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sT. "ZOIX COUNTY ZON DI:I'ARTM
AS BUILT' SANI 'I•ARY
Owner �
Address
IU
City /State 1A sr c�zo,X ',998
zov U N , �
Go
Legal Description:
Lot Block Subdivision/CSM # LI&I /2 A, i c 3
; SC /. N h' , Sec. N -R I C. W, b of
U. y wGC, d u I l PIN # 15p—
�D -�o -oct>
SEPTIC TANK -- DOSE CI1AMBEIt -- HOLDING TANK - INFORMATION:
ORMATION:
Tank manufacturer Size ST/PC !l.�G LSv
Pump manufacturer a / /,c 1 Setback from: House y(7 Well S P/L
Alarm location 13 , rlt Modet /3-7
�._ e art
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake
Meter location — Water Line
Alarm location
SOIL ABSORPTION SYSTEM;
Type of system: 1 � t I ,rl We Width Len G
Setback from; House Well 9 S' _ L Number of Trenches
—�-- U P✓L Vent to fresh air intake
ELEVATIONS:
Description of benchmark P Y / U t ye o G/ &F /� 4 , / f [iirC e 4
Description of alternate benchmark Elevation l�
1 3 Elevation
Building Sewer ? d ST/HT Inlet ?? ST Outlet -
PC Inlet
PC Bottom 7 S Header/Manifold Y, < -O. /
Top of ST/PC Manhole Cover d .3
Distribution Lines
Bottom of System
Final Grade
Date of installation k k? ermit n mber 3 (777_3� State plan number
Plumber's signature _ License number ���� 7 ? S� Date � PsL_
Inspectors
Conlpicic plot plan K
• AWiscbnsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division yST . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar i"
Personal information you provice may be used for secondary purposes [Privacy Livy, s.15.04 (1)(m)].
Permit Holder' Town of: State Plan ID No.:
FAST, DOVATb 4b1�'Id4 iti ❑
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel TlaIlIt'"1020-30 -000
� Tl 1 ':� PA A.U.
TANK INFORMATION ELEVATION DATA A9800121
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 01 d r t 1000 Bench ark a 44. /-
Dosing eo ba GSb /ate, /� (�•5/ S�2.gs�
Aeration Bldg. Sewer 2;.1/ - 7�.
Holding St M, Inlet - 77 l8�
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. A V to ROAD Dt Inlet
A Z U a -t�b' NA Dt Bottom 3�.q3 3 S_ NA Header / Man. $'• 2
Aeration A Dist. Pipe a 2 >j `7 - 3. 12
Holding Bot. System 2 2
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
cse I �/ 9. wl,,, 2 i. 3 o • l
Model Number I 1W 3� 7 °�3 ` GPM
TD H Lift 1 9 G Friction 1. 27 Svstemm
p TDH�3 [l t
Forcemain Length 1/6)*' Did. I-f ' Dist.ToWell
SOIL ABSORPTION SYSTEM ) 15 -
W E TRENCH Width f Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
NI N is 0 DI NI N
SYSTEM TO P / L BLDG WELL LAKE / AM LEAC G Manufacturer:
SETBACK
INFORMATION Type O �t i
CHAMBE
System:aT �`1 OR UNIT
DISTRIBUTION SYSTEM
Header / old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
it �Q� , /d / .,
Length _L Dia. Length 2A5 . Dia. � Spacing 3�s
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Sys ems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No ❑ Yes El
Depth
COMMENTS: (Include code discrepancies, persons present, etc.) 8,C $ .qp 7•ZS
LOCATION: WOODVILLE 35.29.16,SE,NE EAST BOUNDARY ROAD•/ �1L•S3 Zo � g
. � Am ' Z (.7 L/3
Plan revision req� dt g s J No �+ —
Use other side for additional information. p �8
SBD -6710 (R.3/97) Date Inspect 's Signature ert. No.
V i scons in SANITARY PERMIT APPLICATION 201 E w sn ngton 8 "Si °n
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 81/2 x 11 inches in size. `
• See reverse side for instructions for completing this application State Sanitary Permit Number
; O - 7 - 7 - 3
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numbe
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION 5�
Property O ner Name / Property ocation
<0! L /�C°I "v4,S � T ,�y , N , R /
Property Owner's Mailing Address Lot Number Block Number
C
Statf / Zip Code Phone Number �/ Subdivision Name or CSM Number
4 l 7C I LIA . ',. jFd 3_�j & ;L, ( j5� l a 7 - Iry l - i( I9
IL TYPE OF — BUILDING: ILDING: (check one) E] State Owned ❑. qt Nearest Road 3
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF (A.I° e' dt� • I/ e-- 1 L 4 s C d4 ,
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/ Condo 1 1?� - 1 102 0 - 2 6 - 'G
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 New 2 [] Replacement 3_ ❑ Replacement of 4_ E] Reconnection of 5 [] Repair of an
- _____System ________ System____ _________TankOnly______________ Existing System _________Exlstingsystem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Expe 'mental Other
11 ❑ Ol
.Seepage Bed 21 lound 30 Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit e- Sy S 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
3 00 Required (sq. ft.) Propose (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elev ti ry
�� Feet Feet
VII. TANK Capacity gallons Total #of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel lass Plastic A
New Exist in strutted g Pp-
Tanks Tanks
e IcTank C- I ) " j',yle d wc� c � ❑ ❑ ❑ 1 ❑ ❑
SPONSIBILITY STATEMENT
I, the undersigned, assume responsibility or installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Signature ( lo stamps) PRSW o.: Business Phone Number:
Plumber's Ac dress (Street, C , State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing gent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee) l / OIL Adverse Determination ioa C'
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6396 (8.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
Safety and Buildings
2226 ROSE ST
LA CROSSE WI 54603 -1905
isconsin Tommy G. Thompson, Governor
Depa rtment of Comm erce William J. McCoshen, Secretary
April 20, 1998
CUST ID No.267341 ATTN: POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN
421 N MAIN ST
PO BOX 74
RIVER FALLS WI 54022
RE: CONDITIONAL APPROVAL Transaction ID No. 75587
APPROVAL EXPIRES: 04/20/2000
SITE:
Site ID: 5786
ST CROIX County, Village of WOODVILL$
SE1 /4, NE1 /4 & SEIA, NE, S35, T29N, R16W
DONALD FAST
FOR:
Description: AT -GRADE
Object Type: POWT System Regulated Object ID No.: 13910 ; - --
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes listed in the regarding line above. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with
all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and
with the Wisconsin At -Grade Soil Absorption System Manual (Pub. 15.21).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard by discharge of partially treated or untreated liquid wastes to ground surface or into surface waters or
groundwaters of the state, the owner will employ a properly licensed plumber to repair, modify or replace
this system (including the possibility of installation of a holding tank with proper disposal) with such action
approved by the Division and appropriate local officials.
• 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 /instal lation/operation.
WEGERER SOIL TESTING & DESIGN Page 2 4120/98
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead. When making an inquiry or submitting additional information, please refer to Transaction ID
No. in the regarding line.
Sincerely,
DATE RECEIVED 04/16/1998
FEE REQUIRED S 180.00
&RARDM SWIM , POWTS PLAN REVIEWER FEE RECEIVED S 180.00
Integrated Services BALANCE DUE S 0.00
(608)785-9348, MON - FRI, 7:15 AM - 4:00 PM
JSWIM @COMMERCE.STATE. WI.US
Page of 6
AT -GRADE SYSTEM
FOR
A Z BEDROOM RESIDENCE 7 5 5
LOCATED IN THE S4; 1/4 OF THE N2, 1/4 OF SECTION 3 5 , T L t N, R �6 W,
1139WN- OF W 0017 Vt LLC- , S r • C410t X COUNTY , WISCONSIN •
LAT 1 of (Z'srl Uo�. `Z., � �y�35� Pip rv). 19Z- tpZO -3p
Rp("
D
INDE% S AF APR t R 19 98
PAGE 1 *of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN �V
PA GE 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
t�ve.
S3Pr�Ovvliu, ivf S��o�
II '
PIZE'7PARE BY
LJEGEE�EF2 S4rJ = L T
• •
E S T I N t'J •tom._
DES I GN ST_=F;tw ICE f ...••• »•.. �j�
P.0 %,,•T•S• ll P_0. BOX 74 421 4i. KAIM ST_ r ARTHUR 1. •
• 16 i WEGEREp
Coflditi4 nu R1119. FALLS- 8I 54022 2 - 915PrH,
t�p �p� F'D
7 15-44 - 5-0 165 ' % j
COMMERCE `
DINGS '•••.........••
DEPART YAN C ,•� IGI��
v►s�o �
+ ++++®•••N��
SEE 4,ORRE NDENCE
JOB NO-
B - � j
APR -20 -98 MON 01:14 PM NELSENWEBERS RVEYING.M 1 715 425 6864 P.02
P EB PLAN page Z• of
scale 1"= r
t
- 1N - L 10 Bl�Z Psi• LZr So' FWM S I T E -
qP
o�
g.
6 oa
r bo'or-14'"r
/ r
'Pis rtitn.. �lZ" Cvuic'R V A+
►-
�.. pv c, F•.
L
/ r
b0 Kvor c(Mnhcr t>SL'
a�N�'E S1J OF \ / ^� CLR,{�
2 7.
o�S'�R1$ �1�YV P1PQ
10: qb r� e.. Lor �"1 L'Z .q 1.Op' �N � 0i`1 - eti. • tOU • 0 bry �►l b " FYsov�
ui4�l �� �g GRovw�p 1� g it ►p' wWb • OJT
NOTES
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( required)
4. - Septic tank to be\ /.65o gallon capacity manufactured by
5. Bench Marks S US
6. Divert surface water around system to. prevent. pond.ing at the uphill side.
PPR - 20 -98 MON 01:14 PM NELSEN WEBER SURVEYING,M 1 715 425 6864
' P.03
r
}5 B I >5
>5' �2'
I" -- --- ---- � - - --- - I
W DIST.RIBUTION LATERALS
I OBSERVATION PIPS I
1/6 8 I/6 B •
1/2 B
3:1 SLOPE PERIMETER
DESIGN LINEAR LOADING RATE(DLLR)= S•o
DESIGN DAILY FLOW RATE(DDFR)= al'D
DESIGN LOAD RATE(DLR)=
APPROVED 1/2 " -2 1 /2" AGGREGATE
Fabric Distribution Lateral - ELIUU q 3.D'
STABILIZED
Observation --,, �-- Soil Cover- V
Well 12 t
1 S q SLOPE PLOWF,D LAYER
>5' A Mgt 5�
A= %5 B= 60'
L= 74 W=
Fig. 8a. Plan View and Gross Section of Wisconsin At -grade Unic with a
Single Absorption Area on a Sloping Site
APR -20 -98 MON 01:15 PM NELSEN WEBER SURVEYING,M 1 715 425 6864 P.O4
Page Of (�
Perferojed Pipe Deioll
End Vier
Perforated
Eno Coo &t PVC PVG Pipe
W
Install permanent
at end of each lateral
Holes located On Plottom,
Are EQuolry'Spaced
Q End Cup
Q
~ PVC Force Main
O�stnou�i0n
Pip
t,osl Hole Should Be
Ncit To End Cop
Distribution PiQe Loyou►
P Za -SFt
X 3 L , Inches
Y 3b Inches
Hole Diameter 11 Y Inch
�
Lateral ) 11 1 4 Inches)
Manifold — Inches
Force Main Inches
#o holes/pipe VQ-
Invert Elevation of Laterals ` Ft.
Place 1st hole from tee with succeeding holes at 3 V " intexvals,
Last hole to be next to the end cap.
- Combination Septic;Tank and
Pd-MP CHAMBER CRO55 SECTIOU ARID SPECIFICATIOUS ' PAGE S OF
VEiJT CAP WEATHER PROOF
JUAICTION 15 .
4'C.I. VENT PIPE APPROVED LOCKING
�% 10' FROM DOOR. MAWHOLE COVER ;till"
- ,WINDOW OR FRESH wAttrJlWG Ll48EC..
ALR IJJTAKI cw.�Du�r
6" M ►rx . I 'r" h1I IJ. Alk
t�L '0 °""N• ,�
y " I►JS�t:*CtlotJ PIPt ' PROVIDE I - - - --
►1JLE AIRTIGHT SEAL I I ((
8 gFFL�S
1 I I
A I APPROVED J011JT:
APPROVED JOIAIT I I I W /C.I. PIPEaKPt'c
W /C.I. PIPEOR Tank construction I il comply with ALARM
ILH1 ('13.15 and 33.20 a I
I I ON
C ! I
�3, do I
LLEV. f T. PUMP -� - -�
OFF
D Co"KETE
��� BLOCK
3" APPRo+c.
RISER EXIT PE.RMITrCD OIJLy IF TAWK MAIJUFACTURER, HAS SUCH APPROVAL BEDDIN4
SEPTIC
SPECIFICATIOLIS
f
D05E %L11bW( -S`TEM 7 T IJUMBER OF DOSES: 3 33 PE.R D"
TA, WK MAIJUFACTURE R:
TAWK :,IZE: �UGL�l �(,SO GALLOWS DO5I< VOLUME r
ALARM MAUUFACTURC.R:
S ""K- IMLLUDIIJG 15ACKIFLOW: GALLONS
MODEL WLIMlBEK: 1 01 NW CAPACITIES: A= 1-1 INCHES OR 38 GALLOyg
SWITCH TtsPC: 1"'1�ZCUR`�' B= Z ItjCHESOR _L- G(LLOUS
PUMP PIAIJUFACTURCK* r- I INCHES OR ` \ CA
MODEL HUMBER: 01 , 9S D- 1Z INCHES OR -L GALLOWS
SWITCH TYPE:
j� �GL) IZ -- IJOTE: PUMP AMD ALARM ARE TO bC kz,
MI DISCHARGE RATE Z —GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE CETWCEU PUMP OFF AIJD.D15TRIBUT101J PIPE.. N-SJO FEET
+ MILIIMUM M SUPPLY PRESSURE .. 2.50 FEET
1�Q \,� FT. -Cl
+ FEET OF FORCE MAIN X �Ofr.FR FACTOR__ ` , FEET
TOTAL Dy1JAMIC HEAD - \1. -1'1 FEET
P DIAMETER -
3 $ �'
Pump chamber
IWTEKLIAL. DIMLWStOkl� Of TAWK: LF-kl&TH ;WIDTH - ;LIQUID DEPTH
BOTTOM AREA - - 231= - GAL /INCH
AS PER MANUFACTURER GAL /INCH
' • W HEAD CAPACITY CURVE 3 7/8 6 1/4
M 4 30 MODEL 6498" 4 5/8
8
2
o I 3 5/8
6
= 6 ® Q
U -+
o} 15 O
4 4 3/t6
J
10
3.40
2
5 1 112 -11 1/2 NPT
0
U.S. GALLONS 10 20 30 40 50 60 1 70 80
LITERS 80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEAD/FLOWPER MINUTE
EFFLUENTAND DEWATERING
CAPACITY 1 2
HEAD UNITS /MIN I
FEET METERS GALS LTRS
5 1.52 72 273 I
10 3.05 61 231
15 4.57 45 170 4 3/16
20 6.10 25 95
Lock Valve 23'
SK1102
C ONSULT FACTORY FOR SPECIAL APPLIC AT ICONc
• Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available with Double piggyback variable level float switches are available
or without alarm switches. for variable level long cycle controls.
SELECT ION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all modeis - Weight 39 lbs. 12 H.P. 2. Single piggyback variable level float switch or double piggyback variable level,
98 Series Control Selection float switch. Refer to FM0477.
Model I Volts -Ph Mode Amps I Simplex Duplex 1 Mechanical alternator 10 -0072 or 10 -0075.
M98 115 1 A Jto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak.
N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4)
float system.
D98 230 1 Auto 47 t or 1 & 7 —
6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in
E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002.
T Two (2) hole J -Pak, for watertight connection or splice.
CAUTK'Ili
Fork* mlatononadditionalZoellerproducts refer locatalogonCombination Starter, FM0514;Piggyback All instal!ztion cf cco;:als, arctection devices and wiring should be done by a qualified
Variable Level Switches, FM0477, Elect Alternator, FM0486; Mechanical Alternator. FM0495;Sump/ licensed eiectriciar A .; Oeciri.a[,lrid safety cod" should be followed including
the most
Sewage Basins, FM0487.and Single Phase Simplex PumpControtiAlann Systems, FM0732. recent Naticnal E ec!r- -ode ".EC i a; d t e Occupaticnal Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
Tso: 3 49 C ane Ru 347 Manufacturers of
L SHIP IP T0: 3649 Cane Run Road
Louisville, KY 40211 -1961 Quuiry PUMPS S.vCZ 1; 9..�.9
PL/MP l0. (502)778-2731-1(800)928-PUMP
FAX(SU2) 774 -362
W&onsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of - 1
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point -direction is A% of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dist tb dearest °road!
APPLICANT INFORMATION-PLEASE p�R 14T `\ REVIEWED BY DATE
PROPERTY OWNER: -` PROPERTY LOCATION NN_- Nuti
�O►J t°CL.� Ff�ST a 5 60Ye -. LOT SNE 1/4 V,1 f_* 1 /4,S 3S T Z - 4 ,N,R E(
PROPERTY OWNER'.S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
`51O. O T?4 PtIJ�. cRulk _ (2 S1^.'t \ . P9 3 \10 5
CITY STATE ZIP CODE- PH 69 _ RVILLAGE ❑TOWN NEAREST ROAD
..���
New Construction Use [x] Residential / Number of bedrooms (] Addition to e xisting builoing
[ ] Replacement [ ] Public or commercial describe
- r- G�UY�
Code derived daily flow 3A0 gpd Recommended design loading rate a -'- bed, gpol* trench, gpolft
"IL L? - %AA sa, t-i TrT- GV:-�M
Absorption area required - bed, ft - trench, ft Maximum design loafing rate a 6 bed, gpd/tt - trench, gpd/9
Recommended infiltration surface elevation(s) °I. _-• S It (as referred to site plan benchmark)
Additional design /site considerations 7- 1JD f4T CtL" SS[3T�j (z X \z Q ')
Parent material 1.,oEs3 a u\z_R 'n\.\- Flood plain elevation, if applicable ►y•R It
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for stem ❑ S ®U OS ❑ U ❑ S ®U z S ❑ U ❑ S ®U I ❑ S ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Bardaly Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. g� Trerxt
F7_ -3I� �o�cZ 31L sll �s�k tits►- �s 1�� 6 -
Ground S H 2 V/t _ �S D 7n v it- d-S - • 6
elev.
8I ±it %4S 'i R_ 31
Depth to 5 S 3-66 7- S `1 R Y
limiting
facto �1
Remarks:
Boring #
� c s 2 v� L `
o s
`� n. 3 t 3 � L Z�- �� �n `F► - -
I Z z �g to �► cZ X16 -
3 • 6 _
Ground
elev. 3 6 - �S -1. S `'►R /6 _ S o m -
q•Z ft
Depth to N s -1 S 31 y , o,, ,,,-�- s t�,o s _ ose ► L Res t c '
limiting
factor
3b'
Remarks:
CST Name: - Please Print Arthur L. We erer Phone: 715 - 425 -0165
egerer Soil Testing & Design.Service -P.O. Box 74 River Falls,WI 54022'
Signature: Date: Q8 -"7 CST Number:
c. t{ -`� M00576
PLOT PLAN Pa 3 of 3
SCALE 1 "= Htj '
W LZTEIOT So' . frl om n
4r J
1-3 r
I
6 c
$3 `1y,
Z�
corvlev R 9.Z..$'
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CST Signature Date Signed Telephone No. CST #
SAFETY AND BUILDINGS DIVISION
201 East Washington Avenue
P.O. Box 7969
Madison, Wisconsin 53707
isconsin
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
At -Grade System
Onsite Verification Report
Are the soil and landscape features accurately reported on the
Soil and Site Evaluation Form
yes no
If no, provide a further description by including an onsite
report, which may consist of a soil profile report, or provide a
brief explanation below.
If yes, what other type of Private Owned Waste Treatment System
(POWTS) could be used?
mom
Coun Offic 1 Signature Date
Property Location
ha Id f7ati 157 10 T� A ve- &Vwirl Tom/ SYODZ
Landowners Name
SBD- 10513(N.11/96)
Wisconsin Department of Commerce S Tm i ^ "[ $ VALUATION
Division of Safety and Buildings - / Page of
Bureau of Integrated Services in a aEi rce # s r . !{� I ' t � .09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/ X n musty Coun
� include, but not limited to: vertical and horizontal ref gFe point S BM), direction and j r O
percent slope, scale or dimensions, north arrow, and Boston arld tafic to�st parcel I.D. # I tZ 9p�
5 ST CROIX Cb NZ - v
R�
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U TY
APPLICANT INFORMATION - Please prin l�fQfop FiCE ,,, Reviewed by Date
Personal information you provide may be used for secondary pu r q
e.�cy Law, s. 15.
Property Owner I r rty Location C �
0 0A ro —� Govt. Lot !v4 114N� 1 /4,S3�T� ,N,R MW W
Property Owner's Mailing Address Lot # I Block# ubd. Name or CSM#
1 6 A.,
City State Zip Code Phone Number
❑ C Village Town Nt Road
New Construction Use: Residential /Number of bedrooms 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe: —
Code derived daily flow 7 o g Recommended design loading rate _ Lft bed, gpdA? O /ry trench, gpcL*
Absorption area required _�/�7 be d, ft l�L� trerich, ft2 Maximum design loading rate 6'�bed, gp��� t, gp�
Recommended infiltration surface elevation(s)'50 Q f -5 R tC r / ft (as referred to site plan benchmark)
Additional design /site con 'dera ns n to ^ ` 4' C S a
Parent material ii / Flood plain elevation, if applicable a 1 ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = , Unsuitable for system S ❑ u IRS ❑ U ®S ❑ u ka s ❑ u ❑ S 4111 ❑ s ®. u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
n -5 IO el' 3/ o,v s w tlk 6'`�' D-5S
`J 6 i m s �� s � ,s- 0-.6
Ground 3 Y � ,$ . U -5 (}
elev
13
`(' o-
%
-
Depth to -c 5 •-- — O' o-g
limiting
factor ,t
Remarks: Uaa l5 —fis —s /y'Yslf a- -0. 150 ��— ,a alC'�p ss w� S e �cI�cxvoL
Boring #
k
02 .?
Y/C 716 :0,
Ground /d /�3 ✓ —rr� Io
elev. �-
zf`�i�y ; 6, 5
Depth to
limiting S y r 5
fact r j
in. Remark f=n , X r s Ili S( a
CST Name (Please Print) Signature Telephone No.
Soil Testing Service
Address Mondovi, WI 54755 -8145 Date CST Numbe 97
F4 6) 882 9Q0 I
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ry\-
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Soil f� rService
W 35501 166k Rd.
Mondovi, Wi 54755.8145 ( �� sc
(715) 832 -0020
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer n C/ S Z`
Mailing Address l 5 / y C4
Property Address /� 4 /0/w • n IG4
/ (Verific required from Planning Department for new construction)
�.�/
City/State o 4/ Parcel Identification Number _1 R- - 1 W D - 3 D D(X )
LEGAL DESCRIPTION
Property Location SL V4, IV %., Sec. . T 2 q N -RAW, jDwrr of U-)v o CIO
I ��
Subdivision Lot #
Certified Survey Map # S / `� ? / Volume 12- . Page # `l S ' -
Warranty Deed # S 2 Volume 1 � U . Page # S
Spec house ❑ yes Vo Lot lines identifiable D 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
masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 M e
ATURE OF LICIXNT DATE
OWNER CEATIFICATION
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 descri ve, b e of a warranty deed recorded in Register of Deeds Office.
��
SlGNXhJRJE OF APPLIrAAW J 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
U
5'718�� STATE DAR OF WISCONSIN FORM 2 — :9+32 _
WARRANTY DEED
DOCUMENT NO. r.
V�L 1?�OFe�t 541
r r . REGIST k" bfF'ICE
Thomas 0. McCulloch and S andra J McCulloch, ST. CR IX CO.. WI
h us band and wife, Road for Rtcwa
— I
-' _ - JAN 2 8 1998"
coneys and warrants Donald J. Fast and Chariet K. 8:30 AM
Chermack, as joint ten ants _ .�✓ , L�"x
P+ t�► „f 0��� `s
z.
k rRIS SPACE RESERIEO FOR 9 ECORDWG OATH
NAME ANC RETURN ADCRESS '
the following described real estate in S t . Cro C -aunty P
State of Wisconsin: Edina Realty Title +_
225518
r
_ 192 1020 -30 -000
PAR_! DENTFICATiON NUMBER .'
'.l
Lot 1 of Certified Survey Map °fled in Volume 12, Page 3405, as Poctmtent No. '
571471 being past of the NE 1/4 of NE 1/4 and SE 1/4 of NE 1/4 of Section 35,
T29N, R16W, being all of Outlot 10 -nd part of Outlot 11 of the Assessor's
F Plat of the Village of Woodville, St. Croix County, Wisconsin. {
TRANSFER
This is not homestead property.
XXX (is not` '
`1
Exception to warranties easements, restrictions and rights -of -way of record, if any.
':• Datej this 26t day of _ January AD, Iq 98
(SEAL) LG (SEAL)
Thomas 0. McCulloch Sandra J. lloch
_ (SEAL) (SEAL)
— ofVNnWt FnGMFNT ! ._
•
o 0
3
5'714'71
CERTIFIED SURVEY MAP
LOCATED IN THE NE -NE AND IN THE SE -NE OF SECTION 35, T29N, R16W, BEING ALL OF OUTLOT
10 AND PART OF OUTLOT II OF THE ASSESSOR'S PLAT OF THE VILLAGE OF WOODVILLE, ST.CROIX
COUNTY, WI.
PREPARED FOR: THOMAS AND SANDRA McCULLOCH
NOTE: BEARINGS ARE NE CORNER OF
REFERENCED TO THE EAST 3 SECTION 35, T29N,
L I NE OF THE NE 1 R 16W. ( COUNTY SURVEY
(ASSUMED BEARING). ^ NAIL FOUND).
o I °il
I g '
-�- 133133' Z FILED
1 1 JAN 1 9 1998 10 ' /
OUTLOT 10 I KATHLEE w LSH
KA7 EN H.
/�• • - • • • • • Register of DeeO
ds
St. Croix Co., WI !�
W
ct
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/ I , C1 >-:
Q::
Z LOT I WI ICI Z
° o 0 10.96 ACRES - Z�:
477,555 SO. FT.) I
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