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Home My WebLink About040-1013-50-000 C o 0 0 V ^ Q Gr� o a � I m I d C 0 O a O ey w '3 � @ a c m c 'tt c t i 0 c -o •- `h m o 0 N Q O N I CD - m (D a z > 3 t O U C _ LL c a `- N - a) O Q� 'O (9 i I O v I Z a m c 0 O z v c w U a) o N Z d o cn P m CD z c - a M y _ N_ N � N O C • O N Q O U O z m z o � E N O m O N O � ar Q N r CO O al i W a) O 0 D D a .0 N fn N fn � x ;F o LL LO *i O O O o ° z d ! 0 0 '0 N 7 O N N to J U ', = rn rn � M LO N 0 C) _ E 04 t Q CL N .0 O CO *via 'O E O O V N 0� O O E O M O a) a) C N 0 0 Lo M a C N � N N c a� m ao CA = O N w O C f M O Lu 00 i' 'c N � m -a .c o ~ O N i L O O 00' O O U • L� O O H LL M O N z Q' fn. O y o CL w • CL E `�1 A c a � I 0 WEGERER, WF,BER & ASSOCIATES 421 N. MAIN STREET . Land Surveying • Civil Engineering RIVER FALLS, WI 54022 PHONE (715) 425 -0164 Percolation Tests ATTN: DATE CC: SUBJECT: _ WE ARE ENCLOSING THE FOLLOWING ITEMS: NO. OF COPIES DESCRIPTION ?6—'PVLOv%O PLKN FA H Idu G SENT TO YOU FOR THE FOLLOWING REASONS: ❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED ❑ INFORMATION DESIRED [FOR YOUR USE ❑ APPROVED AS NOTED ❑ RETURN COPIES ❑ NOT APPROVED ❑ FOR REVIEW AND COMMENT ❑ WEGERER, WEBER & ASSOCIATES t Safety and Buildings Division 'R P APPROVAL Bureau of Plumbing P.O Box 7 969 General Plumbing Plan : r. -. Madison, wl 53707 Private Sewage Plan Telephone: (608)266 -3815 �. Plan Identification No. I E> 1 * Gallons Per Day � f 1 PRIORITY PLAN REVIEW ONLY Plan Review Fee Received Petition For Variance Fee_ Rec. Project Name Project Location - Street No. or Legal Description L FA s e �iNi e ►�( ` unty ❑ City ❑ Village Town of: —7 — vo 1 5 v The plumbing plans and specifications for this project hav een reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved ". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLAN Oahe (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plu mbin g p plumbing has reviewed these tans for lumbin and /or p rivate sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By James Sargent Bureau Director If Questions = d By: Date ,Approved Ae Contact cc: riv e Se4 ge Consultant ❑ Plumbing Consultant ❑ Environmental Health >unty ❑ Local PI ❑ Facilities Need Analysis Section UW -SSWMP ❑ Plumber ❑ Department of Agriculture DuHR - SBD -6099 (R. 01/85) ❑ Owner ❑ Other x II I _ � /�T --�� _l ►J i.' ` ` V t} � i< p� -J ►J Chi T ��U�' 5 T C�ZU �1C �`JF , �1J' "-L OF TI T�-� S H �T -. Z - OF y - �Zt�'s �GT _y - _ Pwr. n�R►�_- art v�Lw 850781,1 RECEIVED NOV 18 19� pl_II��RI�I(; BUREAU --x - zz mz X,3 zy Y.. L4 ----------- JQ L G Pc L- To CS c- 'S',") L C OJQ C�NZ-G�t�: e -T L 'r.S Q Z� L LED. 8 5 78 11 RECEIVED NOV I (�' 19e , PlAWRIkic" C'URFAU 1 1 / i I io � I i 14 I I 1 4 PAC SOLI wA u PIPE 3o i� oC of L �v N 9 9' 5 v!- -o .5` of — - =IZA 0 5 of -15M 1 -4 Y I I CO SSG 8507811 .4 ` x- \zVn1JG G _ ;\Z.� S`�Y1C `r?J \� 1't) `� �OUI`� Gib L C.Ft?•�Cii'f �.r. ;a {.JU rfa.'_Tu2� _ a3� \�� ;u.�_�� •C.�S't LicO!J p::�E 3 � `'yJ� L�t�'�! Slur i� �� GT•��h�D_ .RECEIVED NOV 18 19r PI- 1MgIniG BUREAU '3 G7>—,g 4 z" r-: "X. — � -- - _ - 1 . — I 13 e ago Xk S RECEIVED NOV PI_1.141MINtr BUREAU ,,- E .7- 7 D I L H R Safety and Buildings Division A..u.a..� PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, Wl 53707 ` Private Sewage Plans Telephone: (608)266 -3815 ` 4 6 7 af� gy - -4)0 - fe7T A t Project Name Project Location - Street No. or Legal Description C /—t r C P ounty ❑ City ❑ Village j Town of: /� - The plumbing plans and specifications for this project have reviewed for compliance with applicable code requirements. T is approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped "conditionally approved ". This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLAN 1)� (2) (3a) (3b) (4a) (4b) (6) (7) This approval will expire two years f the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and /or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent Bureau Director I If Questions Plans Approved By: ' ,' r - f Dat Approved Contact ♦ - , .-�_. r 1 cz cc: riva`te Se%kage Consultant El Plumbing Consultant 11 Environmental Health 4c ) ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW -SSWMP ❑ Plumber ❑ Department of Agriculture DILHR - SBD -6099 (R. 01/85) ❑ Owner 11 Other G� 7til 4.08/83) (Plb 100a): (Wis Stats. S. 145.02) SV +' STATE OF WISCONSIN DILHR Detach And Return Upper DIVISION of SAFM & BUILDINGS Porti Of This Form With ° BUREAU of PLUM 201 E. WASHINGTON AYE: -RM 141 Any Return Correspondence P.o Boxes MADISON-'B$907 ''7 � 518 -266 -3895 DATE: n �� PROJECT: 11 / 18/85 /jF gip Fahning, MPl ,. binary Clinic N E,Nw,4,2,t �. Tn Troy William Schumaker St. Croix 'WI Route 2 t Ellsworth, 61 54011 L P . LAN ID. # 85 -07811 DETACH HERE PROJECTNAME Fahning, Mel - Veterinary Clinic _ PLANiD. 855 - 07811 This is to acknowledge receipt of your plans and specifications for the above - indicated project. Preliminary review indicates the required fee is $ = % 0 > Fee Received is $ 50.00 Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in , .abeyance. ❑ Plans being returned. ❑ Overpayment - Refund forthcoming. - Additional information required. SEE BELOW. ❑ No fee has been remitted. Planswill be held in abeyance. 1; Plan Submission ❑ Soil boring and percolation test data on i 15 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (f copy) ❑ All information submitted shall be signed; dated and sealed or ❑ Complete data relative -to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required, (1 copy) Administrative Code ❑ Affidavit enclosed. ❑ Condominium'declaration. (1 copy) El Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, ,water- ❑ Holding tank profile showing vent, manhole, alaim, course, swimming pools, water service' piping, ail weather ser- and manufacturer ifstate approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. Holding tank agreement signed by owner and local II, Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement and notarized. (1 copy) county or soil boring and percolation test data-on ❑ County onsite required. (1 copy) ❑ Design calculations, 115 completed by CST,showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on theland parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all- weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head'and gations . pumped per cycle. 111. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in- entire area of soil absorption Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flowrate (GPM). Location of area suitable for replacement system — provide soil ❑ Cross section of dosing tank showing pumps) or siphon (s):- data. ❑ Construction details of septic; holding or dose tank if site VI.- Systems in Fill (Fill must be placed prior to ptan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. CROIX COUNTY ZONING AS I3UILT SANI'T'ARY REPORT Owner & Address 5 Z City /Blatt r. Legal Description: Lot Block Subdivision/CSM It '/• IUE '/, IU►v Sec. I—, T _MN -R�q W, Town of 7�o Y PIN ft 6`l6 - /66 SEPTIC "WANK — DOSE CHAMBER — HOLDING TANK INFORMATION'1 53e, Tank manufacturer Size ST/PC Setback from: House 7 e We11 1„GY9fi P /LZ Pump manufacturer Model Alarm location (BOLDING TANKS ONLY) Setbacks: Service road _ Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: RE D Setback from: House Width i2 Length �� Number of Trenches _ W P/L, 2 / Vent to fresh air intake ELEVATIONS: Description of benchmark RIM, w �"� eap S�O� �c n ¢�+v' 'l (�t/E5 o r U�,4 F�,� Elevation Description of alternate benchmark fi,v. f(ooe $ t..,_ /' Elevation / I. 7 Building Sewer __L ST/HT Inlet Z ST Outlet, b PC Inlet PC Bottom Header/Manifold 9 7. 5 Top of ST/PC Manhole Cover ybp , G Distribution Lines ( ) " 7.38 ( ) ( ) Bottom of S Final Grade Date of installation 9 /2 zl epermit number State plan nutnbcr 32 0233 Plumber's signatur U , License number _ 2 7 _3z y�_ Date 9 /.13/ Inspector �i r Complete plot plan K Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: 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)]. 320233 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: FAHNING, MELVYN TROY CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No.: Do 100 goA(a, O.� �,�/� f.. 040- 1013 -50 -000 TANK INFORMATION ELEVATION DATA A9800422 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. �Z0a Bench a �* q 6c:i- Dosi 9 Aeration Bldg. Sewer q 1 / 00. , Holding St /Ht Inlet �" 0 $ 9T 2z TANK SETBAC ORMATION St/ Ht Outlet Z c/,q.,D Le TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet ir ptic Z Sb 1,0'` -7 3 NA Dt Bottom Dosing NA Header/ Man. 6 .g0 9 7 - r Aeration NA Dist. Pipe G .qZ. 9 7 3r Holding Bot. System 77e 1 v 6 •5.d- PUMP / SIPHON INFORMATION Final Grade �/. 9g. 8' Manufacturer Demand S. �) lao fj Model Nu ir GPM TDH Lift Lriction S s TDH Ft Forcemain Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BWPT RENCH H width IZ � Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION Wr !! SYSTEM TO P/ L BLDG WELL SETBACK LAKE /STREAM LEACHING :nu �acu INFORMATION Type O CHAMBER Syster :dwll �_-4 2& r 100- Model Nu r. OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Y Length 5 Dia. y Spacing G Se H 0 sr-A Z72-7 3'7 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 E] Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 04.28.19.53C,NE,NW 592 HIGHWAY 35 t2t{l.cuac' aQ, {.g,r� ACf,4b01 — lop Plan revision required? ❑ Yes [(No Use other side for additional information. L q 1 2z j Cw SBD -6710 (R.3/97) Date Inspe is Signature Cer3 No. Safety and Buildings Division N06consin SANITARY PERMIT APPLICATION Po o Was h ington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check it revision pr s application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION "- � 14/Z( 6 Property y1f/ Owne Name �A'KA11�9G Alt o4e / , L,V 1/4, S Y T � , N, R `? E (or) le Pro�pperty Owner 's lylaail�g Addr Lot Number Block Number C it,State , r � Zip �q� Phone one Number Subdivision Name or CSM Number 0516 Ir � �j II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t Nearest Road ❑ Village w 3 5 Public 1 or 2 Family Dwelling - No. of bedrooms Town OF & � 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 5d 2 ❑ Assembly Hall 6 Medical Facility/ fdw�e 10 E] Outdoor Recreational Facility 3 E] 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. ❑ 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 n (] [] F] Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 ❑ Seepage Pit 12 X S`� 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade q5-0 Required sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. /inch) c� Elevation 410 � � Feet 9? �— Feet VII. TANK Capacity in gallons Total # of site INFORMATION Gallons Tanks Manufacturer's Name Concrete Con steel Fiber- plastic App - New Existing strutted glass App. Tanks Tanks Se is Tan r an iZ IZOO 1 V 15e'X5 ❑ ❑ ❑ ❑ _ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' ignatp%oa, ps) MP / MPRSW No.: Business Phone Number: - Erf- � z'1z 7; s- 'Y 3111 Plumber's Address (Street, City, State, Zip Code): 45 kssl�R W/ 5 'Me 5p IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing /agent Signature (No Stamps) A roved Surcharge Fee) ® pp ❑ Owner Given Initial ��99 00 �] Adverse Determ / d� �oo / /Adverse Determ / T � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 15837 USH 63 HAYWARD WI 54843 -8107 Visconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary September 01, 1998 CUST ID No.223242 JEFFERY V FOX PO BOX 295 DRESSER WI 54009 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/01/2000 Ise}ficaton Numbgrs Transaction ID No. 142606 Site ID No. 159563 SITE: Please refer bcithiclettt i o m ain,'` Site ID: 159563 abQVe, an'?all;00rresponc�enc e'ixgey. ST CROIX County, Town of TROY NEIA, NW1 /4, S4, T2N, R81W MELVIN FAHMING VETERNARY CLINIC SEPTIC SYSTEM FOR: Description: NON PRESSURIZES IN GROUND SYSTEM, 450 GPD Object Type: POWT System Regulated Object ID No.: 422798 P The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Con dit and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. APPR DEPARTNI[ NT, of viaF The following conditions shall be met during construction or installation and prior to occupancy or use: DSV n , t ( � A 1. This plan action is subject to designer comments on the plan. 4: CC:' RE 2. This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 3. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). 4. The replacement area shall not be disturbed per COMM 83.09(1)(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 08/27/1998 FEE REQUIRED $ 110.00 PATRICIA SHANDORF , POWTS PL N REVIEWER FEE RECEIVED $ 110.00 Integrated Services BALANCE DUE $ 0.00 (715)634-7810, M -F 7:45 AM - 4:30 PM PHHANDORF @COMMERCE. STATE. WI. US AbgV G All SEPTf S ` /s ,CM /NDEu at - rill« Sr1EE l AXAM 7 &rzRNARiAA1 Oj// /a /'o R /VIE[ ✓ ff HM 10 to Anoo ass - 592 t/wY 35 /A- IDS W1 SyD //. 1-E bisG . ME !y NW 11 y CEC 9 7 A, )f 1 9 k/ RAW JD � J T.S. ionally /NbEU Stfi =�� 7'AIrE l OV T i1�+ 5 /?✓N6 ��E Z ERC cA P )q6E 3 T NGS Sox T ES> fM�En SPONDENCE / 4 Z- 4- 0 This aPProvai does not in- pians for the genera, plumbing is required for r PAP +n9 to the septidhoiding tan is k that must be submitted and a this P�Ct Those pklns Ch. ILHR 82 WAC. PPro ved in accobarxe WM �LU,t.�.BER Slb �tl�l'1JIZ D�47� �GE � 09 - -97 14:39 CR055 COUNTY ID= 7152943138 p.6� MEt i�inJ Fs1+1�?,,/G IVCYY �Jv4/' /y ccc Y T Z6 AJ, R 19 VV 592 #wy 35 ��nv 70,vvsn�P �i�ason/ Y ✓! 5�0 /G IZxS.y II n!i P�tS ZZ32 4Z a ` 1ZOO 6At< VJEEA SEPrc7AP X ADUSE } 4 SUED d z B y,4nPdS�n z N >: SAlW ®1'►�EiL I SE�/G!✓►�IR�C It 1 904 S AINV6 Alt. (`O"Ef o,= SNS E1�5v loo & NAI",•� 2 b7m Si�1N SF .onlV�it 4r stfF,p 6LZ✓ �71 i7 Q SatL RbT/s/G SCALF I �� Srzii✓G 2 1 0 W ME DIC AL &L 756P LEER /So G+Lf Dtil /5 PA716 MTS f DA)l AO G ?D eXI4 150 GHQ Dk►Y FLboR D RAIW5 50 GAOFA - 1,50 DAy. 770 IV56 (AL PER CDfl y &t 10 M .7 L&IjWN /'hartE DR4Y�ttQfG- G�"r�tJK qSD 4 - T5a M1113 sEp'ie TA jlc_ 5i zg )Z GAL J�11tJ SE I c F _ f , 1 t I { CROSS SECTION OF A BED OR TRENCH SYSTEM (DELETE OUTSIDE LATERALS FOR A TRENCH SYSTEM) q r ( SOIL FILL DISTRIBUTION PIPE / APPROVED SUMTHETIC COVER 2" OF AGGREGATE J �' OR 9" OF STRAW OK MARSH HkJ aOF % -Z'� AGGREGATE ELEV. OF 96,5 FEET_ DISTRIOUTIOIJ PIPE TO bE AT LEAST �8 WCHES OELOW ORIGIMAL GRADE AMD AT LEAST20 IAICHES BUT IJO MORE THAI) 42. 11JCHES DELOW FINAL GRADE MAXIMUM DEPTH OF EXCAVATIOM FROM ORIGiQA.L CI:ADE WELL 3E: SLR _ WCHES MIMMUM DEPTH OF EXCAVATIOij FKO,A ORIGIIJAL GKADE WILL. BE: _ 3' INCHES S I G IJ E D : LICEM IJ0 M13ER: DATE: 2 1 28 _, OF Wisconsin Department of Commerce SOIL AND SITE EVALUATION .Division of Safety and Buildings Page / of Bureau ofartegrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and "r C b f Co percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 4 yb- o ! - a APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location i ' • 1 r E U rn ., c l Govt. Lot 1)E 1/4 NW1 14,S T C O ,N,R 9 E (or)o Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 59D, Fl 35 City State f Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road uc� 5 0 h I t.�y 622 It, (_. i' )381, -$ 2 E. 'rKo Y 4 4 ,,)u 3 " New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement 5}Public or commercial - Describe: _U _ e + C I , �, i _ _ Code derived daily flow 3 00 gpd Recommended design loading rate bed, d /ft gp trench, gpd /ft Absorption area required bed, ft _trench, ft Maximum design loading rate 1 bed, gpd /ft g trench, gpd /11 Recommended infiltration surface elevation(s)1 �_ glo. 1']� d } $ ` $ ;;)— (as referred to site plan benchmark) Additional design /site considerations _ Parent material . 4 �k1 00+ La cy Flood plain elevation, if applicable it k 7 — Unsuitable uitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank for system ® S ❑ U S ❑ U ® S ❑ U ® S ❑ U ❑ s ® U ❑ S �A U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0- o 10 Z -, am to rn f r Ct s a 5 I o c Ground 3 .a'1 1 D `1(�c. SI �.._ _ ._. 5 L a w S b tL M L �J 1 O F lev. 1 `I 0 - L C -- ,1 fto Depth to `IS- I U y ` _ — - $ tvt "' r 7 limiting factor 'aS in. Remarks: Boring # a a )0 -1 o`I K y f _ -_____ _ L c,4o 6k i F . S 3 I -a8 10 k 6 it, L• c= vj �6 WT IF r- Cw ►v . S Ground 4 yy 1 `� R 5/ -_ O_ 5 1M L C w elev. Depth to - limiting factor --g-S Remarks: CST Itme (Please Print) Signature Telephone No. 5 a r k - �.,__ - 7 1 4 8 Address Date CST Number x7 I. a f :Sta F ro,'-, 4, 1, < aa 1 - 7 b 54aD1�, t e_1'vh� n F ! ur a n r� - NE /-�� NW / SL c. 4, 1. a$0 R19 S. S-#ark vo N 33' --7 > E m I CE So _ ADD 1 ; I Q16 S� Cc F yy I i. tl h G - jy� 4 J I SI,�cA 7 i Q 4 1 l O 99 �� ) 99.�a' Sot s E c o ��,- �.�. �� a 9 9, :55 R� g9•bD � C3 bor�.l.o` Q S W e- B 3 q9, a' 83 9 7. 17 • 8 4 0 19.10' as 91.13' 5S 9 9 . ?y Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division Of Safety and Buildings Page of Bureau of Integrated Services in accgr0`dn - ,WVttht, ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 i1 inches irWe Pia6 rh4W County include, but not limited to: vertical and horizontal* ferot ce poi, ($t t you tion V`nd S �' Q R percent slope, scale or dimensions, north arrow, nd.lOcation and' °(f§ta' o nearZi6l�ad. parcel I.D. # APPLICANT INFORMATION - Please r ot all in qr 06 ,- { Reviewed b 3 ~ Q ate Personal information you provide may be used for second�Ty'prrrposes s. 15.04(1i Property Owner E E�rojp 'rty Location / I g �� 6� '4t. Lot N E 1/4 �} 1/4,S T �g ,N,R ! E (or)o Property Owner's Mailing Address � / Lot # I Block# j Subd. Name or CSM# , V 35 City State Zip Code Phone Number El city El Village [S? Town Nearest Road v W1 SyD)G ( 7 1 S )396 -P3' "�94 Y 3 New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement [Public or commercial - Describe: N/ f+ C1 t yy s C'° Code derived daily flow 300 gpd Recommended design loading rate •_ bed, gpd /ft , trench, gpd/ft Absorption area required oZq bed, ft -)"� trench, ft Maximum design loading rate bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) q lo. 17> a 3 } $ �j )� 5 ;;)- (as referred to site plan benchmark) Additional design /site considerations Parent material S C \C, � o " t A } c.. S ! Flood plain elevation, if applicable ft r=u— Suita ble for system Conventional Mound In Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system S ❑ U ® S ❑ U ®S ❑ U ®S ❑ U ❑ S ® U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 3 _al"f 1 0'1 �,� �,._ S L Q fr1 � btu �lev. � F Z 1 w..� t91G � L ft• Ll _7_95 C? �I L 5 U ` 5 L W "" .'7 g yS -� ID �f Depth to ----^ - J Yvt "_ , - 7 limiting factor 35 in. Remarks: Boring # 1 O -IQ I o °1 ' /� - -- r, G1(1.. I ,\ , 5 , IP a, a io -► ray N — _ L aft\56 cw Ground 99 `1V -BS I Ia ............. -- - Depth to limiting factor 85 in. Remarks: CST Name (Please Print) Signature Telephone No. 5 C, r- 15 - -35 38 Add p Q Da (� CST Number � : a. t d" 1 4 1l it O - IoR - 19 a;t 7 rrt; - r Fa ti. h pa 5 e L-I 3 N IE 19 ZT. 54 Cmre- vgj,�Cl' 54 N\ Q a 1 tf ( LM 30� � _ 3f � S 0 I S c > ra,6 1S, to o ---------- + Q Brv1� �o +t0� 5,$,►.S - `'1 � Fef e (N 100,00 Q 00.06 1'7 99.1;t o O n * 4 S O E I r � I 6D q 9,:5S bore-N\ole-S ® we-11 q9. Sa 83 cl 7. y 7' 89 99.yD B q 19. as 91.11 13 S q ck. ly I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer M E a FAiA M 1 N g, Mailing Address 4`I2 #Vly 35 91 /050p H y bl C� Property Address 'S q Z N W V 35 14y riot') �� ,' j ya / A tt // (Verification required from Planning Department for new construction) City /State TIUDSotJ Vd I OX OIL Parcel Identification Number _CHO — 101-3 —.'SQ LEGAL DESCRIPTION Property Location �� /,, 1�t� y,, Sec. L Y T_Ze N -R W, Town of Z�, TRo% Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # _ 53 q3 g Volume I I 2_ Page # �0 Spec house ❑ yes X 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 ftmction 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, restrictedplumber or a licensedpumper 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. I/we, the undersigned have -rea , 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 a three year expiration date. el'�' ' SI GNATURE 'OF APPLI ANT 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. S GNAT'URE OF APPLIC 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