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HomeMy WebLinkAbout040-1082-60-100 �I- ('ftOIX COUNTY ZONING DEI'AR'I'MI; AS BUIL'I' SANITARY REPORT Owner h ': Address �._......, ,�� City /State V z^tv�,� ; OF «E Legal Description: Lot --LL Block 10 A Subdivision/CSM # fn c" y tUA) /' A2(d,.l, Sec. a I , Ta?N-R jqW, Town of Qq - SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: 3d Sc - Tank manufacturer Size ST/PC 10150 '75 Os -- etback from: House Pump manufacturer odel Well C�'� _ �f �� Alarm location (HOLDING TANKS ONLY) Setbacks: Service road --AILI— Vent to fresh air intake Meter location IU A Water Line /),Y Alarm location t l)M SOIL ABSORPTION SYSTEM: Type of system: Width 2 Length Setback from: House Well -- > _` —�- Number of Trenches P/L �� Vent to fresh air intake ELEVATIONS: Description of benchmark C MA 41Z FE Description of alternate benchmark' i W Elevati USt` Elevation 1Q��� n �o(A J6 -► � a Building Sewer q'1 J� ST/HT Inlet 3 I ST Outlet --- PC Inlet PC Bottom 9-01 � Header/Manifold � � Top of ST/PC Manhole Cover Distribution Lines Bottom of System( ) q 8 ( ) Final Grade Date of installation /d //5 Permi number 1 a -- � tate plan number Plumber's signature, """L. // �ccasc number (O,5 ?9 Date Inspector Comploc plot plan K NOTICE: Please provide (lie 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. 4--bw N 5 \I' NLL`"/ (� 0 PLAN VIEW71 �r 1{0 l a 1-4 S - , 361 - 44' tiS ALt INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: Safety and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) sanitar Permit N 320224 4 Personal information you provice may be used for secondary purposes [Privacy L V , s.15.04 (1)( m)]. W HITE,deDOUGLAS _T 1 village Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: UU }}�� Parcel Tax No.: 1 60 T IUD ski � ;�.- 4da.� 040- 1082 -60 -100 TANK INFORMATION ELEVATION DATA A9800412 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ptic f 2 Benchm r -83 1 oy.g3 1 06 Dosing i71'�- 7 �(f• �M Ib�l� /o Dy 2 Aeration ,_ - - - - -- =_- - -- Bldg. Sewer p .$ S• 33 - � Holding �`° %� (PIft Inlet j I 3 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. vent to ROAD Dt Inlet Air Intake ep (P O� NI . .I NA Dt Bottom Dosing �, r� �2" NA Header / Man. 99 :f�� Dist. Pipe - -- A �DJ.$ ,3.J� `g • �j% Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ��a i,,„ bf .3 / - J Model Number M&b GPM / TDH Lift &•Q Lrictionlq'Z System�� TDH/0 Ft Forcemain Length -7 ' Dia. FFii " Dist. To Well SOIL ABSORPTION SYSTEM - 2. 7 BED RENCH Width r Length / f No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N & Z J DI MENSION S SYSTEM TO P / L BLDG WELL LAKE / STREAM LEAC ING Manufacturer: — -- SETBACK CHAM INFORMATION Type Of S 'via OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) ' I x Hole Size x Hole Spacing Vent To Air Intake I Length r Dia. ; N Length Dia. �J �U Spacing 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 21.28.19,NW,NW 288 TOWNSVALLEY ROAD — LOT 4 o l tm4v1 �l>,4vr r ►olr�(� Fi 1011s'`►C Plan revlslo re ulre? Yes o Use other side for additional information. I IZ q� cau_ t FTq I SBD 6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division NV Isconsin SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 5+ C20 It • See reverse side for instructions for completing this application State sanitary Permit Number vVQj Personal information you provide may be used for secondary purposes ❑ check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N /S Property Rwner Name Property Location eQ 0 u - I U(,VN4 �/V/4, S T Z V, N, R E (or Property Owner's Tailing Address n Lot Number Block Numbed__ City, 5e 'EN S Zip Ce Z Phone Numb Subdi e or CSM Numb r � 3 �� 5 11. TYP F B UI LDING: (check on ❑ State Owned 0 Cit Nearest Road ❑ Village Public 1 or 2 Famil Dwellin - No. of bedrooms _L— wn OF � W Ley 2� III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 — /Os 2 – 0 4,041 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. bg New 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System ________ System_____________ Tank Only______________ ExistinQSystem _________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 U,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. 1 7. Final Grade Required (sq. ft.) Proposed (s q. ft.) (Gals/day /sq. ft.) (Min. /inch) D Elevation U V s :so A o � � 90• � Feet 160. 5 Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Ex p er. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con - Steel glass Plastic A p p New Existing structed Tanks Tanks I G Septic Tank or Holding Tank 7 [ G f ❑ ❑ 1 ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 50 ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. n Plumb 's Name: (Print) Plumbe ' Siga N tamps) MP /hltt?�'NO.: Business Phone Number: �5�� ��? 2 Plumber s A ress (S�reet, City, State, Zip Cod r IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa nitary Permit Fee (Includes Groundwater D ate Issued Issuing en t s) A roved Surcharge Fee) pp ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber - Safety and Buildings 2226 ROSE ST • LA CROSSE WI 54603 -1905 N *isconsin Tommy G. Thompson, Governor Department of Co ! , ` :` William J. McCoshen, secretary September 02, 1998 CUST ID No.267341 : POWTS INSPECTOR CJ c,aclx 1 WEGERER SOIL TESTING & DESIGN ?:IµG � 421 N MAIN ST PO BOX 74 RIVER FALLS WI 54022 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/02/2000 Identification Numbers Transaction ID No. 144982 Site ID No. 13715 SITE: Please refer to both identification numbers, Site ID: 13715 above, in all correspondence with the agency. St. Croix County, Town of Troy NW1 /4, NWl/4, S21, T28N, R19W Douglas White FOR: Description: Mound revision Object Type: POWT System Regulated Object ID No.: 29015 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. • 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. Adm. Code. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 08/27/1998 FEE REQUIRED $ 60.00 GERARD M SWIM POWTS PLAN REVIEWER FEE RECEIVED $ 60.00 Integrated Services BALANCE DUE $ 0.00 (608)785-9348, MON - FRI, 7:15 AM - 4:00 PM JS WIM @COMMERCE. STATE. WI.US r Pag 1 of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE NW 1/4 OF THE Nw 1/4 OF SECTION 2 ) , T 28 N, R 19 W, TOWN OF 2p� , S1-• C,(,T,011( COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR P : WT.S. Conditionally APPROVED g 6�d Ffl�.co� b�ztvE l\j F t-j L S O ZZ DEPARTMENT OF COMMERCE DIVIS ►OtAFE AND LD:NGS SEE GORRESP EIS` C PREPARED BY WEGEE�EF2 SO = L TESTING AND. I3ES I GN SIER�1 I CE +•� ?,• ARTHUR L F.O. BOX 74 421 K. IIAIM ST. $ ? WEGE ER RIVET FALLS. YI 54422 ! 5 r 715 -4rj -0165 i W .� �` ; S T�i1.S i' 1 S P1 ZEV \S 1 OhQ O F PLC 9 _ V� L0i� S ` = 2 - s - 9 JOB NO_ PLOT PLAN . - Page Z of (� Scale 1 "= y,Q' j7 64' �tit`�vM of �B O F h uvrup . O1Z J \ I d 2 V O, br J r 2 i y J N NOTES = � - L� - IOD,p' pN S�1kE Z 4" R80UF G Ru�.h , p I to 5`�tdC�Qf��g_ � t�v � � 1U 3� t'rT LL'RsT Z ` 'i - �t - a r` >� u v►'� . _. iti Y Sp• k h> K7 LM SIT IS` F1z0M `YPo�k. NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each. lateral. ( Y required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. - Septic tank to be \7tSo /7S0 gallon capacity manufactured by 5. Bench Marks StE� "OVA 6. Divert surface water around system to prevent.ponding at the uphill side. Page 3 Of Approved Synthetic Covering F1sTV� c- 33 Distribution Pipe Medium Sand H G Topsoil - - - -- - =_- F Elev. . E " u b %\ % Slope Bed Of 2 2 ( Force Main Plowed Aggregate From Pump Layer D V Q Ft. Cross Section Of A Mound System Using E \•$8 Ft. A Bed For The Absorption Area F 6,� Ft. G V O Ft. A 8 Ft. H 1 - Ft. Linear Loading Rate= °I •S GPD /LN FT B 63 Ft. Design Loading Rate= Qj•3b.GPD /SQ FT j 0 Ft. J - 7 Ft. K \Z Ft. vF� W 3 Z Ft. L Observation Pipe n g K I - -t �. - - - -- ----- - - - - -- ------------------ - - --•� Force Main � Distribution Bed Of i o�pusXT� — 2 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page y Of (� Perforated Pipe Detoll 't / End View )Perforated End Cap. PVC Pipe any` Install permanent at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe piste ution Pipe Last Hole Should Be I Next To End Cap End Cap P 3 O Ft. Distribution Pipe Layout S Ft. X Inches Y 1 (R Inches Hole Diameter 111 Inch Lateral Vi Inches Manifold 2' Inches Force Main Z Inches # of holes /pipe o Invert Elevation of Laterals 4S• i=t. H Place 1st hole ZLI from center of manifold with succeeding holes at L9 4 intervals. Last hole to be next to the end cap. Combination Sep- ac; and PUMP CHAMBER CROSS SECTIOU ARID SPECIFICATIOMS ' PAGE S OF -VEAIT CAP WEATHER PROOF JUIJCTIOAJ 80X 4'C.I. VENT PIPC APPROVED LOCKIIUG �:. 10' FROM DOOR. MAIJHdLE COVER sv 1�N - .AmooW OR FRESH wARr t11J�. LA�6EC.. AIR IIJTAKE cotaDutT s 6 11". 16 "MIAI. ---- - - - - -- y'�Il.lsht'�TIOtJ PIPC PROVIDE I -- -- IIJLE T AIRTIGHT SEAL I 1 v 3 gFFL�S IAIT A I I APPROVED JOIIJTS' APPROVED JO I II ( W /C.I. PIPE�puc W /C.I. PIPEaR Tank construction I 11 shall comply with I I ALARM ILHR 1,3.15 and 33.20 a ( I I I OBI I LLCV. b-2 S FT __� PUMP � OFF D CoucRETE 9 0 JO 5LOCK R B DDINC, RISE EXIT PER IJ PERMITTED OLy IF TAW MAIJUFACTURER HAS SUCH APPROVAL BEp01N4 SEPTIC f SPEC.IFICATIOUS D05E WMBER OF DOSES: 3 ' I O PER D" TA1JK MAIJUFACTURCR: TAWK SIZC: ` ISO GALLOUS DOSE VOLUME r ALARM MA►JUFACTURC.R: S.S.�LTRO SYS�YIS IAICLUDING OACKPLOW: » �'y GALLON$ MODEL DUMBER: �W CAPACITIES: A= Z S IAiCHCS OR 4 03' 3 CALLOUS SWITCH TyPC: ��ZCIJ�Y 8 = WCHWOR G�LLOUS BUMP MANUFACTURER: 1���ZS C= IUCHES OR \11 4 GALLOUS MODEL MUMBER: SR�1 4 D- INCHES OR � U, ' Z CALLOUS SWITCH TYPE: t� ��ZI°U1ZY ►DOTE: PUMP AMD ALARM ARC TO 15L z MIMIMUM DISCKARU RATE 31 "�� GPM IN5TALLED OW 5EPARATE CIRCUIT5 VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD.D15TRIBUTIOW PIPE.. -1' -)5 FEET + MIUIMUM WETWORK SUPPLY PRESSURE , , , , . . . . . 2 SD FEET + 6S F E E T OF FORCE MAIN X 1� F / F T . FRICT1o1J FACTOR - - �'�$ FEET TOTAL OylJAMIC HEAD = � ' FEET Pump chamber DIAMETER IIJTERLIAL DIMLWSIOLI OF TAUK: LE►L16TH — ;WIDTH _ ;LIQUID DEPTH BOTTOM AREA 231= — GAL /INCH AS PER MANUFACTURER GAL /INCH I TOTAL HEAD IN FEET wt utc)l _ O to O cn O c O O O O o N O m O D w - D D w _ C7 O N H ° -� D C 4N H G) O D O �— r H CTl m Z ° N O 3 m O 3 Z O c 7 --1 H J m Z O C N —f o m OD O w N O CO O W O O O o — N W cn m v m co TOTAL HEAD IN METERS Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 I.'abur and Human Relations Divi3ion of Safety & BuikNngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. \ -SLAQblti1 G APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE a- - q PROPERTY OWNER: PROPERTY LOCATION ST�V e 3 %QST 684.1:0T MX 114 NW1 /4,SZ - \ T Z8 ,N,R 19 E $'_L PROPERTY OWNER . - S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # S QZ >v GM Lw Z. STfaV - nr' \1 au'H 17Q • y — C.S.M. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD "Pf7.� GA 300 6 0 (17o) 43y- u SSS \Zb _ [Xj New Construction Use [XJ Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 4So gpd Recommended design loading rate bed, gpd/ft - trench, gpd/ft Absorption area required 31 S bed, ft - !S - IS trench, ft Maximum design loading rate 5 bed, gpd/ft - b trench, gpd/ft Recommended infiltration surface elevation(s) :-f b - (j It (as referred to site plan benchmark) Additional design/ site considerations w/ 8x 1 4 - )' g00 . M i ry t M QM 1Z OF S Prrb 1--f L L , Parent material S I. t 5'ez\ Yn N'�vT Rood plain elevation, if applicable 1- A - It S = Suitable for system CONVENTIONAL MOUND "ROUND PRESSURE I AT -GRADE SYSTEM IN R11 I HOLDING TANK U= Unsuitable for sy stem El ®U N S ❑ U ❑ S O U El O U ❑ S O U [:1 S IOU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bcur>dary Roots GPD /ft in. Munsell QU. Sz. Cont Color Gr. Sz. Sh. Bed reach o_tp to`t� 3Cz - So Z �w 1 S .� Z 3 S 11 `F � m ��. • s Ground 3 2 6 39 I o'-I tZ 3 l` - s 1 c I 1 0 s b)z Mf V ew - z- 3 elev. 8 p9 -S lo�c�z - Depth to limiting factor 3 °t" Remarks: Boring # lz31z E l Z ct B . 1 k:�-1 .z 3 t L - ; ( z �s b� >n FI- S - s . 3 Ig_3g - )•S`11 3/y - is os1 Ni° 3b1t es — •\( I S Ground - elev. 3$_ 1• S`-12 3!y � S `ttz s/8 Se1 Orr, w► 9 d.s fL Depth limitin factor Remarks: Cob Y T Name. Please Print Phone: Arthur L. We erer 715 4Ufi.S..._. Ve r Soil Testing & Design Service - P.O. Box 74 River Falls, 4 Signature: ? Date: — CST Number. I 4t-�� 8 -o ) -3 5, [ M005 PLOT PLAN Page 3 of 3 SCALE 1 "= 6&L. 6 ' B•3 � \ a� d caw► +� z. o�� o � N Z v � J 2 ji I� N 1 NoT�S = 8 1 - LTLEU. 100.p� 0" Sil - 2.4 PtED -E GR.3u"-D ►ry 5` 1rRTR�E_ V�j - M ST z- ` Fl r-1 M u uKA) . �� M w • y S OS k �( ' - _ i 98-0 ! GI9i�' ( 715 ) 4L-0165 M 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Latzer and Human Relations Div*n of Safety & Builclngs in accord with ILHR 83.05, Wi Adm. Code COUNTY s G� uj x Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but _ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # j dimensioned, north arrow, and location and distance to nearest road. C /tn 7 -11 - �' E�`'�1N G APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION Vol. L r3 R IEWEDBY DATE Cr ru PROPERTY OWNER: Al 49 � r �� PROPERTY LOCATION l & r l G94.4:0T MVJ 114 N W IM,SZ- T Z ,N,R 1 cl E PROPERTY OWNER•:S MAI DDRESS LOT # BLOCK # SUBD. NAME OR CSM # S M tJ GM ow Py - 2.103 S p}J CLV9 1b. v- • y — \Z -upos%zb c. S.M. CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD GA 300 U3 (17q 43q- Ll S85 %b [� New construction Use Residential / Number of bedrooms 3 [) Adc�n to existing building [) Replacement [) Public or commercial describe Code derived daily flow 4S gpd Recommended design loading rate - 3 % fled, gIxW - trench, gpolft Absorption area required 3 - 1 S bed, 9 3ZS trench, 9 Maximum design loading rate • 5 bed, 9pd/ft' • b trench, gpd1ft Recommended infiltration surface elevation(s) °f 6 _ o ft (as referred to site plan benchma(k) Additional design/ site considerations f-'1 byr � w/ 8'y 1 - t - ) ' 13 � • M I ru 1 M um t Z OF Sf�j Ft L L . Parent material S t. t_ 5l20\ V-1 N Rood plain elevation, if applicable F-3 • R • ft S = Suitable for system coNvwn NNAL MOUND &GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S O U MS ❑ U ❑ S ®U ❑ S ®U ❑ S ®U El S 6A U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu, gz Coat Color Texture Gr. Sz. Sh. Roots Bed ten D -l0 lo�tt� sl Z - SO Z� Z 10 - 1 � 31 — s i 1 Z Ground 3 26 39 lo` ltZ 3lL elev. 8 0 1. Z ft 1.o -lz )]G � 1 S yR s/e Depth to limiting factor 39" Remarks: Boring# 0 -9 1 o`1 tz31Z — s� Z'� `Mt�h Cw •S ',� Z 4- 1 8 . l b`'! \L 31 ` - S i I - L F S \t M ft- c S - S 3 ►$ -3a s�fQ 31 — is asp 1Z--g�bh _wlv��- eS — •� -S Ground elev. 3$ -6S 1•S`>tz31y � Se-1 err. v►� Fti, - ►�P .Z Ol .5 fL Depth to limiting f clot q -T 316-1 1 Remarks: CS T Nante: ?IeasePrint Phone Arthur L. We erer 715 425 - 0165 eg rer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 * * Sgnahxe. ` °1 Q -01 Date. ) —_ SI l 9 9' 8 CST Num 0 0 5 7 6 • PROPERTY OWNER \-�5'�" SOIL DESCRIPTION REPORT Page . of �' PARCEL I.D.# • Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Manch Z --Z.9 Th•S y s \ Z S S • L' Ground 3 /9-(,y -)•S `fIZ 3 /y C•-.)SLmsib s1 q \s \ sb)z mU `4- S elev. (=,.0 ft. C )xi S + � S o1= WLIt L1-f Q S I Depth to limiting factor zgw Remarks: Boring # tiJ t E � 4 t` s c•t t_ E v n L v rY T7 Oh.) --o1Z 1-3 1-, 3 0 S la u u S ''............. S,1^-1 • S o kJ lZ -012 b . Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # '•Eh Ground elev. ft. Depth to limiting factor Remarks: nan.P22((P( I()-)\ PLOT PLAN Page 3 of 3 SCALE I"= o -�zQsT LoT L� u e 6 6 6. 6' A t i t 8.3 � 4, taws 1H ` o�,° '• v , i � 2 N Z d g Z etig6s vA _I f�! J y A� IJ �� r � �o �N 1 NOBS = L'Le" 100.0 ON SAihE ` Z4 k rfB E Giwu -p try S'blrN —c-et' 2Tg-Q _ ©1� N C� �CV. �O�.y� N ti l54 w. . •r �jk N .a 4 1 v g 14 @F P1T LLRST Z 5' P-94 M M u V1v� I L/� tai 98 ` , S, 49 ( 715 ) 425' M 00 576 CST Signature Date Sign Telephone No. CST ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _ �(D �p Irell-7 Property Address c T9 9 h f 1/ (Verification required from Planning Department for new construction City/State /►��r /d ��5, Parcel Identification Number LEGAI, DESCRIPTION Property Locatio W '' /4, /U W ' /4, Sec. Z , T e N -R c W, Town of / Subdivision �S/�l , Lot # �. Certified Survey Map # 5 T l J , Volume _ Page # ` Warranty Deed # 7 - , Volume Z 3 D , Page # Spec house ❑ yes' 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 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 days of the thre year a iration date. 4W 9IGNAT APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property d scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. -7j SIGNA 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 HL 1307mcF513 � 1 � p � STATE BAR OF WISCONSIN FORM 2 - 19&Qt 5 '7 5494 WARRANTY DEED DOCUMENT NO. REG T �iLE Steven M Best and Paulette M. Best, $T, C !X CO• W I husband a nd wife, �uJ M *W " conveys and warrants to Mary J. Ai to _ and ndygl.._s _y. _ 4:55 A k4 whi rs- wife AbnA hillalhAnd M T .'S SPACE RESERVED FOR RECORDING DATA .•?':. �ftAME AND RETURN ADDRESS the following do rribed real estate in at, Croix CAMKA State of Wisconsin: PAD=* Pt 040 1nA2- 6n -nnn PARCEL IDENTIFICATION NUMBER Lot Frur (4) of Certified Survey Map in volume Twelve (12) of Certified Survey Maps, page 3415, as Doc_ No. 574158, filed in St. Croix County Register of Deeds Office on March 2, 1998, being part of the Northwest Quarter of the Northwest Quarter (NW1 /4 of NW1 /4) of Section Twenty -one (21), Township Twenty -eight (28) !' North, Range Nineteen (19) Lest, Town of Troy, St. Croix County, 4 Wisconsin. r ;S Q► �f This is not homestead property. AkX (is BOt) Exceptiontowarranties: Easements, restrictions and rights -of -way of record, if any.` Dated this day of March A.D., 19�d—.° (SEAL) - ��--� / .(� (SEAL) 4 ♦ • l qkaven M Best 4 (SEAL) D �1Q // / • (SEAL) Paulette M. Best AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ Suite of =ilaDAXWX GEORGIA e qm Count . authenticated this _, day of 19_ came before the this M day of " .._�..a. 19 19,,&_ , the above named a't Oman V Beat- and Paulette - K.— t TITLE: MEMBER STATE BAR OF WISCONSIN (if not, — authorized by §706.06, Wis. Stats.) to me j 'ahmm to be the person who executed the-foregoing i snd acicn , ._dde the same.,. ' T THIS INSTRUMENT WAS DRAFTE l BY I� co FILED MAR 0 2 1998 ► KATHLEEN H. WALSH 5 4158 '� SLCroixCo. Wi w CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION 21, T28N, RI9W, TOWN OF TROY, ST.CROIX CO.,WI. (BEING PART OF LOT I OF THE C.S.M. VOL. 4, PAGE 1107). PREPARED FOR: STEVEN BEST € OWNED BY: MAX SALZMAN NOTE BEARINGS ARE REFERENCED TO THE NORTH L / NE OF THE NW 114. NW CORNER OF SECTION O (ASSUMED). 2I. (COUNTY MONUMENT 2 FOUN C. S. M. VOL. 4 "'" " ".....•.. .... NORTH LINE OF THE NW 114 N 8 8 ° 44 ' 333 " -- E (R _ C.N 8 804 5 131 " E)__ S 88 ° 44'3 3 'W 495. 12' .I 2154. 18' _ - - - S oo° oo' oo" w PAGE , 1 107 102.61' 3i4' RE -BAR FOUND N 1 i4 CORNER OF SECTION 21. (COUNTY N 86 51' 36" E 589. 16' MONUMENT FOUND). 554.40' 34.76' \ N UNPLATTED LOT 3 LANDS ............ 4.18 ACRES m N� 182,251 SO. FT.) 03 c of rn 4.03 AC. EXC. R/W 3 T O Or M ; ( 175, 494 S O. FT.) .4 CO M I . . u W 66 ,6 4 6 99• C ' z 1 0O L CC o O°!58. LOT 4 4.58 ACRES Z ( 199, 369 SO. FT. I 3 4.28 AC. EXC. RiW �• \ ^' \ to ( 186, 598 SO. FT.) v� Z � 770. 02' R`' 35. 17 S 88 0 45' 14 'W 805. 19' \ \ 3i4" REBAR FOUND. S21 ° 27' 35'E 10. 60. FROM CALCULATED •, N Ir OTE: THIS MAP IS A RECONFIGURATION POSITION. OF LOT I OF THE C. S. M. VOL. 4, PAGE �� 1107 TO CONFORM WITH SUBSEOUENT SURVEY AND DEED RECORDS. NO RECORD AFPROW.D DATA FROM ORIGINAL SURVEY IS SHOWN. C.S.M. VOL. 4 . PAGE 1 Oli4 0 2 '98 S'1' CRO i;Ot.1N1 "Y �ON1 Comp fpY�lrtt;ve ra;�n�lny µ GO