HomeMy WebLinkAbout034-1034-90-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS 7e
SUBDIVISION / CSM# LOT #
SECTION 1-.4-- T~N-R 1.5- W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYS+¢~EM
1a 7-1'
~D ~o~Ce IrlAi/V
1~oc~Nd ~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: -17
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:' L4quid Capacity: ~o2D0"~.4
- io!
Setback from: Well House Other
_
Pump: Manufacturer 0 rf G.
~r cl Mode l#4.,Di/Size p
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length c s Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House lOther
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
i
Header/Manifold Bottom of system f
Existing Grade
/ Final grade
DATE OF INSTALLATION: fl - f- 9
PLUMBER ON JOB:
/fX
LICENSE NUMBER: /0'
INSPECTOR:
3/93:jt
WisconsiryDepartment of Industry, PRIVATE SEWAGE SYSTEM County:
i,abor and Human Relations
Safety INSPECTION REPORT ST. CROIX
and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289340
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
STEVENS, GARY SPRINGFIELD
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
034-1034-90-000
TANK INFORMATION ELEVATION DATA A9700156
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosi ng
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
Verit
irIto ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Mode 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 /Trench Center Bed /Trench Edges Topsoil E] Yes E] No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SPRINGFIELD 15.29.15.239B,SW,SE 3070 CTY RD E
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
f
Safety and Buildings Division
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 County ,
than 8 112 x 11 inches in size. e O /
• See reverse side for instructions for completing this application State Sanitary Permit Number
02 g'~s-fVO
The information you provide may be used by other government agency programs ❑ Check I( revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Propert Owner Name Propert Location 9 r
e e- tV ,SL&)1 /4 RF 1/4, S /S T Nr R W
Property Owner's Mailing Address Lot Number Block Number
o ~d c a/ i
City, State Zip Code Phone Number Subdivision Name or CSM Number
G c ivoo d T lv~ yo /3
U. TYPE F BUILDING: (check one) ❑ State Owned ❑ y TNearest Road
❑ Village
E] Public 1 or 2 Famil Dwellin - No. obedrooms Town of -s /iY /'D a~ 1,15
III. BUILDING USE: (If building type ispublic, gcheck allthat apply) Parcel Tax Number(s) q►
1 ❑ Apartment / Condo
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. Q~ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
_____System ________System_----- _______TankOnly- 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 410 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
/p® - A0 D Feet D,d• 7Feet TANK Ca acit
VII. INFORMATION in galtos Total # of Prefab. Site Fiber- Exper.
Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App
New Existing strutted
Tanks Tanks ~-ry
Septic Tank or Holding Tank X 2 do ® ❑
Lift Pump Tank /Siphon Chamber ✓ o ® I El -1 ❑ ❑ El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb r' Signature: (N Stamps) MP/k4~ No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
a ~ At/~~ wo®~ e " of
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Indudes Groundwater Date Issue Issuing Age t Si nature (No nips)
/
Approved ❑ Owner Given Initial Surcharge Fee)
A,?
Adverse Determination v -
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
1
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.
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; streamsand 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.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Commerce
May 9, 1997 2226 Rose Street
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S97-40436 FEE RECEIVED: 180.00
STEVENS, GARY
SW,SE,15,29,15W
TOWN OF SPRINGFIELD 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,
00 Dennis Sorenson
Wastewater Specialist
Section of Private Sewage
(608) 785-9336 -A 00UNN AGE
SBD-7997 (R.11/96)
Page of 6
MOUND SYSTEM RECEIVED
A y BEDROOM RESIDENCE MAY _ 6 1997
SAFt I v ~ BLDGS. DIV.
LOCATED IN THE 1/4 OF THE S~ 1/4 OF SECTION ~S TZ`l N, R 1S W,
TOWN OF S~2 L I► G F L ETL-V~ . ST <j," X COUNTY, WISCONSIN .
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
G Pc 2`( 5`T'EV ~ S_
30-1 D C~vIV`N( " N
PREPARED BY
WaaaFtER SO 31 L TESTING Log„
AtM .
DES = ~nz s~~v z cE SCCNSti
P.O. B01 74 421 N. MAIN ST. 'S
. ARTHUR L
FP
RIiIER TAUS. NI 54422 WEGEAE~
0.915
71J~L.I-111 OJ i l1LLSWUATK
$ WIB.
~NBBN
JOB NO. S
PLOT -PLAN Page Z- of 6
Scale 1"=wp' x t,~,g~,L
S 9 6 - L~ tip.
L4 Bb"
n_
OF yIP~C
LL
PRIVATE SEWAGE SYSTEM
Conditionally t° °F WrPUC
~ / Cr''l IN . ~Z" Ctf~>
'Utz
A P 10 V E D oft lies vLA rV.
\ DIVISION 0~ ~ETIf AND BUILDINGS
y
SEE CORRESPONDENCE ~tk) 6 a -tiuy'_
~3. 1 'ic of t3.Z
-z2lpvo F.M 6 10
l cap ~3~j S
ro
I
7 ly 87^
IN I
A~ _ I
ovi
3114 `D1R- w'~- e
N~xT t'~ ~o o )%-MT eo*^tPr r
T1~lS •
~,•o-w.
jk( ►n i Tn
r31~'t~4- TT.
Cov~.,~ ~'KD 5 ~ ~
NOTES:
•l. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install-4" observation pipes with approved caps. ( 2 required)
4.-Septic tank to be tizoo gallon capacity manufactured by
`F~lZyn~~:~T' Lam, T >vr-ti1~ ~`KxJ~rc 1'0 Mtbk1LTST J_7S0 6R"*~-ly'~ -
5. Bench Mark S3ouL -
6. Divert surface water around system to.prevent- .ponding at the uphill side.
Page.,-*, of
Approved Synthetic Covering S 97 7 40 4
-
lprs"rm C- 33 Distribution Pipe
Medium Sand
G
Topsoil Elev. 1 Oy • O
`
3 E "
b
6 % Slope
pRIVATE SEWAGE SYSTEM Bed Of 2a- 2 (Force Main Plowed
Conditionally Aggregate From Pump Layer
D N . S Ft. P ROV ED Ag"h
1 913
E Ft.
Cross Section Of A Mound System Using
DIVISION Of SAFETY AND BUII.DIN~ 'S o • ~
A Bed For The Absorption Area F Ft.
G Ft.
SEE CORRESPONDENCE A 8 Ft. H I.5 Ft.
Linear Loading Rate=a-S GPD/LN FT B 63 Ft.
Design Loading Rate= p•y.GPD/SQ FT I llo Ft.
J 9 Ft.
K Ft.
Position
of L g-1 Ft.
Force Main W 33 Ft.
L
Observation Pipe
$ K
rA I - - -
W -
a a
Distribution Bed Of 2 - 2: 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page Of . b
Perforated Pipe Detail
0
End View
)Perforated
End Cap.) PVC Pipe
t. ~
.lo~~o toace -
v. Install permanent-marker
at end of each lateral
® Holes Located On Bottom,
Are Equally Spaced
Q ~S
I
i
Q
PVC
Manifold Pipe
PVC Force Main
Distn ution
Pipe
Last Hole Should Be 1
Next To End Cap
End Cap
I
P 3Q Ft.
Distribution Pipe Layout S Ft.
M
PRIVATE SEWAGE SYSTE X V $ Inches
Conditionally Y u8 Inches
Hole Diameter Inch
Ap Lateral Inch(es)
U BUILDINGS
DIVISION Of SALT AN Manifold Z Inches
~~s' Force Main " Z Inches
SEE CORRESPONDENC~ # of holes/pipe 8
Invert Elevation of LateralskIA-S Ft.
Place lst hole 'L4 "from center of manifold with succeeding holes
at LIS4 intervals. Last hole to be next to the end cap.
' PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS PAGE S- OF
VENT CAP
'i"C.L VENT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE
JUNCTION BOX 'COVER WITH WARNING LABEL
~ 10 FROM DOOR, IP•MILI.
w1mDow OR FRESH
AIR INTAKE
GRADE I 40 MI1J.
t~Z.. L D f I ~
•COWDUIT
~ V .
lh _ _
• PROVIDE I -
IMLET AIRTIGHT SEAL 1 111
YSTEM 1 ! I
APPROVED JOINT/ aTE §$~"t0s truction shall comply I I i ( APPROVED J011JT5
f r-T PRO IIDIN~ I I
R
W ff,W15 and ILHR 83.20 II
n~it i~E ALARM
b
I I o1J
AND BU
--CLEUC1 6'63 FT. ION 01 SAfE0.
PUMP ` OFF
GOR RESP4NoENCE
SEE
pI V O ' COWCRETE biOcK
RISER EXIT PERMITt'ED OIJL'J IF TAWK MAWUFACTURER HAS SUCH APPROVAL Dplµ~
SPEGIFICATICIMS j3LA9Ak0Yf_D
TASiJK MAIJUFACTUR9R: Y I t'p1~S~W PSZ~f}Y- IJUMBER OF DOSES: 3 3 PER DAy
TANK :rIZE: -ISO GALLONS DOSE VOLUME z
S.S• ,~C~1t-O S`l.S{~'I3 ~S6 O GALLONS
ALARM MAIJUFACTURCR: IMCLUOING 5ACKFLOW:
MODEL NUMBER. ~Ol ~w CAPACITIES: A= 2, IUCHE50R yu9' SGALLOU3
swITGH TyPL: ~cuz2 Lf is = Z IIJCHES Olt '101.0 G~LLOL15
PUMP MANUFACTURER: Cu 48 1UCHE50R ~26'OGALLOWS
MODEL NUMBER: D= , I.1Z INCHES OR \q 6'3 GALLONS
IJOTE: PUMP AMD ALARM R TO bC O S
SWITCH TYPE:
MIIJIMUM DISCHARGE RATE 11 y4 GPM INSTALLED OW 5EPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEEIJ PUMP OFF AUD_01STRIBUT16IJ PIPE.. ~'$1 FEET
+ MIAIIMUM NETWORK SUPPLY PRESSURE 2.50 FEET
+ Z() FEET OF FORCE MAIN X 7~ ' Y FYo fLFKIC'rIOU FACTOR. O S S FEET
TOTAL DyWAMIG HEAD FEET
DIAMETER I` q
8
INTERNAL DIMEIJSIOWf Of TANK: LENGTH ;WIDTH --~;LIQUIO DEPTH
BOTTOM AREA 231'= GAL/INCH
AS PER MANUFACTURER = !~I S GAL/INCH _
Goulds
Submersible
Effluent Pump
EP04 871
EP05
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. tic cover with integral handle
Farms Motor: Available for automatic and
•
• EP04 Single phase : 0.4 HP, manual operation. Automatic and oints float switch attachment
Heavy duty sump 115 or 230 V 60 Hz, .4 H models include Mechanical p
• Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering
automatic reset. preset at the factory. rated oil and water resistant.
■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing 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.
• Total heads: up to 24 feet. with three prong grounding SA Canadian StandardsAtisaciation
• Discharge size: 11/2" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (GSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for 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
1040F (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 9 30 5
components. I
Pump: EP05 a
• Solids handling capability: 0 7 25
3/a" maximum. W
• Capacities: up to 60 GPM. 6 20
• Total heads: up to 31 feet.
• Discharge size: 11h' NIT. z 5-
• Mechanical seal: carbon- 0 15
rotary/ceramic-stationary, _j 4
BUNA-N elastomers. A `T,).9
• Temperature: 3 10
104'F (400C) continuous
140°F (600C) intermittent. 2 ~Y
5
1
0 00 10 20 30 40 50 GPM
0 2 4 6 , 8 10 12 m'/h
CAPACITY
0 1995 Goulds Pumps. Inc. Effective may, 1995
Wisconsin Department of Industry, SOIL A N D S1 LU ATI ON REPORT Page 1 of 3
Labor and Human Relations n
Division of Safety & Buildings in ac r tai0 is. Adm. Code
~ COUNTY
Attach complete site plan on paper not less than O x 11 i~ Pla rpu include, but not limited to vertical and horizontal reference i M), direcSor~ of sker, a or
PARCEL I.O. #
dimensioned, north arrow, and location and dis to r ad. ~7 s _
APPLICANT INFORMATION-PLEASE P - ALL INgQ,FOMREVIEWED BY DATE
41
PROPERTY OWNER: ZON VEIATY LOCATION
STL~ S r OpRIOE S ~J 1/4 S$ 1/4,S 5 T N,R 1S E (oAW
BLOCK # SUED. NAME OR CSM #
PROPERTY OWNERS MAILING ADDRESS y ~ 191
3010 C c~ tv'~f 1 C
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD y
G~~1.iwtw~ C~ly,bvl S~ta13 (-Its)z6S-~3z.9 st~2tNG~I~-o ~ivt~T~t N
[ j New Construction Use [A Residential / Number of bedrooms H [ J Addltign to existing buikfmg
Replacement [ j Pubic or commercial describe
Code derived daily flow bbo gpd Recommended design loading rate `_bed, gpoltt2 ' trench, gwl'
Absorption area required S oo bed, ft2 S t"o trench, ft2 Maximum design loading rate • S bed, gpd/ft2 ' trench, gpdjft2
Recommended infiltration surface elevation(s) \ v 3q- Q ft (as referred to site plan benchmark)
Additional design/ site considerations `^'l box- 6 3' a~5) • "IN • l b 4 of SpoW FiL.t_ _
Parent material a t LT! 0u Q% Q, T► Flood plain elevation, if applicable ft
S = SUitab a for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM NJ FILL HOLDING TANK
U= Unsuitable for S stem ❑ S U 0 S ❑ U ❑ S 13U ❑ S O U ❑ S [R u ❑ S IN
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consisterm Boundary Roots GPD/ft
Boring # Horizon in. Munsell tau. Sz. Cont Color Gr. Sz. Sh. Bed rertcft
13 2- -7 -'ZO t b `1, kz- 3 l y - S I I -2 S~ 1z M 4 - Z° k1 1 S . b
Ground 3 1-20 3$ 1 S `i 2 3! y c 1 S SZ S 143 L S bit tn'~~ e lv - -
elev.
ft 8-S1 )o`7R S13 e1 C> m~i - - -
Depth to
limiting
factor
Remarks:
Boring # - s 11 Z~ S~1t wt -~v. a S - S b
Z Soh Yvl f1. Gw - S" b
Z -1 Z l0`1 R 31 - s l
El
3 zy 1.SY23Ly SyR sA6 L ~e sb~ G,,~ - -
Ground _
elev. y S-SZ 1~y D- s/3
toq-1 It
Depth to
limiting
factor
Remarks: • G~v'"'~'-✓p~ S~P'A-6E ~ Z~~ .
T Name:-Please Print Arthur L. We erer Phone. 715-425-0165
Vemg%rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signahire:_ y pJ-)_Slr Date: Q1 7CST Number
"0576
T
2,
PROPERTY OWNER 5~ ~~LS SOIL DESCRIPTION REPORT Page i.of 3
PARCEL I.D. #
Boring # Horizon Depth Dominant Color -Mottles Texture Structure Consistence GPD/ft
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Boundary Roots
3 o- L l R zL z - Si 21,` OL,S Bed Trerxh
Z 6-tv X0,12 3/ - S),l Z` -AAZ f~ cw s
Ground 3 )8-33 Z-S `7fZ 3l y c ~
elev. .Sv 2 Via L 1 csb m~'~ -
9g.~ ft. 4 33-~ to`t2 sl3 y C~ or, _ -
Depth to
limiting +
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
s
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"=
~ k >N~TLL
L4 BD" n
0
LL
~ o
' y
2
J
l
i
I
I 1
M. 6°!0
aa"~~nZ IOZ. g ~ 8~'
8u~o►~ o~ S
m
I
7 i 87,
~N (
A I i @. 3 r l
31y ` bw PvC PIPE ,
~~xT 1Z Petri Puy YuT eo*-IC~R~T-
O\2 O 1 S'rivf?-B
r3 ID 'rat- IT.
(?15 )-42s-0165 _ H00 576
CST Signature Date Sign Telephone No. CST #
WiisconsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Hunan Relators
Dyision of Safety a BuildirW in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Ste'. C,R-l3 ~,X
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D.
not limited 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
C~P~-" sTw ovS , eeY tM S I -J 1/4 Sf! 1/4,S \ 5 T 'L I NR 1S E (AL
PROPERTY OWNER'.S MAILING ADDRESS LOT BLOCK SUBD. NAME OR CSM Nf
301 O Cm) rv1,{ ' E V
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ($rOWN NEAREST ROAD y
at_~wwo C\' yI ivI S4t\3 (115) ZbS- ~3Z 9 sn21NG FLt!LLO Cc~v"T`t
[ ] New Construction Use [A Residential / Number of bedrooms y [ ] Addkn to existing bhakfug
[)q Replacement [ ] Public or commercial describe
Code derived daily flow dbo gpd Recommended design Icedlng rate • ` _bed, gpdMI Uench, gpoltt2
Absorption area required 'S M bed, ft2 S °O trench, It? Maximum design loafing rate - S bed, gpde • trench, gwd
Recommended infiltration surface elevation(s) \O q _ O ft (as referred to site plan benchmark)
Additional design/ site considerations v~o wl b'X 6 "1' S~W . M ln1 - L i~ 4 o F S po_,\) T=i LL .
Parent material z, 1 L`N ou %~m c. Flood plain elevation, if applicable A , ft
S = Suitable for System CONVENTIONAL MOUND W G IOINID PRESSURE AT-GRADE SYSTEM IN FLL HOLDING TANK
S ❑ U 11 S OU ❑ $ Q U ❑ S ®U ❑ S INU
U = Unsuitable for tem ❑ S 13U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Cor>sistienoe Bourdery Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rendh
Z Z-Zo 3!y - S N I Z 'F AA r M`FI- '-\j
Ground 3 2o-3Q, ~.5~2 3ly c ~ L. LtRS1~ L csbk w,~►- c,v - -
elev. _S~
IL
-S1 )oy►Z S13 Oh, yyl - -
Depth to
limiting
factor
ZOh
Remarks:
Boring # I o-1 10`1 ~z Z I Z s 11 2 'F S~1z Vn - V-
Z Z ~ 2,~ 1 u`1 R 3 / - S 1) Z S~4t Yrt Gw _ • S ~ b
3 Z y 1.staL 211y ya Sly L ~csb~ ht cw -
Ground
C; O Y>7 i - - -
elev. It 14 S-SZ 1 o4 D- S13
to~-1
Depth to
limiting
factor
Z
CST Rem2trks: - GlZov~~p~'2 S~.P~A-GE pPl- Zu ~ .
Name:-Please Print Phone. 715-425-0165
Arthur L. We erer
e' rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
sirature. oil- S j Date. V--) u q -1 CST Num p0 5 7 6
PROPERTY OWNER 5~~iz1► SOIL DESCRIPTION REPORT Page i of
PARCEL I.D. tt
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trends
3 o- L tivt R V z si 1 2 `E' S~1Z v-►`~'l~ a-S - • S ,
z 6-~v ~0,12 3l - s)•1 Z~'s1~h m~'~- cw s
Ground 3 )8-33 1.S 7R 3! C~SY2S~g ' L lcsb r~~h C~
& ft.
Depth to
limiting +
factor
Remarks:
Boring #
i
I
r
13
Ground
elev.
ft.
Depth to
limiting
factor '
i
Remarks: #
Boring #
I
Ground I
elev.
ft. '
Depth to
limiting
factor j
I I
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= yQ '
k w~t_
~a~
F-1
4 Bb"
0
0
y
2
J
I
~ztu3 6 p 1~1.tuy _
6°l0
$ l'1, 102. g 87 '
~ Owe o~ g~ S
r M
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7 i . 87,
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IN
rl
01
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NAT 1,r3 P01-jm v,0_kT,. ~j p rv~T eunt~R~ 1'
rtn
bA
r310 T* IT.
a-)- S~
( ) 495 -016s M00576
Signature Date Signed Telephone No. CS #
CST
CERTIFn' D SURVEY t-'AP
u3 r~-.M tJCGI:.
To,s~ship 29 orth.
4 of the southeast 1/4 of Section i5,
Part of the Southwest 1~
of Springfield, St. Croce County. %
Range 15 l,•est, Town
N'DO.OOOOw 332.52 ~ZL
Lo-r 1 O V 00b
~=O SAcRES O Im Nt
_ o ~ m a~ u O
O I n
o l- -o
G~ U)
r~ 10 6\S~ SHED IC9 ~ QU61
I
• QARN ( O ( I OC~~
e
b 2 5-f (DP-'( O FRAME HOUSE - LLD
O
o l~l zJl~
O ,(rj ~ O N4 61.Q
O O o
<n o~ o z
6% 1
~j
1/4- GOP--r29 N , R i 5 1
--r; 0 332 52:
000000 gGA L E l 200
N9
t N 90' 00 00 1✓ lbs./ft. set.
„ iPe stake set weighin 1.13,
.9-58-12,
o Indicates 1" x 24 iron p
S5 1~4 of Section 15,
S,v lr o r of
Description: parcel. of land located in the 4 of the
That certain 1 described as follows: Co'nTnenci^.g at the S 11 corne
F, 15 more ful y „ c:-8!2 feet along the South line of
T ?_9 N, c00 GO' CO described;
the;,ce go
OF ~?NG of the narc,t1 to be :'e-n
said Section ' S. Z\]: o * GO°3 'rO r,~ 054.4& =eet: thence
said SS 1.j4 to the YO 1tiT OF nw 0 ,
b ..i- feet; 2 feet; thence y 9& feet to the F
thenc o~;T
no N r~~°00' " to case:'ent for
e; 1.,~
~ ,00~ ,d
i
o 90 00 j ;2.. .
g _ r 00 ac r^ s. R,o ro a
over the Southerly J3 fee' c
re
r~- C: l:l. to Soutn line
C.`P.DG~L F u cest P )
i. ~
e r.
,=.ed 90o0C'00"-)
tuecr'=::,as`s"
(For p`:rposes of t^nis description all 5
c
20,
of the Sc 1/4 of Section 15, "
St1ite of ',disconsi r:)
County of St. Croix) -1. p., t nat b - direct_on +
-
L. 4'urph'~, Pegistered Land survey red do ; :Hereby divided cer, the lands shoial of the Own,' tes ndreor,
I•James the
Y.er" in ^'.c^ee, I have .^t`~ ~z o*" ';:isce^s n
r. ~ a true
d description are
ti a al records, G ao an 1 -c Ordinances
in accordacce of , and t,-,&t the abov
of St. Croix COun..yi~ Ill
thereof.
resentation
721,~
and correct rep Ja-es L, ','uro y
5t.i~:<d;~„• - ?egistered Lane JUrvevo\~•.Ir,,,-.:;rrrnurnp
6 1!
Da W,:
Record5
St. Cro < County y > 'n
fled Survey raps "R ,~u >03
Cert
ro 3: Wisconsin t;ISC. J~J\a
St. C Co nty, T''...
Volume 2 Pai'e 575
• 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 GA/~ y SJ`~ y eml s
Location of property__5L 1/4_,1/4, Section 1-5- ,T 0 N-R /S W
Township S''Rg/,it o i~?L d Mailing address
3of7D GcRdE, 6,1 eIV ee-~ oodG' "1`,~v~',sol3
Address of site '5;~M
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property Cp/VRi¢ O1
Total size of property _/D X C A'e
Total size of parcel /O X a /Q t°
Date parcel was created ALL A,, /f,a"'
Are all corners and lot lines. identifiable? XYes No
Is this property being developed for (spec house)? Yes _,Y_No
volume '771 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 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. y 2 -7 ~-y 97 , and that I (we) presently
own the proposed site or 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.
X339
Signat e of Applicant Co-Applicant
Date of. ignature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERMOMR cif` ~l Y SfG ye, A/S
MAILING ADDRESS ?O 70 ed> RV
PROPERTY ADDRESS 5414 L°
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, 1/4, Section T_N-R_Z,fW
TOWN OF S~,g/N ST. CROIX COUNTY, WI
-I
SUBDIVISION LOT NUMBER
r, LOT NUMBER
CERTIFIED SURVEY MAP VOLUME o2 , PAGES-7
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/WVe, 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:
DATE: M n
St. Croix County Zoning Office
Government Center
1101 Cann ichael Road
Hudson, WI 54016 11/93
DOCUMENT No. STA"rE BAR OF WISCONSIN FORM 1-1982 CIS SPACE RESERVED FOR RECORDING DATA
WARRANTY DEED
li 31a9 BOOK 771.:~,,~,532
REGISTERS OFFICE
This Deed, made between -Ronald A. Conrad and ST. CROIX CO• WIS.
Brenda__J.--Conrad-,--husband--and--wife---as-join-t-----.-_ °oc~d. '
tnants -and Les11Q Cx .-Conrad for Remrd~6th
day March
- - - - - - -1 Grantor, AA 19 $7
Ind_Gary" A.--St-eve.ns.__a.nd.. De. bie_-J --Stevens.,.-.h.us_band a •00 p,
and..w-i f e-- as-- s urv i vorsh-ip-. mar i t-a l-"-prop-e r.t.y-------
- - - -
- - Grantee, N pays
Witnesseth, That the saiG ;Irantor, for a valuable consideration
S---
- -Cro i-x - RETURN TO Rivard Law Office
conveys to Grantee the following described real estate in t--.__..
County, State of Wisconsin: P.O. Box 9
Glenwood City, WI 54013
Part of Southwest One Quarter (SW4) of Southeast
One Quarter (SEJ) of Section 15, Township 29,
Tax Parcel No
Range 15, described as follows: Commencing at
11 the South One Quarter (SO of said Section 15; thence East 988.12 feet along
the South line of said Southeast One Quarter (SED to point of beginning;
thence East 332.52 feet; thence NOo 30150"W 1309.97 feet West 332.52 feet;
thence S0030150"E 1309.97 feet to point of beginning.
Subject to Highway Easement over Sly 33 feet thereof.
.6 D..
ITP
This Deed is given in satisfaction of a. Land Contract between the parties
hereof, said contract dated May 21, 1981, Recorded May 26, 1981, in Volume
629, Page 515, as Document No. 372017, Office of Register of Deeds, St.
Croix County.
- VII,
29
30. This ls---nOt------ homestead property. '
(jojt (is not)
a Together with all and singular the hereditaments and appurtenances thereunto belonging;
b. And
c 9 warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
37. If
E
IX. CER' and will warrant and defend the same.
I _
-~G Dated this J
-
day of
SIGN
HERE Gr
Prrinamea Ronald A. Conrad
Co.nxad
~I /-._-.--(SEAL) (SEAL)
LEAVE Brenda J. Conrad
HIS AREA
BLANK
AUTHENTICATION ATIION ACKNOWLEDGMENT
pc"500( Signature(s) ------op ~T--UrJSTATE OF WISCONSIN
c~,rJ ss.
--------------------------------------County.
authenticated this ~G!!!day of.-. 19_.V Personally came before me this day of
119 the above named
/
« - ./efZ! / C. J
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
suthorized b
y § 706.06, Wis. Stats.) to me known to be the person . who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Francis X. Rivard -
-----------------G_LeawOAd--.Ci.ty....-W.L.S-4D.13........ Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19.-...._.)
'Names of persons signing in any capacity shou!d be typed or printed below their signatures.
STATE BAR OF WISCONSIN
N.CMi'llerco,rorryR9 FORM No. 1-1982 Stock No. 13001
l x.33
Pc r~~le
~7
2 25