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HomeMy WebLinkAbout040-1090-30-000 N p°i I O60 0o eq o I ° 0 0. o j o t o o - voo I 1-4 a m~v J N Q (D C p) N O N > Er C, LL m > a I N Z ZM c Z c 0 E U. )i w m o c _ o c3 " ° I c3 0) o• N E Q c 2~ E Q o. I a ~ M O M rn~ I!! I w o I Z m d d d N~ Z a m I a m j o o z c aoi z o I o z N Q> m = M O1 N ~i I ? v) • d ° _o 2 U) a a c m 0 0) m Z I Z o 4") H Z w O Z N ! z d j d Its E I ~o E N I _ H l0 7 O- O O O 61 ` d c 0 a Y a o'eoa` .0 IN'caCL .n C mN Q j U) to to I o m to m D z n FL (0 o~ •N 3aaa j~aaa IL (0 I y U- m C7 O N ! I C7> LL 0) U) N N a`) - On) CD VJ J V j> M O) } rn } Z ° A N N - Q' O O 0 O T O to O0 E~ O EL 0 I ~ 7I ~ N 3 co N y c 3 m rn d Q}in I Q A Q U) to C) fA H C 0 M y 0 v E p N O D N N d> O co 0 CD iL O 5 CD C m M -°j C a) c = 0 75 M EO O C I L O C OI C a N N C7 ° ao ~ cMO ayi m o Z I ° o ayi wp c_ d ~ d M iQ O O O y (0 O C13 O N O O •O U N F- I CJ Lc) Z N 2 H J N O Z Z Q' fn BOO ~ ~ ~ ~ € i r € I V V] y R €a €CL Asa a L: n.~ I L: a~ rVAli E 'c o r A ciao 0U) o ca t) c 417P 00 =2 1986 CERTIFIED SURVEY MAP whir of befth DONALD AND JEANETTE JENSEN IN cmk 0810wh wbm* Part of the Northeast 1/4 of the Southeast 1/4 and g the Southeast 1/4 of the Southeast 1/4 of Section do ~2.0 T N 23, Township 28 North, Range 19 West, Town of \ Troy, St. Croix County, Wisconsin. lb I It LANOS_DESC_/N VOL. ti ti ° +41 ' 596, PAG=E 574, ~1° 5~ / do Q c p ~DOC.l3ie 07 ~p Q° ~ ♦ q ~cq~ R /EAST 1401 0 PO ~1 9s s N69.50'46"E 142.24' yb ~0 A yIh Lori 1~~'4-a~ h 0.30T AC 00 Jp \ `N yy11 F ti /3 352 Vj'F \ ` o % Q) f~ o gym Q /54j L o r 2 sqy° Q Is / 4. 000 ACRES M oo/74, 240 SO. FT. O % N£T = 3.439 ACRES 0 /49 620 S0. FT. , APPROVED 1I, G ti Qo O~ lo p°F COT 02 1986 14 01 W ST. C;OfX C", -'j 4 Q 2 Z p COMPREHENStV_' PARKS PIANrdNG .0 O o AND ZONING COMMITTEE ry % a 1 A tip' o~ J ~ e~ Qom/ J,~•~ Qa 0 m ' o SCAL £ 00' o ~ 2 N N O 50' /00' /50' 200' 300' z co 2 to \ N W Q O N > m • Indicates 1" iron pipe found. ' N o CIndicates 1" x 24" iron pipe weighing Q y 1.13 lbs./lin. ft. set. Q1 Dated: September 2, 1986 _`~~~f1111ft~►1r._ i - AS BUILT SANITARY SYSTEM REPORT /17 eER , TOWNSHIP SEC. T, R~W ADD S , ST. CROIX COUNT , ISCONSIN. ::DIVISION , LOT LOT SIZE ' PLAN VIEW Distances IS dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e I I I I i ~ r 'AV Ile's t i I i Indicate North, Ar'ro'w j S CAL - ~I I "'TIC TANK (SMFGR. -CONCRETE STEEL NO. of rings on cover Depth DRY WELL '.CHES N0. of width length area no. of lines. width ! length area depth to top of pip . RATE AREA 'gFQUJREDL -f- AREA AS BUILT ;riaimer: The inspection of this system by St. Croix County does not imply complete ~liance with State Administrative Codes. There are other areas that it is not possible ;.inspect at this point of construction. St. Croix County assumes no liability for :rtem operation. However, if failure is noted the County will make every effort to ermine cause of failure. ,`ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. '-INSPECTOR PATEn PLUMBER ON JOB LICENSE NUMBER s f ~ ~ ~ ~ ._...,.....r-a-.~-.-....-O=re.=.~+~-...:.~i w..,e..w.....~~:fmcc.r<^.....±.wn.+........-...__. . REPORT OF ITISPECTIO?1--I:IDIVIDIIAL SEWAGE DISPOSAI, SYSTEM Snnitary Permitlj~ r State Septic .[AIE T0WOHIP ~Z _ St. Croix County SRPTIC TA'111 Size gallons. umber of Compartments • Distance From: Well ft. 12% or greater slope ft. Building* Wetlands f. ter Highca, ft. DISPOSAL SYSTF:1 Tile Field or Seepage Pit(s) Distance From: j1e1l r K~ ft. 12% or greater slope* ft Building; ft. Wetlands " f FIELD Highwater ft Total length of lines ft. Number of lines Length of each line ~ ft. Distance between lines ft. Width of the trench ft. Total absorption area sq. ft. Depth of rock below tile in. DP_pth of rock over tile ? in.. Cover ....over .rock,, Depth of the below grade in. SZope of trench in per 100 ft. Depth to Bedrock ft. Depth to ground water ft. PITS . Number of pits Outsid iameter ft. Depth below inlet ft. Cravel around Pi~; es no. .Total absorption area V sq. ft. Square feet of seepage trench bottom area required Square feet of s.eepap. e n' area required r C Inspected b r~ Title':.ZIL ' . h Approv • cam' .-Date 3 197, . E1+ J 15 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH r P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: 6_C%, Section , TskN, R 4 E (or) W, Township or Municipality Lot No. , Block] No. divisio Name County '5T 'kC_4-"- Owner's Name: uOQ L Mailing Address: t LS TYPE OF OCCUPANCY: Residence No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION- REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS MOr- O SOIL MAP SHEET SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOI L HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 71 PERIOD 2 PERIOD 3 _ P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- I h1 B_ It SIC 14, PLAN VIEW (Locate percolation tests,soil (bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference points. Cate slope. s IT t N T gr;t~ AD- "'R, L 77--) t1i -t - 8914~r State and County State Permit # PLB-67 Permit Application County Permi ' for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. O'/4 Section T N, R E (or) W I t City O~OCATI ubdivisio Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (spe fy New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percplation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width epth Tile depth (top) No. of Trenches Seepage Bed: Length-- Width Depth Tile depth (top No. of Lines Seepage Pit: In,+id iameter Liquid Depth No. of Seepage Pits Percent slope of land l Zb Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified oil ter NAME C.S.T. # and other information obtained from (owner/builder). Plumber's Signatu p/MPRSW# Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. f ,m t vlj~k: Ile, STC - 104 AS BUILT SANITARY SYSTEM REPORT 14", f7v. OWNER I l C'D ti ADDRESS 7n co NO~X~ 3 R -cZ Rlo~r SUBDIVISION / CSMJ LOT SECTION_ 4 ~T N-R_) 7 ,Town of TrD ST. CROIX COUNTY, WISCONSIN 6 4-sIb PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. F e BENCHMARK: 77Q Of ~crp e has t B kV ALTERNATE DM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: We is tr- Liquid Capacity: ~z ~ ~ 7j'D Go,K Setback from: Well DO House_7 Other N Pump: Manufacturer /r1 Y ors Model# / W.E q0 Size __L2. Float seperation v Gallons/cycle: q,Qy Alarm Locations V SOIL ABSORPTION SYSTEM Width: J Length -25L- Number of trenches Distance & Direction to nearest prop, line: ' Setback from: well: Ibp House Other ELEVATIONS Building Sewer ST Inlet: L9 8 ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system 9.2 o Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: C J s _6Q LICENSE NUMBER: INSPECTOR: 3/93:jt pl o~ ILL/4A scale J 30 .ice 8 $M f1. vy io0 ovnfr a CoNere'~~ Sle6 v I ~ tea M 6a Yaq,t 1. FYI s 3 8r• fJ~~,~ c County: Wisc sih Department of Industry PRIVATE SEWAGE SYSTEM LSboand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299098 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: LARSON, JOHN TROY CST BM Elev.: Insp. BM Elev.: BM Description: r arcel Tax 0- 040-1090-30-000 lop 1 O o rvl>i o+ n ct~ TANK INFORMATION ELEVATION DATA A9700418 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (Z5b Benchmark 3.1z 10s•12 /Od Dosing c7rvt hb -7 -5Z> Aeration Bldg. Sewer IJA-- 13 ~°►'-9 ?l St/ Ht Inlet Holding TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Airlntake ~ Septic +q o _r(5l +75 IF NA Dt Bottom r170 _?5_V2_ Dosing NA Header / Man. 9 5`~ Inlef a 6 9 10.01 rs~a Aeration NA Dist. Pipe „s o. 17 21d► 3o z- Bot. System 0.4 y 05-11 .3 YZ 191 91.f3 Holding PUMP/ SIPHON INFORMATION 71 ry, ojoV • Final Grade $.'7o Kr q, I q# if y-m 49' Manufacturer ~/VI t v 5 Demand. I (i t G •27 Model Number )rv►G~FO 3o GPM TDH Lift%,~b Lrictiongq~ System- TDH J.IyFt OSS Forcemain Length Dia. I-ZI I' Dist. To Well SOIL ABSORPTION SYSTEM BED / RENCH Width e7 L#nglh,, o. Of Trnches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN DIMEN I N LEACHING acturer: SETBACK SYSTEM TO BLDWELL LAKE / STREAM CHAMBER INFORMATION T, Moe um er: 00 -f-I r Y*) Ol OR UNIT DISTRIBUTION SYSTEM Header / Manifold r Distribution Pipe(s) x Hole size x Hole Spacing Vent To Air Intake d r (o "r 72~ Length ~J O 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 1~t~ Bed /Trnch Center ed /Trench Edges Topsoil ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons pr sen , etc.) ~Ca e+t" 9.515 q" 9." 9-&S 9•c,F LOCATION: TROY 23.28.19.364D,NE,SE 232 HIGHWAY 35 we-K 16tbtm /udikCaY /7-1/1 Plan revision required? ~7 Yes ❑ NO ~Z Use other side for additional information. SBD-6710(R 05/91) Date Inspector's nature er- No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: n Safety and Buildings Division *SANITARY SC011S%11 PERMIT APPLICATION Po Bw ~~hinngtonAve. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. St Croix • See reverse side for instructions for completing this application State Sanitary Permit Number X990 q8 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 John Larson NE 1/4 SE 1/4, S 23 T 28 , N, R 19 IR W Property Owner's Mailing Address Lot Number Block Number 232 Highway 35 City, State Zip Code Phone Number Subdivision Name or CSM Number River Falls WI 54022 1(715) 425-7403 II. TYPE F BUILDING: (check one) ❑ State Owned 4 rest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town Df Troy I!Highway 35 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) s-- 1 E] Apartment/ Condo 040-1090-30 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 4_ ❑ Reconnection of 5. ❑ Repair of an System ________System___ Tank Only______________ Existing System _________ExistingSystem 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 (3 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 450 1500 1500 ©..3 1 S Feet 9s a Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank oeldimg-T.*Ak• Q 15-00 ❑ ❑ E ❑ Lift Pump Tank /€7~AIX@C 750 750 1 Wieser nX 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) PI s Signature: o Stamps) MP$t~ No.: Business Phone Number: Paul C.J. te'n 1(715) 425-5544 Plumber's Ac dress (Street, City, State, Zip Code): N8230 945th Street; River Falls, 54022 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Age Sig ature (No S s Approved El Owner Given initial 60 Surcharge Fee) Adverse Determination ljele~) X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6396 (R.11/96) - DISTRIBUTION: Original to county, one copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ` 3 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. FIII In i;he capacity of every new/orexistIng 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, Iocation 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. 5 A le r 30 [ F tern ST CFIOIX CouNTY ONINGOFFICE a 82 r4u d ,2 b ` Cp)~tKGfC Sja 1 Tea ftj I3.~ 8M yi s ,n5 3 B~ 137 7 C/ ~v I ME40 PERFORMANCE CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 . 30 N W W 8 LL 25 ~ Z W 20 6 Q _ W N 15 q tZ D 4 la- 10 Rey - • 12• 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 23833A275 r r i a r ~ d s scale- 30l r O a 71 a Co x ov*fC S lab -a ® yS~~►i Paw4~i'w~ 8.3 1Z5a S~ cow s-Y ~o rga,e ~ri s ~ rno~ 3 Bf. }romtY 67c PAG F CF PUMP CHAMBER CROSS SECTIOIJ AUD SPECIFICATIOQ5 l; VEI~JT CAP 4"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAJG > JUWCTIOM BOX MAMHOLE COVER 25' FROM DOOR, WIMDOW OR FRESH 12"MIU. AIR IAITAKE I GRADE I ~ I 4" MI IJ. ~ I B" ml A1. COAIDUIT-- IB"MIN. X11 PROVIDE I - IAJLET AIRTIGHT SEAL * A I III I III ALARM B I il. I *APPROVED i I ow JOINTS WITH I ELEV_ FT. APPROVED PIPE I 3 ONTO PUMP ` OFF D SOLID SOIL GOAJCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TAIJK MAULIFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIONS DOSE f TANKS MAMUFACTURER: eI-SC'Y KJUMBER OF DOSES: PER DAS TAIJI( SIZE: 7,"O GALLOWS DOSE VOLUME ALARM MAMUFACTURER: ~~YC Alarn, INCLUDIUG 6ACKFLOW: ~~99 GALLONS MODEL IJUMBEK: CAPACITIES: A =023,(p IUCAES OR GALLOWS SWITCH TYPE: FlO4f g= a i INCHES OR 3y,~ GALLOWS PUMP MAMUFACTURER: AVPPS C = 7, y INCHES OR 429.9 GALLOWS MODEL HUMBER: t11 A!U D- INCHES OR GALLOIJS j SWITCH TYPE: F/OQT MOTE: PUMP AMD ALARM ARE TO BE MIIJIMUM DISCHARGE RATE 30 GpM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE 15ETWEEW PUMP OFF AND DISTRIBUTION PIPE..9 FEET + MIJJIMUM METWORK SUPPLY PRESSURE . . . . . 2.5 FEET + FEET OF FORCE MAIN X L. F/oo rtFRICTIOU FACTOR. • FEET TOTAL Dti JAMIL HEAD = - Ll i r FEET IMTERUAL DIMEIJSIONS OF TAIJK: LEIJGTH ;WIDTH -;LIQUID DEPTH 1~~ /0 3 IGNE D LICEOSE HUMBER: 6 ` ~ /97 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 tabor and Human Relations Divi$ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY \m` Attach complete site plan on paper not less than 8 size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference ti n of slope, scale or O L 0 -1 Oq0 30 dimensioned, north arrow, and location and s o nearest ro REVIEWED BY DATE APPLICANT INFORMATION-PLEAS NT MAT PROPERTY OWNER: r P PERTY LOCATION ~-b!\t"3 S r~ tV p,•. e 'doll nVZ 114 S 1/4,S 23 T 28 N, R E(or~N PROPERTY OWNER':S MAILING ADRESS K # SUED. NAME OR CSM # CITY STATE ZIP CORICE AGE MOWN NEART10A3S `q S 00 New Construction Use,N Residential / Number ms 3 Addition to existing building DI Replacement ( ] Public or commercial describe Code derived daily flow 4 SO gpd Recommended design loading rate - bed, gpd/ft2 0 3 trench, gpd/ft2 Absorption area required - bed, ft2 \ S yO trench, ft2 Maximum design loading rate o - -S bed, gpd$ 0.6 trench, gpolft2 Recommended infiltration surface elevation(s) °l Z. 5'!M-t- C."S1 It (as referred to site plan benchmark) f 6 Additional design / site considerations NSF QuM 2t:1Q .0 - -%ZT- w'tYt~45 y -AZ&jCtMT' Lyef-N S --Is Parent material - Flood plain elevation, if applicable N • N . ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U= Unsuitable fors stem 0S ❑ U co S ❑ U WI S❑ U ®S ❑ U ❑ S ®U ❑ S A?U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed t8f1Cf1 ~~•1 o_t9 totiQ Zlf Z~s~1n; m`~r e,w - o-s o. 1 ` Z 1°I~3y l0 `1 31 - SiI ZW►SVn VA CS Ground 3 3~ -S 3 S `11Z Y/6 _ s 1 c s bk w►v-VV e S c, 1,4 0. S elev. g5•Zft. 4 S3-80 ~•S`1Q y/b - `FS V S9 wt~ o.S io• Depth to limiting factor ~ f30" Remarks: Cw - V S o. ~ Boring # p-Zl to'-l~ Z /f S;1 -L-Fs ~k TV- ]R"" Z Z Zl-~to 1o~l~z 31~ - stl 2'£sl~h wt~f~ cS 3 qo-61 S~aY/G - s~ 1 cSU12 6nvq. as - n•y €a.S Ground elev. Ll b1-q3 `)•S `1R V/6 - S O sg wt 0.7 'o, 8 ,I q-9 ft. Depth to limiting factor >q3 Remarks: T Name:-please Print Arthur L. We erer Phone- 715-425-0165 Vegerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnature: Date: CST Number: X14-305 a~c.6, 144y M00576 PROPERTYOWNER 1_ P~f2 Sort SOIL DESCRIPTION REPORT Page of PARCEL I.D.# onto- 10`11)30 s Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerrh b c w `o~ Z/ f - 5. 1 Z`F Sbtit v~'Fh - o-S a z }'<..,3..4,t 2 21-~1u 1o`l\Z 3!` Sly Z'@s~k ti»`f~ cS o,S o L 3 40-62 -r.S`11Zyl6 s~ ~csb12 W1v`~- cS o.~( v.5 Ground elev. D• S ; o, 6 qS.b ft. y 62 -boo • S ~l Q 4l6 - S o s 9 wV 1 Depth to w-S a c LLJTs o F 1 ~s 1 limiting factor l0O Remarks: Boring # L'iSi\kf Ground elev. ft. Depth to limiting factor Remarks: Boring # k' Ground elev. ft. Depth to limiting factor Remarks: Boring # pypyll~hSSw: nvp::. Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 .o ,I SCALE 1"= I i~ LV L.LgYB e~~M.+Ovr 3 uNv t!L q o ~ v S' b' t~L gsz s• 8.3 Z 4 CL4S8 / n ~~~r~vo~TS~B iF.~. et9o~ vomt`NUV 1 2 ( ck 1, vKR. 3 '~p•(~r-1 ~~UV SL awl - l0 V , 0 ona co~2~LsR Ot= eoN c.CL-~~ S L.P~3 _ pw~zL \ s > s u t=tw►~ s-Is V-T-wm-A gy-3US d. ~~C~..6~ L2 y (715 ) 42.5-n1 65 _ 1400576 CST Signature Date Signed Telephone No. CST # ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Jo ~ h, L®rson residence located at: AlE Section T_,;,?- ? N, R~W, Town of Troy Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur f om absorp ion system? 0 ~ Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known): Age of Tank (If known): /~2, C lD ezcd Cj S~ein~eyl ignatu ) (Name) Please print 1yl P 7~0 (Title) (License Number) ~ol~ 19 ~ Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle . Name l Up I C S(e/~j ~(r S ignatur~ P PRS SEP-10.1957 WED 11:27 ID:STEINER PLUMB & ELEC TEL:715 425 8818 P:03 R TCw 100 shim applicativit fox to to be oomplated 4n fall, and signed by tho o-'owner(s) of the ptuopperty being devola ed.. Any ipadequaclas will only rasult in delays of the permit Januanae. should this davelop"anb be intended for re"C0.0 by ownar/eobtraatot" (epea houna), Wien a second rprm should be retained and ComplAlted when the property in sold and eubtaitto4 to thin ofriaa aiith the apptoprialte doed recording. r~4_~~_+t~~ r - a--rte owa&v*x of property _ John Larson wr.atlon or BeGtion w. .•T_ $,N-,~ ~w Tpwnship TrnT,,~,~Maili,rig addree$,~32 Hiehtaa.J5..~.._,. River Falls, W1 5+022 Subdivisibn nameLot no. othdar homea 'an property? yes- NO Previous enmer of propert Total sitw of propazty W Total sign of parcel Date paxCAl was creatad Are all corners and lot lines Identifiable? ~~Xes No is thig property beiU9 developed for (vpec houde)? ~ Yei~ ~ No Volume _ and Page Numbe as recorded with the kegi,ster of peedd. fr~wr+~~~1_~~~.rr~r.+r~++r~_r.r.wnF~ ~.wrM_~r~~rr~~w•w~Y~~rrf.+~wr_~..r+i~~+w~~ xNOLUDB WITR TS28 {APPLX04TXOK TKN rOLLOWING! A wARltuTX m v whiob inoluden a I)OCTIHMT WMERt Vc3LUMB AND PAGE xwmesx AND THS 8"L OF T1115 P.WIS FAt 01F 0121909. z:, aidai,ti.on, Al certified survey, it available, would be belpful 50 RG to KV014 delays oir the reviewing process. If the deed delicript-ion revs rdnces to a1 Cortirled survCay 156p, the Cert;i,ried survey Wakl shsll also be raquired. VVo1PgjkTY 4w> JR eERTY>~XcATTb>N 1 (we) certify that all a+tiRtemeltts on tilig fazes ara+ trine to the best of Jay (our) knowledge that T (WCs) as (arc) tho owner(a) Pf thn property described in thib i,nrurinat.ion 3'oxue by virt-ua of a warranty daed rooorded in the affiae of tha county ta.0crinter or Deado as Document M. , and that i NO Itkrecolttly own the pxpposetd site for the treiaga disposal sy"t-s" air x NO) abCainafl an oaaeMent, to run -fie above described property, rdr the ConstrMotion oJM said systeJa, slid the name harm been duly reooZdctd tat the orrice tJr,f: Me county Register of D104548 as Decstf,tnant No_ gi a ure o ' Appl cunt CO-App sranC - -J Da of siOnturd I t~ of Sig bre SEP-10.1597 WED 11:27 ID:STEINER PLUMB & ELEC TEL:715 425 8818 P:02 STG-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERJBUYIt NIAMUNG ADDRESS 232 Ili hwa 35; -Biver Ealls W1 402.9 PROPERTY ADDRESS. (location of septic system) Pieria obtain from the Plarwing Dope. CITY/STATE PROPERTY LOCATION NE 1/49 SE 1/4, Section 23 t 28 _N-R 19 W TOWN OF Troy ST, CROIX COUNTYs WI SUBDIVISION IAT NUASER CERTUNDS' RVEYMAP .~._,VOLUMEPAGE_, ~LOTNUMBER - 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 Query dumi years or sooner, if needed by licensed septic fella pumper. What you put into the system aaa affect the function of the septic tank as a treatment stago 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 acoepted this program in August of 1980, with the requirement that owners Q,f all new systems agree to keep their system properly maintained. The proporty owner agrees to submit to St. Croix Zoning a certification. form, signed by the owner and by a roarer 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 Nava read the above requirematats and agree to maintain the private sawagu disposal system in aeoordance with the standards set forth, heroin, as set by the Wisconsin DNIL Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three ye expiration da SIGNED: DATE' St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 . Hudson, Wl 54016 t- t GOiU#$3MT NO. l y^ rl / STATE BAR OF ySSCUNSSN-FORM t ~ NTY 351310*7 VOl VVU THIS SPACE wARRAO FODEEDOR0ING DATA ~ THIS DEED, made between Jerry J. Co rbo and Phyllis REGISTERS OFFICE IM. orbo, husband and wife, as joint tenants ST. CROIX CO., WIS. _ Recd. for Record M, 9 Grantor day of Ju1"° A. D. 19 79 and __--J-Qhn A. Larson, a single man x at q, Grantee, W i It n e s s e It h, That the said Grantor, for a valuable consideration RETURN TO 1 St. Croix conveys 'o Grantee the following described real estate in County, State of Wisconsin: A parcel of land located in } E~SE4 described as follows: Beginning at inter- section of West line of said E'ASE', with S right a of way line of Chicago-St. Paul, Minneapolis I and Omaha Railway Company, thence SS2 321E along Tax Key No. i said right of way line 293.8 feet, thence SW at a right angle to such right of way line 153.2 feet, thence W 140 feet, thence N along W line of said EASE', 300 feet to point of beginning; also all of 100 foot right of way of Chicago, St. Paul, Minneapolis and Omaha Railway Company (former Hudson to Ellsworth line) which is adjacent to and N of the following described parcel of land: A parcel of 1 acre located in E~SE4, described as follows: Beginning at intersection of W line of said E'~SE; with S right of way line of ~hicago, St.. Paul, Minneapolis and Omaha Railway Company, thence S 52 321E along said right of way line a distance of 293.8 feet, thence SW at a right angle to such right of way line 153.2 feet, thence W 140 feet, thence N along W line of said EhSE; 300 feet to point of beginning, the strip of land hereby conveyed being approximately 100 feet wide and being located in E'-ZSE',; all in Sec. 23-28-19. The above described premises contain 1' acres, more or less. 1 This_L4-._.___---homestead property. ' (is) (is not) Together with all and singular the he:editaments and appurtenances thereunto belonging; 1i11111.7FER And _-Jerry. J,_. Co_rbo and Phyllis M. Corhu____________._ in an warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except J easements and restrictions of record FEE and will warrant and defend the same. 7 Dated this ----sixth 79 -day' of -------J>r ly - - - - 19_-. I i -(SEAS.) - b} - / .(SEAL) Jer. J. orbo { _ --(SEAL) _._(SEAL) I s Phy_ lis M. Corbo AUTHENTICATION ACKNOWLEDGMENT I Signatures authenticated this _day of STATE Ot' WISCONSIN ' 19 i ss. PIERCE County. I Personally came before me, this-_6Lay of l - -T July. 1979 the above named Jerry J TITLE MF%iFER STATE BAR OF WISCONSIN -Corbo and Phyllis M._Corbo (If not. - - - authorized by r 706-06, Wis. Scats.) This instrument was drafted by 'r u`r=- a Keith D Rodli, Attorney to me known to bt thi: r' 'scn_5__ •s~o'executecr the fore- ST. CROIX COUNTY WISCONSIN ZONING OFFICE a N ° n u u ■ r~rr ~ ` l , S ROIX COUNTY GOVERNMENT CENTER ` 1101 Carmichael Road " _ G~ Hudson, WI 54016-7710 RECEM J. • (715) 386-4680 e sT CROIX ! :;tlUN Y Y ; . e~~N1NGOFFICE November 5, 1997 Steiner Plumbing and Heating, Inc. Paul Steiner N8230 945th St. River Falls, WI 54022 RE: John Larson's final septic inspection in the town of Troy. Sanitary Permit # 299098 Dear Paul: Pursuant to our conversation on November 4, 1997, we discussed that a revised plot plan is required since the existing(two)750 gallons septic tanks had to be abandoned during construction. Please show on the revised plot plan the location of the new combination septic tank. Also provide a pump curve for the Myers (ME40) pump installed. Thank you. Sincerely, kw~~~ Rod Eslinger Zoning Technician ST. CROIX COUNTY WISCONSIN ZONING OFFICE N N N N- M N Note ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 5, 1997 Steiner Plumbing and Heating, Inc. Paul Steiner N8230 945th St. River Falls, WI 54022 RE: John Larson's final septic inspection in the town of Troy. Sanitary Permit # 299098 Dear Paul: Pursuant to our conversation on November 4, 1997, we discussed that a revised plot plan is required since the existing(two)750 gallons septic tanks had to be abandoned during construction. Please show on the revised plot plan the location of the new combination septic tank. Also provide a pump curve for the Myers (ME40) pump installed. Thank you. Sincerely, Rod Eslinger Zoning Technician