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HomeMy WebLinkAbout042-1007-40-000 (2)•t.o"*County Planni*n Zonin Wednesday, October 17, 2012 at 11: 08:07 AM Detail Sanitary Information Page 1 of 1 ti Computer #: 042-1007-40-000 Sub/Plat: NA Section: 4 Parcel #: 04.29.18.52A Lot: 1 TN/RNG: T29N R18W Municipality: Warren, Town of CSM: Vol. 03 Pg. 743 114114: SE 1/4 NE 1/4 A Owner: Cowles, Myren R. & Karen 1185118th Avenue Roberts, WI 54023 State Permit: 18066 Issued: 11/01/1978 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 366 Installed: 11/16/1978 POWTS Detail: Bed- Seepage Bedrooms: 3 POWTS Pretreatment: NA Notes Issuer/Inspector As Built Harold Barber Yes Tom Nelson Signed Off: Yes Plumber Other Requirements Steel, Gary L. #3331 Owner: Vale, Charles 1185 118th Avenue Roberts, WI 54023 State Permit: 199832 Issued: 09/10/1993 POWTS Dispersal: Mound County Permit: 0 Installed: 10/07/1993 POWTS Detail: NA POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Tom Nelson Yes Nechville, Henry Jim Thompson Signed Off: Yes Maintenance Scheduled Pump Date Pumped 10/7/ 1996 9/7/2012 10/7/2005 7/14/2008 7/14/2011 9/7/2015 Other Requirements Notification Notification 04/20/2006 WI Fund: Additional Notes Money Owed letter from Harold Barber to state complained that $0.00 Richard Hopkins installed system without permits because the CSM wasn't approved until December 1978. 1000 gal. Weeks tank to 12' x 70' bed. File with replacement permit Permit: Replacement Bedrooms: 3 WI Fund: Additional Notes Money Owed data from notecard - fled with 1978 original permit $0.00 Parcel #: 042-1007-40-000 4 10/17/2012 10,56 AM PAGE 1 OF 1 Alt. Parcel #: 04.29.18.52A 042 - TOWN OF WARREN ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - BOHLKEN, DAVID & PAMELA DAVID & PAMELA BOHLKEN 1185 118TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 1185 118TH AVE SC 2422 SCH D ST CROIX CENTRAL SID 1700 WITC 2 Legal Description: Acres: 11.550 Plat: 0743-CSM 03-0743 042-78 SEC 4 T29N R18W IN SE NE LOT 1 CSM VOL Block/Condo Bldg: LOT 01 3-743 ORD EXC, PT TO PARCEL DESC 948/333 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 04-29N-18W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 10/02/200�� 861547 WD 533366 1138/347 WD 05/01 992 482775 948/333 QC 49 P3 07/2 /1 9 9 1 WD 2012 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/07/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 11-550 861000 142,300 228,300 NO 10 Totals for 2012: General Property 11.550 86,000 142,300 228,300 Woodland 0.000 0 0 Totals for 2011: General Property 11.550 901300 142,300 232,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 523 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 S T C 104 AS BUILT SANITARY SYSTEM REPORT OWNER- ADDRES SUBDIVISION f CSM# LOT !0 SECTION -T N-R W, Town o f Y, -1 S 2, S'C ST. CROIX COUN WI ONS IR PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ni 19rn 7 Y � 0 1 r Me� 4A, rlZr-,"J MID A� INDICATE NORTH ARROW eep� Ile Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover' ,a BENCHMARK: ALTERNATE BM: SEPTIC TANK PUMP CHAMBER HOLDING -TANK INFOIU4ATION Liquid Capacity: Manufacturer: "" *` ®-Setback f rom: 14ell House 3 Other °`� -� �._.� i�"� � C2 Pump: Manufacturer Model size Float seperation allons/ cycle Alarm Location -:,SOIL ABSORPTION SYSTEM 00*-, Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well:House Other ELEVATIONS Building Sewer ST Inlet. ST outlet .7o. 5�_jl4�iv PC inlet PC bottom Pump Off 4y; Bottom of system J7 Header/Manifold ZL� �,. S_ Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: '006 LICENSE NUMBER: st� 02 INSPECTOR: 3 / 9 3 : jt r LOCIARION sari Mus4* 29.18.52APRIVATE SEWAGE SYSTEM Labor and Human Relations INSPECTION REPORT Safety anr±#Buddings Division (ATTACH TO PERMIT) O�ENERAL INFORMATION L�_ Permit Holder's Name: ❑ City [] Village Town of0 'INTtW EI .: I p. BM Descriptio TJ&_&&%,&%&.A,&,9 ✓ F TANK INFORMATION TYPE MANUFACTURER CAPACITY Septi c- Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO P J L WELL BLDG. vent to Air Intake ROAD Septic - NA Dosi n+g : ; / >,� NA Aeration NA Holding PUMP / StNFORMATION Manufacturer bem`and �r Model Number 0 GPMI Friction System TDH Lift' TDH r; Ft L H Forcemain Length Dia. �', ' Dist. To Well >/Co SOIL ABSORPTION SYSTEM ELEVATION DATA County: Sanitar rTnit State Pl Parcel Tax No.: L_ 042-1007-4ru-000 A9300238 STATION BS HI FS ELEV. Benchmark Bldg. Sewer S t Y/1,1 LInet .. St f Outlet Dt Inlet Dt Bottom -jigAder Dist. Pipe Bot. System f Final Grade BED /TRENCH Width Length .- No. Of Trenches PIT No. Of Pits Inside Dia. Li q Depth Liquid DIMEN51QNSZ DIMENSI N SYSTEM TO P J L BLDG WELL LAKE /STREAM LEACHING turer Manufac�. SETBACK INFORMATION CHAMBER _ Type Of Model Number: System: �`r' �, OR UNIT DISTRIBUTION SYSTEM Manifold Distribution Pipe(s) x Hale Size ., x Hole Spacing Vent To Air Intake Length ` Dia Length Dia Spacing 41 > 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 / T�� Center Bed I Tverfc1h Edges _ r� Topsoil [ - es ❑ No es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) , LOCATION: WARRED 4.2 9.18.5 2A J, Plan revision required? [[ Yes Use other side for additional information. 4 '���►-----� SBD-6710 (R 05/91) Date Inspector's Signature/Cert No QAKIITARV DFRUIT APPI WATInN QIL."Fi In accord with ILHR 83.05, Wis. Adm. Code i COUNTY —Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANI-,Pkov P 81/2x 11 inches in size. 1:1 C h 06/k i7revoision to-"po'r'evious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION y 4 4 S T ;Z( PROPERTY OWF4ER'S MAILING AWRESS LOT # BLOCK # CITXST 17E r-S ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER � �j _IZZ-5, 11. TYPE OF BUILDING: (Check one L_j C, I TY NEAREST ROAD State Owned ® LLAGE - TOWN QL El Public [El or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 111111. BUILDING USE: (If building type is public, check all that apply) 1 El Apt/Condo 2 ❑ Assembly Hall 6 D Medical Facility/Nursing Home 10 0 Outdoor Recreational Facility 3 El Campground 7 El Merchandise: Sales/Repairs 11 Q Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 F1 Off ice/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. El New 2. Replacement 3. E] Replacement of 4.0 Reconnection of 5. 0 Repair of an System System Tank Only Existing System Existing System B) El A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 00� -1 Holding Tank 11 El Seepage Bed 21 Mound 30 ❑F-1 Specify Type 41 ❑F 12 L1 Seepage Trench 22 ❑ In -Ground 42 Q Pit Privy 13 1:1 Seepage Pit Pressure 43 F] Vault Privy 14 El System -In -Fill Via ABSORPTION V1. ABSORPTION SYSTEM INFORMATION: 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE r1GALLONSPERDAY REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) /C /, 61 ELEVATION t , .1 C Feet Feet 11. TANK V Vil. TANK INFORMATION CAPA(�Wy in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Site Con- Steel Fiber- glass Plastic Exper. App. New Existing Tanks Tanks structed Septic Tank or Holdi,ng Tank Lift Pump Tank/Siphon Chamberl. e% if) El TF Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber,'s Name (Print): Plumber's Signature: (No Stamp M RSW N. Business Phone Number: Adwry y ............ Plum bdr's-Addrds's (Street, City, State, Zip Code): IX. COUNTYIDEPARTIMENT USE ONLY Approved Disapproved Owner Given initial Sanitary Permit Fee (includes Groundwater Surcharge Fee) Ee7ssued Issuing Agen r Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: I SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. V 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. Vl. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'A x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11 /88) PROJECT TNDEX SH"ll-FiT &93 em027 04 OWNER : �14 /,L&-- 7i_,_�r-- 2 Y6 - 31 yT ADDRESS: t(t- 5- 7` )POR LR T-5 SITE LOCATION: /V E � To LoAo 0 F t�P 0 ('0 u A3 y PROJECT DKOCRIPTICON : 13Y Al A 00 fi L) A A u Aj feo�'l )1ICA—) A s sr � �s p,eadosED PAGE 1. PLOT PLAN VT7,,WS PAGE 2. MOUND CROSS SECTION & SYS"L",11 PLAN r PAGE 3. PI-FE LATERAL -.,jAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CR(",SS SECMTONS PAGE 5. PUMP PERFORMATIC' SPECS OR SIPHON SPECS PLUMBER: DESIGNER 048" inosErirw. DATE: ULBRICHr DllEo SIGNATURE: y HU Wis. o . ID � . / U f- S S93-02704 y0 UV Disrv,P(3 E l STi,�U scr*,/ 6-4 TEE B IE� . 00&6,EGTEO sy JT w; t " S�tip /©40 zJ;_ 'ter �7 CO3(JUE/f'SrtT/0A/ 5 /E1iRS OLD. T No c- UEe1,F y s. zF w�� �tispE c r/czv �-orP W � i/ T o 7(0144 [ �'' / �`� M r �' h U �` 1 OF ,ZOO — �� 2 M� +,c, �, k I N S 6 Q( E S o F SY N C-£ -' E 0 S X = io d, p " 2 5LEU4-T/•0AJS T-OP OF R o c /0 �• �� z S �. _ Of Page _ -ro of ]AT-EP6L-S 161. y S93os02704 Synthetic Covering Distribution Pipe - Medium Sand s H aG y sYcH � . E'�E Topsoil E D .......... ...... ... .... .... ... 3 r , i % Slope u� Bed Of� Force Loin Plowed Aggregate iaye: Ft. E �" � Ft. ,,doss Section Of A Mound System Using ,. �,'� S� A Bed For The Absorption Area Ft' so G Ft. Ot A _ Ft. H - Ft. ,Olt, B to 3 F t . ,�s K / 2- F t . g't�`t • �� L' Ft. J % Ft. 00 1 /? Ft, W 33 Ft,.� ti L_ Observation Pipe 1 Ai ` d� 0 Distribution Bed Of 2 Pipe P Acgregate 1 Observation Pipe Permcnent Markers Plan View Of Mound Using A Bed For The Absorption Area r �s �=,P ., = o,�,�. y &/A 74Crc-w . j/ r T� 13/C 0 Z--% ---% .2 . 3� Pagef _. O V o 0 0 IVA4 6- )'5-0 e r P +s . �r4S T k l Y1,410E Perforated Pipe Detail ,ei'Gti r rOoe VA I V M e 3 sw2 7 0 4 vA(v 4 % ''oA-'' 112 0 End View )Perlorofed End Cop ,y+ PVC Pipe Oj . Doti Holds Located on Bottom, Are Equolly Spaced R PVC ( Monilold Pipe Uistribution Isr /! Pipe ' Hole Should Be Next 7o End M�N,iolD � / % Distribution Pipe Layout P tP� zt R C Si PO ICA-f S `r X �'`� Inches 2-5� � �M � t' UG Y �G Inches � I o a Hole Diameteril �t `Lateral C_ _ Inch(es ) 10111 ►� Manifold Inches Force Main 2- Inches sti�w 0'� # of holes/pipe s o Invert Elevation of LateralsFt • PAer Q T i S 2— 7 i 5f 2-- TOTAL— *7DiS-TR%f-3urioA..j 'DISCHA\PG E Q^rE F0P, Kie'iwoRK D, AT E J S93 - 027 04 _PUMP CHAMBER CROSS SECTIOIJ AMD SPECIFICATIOUS pf} OF S VENT CAP 4"C.I. VCrJT PIPE WEATHER PROOF APPROVED LOCKING JUJUCTIOU BOX �MkMHOLE COVER 25' FROM DOOR,, wl uvIltii`A)(,- 1AI&C WIIJDOW OR FRESH 12~MIU. I AIR IMTAKE GRADE ( _..; , y � I I 1B" AIM. lo�COQDUIT `------i----..__ J/ -} � IM LE T APPROVED J01NT 1,1% C.T. PIPE EXTENDiMC- 3% OQTO SOLID SOIL ELEV. Il-/,7 FT. 1 PROVIDE AIRTIGHT I I ��f' • I ` .1011?TS pit �''�,all I I APPROVED ti► W/C.I. PIPE ,Ott I A p M EXT E 1•J t7 I iJ G 3 tX ONTO SOLID SOIL SUM o sIL I .... P OFF yy S no 6-- 40 f .•� � `�� � � BLocrc + lb VA E { iT PERMITTED OQLy IF TAQk MAfJUFACTURER HAS SUCH APPROVAL SEPTIC E 8PCC.IFI'CATIDUS DOSE -�-� ��,v��-� ':�O . (DUMBER OF DOSES:- .PER DAB TAWKS MAWLIFACTURLEK: - 150 TAWK SIZE: L� GALLOQS DOSE VOLUME �JcL� ALARMMA►.IUFACTUI�ER: _ Lz V� f A/f} QI�'� �{r INCLUDI�.1u BACKFLCW: GALLONS CAPACITIES. A = ��'S IUCNES OR �� GGALLOWSMODEL IJUMBER.• �F-RrvRZ f1C 2AT swITGH T"yPE: I B-_,____lh1CNE5 QR G�►LLs�1.15 UFACTUftER: � oE- I C = ', 5 1,ki HES OR l s i .LL0' .5 PUMP MAM �j �/; -� �; t`J M5ER: �3 _Ii2 H V G = 1 SL� :4'.:. HES 0R �.---�- GALLONS MODEL U SWITCH T�PE:�`��� 'k IJOTE: PUMP AFJD ALARM ARE Td BE INSTALLED Ohl SEPARATE CIRCUITS MI tJ I MUM DISCHARGE RATE 3-5-GPM I UT 4hJ PIPE.. -�. (e FEET �� � VERTIC^L DIF!` EREMCE bETWIEU PUMP OFF AUD DISTR B I 2.5 FEET 6A G (.L, + MIUIMUM METWORK SUPPI, PRESSURE --- I -}- 5 FEET OF FORCE MAIM X � .�S F too fj.FKiCTION FACTOR.. ` S� _ FEE7 TOTAL. 013QAMIC. HEAD = �_ FEET P0 UAJD 3f TH •WIDTH -� ;LIQUID pEPT N )MTERtJAL. DIMLWSIOtJS OF TA1 K: LF-KIG ` 9 6 A �N5 3� C D g3 HEAD CAPACITY CURVE MODEL "98" 30 8 25 z 6 20 15 4 10 _ 2 5 0 10 20 30 40 50 60 70 80 U.S. GALLONS LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER h tf,UTE EFFLUENT AND DEWATERING CAPACITY HEAD UNITS/MIN FEET METERS GALS i_ I RS S93os02704 - 6 1/4 4 5/8 3 5/8 16 1 1 /2-1 1 1 /2 NPT 5 I.De 72 41111 10 3.0505 61 231 15 4.57 45 I70 -- 20 6.10 25 95 16 Lock Valve )3' CONSULT FACTORY FOR SPECIAL APPLICATIONS i Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm, three phase systems. p Mechanical alternators, for dt!plex systems, are available with or • Double piggyback mere-ury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - i/2 M,P. 2 sin I'm i back me float 't h d bl ' ba k fl I. Series Control Model Volts -Ph Mode Amps Simplex M98 115 1 Auto 9.0 ., 1 or 1 & 7 N98 115 1 Non 9.0 2 or 2 & 6 D98 230 1 Auto 4.5 1 or i & 7 E98 230 1 Non 4.5 2 or 2 & 6 Idp ggy rcury swt c c.r ou a piggy c mercury, oa Selection switch. Refer to FM0477. Duplex 3. Mechanical alternator 10-0072 or 10-0075. 4. See FM0712, for correct model of Ftectrical Alternator, "E-Pak". 3 or 4 & 5 5. Mercury sensor float switch 10-02 2:5 .used as a control activator, specify _ duplex (3) or (4) float system. 6. Four (4) hole " J-Pak", junctior, box, for wal—Iignt connection or wired -in sim- 3 or 4 & 5 plex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watr!rtight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combin:,tion Starter, FM0514, All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FM0477: Electrical Alternator, FM0486; Nl-.chanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ- FM0495: Alarm Package, EM0513; Sump/Sewage Basins, FM0487: and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor I's Er gineered into the design of every Zoeiler pump. MA:! TO. P.U. 8OX 16347 tourwr"'", KY 40256-034T Manufacturers o/ .. . SHIP T0: 3280 rJ;:' Millers lane L0!,!� vlrit', KY 4016 ,�UAl/TY /�Uii/PS S/NCE /9..�9 (501) 118-2731 • FAX 1502) 174-3624 ` SAFETY & BUILDINGS DIVISION ` State of Wisconsin Department ofIndustry, Labor and Human Relations August 30, 1993 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 855 O/NEILL ROAD HUO3ON WI 54016 RE: PLAN S93-02704 VALE` CHARLES NE,NE,4,29°18W TOWN OF WARREN MOUND SYSTEM 201 Fast Washington Avenue P. O. Box 7969 Madison WI 53707 FEE RECEIVED: COUNTY OF ST CROIX The Department has reviewed the above -referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. Th1s system has not been reviewed for the code requirements set forth in chapter TLHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. Allpermits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below- Please refer to the plan number shown above. i Plan Reviewer Section of Private Sewage (608) 266-8230 7:00 to 3c45 Mon. thu Fri mBur99v.v"/mu Wisconsin Department of Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Division of Safety & Buildings in accnrri with 11 H R Rq W; Wic Arlm r _nr n Page / of 3 COUNTY s-r 6 lea� � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ' PARCEL I.D. not limitQd to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT /Pit- 1/4 It'E 1/4,S T f ,N,R T E (or) ' i1 PROPERTY OWNERS WAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 7 CITY, STATE ZIP CODE PHONE NUMBER c �rS1 2-�'� 3i y'�iP�P�✓ ❑CITY ❑VILLAGE ENOWN NEARS T R AD rr r New Construction Use [X j Residential / Number of bedrooms y ( ] Addition to existing building FIR cement [ J Public or commercial describe -- Code derived daily flow aC� gpd Recommended design loadingrate S bed 2 trench 2 , 9P� . gpcilft Absorption area required , \ bed, ft2 -�_O trench, ft2 Maximum design loading rate bred, gpd/ft2 trench, gpd/tt2 Recommended infiltration surface elevation(s) l � ft (as referred to site plan benchmark) Additional design / site considerations "F—D,e Parent material �% �� -S��%� _ ��T 4)1-41E-vr Flood plain elevation, if applicable �v7-111 S = Suitable for system U = Unsuitable fors stem CONVENTIONAL ❑ S ® U MOUND ® S ❑ U IN -GROUND PRESSURE ❑ S ®U AT -GRADE ❑ S O U SYSTEM IN FILL ❑ S .❑ U HOLDING TANK ❑ S ❑ U Boring # f{���u�ti5wkv5 �:•. Ground elev. 99.�ft. Depth to limiting factor , _J Boring # �'hti�{titiQ�4�� iGround elev. ft. Depth to limiting factor f� ff A /0 YX 511 2, f Lj k r e � y 5 4 '51j ; sy/F IL .�.,, Remarks: O f ZeA> G r ' S / , ' ram- 7 Avfpl>�e 4 F. ,/ .,� � '' ;ST Name: --Please Print 7 7fZ-.#6R r C. 7Phone: el S, Address: (p✓�-ter- All/'G- /�© �,�1%�'�`c'�A.) K��'/„� .S�c��Cy �— 9— � � C'.ST�9 .2 Si nature: Date: CST Number: .4 78 /Y aC /P*oe o& /16f a'5 7 ekoeElrally el,15el I� r 7'(0 A-1Z a cio2o-w &a- BE-S 7- • /vim �'- �,�°'r'r� fir3� �i �` � . �' fi�� %�' �;,s-� so;l� /l�-ti SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boubry Roots GPD/ft Bed rrinr& YXI YX' �//c/,e' 0 yl/ s , I TIC? tit IQp ILI i Remarks: ffOl'r zy.0 `Li 3 i S W C ,I er' y eel Af o T�' 0 5*44..vQ 13 - -oC PROPERTY OWNER C�{��� U� �r SOIL D E S C F- M O N REPORT PARCEL I.D. i i Page Z of Ground y-7,�ft. Depth to limiting factor .� __._fZ tit r. J• ti�ti Ground elev. It Depth to limiting factor Boring # [3 Ground elev. ft Depth to limiting factor Boring # El Ground elev. ft Depth to Umiting WWI` Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consiskm Bwxby Roots Fpjjjt2 Bed 7ionch z -7_ IF Ao Yle Y16 s,� L. f s,�� ' ,� =s � f . S - 6 y y Go s Y� c ` s/ s s/ 1, �, 67A nK `F Q, i`loT_5 smarks: emarks: Remarks: Corti oaonio nc ins►% /V 07 S ea v T/ ae" o AgeAges� �v r� 0 So / le i At yo SCALE. • _ �4� �ffaE �i'TS 9 7. 7.3 3 . A27,0:STI,v(r 5a./ Z�rvp toiQoPoSe-O :4yf�.'���r� R£D is o S u(r& e-STED e� 1 C-VATI pA3 OF S y s TE,o, w eta, satin ` eox - f 71 Q Z& 7 /o 3, /os ' $Z W 0 pEP co.vuEiP.�row �. ��� o1e.* s 1iNi¢L �l� ®L!/•�J�i� 5 yam, ._.� 35 O v�iitJ(t 1iv5;e41 "Oki i)'-" O I,uSOEG Tl4VD� wEll ----= 8Z sF iu�cEssttre y 7f,l 4 �-��<< •T V Mr ilk f h U I -A m F 12.00 ADO 2.w4- +A ^'k JN ,S��iES wrfi i�u 30, ©F lST' T�1Nk D k 7 c ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: 1/4, AIE 1/41 Sec. T.,-�? N R Town of LV.a %k Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 0 Did flow back occur from absorption system? Yes No6-1(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: 9-6--e ron.struction: Prefab Concrete Steel other Z Manufacurer (if known): C. i - Age of Tank (if known) : / 7 (SignatYr-e) (Name) Please / Print -9 (License Number) (Title) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83., Wis. Adm. Code (except f o r inspection opening over outlet baffle). 7 Name Signature 1110 M P M P R S Z114e — 1� 14- 5/88 I-. STC -- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER BUYER C2 � Q�-c�q Vo.C..c-� ROUTE/BOX NUMBER I I g S� /'/ LA FIRE NO* CITY/STATE ����f�.S UJJ ZIP s J119 �3 PROPERTY LOCATION: IV F,1/4 /V PE� 1/9, Section � , T 72,`� N, R_/ 81 W, Town o f w , St, Croix County, Subdivision , Lot No. . 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after Inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning; Office within 30 days of the three year expiration date. St. Croix County Zoning office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address S T C - 100 This application form is to be completed in full and signed by I the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/con'tractor,(spec house), thenia second form should be retained and completed when the property' is sold and submitted to thj,,s_ office with the appropriate deed recording. ------------------------------------------------------------------------ Owner of property FIS Location of, property kj/�--1/4 1/4, Section T N-RI W Township Mailing address ReA uld Address of site SGz�,-�.,,t . Subdivision name —Lot no. Other homes on property? yes No Previous owner of property Total size of parcel 1-3 Date parcel -was created Are all corners and lot lines identifiable? /---'-_Yes -No Is this property being developed for (spec house) ?.____Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful So as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that.I (we) am (are) the owner(s) of the property described in this 'Information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. Signature of applicant Co -applicant i Date of Signature Date of Signature I � ' DOCUMENT NO. VypRRANT1/ DEED # THIS SPACE RESERVED FOR RECORDING DATA .I f STATE BAR OF WISCONSIN FORM 2 --- 1982'1' F 47t7r`*8 REGISTER'S OFFICE ST. CROIX CO., WI Myren R. Cowles and Deborah L. Cowles, Rs['d for Record hu"sbarid� d6d wife• •as .marital survi'vor'shi'p prope,�ty ....................................................I.......------ . ..----........_............ ;, JUL 2 3 1991 .... ........ I ..... ............................... --.. at 8: 30 A. M cony •ys and w:;rratsts to .. C David Vai.le -arid . CarO.yn 1�1: "gale , husba_nd and. wife•- as _-m3r ta.l survivc?rship ... property-......... - - - ..................... 1"URegisfefof Deed; . ....... ........ ......................... .......... .............. -- -•............_.....---------•---- 1 . . .. ... ................. I............ ......................... _.... .... !II i�CtURIV-TO - - .......... - �l I. .... ._.. -• •............................. ..- . ..... .................... .._ .......... ........................... -- ... --- �I the following described real estate in ................ .._Cr.Q.i x .......... county, =_ - f State of Wisconsin: Tax Parcel No ............................... Part of the SEk of NE'k, of Section 4, Township 29 North, Range 18 West, St. Croix County, Wisconsin Oejcribed as follows: Lot 1 of Certified Survey Map filed December 5, 1978 in Vol. "3", Page 743, Doc. No. 353715, EXCEPTING THEREFROM the following described property: A parcel of* land located in the SE'k of the NEk of Section 4, T29N, R18W, Town of Warren, St. Croix County, Wisconsin described as follows: Commencing at the NE corner of Section 49 thence S00 00' 0011E (bearings referenced to the East line of the NEk of Section 4, assumed S00 0010011E) 1251.96' ; thence• S89 08' 34 "W 1275.89' to the Point of Beginning; thence S0052'03"W 1253.9211; thence 989 04'30"W 32.001; thence N170 1010111E 1253.59' ; thence N89 08' 34 "E 47.33' to -the Point of Beginning, containing 49716 square feet (1.141 acres) more or less. *TOGETHER WITH roadway easement as shown on said Certified Survey Eap . is This .... _............... ....... homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights -of -way of record, if any. Doted this ._........._..._....� da of ----------- July ......................................... , is..91.. .._ ------ ------- ]r i ....................(S E AL ) SEAL��`�'-1-,-�.. =G.- ...... Myren R. Cowles Deborah L. Cowles ................._................_..._.......................... « .... ...__. .......... .......................................... .(SEAL) AUTHENTICATION Signature(s) -._........ -............................... =----------------- --/..--------------..---'------/.._........_......------------------------ . . authenticated this `...._..day of ' )::-.4.:--'.--__--_-- 19.`.... L IL a---,-------•---'---r._�....._:.._.�� -- -- --——--------- - - - -- — ----- -f--- - TITLE: MEMBER STATE BAR OF WISCON'SIN (If not- ------------------------------------------------------------ authorized by j 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY ............ Kxiat I .. gland --- Lunde.en.----.--.---- Attoe.. ,, at Law ----•--------••..........................----------------•---------------------- (Signatures' may be authenticated or acknoRledgrd. Both -ire not necessary.) ......... .............. . . - .. -(SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ss. --------------------------------------County. Personally came before me this ................day of -•---------------------••--------------- 19-------- the above named :o me known to be the person -.-----_---_ who executed the foregoing instrument and acknowledge the same. �....................................... Notary Public ..................... .. __ Count, Wis. NIV Commission is Permanent. (If not, state expiration date...... .......................--...... ---.. ......... ..., 19 .) *Names of persons signing in any capacity shll-IlJ be t),re-1 .r a r.ntiA bi•1iIw th+ it biStinwres. WARRANTY DEED STATE BAIL OF %ISCONSIN V1'iy; nnsin [.�ycnl !1L►��I. Cit. itl� 1.011,%l rJo 2 — 1'i'n'2 kl,, 0 353715 ST. CROIX COUNTY SURVEYOR'S RECORD CERT IFIED SURVEY MAP DARYL COWLES, ET AL o. CoNKELti ��,IN►�s bg1s�M Off � Ste w C5 N.E. C 0R. SEC. + T29N, R18W (FOUND SPIKE) ( f. ROAD l©, as OF N E• CORNER ) -i -33' �-o I SCALE; /"= 300 32 $p REF 44Z . 30' 442.30' 44 2. 30' C £ 1q04D /I' E'ASr F o Indicates 1" x 24" - OF S. E. C ORNIW 1 iron pipe stake S 890 4¢3D W weighing 1.13 #/ft. 3 2 6. 9740' DESC RIFT ICON 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 890 08' 3411 W along the North line thereof 882.14 feet; thence along a curve concave Easterly having a radius of 80.00 feet and chord 1"earing S 110 16' 2511 E 156.85 feet; thence N 670 20' 29" E 237.70 feet; `1`,�111111111111 llllll/// , 0��/r Sg9 dg'34' w N.E: Cd RNER LOT 2 JAM!ES L. n�•:�f r 1 : e� . N � ti.bTL (1i!JRPHY CHORD 8EAR/N6 S 11 62S E' .-- /�D•T2' o _ S 2 _- ' . RIVER FALLS, ' �Q 0 -10, WISC. ti•� 23�+ q14 a.LrN� o O� 2 Z ZA,5EMeE�1..r C>GTAxL_ LOT 3 LANo d - (easement description continued) thence N 890 08' 3411 E to the East line of the above, described parcel; thence N 000 00' 0011 E along said East line a distance of 66.00 feet to the Point of Beginning. Vol. 3 Page 743. Certified Survey Maps S t . Croix County, Wis . 4411.07 (See reverse for Certification) COMN!ERC�AL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, W '- isbonsin 54730 715 - 962 - 3121 800 - 962 - 5227 if ST* CRON ZONING ST* COI X COUNTY COURTHOUSE HUDSONt W1 54016 ATTN'f' THOMAS C. NELSON Coliform Bacteria/100 ml Nitrate -Nitrogen, mg/L RE It PORT NO@`# 06394/01 RF-PORT DATE*' 6/13/91 DATE RECEIVED*# 6/12/91 PAGE 1 �' ,fib --' O"Ro Myron Cowles T LOCATIC . 1185-118th Ave. Roberts COLLECTOR11 Mt Jenk i SOURCE OF SAMPLE*4 Outside faucet COLIFORM# 0 /100 mi INTERPRETATIONt BacieriologicaLLY SAFE NITRATE- l 3 ppm Above 10 ppm exceeds the recomwnded Public Drinking Water Standard. LAB TECHNICIAN14 Pam Cane WI Approved Lab No* 19 '%tAD E P EN40 O 0 Means "LESS TW" Defelictable Level Approved by" PROFESSIONAL LABORATORY SERVICES SINCE 1952 db JJ STs CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private Individuals. Completion of this form is essential so that the property can be located,, 14 Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING-----_,.---.- --_---..,,.--,V,.--....._..--FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $127.00 (For VOCIS) SEPTIC SYSTEM INSPECTION ----------------- FEE: $ 2 5 . 0 0 (Determines if system is properly functioning at inspection) J1^ Property owner's n a me P ,a �-��, UCH time of Property owner's address Legal Descr0 iption 1/4 of the 1/4 of Section T 2q N-R Town of Lot Number —Subdivision Name FIRE NUMBER LOCK BOX NUMBER a 1 A , e7) Color of house rA hAa, Realty sign 6,yl house? If so, list f irm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A KAP,I,e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. if the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. 0 WINTER TESTING, Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. if this is the case, please make proper arrangements with this off ice to ensure time when entry may be g ined. Firm or Individual requestin �4-4r:7 ct�e 'C s (eq vices : Telephone Number 'k U REPORT TO BE SE TO: Closing date Signature 0 WARREN T29N:-P.18w"' 29 SEE PAGE 4J 0 1 E 0 Rlchal-d 1� —1P 7- 04 A tQ Arf 17 (�;a 7LY leobcrl 63 C017171C C1,4, 6, -Z1-7C T37S.-r-9 ea/ "UC //C/- t CO I-rO- /'7 1-7 C 7/p -Derl-Ick. T out L' "All C5 if LeeW cry Senn 0,-7 4 e 1V&1,SOr7 4-6 Nancy'0 rMn �n Tholvas 159 W PlIen Lr ,peter a. S. �9 Ltj F) L56'.6 7 11b /11"' Ili I.M] TP Malone-q 2,974 C")?- I C t A VC. 0 serpd nMJ rN* 0 0 LLOJ wr 5 45 1-7 -74 mazy / Iq /< C(2 /777 60 9754 cnneM (IT 917n T' f PaITA--1,2 F 5�'& Iva a/7" 70 eo J Jo 60 T fT 5952 Rode. /' ,r -170-7CZ/,5e IF -Z20'-f's Gordon f t5 1q. C / Ile ar'c c.A /Vf-- M7 •Llan 17 G Ike J-/ 96 /60 -zoo �00 /5/ &9 7K Ye a ■AYE. 0 e! I /eJo�Z- 0 AV an '8C-�-k & LOA VE 'y mcl<cancL Girl Scout V 460 7S. "P, 117C I /ja Aold C/7 V, Me- 3;1.z RIch r J7 I I e hi yo 1 ;67 0 14 13 Q- 04ailld 9 e e C017711k rZ -V/O/�e C Y/C C Ur k) Q �F421-1 r� — 'K �") 4) nna '57-e' /Y" lloldc-Y7 761(o 4Z TIS 2 8 Marr 11, 14-7S7 41 a HO Tr 17 tr 8/00M /0 TR 2 ■ -D 12 a 5 a I w 0 .9ra t&f �Iq w Aeoh z L 77m-lma 97 CIO-/ ......... PLUA5.4 IT Jr qj rq 00 A—. t4i fe ww ro,77 N IY5 /460 'V "NO qj qj ON A�O T) ,k' 11wc1)q4f! o-0 /�'� 5, - a qj �d Lki 4' Rye 10,6. .25- v g fed Q Z'/g .... .... 0C. IJ9 0 4- n Q. aid T Spew N tj LU C/- Ll "0 44s' 4 159 /c- IS-& 7Y - vy Tit S 'N'O vQ3 Sj nvtorzn/714 P � �) � L4 VE, ROBE RT 1076 c� 0 0 Olt VA Rl Q� 10 %4 � JU PC9y no. r �j 'a c7a .-7-lo zwerx" 0/7 • A qj 09 1 er k) toe, -5 (o 40 lef?e cye 167 fjr)der onF 24f-0 10 R A -la Y-A /7C(/ tl 1 0 Srad)� C'y 26 Da• IN Carol• VISO" 65 -q.9 0/47 V if Oyer 170(ye - I kz� f 'rull -or 0 eo AO - .4 -Z-:, 5hU GreOfI [Ze7C-1 Ix?"sj ,U "re yy AfDZ � 1377 Jti h Gloria 7-r r V-5, A& ed 0 N 11G 0 f' 'V 4541 It e- Dormles T 4.0 4, 94 ia9 7 0 e97 74- o ro ts. W117 193 e8 2377 )Irw 71 J4 35 4_ 'I /'r 0 -Vea,? Cr qu q, 'Uq VIk Z5- :t C KIrr NN eo 7 le- ad a a,? 4 75 a A Rog er ti C N 19/717 Jr'n rlc-l< /r IM017a IC191d"!�1 "c"O 17 Anen 1-94 Do 'riot o 1991 ;E 17 900 1000 1100 1200 1300 1400 1500 Dependable Hybrids From B E A 4-H Dependable People Richard H. Kamm 1382 - 100th Avenue TM Roberts, Wisconsin CIBA-GEIG ' Call: 749-3332 Seed Division A June 12, 1991 Judy Steiner Edina Realty 700 2nd St, Hudson, WI 54016 Dear Ms. Steiner: ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 An inspection of the septic system on the property of Myren Cowles, located at 1185 118th Ave., Roberts, WI was conducted on June 11, 1991, At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. erely, Mar kins Assistant Zoning Administrator cj J.�7 C11_1tL1 Vt\l r TQT.�'N S:� i p c • ADDRESS ST. CROIXCOUNTY, WISCONSIN . ,DIVISION LOT r LOT SIZE PLANS VIEW ,Distances & dimensions to meet requirements of HE2.20 SHOW EVERYTHING TWITHIN 100 FEET OF SYSTEM i • o y r r • r r • a _ L12 4:� •. r { 1 -TIC TANK (S) _ MFGR. '. CONCRETE 4---_' SfiE LEL NO, of rings on cover Depth 2_.' Y WELL ,.NCHES NO. of width iengtE area no. of lines width length I� area de tit to top of ipe, RU CA'T E �, __ --�/),/.f €_ Li RATE AREA REQUIRED 0 AREA AS BUILT :claimer: The inspection of this s stem b * St. Croi � � x County does not imply complete fiance with State Administrative Codes. There are other areas that it is not o p ssible �. inspect at this point of construction. St. Croix 'County -.ssumes no liabilityfor _ tem operation. Eowever, if failure is noted h the County well make every effort to _erm_ine cause of failure, a �ASES AMi OILS SIHOULD► NOT DE DISPOSED THROUGH THIS SYSTEM.. INSA E TO)Z '1LLL �i D!,JED PLUMBER' ON JOB LICENSE NUiB � ER r . a • • • ?-I -I DIVIl)IJAL S '-JACE DISPOS�V, SYS'vEJ.i }tPOT,T OT' I?15PrCTT�p Sallitary Porn, it r State Septic TOWNSHIP • t. Croix.. County Size �.� gallons . 'cumber of Compartments . Distance From: We11, f t, 1.270 or greater slope-_ � pe_ _ � 1. • building : ? ft. Wetlands ft iti811w,ater ft, DISPOSAL SYSTE:1 Tile FieId or See acre Pit s Distance Prom. TIelI c ft. 12% or greater slope ft Building t, Wetlands r f, FIELD 11.ighwater f t . Total length of lines " ? ft. i�Tul:1b r _ �r Number o.. lines—"— Length of each line ft. Distance between lines ( ft. Width of the trench .� t. s Total absorption area C , . t.� q, ft. Dcpt�1. of rock be -lot, the in. Dp-th of rock over., P the in. Cover jDver rock.,'_ Depth of the beloli grade J in. . Sld o of _ � � P trench� in -ner 100 ft. Depth to Bedrock ft. Depth to . • around Water f t, PITS Number of 'O is Outside diamete ft . Depth below inlet f t . Gravel around pit : no . Total absorption ' xption area sq. ft. Square feet of seepage trench bottom. are ' a required , �:quare feet of e;epage it area required . Inspected by Title • / • . Approved , � Date -',- / 197 �' c<r • Rejected Date 197 EH 115 • WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:A�L'14, Section T,;7N, R &E (or) W, Township or Municipality Lot No. — Block No.—, County Subdivision Name Owner's Name: &_ Mailing Address: V TYPE OF OCCUPANCY: Residence L-_ No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW 4____ -_ ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS /,O - A _0— Z V PERCO TION TE TS /Z2 -_ ;2, SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST NUM— BER DEPTH INCHES CHARACTER OF SOIL THICKNESS IN INCHES HOURS SINCE HOLE 1ST WETTED WATER IN HOLE AFTER SWELLING TEST TIME INTERVAL IN MINUTES DROP IN WATER LEVEL, INCHES RATE MIN/IN PERIOD 1 PERIOD 2 PERIOD 3 P_ 1(v ell i P_ f P SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES (DEPTH/TO TO BEDROCK IF OBSERVED) OBSERVED ESTIMATED HIGHEST B­ Z2 1 S'e Z — r_=!! ka k vp B— 3 - ----- A Ir .2 q ZZE B 7 A 7 lil - 15 I PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square fe t of suitable areas. Indicate nu ber of square feet of absorption area needed for building type and occupancy. A a 0-_* /ZL- /�� Indicate scale or distances. Give horizontal and vertical reference poinlifs-Tdicadslope. rp 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. ? .. ) Name (print) WJ C� 1114 !qlr- _+� C/ I & -15, Certification No.A.413 Address- 4a j'y j Name of installer if known tN OAL� 74/ COPY A -LOCAL AUTHORITY CST Signature State and County PLB67 V Permit Application for Private Domestic Sewage Systems . 4. *DENOTES STATE APPROVAL REQUIRED State Permit # County Perm County Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPE TY Mailing 00AT ress: B. LOCATI '/4 Section 1/4 0 0 T� N, R -4 E (or) W Lot# .------City Subdivision Name, nearest road, lake or landmark Blk# Village Township "ke,0e*e_ C. TYPE OF OC UPANCY, Commercial *Industrial *Other (specify) *Variance /) Single family Duplex CNo. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher Lly-CS NO Food Waste Grinder YES L__-NO # of Bathrooms -)-;:- Automatic Washer L---YES NO Other (specify) E. SEPTIC TANK CAPACITY 1� 42:Z2 Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area 2f 51 Z) sq. ft. New ---Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches SeepageBed: LengthA Width Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land d % 27X Distance from critical slope 1, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-1 15 prepared by the Certi f Soil Tester, NAME jW/ e, / �� i<�D �► C.S.T. # Y,4 and other information obtained from 4 (owner/builder). Plumber's Signature MP/MPRSW# .110 '�^_e Phone # Plumber s iNduress PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 0 C WC I? Do Not Write in Spa Below FO DEPARTMENT USE ONLY Date of Application —3 '?IF e e s aid: State t Date /7M 0-,-7k Cunt v Permit Issuecl/.&ajeewd (date) -Issuing' Agent Name 5E��_10 Inspection Yes�No — Valid# Date Rec"d 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 ST. CROIX COUNTY WI SCOW S IN ZONING OFFICE 386-5581 Ex. 49 & 56 COURTHOUSE HUDSON 54016 November 7, 1978 Mr. Duane Strausman Division of Health Plumbing & Related Services P. 0. Box 309 Madison, Wisconsin 53703 Dear Sir: I am very disappointed in the attitude of Mr. Richard Hopkins, a master plumber-restricted sewer, from New Richmond, Wisconsin. Mr. Hopkins came into our office with the necessary forms for a sanitary permit for Mr. Myren Cowles. State Septic permit number 18066 was filled out by our office but was not released to Mr. Hopkins because the proposed subdivision had not yet meet the standards of the subdivision ordinance. Mr. Hopkins was told that once the required road was built, the survey for the subdivision would be released, and at that time, we would send him the permits so that he could begin work. Instead of waiting, Mr. Hopkins went ahead anyway and installed the system without the necessary permits hoping that once the subdivision was approvedp he could obtain the permits and call us for an inspection. It is my feeling that this action of his was in defiance of the sanitary code of the State Statutes. If he is to continue working within St. Croix County, he will need to comply with the rules and regulations of the Statutes. Sin erely, C� �7 HAROLD C. BARBER Zoning Adminis trator HCB:jh cc -. Richard Hopkins