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HomeMy WebLinkAbout022-1021-70-100 n co O m n O m_ F d C c m _L y O N C 0 0 <1 s OD ] Oo to O "O C 7 N N rr C` co N 'o oo .7 a- =r :z CD CO s (D 0 5- ? 0D o O :3 3 En L~ ~ m J _ O (O_ -D°g 3 N fD N n NO JO C.0 0 3 7 N O * O O C -4 M m c co a o (D ( D C n - N N G o o ~ 3 ~ ~ i C, 0 r-j (D A NO v CL Z 8 r O 4 (D c .OI-. c !Y "Wa O O O ev U) cn Z o=r • c ai N y o o D 3 Q T 0 aCi co CD fD N CD D r I N ~ = (D ~.I (O a g 3 d a 4 N pz zz~ ° D D o (~Vy N AO? w rr CL m n ~7 N • N C CD N ~ •P Z A I .'p z o 3 I (n N co w m a Z a cn 00 z A O II O O N O O CO O O 3 Q CD N - •o C C N d j U7 a N> G N (Q N d a. O 0 -4 N ? O T O P• O. to O N> N N O 0 3 i O M O j a n N N N O Q- 00 - CL m N ?3 W~ C CD S N O C N O < n 7- (D 3 3 n p O j n w v d 3 Q CD 3 c o v Q <ms>- ? 3oCD y < 0) CD CD A cn. N N O C) O o N m tj o m< ID . p~ a N D M. Z O C O. O. W Q a 5D N S y N v' ~O N N d p. "-0O a (D N Q CD O- O O C N T d t-h , N N O' < S C 7 N =r n (D o Z O S O a N F m i m a cn =3 C Y f to O ° a O (D C) (0a -7 0-coo 08 -a8,t~'jgas ~-~a STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~,,'~Y ~~,oo@vT ADDRESS i 9 SUBDIVISION / CSM# # SECTION.___e_T ,2¢ N-R-"Lir-W, Town o Z411-1 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Gv✓ /gar j° poi INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 4 BENCHMARK• Sa n►_G l ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_ Liquid capacity: llc d Setback from: Well House Other Pump: Manufacturer Model Oda # S- Size Float seperation Gallons/cycle: Cc3 Alarm Locations SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: 4.' Setback from: well: House-&C<2'_ Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: ~~Z PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93: it ` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Salty and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar8947 i Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. 7 Permit HUPPERT , NaMARK 14a ~Yi~J~gg_ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: 11V C1~liV Parcel TdV!f_.1021-70-000 TANK INFORMATION ELEVATION DATA A9700287 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark loo Dosing Aeration Bldg. Sewer /S//J- C1 l~ Z.6 y Holding St//Of Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Header / Man. U~• Aeration NA Dist. Pipe Holding Bot. System 46 0 7, PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ? / Model Number GPM 2(_ - tr ^ r y: TDH Lift Friction System TDH Ft C' oss Head _7 Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER model Number: System: 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/TrenCla~Center Bed /Trench Edges Topsoil E] Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION.: KINNICKII~NIC 8.28.18.125A,SE,SE 1079 COULEE TRAIL LOT 1 Plan revision required? ❑ Yes ❑ No Use other side for additional information. 7 SBD-6710 (R.3/97) Date Inspector's Signature Cert. IN ADDITIONAL COMMENTS AND SKETCH t ' 3 t SANITARY PERMIT NUMBER: Safety and Buildings Division - SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 r Attach complete plans (to the county copy only) for the system, on paper not less County ~q than 81/2 x 11 inches in size. 0 See reverse side for instructions for completing this application State Sanitar Permit Number 9~lq/ The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location aV yt, eV7" A 1/4, S T.9 g' , N, R /,f E (or6p Property Owner's Mai ing Address Lot Number / Block Number sv -2210' ~ a 1@ Ai d . / Zip Code Phone Number Subdivision Name r M N mber City, State is-y'aaA. ) 05 rq ja. _316 7 II. TYPE F B L ING: (check one) ❑ State Owned o qty Nearest Road ❑ Village r ; Public 1 or 2 Family Dwelling - No_ of bedrooms Town OF . a.~ ck~'ad~ a LL e III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo /0 C) 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 Q 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. Eg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only - Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage 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 YS~ Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation D CJ Feet 9g~ ~6_ Feet VII. TANK Ca in aacltlto s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New I xistin strutted Tank Tanks Septic Tank or Holding Tank C.- DA rv~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber at t- .5.- ! 19- ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatur : (No Stamps) MPRSW No. TBusiness Phone Number: f/I a`aG svc 1 S~ - !D2 Plumber's Ac dress (Street, City, State, Zip Code): 1,67d 4rc 0 get A 5 we IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee (includes Groundwater ate Issued Issuing Age Sig re No Sta charge Fee) , Sur Approved ❑Owner Given Initial ~j CX (~cr Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber 2 t INSTRUCTIONS a 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, 608-266-3151. 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, pumpAiphon 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. IVIP, 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; replacerent 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. I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations July 14, 1997 1340 East Green Bay Street SUITE 300 Shawano WI 54166 I WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE_ PLAN S97-30723 FEE RECEIVED: 180.00 HUPPERT MARK SE,SE,8,28,18W TOWN OF KINNICK,INNIC 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, , ~1101 X n' ~4- REC.F_IVF Keit Wilkinson ca g w0 Plan Reviewer Jill " .r Section of Private Sewage ST CROIX 715 524-3627 S' COUNTY ZONINGOFFICE SBDA-6928 (R. 10/84) Page of 6 . MOUND SYSTEM R~C FOR sqF ✓tz A 3 BEDROOM RESIDENCE Fj y 19 ~Bl 19 o~ , rv ~ l l ~ - S'tT' lid 19,.E ~ nib I LOCATED IN THE SE 1/4 OF THE SE 1/4 OF SECTION 8 TSB N, R 1$ W, TOWN OF V z_. t JQ F C ~ 1C , S 7. <2A _ yR)4 COUNTY, WISCONSIN . S97-30"723 INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR PAKTA w o a o~ti`rii CondM A pnn PREPARED BY $ ow:+A~e+rro~ L~IECEF E:FZ SO I L . TEST I htG ~aES z NDs>=FZV ~ cE COJys'ti ••'0 F.O. B01 74 421 K. KAIK ST. ARTHUR L • WEOEREII RIVET? FALLS. YI 54022 = o-s,sr r.LSWORT". WIS. 115-42`.r-0Ib5 1 ~s1G14 11► ilk JOB NO. OM Lq4 "gi w~l a 4AI O WHO" 3 i. ~3 PLOT : PLAlyL _ Page _ of _ Scale 1"= ~v L) ' 6s y A o ~ v l'141S F~1Zg~ ~ IN el °l4 s? - ? to'oGy"P~e .I B•Z J J6o op'` 96. - b COhllavyZ ~._Q~ LT_ 98.0 '4 tt V, L ~Co BE PvT LAST 50' r-A-LOH MINI vp t :tip FYT \-"NAT 2S' V--k" zS , NOTES: -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install.4" observation pipes with approved caps. ( Z required) 4. -Septic tank to be \WC0 /6 Sp gallon capacity manufactured by M l b WC~S~ PAS. ) N C, 5. Bench Mark IEL loo o' <:*j `mlp. of 31u` -bt-N '-~1NwftLL.- Pt RE 6. Divert surface water around system to. prevent.ponding at the uphill side. Page 3 -Of b Approved Synthetic Covering rysTM c 33 Distribution Pipe Medium Sand _ H . G ' Topsoil ~ Eled. Oar" 3 E D b gj % Slope Force Main Plowed Trench of V'-2k" From Pump Layer Aggregate Undisturbed D 1 , o Ft. Soil E 1.V Ft. Cross Section Of A Mound System Using F O-% Ft. I Trench For The Absorption Area G 1•a Ft. A S Ft. H I- S Ft. B -1 S Ft. I 1S Ft. Linear Loading Rate= 6.13 GPD/LN FT 1 Ft. Design Loading Rate= 0.3 GPD/SQ FT K lo•S Ft. L 96 Ft. 444- #e Position of Force Main W 2--7 Ft. 14 L 8 K ~➢tIIin r A. T ~c- w " Distribution Trench Of 2 - 2 Pipe Aggregate 1 I Observation Permanent Pipes Markers (Anchor securely) Mound Using I Trench For Absorption Area Page q Of Perforated Pipe Detail 0 End View , Perforated End Cap.) b``y PVC Pipe i . , G z, Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cap P ~'4 * PVC Force Main Distrioution Pipe Last Hole Should Be Next To End Cap Distribution Pipe Layout p 36•ZSR. X 30 Inches y 30 Inches Hole Diameter 1/Y Inch Lateral O V Inch(es) Manifold Inches Force Main Z Inches # of holes/pipe .3~t 1S Invert Elevation of Laterals 'J8.S Ft. 1S X 1, • 1`t •SS XZ~ 3 S.1 G~M'1 Place lst hole ~Sa from tee with succeeding holes at 3p`' intervals. Last hole to be next to the end cap. i i Combination Septa- c; Tank and PdMP CHAMBER CROSS SECTION AMD SPECIFICATIOUS ' PAGE 5 OF C0 WEATHER PROOF -VENT CAP rAPPROVED JUAlCT101J 90X `1"C.I. VEMT PIPC LOCKIRJG 10' FROM DOOR. MAWHOLE COVER w1'M .rINDOW OR FRESH A.~INTAKE c P 9-2 t t 'fAAl ~ MIIJ. . I ~ IeMIU. PROVIDE I - IA! LE T - ~ AIRTIGHT SEAL I I I 3gFF~~S I I ( APPROVED J01103 APPROVED JOIM-r A I III W/C.I. rIPE4FvC W/C.T. PIPEaR Tank construction I I ALARM shall comply with _ I I I ILHP ('13.15 and 83.20 b I I I o1J C I I ~R Ll S I CLEV. FT. PUMP,- --j1_ OFF D COIJCRETE ~ ~Y•oo' BLOCK 13" APPRa'£: R15ER EXIT PERMITTED OWLS IF TAWK MAWLIFACTURER HAS SUCH APPROVAL. BEDOIN4 SPECIFICATIOKIS SEPTIC f DOSE IJUMBER OF DOSES: 3'SS PER D" TAMK MM.IUFACTURER: TAWK 51ZC : ZC~UD y GALLONS DOSE VOLUME 1 INCLUDING 6ACKFLOW: \ 3 GALLONS ALARM MAUUFACTUFLCR: S'S' ~~ISTt'~' c _ MODEL NUMBER' CAPACITIES: A= lg IUCHES OR b( GALLOIJS SWITCH TYPE' B= z IUCHES~ DR =L- G(~LLOA15 PUMP MANUFACTURER: ~oV bS C= p I1J[HE5OR S3 GALLO►J5 MODEL NUMBER: 381 1 ~D S D- 9 INCHES OR \y53 GALLONS SWITCH TYPE: Y-1 c MOTE: PUMP A1JD ALARM ARE TO bC - MIMIMUM DISCHARGE RATE 35' 1 GPM INSTALLED OW 5EPARATE CIRCUITS VERTICAL DIFFEREMCE CETWEEIJ PUMP OFF AL.10-015TRIBUTIOIJ PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE 2 S~ FEET -I- bO FEET OF FORCE MAIN X x`4.3 FYoFLFRICTIOU FACTOR. 3'89 FEET TOTAL DtI JAMIC HEAD = Z~' ~4 FEET Pump chamber DIAMETER 3$" INTERLIAE. DIMEN510Wf Of TAQK. LEW&TH - ;WIDTH _--;LIQUID DEPTH BOTTOM AREA 231= GAL/INCH AS PER MANUFACTURER ~-1.'~ GAL/INCH Goulds6 o~ Submersible Effluent Pump EP04 EP05 3871 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment • • EP04 Single phase: 0.4 HP, points. Heavy duty sump 115 or 230 V, 60 Hz,1550 models include Mechanical • Water transfer Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, Pump: EP04 built in overload with ■ EP04 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi-open design 3/4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Q. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding - 0 Optional 20 foot ■ EP05 Impeller: Thermo- Discharge size: l 1/z" NPT. plug. P plastic enclosed design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with end in "F" or "AC".) rotary/ceramic-stationary, three prong grounding plug improved performance. BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104°F (400C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series . METERS FEET stainless steel. 10- • Capable of running dry without damage to s 30 ~-5GPM - components. _ Pump: EP05 8 251717 • Solids handling capability: 0 25 maximum. a 7 W • Capacities: up to 60 GPM. X s 20 Z.o' 1 • Total heads: up to 31 feet. • Discharge size: 11h" NPT. Z 5 - - - - - • Mechanical seal: carbon- 0 15 rotary/ceramic-stationary, _j 4 BUNG-N elastomers. o EPOS, Temperature: 3 10 + 3s•1 1040F (400C) continuous 140°F (600C) intermittent. 2 i 5 1 0 00 10 20 30 40 50 GPM L L 0 2 4 6 8 10 12 m~lh CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 PlIA71 Wisconsin department of Industry, t c3 SOIL AND SITE 1, u Labor and Human Relations , - Page ; 01% Division of Safety and Buildings in accordance with s ALH0 83.09,. V1 & Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plant . Cou p/•x Include, but not limited to: vertical and horizontal reference point (BM), direction hand g , percent slope, scale or dimensions, north arrow, and location and distance to ne r' ad. R, el LD. # •.o ~'~~~fli►/~ r Date APPLICANT INFORMATION - Please print all information. 'Personal information you provide may be used1or secondary purposes (Privacy law, s. 15.04 (1) (m) . Property Owner Q Property Loca o Govt. Lot 5~ 1/4 5,,e- 1/4,S ? T 28 N,R If E (or o Property Owner's Malting Address Lot # Block# Subd. Name or CSM# ///z /pD ff" ffv-2 , Cs~I 10E1vv1106-- City State Zip Code Phone Number Nearest Road ~vI3ERTS Cv/- 51lo2- z..- ( 71.x) 7V 3 5;'o7 ❑ city , Village UR-ITown Co vlee- T.Pf,L 93 New Construction Use: 211esidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow &00 gpd Recommended design loading rate • '9' bed, gpd/fl2 `_4 trench, gpde Absorption area required D 0 bed, ft2 SOS trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 • •7 trench, gpd/112 Recommended Infiltration surface elevation(s) S'am' ?J It (as referred to site plan benchmark) Additional design/site cons aflons Tom' SUlT~I'b/E D,,Ly p)e MOl wig 'j~/PE `s~/sT-E~ls Pare nt material jr 1 ' ShOW5 +y UV73011 -c- 1V/1~/'v Flood plain elevation, if applicable N~ it L O ~1 v E S = Suitable for system conventional ~M-,ouunnd In-Ground ,P~ressu e AT-Grade System in,Fillll Holding Tank 1 ❑ S in L~'U E] S U U - Unsuitable for system ❑ S L~J U 'u' S ❑ U ❑ S L'o ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench D -1/ /o YR :y2 A;YR 2.-f 5 h,~ /w►fR C S 3v'F S ; . Co 2- 911- / v Y -t7/ 2- /f sh/C nW fR GS I Uf • y . 5r Ground 2 .5 elev. 3 17-31 Id 31S IN 7.5 YR 51& Depth to , limiting factor r~~s Remarks: • Co Boring # 0-5' /o yie 2f 5he fk GS L U .5 2- /0 Ze /0,4W Ar's-he -6e C5 lPf -Y: -5 Ground 17 -3 4( /10 YR '551'1- 21,19 S AM fle es, /P 7C .5 .6 elev. c di' S~ L 2,1* s! . s ; . G 7, Depth to limiting factor 3 In. Remarks: CST Name (Please Print) Signature " Telephone No. '9 a y e tZ_-r 1a L(3 R i 3 9Co - d f9?5 Address Date CST Number rs. 4011 PROPERTY OWNER 61' SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Go / ( l eeye (~f C~ Boring # Horizon Depth Dominant Color Mottles FGr tructure 2 In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots . Sz. Sh. N" Bed Trench 3 w / a-~ io yie z/Z o ,y s hXAll AR cs 3vf , s ; . 2 is _ 3 . d s,d ,wt s / . y ' Ground 3 -3 313 eMIJ .2f shll elev. 7C CS , - t!o /o y 3 ez 57/L- z s Depth to ? S yle 51 limiting factor In. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure In. Munsell Qu..Sz. Cont. Color Texture Gr. Sz. Consistence Boundary Roots PD/ Bed Trench Boring # Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in' Remarks: a —- -- co 0 , / ,s_________—_____________0 o 1 0 rn In �, o -1 as\ w A o -41 11-7 t � L 1/0� Z 1 G Nk c N d y a u' 2. o N pe ro o m ,. i ID 1 N ch C W F F. cz,c r-- C c 4 k o y km 13 mv\ N 'ts C) f V\ t —1.: ../Z, -.............._ a m .� cu t \, I o 0 • . (.......) U CERTIFIED SURVEY MAP CORDON A, TRUESDILL JR. Located in the NE1/4 of the SE1/4 and the SE1/4 of the SE1/4 of Section.8,T28N,R18W, Town of Kinnickinnic, St. Croix County, Wisconsin. 0ti:ners address: 1112 100th Ave, Roberts , Ili, 54023 Dated May 23, 1996. This instrument drafted by: ?' 11•,G', 61- I vzvpidi r reD LAND. , 3, „ I S I/• 36' j.r./.�� w ( 1 _Z------------- ------ .797. 7I ' •46 4.58' ,J' J.t' 1 W • r a O J W I W kJ o 0 ; ct et z. I.MO QV l> O ` N'' a Q 4. o, O e h in ! I • ar J O 1 w , m I y m �t , , 3 o, • k :h (1.11 ? t., 1. :`. •Q L l a ? 1 W 4- er ft,, x • 3 ` < , e cif J Q O O q ►, a Ck 1. J Q t' `n O c 4 W a h vl ' II v °; 'K I o, W `t I O W 1 k z H (0IIqr' I b W)1• I31 a ti • o\ N Cr. ...ji 4 N 04' 55' zz"E _ 472 15 ' '" . v. M ZI t .! 439.01' — Q. • 3 �1 I kit I ct ti wI c - w 4kJ et " JI • , _ - �.� o 1. gi I 4, 44 N �I N. I k, is: �, -iI h / ®, c3/7/ a _ W L. m V1 7 `t o 41 J • ee, „, . : } ,.. r,i // 1 :.) „.. _ .. � Q � ht 3 / p 41 "� I Wa h � / / / J O frl INJ O Ct vt . .. / / cn n Ill /1 h 'NW o d . q Lh N \ ; . ,:-. ...,,,______ IN r / '.40 / a 500.20_ ____.. t • $ ' \f `i 4/.3® ---i__ NCI" 45 ' 52 ""£ 541.58 ' xZ rr�. faFt /!? ‘c0ONs, p .mot' / for T L I N£ /r ..1.,0,,.....,.•,YL h h POINT OF BEGINNING op THE FED/e• JOSEFH�V m UNpLATTEO _LANDS_ * GRANBFRr, s 2zs5 n wi Mc/CATES S-CTIO.N CORNER MONUMENT • 1 o (45 NOTED 1 -7•a nA 4 m Y 0 INDICATES 1"X 24 " IRON PIPE WEIGHING .1,1 o Q N � 1,68 L B5./L /N. Fr. SET. �.5n' -- - INDICATES FENCE REMNANTS Joseph W. Granb'r2, ro tx Matt" r" I r00' SITE : 1 OF 2 Regist.ered Land Surveyor � w a 25• 50' roc). 'Q0' J00' m f PROVED s FILED ,o AUG 2 9 1996 s AUG 2 7.'%. A7 KATHLEEN H. WALE{ Register of Deeds SL Croix Co., WI S' CROIX COUNT( Comprehensive Planrlit 54886 ti Zoning and Parks Committer CERTIFIED SURVEY MAP If not recorded GORDON A, TRUESDILL JR. within 30 days of apmoval date Located in the NE1/4 of the SE1/4 and the SE1/4 of the SE1/4 of Section 8, T28N,R18W, ToWfiro'fal shad be Kinnickinnic, St. Croix County, Wisconsin. Owners address: 1112 100th Ave. Roberts, Wi. 54023 Dated May 23, 1996. This instrument drafted by: J,W~,fq~: "Revised this 19th day o Juiy, 1996." 6' I PL A T D TE _ L ANDS I 3. St//° 36' 35 "W 497.71 I ` 33' 33' 464.5,9'. II I W I ~ \ I I 1 " 2 V o M~ MI~ I c Q o W W ~ I e N N M I . I O IM ~ ~ h ` W, m y a iv " W i~ yl I O W a 0 3 W _ ~ ~ © a' ~ O O Q j ~ -4 o I W Q~ I W O W Q I I ~ I O' a0 Q 2 k m O~ vl ~ ~ h k Q m ~I I IRf m J~ J e Ni04-55'22"E 472.15' W Vf W ZI © X' f 439.01' h " 3 2 ~I I WI I I O ~ ~1 °u ? v~ W W N Q~ ;gy ~p1 QQ Q1 ~I to m CSI O 'j © W ' e M Ji tk o a / / d o 3 a i O~ `s Q W. hZ a O o ohm J oN~ a 3Z hp I e / co ~ v Q W O m / S T C - 100 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 4 Location of roperty N _1/41/4, Section/ T Ra W Township /~(j s C, n , •c. Mailing address N/7-0 iV C4, 4 Address of site /S 9 ~n ~-d• ~ ~ 71-,~ Subdivision name ~:_S °4 ~JD~• ! f C Lot no. other homes on property? Yes -No Previous owner of property Total size of property 3. (a L4 Total size of parcel Date parcel was created Are all corners and lot lin`s identifiable? ~C Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number '~51 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. 31;"% , 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 the County Register of Deeds as Document No. n In wit r 1. V1 ignature of UP-1-1crant-,F Co-Applicant Date of Signature Date of Signature IF , r S'I'C-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County M}k.. rC. t-a e t a~ I➢ , OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS / G? ya .zo✓ L ,~t t L ec (Iocat i of septic system) Please obtain from the Planning Dept. CITY/STATE. t - PROPERTY LOCATION 1/4, 1/4, Section TN-R_1`W TOWN OF ST. CROIX COUN'T'Y, WI SUBDIVISION LOT NUMBER A_ CERTIFIED SURVEY MAP , VOLUME, PAGE 315 , LOTNur*iBER__ 1 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 heeded 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 year expiration date. SIGNED: DAIT: St. Croix County Zoning Office. Government Center 1101 Carmichael Road Hudson, WI 54016 11 /93 !a'0 Pe` VOL J.?50PApE294 . 560'7 WARRAN'T'Y DEED DOCUMENT NO. RE GIs'! 1. f ST. CROIX CTY., This Deed made between GORDON A. to TRUESDILL a/it/a Gordon A. Truesdill, Jr., a Single Out! 8 1997 man, Grantor and MARK A. HUPPERT and HEIDI J. # 11:00 A HUPPERT, husband and wife as survivorship marital property, Grantees, A.prawdoeosn Witnesseth, That the said Grantor conveys to Grantees 'the following described real estate in St. Croix County, State of Wisconsin: Tax Parcel No RETURN TO: Z6 a / Lot 1 of Certified Survey Map filed August 29, 1996 in Vol. 11 of Certified Survey Maps, pop 3157, as Document No. 548864, being a pert of the NE 1/4 of the SE 1/4 and a part of the SE 1/4 of the SE 1/4 of Section 8, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin. T7WER This is not homestead property. 3 FEE Togedwr with all and singular the hereditaments and appurtenances thereunto belonging, And wad that the We is good, indcfcml* in fee simple and free and clear of cc-umbrances, and will warrant and defend same. N Dated this --day of July, 1997. Y (SEAL) Gordon A. Truesdill &Wa Gordon A. Truesdill, Jr. STATE OF WISCONSIN AS ST. CROIX COUNTY p Personally came before me this ~ day of July, 1997 the above noed Gordon A. Truesdill aWa Gordon A. Truesdill, Jr., to me known to be the peon execu foregoing instrument and acknowledged the saw. Notary Public, Sta of W' ns:n My mission expires: THIS INSTRUMENT DRAFTED BY: Robert W. Mudge Brenda Poulin MUDGE, PORTER, LUNDEEN do SEGUIN, S.C. Notary Public 110 Second Street, P.O. Boa 469 State of Wisconsin Hudson, Wisconsin 54016 i