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HomeMy WebLinkAbout042-1007-70-000 2 0 2 0 � \ j k o \ 0 2 � b . � 2 . � $ � @ � z ) ? z 2 ] § J CL q � � a I - = I E . z / = 22 / $ a ■ § � \ § :!t 7 ] kkf� D } _ 4) E 2 2 9 \ � � ) ) ƒ , k t \ / \ k § 0 z / z ' e � - . »o Z C I Q . R 2 ) i ) L . 2 ■ k § k IL ) > / k n \\ k k k Fl z -¥ a a 2 § 0 U - 2 -j � ;k \ \ ƒ 1 \ \ 5 2 \ / \ E / / c & \ c = � U) « \ _� k = E r C4 k§ 0 k/ k k {\\ k § \ \ :] # @ ©a § § 2 ƒ ƒ 2 C"! g \ ) I { $ $ - k 3 co \) o z/ z \ CIS � ■ � / 2) M \ I - _ " 0. « . E & ' k a § / v a : U) v o Parcel #: 042 - 1007 -70 -000 10/18/2006 05:12 PM PAGE 1 OF 1 Alt. Parcel M 04.29.18.52C 042 - TOWN OF WARREN Current I X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner LAWRENCE A &GLORIA TRST AEBLY O - AEBLY, LAWRENCE A & GLORIA TRST 1168 120TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): mary Type Dist # Description * 1168 120TH ST U SC 2422 ST CROIX CENTRAL e SP 1700 WITC Legal Description: Acres: 14.600 Plat: N/A -NOT AVAILABLE SEC 4 T29N R18W IN SE NE LOT 3 CSM VOL Block/Condo Bldg: 3/743 ORD Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 05/03/2000 622273 1507/267 WD 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations Last Changed: 10/19/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 14.600 77,300 165,600 242,900 NO Totals for 2006: General Property 14.600 77,300 165,600 242,900 Woodland 0.000 0 0 Totals for 2005: General Property 14.600 77,300 165,600 242,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch M 207 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 AS BUILT SANITARY SYSTEM REPORT ;1 OWNER• TOWNSHIP Warij e EC. N - R/,?W ADDRESS �' "� s? ST. CROIX COUNTY, WISCONSIN. SUBDIVISION LOT — LOT SIZE - PLAN VIEW Distances and dimensions to meet requirements of H63 SHO W - EVERYTHING WITHIN 100 FEET OF SYSTEM i a 4. - -- -- — - - _ I di a North � A row — - — 1- SCALE . �' = o L BENCHMARK: (Permanent reference Point) Describe: % rn�frs �sq -yam Elevation of vertical reference oint: ' `� P lO0 O Slope at site: SEPTIC TANK: Manufacturer: eurrscr Liquid Capacity: Number of rings on cover Tank manhole cover elevation - ' ,&V' i Tank Inlet Elevation: '/ ' Z ' Tank Outlet Elevation: iio '-p-.4 _ PUMP CHAMBER Manufacturer: Number of gallons Nwnber of gal. pump set for a cyc e_ gallons; total capacity o distribution lines gallon: size o pump head; gallon per minute horsepower Erand name of pump and model number ; Type of warning evice HOLDING TANK: Manufacturer Number of gallons F1 nvnt-i nr% of rnnrnhnl n nnver� DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & H^JMAN RELATIONS PRIVATE SEWAGE SYSTEMS �� 0 DIVISION MA DISOjU, WI 53707 BOX 7969 ` /� BUREAU OF PLUMBING CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: o r 1:1 Holding Tank ❑ In- Ground Pressure 1:1 Mound [If assigned) NA E OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE f � 5 fi r; Q - r BENCH MARK (Per ent reference point) D RIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. r) 1 4 Ta g n -- R r c ry Name of Plumbrr: MP /MPgSW No.. County Sanitary Perma Number: ens. rage. �S 6 9 (a:j to - 13� SEPTIC TANK /HOLDING TAN S 3 v MANUFACTURER LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKINGJJCCO R c, P O JDED: PRO DEA ` 2 c. T �= ���.! O ��o.� ,YES ❑NO �E ❑NO BEDDING. VENT DI VENT MATL HIGH os ' . ROAD: PROPERTY WELL: BUILDING: TO FRESH (� ( ALAR LINE AIR LET X YES ONO ` + ❑NO L / Ah / `V' /11 I VENT DOSING CHAMBER: MANUFACTURER BE DUI NG. LIQUID CAPA(' PUMP MUDEL PUMP /SIPHON MANUFACTURER RES NG LABEL LOCKING COVER DED. PROVIDED: ❑YES ❑ ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. ,PROPERTY WELL BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN LINE AIR INLET. PUMP ON AND OFF) DYES ❑NO �� SOIL ABSORPTION SYSTEM heck t e soil moisture at the depth of plowing LENGTH J DIAMITER MATERIAL AND MARKING or excay.*tion. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) P CONVENTIONAL SYSTEM: WIDTH LENGTH NO. OF DISTR. PIPE SPACING. COVER_. e J INSID DIA. -PITS LIQUID ryy p�' TRENCH ES M RIAL: DEPTH'. FILL DEPTH UISTH. PIPE DISTR. PIPE IDISTR. PIPE MATERIAL. NO. e PROPERTY WELL BUILDING: VENT TO FRESH BELOW CS { ABOVE COVER E EV. INNLFI ELEV. END �/) 7 PIP LINE. AIg� / . MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE j` PERMANENT MARKERS J OBSERVATION WELLS It ❑YES ❑NO DYES ❑NO DEPTH OVER TRENCH BED DEPTH OVEH TRENC.BE ` I DVTH OF TOPSOIL I SODDID SEEDED MULCHED. CENTER EDGES ❑YES 1:1 NO DYES 1:1 N o DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: `e WIDTH LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE -. FILL DEPTH ABOVE COVER. ,� THE CHES. T x,Po'x MANIFO LD PUMP A IFOLD DIST _PIPE MANIFOLD MATERIAL NO. DISTR DISTR_PIPE DISTRIBUTION PIPE MATERIAL &MARKING TE E T T� ELEV.. ELEV_ I�. E .. PIPES' DIA.: 2,0 HOLE SIZE HOLE SPAC(N'G PRILLED CORKECTLY' COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED TE t • T TTTE'i tZ' PLANS. YES L NO Y ES El NO COMMENTS: PERM ENT M KE : OBSERVATION WELLS. INIPROPER WELL: BUILDING LINE: ❑YES 1:1 NO - ]YES El Ei ' 15 47 R1 d s tz � Sketch System on Retain 'n county file for audit. Reverse Side. SIGNATURE ,-' I TITLE DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN I ELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: 376 r -3z ay: P Property Location: ait" wi#ege Or Township: County: S� 1 /4 lV,r Y's / iT 2Q Ni R 5 (or W ',S a o j Lot Numb No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: 5 er: Blk (If assigned) TYPE OF BUILDING Number of ❑ Public* ❑ Variance* ❑ Other (specify)* Bedrooms: 5? 2 Family * State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLAS NEW REPLACE- OTHER S GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY ZBO ✓ �,� HOLDING TANK CAPACITY LIFT PUMPTANK /SIPHON CHAMBER MANUFACTURER: ,E EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): 21 ❑ Replacement ❑ Experimental E Seepage Bed ❑ Seepage Pit Z� /Z60 ❑ Alternative (specify) ❑ Seepage Trench /40m. It B• i Water Su ply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint E]. Public I s ..-C- I, the undersigned, hereby assume responsibility for installation of the private sewag system shown on the attached plans. Name of Plumber: Signature: MPI�MPRO No.: Phone Number: Plumber's Address: r Name of Designer: 5f�D2Z. COUNTY /DEPARTMENT USE ONLY Signs ure of Issuin Agent: F e:�O� Date: QQ���� El APPROVED Sanitary Permit Number: �� ^ W�� ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY &BUILDINGS INDUSTRY, CC DIVISION HUMAN REDLATIONS PERCOLATION TESTS (��J) MADISON W BOX 53707 LOCATION: SECTION: I TOWNSHIP /MUNICIPALITY: LOT NO.: BILK. NO.: SUBDIVISION NAME: sE 1 /�W 1 tl /T.;? N /R/j E (o ► � — -- COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: r �' 'P USE f DATES OBSERVATIONS MADE ,NO. BEDRMS.: COMMER AL DES RIPTION: N S: N TESTS: �/ _ New ❑Replace I 7 9- 1 RATING: S= Site suitable for system U= Site unsuitable for system I ONVF,NTIO MOUND: � IN - GROMEN �D SYSTEM: (optional) f L �� _ ✓ ✓ J J J J / �� J� UU S ,.� n>,- l �e'0 _Vy'xs3' If Percolation Tests are NOT required re DESIGN RATE: SYSTEM E 4 If any portion of the lot is in the under s.H63.09(5)(b), indicate: /� Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS I _ S " A s BORINGI TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTUR12r, AND DEPTH NUMBER IDEPTH IN. ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /J�� l3if J/r B- 7 — T A 92 ' .. C y u , Y' 6 5• / / 7 d .P /!Tn Jil�.+� / -w gr, /6 ° �C�/13.s s: +u s /,' S� B- 6- B- A ff Z' ei s 731 _V/ w B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD t PERIOD PERIOD PER INCH P- P- P- S P-. ro ±Z r PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION !d® <<o a e k 1 r .p _........ .�` ' S .s .,.m .._.,.. • AI IM i r 3 e. F� • 67a DEC 353715 PAO 010004 DARYL C WLES, ' S T ' '" 1KC CGR SEC. r49,# R18W ��(�� � +. ►� � �' � f ,� SPIKE ) N89008434 "E (. + ROAD /0' EAST fns ,,,,.•..1 441.07 441,07' 441.07 4f N E• CORAIER ) 43' Rogow �... EASE'PJEA' a� Seto JLW " 9 MIL NT FaR �gbitM T o a O LOT I e LOT 2 ' a LQT . Z a 0 .� /2.7 4 N. /2. O N /2.T ' o /vc �- ACRES RGRES, e RES • _ `� `° f � `b� , k: °t v .ti �' • $f 4 M�,,/� ._ 9gVa t = = �Y f. • Pi ,{y } 1t e d S7 y f SCALE: e�442 «3G►'�,0.:,,� 4#2.,x' ... ,+�;#�►IID # EAST ,, �, > x OF S.E C RNER o Indicates 1" x 24 " *Q4 30 "W r ,< iron pipe stake weighing 1.13 # /ft. y ' DF.WRIPTION The Southeast 1/4 of the No rth east :l / of Section '4 TCVi'nship 29 N "6rth. , Range 18 West, Town of Warren, St. 'Grout County Wiecartsin f ,aub .Jsot U easement for Town Road purposes aver the East 33 'feet "thereof and aub�ec'L 'tc easement over the following described tract within the above dosort peel for roadway purposes; Beginning at the Northeast corner" of the above dedstcribed parcel ya thence go S 890 08' �4" W along the North line thereof 88Z`14 feet; thence along a curve concave Easterly having a radius "of 80.00 feed ar►d ohord �earing S 1 16' 2 E 156085 feet; � thence N b7° 20 2 9" E 237•" 'eat;.; ORIN'S or G 0 JAMES L. ki+AP. !Y .� Can sail Errs N - -C /9f!•T2' M S 1 0 4 2 1 RiVCR FALLS, © , '70 W1 SC. ,yw' e.�.�Ne . 23 p• ��� .sK. 'M r C>c°TAs�. ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Property Address City /State Legal Description: Lot 3 Block Subdivision/CSM # > 5 7 / o '/a � %4, Sec. _3 T 2YN -R , Town of ,A _`il . 4W --ca? l SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank m uf� _ �o N t o � Size ST/PC 1 g a O/ Setback from: House 15 Well Z2 P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road 7�� Vent to fresh air intake _7 I Water Line S O Meter location Alarm location SOIL ABSORPTION SYSTEM- 3 �I - Type of system: Width ^ 3 Length 'S Number of Trenches 3 Setback from: Hous; �D Well ' P/L Vent to fresh air intake 7 :Z�3 5� , " ELEVATIONS : ELEVATIONS Description of benchmark Y� i _% a a Imo Elevation l D o, o o Description of alternate benchmark g S&W Elevation 92 2� Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover B,,d&Ln lJo ll-0- q 7 , 5?6 ` Distribution Lines W) ?v 1,6; S B (G.) r� `� • �5 � Bottom of System M 9c9 9 S (G} 5? 7, 99 Final Grade ((,4 g S-. (/� . S ( 9 -;>, 'y 1 5 Date of installation, termit number _35 State plan number &k__ Plumber's signature s-✓r ur License number 05 :1- 5 Date Inspector 61� Complete plot plan ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y Safety'and Buildings Division Co unty - ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary D it1 t: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. Md Rolde[ shame: f]_ it 11!/�Ilage Town of: State Plan ID No.: CST BM Elev_: Insp. BM Elev.: BM Description: K�:1V Parcel Tft� jai o 'z 6t -Vw4 4i TANK INFORMATION ELEVATION DATA A9800543 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben t& °fX2 92. 4;7— Dosi ng Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent to ° TANK TO P/ L WELL BLDG. Air Intake ROAD Inlet_ ) Septic NA � �z Z 11 Dosing NA Header / Man. Aeration NA Dist. Pipe °y o•5 11 og rr.& 0- Holding Bot. System 13 bpi �.�3- -7 3 PUMP/ SIPHON INFORMATION Final Grade q .a r, -3,; Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss H ea Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED ENC --'W idth Length Lg No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � DIMENSION S SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC INFORMATION Type , , AMBER Mo er. Syst "" - )I t-:1 :5 '- i DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) 1 ! rHole Size x ole Spacing Vent To Air Intake Length qy Dia. Length L Dia. --I Spacing L I - I /1ur. r S 4 4 '.ZC7t� 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.) a3 e3 LOCATION: WARREN 04.29.18.52C,SE,NE 1168 120TH STREET //D Q C � ✓LG�ti'- Jti�taE� GIS�S Plan revision 're ired? ❑ Yes M Use other side for additional information. SBD -6710 (R.3/97) Date Insp or's Signature o 01E w sBn il gtonAve - s � *6cons i SAN S n In accord with ILHR 83.05 W is. Ad m. 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 1 than 8 vi x 11 inches in size. S�• • See reverse side for instructions for completing this application State Sanitary Permit Num er 3;4� The information you provide may be used by other government agency programs ❑ Check if revision to previobs application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location L A R k y 4 /=- 1. V 5E 1/4 NE V 4 ,S y T 21 ,N,RIS NOW Property Owner's ailing Address Lot Number Block Number / I ; Z 0 5 J <$M Cit , State Zip Code Phone Number Subdivision Name or CSM Number 5 J aBEQr$ wr 3 (7ir >�w1► -48� csm 353z1S vd23 P 7q3 11. TYPE OF BUILDING: (check one) ❑ State Owned ° c ity Ne f arest Road /oZo S , l Public 1 or 2 Family Dwelling - No. of bedrooms Town OF LOA R R E IV / / 8 C III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) o � - 1 col - - 70 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 IV. TYPE OF PERMIT: (Check only one box on Fine A. Check box on line B, if applicable) A) 1. ❑ New 2. G&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) � _ EVIV 1 r ,. a 611AM 1�. - 4; 60, p4U� �3/• :Z5 4 4- - P Non- Pressurized Distribution Pressurized Distribution Experimental therh> 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ¢Seepage Trench 22 ❑ In- Ground Pressure p> 1 )( Fl. 2$� 42 ❑ Pit Privy - 13 ❑ Seepage Pit 43 E] Vault Privy 14 ❑ System -In -Fill l — ? �" 13 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17. Final Grade 0 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) s'> g /.o _ Elevation /;Zoo - a � — Ta - 8 9. c le et `� 3, q 8 Feet Capacit VII. TANK i Ca allo s n Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks it ' / /� pticTank /1 /; co r 1 4 • 1 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I 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: (Print) Plumber's Signature: (No Stamps) MP /MPRSW NO.: Business Phone Number: Plumber's Ac dress (Street, City, State, Zip Code): 9 4 14 w IS R6 B T S t �Y o ,X. IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing nt Signature (No Stamps) Approved [:]Owner Given Initial ' `! Surcharge Fee) 6th Adverse Determination b 0 �' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: P (b v ; #ktf, o w-ko c.e h g►cot*z�i► -ate ocf 7 ►15pr _ SBD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber - Cost- Effective Solutions for On -Site Systems e 77777-- EnviroCham Chamber n ' 1 f Cost-Effective Solutions ■ Two - for -One Chamber' ■ snap -on EqualFloTM End Plate EnviroChamber units can Eliminates need for screws and power tools, saving be divided in two by cutting time and labor. on the center line, so half- ■ Fast and Easy Installation chambers can be used to Lightweight, strong high- density polyethylene means complete a trench. Saves no heavy equipment is needed, and installation is time, reduces additional faster. excavation costs, and ■ unique Rib Design eliminates using more Strong, innovative rib design requires less backfill product than is necessary material, saving material and labor costs. Patent pending Designed-in B enefits ■ New Equal Distribution ■ Chamber Design Benefits system Solid top prevents water and soil intrusion, while open The unique end plate bottom means no stone masking. No f ilter fabric is design allows more equal required. sro. distribution of effluent ■ Gravelless system from the distribution pipe Eliminates stone masking, stone clean -up, and mini- 'x into the first chamber. The mizes landscape damage. And there's no need to wait EqualFloT" distribution end for gravel delivery trucks. plate minimizes scouring ■ unique sidewall Design and erosion at the inlet Louvers are set at a 30 angle to help prevent soil area. intrusion. The end portion of the sidewall is closed off ■ H -10 or H -20 Load Rated to help avoid soil intrusion through open louvers. Meets and exceeds load Studies have shown that increased sidewall area requirements. enhances treatment by allowing more oxygen transfer through the soil for efficient biomat Formation. Value-Added Benefits ■ High Density Polyethyl- ■ Made of 100% Recycled ■ Five -Year warranty ene Construction Materials EnviroChamber units are Strong, lightweight, Allows use of an environ- warranted against defective abrasion - resistant and mentally Friendly product. materials and workmanship impervious to most for five years.' ' chemicals found in sewage. Y �, See complete warranty on back for details. i E as y f or I • Excavate trench to required width and depth; level surface. Clear away any large stones or roots. Scour sidewall areas, if necessary. • Install EnviroChamber units on trench bottom and snap together ■ Install end plate and distribution pipe (pipe does not extend beyond end plate). ■ Complete backfill operations. ' See EnviroChamber unit Installation Instructions. This product is solely intended for the conveyance of fluids. Access into this product for mainte- nance, inspection, or other reason should be done in strict accordance with OSHA recommendations for confined space entry. Vonfi Trench Bed _ x,1 ,,,;�,t w I �� 11 •I �iiA•d'ol I Com pare Envir Adva Envir Advantage • " In i • DiffuserTM Unit (H-10 or H-20) ( Chamber Chamber Size 12 "x34"x75" 12 "x34 "x75" 11 "x3VVY' c Sidewall 8 +33% 6 6.5" Capacity 87 gal. +13% 77 gal. N/A N Invert Height 8" +14% 7 6.5" Size 17.5 "x34 "x75" 16 "OVV5" 14"x3VVY' Sidewall 14.5 +32% 11 " 9.5" Capacity 138 gal. +13% 122 gal. N/A Invert Height 14" +27% 1 1 " 9" Compared to Infiltrator chambers '31. J -P+ v' " m " e r— _P ew __ InfiitratorT" is a trademark of Infiltrator systems Inc. Bio DiffuserT" is a trademark of PSA, Inc. Five Y ear / Warranty (a) THE STRUCTURAL INTEGRITY OF EACH ENVIROCHAMBERTM LOSS OR EXPENSE INCURRED BY BUYER. SPECIFICALLY UNIT, WHEN INSTALLED IN ACCORDANCE WITH EXCLUDED FROM WARRANTY COVERAGE ARE: DEFECTS OR MANUFACTURER'S INSTRUCTIONS, IS WARRANTED TO THE DAMAGE TO THE CHAMBERS DUE TO UNAUTHORIZED USE; ORIGINAL PURCHASER AGAINST DEFECTIVE MATERIALS AND ORDINARY WEAR AND TEAR; ALTERATION, ACCIDENT, MISUSE, WORKMANSHIP FOR FIVE YEARS FROM DATE OF MANUFACTURE. INSTALLATION ERROR, ABUSE OR NEGLECT OF THE CHAMBERS; SHOULD A DEFECT APPEAR WITHIN THE WARRANTY PERIOD, THE CHAMBERS BEING SUBJECTED TO STRESSES GREATER THAN PURCHASER MUST INFORM HANCOR, INC. OF THE DEFECT THOSE PRESCRIBED IN THE INSTALLATION INSTRUCTIONS; THE WITHIN FIFTEEN (15) DAYS. HANCOR, INC. WILL SUPPLY A PLACEMENT BY BUYER OF IMPROPER MATERIALS INTO BUYER'S REPLACEMENT CHAMBER. HANCOR, INC.'S LIABILITY SPECIFI- SYSTEM; OR ANY OTHER EVENT NOT CAUSED BY THE COMPANY. CALLY EXCLUDES THE COST OF REMOVAL AND /OR INSTALLATION OF THE CHAMBERS. FURTHERMORE, IN NO EVENT SHALL THE COMPANY BE RESPOW SIBLE FOR ANY LOSS OR DAMAGE TO THE BUYER, THE CHAMBERS (b) THE WARRANTY IN SUBPARAGRAPH (a) IS EXCLUSIVE. OR ANY THIRD PARTY RESULTING FROM ITS INSTALLATION OR THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE SHIPMENT. BUYER SHALL BE SOLELY RESPONSIBLE FOR CHAMBERS, INCLUDING NO WARRANTIES OF MERCHANTABILITY ENSURING THAT INSTALLATION OF THE SYSTEM IS COMPLETED IN OR FITNESS FOR A PARTICULAR PURPOSE. THE WARRANTY ACCORDANCE WITH ALL APPLICABLE LAWS, CODES, RULES AND DOES NOT EXTEND TO PUNITIVE, EXEMPLARY, INCIDENTAL, REGULATIONS. CONSEQUENTIAL, SPECIAL OR INDIRECT DAMAGES. THE COMPANY SHALL NOT BE LIABLE FOR PENALTIES OR LIQUI- (c) NO REPRESENTATIVE OF THE COMPANY HAS THE AUTHORITY DATED DAMAGES, INCLUDING LOSS OF PRODUCTION AND TO CHANGE THIS WARRANTY IN ANY MANNER WHATSOEVER, OR PROFITS, LABOR AND MATERIALS, OVERHEAD COSTS, OR OTHER TO EXTEND THIS WARRANTY. NO WARRANTY APPLIES TO ANY PARTY OTHER THAN TO THE ORIGINAL BUYER. Hancor Offering a Full Line of Products for On-Site Waste Management Sewage Ejector Sumps Norwescol Septic Tanks Gravelless Pipe Distribution Sumps Distribution Boxes Co- Extruded Smoothwall Alternator Valves Sewer 8 Drain Pipe For Distributor's Use: 7r777 Jr0 = C/1fl0/0ff y • / nnv vation • Sv /utionS ­ Hancor, Inc. • 401 Olive St. • Findlay, Ohio 45840 • Phone 1- 888 -FOR -PIPE • Fax 1- 888 - FAX -PIPE m 1998 Hancor, Inc. Hancor@, EnviroChamber". and EqualFlo" are trademarks of Hancor, Inc. v u. h a n c o r. c o m 11201 11:0698 Printed in U.S.A. Norwesco ," is a trademark of Norwesco, Inc. Your llul nc Pipclina• i � \\ _ `\ M� 41 ` , cr _ \\ O W t u ba CC- LL V13. V�l rA VN IA � q � w A • r Wisconsin.Department of Industry SOIL AND SITE EVALUATION / Labor and Human Relations Page . ` of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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), .Arect)on and Sl • �al percent slope, scale or dimensions, north arrow, and location and distance nea p I. D. # t� f /bb 7 - 70 APPLICANT INFORMATION - Please print all in for n. „ r {, Revte i d y Date Personal Information you provide may be used for secondary purposes (Priva a ' s. 15 04 (t) (rra) ? ND V, C6 / Property Owner `� Q ' �; Proprs�ation I. Ao ��rJ�-7 ° ` y GtS (tiY 1 /!X /vim 1 /4,S T 2 - 5 7 ,N,R 1,6 E (or)© Property Owner's Mailing Address ` T BI .Subd. Name or CSM# ST • I n-1 1� S3Z6 l/0 /. 3 City State Zip Code Phone Number Near st Road iP0 �3Q2TS /� /• .Syo 2 i (7l S) ZyG • y87 El City lla� E Town ��� . /2,0 ❑ New Construction Use: L1Residential / Number of bedrooms Addition to existing building Il eplacement ❑ Public or commercial - Describe: _,/ //,� = �(/O r O e�e!�OAJoA44 �D Code derived daily flow (0 6V gpd ' ,,j] Recommended design loading rate bed, gpd/ft S trench, gpd/ft Absorption area required fI bed, ft yU" trench, ft Maximum design loading rate /R bed, gpd/fi trench, gpd /ft Recommended infiltration surface elevation(s) -5,0C TC1 • 3 ft (as referred to site plan benchmark) Additional design /site considerations Parent material 1DE5 O&Zt .51jAIQ l ` j Flood plain elevation, if applicable ft S = Suitable for system �Conven ' nal ,M�oun�d In -Groun assure �AT -Gr System in Fill Holding Tank U = Unsuitable for system L7 5 ❑ U L�f.s ❑ U S ❑ U E] u ❑ s E] S u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o- /o y o 3/3 - �. z s 4" �j• /3 io slip / 3/ 3 L / I . ds / e Ground 3 � . 3 7•S YX l �— SL- l siJ� ti" elev. l7• e ft. /fs e /),4 F1' 71 4,e . S Depth to limiting factor Remarks: Boring # G4l t f • S . G � r� 313 — /- S If f, S 2,., y •1 /0 YX 3 3 YIL 2 fs W cls cw //'L" Ground 73• ft. Depth to c �'V S S / •S Gd CD G�� So L S limiting factor In Remarks: 1 3?- 4 -72T 1 ,y0e-T' *le- `/Z'y 7 //r/' fl CST Name (Please Print) �0�� r ^��� ! � r Signature Telephone No��� y 7/S • 386 Address Date CST Number % wr. 2 z- y'8 22- *31 Ulbricht Private Sewage Consultants G, w d IVN � r O b tA � C ' � N ' Z oy �. ��-,wM ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �t.QYVy Mailing Address ilk' 1 zu Property Address O oZ (Verification required from Planning Department for new construction) City /State �; A� Parcel Identification Number O 12, / d o 7`7 LEGAL DESCRIPTION Property Location 5 E '/,, !1! E %,, Sec. '�� T_2�_N -R 1 B W, Town of L3 a- nn� -r•� Subdivision D Csa_ �', Lot # � . Certified Survey Map # _ 9 S ,a 7 15 , Volume 2 , Page # 7 q.3 Warranty Deed # / 4 , Volume � 4 0 , Page # Spec house ❑ yes A no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the 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 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. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLIC NT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** i ** 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 '1. x � Lrl�e/.k• ' � L �rw R�T� n�� } Mnn+ �',�, S � •{� TIT a. E ha 1NEt IWAC r apeatRlf !'011 MGM .x' A 4 904 r US OFM .�...... ..� 1. ».s}"1C :.. » ... ............» ST. C1!"w (no Vii. ..M�t......a w.r .. ................ »_.....ar..» »r. Reed. tar R,00rd f_3jU+ ». .................._ _..,..... _._.............. .. ...... .IA.D. 19 MGM 8230 A .................. Y ...... »..w.a..... ........... ».... »............ »......a. '� i wta+.- M..... N. M. iM• r.. YY.». ea... M..»...... r.. ...»...a..N.w.Rw...a.a»a»..»... .. »»..»....N... Wr�wN6 wd a4M in �..1f s..Aml .......... a fart of nj of X9 of See A T29 M18W Tax Ip Iio .... ..........„....w. Described ao Lot 3 of Certified Surrey lisp ar recorded is Vole 3 my 743. Document me 353715 eat certified ft"*Y litp. �? ��SF�i► i I C Ff 1 L+E !i ?w,.e warranty. Dead is g iven in satisfaction of certain Land contract recorded in Vol -3. page 743, Document no °353715 of j C- of ie.: Survey Map i This .... IN I b iestead property. •• i' vl (is not) Exception I* warranties: 1 j IV Dated this ------ -------- - .. :`----------- .....--- day of - - -- - - - - -- - .198.3_. ...... • . ................ .......(SE Arthur ttllia __Gofhaa,� Jr. ° ............. ":- _--- ....... :- ..... _ ................. . ....... . ....................... ....................... .... .... ( SEAL) ................................ ............................ (SEAL) • , AUTHBNTICATION ACHNOWLSDOMSNT Signatures authenticated this .................. day of STATE OF WISCON3IN } .......... ...... ••....•......- -•---......•..._, 19........ - 1 .1 , ; as. = v` �-------- - - - - -- County. i ............ ° ..... .. .............................. Personally came before me, this . - �k ...... day of 1913. the above named • ... ..................•..... v TITLE: MEMBER STATE BAH OF WISCONSIN - -----......•...- -•.,...... A f ...... ............... ••••• °..... (if not . ........................... - A . - . . ............................ authorised by 1 706.06, Wis. Stats.) ................... ......... .................................................. ...................... HIS INSTR WAS 0 sr to me known to he - *he.4 rson who executed the Darryl Cowles '.oregoing instrument and ie she same. I Z O f' 35371.5 Of . s'` Crop CERTIFIED SURVEY MAP Tt g APP� DARYL COWLES, ET AL .N £. COR. SEC. �O7g 4 T 29N, #R/9 W VOW t (FOUND SPIKE) ST. C / 3 Z3.2 2' h A So /Y89 "E i ROAD 1,0'£Asr 4 0 — � . D oi, 44/.OT 441.07" 441.07 , of N E• CORNER ) ROAVW qPA _ EASEM£N7" a . SEE GW LAe EMS NT CoR 9CASHM wT I V � b6T/►.tt�. I v I a OT L l LOT 2 o O o a LOT. �y o p o �~ ( h Q. Z \ /2.7 o N /2.7 p N /2.7 W ACRES 2 ACRES ACRES I a N y pPPR Al OF THIAN LNOP :z0 �IIS ` FOR I NOT ►`� 9 kZA gU00. iT' OR SEPTIC c Y TEM. o. ING S �,'• 33' SCALE: l "= 300 32� 8$ 4 REF 1 N .1 0. 442.30' 442.30' 44 2.30' ( ROAD /l EAST o Indicates 1' x 24 S 89 °04.30 "w OF S.E.CORNER 1 iron pipe stake weighing 1.13 # /ft. /326.90 DESCRIPTION: The Southeast 1/4 of the Northeast 1/4 of Section 4, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, subject to easement for Town Road purposes over the East 33 feet thereof and subject to easement over the following described tract within the above described parcel for roadway purposes; Beginning at the Northeast corner of the above described parcel, thence go S 89 08' 34" W along the North line thereof 882.14 feet; thence along a curve concave Easterly having a radius of 80.00 feet and chord bearing S 11 16' 2 5 1 ' E 156.85 feet; thence N 67 20' 29 E 237.70 feet; �a��;��titnm+nnuiiii��i N.E. CORNER LOT Z 0, C C) r V 4 41 .07 JM-1ES L. I. COT L 9V- /NA k1l U; P H Y _ CHORD 8EA81# S 11"16'2f Z* _ r .. �. -