Sewer A
-r.
Holding
°' "' St /#f Inlet
TANK SETBACK INFORMATION St/ Ht OutletI �-
TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet
irl
Septic j ' NA Dt Bottom
Dosing NA / Man. ;
Aeration __. NA Dist. Pipe ri
Holding - -- - -- Bot. System 5
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer," Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss
Forcemain Length 16117 Dia. H ? " Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia --- - tiquK Depth
DIMENSIONS DIMEN 1 1
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM -ITA anufacturer:
INFORMATION Type Of w CH, ER Model Number:
System: /✓Cc,., . r OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length 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 TX�Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.)
LOCATION: SPRINGFIELD 15.29.15.228D,SE,NE 952 RUSTIC ROAD #3
/ W �
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
V iscons i n SANITARY PERMIT APPLICATION 201 W sBngo
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis: Adm. Code Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County /J
than 8 1/2 x 11 inches in size. . rc 1. e o ")e
• See reverse side for instructions for completing this application state Sanit y Permit Number
15 , 9 98
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name / Property Location
� c,w / C C_ er 1 /4NfE 1/4, S 1 S' T a y , N, R i s k(or) W
Propert Owner's Mailing Address I- Number Block Number
S.Z R4s't:r`L l -4d �at
City, State Zip Code Phone Number Subdivision Name or CSM Number ' /G
IL TYPE OF BUILDING: (check one) E] State Owned 2 Ic �+ Nearest Road /
Public 1 or 2 Family Dwelling - No. of bedrooms ✓ E] To OF .S'
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo
U3 V /0 3 - �s'
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. IA 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 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
?4 — 3 7 6 /, / �r S�Feet /Ov. •— Feet
Cap H
VII. TANK in a Fiber- Total # of Prefab. Site Fib Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New strutted
Tank
Septic Tank or Holding Tank 1 t 06 ( El El 1:1 1:1 E] Lift Pump Tank /Siphon Chamber (� 5 U ( r El 11 E] 11 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility_f r installa ' of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb s Signatur : ( tamps) MP /MPRSW No.: Business Phone Number:
s' 0� X2 ?s''
Plumber's Address (Street,, City, ate, Zip Code): _
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Ap proved '(la Surcharge Fee)
A _
pp ❑Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
CUN LaCrosse, Wisconsin 54603
SCOT I si I Tommy G. Thompson, Gw^mor
Department of Commerce ~� , William J. McCoshen, Secietary
( f,�
. t
Transaction ID No. 118503 Date: 7/27/98
z J C " i
cat
v bG O k
'c qtr
The Transaction ID No. noted above has been reviewed ford "n' fo nce wits, C 11 le Wisconsin Administrative
,
Codes and Wisconsin Statutes. Conditional approval is hereby i pd" .. -� sy� plan submittal. All noted items
must be corrected. The review and approval of the system is base 45, Wisconsin Statutes, and chapters
Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on
the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters
Comm 50 -64, Wisconsin Administrative Code.
This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan
approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation
shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the
appropriate inspector when inspections can be made. 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. Stats.
• 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.
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,
r
Card
Integrated Services POWTS Plan Reviewer
(608)785 -9348, Mon.— Fri. 7:15AM to 4:00 PM
jswitn@commerce.state.wi.us.
SBD5524 -E (R. 2198)
' Page of 6
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE SE 1/4 OF THE NE 1/4 OF SECTION %S ,T Zq- N, R W,
TOWN OF SpV,1,jG �=j , Sr- CtzA LX COUNTY, WISCONSIN.
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION:
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR l tipyLU ll Y
c
�� ItCE
° ISZ K.vS - nc R.O rrD NJ C3 pCPAR�MFNFESYpM
s '
was
se E cc; 0RRE
NOE
PREPARED BY
WECEERER SO I L TESTING
AND .,
I3 ���pMO
ES I GtV SEEF Z%l ICE CO•lys+
F.O. BOX 14 421 K. KAIM ST. x* r••'~~
RIVE. FALLS. MI 54022 •
ARTMUA L
715- 42`r41b5 W£GERER
DA75 �
• Ru sWORTM,
Z (�
WIS.
'►i S IGN
JOB NO.
PLOT PLAN Page Z of
Scale 1" =L40 ' r
1J�rPC1ZS�s1' P RUP�`N( �! N E
E
3 �E
32'
B. ZS
Imo NoT ro►.tpA -t
.3
\3S'O�
I
S �`RC �'h+�kt co �.►Zu vcz t'i.. ° l'l - 5' I �
B0T'Tbm OF $ e,D 1
L'L. 48•S'
Lon 9 I!
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iyOT�': ��S'S1NG - CY0�2f `�tJ1zS `lU 8� P1"3li/t11�0A1� iF�S 1�1Z �'OD�.=
NOTES
•1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Y required)
3. Install 4" observation pipes with approved caps. ( 2 required)
4. tank to be \ 00016S0 gallon capacity manufactured by
, )tic,
5. Bench Marks S Orz' f'Mn y e
6. Divert surface water around system to prevent.ponding at the.uphill side.
Page _3L Of C
Approved Synthetic Covering
Rs c. 33 Distribution Pipe
Medium Sand
H G
Topsoil l = — _ —_ F Elev . `l a • S
E D
3 ` -
b
y %Slope
Bed Of "- 2 2 ( Force M o in Plowed 2
Aggregate From Pump Layer
D 1 -O Ft.
3Z Ft.
•
�
Cross Section Of A Mound System Using E F N -1 Ft.
A Bed For The Absorption Area
G 1•v Ft.
A Ft. H 1 Ft.
Linear Loading Rate = `a /LN FT B L47 Ft.
Design Loading Rate= c) , 4.GPD /SQ FT j 16 Ft.
J :1. Ft.
K 11 Ft.
Alt R%te- Position L b°1 Ft.
of
Force Main W 3 Z Ft.
L
7, Observation Pipe
�— -- 8 - -- - - - - - -- K
A -
-t
I� - - -- - -- ------------------ - - --•� Fo�-
Distribution Bed Of 2
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page L) Of
Perforated Pipe Detail
End View
) Perforated
End Cop.) ob�e�e QVC Pipe
i . Jo ,ar
a Install permanent
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
Q
PVC
Manifold Pipe
PVC Force Main
Oistn ution
Pipe
Lost Hole Should Be I
Next To End Cop
End Cop
P =Z Ft .
Distribution Pipe Layout
S Ft.
X V $ Inches
_ Y Vg Inches
Hole Diameter I(Y Inch
Lateral I Inches)
Manifold Z Inches
Force Main " Z Inches
# of holes /pipe L
Invert Elevation of Laterals -o Ft.
t,
Place lst hole Zy from center of manifold with succeeding holes
at q$'' intervals. Last hole to be next to the end cap.
,.
- Combination Sept c� Tank arid
'.PUMP CHAMBER CROSS SECTION AN0 SPECIFICATIOAIS:' PAGE S OF
-VCUT CAP WEATHER PROOF
JUIJCTIOU 50K
4'C. I. VENT PIPC APPROVED LOCKIMG
1Q' FROM DOOR. IAAIJHOLE COVER AJIV
- .iaiDOW OR FRESH T +�- �A(tN1 Ll�6EL.
A.LK IIJTAKE COi
r `'
AL
y PIPC PROVIDE --
IAILET AIRTIGHT SEAL
v
APPROVED JOIIJT BiaFPL�S A I I APPROVED JOlA1T:
I I I W /C.I. PIPEoKPUc
W /C.T. PIPEorm Tank construction ( III
shall comply with ) 1 ALARM
I
ILHR 1;3.15 and 33.20 b I
�!l 0
C I I
qi . S
ELEY. FT. PUMP -� -_J
OFF
. �
D CO U CKETE
L . I . 1 1 9LOCK
3" APPQd.F.
K15ER EXIT PERMITTED OULy IF TAW MAWUFACTURI� -K HAS SUCH APPROVAL lUoDiNr,
SEPTIC E SPEGIFICATIC)US
OOSE I- AtDweSI� j pRi��B IJUMBER OF DOSES: 3 ' 4 PI R DAu
TAIJK MAIJUFACTURCR:
TAWK :,IZC: 'I -SO GALLOWS DOSE VOLUME I r-
3
ALARM MAIJUFACTURGR: S .S . � }�(� S`i 51 1 S INCLUDIM& BACKFLOW: GALLONS
MODEL DUMBER: "'Z�I `1w CAPACITIES: A= IMCHES OR 3 � O 1 �0 1 GALLOUg
SWITCH TYPE: I"\gzcV%Z`� 5= Z 11JCHES"OR -� C# �LLOLJ5
PUMP MANUFACTURER: —Z- L X12 C. 9 IULHES OR S GALLOWS
MODEL NUMBER: S3 C, D= 9 INCHES OR l S GALLONS
SWITCH TYPE: I�L2CUCz 1 MOTE: PUMP AMD ALARM ARE TO 5E 6
MIMIMUM DISCHARGE RATE Z % , O t GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AIJO.DISTRIBUTIOW PIPE.. 6 . 1 S FEET
+ /iiwimUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.50 FEET
+ �3S F E E T OF FORCE MAIN X _ - FL FRICTIOM FACTOR.. Z.. Y1 FEET
.= TOTAL DtJUkMIG HEAD '�' Z FE.ET
Pump chamber DIAMETER - 3�
�.
IIJTERAIAL DIMLUSIOWJ OF TAUK: LF-M&TH ;WIDTH - ;LIQUID DEPTH
BOTTOM AREA — - 231= GAL /INCH
AS PER MANUFACTURER - GAL /INCH
,
HEAD CAPACITY CURVE 4 5/8 —
"53 - 57" - "55 - 59" SERIES t 1/2 –11 1/2 NPT
25
-
TOTAL DYNAMIC Ii1=AD /CAPACITY
PER MINUTE
EFFLUENT AND DEWATERING 3 15/16
6 _
50 SERIES
° 4 1/16
Ft. Meters Cat ; Ltrs.
x
V 15 S 1.32 43 163
Q
Z 4 t0 3.05 34 129
p 1s 4.57 19 72
t0 AZ
H 10 Lock Vat—
O
2
5 ze` 08
10 1/16
0
U.S. GALLONS
10 20 30 40 50 l 3 3/32
LITERS
0 80 160
FLOW PER MINUTE
SK200 SKM
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Variable level Float Switches available. a 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
Standard cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required.
Standard cord length - non - automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float
switch. Refer to FMO447.
M53155 and 57159 Series Control Selection 3. Mechanical aftemator "M -Pak" 10 -0072 or 10 -0075.
Model Volts Ph Mode Amps Simplex Duplex 4. See FM0712 for correct model of Electrical Alternator, E -Pak.
M53155 & M57159 115 1 Auto 8.0 1 or 1 & 7 — 5. Variable level control switch 10 -0225 used as a control activator, with E -Pak (3) or
N 7 1 1 80 4
8 7 1 Au 4.0 1 or 1 7 — (4) float system.
E53155 & E57 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in simplex or 2
Pump operation, PM 10 -0002.
53 Series - WL 221bs. 57 Series - WL 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice,
55 Series - WL 24 lbs. 59 Series - Wt. 30 lbs. PIN 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, FMO477; Electrical Alternator, FM0486; Mechanical licensed electrician. All electrical and safety codes should be followed including the
most
Alternator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase Simplex Pump ControUAlarm recent National Electric Code (NEC) 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
Louisville, KY 40256.0347 Manufacturers of. .
Zo SHIP TO: 3649 Cane Run Road _
L Louisville, KY 40211 -1961 Q&IlrY PUMPS SNCE I 4 F ,7
PUMP !O. (501) 778 - 2731.1(800) 928 -PUMP
FAX(502)774 -3624
Wisconsin Department of4ndustry, SOIL A"N D SITE EVALUATION REPORT Page of 3
Labor and Human Relations
division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
F COUNTY
S i - C.�`t.Q A
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
_ ' o " PARCEL I.D. #
not limited to vertical and horizontal reference point (BM), ' gn;aii&%dope, scale or
dimensioned, north arrow, and location and distance t barbst+bad: ` b 34 - p 3 Z _R S
APPLICANT INFORMATION- PLEASE PRIN Af:'INFORMAION - REVIEWED BY DATE
I`'' ` ,
PROPERTY OWNERS: "":' PRO14j:Ij. LOCATION
Fr0z) 1 Z_qzw 9"'Z� F)GIJ ErS S 1/4 NIv 1/4,S S T Z N,R 1 S E (or
PROPERTY OWNERS MAILING ADDRESS i S r z �.vs- ��ojkr. r 8.OT #/ s LOCK # SUURn NAME OR CSM #
°tsnc � 'N
fm b.�3 C , Y"1 vu� Z *6e. 1 463
CITY, STATE ZIP CODE P ONE NUMMG -' ., 7Y' ILLAGE MOWN NEAREST ROAD
GI�NWODD Cl't`l,f�l Suol3 (� Z6S- �f3tE� tiLt-3G ='Lt�' I - RbsilcVt) Iv0.3
[ ] New Construction Use [>Q Residential / Number of s i [ J Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow '1SD gpd Recommended design loading rate '4 ed, gpd/ft trench, gpd/ft
Absorption area required 3 bed, ft 3 trench, ft Maximum design loading rate S bed, gpd/ft trench, gpd/ft
Recommended infiltration surface elevation(s) R5 . S ft (as referred to site plan benchmark)
Additional design/ site considerations `f'1ov w/ 3' X q B . Y'\ 0 W 1 �1Uwt �2 aF Sfl , ,jb Fr Lc- .
Parent material st LM ovM G fie, p t t_ Flood plain elevation, if applicable /J A . ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TAW
U = Unsuitable fors stem El S ®U ®S ❑ U ❑ S R U ❑ S ®U ❑ S RU ❑ S ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Botrtcialy Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITmnch
{�v \hi i••rii
F t)_� 1 313 si Z
::
2_
1 C 5 k Yn u`F>^
Ground 3 ZI -3$ 10 LA L/ly
elev.
a 6•1 ft. * -S9 164 R- Ll l� - �.S�IR s16 S�I ��n 1>1 u`FI� — • 3 ` `y
Depth to y C'0 >v S 3 S of o w GtM S
limiting
f3
Remarks:
Boring #
t cZ 3 2 � b1z mid - eS \\J s
0
3 1i i6 1 r) l Tt- q l 6 — 1 �s �sbk m v Jf _ c-& — . s: L
Ground
elev. Z J4 - i.SyR Vl6 S`ttZS Sic Z -b� v►�`F't cg - ,q `.S
G - 1 -9 ft.
Depth to S uZS0 t b `1 R, YA U - - .q. - 5
limiting
factor
Remarks:
CS T Name-.--Please Print PhOfe
Arthur L. We erer 715- 425 -0165
M gerer Soil Testing &Design Service -P.O. Box 74 River Falls,WI 54022'
Signature: 1 Date: CST Number:
M00576
of
PLOT p LL' i�.v Page '3
SCALE 1 "= Yo
U� � QUP�1Z`ri( L1 N E
_ Ems•
�..mo NAT �oti^�tpR
1K 4 0
3 13biu� I
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co Nlvv�. hTl. °l`1.5�
8 0 rMM OF $ Qt>
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Onl 8o M OF S It I NC Ff " J \4)\J �, 010I' ?j R .
� a
4
( 715 ) 425-0 M00576
CST Signature Date Signed Telephone No. CST #
- Wisconsin Department of :Industry, SOIL AND SITE .,_EVALUATION REPORT Page \ of 3
Labor and Human Relations
DW*h of safety B uiktings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ST. C.Ctpl ,)C.
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. b 3f — l 13 Z _q S
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNED: PROPERTY LOCATION
lijM PIGo LSS w 111 se" Sf—r 1/4 N Rr 1 /4,S 1 S T Zat ,N,R 1 S E (a
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # , ,
qSZ t�vsTlc � r•3D. — c3m vow Z, Vkst 1 /63
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE DOWN NEAREST ROAD
Gui�wobD el`'t�,w1 suot3 (�iS7Zt�S �{3�B SPtz.t�G�t.�Z.D tZt�s`RcR.D ►v0.3
(j New Conshction Use N Residential / Number of bedrooms 3 [ ] AdMQn to existing building
I Replacement [ ] Public or commercial describe
Code derived daffy flow y.SO gpd Recommended design loading rate , 1 bed, gpolft - gpddtg
Absorption area required 3 bed, ft 3 - ) S trench, ft Ma)dmum design loading rate • S bed, gpd/ft • b trench, gpd/9
Recommended infiltration surface elevation(s) `38 .5 It (as referred to site plan benchmark)
Additional design/ site considerations 't'1ov"\ w/ S' X t-1, ' Btu . 1r'1 t W f Y1 U M \Z " cr - SA Fc LL- .
Parent material st LM Flood plain elevation, if applicable MA It
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK
U= Unsuitable fors stem I O S I R U ®S ❑ U [IS ®U ❑ S [RU EIS ®U [IS ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed retch
10.1 �z_ 313
z zt �oHCZ �C6 — l`Fs 1 csUk Y>!u'Fh - 'S .-
Ground 3 ZI -3$ `lR Illy — sic 1 2"- aC4
elev.
9 6.1 ft. - S 9 L6 fZ q l 6 � -.S ti cz s s l o we In U `Ft,_ — 3 Y
Depth to
limiting
3t'
Remarks:
Boring # S
o _l lo`t 3I3 z K
Z Z o `t R - 316 si 1 Z
3
\z_ \ o1 T1_ V f 6 — 1 �s c gbk m v - cs — , s' . L
Ground
elev. l zb -ql -1.SyR vl S`iIZ s/$ SIC-\ Z'{�e bl� YYITI- C-% — ,q ' .S
C ft rr
Depth to S uZSCA l b `'l R �f76 — 1� s d m YA C
limiting
factor
7
Remarks:
TName:— Please Print Arthur L. We erer Pb00e 715 - 425 -0165
g rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022'
Signature: R g- L 6 Date: CST Number:
M00576
.. PLOT PLAN Page 3 of
SCALE 1"= Ho
� Ems•
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8.3 ' � � i 'Rtis Muff
3 13bR wl
co•�ty v� �. , a'1.5'
B o rmm OF tt Qr>
frLCP 9
! !\ �►v G Wing 4
1
X
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"Yu N
3w► %k l - IEt A0 0 , o' 0)-3 NZ ccAZ.1:1 eTL OF CCV'J a�L &�eE of PM .
or l "Vau - 'I - U -t OF S i b miG PTi' NW V,1�4Nx � cUlzpuc'R .
0 fl
715 ) 42.5 - 07 6 _ M 005 76
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
II OW NERSHIP CERTIFICATION FORM
OOwner/Buyer A211 n o w W� r / s e- mac..
Mailing Address S� 1?u s t, Q_ R Gl /e h W o o d
Property Address S e.
(Verification required from Planning Department for new construction)
City/State t 1 g h Lt, vc, Parcel Identification Number
LEGAL DESCRIPTION
Property Location '/., d '/., Sec. IS T_g_LN -R � 5 W, Town of _ 5 ' yo 12 1 0
Subdivision , Lot # LOC7
Certified Survey Map # U , Volume V6 Z , Page # 1- 14-3
Warranty Deed # 3 � I r Z , Volume �3 , Page # � 0
Spec house ❑ yes M-ifo Lot lines identifiable ❑ yes Mad'
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.
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 the St. Croix County Zoning Office within 30
days of the three year expiration date.
L
SIGNATURE OF APPLICANT DATE
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 property l oescrib eove, virtue of a warranty deed recorded in Register of Deeds Office.
I`S NATURE O 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
CERTIFIED SURVEY NO 463
Part of the SE4 of the NE4 of Section 15, Town 29 North, Range 15 West,
Town of Springfield, County of St. Croix, State of Wisconsin described
in V 2 of Certified Survey Maps, page 463 as Certified Survey
No. bb ; being a part of Lot 1, Certified Survey No. 290 as recorded
in the Register of Deeds office.
3433'73
I �
I
LOT I CERTIFED ,SURVEY .. NO.; 290, I 6 i
• S 89 14' E I I MM
;(— 19 90 526.00' A" n"
:O � os" z +f 0' � I
9 m
,. O
N N
I 10 1
to PROPOSED 20
1
.Z;� ? O HOUSE 300.0 I Nm
Ca 1 f
�/� -n a
.g O q Z a LOT I N O I yN
O y
0)
r
Cr 0 o N Q 3. IT ACRES APPROVED o 1 M z LU 0 om
:Cl1 L" ~� 0 o m 1 zo
U 1 fV m
:C f O ,.. f - , o
:< < z° o SEP 21 1977 1 0=
. m > Z F— O m
O 0z
{ 5 e; a w a ST. CROIX COU.:TY 8,90 I 0m
0° ArO Q. 0 5 Us COMPREHENSIVE PARKS PLAN:'':.G X3.0
9 Co tt 526.00' s" 33.0
N 89 14' 04" W
EAST 1/4 CDR. OF /I
SEC. 15,T29N, R15W
UNPLATTED LANDS I I I
LEGEND SCALE ' 3
1"- 100 ♦ g
3/4 "z 30" ROUND IRON ROD F I L E D
WEIGHING 1.502 LBS. /L.F'
SAP 231977
O 1 1/4" ROUND IRON ROD FOUND JA4u O' COWINELL
§ of essN co
I, Croft Gssty,
WUSMSIM
I, Thomas G. Kuester, registered land surveyor, hereby certify that 6 1 B
have surveyed, divided and mapped a part of Lot 1, Certified Survey Map
recorded in Volume 1, Page 290, being a part of the SE- of the NE-I,, of Section
15, T 29 N, R 15 W, Town of Springfield, County of St. Croix, State of
Wisconsin, more particularly described as follows:
Commencing at the East one quarter corner of said Section 15; gG0NS�� y �
Thence N. 89 14' 04" W. 33.00 feet to the point of beginning;
IAIEIIm �
Thence continuing N. 89 14' 04" W. 526.00 feet; 5 -1345 =
Thence N. 00 00' 58" W. 263.00 feet;
Thence S. 89 14' 04" E. 526.00 feet; Su
total 0
Thence S. 00 00' 58" E. 263.00 feet to the point of beginning.
Said parcel contains 3.17 acres more or less.