HomeMy WebLinkAbout014-1055-70-000
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
' Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanita 299034
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
RIBA, MILTON & MYRNA FOREST
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/ 0. Gb 60, 6-4 ~ r r 014-1055-70-000
~''P Ea
TANK INFORMATION ELEVATION DATA A9700351
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Lc/P,SP~r> / f''Gt: % 1 J✓J Benchmark y k S/~ /L ~J
Dosing C
Aeration Bldg. Sewer 75- ¢ 9~ 3 ~7
Holding St/ffi inlet 11,62
TA SETBACK INFORMATION St / I Outlet
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
irl
Septic 3 '83/ NA Dt Bottom 5, Z
Dosing NA US&Ur / Man. F2 (,S '
Aeration NA Dist. Pipe 5
99/`
Hol g Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Jr0 ma.-~ Demand
Model Number GPM
TDH Lift Friction System q-? TDH Ft
Loss Head 7
Forcemain 1 1 Length //0 ' Dia. -2Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liq Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI Manufacturer:
J / SETBACK CHA ER
► INFORMATION Type O Model Number:
System: 30 OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) ~Y_ '}-r cl
LOCATION: FOREST 26.31.15.416,SE,SE X082 STATF,,ROAD 64
Ckj.Qx.._- tl.-tteC~ :'L.~~ 7`t.-/t..f'! ~~>'✓:.ti,'. lG~-.y /'.1':'...~~~y
,7
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
y
SANITARY PERMIT NUMBER:
tE.
Safety and Buildings Division
~~■■-r■r■ SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Count
than 8 v2 x 11 inches in size. e
• See reverse side for instructions for completing this application State Sanitary Permit NN mmbber~4
The information you provide may be used by other government agency programs ❑ Cfi kit revision"tdprevious application
[Privacy Law, s. 15.04 (1) (m)]. Sta+( Flare I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Prope caner me Q Propert Location
(~Yi 1/4 1/4, S4. T !
✓ r N• R J t (or
Property Owner's Mailing Address Lot Number Block Numb..ec-
4- Jam.
Cit S to Zip Code Phone Number Subdivision Name or M Number
Ill. TYPE F BUILD G: (check one) ❑ State Owned E] qty Nearest Road
p Village
i
Public 1 or 2 Family Dwelling - No. of bedrooms etiown OF
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)) 1 ❑ Apartment / Condo ON-/0,55-70
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. rf{Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
System X System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21A Mound 30 ❑ Specify Type 41 Q Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
J Required (sq. ft.) Proposed (sq. ft.) (Gals/da q. ft.) (Min./inch) q E
vat? _
1e, '
Feet 71 Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Ex er.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel Plastic p
New Existing structed glass App.
Tanks Tanks
Septic Tank or HnI ark V 'l 25~~ l~lL/~.S!'I El El ❑ El 11
Lift Pump Tank /Siphon 6..;, j ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATE-MENT
I, the undersigned, assume responsibili for i io 4if the onsite sewage system shown on the attached plans.
Plumbs Name: (Print Plu er' n re:„( Stamps) MP/MPRSW No.: Business Phone Number:
JO p,,;, L N l y%7 S""e ~l Z3 Z~v 'SG
a1Z
Plu b i' Address (Street, C,iry,~ State, Zip Code): f
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved San Lary Permit Fee (Includes Groundwater Date Issue Issuing gent Signature (No Sta s)
A roved urcharge ree)
pp ❑ Owner Given Initial ~ GO)/S p~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 1
i SBD-6398 (R. 05/94) 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 maybe renewed before the expiration date, and at a 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
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 and Buildings Division, 608-266-3815-
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
It. 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 on 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.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/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.
VIII_ 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 1/2 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 contamination investigations
and establishment of standards.
d
d
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Commerce
August 4, 1997 1340 East Green Bay Street
SUITE 300
Shawano W
WEGERER SOIL TESTING ~0
421 N MAIN STREET _
PO BOX 74!r~ i N '997
RIVER FALLS WI 54022
RE: PLAN 597-30881 FEE RECEI D'-.
RIBA MILTON Z
SE,SE,26,31,15W
TOWN OF FOREST COUNTY OF ST CROIX
MOUND SYSTEM
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 Comm 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter Comm 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.
All permits 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.
Sincerely, (p
^ .-A
Ke th Wilkinson
Plan Reviewer
Section of Private Sewage
(715) 524-3627
SBD-7997 (R.11/96)
Page of 6
MOUND SYSTEM
FOR
A a BEDROOM RESIDENCE
LOCATED IN THE SE 1/4 OF THE SE 1/4 OF SECTION Z6 ,T31 N, R \S W,
TOWN OF ~jV r , 5T• C\ZO1X COUNTY, WISCONSIN.
INDEX
PAGE l 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN \
PAGE 3 of 6 PLAN VIEW-CROSS SECTION. (oF
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
.PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
r1l L~UN 9ND 1 1 `1 R P.11~ \.QA
Gl~Nwoo~J ~liy, UJl s ~ ~ 13
PREPARED BY
E FZ S tV ~ WECEE~ T- L- T EST I hI G S97-30881
AND . 1?Awn*
3aES = ~t ~~v z cE d~C®Ars ~'~1►
P.O. B01 74 421 K. KAIK ST. ; r• {
RIVER FALLS. V1 54022 ? ARTHURL
i WEOEREA
WORM.
715-42-5-0Ib5 iEILSD-9 15 P
P.O.W.T.S. i
'tionalt
Conde Y.. d~ ~4
APpROVED
DEPARTMENT OF COMMERCE _ Z i _ q l
DNWON OF SAFETY AND BUILDINCA
SEE CORRESPO ~CNCS~
JOB NO. - 2
4
k`" , x n
'n1µ ~54~i rIF.4l G ~~~I~: f'~gQ
PLOT PLAN
Page Z of 6
Scale 1"= 30'
r-
1
1 N
1 B.3
1 ~
yl
1
C
8 Z 1 S/ o n 8.1 d7 . - VS1 kJ I-xL t_
l ~.gV° x
P,
OG SIDI}v G.
a. q b ,q' o~, cLC»rv~~'
AT cuu~~Z.
s~rn 4 -BS 0V y
x TRrkc M 11 h, , L`Z4 COU J'Tt
WELL.
3 $C~ZZJ'~f
1'~o~3E
N mlLr,=
~X l ~~►~1G ~t'nvYz_~' lb ~3c
l~ i
7 0
nJ M
r
' 3 2 O ST,
s ~~os t)
by
NOTES:
•1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( V required)
3. Install 4" observation pipes with approved caps. ( Z required)
4.-Septic tank to be %0U/6S0 gallon capacity manufactured by
I-) [ D►-Jzs ~J Q1Z R S7 , ) Aj C-
5. Bench Mark S 1°t~3t~UF
6. Divert surface water around system to.prevent .ponding at the uphill side.
Page 3 Of t<,
Approved Synthetic Covering
FIST" C 33 Distribution Pipe
Medium Sand
H _ G
Topsoil F Elev. X15. S
3 E
b
l % Slope
Bed Of 2~- 2 Force Main Plowed
Aggregate From Pump Layer,
D 1, S Ft.
0-2.(07-
E Ft.
Cross Section Of A Mound System Using
f 0-b Ft.
A Bed For The Absorption Area
G -\•'z Ft.
A Ft. H 1-S Ft.
Linear Loading Rate= q - b GPD/LN FT B 14'7 Ft.
2z.9
Design Loading Rate= o•3't.GPD/SQ FT I ~K Ft.
J -7 Ft.
K 1 Ft 13.1
L 73.2
of-, _ 9
-For-Ge Maa n W a-!& 'Ft 37
L
J Observation Pipe
A - -
W o----- Force Main
1-
t\ ((~'~II([+~
M p OL~I"'Vt~ ) 1G
Distribution \",-B ed Of 2 - 2 2 two
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchbr securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page H'Of
Perforated Pipe Detail
0
End View
),Perforated
End Cap. ob\c PVC Pipe Install permanent marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
P
PVC
Manifold Pipe
Distri ution
Pipe
Last Hole Should Be
Next To End Cop
End Cap
P Z Z Ft.
Distribution Pipe- Layout S V Ft.
X Ye Inches
Y '4? Inches
Hole Diameter t1y Inch
Lateral _L Inch(es)
Manifold Z Inches
Force Main " Z Inches
# of holes/pipe
Invert Elevation of Laterals q -aoFt.
L,7<, 1• V-) = 702 x~ = ZS U$ GP>vI
Place lst hole from center of manifold with succeeding holes
at L& intervals. Last hole to be next to the end cap.
_ Combination Septic, Tank and -
PUTAP CHAMBER CRO55 SECYIOIJ KJD SPECIFICATIOMS PAGE S OF
-VEUT CAP WEATHER PROOF
JUIJCTIOIJ BOX
4'C-T. VENT PIPC APPROVED LOCKIIJG
' 10' FROM ODOR, M&WHOLE COYER wt
Z wAttNIIJ6 ~l~6El..
,iIMDOW OR FRESH
AJK IWTAKE S co~Du> r
t
bit NtR-x . ~~`-N• ( 'i" HIU.
I 16 AIM.
i8'PIIAI. _
y'~IUS~LoN Piet PROVIDE (
iMLE T TIT AIRTIGHT SEAL I I (I
A I III APPROVED JOIIJT.
APPROVED JOIIJT I III W/C.I. PIPE0KH'c
Olt V
W/C.I. PIFF.
Tank construction I II ALARM
shall comply with "I I(
ILHP (83.15 and 33.20 I
I I Oki
C !
I
CLEY.86` v~ FL
PUMP ~ OFF
D CouCRETE
n BLOCK
13" APPRoyr-
RISER EXIT PERMITTED OIJLy IF TAUK MAIJUFkC.TURLR HAS SUCH APPROVAL gEDpIN4
5PECIFICAT IOLIS
SEPTIC F
TA, OOSIEK MAIJUFACTUfZCR: IJttMFSER OF DOSES: 3'~5 PER D"
TAWK 51ZL: bSC) GALLOUS DOSE VOLUME I
S S. IUCLUDIUG OACKFLOW: GALLows
ALARM MAUU FACTU KIi. R:
MODEL L1UM6ER: CAPACITIES: A= I~ IAICHESOR 306 GALLOAJ5
SWITCH TJPC• l`'1~Z~ y~Y B = Z IIJCHES OR G( LLOIJS
PUMP MANUFACTURER: Ay2uCC A ~ y\~ I'I~ ` _ C = 8 ILKHES OR l 3 GALLOUS
MODEL IJUMBER: 1 ivj D- INCHES OR \~10 GALLOUS
'tt~Ttct = 6 11 to
ror
SWITCH TYPE: JJOTE: PUMP AkJD ALARM ARE TO 6E
Zg~u GPM IN5TALLED OW SEPARATE CIRCUITS
MIUIMUM DISCKARGE -RATE
VERTICAL DIFFERENCE CETWCEIJ PUMP Off AIJD.DISTRIBUTIOIJ PIPE.. FEET
+ miutmUM METWORK SUPPLY PRESSURE , . . . . . . . 2.50 FCET
+ FEET OF FORCE MAIM X 161 FYoFLFRtCTIDU FACTOR-. FEET
TOTAL D9WkMIG HEAD FEET
Pump chamber DIAMETER
33
UJTERLIAL. DIMEWSIOW~ OF TAUK: LELIGTH ;WIDTH ;LIQUID DEPTH
BOTTOM AREA 231 GAL/INCH
AS PER MANUFACTURER = ~,.,0... GAL/INCH
~ifNGINERING, DETAILS"~;SW25/33
Performance Dota
fump Characteristics 32
Pmn /Mater Unit S§6wz& e
Manual Models SW251A1 SW33M1 W 24
~qq
Aviomatk Models SW25Ai SW33A1 W 1/3 HP
Hor"power 1/4
1/3 to
Fd Load Amps 8.0 10.0 q v4 HP
Motor trp,? s64a+4 Pola t4 petal a
R.Is.AL 1556 0 8
r
Pltasa 0 1 0
Voltage } ! S
l Hertz 60 Q 0 10 20 30 40 so so
t~eratiaa IMltaflleltlMt CAPACITY U.S. G.P.M.
ianrs»rature 120°F Ambient T* ftl Kiad tf••tj 4 6 8 10 13 14 16 13 20 22 24
NiM D*s'gn A 1/4141• 44 41 36 33 29 36 23 18 12 b 0
lasulation Class A "til4 11/3 11P 47 45 43 40 31 34 30 26 32 16 10
p,srltarge Size 1 i /2 NPir
SoWi handling
twt Weight 30 *s.
3-1/2 5.W8
Power Cord 18/1, SPW, 10, std. 2 --•a ~'npo dw,+.nstonsmcs
W eptietsdil i ! vary:1/! ~
I 1-1/2?VT t MaF1Wmmrun4Mpurpm
3.1/2 01SCHA RGE ul~pl crlelYei
Materii. ~R1017+Oht a11~M{~t50.r
cais Of COhStMCtiQ4~'
[ }fondle Steel 3-1/2 5. Oe{ nw" 16 r*
6. N4 re~ro flw 10
to
Ltibritpting 0'ti Dieienric Qlt
~oisdladiM.
Motor Housing Cost ken
ohs Casing- Celt IraM
tiiethae-w Sad Farr. Carbon/Cerm k
Shoft 5001 Sad bwlzod Staa1
Sp $tow"s Stall
,ks: 6trexr'F1 PUMP
k 1a•1/8 ON ~
14~aftRa 1'fastk 9-1, 2
Wpoller
U r Bearing eransa Sim* Daar DISCHARGE
HEIGHT f
Lower Bearin . Sia k ad BMW,
StroGtar/lynse F~astk 3 PUMP
OF l
. fasteners StaiMlesi Steel
• c..}--/qp. ..y, .a 1f1 :M'rM J)(V 'ti.A~
x
/A41tR ws'~t~cr
I !Mr~le 447
19)
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations-
Div&on of Safety & Buik6ngs in accord with ILHR 83.05, Wis. Adm. Code
r COUNTY
s'~-• <_Q zZz uc
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. O 1 q - 10 S S- 7 0
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
f"111,~Dt') Prly~ 1')~-f Q {V A R $ra GOW. LOT- SE 1/4 S E 1/4,SZ(o T 3) N,R N S E (oli
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
30 8 Z ";wnVb 64 - -
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
GLZ~WubO ctrl, bvl s~1p 13 S) Z`S- LLOS S ~pQ CS T' s *O'e 1wtm 611
[ ] New Construction Use L4 Residential / Number of bedrooms 3 [ J Addiiti.Qn to existing building
pQ Replacement [ J Public or commercial describe
Code derived daily flow 'A S) gpd Recommended design loading rate o -'3-7 bed, gpd/ft2 - trench, gpd/ft2
Absorption area required 3-t 5 bed, ft2 S trench, ft2 Ma:amum design loading rate o • `f bed, gpd$ 0- S trench, gpd/112
Recommended infiltration surface elevation(s) a S- S fit (as referred to site plan benchmark)
Additional design/ site considerations MZ~u►,.,b Lv/ 55C LI~' f3C* . M ) ti !P-I U M I. 'S' Cf= SAsvb RLL
Parentmaterial '_o'?,VS oulei-t 6>-+tClftc -nu Flood plain elevation, if applicable r., •A , it
S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem D S [RU 19S O U ❑ S U D S O U EIS O U D S OU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. Bea ranch
x ~ O-`c `b`~t2 3 1Z
< s<;> Z G-19 7-S`ill VA - Sl1 ?M %bVC C S 1v ~ -S
,
Ground 3 1a ~o~I p- 31L S `1 R SJ6 ~i c~ Zrrl sbk w~~1 cS - "`l -S
elev.
01 ft y z$-33 lb,j iZ 3lz L~ > Y~~►- cl,,, un. .z
Depth to S 33-yy LO`1 1z y/ si I m fi - u.p? , z
limiting
factor w
Remarks:
Boring #
~~--A~ J b-9 Lo`•ltz 31 z -S L ( Z'FSbk ~'F~ ot. S 1 u~ • S . ~
Z 9-Z6 ~o`1cz 31L si I 2ln ~~h 'F1- eS 1v~ S
3 26-t!b ~.SyfZYl6 e Z.s`i2S1g gc~ 1n~~ _ Np .Z
Ground
elev.
96-S ft.
Depth to
limiting
factorN -
Remarks:
CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165
eygerer Soil Testing & Design Service-P.O.. Box 74 River Falls,WI 54022
S' nature:
~9 qj - 'LZ.6 Date: °7 ~ - cj CST Number: M0057
6
i
PROPERTY OWNER SOIL DESCRIPTION REPORT Page?- of3
PARCEL I.D.# OLq to SS-1p
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed I
3 0-1 L p `-t R 31 I. sit Z s ~1~ m`~I- s v , S • 6
Z 20 Sytz Y/6 - s~c~ sbk cs 1v`~ "4 5
Ground S Z.L, --rl S 2VA c ~.S R S ~8 s e-Sbk wt~>^ Cg - •S
elev.
S8.5ft. t4 Z7 3S l~'1 R.2-1 ~L " si~ Orn m'~1- -Z
Depth to
limiting
factor i
Remarks:
Boring #
i
Ground
elev.
ft.
i
Depth to
limiting
factor
Remarks:
Boring #
i
i
Ground '
elev.
ft. `
Depth to i
limiting I
factor i
i
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
PLOT PLAN Page 71, of 3
.SCALE 1"= 30 '
I
r-
vt tTL SS - A LS'Tv\ZB `nom S Pl'IL~;
~N I
1 B•3 ~
1
m
B0' ~,V F~ 44 O + M
m
aZ !yon r B.1o X~~lJVLTLL
10O.p' Otv ~Ol'ipl-~
O~ StDI)v G•
rt. qb.q' otv GMO
AT c-vu~~Z.
G PAR _ v t~'2
x`'n e
~.lrc
f~-
C
3 BD\Z
liv\J3E
FL. ~1 .
y -fl
N
3lO `R'F ST,
_ s••t-rc~ ~-opc~ 6 Y
+ (715 ) 42A-0165 M00576
CST Signature Date.Signed Telephone No. CST #
8 T C - 100
This application form is to be completed in full and signed b
.owner(s) of the property being developed. An made
only result in Any by the
delays of the permit issuance. Shoal s will
development be intended for Should
house resale by owner/contractor, this
then a second form should be retained and completed (when
the property is sold
and submitted to this office with the
appropriate deed recording.
Owner of property
Location of propert '°a
Y_1/4 r 1/4, section N_R / S 'Township 6o c<< r
Mailing address
1aYi ~A10
Address of site
Subdivision name Other homes on Lot no . YU property?
Yes No
Previous owner of property
Total size of property ~
Total size of parcel
Date parcel was created~~
Are all corners and lot lines ` ide~t O~• ~
Is this propel cable, , c Yes
y being developed for (spec house) ? Yes N~
Volume --L= and Page N o? 1~ - __No
umber as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY PEED which includes a
NUMBER AND THE SEAL OF THE DOCUMENT NUMBER, VOLUME AND PAGE
certified survey REGISTER OF DEEDS. In addition, a
delays , if available, would be helpful so as to avoid
Y of the reviewing
references to a Certifi d survey process. If the deed description
shall also be required. Map, the Certified Survey Map
I PROPERTY OWNER CERTIFICATION
(we) certify that all statements on this form are true t
best of my (our) knowledge that I
property described in this (are) the owner (s) of the
information deed recorded i~np ~tthhe ofce lof the Co ntY vRegiirtue ster of a
Deeds as Document No. -s~1~~jJs
own the p of I (we
Pro osed site for the sewage diand sposal tsystem) orr I e (we)
obtained an easement, to run the above described property,
construction of said system, and the same has been duly recorded
the office for the
of the County Register of Deeds as in
Document No.
t
Signature of Applicant
Co-Applicant
Date oLf-S~t~~.
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER'y~ is f ' ti
MAILING ADDRESS $ Z >T *41 f, ~E^ Lf J
PROPERTY ADDRESS -5a- -pe,
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE t; t
PROPERTY LOCATION 1/4, 1/4, Section t, C, T N-R
TOWN OF rc~~° « T ST. CROIX COUNTY, WI
SUBDIVISION
LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system canaffect 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 60% 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 system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater 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.
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 DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED: ' GG~
DATE: ! 2 -?7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
1d DOCUMENT NO. 455 WARRANTY DEED
BOOK r;, ' ?_I STATE OF WISCONSIN-FORM 9
2 9 8 S" 0 5 THIS SPACE RESERVED FOR RECORDOW DATA
R E G I ST E R C, r t: t=
THIS INDE URE,Made by_GOrdOn_L,_B0it07bt. ST. CROIX CO., WIS.
---Vio-1a-41---tia tamt,Husband-and- Wife,--as- Joint----- Recd for R,2cord th; ??rte j
Tenants---___--- d Y c nctcber _ _A.D.19.69
grantor _s_- of fit..--Croi x County, Wisconsin, hereby conveys and warrants 8t_ 1.00 PM.
t0--Mi-1t,On-_F.--Ri1 a-and-Myrna- B. _Ri.ba-, -Husband..-------- , David "'one
and Wifei as Joint Tenants
- d
Pter -fp
I
I J~ ~PL1~NL--Ii
- grantee-s- RETIJRN TO
Count} Wisconsin, for the sum of
P Rivard
-Twenty Three Thousand ($23,000.00) Richard Chard - -----------Dol3-ar- Glenwood City, Wis.
the following tract of land in -St ~..--.Croix County, State of Wisconsin;
East Half (E 1/2) of South East Quarter (SE 1/4) of Section 261
Township 31 North, Range 15 West.
I~~I
i
I
Grantors agree to pay Real Estate taxes for the year 1660.
I
FEE
ul
~I
II
l
I!I
IN WITNESS WHEREOF, the said grantor _.S_.__. lia -Ve _ hereunto set --their. hand s -,Ind =cal s this 2 2nd
day of __SegtembP_r_- , A. D., 19 -0.9 .
r i
S ED AND SE IN PRISENCE OF 2"L 7 (SEA )
Gordon-> L. haitomt
2-Z X (SEAL)
Nola _H.- Ftoitomt -
D A~tc~ A12 /I Q ~C /Y / (SEAL)
(SEAL)
STATE OF WISCONSIN,
St. Croix t, ss.
- ounty.
Personally came before me, this 2211d___.__._...-----_ day of.._-_-- September A. D., 19_6_9. .
.t t a nny ann T._ Rni tnmt and lli nl a H_ Flni tnmt - Httchanri anri Inli fo