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HomeMy WebLinkAbout040-1231-70-000 r ST. CROIX COUNTY ZONING DE TMWA T AS BUILT SANITARY F Owner le, S vtso _. Address 3 (3u��cr C City/State -JN Legal Description: :_CawY�GCi~F� v , Lot Block — Subdivision/CSM # t /a 1L '/ s S , Sec. :?, T_Z$N -RAW, Town of r If SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer (,,.1.w- k s Size ST/PC 1064 &oSetback from: House -38' Well 7 P/L Pump manufacturer Model �- P O 'y Alarm location 1 (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: fre.-icA Width 3 Length So Number of Trenches 3 Setback from: House -V /V Well 4 P/L 6 -'_ Vent to fresh air intake ELEVATIONS Description of benchmark oL /�� n a kJ4s 1 Lvf Lim Elevation /� Description of alternate bench mark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () () ( ) Bottom of System ( ) O ( ) Final Grade O O ( ) Date of installation 0 / Permit number - State plan number Plumber's signature License number 226Sz-1 Date 2I&Ico Inspector /Z1- Complete plot plan { Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county Safety and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary P :f it41`8.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. h NbftG Et, j )] Village ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 190 "1231-70 -000 TANK INFORMATION ELEVATION DATA A98005353, 2,WJ J iq '� TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Ben h a ,� 3, 1173.E ► oa Dosing � a ovf/ r�) 7� ? l'•'� l �C� Aeration Bldg. Sewer Holding St/iJI Inlet " TANK SETBACK INFORMATION St /O Outlet TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet - Q Air � 7 Se 0` - I, IoC' s' J NA Dt Bottom Z &S osi g -F v ? q NA Header/Man. S, o %; Aeration NA Dist. Pipe �ayu fo• /9 ®j ?��� Holding Bot. System �,5G PUMP/ SIPHON INFORMATION Final Grade �{�'� : y,7 99•oZ/ Manufacturer o� Demandb Model Number ��� y / c (S GPM TDH Liftj,1, Lriction,�� I Systemf TDHj3,>✓gFt � Forcemain Length / Dia. aHP ,e Dist. To Well SOIL ABSORPTION SYSTEM BED EN Width �/ Length No. Of Trenches PIT No. Of Pits Inside Dia. DIM N J DIMENSION EACHING M nuf ctur r: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM ,f f j',� � tfr� A INFORMATION Type O CHAMBER / � Mo a Num er: System b 4 1 + ( � ; OR UNI 1 A t4A, A e i ` DISTRIBUTION SYSTEM ` Header/Manifold �a Distribution Pipe( W x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length .a+a. Spacing {' -A r 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 g p E] Yes ❑ No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) /6 Si LOCATION: TROY 3.28.19,NE,SE 693 BUTTERCUP COURT - COUNTRYWOOD LOT 7 C-D oa1 d . hn Dot Plan revision required? p°t Yes ONo n Use other side for additional information. � 1 --2 �� -� _j SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. i ' Safety and Buildings Division NV SANITARY PERMIT APPLICATION 201 W. Washington Avenue Isconsin 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 cal` than 8 1/2 x 11 inches in size. r • See reverse side for instructions for completing this application State Sanitary Perm Number Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop y Owner N a Property Location 1/4,S 3 T 2& , N, R / �(or Pro wner's ilin Address Lot Number pert Block NumAr City, state I Zip Code Phone Number Subdivision Name o CSM Numb r j ( &/V Z - 36 71 au�► Gad P BUILDING: (check one) ❑ State Owned it Nearest Road it ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms �_ Town OF �/ �/d III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo t e5/d IJ3 1 — w 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. g 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 6perim€sntal then 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 [:]Holding Tank 12 Cg Seepage Trench 22 ❑ In- Ground Pressure `// 42 ❑ Pit Privy 13 ❑ Seepage Pit Q,c All #I Cw GhAolw<-A4� 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 Ehe 7 Final Grade Re*;d (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min_/inch) k, Elevation 7`�l3 q ,'Z dr 9�- "Feet IV Feet VII. TANK Capa ity Site in gallons Total # of Manufacturers Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION Gallons Tanks Concrete glass App New Existin strutted Tanks Tanks ptic Tank Holding Tank �� ��Q / ' C l ❑ ❑ ❑ El 1:1 ift Pum T phon Chamberlem I 1 ,W4p / ❑ ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plum s Signature: (No (amps) MP /MPRSW o.: Business Phone Number: — ' Plumber' Addres (Street, City, State, Zip Cod ): z4j!� IX. COUNTY/ DEPARTMENT USE ONLY j' ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) surcharge Fee) 1 XApproved ❑ Owner Given Initial 1 01 Adverse Determination ! X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber JOB TIMM EXCAVATING SHEET NO. 6/ OF 3 Route 1 Box 192 16— Y� WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ,, .......... . .......... ........... ........... ........... ........... ...................... ..................... ......... . ..... ........... ........... ........... .......... . .......... ........... ........... ................ .......... ........................... ........... ........... ........... ........... ........... .......... .......... ........... ........... ........... ........... .......... .......... ........... .......... .......... ........... ......... . ................. ........... .... ...... ........... .......... ........... ........... . ......... .......... ............ .......... ; ...... ... ........... .................. .......... .................. ........... ? .......... ...... .... ........... .......... .......... ........... ........... ..... ........... ........... .. ........... .......... .. ........ — , - - -i . .......... . ..... .... .... .............................. ...... ..... ..... .... ... ...... ...... ........... ...... ........ ............ - ........... ........... .......... .......... .......... —4— . . . ....... ... ..... ... ............ ........... --------- - ........... .......... ....... .......... ........... .......... .......... .... ............................... ...... ........... ...... ........... ........... ........... ........... ----------- ---------- .......... ............ .......... . ...... ..... .. .. ...... ..... ........... ........... ........... ........... ....................... .......... . ........... ............. .......... .......... ...... .... ...... .... ................. . ... .......... ........... .............................................. ; ........... .......... ....... .............. ........... .......... i ............. .. . .......... ........... ........... .......... ......... . . ................................................ ...... ........... ... ..... ........... .......... ....... ... ........... ........... .. ........ ..................... ........... ........... ........... ........... .......... .......... .......... ........... ........... ........... ........... ........... . . ........ ............ .... .......... .......... .......... ? . . ..... ....................... .................... . .. ..... ........... .......... .................. .... ........... ........... ........... .......... ........... ................................... .............. . .... ..... ......... ........... ........... ....................... ...... ...... .......... .......... .......... .......... .............. ........... ............ ..... .............. ........... ....................... .... . ........ .................. ........... ...................... ........... .......... .................... ..... ........ ........... ........... ........... .. ......... .......... .......... ....... ........... ........... ........... .......... .......... ........... ...... ........ ........... . . ...... .......... ........... ........... .......... .......... ...... ........... ................. ................. .......... .......... .......... .......... ........... ........ .... ...... .... ...... ..... ........... ........... .......... ........... ........................ .......... ; ... ...... ........... ........... ... .... .......... 13 .......... .......... ........ ........... ........... ........... -- ------- ........... ........... ----------- .......... ........... .......... .. . .............. ....................... ........... ........... ........... .......... ......... ........... ........... ............. .. ........... ........... ... ................. ................ ............ ........... ........... ...................... ............ --------- . ..... ...................................... ................. ........... ....................... .. .......... 1...�� �lsv ... .R tda ............. . .............. ........... ........... ................... .......... .............. ................ ........... . .............. ........... ........................ . ... -------- ................ ........... .......... ....................... . .. ... . . ...... ............. ............ .... . .... ............ ........ - ----- .......... ................. ........... ........... ---------- ...................... ----------------- ............ ............... ............... .. ............... ----------- .......... ........... ................ ............... .............................. ------------------ - - ---------- .......... ........... .......... ......... I .......... ............. ............... ---------- ........... -Alf 74 ........... .. ..... ......................... ........... ........... ---------- ........... .............. ..................... ................ — ----------- ................... . .... .. .. ...................... ........... ................... ..................... -------------- ................ 50 .......... ----------- .......... .......... ....... ... ........... ----------- ......................... ............. PRODUCT 205-1 Inc., Groton, Mass 01471. To Order PHONE TOLL FREE I-BW225-6380 JOB TIMM EXCAVATING SHEET NO. Z OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY i! '1<d °� DATE /'0' Zz. - fzF (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE SCALE ... ..... .:.... �l� 1 ... +fib ... n `_. ... .. . PRODUCT 205-1 Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1-80G-2256380 47 C ' lz3�- 70 PAGE 3 OF 3 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE — __r WEATHER PROOF APPROVED LOCKING 25' FRCM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH I2 /�iLi• AIR INTAKE GRADE I I y' MIN. ` -_ W. CONQUIT IB 'M ____ - - - - -- PROVIDE _T AIRTIGHT SEAL I I' APPROVED JOINT A I III APPRDVED JOINTS W /C.I. PIPE. I I W /C.I. PIPE EXTENDIAIC. 3' I II EXTENDIIJG 3' ONTO SOLID ALARM B I I ONTO SOLID SOIL . I i C I I ON I I I I Pump --- - -� � OFF D CONCRETE BLOCK RISER EXIT PERMITTED UNLy IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOUS SEPTIC AND �J DOSE TANKS MANUFACTURER: Cf/ NUMBER OF DOSES: PER DAy TANK !,IZE : GALLONS DOSE VOLUME ALARM MANUFACTURER: INCLUDING BACKFLOW: �4 S7 GALLONS MODEL KIUMBER: /a� /�lt) CAPACITIES: A = Z INCHE5OR 5 /�' 9 6 GALLOw5 SWITCH TYPE: = Z INCHES OR SlG © Q6A'_ LO►.1S PUMP MANUFACTURER: �tl - C = 641A INCHES OR Io S �Z GA , _LOIJS MODEL NUMBER: D =INCHES OR JzV-dd GALLONS SWITCH TYPE: - IBC NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARVE RATE GPM, INSTALLED ON�SEPARATE CIRCUITS VERTICAL DIFFERENCE B '1�ICEIJ PUMP OFF AND DfSTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . .t- FEET + 10 FEET OF FORCE MAIN X / I F pFr.FRlCT10N FACTOR.. 7- FEET 7 TOTAL DYNAMIC HEAD = FEET %�r Z-6 INTERNAL QIMLWSIONZ OF TANK: LENGTH � ;WIDTH —;LIQUID DEPTH � G SIGNED:.__, LICENSE 1JUMBER: a DATE: ` 70 -117 - Goulds Submersible Effluent Pump 3 871 EPO4 EP05 µ" ApPLI�'�IONS • Fasteners: 300 series • kl submerged in high ■ Motor Housing: Cast iron -, stainless steel grade turbine oil for for efficient heat transfer, 'signed for the . Capable of running lut^rication and efficient strength, and durability. fpllowinp uses: dry without damage to he it transfer. Iffluentks� stems g ■Motor Cover: Thermoplas- components. • Home r ; Available for automatic and tic cover with integral handle Motor: and float switch attachment Farm me ndal operation. Automatic Hea sum EPO4Single ase: 0.4 HP, ti A points. p models include Mechanical +�Watet'transfer 115 or 230 , 60 Hz,'1550 Floa. Switch assembled and ■ Power Cable: Severe duty -RPM, built in , )verload with • Dewatq,4ng presat at the factory. rated oil and water resistant. .; automatic reset. ■ Bearings: Upper and lower U SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEAY heavy duty ball bearing 115 V, 60 Hz, 'l550 RPM, construction. f t tmp" built in overload with ■ E4 Impeller: Thermo - d Vdandling capability: automatic reset plastic Semi -open design / t mum. • Power cord: 1'l foot AGENCY LISTING 4 standard l 1 t SJTO with pump out vanes for Capp s, up to 55 GPM. sanarengi ,�, p SP Canadian Standards Association t , mec :apical seal protection. .Tb up to 24 feet. with three pro�tg grounding '�. +Disc t e size: l' /2 "NPT, plug. Optional 20 foot ■ EF 65 Impeller: Thermo - +. plastic enclosed design for (CSA listed model numbers Mec (seal: carbon- length, SJTW with end in impr °yVed performance. F or "AC .) - rotarylatttic- stationary, three prong grounding plug gUNA- N ":elastomers. (standard on E P05). ■ Ct sing and Base: Rugged +'1 empeCature: then,ioplastic design provides � ; 104° "d0 °C) continuous supedor strength and 140 ° 1�C)'intermittent. corrc;sion resistance. �. •- Fastener§ :300 series METERS FEET t stain ,#teel. i o '(spi)f running - - -- -- _ - — -- - . - !y w, n ut damage to s 30 _ _11 5� components. ! 1 P h�andlin capabilit 6 __ __ __ — _- _ -. -- _ _ -- z.5 Ft' V4" maximum.g p tY' 7 25 • "Capacities: up to 60 GPM. _ + Total bads: Up to 31 feet. 6 20 _ + bisch .oealze 1'!z NPT. -- -- - - -- -- — _ " � 5 -- . _- llechatiical seal: carbon- c 15 rotarylreramic- stationary, =X BUNAyNyelastomers. a Tempetature: a t >> 140 16 intermittent. 2 k� 104 Q. C continuous 5 _ 1 - a 1 0' to 20 30 40 T 50 GPM 3a i' C 2 , 6 8 10 12 m /h CAPACITY 0 1995 � Pumps, Inc. Effective May, 1995 83871 wiss-onsin Delrartment of Commerce SOIL AND SITE EVALUATION p age I o f 3 Division of Safety and Buildings 1' yin a", with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than ll%x i 6�481n size. Plan must Count include, but not limited to: vertical and horizontal reference point (BM), direction and y St. Croix percent slope, scale or dimemsions, nqr WOW, and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION' rs 'Please print all Information. 040123170 Personal information you provide ma , t for r purposes (Privacy Law, s. 15.04 (1) (m)). Re' wed B Date 4F Property Owner Property Location Johnson, Doug ` ( Govt. Lot NE 1/4 SE 1/4 S 3 T 28 N 19 W Propert Owner's Mailing Addr ,.� Lot # Block # ubd Name or CSM# 16120 6th St., N. r r c "c- i' 7 ❑ Country Wood City , State� Number ❑ City ❑ Village ®Town Nearest Road Lakeland �U43 �9 1 Troy Tower IZ New Construction Use: e�idler#ti�l .:Number of bedrooms 3 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate • bed, gpd /ft - trench, gpd/ft- Absorption area required 900 bed, ft= 750 trench, ft Maximum design loading rate • bed, gpd/ft •g tr ench, gpd/ft Recommended infiltration surface eievabon(s) 96 ft (as referred to site plan benchmar Additional design / site Consideration install 3 - 3' x 48' Sidewinder, Hi capacity "turtle - shell" trenches Parent material loess over sandy/loamy outwash Flood plain elevation, if applicable NA It S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ®❑ U M S❑ U ® S❑ U ® S❑ U ❑ S Z U ❑ S X U Depth Dominant Color Mottles Structure GPDIft Horizon Texture Consistence Boundary Bounda Roots --- -- - - - - -- Boring# In. Munsell C!u. Sz. Cont. Color Gr. Sz. Sh. � Bed ;Trench 1 0 -6 IOYR 3/3 - sil 2 m cr mvfr cs 2f1 m .5 - -- - - - -- -- 2 6 -14 l OYR 3/3 - sl 2 f sbk dsh cs 1 m .5 .6 Ground 3 14 -32 1OYR 4/6 - sl 2 m sbk dh cs I If 1 .5 .6 elev - 97.4 It 4 32 -90 SSBR NP NP Depth to limiting - - -- { factor - - -- Remarks: SSBR is by resistance to pene tration; san are weakly ce w high conc entrations o iron, BR is monolithic 1 0 -5 10YR 3/3 - sil 2 m cr mvfr cs 2flm .5 .6 lOYR 3/3 — sil - -2 f sbk _ dsh cs _ . I m .5 ' 6 _ Ground 3 13 -31 10YR 4/6 - sl 2 m sbk dvh cs If 5 .6 elev - - -- -- -- - -- - -. - -- 4 99.4 ft 4 31 -56 7.5YR 4/4,4/6 - s 0 sg j ml 1 cs - .7 8 Depth to - s 0 sg ml cs 8 5 56 -62 SYR 4/6 7 _ ' , limiting 6 62 -8Q 1OYR 4/6 - s 0 s ml - - 7 8 factor g ,80. .. u -- — — _ —� - - - -- - -, _ Remarks: inclusions of 2.5 2.5/2, t5lil mcos below 6 2 11 CST Name (Please print) Signature: Telephone No. Henry F. Grote i ,i . 715 -665 -2681 Address Certif of Testing - - -- - -_ -- -- - —_ P.O. Box 57, Knapp, Wl` 54749 9/23/1998 222774umber R 1 f 4 a„ r �a ~ ►�(e� � ��cX 1C� ti n o o � t3 �- �9 g • to Z•'� rSr. z� a � i..► ta � ;. � o �s¢� �.� 1. � Q,�.,, �,4•� r VAsconsin Department of Commerce SOIL AND SITE EVALUATION page 1 of 3 Division of Safety and Buildings /�� " inche Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not a 1 1* 1 �.'�IS ) ] c si ze. Plan must include, but not limited to: vertical and horizontal referonce point (BM) Count , direction and y St. Croix percent slope, scale or dimemsions, north aff and p and distance to nearest road. - APPLICANT INFORMATION - ' Parcel LD.# 0401231 3k�rkhtall infor►nation. Personal information you provide may be u for sbcondary py�oses (Privacy Low, S. 15.04 (1) (m)). Review B Date 6 � Property Owner ❑; ^ + ,1 Property Location NE 1/4 SE 1/4 3 28 19 W John Doug -. ; Govt. Lot S T N,R P rt Owner's Mailing Address ro Pe 9 j ^v - Lot # Block # Subd Name or CSM# 16120 6 St., N . �'Y i 7 Country Wood : r _� City Ste } dip Qp� �fJumber ❑ City ❑Village Town Nearest Road Lakeland X3,5043 9 Troy Tower Z New Construction Use, ® t�l Nu7n bedrooms 3 ❑Addition to existing building ❑ Replacement ❑ Z lic or menial describe Code Derived daily flow 450 gpd Recommended design loading rate -5 bed, gpd/ft= - trench, gpd/ft- Absorption area required 900 bed, ft' 750 trench, ft. Maximum design loading rate • bed, gpd/ft' .8 t rench, gpd/ft Recommended infiltration surface elevation(s) 96.05 ft (as referred to site plan benchmar Additional design / site consideration Install 3 - 3' x 48' Sidewinder, Hi- capacity "turtle - shell" trenches Parent material loess over sandy /loamy outwash Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system M❑ U ® S❑ U ® S Cl U ® S ❑ U E S X U I, S X U Depth Dominant Color Mottles Structure GPDIft Horizon Texture Consistence Boundary Bounda Roots Bonng# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 ' 1 0 -6 10YR 3/3 - sit 2 m cr mvfr cs 2flm ! .5 .6 2 6 -14 10YR 3/3 - sl 2 f sbk dsh cs lm .5 .6 Ground 3 14 -32 1 OYR 4/6 - sl 2 m sbk dh cs if .5 .6 elev _ 97.4 ft 4 32 -90 SSBR NP NP Depth to limiting -- - factor 32' - Remarks: SS is by resistance to penetration; s ands are w y ce men w/ high concentrations of iron, BR is monolithic L 2 1 0 -5 IOYR 3/3 - sill 2 m cr mvfr cs 2flm .5 .6 ail 2 5 -13 1 1OYR 3/3 - sil 2 f sbk dsh cs im .5 .6 Ground 3 13 -31 10YR 4/6 - sl 2 m sbk dvh cs if .5 .6 elev 99.4 ft 4 31 -56 7.5YR 4/4,4/6 - s 0 sg ml cs - .7 .8 Depth to 5 56 -62 5YR 4/6 - s 0 sg ml cs - .7 .8 limiting 6 62-80 -80 l OYR 4/6 - s 0 sg ml _ - 7 .8 80' I Remarks. o SYR .S /2, .S 4 mcos be ow " CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 -665 -2681 Address C ertif ied of esUng -- - -- --_- - - - - — -- - -- - P.O. Box 57, Knapp, WI` 54749 9 /2 3/1998 2227 4um Ri CA d+. PlsX l C7 y C9 4ro 1 L 1 ► O 1-o4 - 4 Ca / X11 =- SL= - ;•z�{-� ►mow lz �o o � 4b �� ►� ►� � s=ue' u e 0-0.03 99 �Sa� C. 4. 1.l a� !i ►`,�� Tat is ww- a � s ST CROIX COUNTY,& SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l c%- If t L n1 r J Mailing Address o 6 ,L� 1, 4 Z -VvV , V tl Sjr'o,/3 Property Address (Verification required from Planning gepartment for new construction) g; - k 4o_ L.- City /State fil 4 I W r Parcel Identification Number LEGAL DESCRIPTION Property Location & -� %4, 59 %4, Sec. �, T_,20 N -R_ W, Town of 4�Z Subdivision a-"J" IJ04 Lot # Certified Survey Map # Volume , Page # Warranty Deed # 60 q K Volume �6� , Page # Spec house ❑ yes ® no Lot lines identifiable 9d 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 masterplumber, journeyman plumber, restricted plumber or a licensedpumperverifying 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. SIGN OF ALOPLICA NT 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. Dz!� - 5-- /� 1 2,1 1 SIGNAtURE OF AITLICANT 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 SHEET - STREET------, \ <�� \\ 51 S89 0 52'31 "E \�_ _ 125.50 2.04 ACRES `SO 0�., , 88,827 S0. FT. w h ' \ 31 N8952 31 "W _ 95. to 30 \ ooi N,� — TEMPORARY (80' F CUL - DE -SAC TC E REMOVED UPON R N g5 0 34"2O O CXTENSION. z i 7 8 0 6 g 2.04 ACRES \ ni 88,857 SQ. 2.04 ACRES v Q T nil ✓ °' 88,789 SO. FT 10 4 \ \ 4 Ln -4 f mi m 2.04 ACRES W cl 1.76 AC. EXC. ESMT. .•O \ 8,846 SO. FT. 76,584 SQ. FT A $ I 301 01 4 C p l w I m r I W i m � 1 I I o 217.50' 1 I � 235.11' 165.24' 187.50 + 30.00' m 1 1 C S89 0 E 617.85' � m r I N �L 0 N 0o O n ' 1 v C ao 33 33 0 �- 1 3.13 ACRES 1 1 m 1 136,189 SQ. FT. �n m 1 1U N89 "W 581.47' m N I 1 0