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HomeMy WebLinkAbout040-1054-30-000 n N p-0 n d ~1 O p"j F c v p 4' ° m m m v A < co CD o <1 • CD 00 rs p _ O Q1 0 0@ @ 7 W O j F O A "4 1 N A =3 N W r~ °O °O O° Q c n W ° W p R O co am cn 3 rn co o 0 7 N O ~ °O rte.. O C7 m m c ° z D C a W N O 3 _ O CD CL O O ! 11 O (D C: O co .1 lz x CD co co v (D tom tnn 0 o c r a TI ~ O o O D V~ N N ~E' w o CD cr M O O o p O O _ CD M A N N m p1 V N N fD = ~ O C .d+ N N -4 CL z o z z O D D o ° na O ° o a h CD 'I c w ~o_ 3 z CD ° z a U) X a z o O m W m CD 00 z 3 p 0 ;u ° Cl) C~ CCD iz W N N r7 S n 3 N C Q C CD a Q. G Q O T N N C O N S O G Q ~ OZ N CD ~ -4 N V N of c', A O fi (D n O N a O (D O ~ V ° O O Op O 0 ~ 0 t,4 C Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT IX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Personal information you provice maybe used for secondary purposes [Privacy La s.15.04 (1)(m)]. PerrpjtHglder's hgKRY ❑ City,, jL1Y illage ❑ Town of: State Plan ID No.: 7I51{ 1 CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel T `~b=1054-30-000 TANK INFORMATION ELEVA ION DATA 1 5, z?' r ' Z,03 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Ip q~•~ DD Dosing S~ i~ res .(oS 01,65 Op Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION fit/ Outlet C%_ of TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic -xt` NA Dt Bottom Dosing f '>130 '7101' y 101 NA Header / Man. Aeration NA Dist. Pipe N tt 9s Holding Bot. System 5 A# 'K.03 s 0 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number gjAA '4 GPM MA-. 12:'m 1,0 TDH Lift Friction D. IS Syestem 1 TDH \2,' Ft Forcemain Length IcZ Dia. Dist. To Well SOIL ABSORPTION SYSTEM E TAY Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth MEN I N I DIMENSI N SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O t r CHAMBER Model Number: System: ( >tqb >!50 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 5' Dia. Length rLI.B Dia. I Spacing I << 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 ❑ Y o Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 13.28.19.203B,SE,SW 306 COUNTY U TN Son ® Inn - z ~ - ~ a► + P~ i Plan revision required? ❑ Yes ❑ No Use other side for additional information. 2,l~,~ SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e E s E E , E : e ~ i e j g 8 & e Fa i. g E f • - atconsnn PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT ST. eROIx `Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) SanitaIN9056 Permit OENHoI TE Jame: City ❑ Village Town o : State Plan ID No.: R YY CST BM Elev.: L nsp. BM Elev.; BM Description: Parcel Tax No.: uy,~ Zoo -M 1~__4 040-1054-30-000 TANK INFORMATION ELEVATION DATA A9700373 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~eay~/ CC-t~5 a>~ Benchmark •/p ef. A Dosing ~V1 t' S .45r oa Aeration Bldg. Sewer _ Holding St/Ht Inlet , TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic 1 ap' SS- a~' NA Dt Bottom 711 gf Dosing S7- > 130') NA Header / Man. '767,-7-& Aeration NA Dist. Pipe 9s- N s-. in T_,1 Holding Bot. System ~ t•f, Z 9S, 03 S-911 Vs-% 0 PUMP / SIPHON INFORMATION Final Grade Manufacturer ~1(l tom' De and a~ Model Number "GPM r TDH Lift .U Lrictio ASyestema1~ TDH (Z.SFt oss r! Forcemain Length [oz' Fii Dia. " Dist. To Well SOIL ABSORPTION SYSTEM Width i Length i No.Of =fenthes PIT No. Of Pits Inside Dia. Liquid Depth MEN I N 5 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Typeo CHAMBER Model Numer: System: (os- > I'to > I SO OR UNIT DISTRIBUTION SYSTEM Header / Mani;old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake p Length Dia. Length Dia. Spacing It o SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 3 .7 Zu k71 LOCATION: TROY 13.28.19.2044,SE,SW f1j ~r Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. N ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: ' ti Gr, Safety and Buildings Division N%jConSin 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 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81a x 11 inches insize. St Croix • See reverse side for instructions for completing this application State Sanitary Permit mber The information you provide may be used by other government agency programs ❑ Check ll revviission to previdlis application [Privacy Law, s. 15.04(1)(m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION S95-31465- Property Owner Name Propert Location Terry Roen SE 1/4 1/4, S 13 T 28 , N, R 19 W Property Owner's Mailing Address Lot Number 70~ City, umber 306 Count U State Zip Code Phone Number Subdivision Name or CSM Number River Falls, 1 54022 1(715)4257490 II. TYPE F BUILDING: (check one) ❑ State Owned Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms - 3 Town OF Troy County Q 111. BUILDING USE,: (If building type is public, check all that apply) Parcel Tax Number(s) 040-1054-30 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. [X Replacement 3. ❑ Replacement of 41 ❑ Reconnection of 5. ❑ Repair of an Tank ------System --------System ______ly______________ Existing -Svstem - Ex ---q----- 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 450 375 375 .4 q5-n Feet Feet VII. TANK Capacity Total # of r Prefab. Site Fiber- Exper. i INFORMATION gallons Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank orAtoj l4)gKN k > D00 ] 1000 1 le s er 1:1 ❑ ❑ Lift Pump Tank I6)MXiX03M%X 750 750 1 Wieser ® ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P/1fflX ?4o.: Business Phone Number: Paul C.J. Steiner M 6780 (715) 425-5544 Plumber's A( dress (Street, City, State, Zip Code): N8230 945th Street; River Falls WI 54022 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater [4 ate ssue Issuing Agent Signature (No Stamps) k Approved Approved El Owner Given Initial Surcharge fee) / 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 l 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, 608-266-3151. 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. IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 isto 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. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations October 24, 1995 1340 East Green Bay Street SUITE 300 Shawano WI 54166 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S95-31465 FEE RECEIVED: 180.00 ROEN TERRY SE,SW,13,28,19W TOWN OF ST CROIX 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 ILHR 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 ILHR 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, Ke th Wilkinson Plan Reviewer Section of Private Sewage (715) 524-3627 SUDA-0928 (R. 10/94) i T Page of 6 •r MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SE 1/4 OF THE Sw 1/4 OF SECTION 13 , T 78 N, R 1? W, TOWN OF ~'~p-( , ST• C~ZULX COUNTY, WISCONSIN. INDEX PAGE l '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 s SYS-t-9.EPARED FOR ~IS1TE SEA ASE y titlt~6~iGS r t yi~+° iw8•btJ ~ _ _ t PREPARED BY WECEFRER AND, 111_ TEST I NG m®o pis/ ~ ® ® DES I C1%4 SERV = CE F.O. B01 74 421 K. KAIK ST_ e""= wcEFl RIVES? FALLS. MI 54012 0-915 P a RLswoarH, 715-42"165 wr. I G 14 JD -7-a1 S 595-31465 JOB NO. 9.S-SOS PLOT PLAN • Page -z-of 6 Scale 1"= qO' SYSTEM t- ~ r ONSITE SEV'JAGE x al n a ~,i RE TIONS DEPARTMF!" 3 L - [al~F~a is &V y. ! o Stan r oP ~r 4 P~ 1Z-SCIST1X)G `fit 11.f~ ( ZZCn f.T_tN , IQ(.) of Z lp j 0 wt, ~l-~h cE F_ LT_~~ 000 ~It~t~_N_G K' g`pG B,1 k=L 89 . Z k'-~l ~.i~-CE ►'v~'~[`F 1~ LUllp GI'tL::: a'~ ~ ~ 8N'I 3 t ' - IU Z S 11t y, J 8}'I - fit. IUrJ.p oN C~2~u~ i I ~ d ~~ou~ C~lulu~v0 o~ ~ o ? - it p i 1 y!' I I a~ I y /I .moo jc+ Z 2 2S, I B44 act& + tL85° Qz~'j ~O Me- L4 t @ nY'mm of 6ND wL 9 S. O NOTES: 1. 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. ( Z required) 4. Septic tank to be loop gallon capacity manufactured by wvFStiz- Cooed 1~'bucn Ct F- k3eftel~) - '~ztu vz- `tv g(E~-w{lRse2 7Sp Ott, ` *kAr- 5 . Bench Mark S 0 UE 65 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of b 4 Approved Synthetic Covering FVS7 -t C- 33 Distribution Pipe Medium Sand Topsoil H G F Elev. C~ S .0 -JI E p 3 b 8 % Slope Bed Of is 2 %2 (Force Main Plowed Aggregate From Pump Layer D 1.0 Ft. Cross Section Of A Mound System Using E Ft. F a•8 Ft. A Bed For The Absorption Area G \'r,3 Ft. A g Ft. H 1.5 Ft. Linear Loading Rate= a • 6 GPD/LN FT B Ft. Design Loading Rate= o.y GPD/SQ FT I 1b Ft. J -7 Ft. K Ft. osition L bq Ft. of - Force Main W 3 1 Ft. L Observation Pipe A I - - I•-- EN1-------------•I W a SIDE S'EVV Fer-~e-KAe~~r Dist rib~~r~'"'"~. - Of -1"- 2,;,-N c: 2 2 ggregate ,~~~1?"liaan,,,;~`';~p~otY; RELATIONS F ` A~F-fy AND g0i i 1Mnent Markers (Anchor W-6 'Y ~l SEE cORFESPONDENCE -31465 Plan View of Mound Using A Bed For The Absorption Area • Page Of 6 Perforoted Pipe Oetoll 0 End View Perforated End Cop) ~\e t' PVC Pipe 1 . ,a `ooce aS Install permanent-marker at end of each lateral I Holes Located On Bottom, Are Equally Spaced Q ~S i i P PVC Manifold Pipe f~ PVC Force Main Oistri ution Pipe lost Hole Should Be I Next To End Cap End Cap ONSITE SEWAGE SYSTEM P 21-9 Ft. ion Pipe Layout S y Ft. X ~4Q InchPs HUMAN RELATIONS Y _l 0 Inches c r AND , UEPARTR,E,~~.:- nUfiTrtY dam= ° 0- SA~Eyy ANO BUILDING Hole Diameter Inch Lateral 1 Inch(es ) Manifold Z Inches SEE OOP,RESPONDENGE Force Main Z Inches # of holes/pipe -7 Invert Elevation of Laterals q S.S Ft. -7x1.\7= ~•I°t X~(= 3Z_7 ~ G1~1-1 y Place 1st hole Zu from center of manifold with succeeding holes 11 at ~!0intervals. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS • PAGE S OF b M ~ ffT VENT CAP H'C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE 10 'FROM JUMCTIOLI 80X COVER WITH WARNING LABEL ODOR, I2'MiU. WIIJDOW OR FRESH I - AIR IIJTAKE I GRADE I I `i• MIN. 18' MIIJ. COWDUIT TE~~1Stt 11~ DE IMLET SEWAGE 4RVI T SEAL I I I Iov,& I III v APPROVED JOINT/ A Tank OnSt1;Act Omply I III APPROVED JOINTS w l bb, 1233,.:15 ate 152 , 8 3QONS I I I r 7 n~1 ❑ I I I ALARM aO,,I~ i i~1° Sti1LD1NGS C f' 4. i I CLEV.8~.0gFT. SEE . C.~O~ '~SPPUMPS --j OFF 0 e U O I COLICRETE BLOCK 3" APPROVep RISER EXIT PERPIITTED OWL'J IF TANK MANUFACTURER HAS SUCH APPROVAL. UDDINQ SPEGIFICATIOUS DOSE LUl U~SENZ COUQVZT~r J. 6 3 TAUK MMJUFACTURER: UUMDER OF DOSES: PER DA4 TAAJK 51ZE : 150 GALLOWS DOSE VOLUME ALARM MANUFACTURER: 1-1iSTI~*1s INCLUDING, DACKFLOW: GALLONS MODEL NUMBER: O 1~ w CAPACITIES: A = S IMCHE5 OR 30d ` $ GALLONS 3WITCH TYPE: R g = Z- INCHES OR 20', 4LLOL35 PUMP MANUFACTURER' 'N14 VNZs cm -7 ILICHE5OR `uD 3 GALLOWS MODEL UUMSER: S R Al D- IMCHES OR GALLONS cuR~f MOTE: PUMP Ak1D ALARM R[ TO E`l SWITCH TYPE: MlAIIMUM DISCHARGE RATE 3Z' 6 GPM INSTALLED OM 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD.DISTRIBUTIOU PIPE.. Ll Z FEET 4- MINIMUM NETWORK SUPPLY PRESSURE , . , , , . . 2.5'0 FEET- + 1_4 FEET OF FORCE MAIN X Z` 1 I[T F~ ~L ►ooFr.fRICTIO►J FA-10R.- ' TOTAL OyUAMIC HEAD = 1Z` b6 FEET TOTAL DIAMETER 3~ i~ IIJTERLIAI- DIMEWSIOW~ OF TANK: LEk1&TH ;WIDTH - ;LIQUID DEPTH BOTTOM AREA - - 231 GAL/INCH AS PER MANUFACTURER - ZO.O_S GAL/INCH _ TOTAL HEAD IN FEET K/L 1~PtUE 6 0 - - N N (A O Ul O CTl O to O O O O ~ O N O N m nO O A -0 - D w C7 ° N H O J n -P, H G) ° D O F r H 0 0 z Lo 3 u m m 7 ° H J fTl z o c N m m ° 0 w N O O W W O O O O - N W P Ul Ql ~I m co TOTAL HEAD IN METERS S95-31465 335541 CERTIFIED SURVEY MAP for HAROLD VON KUSTER Part of the Southeast 1/4 of the Southwest 1/4 of Section 13, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. N g \a ~ SCAt.~ : I" = too' ~o zh 335541 SEARINGS Basmo 9 0" N/S LNa of SEc. 24,TZSN, R 19W CD LED ti s Assun eLi> per- rtoaTH 90o w SEP Y7 1976 " APPR vED ~s r for coc.N.Kde, cc X COUNT $T. C PLANNING b'booo„b w SM. PREHEi-4S ` . ;T iEE S• pNp ZON-- 5. , S 0 AGrRv- s " SEP 1 5 1976 o. 0 9. APPROVAL OF THIS MINOR SUBDIVISION F DOES NOT Mc FOR SEPTIC SYSTEM. REFER Tu H62.20 S S %q Colt. 0. 39• ; SGG 1'3~ e p n $TC - 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/contraotor, (spec house), then a second form should be retained and complbted when the property is sold and submitted to this office with the appropriate deed recording. owner of property / R A Y- m P fC r L. e f-1_ f ]vocation of property~',A 541114, Section.L3_,T Township 0 Mailing address D 6 ex_,c &1')° Vex r`S- Zell Sao ZZ Address of site 304 `a 4tW _r GC i Vfirfe c t S Subdivision name A Lot no. Other hostess 'on property? Yes No Previous owner of property Total site of property S Aeler.7 S , Total size of parcel S /e S Date parcel was created / 7~ /997 ~v*t s ; ~'u~T~o N Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? _ Yes R No volume _ and Page Number as recorded with the Register of Deeds. - T__-------------- INCLUDE WITH THIS APPLICATION THE FOLLOWXNG: A WARRANTY DEED which includes a DOCUMENT HUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER 01' 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 ail statements on this form are true to the best of my (our) knowledge that I (we) aim (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 Nt.. ~~o /oS~- 3 O and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained as easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the oft'ice of the County Register of Deeds as Document No. Signatur f Ap licant Co-App cant Date of Sign ture late of Signatim STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County -7v Y_ 14 /e L • O ~'/1/ OWNER/BUYER / c iP /e / MAILING ADDRESS J 0 l~©r~c I~~` PROPERTY ADDRESS A4 / V E~e 2- 2 (4L'Ice ocation of septic system) Please obtain from the Planning Dept. CITY/STATE / 4 t_ t- S ~40 2 PROPERTY LOCATION S AE 1/4, S ZJ 1/4, Section Z -:2, , T_,g- N-R,& 9 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system 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. SIG DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 'UMENT 132. STATE I" OF VWCO"S VOL 553 PaAR x THIS $.,CF AM"* .mot tAcot~t»~ 339833 _J-- - REGISTERS a T7itS DEED. made betxeen Harold B. VonKuster and Violet ST. C20iX CO) -t._ VonKuster, husband and wipe---- - - Reed for R-MM *is- day of liav AD 19,n Grant or and Tprrv A _ Rnan _ W{,fA. a._ at 2:15 p., tt. {~int. #,gnantg James O'Connell T Grantee, of DOW* Witaesseth, That the said Grantor for s valuable considerationFive Thousand ~A~ "~Qn►~ and Noj1 ($5,000.00 _ ****Dollars conveys to Grantee the following described real estate in `St. Croix C..ty, WTWMt TO ~s< t State of Wisconsin: St. Croix CO. AlAtraet 000 That part of the sor'~heast quarter of the southwest quarter (SE4M'1,) of Secti-r 13, 'rnwnship 28 North, Range 19 best Ts: Key r C This is not b~stead Prop ° described in that certified survey map filed September 17, 1976 in Volume 1, page 297 of the Certified Survey Maps of 5t. Croix County This deed is given in order to carry out the terms of a land contract between tka parties dated October 15, 1976• r FED' p Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaielnpl _ t4 And - _ mold E. Von Kuster and Vilet Von Kuster, husband aid wife (4j warra.tts that the title is good, indefeasible in fee simple and free and clear of encumbrance., except S'i af:inar w,►gp~nt~ f~ - and will warrant and defend the same. Executed at River Falls, Wisconsin this- 2 day of Lpr , 14 . r t SIGNED AND SEALED IN PRESENCE OF r. _ j>1d E. V(MFJlqter.. 'U.~• ~crc~ ( Violet Von !Custer it (WAL) -(AL) Harold B. VonKuster and Vilet Von Kuster, husband and fund authenticated this 28th day of _ April 19 77 L. J. Peters _ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P` of 3 Lal q and Human Relations Divis6n of Safety 8 Buikbngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY 6 1d Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARC R dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REV BY PROPERTY OWNER: PROPERTY LOCATION TES ~2. QFIV 691r Ft9i Sti 114 Sf+V 1/4,S~ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR IuY MY 3O b C-`R1 "V" - CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OTOWN NEA [RLL)el2. F*uS,1Ul Sqoz.Z (71S)gz-5-"7gg0 -r7_04 C--VIA + U" New Construction Use P4 Residential /Number of bedrooms 3 [ ] AdditiQn to existing building pQ Replacement [ ] Public or commercial describe Code derived daily flow y5D gpd Recommended design loading rate o- y bed, gpd/ft2 trench, gpd19 Absorption area required 3Z3 bed, ft2 - trench, ft2 Maximum design loading rate O - -S bed, gpd/ft2 0- b trench, gpd/ft2 Recommended infiltration surface elevation(s) ct S • C~ r ft (as referred to site plan benchmark) Additional design/ site considerations `ti'\pU►Vp 1.j/ 8 '7c 1.t1' g Qb , "Irv. \'01= S tN)Ljb FILL. Parent material S ~ S 1 Uv~j L y ~ ~ -TlL ~ Flood plain elevation, if applicable 1~1 o fc~ • It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S Nu IN ~U ❑S ®U ❑S ®U ❑S ®U ❑S WU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench h<: > Z 11 3 1 v y tZ 3 - sit Z►nsU~ m - 0-5 0-L 1 , Ground 3 -q --),s `1 tZ p l y f l Li SZ .s 1 C.~ l C s b ~C M ~ cS - - elev. X -;3.3 It V 4A to`C(z- q TS C• O•S o.~ Depth to S la x ~ LP's Q'Is I„t limiting factor Remarks: Boring # 0.10 to `tCZ 31 Z S t Z~ `Fsbk ~^~1r C -S o. Z Z 10--? 10 ~'l 2 3 j ` - S Z rn Shk r'L~ cs p. S o . 3 t S Ia S o -S it- S Ground tZ5~3 18 elev. Su_6y . S Y R 3Ly gc C O~n-~ wt ' 9,0 Depth to ~v limiting factor Remarks: CST Name:-Please Print Arthur L. We e r e r Phone: 715-425-0165 egerer Soil T sting & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: °t S- 3u5 ~D -qS M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of v PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles TexturO Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0_10 1o~tiZ- 3IZ - S~ 2. 's X12 ~vv ~S c.s a. 3k - 6/y o-L Ground 3 Z?-6D Ib` vz-&1 c1.S ytz Sl$ ~5 pw~ lvtu`F`. elev. GIB \ ft. Cpy~ fv S S MU 5~ '@ Depth to ~ 1 aklh) JkIM S SH R__ 3 14 c 3 0 w7u S limiting fact % Remarks: Boring # ~ 0-1.0 l~`~t.tZ 31z. St ~ - - - - y . z t o -zq l o~ tz 3 I6 - s i S - - - - 1 - ^ 3 Z-1 ski 3! s-1 tz sly S) Ground I C1 - _ - i- elev. 3S_~!~ 7• S `-tR 3ty 1.SLcm S /P. SS .oft. Depth to ~O ►v G w C G limiting factor Z01 Remarks: Boring # Ground elev, i ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: - SRfI-93301R 05x9?1 PLOT PLAN Page 3 of 3 SCALE I"= 4 p ' x ~ D U J 0 r` J to m ~ I Q'l iL S k!"Wn t 'C^Pn~1a L N j ~~o~ . tL9 3 8 of 89 Z 8.~ g,Z v I Bl'~ f 11J J 8~ - LTL. 1u~.0 o►v CgSZti i o f C(yv C -Z its 2 ~ y ~ eLy y ~c .9u.o' > i3 L Y'CUm of i3ft LL, q S. 0 r qs-3oS (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # and De iao~us", SOIL AND SITE EVALUATION REPORT Page 1 of 3 I"Wri n Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on Ste' C~t X paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (EINA), drection 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 -rFQ.~-t'( ~-OE1V 60Vf-t6T 5t& 114 _S10 1/4,S 13 T N,R l~ E(or~ PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 3 o b C `T11 .4 V," - CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD [Rium FNuSrIUI Stto2.z (-)IS)-uLS_-?q9() -T-R- 4 (-1-H , U" [ ] New Construction Use [JQ Residential / Number of bedrooms 3 [ ] AddifiQn to existing building PQ Replacement [ ] Public or commercial describe Code derived daily flow LISD gpd Recommended design loading rate _9L y bed, gpd$ - trench, gpd1ft2 Absorption area required 3~S bed, 11:2 trench, ft2 Maximum design loading rate O - S bed, gpd/ft2 O- trench, gpdM1 Recommended infiltration surface elevation(s) °l S • ' ft (as referred to site plan benchmark) Additional design'/ site considerations 4-1\\) t.u / 8 "A- q-1' $ @p , Y-1 t k) . 1 O F S fw~b FILL Parent material S t ~ 8 ~Uw L > ( T L l Flood plain elevation, if applicable f\1 • A It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ❑ S ®U ®S ❑ U ❑ S IOU ❑ S ®U ❑ S ®U ❑ S IOU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. Bed Tw& OEM -1 ~t 3t si{ z sbk ~ cS _ o,s u> Z 113~j lbyV__-3 - si` Z►nsUk Yvt - o-S 0.~ Ground 3 ~(-fib ~,SYtZ -3L f l -{R--5 1 l0- 3bk M elev. q3.% ft y 113jp_ ~1~~ TS O S 0.~ Depth to S -Lo °lo -t `LM (Z"s ~ p'1 lurs imiting factor 3LL" Remarks: Boring # 0..10 LO `1 t _ 31Z S 1 Z `Fsblrz ~^'l lr` C-S _ a-S o. b Z Z 10?~, 10`12.31L s1` Z»-tSl~k Y~,~t^ C--S\ 0-S o.~ 3 _S43 S 41I _3f ~_S`t2 S !g S ~ +~~l--YnF CS _ Ground elev. SL)--6y 7.SYR 31y -).S~25~ C~ O wt _ _ 9,0 ft. Depth to 3 w limiting factor Z$" Remarks: CST Name:-Please Print Arthur L. We erer Phone. 715-425-0165 Jegerer Soil T sting & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: z4p4w p Date: CST Number: 0 f C' S- Sus LD -~~-qS M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Try 3~ °-10 \o~-1~Z X12 - S1 Z s~12 i-- aS u.S a.6 Ground 3 Z$-60 Ib`tvL 61 elev. Q-C h fv S S4 P- va t-Alb 3 V S C. Depth to 023 C~-0ty N S_ S 3 wt c s 0 S limiting faL Remarks: Boring # o-tO tee-tcZ 31z SLI 3 z-°l-3S S`~R ~l ~ S~tR S~t~ S ~ - ~ _ Ground c t Depth to ~O C' w C 6 i limiting factor E ZOI4 i Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: -,Rn-0330(R O5/99~ PLOT PLAN Page 3 of 3 w SCALE 1"= 40 ' k U J 1 rn ~ p J 0 i. m~ I ia't x ~---_j stmht~ 1~h L~ l- ClA3 kL84 Z J ~ 8.1 6.1 BN'I 3t~ ZS~~ (V ' h ' J 8?'I - tTL, tuo.0 urN Culz1~ ire ofC~ 2 i 3 ~uv~ 6i~U~0. o~ ' o D n~ Y Z$, B.3 . 31, s:y x.46 ~ t~.as° (IoUwIvQlk Lv_cl o' I 6,arnM of BND ZL 4S.0 ~ 9s -30S 715 ) 425-01 n5-_ 1400576 CST Signature Date Signed Telephone No. CST #