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HomeMy WebLinkAbout018-1026-90-100 { ~ a-a C) > O 0 3 0 Q O N ti ~ ~ T I o = I h CL f0 ° O O 0 - C N Y E :F 7 o9 -00 w N zO O 0 , CO . L _ U O c/) N Z y N m 0 - a Z ° c m cfOio°Og LL CC~ cO O 0 U co Z ?r 0 •n L 0 CL Q C ca ?i w ~ ~ Z £ I ~ v £ ~ I 0) CD n Z = °o Z a m 0 M Z O Z a c V O N W Z c c 0 0 N 3 o' N G 1~ N 0 O O O N O U w O O 0 Q 0 Z m z Z Z o ~ E cy) N I N _ R U_ L 0 0 ` CL CL l6 y N 0 0 G G a o Z r. O F F H 3 N LO O O O a •N _ m a (L IL cU)I,' co-1 L) 0)m } LO co -o O D O M - O N 0 O O = V 0~ CL U) m N c ~n 6 N N .0 L a y Q ca 0 O 7 a+ O 04 0 O C 0 N c O O C~~+ 00 F _ 0 U O O m 0 0 a) (f - r- C. V) C 0 0 i-i O 0 N C C oO 0 C O N tC! E N M y N H F- r '0 N N 0 c N a) q • O ~2 _ E N O Z N r \ ~ w v E V ~ m g E `m a ~ o a g ' r c `IV a v rr~~ o A vat Ov>v • Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) sanitary Permit 3 GENERAL INFORMATION 284233 Town of: State Plan ID No.: 71 Permit Holder's Name: ❑ City ❑ Village VRIEZE JOHN HAMMOND CST BM Elev.: Insp. BM Elev.: , BM Description: / Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9700002 97 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /O Benchmark 06~ C8 750 g t~ I" J5 Dosing Aeration- Bldg. Sewer Hol St /I Inlet ST TANK SETBACK INFORMATION St/ JoE Outlet pr Vent - TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet y1 i Septic 50/ >~56 ^ S a'= NA Dt Bottom /oL = 75//07 Dosing ro " ~Sd NA Header dbw- Aeration j NA Dist. Pipe i t Holdin Bot. System ~ri.Sz5 i PUMP/ d INFORMATION Final Grade iz Manufacturer 4- Model Number $s P d d i TDH Lift (r Friction System TDH Ft oss Head Forcemain Length /7// Dia. Dist. To Well > ~Q SOIL ABSORPTION SYSTEM BED/TRENCH Width S Length/,,,) No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ),DIMEN u acturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER Model Number: INFORMATION Type O n e•. System: C,41 Ll~, OR UNIT DISTRIBUTION SYSTEM Header / Men+fetd r- Distribution Pipe(s), x Hole Size x Hole Spacing Vent To Air Intake Length I Dia. 7 Length Dia. t/ Spacing ` " SOIL COVER x Pressure Systems Only xx Mound Or At-Grad stems Only De th Over xx Depth Of a.. xx Seeded /Sodded xx Mulched Depth Over P Bed /Trench Center 3U - 7~ Bed /Trench Edgesd - rd Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) A LOCATION: HAMMOND.13.29.7W,I~W,NW 200TH STREET u~,^..~.E moo, d = d-) q,1 751 © oT ""If fl , r d Plan revision required? [3 Yes No 9 Use other side for additional information. / dvl~~- SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~O`jh1~~ ~eZ C_ ADDRESS SUBDIVISION / CSM# LOT # SECTIONt5 T g? N-R W, Town of / crrtrri L ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~n9Ly 1 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION tit :lc. Sr-.i- Z Sd `~~Sh Cc±rn kj~ Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Zcie /k,f Model# 1 Size Float seperation Gallons/cycle: Alarm Location- SOIL ABSORPTION SYSTEM Width: Length Number of trenches Z Distance & Direction to nearest prop. line: 4,,cr Setback from: well: ~House 32C Other ELEVATIONS Building Sewer ST Inlet: J~ 5~ T ST outlet: PC inlet j PC bottom 0-Z Li. / Pump Off Header/Manifold 15_ Bottom of system Existing Grade Final grade 'g- DATE OF INSTALLATION: 04 PLUMBER ON JOB: LICENSE NUMBER: p 1~ ~t~ O 00 / INSPECTOR: 3/93:jt 90 ~ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 .O.O E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P P. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ST L•,y • See reverse side for instructions for completing this application State Sanitary Permit Number If) 1191~2/ -9 T The information you provide may be used by other government agency programs The Law, s. 15.04 you (o de ❑ Check if revision'fo [Privacy rei& application State Plan I.D. Number L APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 3- 4 ~ri4 ~Iin, S T r N, R/ 7 E (older Property Owner's Mailing Address Lot Number, Block Nua+beF 0 ( Cit , State Zip Code Phone Number Subdivision Name o CSM Number/ C l! C_ 3 7 Ill. TYPE F BUILDING: (check one) ❑ State Owned ❑ It~r Nearest Road Public or 2 Family Dwelling - No. of bedrooms ❑ vdwn of Ai~;-/" GTE III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo e W 00- 6 " 70- too 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 ,;E 2. E] Replacement 3. E3 Replacement of 4. E) Reconnection of 5. E] Repair of an Ystem System Tank OnlyExisting 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 ;9$-eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet l.l' Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per. New Existin Gallons Tanks Concrete Con- Steel glass Plastic App Tanks Tanks / strutted Septic Tank or Holding Tank <owv G f cti v ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber X, ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) PRSW NO.: Business Phone Number: Plumber's Address (Street, City State, Zip Code): , IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit F22 (includes Groundwater [ate ssue g Agent Si nature (No Sta s) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination ~1~~ G-7 X. CONDITIONS OF APPROVAL / REASONS FOOR DISAPPROVAL: 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 may be 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. II. 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. PLOT PLAN SCALE V'= ~-~-c3a~ Rs s Crow mo o ~ ~0 p tT-/~ 0 S Lv~ ~p TG c, 1c / $*1 ' a--, tb .O' o~i Ntttl 30~ 1~ BOI~~ 6ft~fl~hA ~U ' o tir tn- 01 ~ \ `rGC /f `1 ~ ~ 6 6 User va/. a, y,s o , B•b' ~ 49 ? ~ec~ Q s-s EL - too. o' or,, tu'`tt1Gl1 6 , 3iu'`b~q, pL~snc Plot w/LttT)i. -PJ L~l~ZIU rW1Z l!v 1~M- ~MVD ~1 R~ 3~os. N1.9 $ s ktt)U S IE' MUST et PtT LLzkS - 2s' FVtOr .a C36 WtTLL " 5~ << . SEPTIC TANK &*PUMP CHAMBER CROSS SECTION AND SPECIFICATION, • f 4" CI VENT PIPE 12" MIN. ABOVE GRADE F WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER t FINISHED GRADE 4" CI RIESER W/ PADLOCK WARNING LABEL MIN. AB OV E G ADE 4" MIN. 18 " I N . 6" MAX. * * INLET GAS- WATER TIGHT SEALS AS- TIGHT: EAL : \A PROVED A S 4" BAFFLE I ALM JOINTS W/ CI CI PIPE B , PIPE 3' ONTO 3' ONTO -F- ~ ~ ON SOLID SOIL SOLID C 1 ' SOIL PUMP OFF ELEV. LFT. OFF RISER EXIT D PERMITTED ONL) IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: ~ • . 'r~ ou TANK_ SIZES: SEPTIC } GAL. DOSE VOLUME INCLUDING / DOSE GAL. F LOWBACK: 1.3 GAL. ALARM MANUFACTURER: s~ Fc~ CAPACITIES: A =ZINCHES =-3.. MODEL NUMBER: SWITCH TYPE: ,die.-c4eiy B = 2 INCHES = --3-), Y GAL. PUMP MANUFACTURER: C C P,- C = ! INCHES = / y / GAL. . If MODEL NUMBER: 4g- D = INCHES = 00-2 GAL. SWITCH TYPE: ► er c REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . _ f~•FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . • • • • • • • • + FEET FORCEMAIN X 1,LY FT/100 FT. FRICTION FACTOR . FEET TOTAL DYNAMIC HEAD = 11/•..7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH T ; WIDTH DIAMETER LIQUID DEPTH k ~6 7~ f~ ~h G~ t SIGNED: c LICENSE NUMBER: 1Vfg VjV DATE: / 3 7/8 6 1/4 - - HEAD CAPACITY CURVE 4 5/8 MODEL "98" I 1 o ® I 3 5/Fl 6 2 m - 6 O 1 10 1 1/x..11 1/7 2 5 0 0 30 40 50 60 - .S. WcI.LONS 10 2 240 RS 80 160 - 0 FLOW PER MINUTE - NOTE TOTAL DYNAMIC =off= pEA M EffIUENr =off= 12 CAPACITY HEAD uwITS(M# I FEET METERS GALS LTRS A 3/16 5 1.52 72 273 _ 10 3.05 61 231 I 15 4.57 25 's 170 20 6.10 95 ^ ` - 23' s."•: Lock VsNe LT FACTORY FOR SPECIAL APPLICATIONSavailable for controlling single CONSU stems, are available and Variable level float switches are duplex systems, and three phase systems. • Electrical alternators, for Double piggyback variable level float switches are available for • supplied with an alarm. controls. • Mechanical alternators, for duplex systems, are available with or variable level long without alarm switches. SELECTION GUIDE required. 1. Integral float oPsMb 2 P* MO&MOW switch, no external control variable vet. + H.P. 2. Single piggybe& variable level W switch or double P199Y6sc ' float wfth. Refer to FMO477. Standard all models - Weiht 39 lonbo~ selection 3. Mechanleal altemetDr 104072 or 10-0075. 'E-Pak*. u lox 4. See FM0712. for eorroct model of Electrical Alfemator.. activator, specib duplex (3) or N) Sim lox 100225 used as a control ModN Voffa-Ph Mode Am - 5. control switch M98 115 1 Auto 9 4 1 2 or or 1 2 8 3 , 7 6 3 or 4 8 5 Boat system. box, for watertight connection or wired-in N98 115 1 Non g •4 6. Four (4) hole •J-Pak. 1 00002. or duplex operagion, Egg Do 230 230 1 1 Non Auto 47 1 Or 2 1 2 8 6 7 6 3 or 4 8 5 simplex 4.7 7. Two (2) hole 'J-Pak'. for we~ oonne05on or splice. CAUTION 11"d Wiring should be done M s qu*IM*d protection devices licensed e1M ds As and sal ttl codes eheuld be followed McWdIng the end Occupild be Safety 1" lu Ad on Comtine6a+ SLaAM, FM0514; For intonne(ari on additional Zoeller p AN InMIM~ Of 00nt" and Health r 477e ~ W Alm FM0466: Msdunkel Axeme- most reeeltt Nstisnel EloWe Code (N!Cl Switches. - FMpN& AWm pa<~,kage, FM0513: S 77 Beds, F"7; snd Simplex ConNot BSc. (OSHA). pWA@ck variable FM". RESERVE POWERED DESIGN ign of every Zoeller pump. For unusual conditions a reserve safety factor is engineered A. W L TO: P.O. BOX 101 ~d . A~ otbi 7 ^sW 70 3XI ON~ LOW rr Pu~vw S#c~ /939 louisvM. KY 10118 ~ Q !1 »8.2731.1(800I9Z8•PIN~ PUMP !O FAX(M) 774.3671 A 7 rap 1 ~ M 1 y rF' I G M r ' y t I l 9 K TJO M 14 ~ n a f r J 1 I e-TAN i 1 1 l ~~ttK 1 ~ _ r ' C' It, W 1-6 ro w A tS it .A"` ~ 1 • I ~ _ ti T~ IF i N 04 a ~o c'I n V r" w a r •i x c) yC x a i e~ ~n qo Ci W, x 1+( eH H H U\ r . hh s _ rn C x b In 0 CA MEMO m .4 fn In 0 r e v .N Z O -3 O M CxI ~ O ~ > c- x f~I u+ o -4 CA r ~ W ~x i~ ~ 0 z Jin C C rr l ~1 ` ~ ~ Wisconsin Department Relations Industry, SOIL AND SITE EVALUATION REPORT Page 1 of Labo? and Human Relati 'Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S-T Q-~ l~ 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION -YV H N V Z~ GOW.. E N W 1/4 NIu 1/4,S 21 T -Z N,R 1-2 E (wj,~ PROPERTY OWNER':S MAILING ADDRESyS~ ` LOT # BLOCK # [SUBD.NAMEORCSM# ` Z~ C UI~fV _ CITY STATE ZIP CODE PHONE NU9MBER []CITY OVILLAGE (MOWN NEAREST ROAD ~ Lflwl JU j IN S 00 Z 1 ~ ~ t/ . 3 6`13 ~ y'l r'1 x.10 L.`~{ " L New Construction Use Residential / Number of bedrooms 3 j J Replacement [ J Addition to existing building [ J Public or commercial describe Code derived daily flow _ q SO gpd Recommended design loading rate b -r -bed, gpdV p ; b trench, gpd/ft2 Absorption area required 9 R0 bed, ft2 S o trench, ft2 Maximum design loading rate o. S 2 bed, gpd/ft o. b trench, gpd/ft2 Recommended infiltration surface elevation(s) °I q. S ft (as referred to site plan benchmark) Additional design /site considerations RiM wI M .@uD ~-Z' yc ' S' B@'D . ~bS P-Ur'1P Q F 11 1Z j . ESU arent material y Q V 4 G~J Flood plain elevation, if applicable N : N . ft = S uitable for system VENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL =Unsuitable fors stem ®S OU ®S OU ®S OU NS OU NS OU HOLDING TANK ❑S ®tJ SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bounclary Roots Bed Trench 1 1 ~O`t2 313 51 \W1 Sb1'c w.u`E~ cS - 10.y o.S Ground 3 1$-°lb 10 `1R S16 _ S o S~ - 0.43 elev. °1$ . S ft. Depth to limiting factor Remarks: Boring # Sr ~uti~2 3 1 >nS~ rnv'~1~ ~s u.y ~.s e 101f r 1 S S O S 1ti1 1 - O. 7 0. b Ground elev. °18 Z-ft. Depth to limiting facto y Remarks: T 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: y Date: CST Number: q ' S~ L1 --1 M00576 V1C1 - _ SOIL DESCRIPTION REPORT Page of' PROPERTY OWNER # PARCEL IA Boring # Ho Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Horizon Bed T t & in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Z $-Z`]-SyR 31~ - 6H91 Cs 6k U -f-v. Ground Z1-bS t0 `12 YlG S O S~j rn c - ° ° g elev. - b-5 0 ~o~•a ft. t/ 6 S-913 )o `i R v/y - S c~ sg l Depth to limiting factor .f O5 cl, Remarks: Boring # Ground elev. Q9f ft. Depth to limiting factorq Remarks: Boring # Y11 3 rnv`F~ G S - u Y o S 5 S~pllt N v fit- GS V ! ° S F-- yZ 9~; u O S9 Yv~ I ~ o-So.b Ground ' elev. °f9 -Zft. Depth to limiting factor Remarks: Boring # 1 S~ hn s 1~k v 'Fti` G S - o y • .S 0-8 ~~oKtL 3l~ kati??i _ i Z g-31 ~•S`tl'=. 31y Gas) lcSl~k vvty"~~. cs ~•V;o-S 3 3)-9e 1u-I2 sJ(~, - S O S5 I v• Ground elev. ~B ,Oft. Depth to limiting factor 7 °1 D? Remarks: SBD-8330(8.05/92) " PLOT PLAN Page 3 of 3 SCALE 1"= 30 1!3 S 1{pw~ 04KI ~ r a7 11I_ 0 / ~*1 - LsL. ~bZ.Oo~i NFL 30~ 1~BO11~ GR1Jlh~ ~ 10'' O 1 h . TZk~ . S,3 L'1. lop o v CrL 9 b o v~ el 9 9 ? N 3iU `tttA. PLO,9'nc Plot I-J/L T4. IZ-L a.e- ,N- l ~~Z 1V ~"~1Z 11 1 1'nkL PNuD 13.1 ~R 3~os CL9$S - ~-1vu s r-~vs1- et t~T ~Ctt-sr 2s_~ r~wwr I3 s G2~ y-1---9 (715 ) 4Z5- 6 9 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 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 S- 1 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION _T ~ H N v GOVT. I: N IA3114 NlU1/4,S 13 T Z? N,R 1-7 E (ore PROPERTY OWNER':S MAILING ADDRESS _ LOT # BLOCK # SUBD. NAME OR CSM # • Zo ~ c-UV rv _ CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD VCCD►,.nm1ly S ooZ is) 69y.369 !-~~y'1►~-~ tvo c.-,Zt" L" New Construction Use UQ Residential / Number of bedrooms 3 j ]Replacement Additi~rt to existing building [ ] Public or commercial describe - Code derived daily flow _ SO gfd Recommended design loading rate b - S bed, gpdAt2 O - _6 trench, gpd/ft2 Absorption area required 9 R0 bed, 112 -2 S O trench, ft2 Ma)dmum design loading rate n. S bed, gpd/ft2 Q. 6 trench, g 2 pd/ft Recommended infiltration surface elevation(s) 01 ft (as referred to site plan benchmark) Additional design/ site considerations VLTC,U°w1 M4_91J-0 • Y-_71 S'_.9M . 'Pf ' bu3E. P_lkiV> MPM VS - -IZOQQI . Parent material Lo t~w>,4 U v Strnn~ 6t?.J ~ Rood plain elevation, if applicable N . It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem RIS O U I T' ®S O U ®S ❑ U NS O U 0S O U O S RrU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Wftles Structure GPD/ft in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Bouxlay Roots Bed rertdt ~=1 t0`-t2 J!3 s 1 1W1 SVw_ m~j~>^ s - o•y o s Z -7-1P 7-S11 \Z S !y - 6tis~ c ~1~ rn U cS d `I U_5 Ground 3 18-01(l 10 `i R S J - S O S th - 0 1 U • S3 elev. M's ft. Depth to limiting factor Remarks: Boring # ~Sa >yyy 1 °-1 IoHtt 313 s 1Sti mv'~H cS - u.y ~.S Z 7_ °J 10`1 lZ S 1 - S o S y,q - o. 7 0, 5 Ground elev. °l8• Lft Depth to limiting facto Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: ✓l _ CST Number: q y, S M00576 _ -L 'of . •3 . PROPERTYOWNER V11~ Z~ SOIL DESCRIPTION REPORT Page PARCEL I.D. # GPI)/ft Depth Dominant Color Mottles Texture Structure Consistence BRoots Bed Trench Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. G~-g 1 1 cSbk ~►v~f-~ C o•y ~.s 3 Z`7-bS tv yR YlG ~ S d s rn ~ c~ - o U Ground elev. C1 g g 1 - a• S U 6 U 6 S -90 )O `1 R V/y< - S Depth to limiting factor Remarks: Boring # 6 U Ground elev, qq1 ft. : Depth to limiting factor, i Remarks: Boring # O-~ ~~ltZ 3 l 3 S ) m ~ ;:M 14 -L -1 .3 4 (Z ,..k..:;. Gr s~ 1 G v o.. S 3 qZ 98 Ground elev. 99-Zft. Depth to limiting factor i 7 .9 8 ' Remarks: Boring # 1 \I. 3 vn v 'Fv C S - o • ~5, ,5 i o- 8 t ~t t 3 S 1 1 w► s 1~k G,-s) ~cSbh w~v`s`h c.s _ u.~Jjo_s IN to 42 5 I (o - S O Sg ~ I ca,~ o•~ Ground 3 elev. 3 , Oft. Depth to limiting factor 7 °1 D 4 Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 3p ~-a-c~r l~s s how cn, I -h o 0 0 / $*1 - Lam, ~t) Z.O` o+v Iv 1v L 30' %NBOQ1E GTWU t ~ N l0'41 t1 • 112~b' . 6.3 e1 Lei c) o / v 61 3°~° / B. b' ~1 9 9 ? s, y N c~ 6` ~ Q!y - L-TL. \oo. o' o~., \0''111GlI IZ~ 9.8 \-L ~z s~ 1~3\~ NCR. S CW 1Z 11 1 1 ~1 kL Pwivb 01 t4-5y (715 ) 425-01,65 1400576 CST Signature Date Signed Telephone No. CST # C\j O1 FILED 6 OCT 2 2 1996 KATHLEEN H.WALSH 2 2 X95. 4Z Register of Deeds 551147 SL Croix Co., WI ~ ...........F1i:'N'sivu ;.liar:^.i• CERTIFIED SURVEY MAP Vrieze Farms, Inc. recr.:,ded r;:.~;ai Sri cfay>; 1 Located in the NW4 of the NW4 of Section 13, T29N,R17W, Town.:;pf,;~4emohd o St. Croix County, Wisconsin. f~,, Owners address: 20 8 L~. "E" aZa Baldwin, Wi. 0 3 W 54002 V1 h ~ ~ N °v ? y UNPL A T T ED LANDS N89050' 5/ "E 595.05' 3 3.0 562.05' I I33' 33' i W I ° v J LOT 1 I. O I I h ` 313,537 SOUARE FEET W (7 I98AC.) INCL. R.O.W. = I I 295,821 SOUARE FEET Qf I ~1 I m (6.791 AC. I EXCL. R. O. W. ° Q to Q1 ZI W I ~o co ~j: u I Q 41 I WI V ( h IAJ 0 3 W v C. yi 3 m: W h I ~f It h o QI QI I i e cLI ~f p (p ~ 3 (n Z~ I O O m JI JI {ZI 2 2 m; o ° (v~ I 0 INDICATES I"X 24 IRON PIPE WEIGHING 1.68 L BS. / L / N. FT. SET. I I INDICATES SECTION CORNER MONUMENT (AS NOTED) I 3.00 540.08 I S 89 ° 50' 5 I" W 573.08 3 UNPLATTED LANDS CERTIFIED SURVEY MAP VRIEZE FARMS, INC. Located in the NW 1/4 of the NW 1/4 of Section 13, T 29 N, R 17 W, Town of Hammond, St. Croix County, Wisconsin. DESCRIPTION A parcel of land located in the NWI/4 of the NWI/4 of Section 13, T29N,R17W, Town of Hammond, St. Croix County, Wisconsin, further described as follows: Commencing at the NW corner of Section 13; thence S00°37'44"E 523.60' along the West line of the NW 1/4 of said Section 13 to the Point of Beginning; thence N89°50'51 "E 595.05'; thence S01°42'56"W 537.10'; thence S89*50'51 "W 573.08' to said West line of the NWI/4 of said Section 13; thence NO0°37'44"W 536.84' along said West line of the NW1/4 to the Point of Beginning, containing 313,537 square feet (7.198 acres) more or less and being subject to easements restrictions and covenants of record. Bearings referenced to the West line of the NWI/4 of Section 13, assumed S00 37'44"E. State of Wisconsin) County of St. Croix) I, Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certify that by the direction of the owners, Vrieze Farms, Inc., I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the ordinances of St. Croix County and that this map and description are a true and correct representation thereof. GENERAL NOTICE STATEMENT Each parcel shown in this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing and parcel contact the St. Croix County Zoning Office and the appropriate Town Board for advice. This instrument drafted by Joseph W. Granberg. Dated September 25, 1996. MURPHY LAND SURVEYING W9302 800TH AVE. River Falls, WI 54022 CON M • ~ 8TC- 100 `y This application form is to be completed in full and signed by 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/contractor, (spec house), 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 ,JewN */F Z'E_ Location of propertyl(J_;ci 1/4 Alxy 1/4, Section /.3T 27 N-R /7 Township 4vPb Mailingaddress ;30f4- C%`i' A'o/of- , wiz Address of site 19 7 Do c5~ Subdivision name Lot no. / other homes on property? Yes No Previous owner of property //vrN,~.vv Total size of property 6.79 ,fC, Total size of parcel ? y Date parcel was created 0(,-7- 7,7-, `lG Are all corners and lot lines identifiable? ✓SCes No Is this property being developed for (spec house)? Yes P,-' No Volume S and Page Number l/Z 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 AND 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. __3 3/ -3 911" , 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 f the County Register of Deeds as Document No. ~ Sign re o Appl' ant Co-Applicant Dat of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER J,-W j 1//2/ /e ZE Fy MAILING ADDRESS -2-034, C dUNTif a O D PROPERTY ADDRESS q27 (location of septic system) Please obtain from the Planning Dept. CITY/STATE 13ACAWI u , A'~r 5wooz, PROPERTY LOCATION /Uw 1/4, N*/ 1/4, Section 13 T 21 N-R 7 W I TOWN OF Mow O ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP 50# 97 , VOLUME ` AGE ; LOT NUMBER I 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 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 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 ye iration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. I I STATE BAk OF WISCONSIN-FORM 3 OU11 CLAIM DEED Ii Yot 533 Pa"E X12 THIS SPACE RESERVED FOR RECORDING DATA 3313r78 -1- - , II BY THIS DEED, Vrieze t1;~k~ Et;~gPne Vrieze tttOISTERS OFFICE and Jean Vrieze, _usband and wife as joint tenants and each in their own right _ Grantor-, sr• CROtX CO.. WIS. Vrieze Farms, Inc. Recd for Re=d this--~- quit-cleime to Feb aI' day of _A.0.19_T6 r Gr ntee_, for valuable consideration Sixty-Four raousan! and no 100 --A& M. 64 000.00 1M11 irs the following described teat estate in St. Croix County, Slats of Wisconsin: (Rellttst of be*& PARCEL NO. It The North Half N) of the Northwest Quarter RETt1R o NW of Section 13, Township 29 North Range 17 West, excepting therefrom parcel number one the following des- cribed parcels Commencing at a point 630 feet East of the Northwest corner Tax Key R of the North Half of the Northwest Quarter Section 13, Township This is homestead Property. 29 North Range 17 West; thence South 490 feet; thence East 380 feet; thence North---•I490 feet; thence West 380 feet to place of beginning. PARCEL NO. 2: The South Half (SJ) of the North Half (?421) of the Southwest Quarter (SW}) of Section 12, Township 29 North Range 17 West, excepting from said parcel number two the following described parcels Commencing 1405.35 feet North of the Southwest corner of said Section 12-29-17, thence East 449 feet parcel with the South line of said section 12, thence North 230 feet, parcel with the West, line of said Section 12, thence West 449 feet, thence South 230 feet, on the West line of said Section 12 to potint of beginning. PARCEL NO.3: The, South Halt (Sz) of the Southwest Quarter (SW}) of section 12, Township 29 North Range 17 West. All of the above and foregoing property being subject to right-of-xay and road and t utility easements of record. -jam---" EXEbM Executed at Spring Valley, Wisconsin this 30th day of January . 19 76 . SIGNED AND SEALED IN PRESENCE OF 1 (SEAL) es eft riez SEAL) Je Vrieze 4 ✓ (SEAL) I (SEAL) Signatures of