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CROIX OUNTY ZONING DEPARTME NT Asa T SANITARY REPORT, Owner RENEW Elo mkt L,l ° L .\ Address T oY du2k)E V Goer (?OP 566 City /State Op 0 k Sr 1, 998 Legal Description: , � AorX ~- Lot � 6 Block _ Ury N Subdivision/CSM # �Z�ry "OFFS E % ;5 Sec. l9 C �., T zo R N_-� W, Town of TRo y PIN # _ av SEPTIC TANK —DOSE CHAMBER -- HOLDING TANK �" A � /?. 13 � INFORMATION Tank manufacturer 4�/ Fk 2pp GC Pump manufacturer ize ST/PC / Setback from: House �� Alarm location - Model Well Z8 p/L 4 16 � (HOLDING TANKS ONLY) Setbacks: Service road �— Meter location Vent to fresh air intake Water Line Alarm location SOIL. ABSORPTION SYSTEM: Type of system: Width $` L ength Setback gym: House -2. Well p/L Number of Trenches Vent to fresh air intake ELEVATIONS: Description of bench - T- p 6 F. W , Description of alternate bencmark ✓�, S � Elevation Op Elevation 9 7.7 Building Sewer ST/HT Inlet 95 ST Outlet pC Inlet PC Bottom Header/m 9/, Z Distribution Lines Top of ST/PC Manhole Cover O � - 9� Bottom of System ( ) Final Grade ( ) Date of installation Y Permit number � � State plan number `1810 33.5 Plumber's signatur License numbero�a a Inspector p Date ('omplete plot plan or y , 1 NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 3-ROY 1 ip,.E C�oc �OAkSE MlI11117(IJAF_ EM 'et2 BTM. 51p61N& LEV. 97 7 2$1 • 36 4 161 'MP bt/Ct,� �rl&v too ' • scn,E ) if() i t • j. Je so EEL Ill I I I I Zoo Ter To P,2O L,il ) INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County CROIX 4,Vty and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarMecjr " Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). My �p W�fin r ' RPRISES, LLC �'fib Village Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.. ; Description: Parcel Tax No.: 1 00 1 v v.0 wlG 4 A9800058 '°'` OA TANK INFORMATION ELEVATION DATA 4f' K TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e tI V�fc�KS lZC'C:> Benchm a , 2. 1DZ 0 I tsa Dosing t k W 13M — 2.2'Fj qGe1. 97-7 Aerate Bldg. Sewer I OZ 0t' S8o °I rr -� Holding Inlet IpZ.o(p &.4% TANK SETBACK INFORMATION �il: Outlet TANK TO P/ L WELL BLDG. Air ROAD tHeader N I�t Septic 7 1 t3 1 NA Dosing NA e,t. ?/, / Aera 'on NA Dist. Pipe 9v.�6 Holding Bot. System �D,yS 90. 06' PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand V►�I�� Irk O� �'' q �' 3 Model Num a GPM TDH Lift Friction Y Ft Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width No. Of Trenches PIT Of Pits ;1n ide Dia. Liquid Depth DIMENSIONS Sd DIMENSION LEACHI nu acturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM CHAMBER Mo Number: INFORMATION TypeO � gam /� OR UNIT System: 4;2c- Sa DISTRIBUTION SYSTEM Header /dGar�i#e4d Distribution Pipes) :xHole Size x Hole Spacing Vent To Air Intake Length / r A Dia. � � Length � Dia. Spacing LJ SOIL COVER x Pressure Systems Only xx Mound Or At -Gra stems Depth Over Depth Over xx Depth Of ` f xx Seeded/ Sodded xx Mulched Bed /Trench Center yd Bed /Trench Edges ~ �� Topsoil [:1 Yes ❑ No E] Yes E] No COMMENTS (Include code discrepancies, persons present, etc.)S LOCATION: TROY 19.20.19 , NE , SW 228 CTY RD F TROY VILLAGE f.-- TLOT L 8 ], I, ilk. t0rA— 0 ��nM o l jdclJ�� �W of C'A -� �b1�_ S t'j ��7 �'"1�' G oC+1��V1 c l l Plan revision required? ❑ Yes C]"No pQ Use other side for additional information. Q(o T� Inspector's5ignature Cert. No. Date SBD -6710 (R.3/97) %R sV ° / o ns� - n SANITARY PERMIT APPLICATION 20 1 e E.W and shn • D of Commerce In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 812 x 11 inches in size. 5 7 CSI YL • See reverse side for instructions for completing this application State Sanitary Permit Nuuumbbeerr� The information you provide may be used by other government agency programs Q Check if re Ion tdprvio eus app cation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pro erty Owner Name Property Location X Vi /4 S VV' 1/4, S /Y T ZO , N, R /9' E (or)dV Property Owner's Mailing Address Lot Number Block Number 8 5 !; Z; 40117Z 1 City, State Zip Code Phone Number Subdivision Nam or CSM Number C E ( z ) y_ 7 7X V cc lG II. TYPE OF BUILDING: (check one) ❑ State Owned itr Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms V own o f III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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 Ru qt ' (7 IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. KNew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an - _____System ________System Tank Only _____________ y stem ______________ Existing Sy ________ 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 Oseepage 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.) Propose (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 6 7 5 �� • L� . Feet /.S Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- Fiber- Plastic Exper. New Existin Gallons Tanks concrete strutted Steel glass App. Tanks Tanks Septic Tank n /z � 11,1E ❑ ❑ ❑ El El mp Tank /Siphon Chamber I ❑ ❑ ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT ' I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Prin Plumbers Signature: (No st s) MP /MPRSW No.: Business Phone Number: Plumber's A,d�reep (Street, City, Sta e, Zip Code): '! /, / �Q IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin Age t Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) I Adverse Determination �6"o � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-63M (FL 11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber N d SAFETY AND BUILDINGS DIVISION MF visconsin 15 USH 4 3 Hayward, WI 54843 Department of Commerce Mt. Tommy G. Thompson, Governor 20- Mar -98 William J. McCoshen, Secretary Cross Country Excavating Jeff Fox PO 295 Dresser WI 54009 Rehbein Enterprises Plan ID 9810335 NE,SW,19,20,19W Municipality of Troy Inspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): CONVENTIONAL350 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. 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, Patricia Shandorf POWTS Plan Reviewer (715) 634 -4870 SAFETY AND BUILDINGS DIVISION 15837 USH 63 Hayward, Wisconsin 54843 Tommy G. Thompson, Governor PAGE 2 William J. McCoshen, Secretary March 20, 1998 RE: PLAN NUMBER 9810335 This approval is for the following: - 350 gpd public conventional system. This approval does not include plans for the general plumbing systems or sewer leading to the septic/holding tank that is required for this project. Those plans must be submitted and approved in accordance with Ch. Comm. 82 WAC. This plan action is subject to comments on the plan. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Patricia Shandorf Plan Reviewer (715) 634 -4870 7:00 - 4:30 s PRIVATE SEWAGE SYSTEM Departrnent Of Commerce Safety and REVIEW APPLICATION Bureau of Integrated e Division Services Hayward Office LaCrosse Office Madison Office Shawano Office 209 W. 1st St. 2226 Rose Street Waukesha Office 201 E. Washington Ave. 1340 E. Green Bay St. 401 Pilot Court, Ste. C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 608 785 -9334 Suite Hayward, WI 54843 Phone no Waukesha, WI 8-860 ( ) Madison, WI 53707 Shawano, WI 54166 Phone (414) 548 -8606 Phone (715) 634 -4804 Fax (608) 785 -9330 Phone (608) 266 -3151 Phone (715) 524 -3626 F ax Fax (715) 634 -5150 Fax (608) 267 -9566 Fax (715) 524 -3633 (414)548 -8614 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plansfinformation. Your submittal must be received at least two working days prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A samplp of a completed form is on the reverse side for your reference. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)). 1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the information requested below to save time: Appoin ent Date Newer Name 3 Plan Number 2. PROJECT INFORMATION If this review is a revision or extension to your existing Project Name plan identification number, provide that number here: R &tl6 &IU Tof y Project Location a ❑ City ❑ Village of GOVT. LOT gE 1/4 S�,t/ 114,S 19 T ZQ N,R /9 E (or) TRo G 2 R ofx 3. APP LICATION FOR 4. FEE CTATIONS System Type (check one): FEE SUBMITTED System T lude new and existing tanks) A C] At -Grade Up To 1on septic tank ... ............................... ..$110.00...................... H ❑ Holding Tank 1,501 - 2n septic tank .... ............................... ..$120.00...................... M C] Mound 2,501- 5,000 gallon septic tank .... ............................... ..$160.00...................... N (2 Non - Pressurized In -Ground (Conventional) 5 ,001- 9,000 gallon septic tank .... ............................... ..$200.00...................... P ❑ Pressurized In- Ground 9,001 - 15,000 gallon septic tank .... ........ O Other. ....................... ..$300.00...................... ❑ Over 15,000 gallon septic tank .... ............................... ..$500.00...................... . ..............................$ 70.00.................. Building Type (check one): Up To 1,000 gallon dose chamber ..: 1,001 - 2,000 gallon dose chamber . ..............................$ 80.00..................... D ❑ Dwelling, 1 or 2 Family 2,001 - 4,000 gallon dose chamber ............................. ..$100.00....................... P J@ Public Building 4,001 - 8,000 gallon dose chamber ............................. ..$120.00................. S ❑ State Owned Building 8,001 - 12,000 gallon dose chamber ............................. ..$140.00........................... Over 12,000 gallon dose chamber ............................. ..$160.00...................... Up To 5,000 gallon holding tank .... ..............................$ 60.00...................... Code Derived Daily Flow LSD 9Pd 5,001 - 10,000 gallon holding tank .. ............................... ..$100,00,,,,:,,, Over 10,000 gallon holding tank . ............................... ..$150.00....:................. ❑ Check if Replacing Existing System Experimental System (additional one time fee) .............. ..$300.00...................... Revisions to Approved Plan 2 .......... ............................... Petitions for Variance: Setback ..................... ..............$100.00.......... ❑ Petition for Variance ......•••••• Site Evaluation ....................... ..$225.00...................... Plumbing ........ ......................::.. $225,00 ...................... Revision ..... ..............................$ 75.00...................... ❑ Groundwater Monitoring Groundwater Monitoring - Per Site .... ..............................$ 60.00...................... (other than a proposed subdivision) C] Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring ..........$ 60.00 ...................... Subtotal: . //0 MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Priority Review: Enter same amount as Subtotal: ................... 5. SUBMITTING PARTY INFORMATION Total Fee: ................... //0 Telephone No. (include area code 8 extension) Company Name ( _ ) 29y- Sill Contact Person (4 C0VrJT P'y EXCAVATi to No. 8 Street Address or P.O. Box City, Town or Village, State Zip Code Z�iS >' R 146 Aerobic or prepackaged treatment system fees are calculated based on c a D 2 Revision fees are not applicable to temporary holding tanks or extensions to existing 1approvals ark and dose chambers. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SBD -6748 (R. 07/98) OVER _-_._ f�cj( IC OONVEIOTIOALA SEPT I0- SVSTL -)4 IlI/D�u + iT1.E SHOE- - T FR OJE cl' — ?boy I�URNF �n�F G6uRS E- NI4IA17: (�LDLr OV✓NLR - RENRK)AI EUTER PRISES LL C Mh -ES 5 pl L- BLA E- , m W 55yy9 G,ErrL Des.- WE �y S � SEA l9 T ZD. / ✓, R /9 lV TRDY 7ow1vrv1? 57 d9D 1X C(5 SuB 61v/s /o)v - T?UY yZJ,61, L pL.AIU J n '� - 9�'I U335 P.O.W.T.S. A b-c x SVEE :T P 1 Conditionally RLOT RAN ?v&L z APPROVED ft-AJV X /E I V* eW,!q .5E(. f�G� 3 DEPARTMENT Of COMMERCE DIVISION OF SAFEt swLDIN" SaL ?ES; AITA CAE n SEE GORRESPONDEM ,DATE 1. 03 3 ] fq &F-- l oF-3 REH,3E /A/ CNTKePRJS&S 96S 1 /MAPLES S IV jjff �H .5W k1 S F-C. 19 %• Z-6, M k J9 VK .9ZAiJ ✓e Ali/ T wA/srli) This approval does not include plans for the general Cr plumbing systems or sewer piping to the septic /holding tank that is required to ih ; P. -Opet. T ?ose plans i must be submitted and a;4acved in accordance r10 (jam i I Ch. ILHR V WAC. �' J2on /-f1L v ✓rEK sL-RTP WANK ( I ( HI.T. AREA ( ro /Vr HINTJtulC6 U/L. IJL IJ t I J� x5o ffE-v 1 WELL �/✓1 z Q - - - -- 1641. t B1 Cr Q2 PA R KtQ, SEA✓Cf/MAPK W J ToP of WrIL 1=L /rte C 1rM, Sw SrDtNG S�S� COR / ✓F�2 D1= ��V. F— q7 7 ❑ �C�1L L�OiZI NQ- Sc/��c S lZ t ML J5 F-NIPLoYi=E S u ZO 6 LACK 3X �hL- J FLVOR BRAJAI x 50 6A L SD fs A L 350 �e9L >�R DAy I-or rr jHGE. 2 6F } IV VEW SEE PAGT 13r--D b)STRISLT10M L.10fF5 � so' FPOM SEPTIC 7AIAK 3' y " SCOO V&L Y � y " DIS7RIBU1l0A) LI11�1 =5 CRvSS S1~C71o1J � IFX 19"30" AP`PROV�p s /NrfiFT /c CO ✓F2 MATERIAL e " lz•� C �e ° I "' P Pi= Fl> L L'LE✓ N10)W PFI�� 3 ar 3 wv isio Department Commerce SOIL AND SITE EVALUATION • Division of safety and B B - -� Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Page of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and to nearest road. l Parcel I.D. # APPLICANT INFORMATION - Piease pri hincrma • �. Reviewed by Date Personal information you provide may be used for P r secorxia r ` ; It' .04 (y) (m)), Property Location P r' ? ovt,L"ot) 1/4 1/4,S T ,N,R (orj i PrWperty Owner's Mailing Address " ` ST cOi;( ot # .. JL b d. Name or COUNTY ZONI / City State Zap Code P cl;oty Village ® Town Nearest Road �T New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement 2 Public or commercial Describe: ,' 7 - '&/mil' Code derived daily flow gpd Recommended design loading rate _bed, Absorption area 9P� —.—�— trench, 9Pd/fi� required _ bed, ft trench, ft2 Maximum design loading rate / i Lbed, gpd/* _ trench, gpd4t Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations _ Parent material Flood plain elevation, if applicable n S Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U Unsuitable for system ®s ❑ u ® s ❑ u ®s ❑ U (O ❑ u CIS ®' u ❑ s El U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 E3 Bed , Trench Ground elev. Depth to limiting factor 796 in. Remarks: Boring # _ ,) L Zic Le s uJ — Ground a d elev. — Depth to — limiting factor 2.x'6 in. Remarks: CST Name ease Signature Telephone No. Address Date CST Number � 0 L SOIL DESCRIPTION REPORT 1PROPERTY OWNER �,-,�/8LE/ -C-AJZ .-5ES Page ' ,of 3 PARCEL I.D.# Boring# Horizon Depth Dominant Color Mottles Structure G D/ft2 Texture Consistence Boundary Roots P in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench y / /,// /ae?/ ✓V� s./ ,_--, ,"h: „,,,4 tik) J .SJ; , G, MEM // /9 %�el* *+// .sl(�r � ,i/kf „,,,, c uJ //1 , .S: , Ground s' /9./ /n '3/ N/9 A ig hK / Xi' 9Se ft. V .si/ J S-5�'/V d // /S .�/ ir,_S �,/ c .d`i — 77 : ,s' Depth to `)S /1I eA 4! / - e ,4,46 51 Qr3 ' w, / b . / : , limiting '� 7i'-fO S`�,S'/e/ /V/ ,sr/ /is;/ pi - >`./' ,.- factor , .�(G in. Remarks: 4" _ . ,;,i s',��,,s - 7 5X'r� - .,;e 3';,,E s,f- Boring # 7,, - / /l n . :VW. _ i j3 /.7 / .i�/ s-/ -7L I „Ye ,,,A, /f,S� , ,G , ,,;-< -. /3: A,A-��/ Nil/ 5',/ , f ,v r r,., /f „-5'. ,to ,, -�o /eIi4 ,di _s/ ,,,s,d , d 4 Qt.,) A f • S—: , Ground `/ /e-.ss- 7,S:14 'V s/ /�.S,,,SdK n/ham (7,J - ,-/: ..5 /,'1 ft. < ."7�/ 1CX/G/! ,UA T 5' l JAB,Sa ,,, / Q�,: / 7 : ,g. Depth to 4 �ilerx S,e-We/ /v/ s^7 l f�O/ ���; - : , limiting , factor r,k< in. Remarks: X., ,�71,:,) s - yS"e5`- -i-t}-s2z ,-_, Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed ,Trench Boring# ) / , / N/ / ` �k•Z� / / as ,€`,. / ©,/� r9 ? / /I S' �rrJ7�r ,,,,, ,� C� i. /Z' / 7 / '' //� /' J W r7 5 /, J{/ ¢ S / l7,, m ,ZJ i r5 : ,C� /DX' -A 4/ .s/ rls6I Ji`r C'.,; 4 t , S ' , Ground -1 -*-l/ / l/ ,,i/ s /3„,,,sr� in/ .1 7: , elev. / 4 ft. — Ll yo /;�°?// �d� 4 Sd�F f, .1�s,�� � ; , s� Depth to limiting factor Q2In. Remarks: �,,1L 4 - 7. S-es- -lo,ys;ze Boring# , Ground , elev. ft. Depth to , limiting factor in. Remarks: SBD-8330(R.07/96) .�" s,�.JC,✓ /1/.��' � ;Bm�i., a�s.u _s'NJ C�,�� ��B6�,t.197, T W N � I i r � � i I 1/ Wisconsin Department Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page � of � Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information yoy provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner L /' Property Location Govt. Lot 1/4 1/4,S T ,N,R E (or) W Property Owner's Mailing Address Lot # Block# N r d. Name or CSM# 8 v� � e City State Zip Code :Phone Number ❑ City ❑ Village [& Town Nearest Road New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement ® Public or commercial - Describe: IK z Ida Code derived daily flow 3e>_ Recommended design loading rate bed, gpd/ft J trench, gpd/Ft Absorption area required 49 ? v bed, ft 0 D trench, ft Maximum design loading rate bed, gpd/fl trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/siteconsiderations Parent material __ q & 4.J 6.4 wits h Flood plain elevation, if applicable ri / w ft S 7SUits ble for system entional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsitable for system IM S ❑ U ©S ❑ U © s ❑ U Q S 1:1 U ❑ S ®U ❑ S © U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2 13 in: ° Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots YIA C4 Bed ,Trench Z • s.l 2rhabi` wI �Z: Ground 3 elev. 3 74 SL If b C, Wl r ft. D- 5 1: ��, � ►M�i , 4 s . Depth to S Ifactorg 7 I M1� I in. ..Remarks: Boring # -3j dtl 6l�I�AG�S h 5 �� 0 �yt) 1 CsS S ji Wt.e>-ll1g t�+l.( �onc�r�►d�tf o-� so,� sat+.►��I'o d i ston- lit.".d 1pael s d IAoe � 10 U40 •-'� �JP�s � eo�c,�t '�Ir3ltRfr' 1�,�v'�a�, s c�c-c� ��s f ,, S- r�� WAS Mt EPORT Page of SOIL DESCRIPTION R Depth Dominant Color Mottles Structure GPO�ft Horizon) in. I Munsell I O Sz. Cont. Color (Texture I Gr. Sz. Sh. I I Roots Bed Tn3ncri 3 3 ;round C 3_ -Z3 'f,SY �o S OS /j'I / G s �!/ �, 7 I O• $ dev. _zrt. C Zl ' = /OY,e 6t S /Y-oc 0.7 0, 8 leplh to 7- 7- Me 70 *1 IWX Allo Remarks: 3oring # 0_S yie 3 Z S " aw ice ¢ o. Ground elev. 3. — D epth to — limi ing Remarks: goring # /�- Ti 4e rJ Ground Depth to limiting*+ factor � Remarks: Boring # Ground elev. R Depth to lirmling factor - I � Remarks: - CanAl4otA.061Gi21 WrIonstn0sparvnentotIndus". SOIL AND SITE EVALUATION REPORT Pag / of 3 Labor and Nurrnan Reiauons g OiwsrawotSatety s 6wldiNs in accord with ILHR 83.05. Wis. Adm. Code na : See 'U.rN. descri`loE-ci -', COUNrY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but ST not limtted to vertical and horizontal reference point IBM), direction and % of slope, scale or PARCEL I.O. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION E %z 5 Al a VAWpW GOVT. LOT 114 &., f ,S /9 T ZO ,N.R / 9 ) W PROPERTY OWNEIT:S MAILING ADDRESS LOT # BLOCK # SUBP NAME OR CS x il�.4F CITY, STATE ZIP CODE PHONE NUMBER FICITY f71VILLAGE WrOWN NEAREST ROAD „ v�SoN Gam/ Sao /G 1�/� 386 - Z9oz r G' Ty' � " New Construction Use ( j Residential / Number of bedroom ( J Addition to existing building j ] Replacement Public or commercial dwribe L OvZl;e /WiiyTEN�/ y /LDi�/cq Code derived daily flow gpd Recommended design loading rate e�". 9 bed, gpd1tt — trench, gPmi2 Absorption area required _ Z bed, ft s¢Z trench, It Maximum design loading rate O ¢ bed, gpdM Q• .' trench, gpd1ft S5*5 Recommended infiltration surface elevation(s) 9y i; e-Z It (as referred to site plan benchmark) Additional design/ site considerations ✓r NO 4�WTsve_-' E E * eX /s, Parent material o�SS T LL D �iTl�r/Q�y Fl� pin elevation, if applicable It S - Suitable for system CONVENTIONAL MOUNO I N-GROUND PR AT SM06 SYSTEM IN FU HoLDM TANK U - Unsuitable for system ❑ S ZU I IBS Cl U I ❑ S f� U ESSURE ❑ S NU I [77 S �U I ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Texture Consistence Bcurxtary Depth Dominant Color Motlfes Structure GPD /ft I in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Roots Bed ITrench Znftb 1 74 Ground G-G O1'4 '5 — S �S rr� / S v-� D 7 O s elev. 4. 71 0,8 Depth to limiting fa 4_ 7 Remarks: Boring # 0 7 O/,Z 3 /z 5 Z�itsb c /y! r A w Gro ra ft vye G G jt! sY� s Depth to limiting fam 4-7 T_ .Remarks: T Namo Flew Print DAMES b. FILKWS Ptanr. (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 1 Sows: Oats CST Number. x `/ 9 7 CSTM03988 P00PERTYQWNE9 SOIL DESCRIPTION REPORT ' Page _ of PARCEL 1.0. s Depth I Oominant Color I Mottles I Structure i I &ui=v G PO /ft� Boring # Horizon Texture Cor�sisflence Roots in. Munsell Qu. Sz. Cant. Color Gr. Sz. Sh. Bed iTre" -S Dy2 3 3 — S 2 .s6�e In r' G� w Y D.���O,4 3 DYE �¢ SG/ Zara 6� 16- &S Zy� D• ¢ �D. S Ground C / 3 -Z3 75Y 6 CS /!/ O, 7 I O. 9 elev. 7 - - o ft. C Z l 3 —�. /OY,e S G — S' OS �'!/ GZ S /Y� A 7 D, B Depth to CZ2 3_5 Q;//Z DYR 3 S QSq M/ 5 limiting 5r-70 129 X /Z 78- /oY/Z All, — Remarks: Boring # Y4 '. O Y/L 44 Ground .� / a w Yt O• S o,� 92 ZZ la, 4 All Depth to lirrnf ng fact Remarks: Boring # Z 14�D.S D,G :............ Si C l a w Z vi DY,e S t /5 CSo� /� ` C G /Y� Q. 7`O. g Ground n 7,7YX 4- -z — Depth to limiting Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: - Seo- OWFLOINI M STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ONVNF"L7yER y By (-�jq _ �— MAMING A ID,RESS .6 S /Va (� /UE I /z'IAl PROPERTY ADDRESS ? (location of septic System) Please obtain from the p lanning Dept. CITY /STATE PROPERTY LOCATION_ 1/4, Sir✓ 1/4, Section 19 , T Zp N -R /9 , TOWN OP W ST. CROJK COUNTY, WI SUBDIVISION �r I lLU LOT NUMBER L CERTIFIED S URVEY MAP VOLUME ___, PAGE , LOTNUMMER_ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping put by licensed septic tank pumper. What ou Y into th as a treatment stage in the waste disposal system. e system cart out the septic tank every affect the � y ears the septic tank St. Croix County residents may be eligible to receive a grant for a m a of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. ma ximum of 60% accepted this program in August of 1980, with the requirement that owners of all stews stems agree Keep their system properly maintained. Y to The prooerty owner agrees to submit to St. Croix Zoning a certification form, signed b t and by a mater plumber, journeyman plumber, restricted plumber or a licensed Pumper verifying that (I ) the on -site wastewater disposal system is in proper Y he owner pumping (if necessary), the septic tank is less th 1 /3 Of sludge condition and s curn (2) after inspection and and I/We, the undersigned have read the above requirements and agree disposal system in accordance with the standards set forth , herein, to e the maintain the private sewage Certification staring that your septic has been maintained must be completed and returneWisconsin the S Cr County Zoning OfFIcer within 30 days of the three year expiration date. to the St. Croix SIGNED: DATE: Z_ — �� l St. Croix County zoning Office Government Center 1 101 Carmichael Road Hudson, Vkq 54016 11/93 03/28/96 10:19 •7y COUNTY CLERK • 40021/003 _ S T C - 100 This application form is to be completed in full and Si ned awner(s) of the property being developed. 9 by the only result in delays of the permit issuance. nade cul s will devel or opment be intended fd this house resale by owner /contractor, (s ec ), then a second form should be retained and completed when the propert y is sold and submitted to this office appropriate deed recording, with the ------------------ - - - - ---------------------------------------------- Owner of property _ Locati xon of 1/ 4 5yf 1/4 Section Township y ' Mailing address 'rte w, / S f Address of s it e PD r `.y�. Subdivision name oT_ OITjt � 8 Lot no. Other homes on property? - ---� --: —Yes b ... Previous owner of property J o h Total size of property v Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this Property being developed for (spec house) ? Yes Volume � Na �� and .Page Number as recorded with the Register of Deeds. � . ------------ --------------------------- - - - - -- ------------- INCLUDE WITH THIS APPLICATION M FOLLOWING: A WARRAN*rY DEED which includes a DOCUMENT NOMBER -AND THE SEAL OF THE REGISTER OF DEEDS R In [Ja�SdEd Lion, a certified survey, if available, would be helpful so as delays of the to avoi reviewing p rocess , d Yf the deed description references to a Certified Survey Map, the certified Survey shall also be required. Y Map I PROPERTY OWNER CERTIFICATION (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the Property described in this information form, by virtue of a warranty deed recorded In Deeds as Document No. office of the county Register of _ $" 9 own the proposed site for the sewage �disposal em and t syst ) r I pr es ently ( obtain an easement, to run the above described ra ert construction of said system, and the same has been duly recorded in ' the Off ice of the County Register Of Deeds as Document No. Signature of Applicant Co Applicant ate of Signature. , Date 0 f Signature �68 IA I L BAR O! "XISCONSIN FORM I - 1982 A R' b WARRANTY DEED Document No. at Pl6f;(�(] This Deed, made between ­--J J. Ruemmele and Barbara A Ruemmele his wife and IF ___ . __ Thomas L. Ruemmele and Nell L R uemmele. h is wife and Grantor, MAY, 2 7 .l.99 r Rehbein Enterprises LLC a Delaware Limited Liability Comp�nv odQ 3:15 P. M _ Grantee, frytatrr ',t t.+rat j Witnesseth, That the said Grantor, for a valuable consideration To" *w, rc. dfc R —d" Da. NAME AND RETURN ADDRESS conveys to Grantee the following described real estate in _St. Croix County County, State of Wisconsin: (Parcel Identification Number) Outlots 2, 4, 5, 7 and all of Outlot 8 except that part of Outlot 8 described in Exhibit A attached hereto. Subject to an easement for ingress and egress over a 33 foot wide strip of land being that part of Outlot 4 of the Plat of Troy Village lying Northerly of and adjacent to Lot 67 of said Plat. Phis is not homestead property ' ! - "A �N sFER (is; (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging, And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, restrictions and highway rights of way of record and will warrant and defend the same. ,/ Daied this 20 day of A/4 )1 Iq (SEAL) "�� (SEAL) ' 3ohn // J. Ru mmele ' T / s R mmele (SEAL) (SEAL) ' Barbara A. Ruemmele ' Nell L. Ruemmel AUTHENTICATION ACKNOWLEDGMENT Signature(s) John J. Ruemmele and Barbara A Ruemmele his wife S'rATE OF WISCONSIN ) and fhomas J. Ruemmele and Nell L. Ruemmele, his , % ile ) ss. authenticated this day of _ , 1997_ County, ) On Personally came before me this day of 19 the above named ' Samuel R. Carl _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 570606 Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INS "rRUMENT WAS DRAFTEE' BY Heywood & Carl. S.C.. Samuel R. Cari 204 Locust St.. P.O. Box 125, Hudson, WI 54016 Notary Public County, Wis. (Signatures may be authenticated or acknowledeed Both are not My rrmmiccinn is npr nnpnr !If —t �r %ro o.,..'.,r:,,n A,I. rec 1244 * 300 EXHIBIT A A parcel of land located in the SE -1/4 of the SW -1/4, the NE -1/4 of the SW -1/4 and the NW- 1,4 of the SW -1/4 of Section 19, T28N, R19W, Town of Troy, St. Croix County, Wisconsin, desc med as follows: Commencing at the South 1/4 corner of said Section 19; thence N00a19'39 "E (assumed bearings referenced to the North -South 1/4 Section line of said Section 19 wrlech bears N 0019'39 "E ) 1305.22' along said North -South 1/4 Section line; thence N89s31'29 "W 660.36' to the point of beginning; thence N89 "3 1'29 "W 637.26' along the North doe of Lot 4, Certified Survey Map, Volume 4, Page 993, Document No. 366634; SOO- 04'41 "E 298.00' along the West line of said Lot 4; thence N89o33'26 "W 24.04'; thrnce Northerly 241.84' along a 1533.00' radius curve concave Westerly whose chord bears 1404-26'28 "E 241.58'; thence Northwesterly 176.98' along a 433.00' radius curve concave Southwesterly whose chord bears N11o47' 14 "W 175.75'; thence S89o31'29 "E 678.56'; thence S0014'07 "W 114.75' to the point of beginning. This parcel contains 1.808 acres, more or less, bring 78,756 square feet, more or less. Subject to easements of record. The parcel shown on this document is being added to the parcel shown on the document recorded in Vol. 4, Page 993, Doc. No. 366634, described as Lot 4, Certified Survey Map, to crease one parcel, and this transaction is thereby exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05(A)(3). , :i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: SZ , _ pRpjX • •s a fety and Buildings Division INSPECTION REPORT sanitarywtbt (ATTACH TO PERMIT) GEN ERA INFORMATIO ur oses (Privacy La s.15.04 (1)(m)]. _ State Plan ID No.: Yo rovice may be used for secondary P p village Town of: Personal information Y P 1­1 Permit Holder's Name; Parcel Tax No.: RNNgEIN -RNTERPR1 I n: BM Elev.: BM Descriptio CST BM Elev.: Insp. Ag7pp522 ELEVATION DATA HI FS ELEV. TANK INFORMATION CAPACITY STATION TYPE MANUFACTURER Bench, mark Septic Dosing Bldg. Se r Aeration St / Inlet Holding / Ht Outlet TANK SETBACK INFORMATIO vent to ROAD Dt Inlet WELL BLDG. irintake TANK TO P / L NA Dt Bottom Septic Header / Man. Dosing N A Dist. Pipe Aeration Bot. System Holding Final Grade PUMP / SIPHON INFORMATION De nd Manufacturer G Model Number F Friction TDH Lift L SYste TDH H Dia Dist. To well . Inside Dia. Forcemain Length T Np_ Of Pits Liquid Depth SOIL ABSORPTION SYSTEM gth No. Of Trenches D EN 1 N Manufacturer: BED I TRENCH REAM Width LEACHING DIM N I N P/ L BLDG WELL LA /ST CHAMBER Mo el Number: SYSTEM TO OR UNIT SETBACK INFORMATION Type AP em. Vent To Air Intak ole Sae x Hole Spacing DISTRIBUTION SYSTE Distribution Pipe(s) Header / Manifold Dia. Spacing Length rade Systems Only Length D' xx Mound Or At xx Seeded / sodded xx Mulched Yes ❑ No SOIL COVER x Pressure Systems Only xx Depth Of [I Yes ❑ No Depth Over Topsoil Depth Over Bed /Trench Edges Bed /Trench Center ancies, persons present, etc.) COMMENTS: Include code discrep ROAD LOCATION TROY 19.20.19.NE,SW 228 COUNTY Plan revision required" ❑Yes ❑ NO cert Use other side for additional information. Inspector's Signature Date emn_R710 (R.3/97) Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. 1 4isconsin I n accord with 1LHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ✓o`er than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 3 boo S 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 RMATI N Prl erty Owner Name Property L cation EtG TER R 3 �.j,� - 1/4 SW 1/4, S T v�0 , N, R /7 E (orA Prdpjrty, owner '; P`IingAddress � � L / i1,t y, Number Block Number _ o�f(ooS V Zi Co Phgne Number Subdivision Name or CSM Number WZ� ( >7K`l -657 0 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ 't Nearest Road [] VII age �QvY Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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 W Office / Feet 13 91 Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 j( New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an ____System System _______ _____________ TankOnly ______________ExlstingSys - ________ExlstingSystem 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 aMound 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: 7. 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/d y /sq. ft.) (Min. /inch) Elevation 3 .50 � �I Z, G� -21 •S Feet ZS, Feet VII. TANK Capauty Site INFORMATION gallons Total a f Manufacturer's Name ame Pre e e Con- Steel glass plastic App in - New Existin strutted eptic Tank 25o Tanks. 1 - 260 El 11 1:1 ❑ ❑ I ump ank — 7SU j '"75 V El El El ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI mb r.'s S attire: a ps) MP /MPRSW No.: Business Phone Number: l,�il1/ ►n IJ ►v �S /l1 P �Z Z Z 3 9 Plu ber's Ac dress (Street, City, S te, Zip Code): 75 IX. COUNTY/ DEPARTMENT USE ONLY [] Disap proved Sanitary Permit Fee Qr water ate Issued Issuing Agen Signature (No Stamps) pp rove Surcharge Fee) ) Cg Approved E] Owner Given Initial D 6� /oa 1 2'2-3 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -8398 (R.11/96) DISTRIBUTION: original to county, One copy To: Safety & Buildings Division, Owner, Plumber SAFETY AND BUILDINGS DIVISION 15837 USH 63 Nvisconsin Hayward, WI 54843 Department of Commerce Tommy G. Thompson, Governor 22- Dec -97 William J. McCoshen, Secretary Cross Country Excavating Jeff Fox PO 295 Dresser WI 54009 Troy Burne Golf Course Plan ID 9711393 NE,SW,19,20,19E Municipality of Troy Inspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): MOUND 350 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 comments on the plan. 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. Sincerel , Thomas Braun Plan Reviewer (715) 634 -3026 Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID p Owner's Name 7//393 N Es Letrall De cription Address E 2 S Y✓ SEC 17 TZa /9 51 5 I ' S `1rj CityNillagefrown County IT OWW o 0-1Z Contents Comments /Special instructions Page q Included Two copies needed for all plans 1 I I Plot Plan 2, Plan View_ /Lateral Return by Mail gross Section Tank & Pump/ 0 Fax Letter to (County) (Submitter) 3­4 Siphon Information Circle One and Provide Fax 5 LAWfIL DEraft 6 Call for Pick -Up: ( ) 7 Q Other 1, the undersigned, hereby certify that the �Se� j�licaLle) plans and specifications submitted P. (J �/W�► herewith were prepared under my Conditionally direction and control R ROVE D Plumber/Designer License/Registration # � L DEPART ENT OF COMMERCE A b ;l t d ss " ` �� City Mate DIVISIO SAfETY AND BUIL GS r 104- 6'S' Signature r SEE CORRESF&A For Office Use Only Attachments: Application Soil & site evaluation Fee Needed for Holding Tank Submittal: One copy of notarized holding tank agreement. (Originals to County) RECEIVED Needed for At -Grade Submittal: Original signed and notarized DEC 2 2 1997 Application for "Use of an At- Grade" County on -site S $ BLM- DIV- One additional set of plans SBD -10268 (N.01/96) This approval does not include pans for the general plumbing systems or sower piptag to the septic/hokholl tank that is required for this project, Those plans - must be submitted and approved in accordance vtidt Rh. ItNR 82 WAC. r " �l PA(-,e OF 5 Lv V e 2 'VA e Lu iz- W h W +� ell 4 Iz u Oq Q W L 11 N a i w � Page Of Straw, Marsh 'Way, Or Synthetic Covering Distribution Pipe Medium Sand H � Topsoil =__:_ _ F 3 E p li % Slope Bed Of 2 2 Force Main Plowed Aggregate Layer D /a Cross Section Of A Mound System Using E 13 .W.'T. ►N• . A Bed For The Absorption Area F 9.9 G /Z. ,FC + N, A (b Ft. H /8 W. + N• Signeds B q Ft. License Number: K /D,?- Ft. Date: L 69,x/ Ft. j S Ft. Alternate Position T Ft. of Force Main W 25.9 Ft. + Observation Pipe B K �.- - -- ------------ ---------- - - - - -- - - - --. W � -� --- - - - - -- - --- - -- �Distribution Bed Of —2- Pipe I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Fage_,ZOf_,;T K , COMBINATION SEPTIC TANK /PUMP CHAMBER (No Scale) 4" CI Vent Pipe with ,Approved Locking Manhole Cover Approved Cap, +25 With Warning Label Attached From Buildings Weatherproof Approved Warning Label Junction Box Vent Cap 12 "Min Final Grade - � 6" Minimum 4�" Minimum I 6" Maximum 4" C.I. Quick 18" Minimum Insp. Pipe Disconnect i 1/4" Weep Baffles - Hole r D aproved Joint /C.I. Pipe ; A Mending 3' Alarm Q� B Approved Joint Tito Solid Soil On 6; w /C.I. Pipe C Extending 3' Off 6' Onto Solid Soi D Conc. Block 3" of Bedding Under Tank-/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: - i Per Day Gallons Per Day /F oFDoses : .5 Gal Ions Volume of Backflow:.......+ /,�16 Gallons Tank Manufacturer: Wie s ..R Total Dose Volume: ........ = _Gallons Tank Size - Septic /Pump: Z5 a S Gallon S Alarm Manufacturer: Model Number: jol Capacities: A 3 inches or 2 115 Gallons Switch Type: MEpeupy + B Z inches or Pump Manufacturer: Gavj.os + C — inches nches or 165 Gallons Model Number: E P©5 + D or /Zo Gallons Minimum Discharge ate: 3 7,2y Gi>M GPM Total ...... w inches or 73-0 Gallons Vertical Difference Between Pump Off and Distribution Pipe: Feet Minimum Required Supply Pressure: ......................... + 3,� Feet _ Feet of Force Main x Z,tv Friction Factor /100 Feet: + /. 3 Feet Z, Inch Diameter Force Main Total Dynamic Head: ... =J Feet Internal Tank Dimensions: Length Width ; Liquid Depth epth 50 " /s' 6 1 Si gnatur icense Numbe z., Date 46 -22 ­97 9 o 5 N, r i •'1 A { METERS FEET -- -- 10 -- ... _ _. MODEL: 3871 30 - -- 6 - - -- -- -- -- 7 -. 6 - 5 a 4 _ EP05 O ' 3 10 — � 2 PO4 0- V 30 40 50 USA FM 0 2 4 6 0 10 12 "PAIr CAPACITY Pump Specifications Features and Benefits 4 /10 and 'b HP • EPO4 impeller- semi -open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Discharge size 1'/:" NPT • EP05 impeller - enclosed design Solids' 1 /4" maximum for improved performance. Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides bearing construction superior strength and corrosion Single phase: 115V resistance. 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 �P manual operation. Page JFOf Perforated Pipe Detoli n End Vier Perforated End Cc p l . 1 PVC Pipe Holes Located On Bottom, S� Are Equally tooted PVC Force Main PVC M ani fold Pipe Distribution Alternate Position Of Pipe Force Main Lost Hole should Be Nest To End Cap Distribution Pipe Layout P 23 Ft. R 36 / r)- S 36 / to X 417– Inches Y Y.- Inches Signed: Diameter �9 Inch • License Number: Lateral I�Z Inches) Manifold Z Inches Date: Force Main Z Inches N of holes /pipe_ Invert Elevation of Laterals `&X Ft. yl wiscogsn oepervr+ent of Industry. $ Q I L AND S I T E EVALUATION R E P O R T f �� P age of 3 I:Aoor and Human Relations e2 q(0 — a ys g Division of Salary 3 atmid'17193 in accord with ILHR 83.05. Wis Adm. Code COUNTY Attach complete site plan an paper not less than 8 1/2 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 1.0.4 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: , PROPERTY LOCATION E %Z 5 Z19t T Z 8 /V, ,�1iA�Ls GOVT. LOT 114 &P ,',0 .S /9 T Z .N,R / 9 Wj W PROPERTY OWNER':S MAILING ADDRESS T 4 BLOCK 4 S / S LUB Z 46 o C T, / - #; " 6 d — - NAME OR CS 201' : 8 �av�E 1 2 19_5101V , TATE ZIP CODE PHONE NUMBER CITY ILLAGE OWN 7 C'- AREST ROAD t o !�/ S¢o /G 17/51386 - Z 90 r T, ff. 4 D< New Construction Use ( Residential / Number of bedrooms � (j Addition to ensting building I 1 R eplacement pq PubtiC f>r me comraW d"Mtn oCn -Q oy�es4 /�i�y T�iV�FNc� �co�109 Code derived daily flow if ;J0 gpd Recommended design Wading rate bed, gpdfft trench, gpolft Absorption area required bed. ftZ french. ft Mammum design loading rate fL�L bed. 9pd/(t p• : ;E ft1ch. gpoltt; Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design/ site considerations �,2ov /off ' ,G $ii� 40W7wee NO go 1, lAwmo Parent material o *Ss Z T O ±FwiwSotpo Flood plain elevation, if applicable /U• It S . Suitable for system CONVENTIONAL MOUNO 1N- GROUND PRESSURE AT.GRAOE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system I C3 RU I r! ❑ U C: S NU ❑ S Is I ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence GPD /ft Boring # Horizon in. I Munsell I Qu. Sz. Cant Color Gr. Sz. Sh. I Y Roots Bed ITrRxIi , S I D 41 13 3 -Z /D Y/l S 6 —' si "c Z�b� rN r' C 5 Zvi O• Z D. 3 Ground C Z3- /o ore S 6 s Os S 14 D 7 O S 3 el ev 74 t5/1. I .` 5 �S q /yl / — O.7 O, 8 Depth to limiting factor 7 Remarks: Boring # ff O -7 oye 3/7- — s/ Z cs'b c /yl r a w Zv D D. 3 8 ' Oj'x S G — /3 �5 h'!/ w G A 7 A 8 Depth to limiting la Remarks: CST Names —.let se Print JAMES b. FILKI S " One: (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 Sgnature. Date. lZ. /. q CST Number: / CSTM03988 10PEI TTIOWNER �/E�sJiylL�. SOIL DESCRIPTION REPORT Page � of 1RCFII.D. � I in. Munsell Depth Dominant Color Cu. Sz. Mo Cont. Color ttles T Structure GPO/ft onng # Horizon I Texture I Gr. Sz. Sh. I Bed Trencri I I DY2 3 3 r ZZ round C / 3 Z rt. C Z l )epth to CZ Z 3 - 5 D Y/Z 5 , �f DYR 3 5 454 37 �r G 3 s AM ¢ G S ©sq C 5 bee — 70 40 1jPi I Remarks: 3oring # 0 -S y 3 Z S�/ 12 �56�L' Ill ��^ GtG�i Zvi I0 5 D.lo : C / G 3 Y 12 el�►� �' Z 51-4 7. SY2 74- - 3 S ft. �- S Depth to limiting tac� I Remarks: Boring # � p -// I DYi� 3 Z — Si/ Z� / � I /� r � Qr,✓ ZI/�I �• too- C / a.7O.9 Ground r e1ev. C Z Gi0- I,: Y/- 4- 1 Z Z 3.6 rt. Depth to limiting fac „ Remarks: Boring # P1 Ground elev. ft Depth to limiting factor Remarks: Sao- UMFiA&M N , m --.a Rio IND to 4D 9 ,Y� O now \.. - 7 E co �8 00 M ° + p ` Ncl- 0 ' °O CID f -- -- _ - C.T.H. � ; m 0 Z 1 . I f;"C, boo