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HomeMy WebLinkAbout040-1241-10-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner } Address S City /State I F& ti WS Legal Description: Lot Block Subdivision/CSM # ' %, SE %, AL1, Sec. X 1 , TAN - RLW, Town of PIN # — . H1 !d - 646 1 9 . SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer 0irt S < w Size ST/PC ) 000 / (W Setback from: House 2 Well P/I. Pump manufacturer M gt M Model ' wo Alarm location a.c w►e�1' DING TANKS ONLY) et : Service road Vent to fresh air intake Water Line Meter to on Alarm locatio SOIL ABSORPTION SYSTEM Type of system: Ah o u n d Width _ Length A 0 7 Number of Trenches Setback from: House Af Well> I 0 d PAL �_ Vent to fresh air intake >2 ELEVATIONS Description of benchmark Elevation Description of alternate benchmark Elevation Building Sewer �� i 3 ST/HT Inlet 3 ST Outlet / PC Inlet "' PC Bottom 'h 3 Header/Manifold 7 Top of ST/BeManhole Cover Distribution Lines O Fit k T Bottom of System Final Grade Date of installation G / 4 1 / Permit number 367 Gk 2 State plan number 6 1 3 6 Plumbers si ature License number 01,2T 9f Date Inspecto Complete plot plan er 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. Ste_o t I " 50' PLAN VIEW ak ( 3 b5ct t)LooN\\\t'e13SWti E1.. 9s�91 No 4 c 0 \31Above GjrorI Wev /aOC/4c1' D« Tree t I M 4. 4, MO' a« o1/54 INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT S + Cret, r. GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. O Permit Holder's N ��'' e / : � [3 City E] Village 15--Town of: State Plan ID No.: L h h CST BM I lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: q4? - RP •S C.• v q0 - t ! - /0 o TANK INFORMATION ELEVATION DATA O� TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 7 Sept er � l p pp Be c k 6osi 4f4 Aeration Bldg. Sewer Holding St Inlet TANK SETBACK INFORMATION y Ut Outlet IZ TANK TO P/ L WELL BLDG. ven ROAD Dt Inlet Air S &&' 7s'- '7 r NA Dt Bottom 9,?js ��• 3 « (q NA Header / Man. p $ (� 87 Aeration NA Dist. Pipe �r' Holding Bot. System p ,c� �•� 9$ O PUMP/ SIPHON INFORMATION • m C Final Grade Manufacturer S Demand �-{ k Itz- 94 Model Number F—:- t) PM -93 1104. 160 TDH Lift J Lriction Systems TDH(O.77t D� Fi 1X Forcemain Length Jrt Dia. V Dist.ToWell L* $,6, /W fo 9S,$'7 SOIL ABSORPTION SYSTEM lia BED TRENCH Width o t Length t No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N D 4 . 7 1 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA ING Manu a SETBACK CHAM INFORMATION Sypem (� r (0( p�'� OR UNIT Model er: DISTRIBUTION SYSTEM ! p Header / M��a[[nifoId Distribution Pipe(s) x Hole Size x Hole Spacing Veg Q ^LL int ake Length 4 Dia. 9L Length y Dia. 1 ` / �/ a Spacing � V4 Qj 4t CZZ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over e� �/ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center �Z� v Bed /Trench Edges Topsoil � 76es ❑ No )j Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) 074 S & ddt e, L [[ � f Plan r ?l� n req red? 4YLes 0 No �� 4 Use other side for additional information. ( SBD -6710 (R.3/97) Date n pector's Sig ature ert. No SANITARY PERMIT APPLICATION 20; E w shnlgtonq vision t• ■onsin P.O. Box 7969 Department of Commerce In accord with ILHR 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 8 1/2 x 11 inches in size. St Croix • See reverse side for instructions for completing this application state Sanitar Permit Number The information you provide maybe 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 RMATION 98 -20136 Property Owner Name Property Location Lynn Rothber er SE 1/4 NE 1/4, S 21 T 28 , N R 19 Rtoo W Property Owner's Mailing Address Lot Number Block Number 183 County Road U City, State Zip Code ' Number Subdivision Name or CSM N mber River Falls WI 54022 `1u - 1 II. TYPE F BUILDING: (check one) E] State Owned Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms �_ ��Town of Troy Saddle Ride Lane III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo o40- o141- ►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. S New 2. ❑ Replacement 3, ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only -------------- Existing System --------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 M Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure ! 42 E] Pit Privy 13 ❑ Seepage Pit IF Y5 5/7 43 ❑ Vault Privy 14 System-in-Fill Z`�''o�Saµ 411 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 (s4 ft.) Proposed (s ft_) (Gals/day /sq. ft.) (Min. /inch) Elevation 450 ,5 37s� z 9 7- 5— Feet Feet Capacit VII. TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks % e Tan hlhd>�kcx 1000 1000 1 Wei ❑ ❑ ❑ ❑ ❑ ft Pump Ta �d51'* 600 600 1 Weiser ® I ❑ I ❑ I ❑ I ❑ ❑ VI11. RnMNSiBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu ber's Signa ur ( o Stamps) M P /rAPH6NMo.: Business Phone Number: Paul C.J. Steiner � C 6780 715 425 -5544 Plumber's Address (Street, City, State, Zip Code)- lly N8230 945th Street; River Falls WI 54022 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) A roved �7J pp El Given Initial Surcharge Fee) Adverse Determination Z& b ° h X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: St3D -63198 (191 t tom) DISTRIBUTION: original to county, one copy To: Safety & Buildings Division, Owner, Plumber SAFETY AND BUILDINGS DIVISION 2226 Rose Street N visconsin La Crosse, WI 54603 Department of Commerce Tommy G. Thompson, Governor 09- Feb -98 --, William J. McCoshen, Secretary Wegerer Soil Testing & Desig LYNN ROTHBERGER 421 N Main St �. PO Box 74 River Falls WI 54022 " ROTHBERGER, LYNN [CAINGOFFICE Plan ID 9820136 SE,NW,21,28,19W Municipality of TROY �! i ;;�;� ' ! nspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): MOUND 450 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, &erard M. Swim POWTS Plan Reviewer (608) 785 -9348 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, WI 54603 i sconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary Page 2 - 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.07/96) File Ref: ti , l Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE 201 30 LOCATED IN THE S F 1/4 OF THE NE 1/4 OF SECTION Z 1 , T � N, R 19 W, TOWN OF �-Rp� , �-, CRWlx COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION RecFive PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT 1998 PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE BLDGS pMV. SAFELY & PREPARED FOR Q l-. 01 t<3 � G E R UF1Z FPrI.Ls, L - i 1 S PREPARED BY WEGERER SOIL TEST I 1 (3 # ,,, %��noMNp�jy AND lvas'/ DES = G{q SERVICE }� •.• �� = ARTHUR F.O. BOX 74 421 K. KAIK Si. = WEGERE4 D815 RIVET? FALLS. VI 54022 = euswoRrr�. p.O W.T.S• 115- 4425AI65 COriditlOri d ••.........• PPRS �slcTr; OMMEF`DEPARTMENT C UILD►NG$ IS10N & Y AN OF D EE CORRES DENCE JOB NO. PLOT PLAN Page Z. of �( ' . Scale 1"= S o' �uq Z C9 b N ✓r� f 1 o � �s F 4k^ VMA j J EL 3 I Q.z 1 t zs ' s � ' Z ZS 1 1 L 99 - a O 1 1 y s s writ l�A 3 _-__ Lois Un,� LI �, 60p. 0 O>`1 c0►.�tovR �. S.S ` � t ttoti V I OF OQp oYL v w tELJ_ h S o�r.� RNb I iT L016T ZS' F1.3.4 Vo Ats NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( V required) 3. Install 4" observation pipes with approved caps. ( z required) 4. tank to be 1uuo1600 gallon capacity manufactured by 1-V t STS Ccw etz Ptz mDV C7� w LD c-T- 1600 - 5. Bench Marks %qE: t'ri3uVE 6. Divert surface water around System to prevent.ponding at the uphill side. Page —of 6 Approved Synthetic Covering 'Fs c- 33 Distribution Pipe Medium Sand -� H -- �� G Topsoil = — _ —_ F Flev. a`1.S0 3 b 7 % Slope Bed Of ' 1 4- 2 - 2 Force Main Plowed Aggregate From Pump Layer D Z. 0 Ft. Cross Section Of A Mound System Using E 1.S6 Ft. A Bed For The Absorption Area F 0A Ft. G k -0 Ft. A 8 Ft. H � • S Ft. Linear Loading Rate = ° I GPD /LN FT B y 1 Ft. Design Loading Rate= 0.3 /SQ FT j 1 — ; Ft. J 9 Ft. K 1U; Ft. r" Lernate e�— n L Ft. W Ft. L Observation Pipe K A I. - - - -- ----- - - - - -- ----------------------- �y o j - - -- � Ma i n Distribution Bed Of % 2 % ~ z Pipe Aggregate Observation Pipe Permanent Markers (Anchbr securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of Perforated Pipe Detail / 0 End View ) Perforated End Cap " `Oc ` PVC Pipe Install permanent J°` at end of each lateral Holes Located On Bottom, Are Equally Spaced Q �S PVC Force Main P PVC Manifold Pipe f Distri ution Pipe Last Hole Should Be I Next To End Cap End Cap P Z- Ft. Distribution Pipe Layout S _L / Ft. X L/S_ Inches Y L1 C(� Inches Hole Diameter Y Inch Lateral ) Inches) Manifold 2 Inches Force Main Z Inches # of holes /pipe Invert Elevation of Laterals - Ft. Place 1st hole 2 from center of manifold with succeeding holes at L/$ �intervals_ Last hole to be next to the end cap. Combination Septdc; Tank and PUMP CHAMBER CROSS SECTIOU ARID SPECIFICATICIMS ' PAGE S OF -VCUT CAP WEATHEK PROOF JUUCTIOk BOX 4'C.1- VENT PIPE APPROVED LOCKING —'10' FROM DOOR, MAWHOLE COVER wI'M .iIMDOW OR FRESH u>'/�(21JIIJG LAgEI`. A�IMTAKE ct�T.TpvTr r i tj 6 . b "r,�N, GRA I `t" MILL I ---- - - - - -- y " Ir�s�e�t�o►.� PIS ll� _ _ _ _ _ PROVIDE I f►JLE T AIRTIGHT SEAL I li V 84FT =LAS I APPROVED JOIM A I I APPROVED J0,01' W /C.I. PIPE OR Tank construction � W /C• PIP Ec4tPnc 1 with ALARM shall comply Y I I I ILHR. ('33.15 and 33.20 e I 1 I I ow C I I i LLLV. FT. PUMPS - -� � OFF i COWCRETE II Q • U O I BLOLK GI1 1 RISER EXIT PERMITTED OW Ly IF TAWK MAUUFACTURER BEDDQ HAS SUCH APPROVAL IN E00tN SEPTIC f w� \��T_I V00 SPECIFICATIC)JS DOSE 1A3� S �_ C�Z WUMbER OF DOSES: 3 ' 6 PER DA4 TI.IJ�C MA►JUFACTURCR: TANK 51ZE: � 00 GALLOUS DOSE VOLUME P ALARM MAIJUFACTURC.R: S� S Eu Sk SST -�}„l itJCLUDitJG OACKFLOW: _ 133 GALLONS MODEL ►DUMBER: ZO \a CAPACITIES: A= I e IMCHE5 OR 32 SI GALLOIJS SWITCH TAPE: yIl�EZC-U1Z L•( B= Z IIJCHES`OR 33 -�( G( LLOUS Pump !''IAMUFACTURER: V E C = S ILICHES OR X3 3 ' 6 CALLOUS MODEL NUMBER' S R " 4 ME � 0 D = I CZ) )I`MCHESLR V& GALLOMS SWITCH TJPE: MOTE: PUMP AMD ALARM ARE TO f5E Z53 pa INSTALLED OIJ 5EPARATE CIRCUITS MIMIMUM DISCHARGE RATE GPM VERTICAL DIFFERENCE BETWEEU PUMP OFF AUD- DISTRIBUTIOM PIPE.. �'� FEET + MIuIMUM NETWORK SUPPLY PRESSURE . , , , . .. , , . . 2-50 FEET F T. ��_ FEET OF FORCE MAIN X 1 '�� /OFLFRICTIOW FAL70R.. �' FEET TOTAL OtiUAMIC HEAD = , �' FEET Pump chamber DIAMETER 3 to INTERWAL DIIALWSIOAI� OF TAWK: LENGTH ;WIDTH _ ;LIQUID DEPTH BOTTOM AREA — 231= r GAL /INCH AO nvv MAMTTPArTTTyPP — . (6'1Z - GAL /TNCH ti6/l 9Lfi6�1 _ TOTAL HEAD IN FEET - o cn O cn o cn o O 0 v i O {' 0 N O O n A — 0 D w C7 O N H ° � '� C7 (17 O - D 0 r C H p m l 0 cn m � 3 �l N 41 Z ° C H � Z o m All C N � m m ° 0 W N O (D O W O O O O — N W -P. cn m v m (D TOTAL HEAD IN METERS bs nd Human D epart ment uman Relations "e"c° Industry, SOIL La a AND SITE EVALUATION REPORT Page \ of 3 labor Divisi m 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 not limited to vertical and horizontal reference point (BM), dir'"n and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to�arest road. O 1 10 —1 Zl I - 1 l� APPLICANT INFORMATION- PLEASE PRINT LL;fNFOR'M4/f DN, �' EWEDBY DATE l vWA 2I PROPERTY OWNER: 1- , PROPERTY.I;OCATION L\ (FAN R-0 � 6(Tjt a.`,._ F . 1/4 lie 114,S - T Ztt .N,R '01 E PROPERTY OWNER'.S MAILING ADDRESS LOT BLOCK SUED. NAME OR CSM # CITY STATE ZIP CODE PH ' Nl}gl UCRY []VILLAGE ®TOWN NEAREST ROAD � lu E1ZFRtcS ►�) sli oz (71 W6 9399 'r2u� Sfl�DIE RtD6E t,tJ. pQ New Construction Use M Residential / Number of bed� . -?s [ [ Additit n to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow qS 0 gpd Recommended design balling rate ` 3 g bed, gpddt ' � trench, gpd/ft Absorption area required 1") S bed, ft 1 - 1 5 trench, ft Maximum design loading rate bed, gpd/ft trench, gpcW Recommended infiltration surface elevation(s) (:1 • S I ft (as referred to site plan benchmark) Additional design /site considerations _F'1WvKM k,/ S 'K y, ' Yl I Iy . - Z\4 4 (-,j= :Sf) &Y FILL Parent material S L C` (y pyL1� Rood plain elevation, if applicable fJ • R - ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ® U MS ❑ U ❑ S ®U ❑ S 11 ®U EI A� U SOIL DESCRIPTION REPORT Boring epth Dominant Color Mottles Structure P D/ft g # Horizon Texture Consistence Botrtdary Roots G in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. g� rertdi i{ 3 E v 1 ) O -$ 1 0`12 31 3 Zmsbk CS .S .� ��'�::? Z g -3 b t o y �Z 31(, — S t l Z.� Sd1z v�► `�� e s S. 6 Ground 3 3 b - l O`i ti 6 /3 ft. Depth to limiting factor 3 Remarks: Boring # I ID --7 toycZ 313 � sib Zms�� �,'� e 1� •S. 6 S \ b L Ground q elev. ft. �o - f o Depth to limiting factor yo"' I - Remarks: T Name: — Please Print Phone: Arthur L. We erer 715 - 425 -0165 egerer Soil Testing & Design Service —P.O. Box 74 River Falls,WI 54022 *nature: /' Date: CST Number M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page . 7of 3 PARCEL I.D.# o - 10 Lt/-l l� Depth Dominant Color Mottles Structure GPD/ft2 in. Boring # Horizon Texture Consistence Boundary Roots Bed Tram Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. 3 o�tR - s� I ZM sb1c m�1r � S �� z -2_y 10 3 � i - s, ) Zm sb'c. 1,rt c4- es - • S L Ground 3 ZV- 1.0`-11Z. CD/3 _ LS 13 R - fv�� �►P elev. 99. ft. Depth to limiting factor 2. " 1 Remarks: Boring # p t5 YO`-tR_ 313 s > ) Z `�Sbl m`F� �S 1`4 •. S . L ,..` Z \-1_3l si) Zi-Sb ( m`ci- as s , L wa Ground 3 z�3b 1 Vlr, — s) c_I 1 �s b m fit^ ►��� NP elev.°le .ft. COl\l 1 N s 1 S% * L 1`-i `t11►J� 1='� G ML�vTs Depth to VAJZ > Sb°)o " limiting factor Remarks: Boring# 0- 1 b`t 31.3 - s l• bT C5 • S <S Z %_ /6 s Z�S1-L. >�'Fl �S - • S I 33-�12. ZOO tcZ V/(, sf -\ \ c_s kv `Fr - • -z • 3 Ground elev. t ' cw \-_s f 1-Q Depth to limiting factor i Remarks: Boring # _ice} = 1 . 13 7_ 13 wt1Z C= G 1"r b tars P N1Z w1`'t `<' �'Ttaj -1 o-q (�1Z Ground By EtL S 1 MUD `3 � ��ifiLUt'� 7"N`� �vU� `T7f� j�1wP�Sp� elev. ft. V—)0v1v p0wJ.1 S �u�jE 1 U a1 D��12 'R� p\ i L��� ZSr Depth to 013 USOb l v 0 U N • limiting factor Remarks: cnn.A2gnhP ------------- PLOT PLAN Pa 3 of 3 SCALE 1 "= SO b b N t r D�z► try 'r � 3 .� s, .3�� , � � Div � "p� R• ��� � Q g Z V � 1 ` �a6 _ Z. a L 4 g�� o �►�tov2�,gS.S` 6z , r Q vvtvgF'm , BE PST LMST' Z s' F12A1-) r-%Uj b . rs w EL 50' K << (715 ) 425 -01 M 00576 CST Signature Date Signed Telephone No. CST # b DepartmentofIndustry , La Wiswrtsin bor and P Human Relations age 3 SOIL AND SITE EVALUATION REPORT 1 of • Labor and 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 S� • C H2O �x 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. O q O - 1 Zq I APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION IM DATE 2• q c PROPERTY OWNER_ PROPERTY LOCATION 1.'I)X1N ?_5 GeV -LeT x Ntr 1/4,S Z.l T _L�a ,N,R 1 0i E(oeW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # N � 3 j 1 - U " - w� �'j CITY STATE ZIP CODE PHONE NUMBER EYM []VILLAGE ®TOWN I NEAREST ROAD � V W) S \Iozz. (?LS) 1 4 Z6- 9399 'X Sftt) E 21D6E L P4 New Construction Use M Residential / Number of bedrooms 3 [ J Additkn to exds&V build'atg [ j Replacement [ j Public or commercial describe Code derived daffy flow L43 0 gpd Recommended design loading rate • 3 g bed, gVW trench, gPdt Absorption area required �3 l 5 bed, ft 1 trench, ft Maximum design loading rate • 5 bed, gpd/ft trench, gpolft Recommended infiltration surface elevations) at -1- S r It (as referred to site plan benchmark) Additional design/ site considerations ki/ 8 gdj . rj t >v • Z 4 C�,j= sf)&_rjb 1=r Lt- . Parent material s L L_ N Ov11Z oL o Wx l `fL Flood plain elevation, if applicable 1.� • A - It S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT -GRADE SYSTEM 11 FILL HOLDING TANK U = Unsuitable fors stem ❑ S ®U [g S ❑ U 0 S ®U ❑ S au ❑ ® S U O S [a U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft S Cont g in. Munsell O z. Color Texture Consistence Bouxlary Roots Gr. Sz. Sh. Bed Tmnch o - 1 o`1 ti 313 — s it Zm S bk`�1^ cS . S .� yY I . , ,�.;.x Z � -3 � 1 o y �Z ..�:.:: >�v 316 s t I Ground 3 3 b - I QN 4 R- 6 1 . 3 elev. O f 6 • fL Depth to limiting factor Remarks: Boring # �,? ) o -� 10y(Z 313 � SlJ Z.mS�� � e \� •S � Z 2 -31 tp`yR- 3(� sr Z`FS�h >nTl- CS — S -`� Ground 3 31 -L/0 - ).S -1t_3fy s 1 �eSbl mVA- aS .k4: -S 9 6 � ft o - 10 y 2 6 l-3 <,S SR - - tvi�" tw Depth to limiting WIN Remarks: T Name.— Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 *"ahm /'-',� a _ t (/ Date: ? 2 _ 9 CST Number: �/ U T M00576 PROPERTY OWNER \-----AN-%_ F1r1 L SOIL DESCRIPTION REPORT ''Page 4-of'; PARCEL I.D.# • Depth Dominant Color Mottles Structure GPD/ft? Boring# Horizon P Texture Consistence Bo ndaty Roots in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench 1 (-3_ ern ))kr - • s °6 '2-y Oy tz 3 c_s � S Ground 3 211- \v`-tSZ elev. c19-2 ft. Depth to limiting factor Remarks: Boring# owniq 2fFf �� Ground elev, ft. Depth to limiting factor Remarks: Boring # • Ground elev. ft. Depth to limiting - factor Remarks: Boring # t > l ' Ground elev. ft. • Depth to limiting factor Remarks: SBD-e33O(R.OS/921 R _ PLOT PLAN Pa 3 of 3 SCALE 1 "= SO C b b N 1 r r N_ i et q6.s' o.� P�hle J ti 3' r't6ovFT G vlvn Lrl.�b b ti 'OB.S Z�Z 3 ZS I 11 'Ii � Ls !EL q ° OtQ °O►Jty X1.9 S.5' of 6mD Q , Nt. (J U7L 4 vsF BF P�r Lklhsr '. S' PkjaM rjou&jD . WELL S p• H 98- 114 ( 715 ) 425 -01 M 00 5 7 6 r CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address — 7 SA OW 1 V 6L Z,j Property Address A l U f2 FA 1 21 (Verification required from Planning Department for new construction) >k�� !oH 3i�yI City /State ,d/&S.e LA 6 Parcel Identification Number Zc7 Z SADD Rid �f N, - �o LEGAL DESCRIPTION 0'10 - /2 Property Location .S C r /,, A ),:-- -' 1 4, Sec. z �, T L8 N -R ( W, Town of - FRO Subdivision ' O (�AT2 Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # S& W 7 5 Volume I 2 - - , Page # Spec house ❑ yes ❑ no Lot lines identifiable X yes O 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIG A O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form areirue to the best of my (our) knowledge. I (we) am (are) the owner(s) of 4 prope cribed above, by virtue of a warranty, deed recorded in Register of Deeds Office. F LICANT 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 W . STATE BAR OF WISCONSIN FORM 2 - 1982 56 I1 ` � WARRANTY DEED DOCUMENT NO. VOL 1271maNa Denni L Nowlin, a s in le erson R S O O FICE } " t � SCO.. WI �^ R eg" r .. a► 6 Lynn F. Rothberger and 997 conveys and warrants to _ 11 :45 A M Susan K. Rothber er, husband and wife as survivorship marital rO rt��q�q l �{� �.ials jj AA .. THIS SPACE RESERVED FOR RECORDING DATA t4 NAME AND RETURN ADDRESS ^ . Croix County. ./f/ �'� VS& the following described bed real estate in State of Wisconsin: A s PARCEL tDENTtFICAT.ON NUMBER ^ Lot 1, Plat of Wyngate in the Town of Troy, St. Croix County, Wisconsin. < �3 i s ,mss This is not _ homestead property. ( (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. October - .A.D. 19 97 � of Dated this / Y (SEAL) +r; i (SEAL) D NIS L. NOWLIN • (SEAL) 4 (SEAL) ACKNOWLEDGMENT e•j '" AUTHENTICATION State of Wisconsin, f Signaiure(s) ss ,� h _St. Croix County. I i . r. day of day of _ Personally Came before me the authenticated this )' 19 October 19 97 , tF.e atx.e nam<d =� .� Dennis L. Nowlin -- TITLE MEMBER STATE BAR O W1SC_'SIN _ -- 4 y: , > >! - -- ; (II nut. who executed the foregoing _ - — x known to be the person fi a authorized by §706 06, «'is. SE-Its , n t s = r�ment 1 a k gr the same ` I F) By ° 1"'�,�. / - oo O a cc 0 o� r h' n n a p R PA r x � r� a C) �2n� p O aye O y O y� �y Co �Cl) zt � � 03 ~ Z g O O lb a Z Z N N oD NN . n I = �� 2 �M 11 `N it � 0 w �I I �► I N I o I I co _ r .I. C l) I a _ _ S 09 00' O ` 00 _ I • ME40 DIMENSIONAL DRAWING MW50 DIMENSIONAL DRAWING "ON _ E ° a 14.76 "OFF" V 6 E E E __ 6.25 00E ri v co 1 -1/2" NPT • ® ((38.1 mm) O bischarge • E F6 • �� rn o� ; ® - 9.64 O a� • • I U !�O • I 5.66 (144mm) 11.68 11.42 (296.5mm) ME40 PERFORMANCE MW50 PERFORMANCE CAPACITY LITERS PER MINUTE CAPACITY LITERS PER MINUTE 0 0 100 200 300 400 500 0 50 100 150 200 250 300 350 30 10 40 12 35 25 6 10 30 W R F 20 W W W W U. 25 8 W Z 6 a u 2 C 2 Q 15 = 20 6 Q = UA w W -j T -4 15 ' 4 Q O 4 Q 10 p 10 O � 2 5 2 5 0 0 10 20 30 40 50 60 70 80 90 100 0 0 0 CA ACITY GALLONS PER MINUTE 0 20 40 60 60 100 120 140 CAPACITY GALLONS PER MINUTE 23833A275 11 ta�b_mpannHurnan Relations of Industry SOIL AND SITE EVALUATION REPORT P of 3 Lbor and Human l P _ 1O " °t Sa fe t y & Bld"gs in accord with IL.HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8.1/2 x 11 inches in size. Plan must include, but �� not limited to vertical and horizontal reference point (Blot), direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ICON N 4 L, G(Aq.:6T Sl� 1/4 K)E* 1 /4,SZI T Z�B ,NR lq E(or W PROPERTY OWNER' :S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1J 1JO � L � N � — w Y t.16 PrTE CITY, STATE ZIP CODE PHONE NUM ER ❑CITY []VILLAGE ®TOWN NEAREST ROAD R,1UL�IZ.�'frl� 38�. 388 I SA'>,Dl RtDG� i it�/h [4 New Construction Use p('J Residential / Number of bedrooms 3 [ J Addikn to existing building I J Replacement [ J Public or commercial describe Code dernred daly flow gpd Recommended design loading rate ed, gpdnt — trench, gpd1ft AIISUPim area required 31 S bed, ft 3 � S trench, f1 Maximum design Wwg rate 1(3-S bed - gpd/ft 0 • � trench, gpd/tt Recommended infiltration surface elevatio(s) Vn • S ft (as referred to site plan benchmark) Addtional design / Site considerations 'r - 16UX Z wl8 ' x y 7 " gin . M 1)'j . Z. o F SY17vb F/ c. c Parent material S L-'T� ovN2.z. Flood plain elevation, 9 applicable 1-3. k ft S = Suitable for system cONVExnoNAL MOUND W- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDWG TANK U = Unsuitable for stem [IS ®U [� S ❑ U ❑ S ®U ❑ S U ❑ S ® U ❑ S [2 11 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Borxiciary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ►ends Y'' ©- a ��`-tQ 313 -- S� Z,,., Sb' w� ►� �-S Ground -- elev. a � Depw to lirnitiog facer Remarks: n9 o # 1 0_ �o�trz31� S1_j ?�+v,sb cS Z -31 k\Mt t 31 L s>`( -Zi Sb� m ft c.S : S L Gramod 3 31 -i1� 7.5 `itZ3 — S) ^Selz vnu ` k CS et l�`tfL6 _� - U%Z' - `l 6 • _ f t bri fa r Remarks: I CSF Nam9.--PIease Print Phone: Arthur L. We erer 715 -425 -0165 V e b g% Soi Testing &- Design Service —P.O. Box.. 74 River.Falls,WI 54022. Si�oue: Date: CSTNumber: - - M00576 PLOT PLAN Pa 3 of SCALE 1 "= SO C 0 N i� i o � 0 cn m EL. 48 -5 ' � �l Do'rtpy -� OF 13�SD �L_ IUU.S � l r y 3U B.Z k v OQ NDT cuOmpn -- r r OK 1 0 1 � N_ 1 6 I-M 1— u� L S . ____ Q pvaF �E P� LWIS ZS' PV-OM ) 7ou-I-,p , ( 715 ) 42 - 0169 1:4 005 ,CST Signature Elate Signed Telephone No, - TS # s Laand nanRelatiorB Indus SOIL AND SITE EVALUATION REPORT Page of . Division of Safety a Builcirxrs 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 �i YX not invited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ID. # dimensioned, north arrow. and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION — l b i3m l iZ l o r b L.. GWT EAT S ZF 1/4 K)� 114,SZ1 T Z ,N,R lq E (or W) PROPERTY OWNEMS MMUNG ADDRESS LOT B BLOCK # SUBD. NAME OR CSM # S°l (_Wl Or_ - _ 1__ — W`fM6P�'E CITY, STATE _ ZIP CODE PHONE NU 0CfTY EMLLAGE ®TOWN NEAREST ROAD R1UNlZ. ,1W -' SgOZ.z 39b. 3 87 '1ZV`1 SPt�OI IZtD6� L1t [4 New Constriction Use p(J Residential / Number of bedrooms 3 [ ] A" to e)dsstug buik6ng [ ] Replacement [ ] Public or commercial describe Code derived d* flow gpd Recommended design Whg rate bed, gpolit — trench, gpolrt Almorplion area required 31 S bed, trench, tt Ivla>o nun design loac" rate . o - s bed gpdwt 0 - (° trend►. 9pW Recw vended infiltration surface elevations) %n • S R (as referred to site plan bendunark) Additional design / Sfle considbr�s 'flwk)p WZA • x L o "Sin, MJly , Z ' OF SlY F LC Paertl material st � oy�Q �o�.t�t� t Flood plain elevation, if app6cble N.N. ft S= Suitable for system . " CONVENTIONAL MOUND Pr- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDM TANK U= Unsuitable for tem 0S W U (0s o U [IS O U EIS , u I DS ®U [IS IOU SOIL DESCRIPTION REPORT Boring # - Horizon Depth Dominant Color fvbitfes Texture Structure Consistence Bourrlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Toxh L Grand 3 - 10` 61 LSB _. el&L 0 1 ft Dept lo fim*9 factr 36y Remarks: . mTl- CS _ -S , } Z Z -3) �D`11Z31� sil Z�' Sb4� rn Vi_ c3 : S , L Gmd y Lit coXc26 z _ , 1)"b GDti9 �r Y law Lit)' � Remarks: _ - 1 e:- Please Prinf Phone: Arthur 'L. We erer 715 -425 -0165 .. 'W So Testing; &- Design .Service -P.O. Box. 74 River. Falls )WI _54022 - Shure - _ - _� Date: _ _ CST NumbeC - - _ ✓ �'� -Qq f'� Mt?0576 PLOT PLAN Pa - "- of - 3 SCALE V= SO C9 b �o N i 1 1 1 0 cv L; r n y ,--1 g Z �,�. �o Tool' cAr tPrl -T o►? ' (/� 1 k1 9 9 t 6.3 1 tp 1 I N Z6.3 6 ► �-q6 _ --- _ _ gyp �—. 600, p ON � 1�LV) A - w (715 ) 49.5 -01 M005_ 7_ ,CST Signature Elate Signed- Tef ephone No. - - - - CST #