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HomeMy WebLinkAbout040-1230-40-000 'ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT Owner 3 � � � \ ,1 /vie /5 �rZ r Address saa L au Legal Description: �<t,G� c,,',Y Lot 6 Block Subdivision/CSM # /, LILT V 4LL,1, Sec. 11. T,�g N -RAW, Town of j i� PIN SEPTIC TANK —DOSE CHAMBER — HOLDING TANK INFORMATION : Tank manufacturer ✓ '( � Size ST/PC, ddSo / 7 6o Setback from: House /�Si �Well /ca1'� moo �f Pump manufacturer 60 /a' Model < ' o y — Alarm location, (HOLDING TANKS ONLY) Setbacks: Service road `U Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: / O Lt,_ Width Length 8S Number of Trenches / Setback from: House z Well /= P/L 7' Vent to fresh air intake ter/ ELEVATIONS: Description of benchmark � •tea L t�'m c,ed by u � _z/olevation Description of alternate benchmark s ; uric %r+ e t- Elevation Building Sewer ST/HT Inlet ST Outlef PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () ( ) Bottom of System () ( ) Final Grade {) ( ) Date of installation / 2 // permit number 30 - 77/ 3 State plan number Plumber's signature License number �� �/ `- Date Inspector Complete plot plan ar Wiscon §in Department of Commerce 'Safety and Bui[dingt Division PRIVATE SEWAGE SYSTEM Coun'8T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitas#771fNo.: Personal information you provice may be used for secondary purposes [Privacy l s.15.04 (1)(m)]. Permit Holder's Name: L[ itu_ ❑ Village E] Town of: State Plan ID No.: I ELSEN , JOHAN YR YY CST BM Elev.: Insp. BM Elev.: BM Description: ParceIG4@1e.1 2 30-40 — TANK INFORMATION ELEVATION DATA A9800102 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� L�5 p Benchmark Dosing yr Aeration Bldg. Sewer Holding St /Ht Inlet °yS ` TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom II 1 U %z' Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number J `4 GPM tForcem!ain Friction System TDH Ft Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE 1 STREAM LEACHING Manufacturer: INFORMATION Type0 CHAMBER Model Num Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold �j Distribution Pipe(sj x Hole Size x Hole Spacing Vent To ILL Air Intake ��� Yq i 5 , 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 L xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil �o "1 ❑Yes ❑ No C] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 16.28.19,NE,SW 346 SOO LINE ROAD C c ru 1 t. ;l Plan revision required? ❑ Yes ❑ No Use other side for additional information. a I SBD -6710 (R.3/97) Date V `, Inspector's Signature Safety and Buildings Division ,- - SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. `�SCOnS� I n r P.O. Box 7969 Department of Commerce acco d with tLHR 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 than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number -� The information you provide may be used by other government agency programs ❑ Check if rev s on to prey ous 6pplication (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pro Owner Name t Property Location Z va 1/4, S j T , N, R (O k kic Property Owner's Mailing Address Lot Number Block umber City, atp, Zip Code Phone Number Subdivision Name or CSM N u rn ber � II. TYPE OF BUILDING: (check one) ❑ State Owned E' 'ty Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ow of /d _T, -, /- III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) t 1 ❑ Apartment/ Condo 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 y�1 New 2 ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5. E] Repair of an !_°'_System ________ System_____________ Tank Only 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: Sf df 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/da /sq. ft.) (Min /inch) ��� Elevation d Sd V �` Feet eet Capacit VII. TANK in Ca gallo s Total # of Prefab. Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel lass Plastic App New Existing strutted g Tanks Tanks Septic Tank Qr_ 11 d(40 1 ' I? E Cr ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /SiphemEhamber v ❑ I ❑ I ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb e ' Name: (Print) Plum Signature: (N Stamps) MP /MPR�S_W Business Phone Number: be "s S - -772 -3-71 Plumber's (dre (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issu Agent Signature (No Stamps) A roved [:] Owner Given initial Surcharge Fee) pp Adverse Determination � �D O � /cib X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber x„ .•- w r SAFETY AND BUILDINGS DIVISION 2226 Rose Street Nvisconsin La Crosse, WI 54603 Department of Commerce Tommy G. Thompson, Governor 24- Mar -98 William J. McCoshen, Secretary TIMM EXCAVATING JOHAN & SUSAN NEILSEN ROGER TIMM 3128 20TH AVE WILSON WI 54027 NIELSEN, JOHAN & SUSAN Plan ID 9820444 NE,SW,16,28,19W Municipality of TROY Inspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): MOUND 600 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page(s). 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. All permits required by the state or local municipality shall be obtained prior to commencement of construction /installation /operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, eerrd POWTS Plan Reviewer (608) 785 -9348 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, Wisconsin 54603 N visconsin 19 41jt � l Torrrry G. Thor "w, Governor Department of Commerce William J. McCoshen, Secretary Page 2 X 20444 - 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, prior to installation. - 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. SBD- 5524 -E (R. 2/98) File Ref: HASTANDARD PARAGRAPHS APPROVAL LIMER.DOC x , J -- �e 0 4 44 Johan & Susan Nielsen - Mound 98 -20444 Sg ,? U� Location: Lot 69, Glover Station, Fourth Addition NE 1/4, SW 1/4, Sec. 16, T 28 N, R 19 W Town: Troy County: St. Croix Date: March 25, 1998 Owner: Johan & Susan Nielsen Address: 1701 Laurel Ave. Hudson, WI 54016 Plumber: Roger Timm t Signature: License # MPRS 226524 Attachments: 6748 -Plan Review Application SBD 8330 V.U.''w.T page 1: cover Conditionally 2: calculations � ®� � D 3: plot plan 4: system cross section DEPARTMENT OF COMMERCE 5: plan view, lateral detail DIVI51oN AF tYAN ►DI NGS -. 6: pump tank exit detail f 7: pump curve SEE CORRE=S DENCE page 1 of 7 System Calculations A. One family residence - i' bedrooms Loading rate gallons /sq ft per day Depth to ground water 7 3 3 in Depth to bedrock in Cross slope a?o % Force main length ��/ ft of Z in Manifold /header length 3 ft of Z in Drainback gallons Lateral length Z @ �' ft of in Lateral elevation ft (bottom of pipe) Lateral hole size `�� in @ g ` in ( f t) spacing i holes /lateral, G holes total Lateral volume ' �° gallons Total lateral discharge rate s'1 gpm @ 'Z ft head Elevation difference ft Friction lose ©•� ft @ 4 ro gpm Total dynamic head � ' `� (F' 4 f t Pump /si�xon * 4S� gpm @ ft of head Manufacturer °" 1 s �� Model # Dose volume 1 gallons � 1 Lift /sip�on tank . -, "• � L '�"' �y ( , gallons Septic tank , 12j �' gallons Measurement pump on & off 4 ' * in Height alarm from tank bottom in Reserve capacity gallons calcs page L of a � L °y' - 68 SCALE 1 "= yr,) ' 5 Y.7 . 7 i 6 e. q / / �R.,�, P PN i 1 i �Lg1q 6 "' gh H'., q Z' o,� � -w., Pi 1 Ut Zb PE _ , 0 NOTE: House to be at least 25' from mound. i Well to be at leas.t 50' from mound. i ) 3 OL 1 w.aa�l \ b S..�Co:1 Sa�+K 1 3 oz d r � l ,, ( l (� •, r 1 l C X: [1 �l�p.tl v`1���► `O'r �gy�11. lt���� w►r► e�v':vM►�p �:�►• ��1� o\.1Lot- %I .. ...all1 b. 4L 0 �'I pvc s. 40 OAA 1 6 g 1 L L (� �� �� T O �'� t r►i 1-. l I 1 S to , r }" �•, p` c.� O ... 1 .� RJ• � Q�n.. T �- � 0� c ... � : _ c; � `� � -� ` o. 0,,r 1 � ?- , 9— o, t 3 t-O i- a� � • y I r N /►1M weI► LACKING COv JL NCTION Li/W, At C A6E.0 , QlACK 4" C.T. lod%P tJ%w0P6"w6 - 6N . �83 • i u� mmm j .I. PIPG• 3' TO wwwuRUD 24" 2 -D. I 4 "C.t e�Lasv WtJT MIN. Z' IL /PArt T ppPQOVtQ A C.Z. Pw KET lbw6 � WFLES LL p^ Q V . rW ECTI ONi T ON — tMt01SZLl� GROIIwo Q " ow PuNP CoatatEr� Lrv. 6�oCK SEPTIC E _"EC.IF(CATIOKJS Q DOSE , TA Ll KS MAIJUFACTUILCK: LIUMSER OF DOSES: PER DAU TAAJK SIZE' _ GALLONS DOSE VOLUME ALARM MMJUiACTNRGR: g J �1¢..-Jlr� -o ILICLUDIU(p OACKFLOW: GALLONS MODCL NUMOER: 1.0 K w CAPACITIES: A= WC141S OR GALLO SWITCH TUPC: �"" �"'r b"'`� B. 2- IAICHES OR 37.2-4 GALLONS PUMP MANLIFACTURCR: ° ``, _ C • � `� IuLMES OR �s 3 GA MODEL NUMBER: 3g� I L- 0 p. Ir\l OR `' }Z GALLONS SWITCH TAPE: ��"'�''` �"-�� MOTE' PUMP AMD ALARM ARE TO bL MIIJIMUM DISC14ALlGt RATE T, GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFfRE14CC bETWCCSi P UAF OFF ANO DISTRIBUTION PIPE.. S _ FEET + m'k, LIM NETWORK SUPPLY PKtSSUILC .... . .. . . . . 2.5 FECT + 1 FEET OF FORE[ MAIIJ X Z ... -2 _ fpoFLFRICT1Oy FACTOR. 0 `�� FEET �•� ,a TOTAL OyNAMIC HEAD = -1 35 FEET g � I&ITCKLIAL. DIME.IJilO/Ji Of TANK: LELI&TH �'— ._:WIDTH �, � ;LIQUID DEPTH L J M OD EL ' • , M Vertical Sump P ump ' ' Submersible Effluent P ump i. l.. ESE Me .; • :. I I i Pump Specifications j '/7 HP METERS FEET Up to 40 GPM 10- MODEL: 3871 Discharge size 1 NPT 9 30 Solids: %* maximum a Motor 25 Single phase: 115V ° Materials of Construction 6 Brass/thermoplastic 5 15 Features and Benefits 4 EPOS ° *Top suction eliminates a ' t impeller clogging. 2 EPD4 • Corrosion resistant 1 5 construction. ° 1 zo 3o do w usa+w • Float actuated switch. 0 2 4 6 B 10 12 111 CAPACITY METERS FEET ' 25 MODEL DVP03 Pump Specifications Features and Benefits ° 620 4 /w and 1 /2 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM with pump out vanes to protect 15 Maximum head to 32' mechanical seal. 3 ,o Discharge size 1 NPT • EP05 impeller - enclosed design Solids: 1 /4" maximum for improved performance. 2- 5 Motor - Rugged glass - filled thermoplastic ' All motors feature ball casing and base design provides ° 0 0 5 ,0 15 20 25 3 35 40 u.S.GPM bearing construction. superior strength and corrosion Single phase: 115V resistance. 0 2 CAPACITY 6 e 10nPAv Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous o ration and feature stainless steel hardware. o -� Wisconsin Department of Industry Pa \ 3 SOIL AND SITE EVALUATION! J�.RORT e of •" g Labor and Human Relations - g ;' ,- je t9tvision of Safety &Buildings in accord with ILHR 83.05, ,Adh1: God@ !' r ;, r '' UNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Ptan mush icacUde bat '' not limited to vertical and horizontal reference point (BM), direction and -4 of slope, Soale or ' L I.D. # dimensioned, north arrow, and location and distance to nearest road = 4 % APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATI N, "I RqTWD BY DATE PROPERTY OWNER: " PROPERTY LOCATt0N , C • lNl • B�f E RuD 1� �lJIJ \ S S C L Z t b`94r'i t9�" ` 1/4 SIB ,S I b T ,N,R 1 E ( W PROPERTY OWNERS MAILING ADDRESS L s BLOCK ,S48D ME OR CSM # L1 S"51 tI ft w 713N CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD RLUiliffTL L,LS,tvl Sy 0, ZZ. (71S) IIU- B I6 1 p�-( Srs0 L1WE' V4KD [kJ New Construction Use. pQ Residential / Number of bedrooms y (J AddttiQrt to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow 6 M gpd Recommended design loading rate C - y bed, gpol(t - trench, gpd/ft Absorption area required SO-Q bed, ft Soo trench, ft Ma)amum design loading rate o , S bed, gpd/ft 0 _ ! trench, gpd1ft Recommended infiltration surface elevation(s) 9 91. S It (as referred to site plan benchmark) Addi tional design / site considerations 0'K- 63 ' 8 °t • ►"-t I 1 OF - a wD F LL . Parent material S ft I h ti'w 1r / ?1 LLZ b o t`o w► t7 Flood plain elevation, if applicable N • A . ft S = Suitable for System CONVENTIONAL I MOUND IN GROUND PRESSURE AT -GRADE SYSTEM_ IN FU HMDNG TANK U = Unsuitable for stem ❑ S I@ U ®S ❑ U [I ®U 11 S IR U ❑ S IY ❑ S Im U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botndaly Roots GPD /ft in. Munsell Ou. Sz. Cont Coke Gr. Sz. Sh. Bed Tmnch F?- ILl 39 1 o`lt� 3!6 Si lf��k rn cS a.S o. b Ground 3 39 - Sy tz y /` — s a It) Hn \j C- S elev. 9g W to `1M 31 � 5 - Depth to 5 _71- to `t Q 813 limiting factor log Remarks: Boring # S l - Z 5 b4 w,�w cw - o.S (I Z : Z 9 -1Z 31b -- ),Sb?- pl - S 1 �Sbh Yh cg - o•�( a.5 Ground elev. Flo_ 1� 4?- S C i - 0 0.0 ft Depth s S u 3_SS I0 L51aS — — limiting factor 1 4 W Remarks: T Name: — Please Print Arthur L, td e e r e r Phone 715 -4 2 5- 016 5 egerer Soil Testing & Desi -gn Service -P.O. Box 74 River Falls,WI 54022 Signature: Date: )� � ` CST Number: - cl y -3Z- 6 M00576 0 PLOT PLAN Page 3 of 3 SCALE 1 "= y� ' SAY S3. ti �a 1 o� V� CL .q o � e•t � B•Z �Q 0 32 ro oR �L�a�'lPMCT i / v IL °Rg 40' oN EL 'tb4 2 / �J L �9 6 ti 8 h - LL. 9.1 ' vT Zb 0 NOTE: House to be at least 25' from mound. Well to be at least 50' from mound. For a 3 bedroom home, design mound with a 6' by 63' bed. pp c1 q -30 6 9 ( 715 ) 425 -01 69 M 00576 CST Signature Date Signed Telephone No. CST # XV�iisconsin D$partment of Industry S 0 I L AND SITE EVALUATION REPORT Page of 3 "Lmbor and Human Relations Division of Safety &-Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST. not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 0- m - 'Em E F)'A 69W. tom NE� 1/4 S 1 /4,S I b T Z8 ,N,R . 1 E( W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # ' I JA N, r-t tit l j S 6 cl — G LV L3Nt ,STrfi W RD O 1T10N CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD 1 RLL)eV. C- LL S,AJI S pLZ (7tS1 tlZ,$- B t 61 p �( S(,�0 LllvIE NPub> [k) New Construction Use QQ Residential / Number of bedrooms y [ j AdditiQrt to ebsting building 1 Replacement (j Public or commercial describe Code derived datltf How b� gpd Recornme >ded design wing rate o - S/ bed, gW __—_ trench, gpd/ft? Absorption area required Soo bed, 1111 Soo trench,1111 Ma)dmum design loading rate o • S bed, gpd/ft 0 - to trench, gpd ft Recommended infiltration surface elevation(s) 9 S1. S ft (as referred to site plan bendmark) Addttonal design/ site `hpv>.tb w / e'x 63 ' a ft . " I". 1 of 9•AND Fri t.t_ . Parent material S 110 h ew 111- / - Ti uc./ b o Lo Fes► t7 Rood plain elevation, fi appficable N • A . It S = Suitable for System COPNE I "AI MOUND "MI I PRESSURE AT -GRADE ' SYSTEM IN FlLL Ha MIG TANK U =Ura tablebr system 0 ®U IRS 01.1 DS ®U ❑S (a 0 CC U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure C.ortsisbertce Bour Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch I 1 0-11 1 3l Z - S Sbk wt ck.-) - o,S o•b Z ) (4 39 IO-(Q 316 _ SO W, ( - o•S v. 1 Ground 3 3 -) • S L I R V/(. - S \ C `Sb1z trot Uj C- _ ° q o s elev. ag i.t, fL 6� �I 10 ` tL 31 � sly �� owe w►�H cS — Depth to 5 - 71- limiting factor Remarks: Boring # , �OyQ Utz - S 1 1 Z� S w►'F1r c w - o•so.l, E 9 - Z2 l0� -112316 - �1► Z`�dk��. eS o.S o. 6 3 ZZ_tj Sly — S 1 cSb1R w,`f1- cg - o•�( €o -S Ground elev. Flo 1 0 `' 1112 - 3 11 f l S titit s !g C t o,,.� >»�w c g — 4t so.o ft oepifi to 5 U3_s5 V_b limiting factor 1 4 W Remarks: T Name:- Please Print Arthur L. 14 e e r e r Phone: 715-4 25- 0165 ress: egerer Soil Testing & Design Service — P.O. Box 74 River Falls,WI 54022 Sgnattue: Date: CST Number: cl q -301- 6 1 —30 _ 9S M00576 P PLA 11-v Page 3 of 3 SCALE 1 "= 141 ' 69 Sly SJ . N N , a ao o� g.t o LXL s �- et, a►1o.LY' e.v ib Zs_� -, Z t Rt1K1 / Lit. ° ilS -`20 oN a•� 3 2, � Z ' t ` �Retiv P l EL Z ttq q 6 "'8h- EL. Q17.9.Z F.u^, PI PC L Ut Zb — 0 NOTE: House to be at least 25' from mound. Well to be at least 50' from mound. For a 3 bedroom home, design mound with a 6' by 63' bed. cl' V- _ 6 9 I -30 —�5 ( 715 ) 42, -0 1400576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ..16 ka n Ae Mailing Address /70% Property Address 3(o Z iC �d / / (Verification required from Planning Department for new construction) City/State &V - &A Parcel Identification Number 0 t10 - 0-30 LEGAL DESCRIPTION Property Location WE I /4, S 1-f ' /4, Sec. / G , T 2 8 N -R_J ? W. Town of Subdivision A ye,. I/, Lot # 6 f Certified Survey Map # Volume , Page # Warranty Deed # :: ppq,/ Volume Page # (P 3 Spec house ❑ yes �4 no Lot lines identifiable A 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 day the three year expiration date. Sht NATURE 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 erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. Inv GNATURE 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 0 2" IRON PIPE, FOUND. ! I I y I V vv I/ -1 • . , 1 " IRON PIPE. FOUND. 2" X 30" IRON PPE WEIGHING 3.65 b./LINEAL FOOT O SET. 1" X 24" IRON PIPE WEIGHING 1.68 b./LWAL FOOT SET AT ALL OTHER LOT CORNERS. NON- MOTORIZED RECREATIONAL TRAIL. TO BE MAINTAINED BY THE HOME OWNERS ASSOCIATON. SIZE SHOWN. - - UTILITY EASEMENT. WIDTH SHOWN. -' BUILDING SETBACK LINE. —31mm— PROPOSED DRIVEWAY LOCATION. y / /O PQ/ // EASEMENT FOR SHARED DRIVEWAY. HIGH WATER LIMITS OF PONDING AREA. 40' DRAINAGE EASEMENT \ GLOVER STATION SECOND ADDITION I 45 I / I o� 2592.73' S 3" E 1076.95 ....... 475. ' 89 °11' 2 ' ..... ........... _ _ •43 ••.•,••• ,• EAST WEST 1/4 S 1296.00' - - - c .. . .............•400. 1 /4 CORNER - - - - - - _ _ _ — TON 16 a �° 0 N, R 19W o 0 10' 20' N SUN, • a 68 M \ 2.167 AC $ 20' 3 94.384 SF ` 1 � S 7g S1 52• N o 514 •x' C a 0 100• / �U o N .. 69 / / J I ° 2.346 AC / y u 0 102.184 SF N L •W� . O� v 6 W 70 y 3.294 AC 3 78° o 143,509 SF 2849 3 5' E G �,h 1 g�y 0 p y �� /• Z EASEMENTS FOR / , I DRIVEWAY SHARED N / BY LOTS 70 do 1 Vl I N 86 0 01' 28" N 477.12' W v I I 66 Ln I 5.180 AC I I U 1 1 I 225.647 S 0 71 F I .r 2.251 AC r-, 1 I •\ U-3 I 98.050 SF I •�