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040-1108-50-100
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Wisconsin Department of Industry, SOIL AND SITE E V A L U A T I T Page of 3 Labor snd Human Relations , Diyisrn of Safety & Buildings in accord with ILHR 8' 05 1 A UNTY Attach complete site plan on paper not less than 81/2 x 11 inches in siz mupl~t c~ S'r - C.~2 C1Lx not limited to vertical and horizontal reference point (BM), direction and pe, r L I.D. # dimensioned, north arrow, and location and distance to nearest road. v GJ ~g96 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATQ D BY DATE T o 0y, PROPERTY OWNER: PER SOU E~) V~ ZSOtu 1/ 4,S 28T N,R lq E(or W PROPERTY OWNER':S MAILING ADDRESS L L AME OR CSM # \1;6 Srvfri~-t - CITY, STATE ZIP CODE PHONE NUMBER (]CITY []VILLAGE )MOWN NEAREST ROAD Rl S 1 11 Sg67_-Z- htS) LJZE _ SS s8 T ,,v► ~r tzb- [)4 New Construction Use Vj Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 6ou gpd Recommended design loading rate - bed, gpd/ft2 ' S trench, gpdfft2 ~ P,~ v Absorption area required Soo bed, ft21'z-cam trench,1112 Maximum design loading rate S bed, gpd/ft2 b trench, gpolit2 Recommended infiltration surface elevation(s) S PVR e tT 3 ft (as referred to site plan benchmark) Additional design / site considerations 3 ')N0, J C S- (!teN S' A LW C. Parent material G LPKV t fr t.. C) S ki Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S El U ®S 11U 1a S❑ U 0S ❑ U [I S ®U 0S Q U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Ou. Sz. Conn Color Texture Gr. Sz. Sh. Consistence Bouxlary Roots Bed Trends s } o-t1 tiO-1 zZ z,(Z - s ` 2~ Sb vn`~L- e-S - S a> Z 11-3 ~O`1Vt-31L S1~ SDk Y~t`F1~ I Ground 3 39 -S3 -A- S `t IZ 2) l - S C 5 bh wl U ~1r ~v ` `l S elev. , S , C- •8fL S3 -1•S-o_ Y/L S O S°i wt - Depth to limiting facto Remarks: Boring # 111 k ~y-s3-SY2 Sly - s~ 1 ~sb env F1- CS <<( `S Ground ` S L elev. y `/R VA - O 9,-1- Zft - Depth b limiting factor Remarks: CST None:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 I Signaere: ~~pp Date: CST Number: i. PROPERTYOWNER_ Q`zZONQ SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 Z - s ' -Zsb CS - . S 2 ZO- S~ 1.v.`1 R 3A6 S 1 I Z. S Yrl C S • S Ground So-- D R - ~S U S m ` S elev. C?6-o ft. 3 C-O w s ra - 7• Y (Z 3 m U Ir :s ' Depth to limiting factor 2 80" Remarks: Boring # E.1 I o -L9 ~oktz ZCz s i1 Z~ ~bL~ wt`~1.~ ~S _ . s Z i9-38 vv-t\Z31 - stI Z~S~k w►`f~. as - •s 3 38-sS w~ 3L r. 7-M'3 k y,l S ^s , Ground 9,b-oft. y sS-8 S`1R 3L '~S s'~ - S Depth to Z~ s s lL CO . E limiting factor i c c~4 Remarks: Boring # S oAZ tie`'I~ itz st I Z`~Sb12 wi S - 5 Z IZ-5 1 1ks\-tR 3l L s i 1 Zsbk `Ft- ~S - s , t 3 sz -,B S IPl-- VA. Ground elev. ft. S ~o Vi U1=- 1- vi- 3 ! M U L- ~v Depth to L t t"~1 G a~ S limiting factor 8V Remarks: Boring # i 13 Ground elev. ft. Depth to limiting factor Remarks: • PLOT P LM Page 3 of 3 SCALE 1"= L10 ' 31y11DIA• pucC PIPIE • w/wooer ~t4'r14. 8.1 I° 0 0 -IP to lit. S' ileI J ~ ro J -L CLO _1 N o1~~ l~vg~, w~..l. 'Co 3~ ~ s0` ~o1~='Rf d1=--S~C.s`t~-1 t'rcz.LsA. u L w q~-zoo )0 -4 -9 ( 715 ) 425-O.7 65 14OQ576 CSTSFgnftIr* Dade Signed r_ _ . Telephone No: - CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 L.ab& and Human Relabons Division of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY S~"' C~a OLk 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 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 SOU C~ V:t ZSON GGW-LET NW 1/4 K) 1/4,S 2B T Z8 N,R lq E(`"L PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM If Vb S CITY, STATE ZIP CODE PHONE NUMBER ❑GITY []VILLAGE MOWN NEAREST ROAD RLSR S 1-JI SgO2-Z htS) ~fLs_ SS~8 o T NSUVttI~! tzb. [)4 New Construction Use Residential / Number of bedrooms [ ] Addikn to existing building 1 Replacement [ ] Public or commercial describe Code derived dairy flow boO gpd Recommended design loading rate - bed, gWt? ' S trench, gpi 1SO0 2 1ZAA) s Absorption area required bed, ft trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) S tE'e- IP LS 3 It (as referred to site plan benchmark) Additional design/ site considerations ' S 'M2` y c-' VyeS - L teH S A $0` LwG Parent material G L-".L ft o1., w P, H Flood plain elevation, if applicable 1 ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for stem as ❑ U ®S ❑ U RI S ❑ U R1 S ❑ U ❑ S ®U ❑ S QI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed re & i <r 0-11 ~o~LCL z.(z - s ` 2~sb rn`~I- e:S • s b Z 11-3q 31L - S1] a~k wiF - `S S I ~•5`tR 3L Ground 3 n -2 S 1 Cs bh tin U Flr 04 elev. Ca. -B it 573_b -'•S'-ctx Y/~ Depth la limiting factor 7 8IZP Remarks: Boring # o-~ 1~~tz Zcz sly Z~~b eS - • S€ all, ZGround elev. y 53-fi8 ~•s `,R VA - - 9.,-ztt Depth b Grrdng factor Remarks: CST Name:-Please Print Arthur L. We erer Phone. 715-425-0165 V egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 i Sgnatre: .p Date: CST Number: i . PROPERTY OWNER S~f~kaTZ-SON SOIL DESCRIPTION REPORT Page?- of 3 PARCEL I.D. x Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BODY Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trees 3 0 -ZD t o Z - s Z s~ C-S 2 Zp..SD 10.`2 R 3~io S t I Z S Yrl C S 5 Ground Su--$b .S `I R - ~S U S m - • S elev. el6-o ft. 3 s r~ 7• fZ 3 vn U s Depth to limiting factor 2 80" ~ ~I Remarks: Boring # o 49 )l7 z 2 Z 19-38 Lv`1CZ3[ - S! Z~sbk wl`~!~ e-S -S 3 31-S S to `2 Q 3 L l~ - S 1 I 2-V'15U k Vq eS _ ^ S 1, Ground 9e1 b ft. y S S -e -I S'j R U j Depth to Z tzr\J s r'l r" -JI-t 3 LL Co . limiting ; factor Remarks: Boring # ; S > iZ-sZ ti~~tR 3~L si J Zw~shk m `F►- ~S - s : Ground elev. U 5 -\7-irTs 0,F S '1 1- tz 3! M U h w 91-4 PSzL .8.3 ft. Depth to L t 1^~1 G wi c~ , S . limiting I factor a Remarks: Boring # E3 Ground elev. j ft. Depth to limiting factor f Remarks: _ PLOT PLAN Page 3 of 3 SCALE 1"= t-a0 ' %b -r3, Oki \Z~wt cti N4"Dlh- F3vC PIPE • w/woos ~~'T►4. a•t o ~ NO O S' L'1 6183 s' Q~ \C\\ ' 6 s J N _ n o~ J EL q6'1- n.3 _1 1~c~vS~ ~tl. ~o t3E ~ SO` ivo~`-[r} OV= S~~}1 PfRCsA, 1 1 n ~ 'owe l,tw P. P, ~~-Z.-7Q (71,5 Y_425=0-165 I400576 CS7 # Telephone NO - - . CSTSi~nafui~e ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT !d RECD f~~} Owner o~ q ~,dc~~ rse.•rJ JA A) 1 6 1998 Address ST CROIX C'b City/State zpNINGp FICE ro Legal Description: I 1;61"L~ 318 `C Lot I Block Subdivision/CSM # zf 514 '/4 vAJ Sec. -IF, TAN-RZY W, Town of Fro Y, PIN # Qq6-110 V `30 - leo 01g.;(8. 1~ .1-33D SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer &1,w e s r Size ST/PC 1606 /LSD Setback from: House 34" Well S-0; PAL Pump manufacturer Yy~v A,1 Model Alarm location 1~h~~ •e (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: stale- p,~~Y,~ Type of system: mdtviel Width Sew Length Number of Trenches Setback from: House 1~;o , Well / do P/L 30 " Vent to fresh air intake ELEVATIONS: Description of benchmark w ra e r xl)e i Elevation 10-4. Description of alternate benchmark Elevation e e v ~e~o Building Sewer ~7 !o ST/HT Inlet q3-411 ST Outlet q 3 • Z.( PC Inlet . YK, PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines 5 9S) ~a ( ) Bottom of System ( ) q 5 2 ( ) Final Grade ( ) ( ) Date of installation ermit number State plan number 97ZD~b Plumber's signature License number Ay,0,gP Date Inspector Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Shaw. alternate benchmark, if applicable. - 7-of ~ d we li"d 4""Wa*M -A PLAN VIEW tt a~ o° I 4h ~ f ~ i 0 r c INDICATE NORTH ARROW Wiscorr,> Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division ST. CROI X INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,Pr~gith` Personal information you provice may be used for secondary purposes [Privacy La 5.15.04 (1)(m)]. d 7711(v~~~ PANDERSONermit Holder's : ❑jjt bKVY l Village Town of: State Plan ID No.: ZO517(o CST BM Elev.: Insp. BM Elev.: BM Description: Sm Vo e crz Parcel Tffft-1108-50-100 ) md /a 01 0'r e-lec-lr i ce d o - Cdr TANK INFORMATION ELEVATION DATA A9700486 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic IN V%/ ~ m©® Benchmark ~ 3(0/013 too' Dosing fo5C Aeration Bldg. Sewer 3-0 TZ 26 Holding St wInlet 77q3. TANK SETBACK INFORMATION W Outlet 93 4 Vent irIto ntake ROAD Dt Inlet Q~ O TANKTO P/L WELL BLDG. A Ar Septic q0` NA Dt Bottom i Dosing NA Header / Man. Aeration NA Dist. Pipe 52! 73-: IN / Holding Bot. System I 95 2 957 PUMP/ SIPHON INFORMATION S,no~x, d/ Final Grade Manufacturer L, Demand U I~I S 6•Z./ Model Number Poll 21(•0SSGPM To on TDH Lift & . ( . Loss o0 Friction: i $ysterrY1~- TDH) p-, Ft Clu~el( inn Forcemain Length ]0d/ Dia. H2 " Dist. To Well C>0 SOIL ABSORPTION SYSTEM ED RENCH Width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N L 75 DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa% urer: INFORMATION TypeO CHAMBER Model umber: System: `/V)ook cl t3o, +1sD + ZDO OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing, Vent To Air Intake Z~ Length T Dia. it Length 35 Dia.~r Spacing I~~~ :5C 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 sr Bed /Trench Edges Topsoil Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.28428419,NW,NE 189 TOWNSVALLEY RD LOT 1 I: {z,~ `1.3e' YT lo1.3,' ~/Jysfetvl fh 2 3 +wre~ jcVm42. v) k avcI p IM 1-!o_y)cL 3• Rats~~f tie~91,~ bed ,2 T10Wirf 9 Ai hr./ V. 97 Plan revision required? ❑ Yes E] No " ~ G Use other side for additional information. ' 7 SBD-6710 (R.3/97) Date Inspector's Signature N ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ` h, Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. V isconsin In accord with ILHR 83 05Wis. 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 81/2 x 11 inches in size. -5, t - Y-o r, • See reverse side for instructions for completing this application State Sanitary Permit N~uumbbeer The information you provide may be used by other government agency programs ❑ Check if revs I Co 1revious 9pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION M05 (O Property Owner Name Property Location tn,_ ire _<,7 kJ 1/4 1/4, S,2 7- T N, R q E (ork Property Own 's Mailing Address Lot Number l Block Number f/C el City, State Zip Code Phone Number Subdivision Name or CSM Number Q~/ e, mat ~l ( ) dl / ,l O II. TYPE F BUILDING: (check one) ❑ State Owned o ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms village Town OF / a 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s d Yd ~ fll Sd 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. $a New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11171 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 y_~_e 12 7 Qt U Feet Feet VII. TANK Capacity in gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ .22M / I& Lift Pump Tank /Siphon Chamber ?~Q e ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N Stamps) MP MPRSW No.: Business Phone Number: Plumber's Ac dress (Street, City, State, Zip Code): e IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved dry P` 't Fee (Includes Groundwater ate Issued Issuin Ag t Si nature (No Stamps) rcharge Fee) Q1 XApproved ❑ Owner Given Initial ~ ~ .i3• / F Adverse Determination X. CONDITIONS OF APPROVAL / RE NS FO ISAPPROVAL: SBD-6396 (R.11/96) DISTRIBUTION: original to county. One copy To: Safety & Buildings Division, Owner, plumber INSTRUCTIONS r 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- V11. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from -DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and (ontrols; 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 AND BUILDINGS DIVISION 2226 Rose Street ~ La Crosse, WI 54603 Department of Commerce Tommy G. Thompson, Governor 20-Oct-97 William J. McCoshen, Secretary 2 3 We ever Soil Testin & Desi". s_f cRO►x g g g ~ cowyTV DOU v DERSON 421 N Main St ZC)%INGOFFICE PO Box 74 ; . " River Falls WI 54022 el z Z DOUG ANDERSON Plan ID 9720596 NW, N E,28,28,19W Municipality of TROY Inspector: Leroy G. Jansky County of St Croix (715) 726-2544 Private Sewage plans including the following element(s): MOUND 450 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page(s). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department. All permits required by the state or local municipality shall be obtained prior to commencement of construction/installation/operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, V. Ira k 1 rd d M. Swim POWTS Plan Reviewer (608) 785-9348 Page of b as r " l'., r L..Y r,.st `a.J MOUND SYSTEM FOR ECEIV ED A 3 BEDROOM RESIDENCE - 0 C j 16 1997 SAFETY & BLDGS. Div. LOCATED IN THE NW 1/4 OF THE ~F 1/4 OF SECTION ,T~$ N, R 19 W, TOWN OF '-R Uc.{ C-ttoK 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 B S ~'awr~ s y Pcu. r ZL Fi\~,kvI s~[ozZ P~ BY WEGEE=ZEFZ SO I I_. TEST I p4( A. DES I Ghi~S1ERV I CE 4;0~~•/~ 1 P.O. 001 74 421 K. KAIK ST. ARTHUR L. P.Q.VU.T•S• RIYEP FALLS. VI 54022 111"EMER 1 25 • ORTH, • Conditionally 71"25-0165 ELLsw"v O~ OF COMMERCE A PPAPINT E LOIN 6S odd I G'14 ET 0 BUl ONISION OF SAF c. ~'~ee~lsoM~ lC-lam -~7 SEE COR SPONDENCE JOB NO. 9-7, 3 3 1 -----PLOT- PLAN - - Page Z of 6 Scale 1"= 40' 1 ,`ti • will 3 en Z.~ - Nvv sF " Ito' oFv"c~~L' D D cou 5 P SON ; Lotto 7- Pvc F.M . t3. i Z!, 8.2 P °1p 6 1 1ti ~u \ 1 V! ? \ bo N~ ~P~t-T' oR ~ ZSi~ 3 Q~MvvR i~1~.`34.0' z~ ` 8 ~ 1 S~v \2Q 'C1}'l S - ~ ' ~T7.9.3 ? a'n0 wt OF 1~~/ C~~ iM LRI-ej • 9S J i -o '0P x - Sneer • w~.C `CS ~E A-r ~keT S o ~ F'RoM ~ uvw~ ~ 2 ~5T P1?oP~~i lY Lliv( LS > S' F\ZOt~t N►U~kA. ~$7 F 7 0 d NOTES: -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( -27-required) 4. -Septic tank to be lpoo gallon capacity manufactured by f-V Ow e`SM;_X / PJ_Z~ckSr rN C. OoSl~- `DVUtz lb QE~ -ISO Qv_ W4 tDW `"VL* . 5. Bench Mark S EtS7 "oV 6. Divert surface water around system to. prevent.pondi.ng at the uphill side. Page 3Of Approved Synthetic Covering l~sT*~► C 33 Distribution Pipe Medium Sand H - Topsoil J ~ F G Elect: °1 D 3 E " 1101 b li~) % Slope (Force Main Plowed - Trench of i"-2 2" From Pump Layer Aggregate 1. Undisturbed 0 Ft. Soil E S Ft. Cross Section Of A Mound System Using F 6.8 Ft. I Trench For The Absorption Area G N - a Ft. A S Ft. H I- S Ft. B --)S Ft. I k S Ft. Linear Loading Rate= q.S GPD/LN FT J -7 Ft. Design Loading Rate= o.3GPD/SQ FT K 11 Ft. L c11 Ft. A4.teraat-e Position of Force W Z'1 Ft. L J ~ t-ofse B K f~tltn A - - - - _ - w " Distribution Trench Of 2 - 2 2 Pipe Aggregate I J Observation Permanent Markers Pipes (anchor securely) Mound Using I Trench For Absorption Area Page Of _6 Perforated Pipe Detoll 0 End View )Perforated End Cop.) PVC Pipe 1 " his ice Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop PVC Force Main Distribution Pipe Last Hole Should Be Next To End Cap Distribution Pipe Layout P 3y S Ft. X 3 Inches Y 3 6 Inches Hole Diameter V Inch Lateral 1 Inch(es) Manifold Inches Force Main Z Inches # of holes/pipe 1Z Invert Elevation of Laterals 9 S•S Ft_ ~ 2- X 1- l1- 1 V . OBI ~c 2..,. Z 8 .CZ 8' G P+~-i Place lst hole from tee with succeeding holes at 36" intervals. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS PAGE 5 OF 6 VENT CAP H C.I. VENT PIPE WEATHER PROOF OVED LOCKING MANHOLE R KPP --r JUAJCTIOIJ 80X OVER WITH WARNING LABEL 10' FROM DOOR, IYMIU. wwoOW OR FRESH AIR WTAKE I GRADE i H"MIN. I COWDUIT PROVIDE I IlJLf=T ~ AIRTIGHT SEAL ( III ~ I III v APPROVED JOINT/ A Tank construction shall comply i ill APPROVED JOINTS with ILHR 83.15 and ILHR 83.20 i ill ALARM I II a l l I I ON C LLEV. FL PUMP---- OFF D 8 O COUC BETE BLOCK ARPRa/EL RISER EXIT PERMITfEO ONLY IF TANK MAAJUFACTURCR HAS SUCH APPROVAL gE,DpIµG SPECIFICATIOAIS DOSE l)~Pj pyZCh'~' NUMBER OF DOSES: 3' 1 S PER DAy TAUK MAAIUFACTURCR: TANK WZ1L: DSO GALLONS DOSE VOLUME t \~Li.S ALARM MAUU.FACTURER: S'S'A SKS 4S INCLUDING DACKFLOW: GALLONS MODEL WUMBCR: 101 HW CAPACITIES: A= 1511zINCHESOlt 10Z. 3GALLON3 SWITCH TYPE' 1'1 2 C La Y 8= Z INCHES OR 30J' O G( LLOIJ5 PUMP MANUFACTURER: GoUL.DS G= -7 INCHES OR v36'S GALLOIJ5 MODEL NUMBER: 381 I Ev-- O4 D= 1 W INCHES OR Z,3' O GALLOWS "E~_CUR-Lf MOTE: PUMP AND ALARM RE TO bE g SWITCH TYPE: MINIMUM DISCHARGE RATE Z$"()8 GPM INSTALLED Old SEPARATE CIRCUITS VERTICAL DIFFERENCE 6ETWEEIJ PUMP OFF AUD_DISTRIBUTIOU PIPE.. S' 33 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . 2.50 FEET + 100 FEET OF FORCE MAIN X %1 FY0 fjKICTIOU FACTOR. 61 FEET TOTAL OyIJAMIC HEAD = ~'~1I FEET DIAMETER - IIJTERNAL. DIMEWSIOW~ OF TANK: LENGTH ;WIDTH - ;LIQUID OEPTH BOTTOM AREA - - 231= GAL/INCH • AS PER MANUFACTURER = 1 q GAL/INCH Goulds or Submersible Effluent Pump 3871 EP04 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically desFgned for the stainless steel. grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. • Effluent systems ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle Motor and float switch attachment • Farms manual operation. Automatic points. Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • RPM, built in overload with rated oil and water resistant. Dewatering preset at the factory. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EP04 built in overload with w EP04 Impeller: Thermo- 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. cp- Canadian standards Association • Total heads: up to 24 feet. with three prong grounding - ■ EP051mpeller: Thermo- Discharge size: 11/2" NPT. plug. Optional 20 foot (CSA 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 104°F (400C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 components. - Al Pump: EP05 8 • Solids handling capability: 0 25 j I 3/4 maximum. a z W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. • Discharge size: 11/2' NPT. Z 5 I • Mechanical seal: carbon- 0 15 rotary/ceramic-stationary, 4 i BUNA-N elastomers. o - i • Temperature: E' 3 10 i 01 41 104°F (400C) continuous 140OF(60°C)intermittent 2 .o i 5 i 1 i 0 0- 0 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m°/h CAPACITY ©1995 Goulds Pumps, Inc. Effective May. 1995 . WEGERER SOIL TESTING and DESIGN SERVICE SOIL TESTING - SEWER SYSTEM DESIGN - MORTGAGE SURVEYS ATTN: DATE CC: SUBJECT: ~pv c:, h ~ THE FOLLOWING ITEMS ARE ENCLOSED OCT t 6 1997- NO. OF DESC TIO ,UNN COPIES - zor~~ S b l L `t~~r 1~ ~ F~ ~ SENT TO YOU FOR THE FOLLOWING REASONS: FOR YOUR USE FOR REVIEW AND COMMENT INFORMATION DESIRED i it ass 1-x,12 ef)&) ueyo-~one S-L8 w e~l: yflh S S o ►^~t irtlT m0 "f"~ w G GkhA-s WEGERER SOIL TESTING AND DESIGN SERVICE j9TL-- w Era P.O.BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715-425-0165 WU'tons-n Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX • Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 284340 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ANDERSON, DOUG TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax 0 0-1108-50-100 TANK INFO MATION ELEVATION DATA TYPE Nlw, ANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht In/ TANK SETBACK INFORMATION St/ Ht utlet TANKTO P/L WELL BLDG. v tto ROAD Dt let Air I ake Septic NA Bottom Dosing NA Header/Man. Aeration N Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION nal Grade Manufacturer DetG d Model Number M T DH Lift Lriction System TDH Ft ead Forcemain Length Dia. Fi Dist. To Wel SOIL ABSORPTION SYSTEM 2.1 j BED/TRENCH Width Length N{. Of Trenches PIT No. Of Pit Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L LDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER de Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pip s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pr ssure Systems Only xx Mound Or At-Grade Systems Only Depth Over /ed/ h O ver xx Depth Of xx Seeded / Sodded xx Mulche Bed /Trench Center Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include c e discrepancies, persons present, etc.) LOCATION: TROY.28 8.19,NW,NE 189 TOWNSVALLEY RD LOT 1 Plan revision quired? ❑ Yes ❑ No Use other si a for additional information. SBD-6710 (R 5/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' 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 811 x 11 inches in size. S 7e ;,,'A. • See reverse side for instructions for completing this application state sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous a lication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Gyso~✓ n/W 1/4,vAK 1/4,Saf- T~;2 ,N,R E(or&V Property O ner's Mailing Address Lot Number Block Number e4✓.fl$'4k14 2 Rd City, State Zip Code Phone Number Subdivision Name or CSM Number er ,C,a!!s Yo cc (7vr) ~ SS17ar e s m Ov / y II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City 'Nearest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ~tJ.u e III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 F1 Apartment /Condo 0,4 e r / lG SD l d 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. VQ New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 1 1 ❑ 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) #s,3 levation ea- 95, 0 Feet Feet 7 $'p 7S' ® r ` VII. TANK Ca in a city Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank mea ,roPwe ra ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: k!!ev a 279915 ?~S~ c-3l.2 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY suing Ag nt Signa re (No ) rE-Ad approved Sa i ary Permit Fee (Includes Groundwater ;7,;l pp Surcharge Fee) A roved ner Given Initial verse De termination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divr ion, 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 i. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form- IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks,- distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve,- pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. w dev T,~~/1~ ~J Tv~ y 2 ~ 3a Ac s ' rL ,p3 ~Q i :Aga, G o Iv -e- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page k of 3 Labor snd Human Relations Dividion of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest 8 O 40- t],p$ so - I OO ~9 REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL I PROPERTY OWNER: ECC, PE ATION bO V G Ia4JO~R so v . 1/4 NL 1/4,S M T Z8 N,A ig E (or 1~N PROPERTY OWNER':S MAILING ADDRESS OCT t QT~# # SUBD. NAME OR CSM # ► ~3 S To►~lusvv~.l -I ~2on~ 19Y? cS" U0 L - ~ \ 3154 CITY, STATE ZIP CODE PHO M-1 ER ~]Crry EptiAGE ®fOWN INEAREST ROAD UN ~JUSukt_L [~q New Construction Use [A Residential /Number of Additi.gn to existing building j ] Replacement [ ] Public or commercial desaibe Code derived daily flow ~I SO gpd Recommended design loading rate - bed, gpd/ft2 - 3 trench, gpd/ft2 Absorption area required 3'1 S bed, ft2 3-1 S trench, ft2 Maximum design loading rate s bed, gpd/ft2 trench, gpd1ft2 Recommended infiltration surface elevation(s) °l S - It (as referred to site plan benchmark) Additional design/ site considerations "'~o~~v~~ w/S'~l5''Z~.~►e~ . Y''~INiw,u►~ 1Z'' o,=a r=~~~, Parent material 5 t LZ-y 5VIZI" ev T Flood plain elevation, if applicable ►y , PS , ft S = Suitable for system COW MIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem El S I@ U 0S O U 0S NU ❑ S ®U EIS IOU O S IN U 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 re & n= - s l s> ` o_V3 Lt3"V Z1 Z s i( z►v< gbh wt~E'r CS :«,v Z 13 -3 t) Ls (2- 31Y dot wi c 4 • s • f, Ground 3 3V-V4 Ylz 3L(, S LIZ 5J8 s [ C~~ rr1 'Fl- - tia • 2 elev. °tq• 1 It Depth to limiting factor 3y~ Remarks: Boring # ` S ;r, o-►~ ~D LfSz- I Z - St 1 Z~nn~Sbk ►^~'Ftr cS Z Z 114-31o wm(z )1y S1I ZT5~6' Wr eS _ -5 .6 3 36-S i 10 `f fZ 3 l(, 1, 4 Q SA S i I wr `fit- - f.>> • Z Ground elev. 9o- 6 It. Depth to limiting factDr Remarks: TNarne:-Please Print Phone: Arthur L. We erer 715-425-0165 g rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnature: Date: CST Number: _ -15--`Z7 M00576 PROPERTY OWNER 11-hA~Z-S~ty SOIL DESCRIPTION REPORT Page '--of PARCELI.D.# 0q0-1108- SO- )lip Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3`l a ~ t 1 Lp `12 L Z - s ' Z►'►•t S bk rn `Fb. C S . Z I ).3 z ) Z jfL )1y - S 11 Z~-a ~k w, -F~- A, . ~ . Ground 3 IZ_SQI l0 `-f2 3~6 ~,SKR ~g Sly Q) kt tvp . Z elev. `P3.2 ft. Depth to E limiting factor } F I f i = I Remarks: .Boring # s i i Ground elev. ft. Depth to ; limiting factor 3 I ' Remarks: Boring # I 13 Ground elev. ft. k Depth to limiting factor I i Remarks: Boring # s .Ground .;:elev... ft. Depth to limiting factor I --T Remarks: SBD-8330(8.05/92) ' PLOT PLAN Page 3 of 3 SCALE 1"= 413 ' 3 QpZ" t-4v v sE "J - ~ o o ~ 0 1 EL o4 2~1 \ CF QILIQ-r~lr- %13K J \ F P ho_ ~elo~ 1 Ls, 4 500' In- 1`117 F A 1' L C$T S FTW" W1 U Ukab _ -~r2_ ~2~T PCtoalY ~~F is >S'Fzo>vt ~ot,x. ,P I ~ ti o tg'~ ar ; O 0 (715 ? 425-0165 M00576 ;CST Signature Date Signed Telephone No. CST # WeisconsinDepartrnentofIndustry, SOIL AND SITE EVALUATION REPORT P k of 3 Labor and Human Relations - DrAispri of Safety & Bwldngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but'(' •X not limited to vertical and horizontal reference point (BNn, direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ©4 to-- b$ - so- 100 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION TZ)OV G r~+~1b ~SD►v, GGVT--LOT t, ► 1/4 Me 1/4,S 213 T Z8 N,R lg E (or 4~V PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # i 9 G Towlusvrc~k_s,4 ~ZorcD Q,%" apt. 11 3* f CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®rOWN NEAREST ROAD RIUIEIZ Frt~S WI SWYLZ Ots)4tS,S598 TRo~( pWUSuk~t, ~ [J9 New Construction Use ly] Residential /Number of bedrooms 3 f I Addition to existing building j) Replacement [ I Public or commercial describe Code derived daily flow `!-S"O gpd Recommended design loading rate - bed, gpd/ft2 - - trench, gpd/ft2 Absorption area required 31 S bed, ft2 3Z S trench, ft2 Maximum design loading rate s bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) °t S - O ft (as referred to site plan benchmark) Additional design/ site considerations m w ~ w /S ' Kl S' 'T2~f e~ . MI IJ) YjL*A 11" Ot- Tfr-O FI LL. , Parent material S t t-'ry 3 V b tr1 C►v T Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable fors stem S ®U ®S ❑ U ❑ S ®U S ®U [IS O U ❑ S M11 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Coat Color Texture Gr. Sz. ShConsistence Boundary Roots Bed tench . OEM= ► -t3 to~Q z(z - sit Zrn gb►z w144- CS - s L 4:}p t"p `72 31Y 73 dh vh'FI- C 4 ~ • 5 Ground 3 3y44 f YtZ 31(, ;-SytR SJf; s i I O`M ►M'~'L - >.,p .•z elev. °14 - ~ ft Depth to limiting factor 3y+ Remarks: Boring # o-ty vo Li 'o-, -z-Z_ si 1 Z s dk ►~`F► O-S - • s • L Z 1qA 101-iR 31y si I Z`Fsbk wry eS 3 36-52 1 U`tlz 3l(, 4 Q S/g S i I . rz w, - ti> • Z Ground elev. go-6fL Depth to limiting factor Remarks: TName:--Please Print Arthur L. We erer Phone- 715-425-0165 eg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sgnatwe: _ - 3 3 [ Date: 1 CST Number: M00576 PROPERTYOWNERA~'LSnty SOIL DESCRIPTION REPORT Page " Z-of 3' PARCEL I.D.# 0k4 0- llUb-SO i1Oy Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxlary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trees 3 0~~1 tib~s Zcz - s zni -YJvr Z ~t.~z ~oYtL 3[Y ~ S1) Z~-~~k `F~ CS _ • ~ Ground 3 3-t_So Lo ~I(Z 3( Sl) 6 ~ . I 't tz S/8 6 tih 1H `F~. tvp . Z. elev. T3 -Z ft. , Depth to j limiting factor 3 Z." i i Remarks: ,Boring # j '13 Ground 3 elev. ft. { Depth to ' limiting factor I. j~ Remarks: Boring # i I 13 Ground elev. ft. f Depth to limiting factor • Remarks: aBoring # Ground r•; g a ev.. , . Depth to limiting factor Remarks: SBD-8330(R.05/92) • PLAN Page 3 of PLOT SCALE 14O 3 Q'D jz" v SF X11 . "j o ~ 0 s3.1 \ \ ~3w1 - Nt tun -a o>J Yoa l J/ \ ~ OF ~Tt.~lt,l C ~b x \ a.2 s ~ ~ X bo tucn- spur ~T oft 25:- z~ 3 0JvRv.R4.O' ~~~~\2q ~hS x.9.3? oF~~c~~ S.o 1 sdo ~ w~~ 'rv_ kr ~T s o' F~Iw~ wt ~vwn _ _ q ~CtL~T PC2oPlY LJAF LS > S' Ft~Awt-w►tit,iJ. t Ft~ tip lg? F 2 O V L/2r d/ ~l~ 1 b -1S °I-7 g~-33I (715 425-01 65 M00576 CST Signature Date Signed Telephone No. CST # FILED 6 NOV 2 7 1996 ► U, KATHLEEN H. WALSH 9 Register of Deeds r SL Croix Co., WI 552649 ti CERTIFIED SURVEY MAP DOYNE AND RUTH ANDERSON Part of the Northwest 1/4 of the Northeast 1/4 of Section 28, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. LOT4 C.S.M. VOL.B PAGE 23/2: r~#'i~H~VED I I I ! • N L/Nf NE l/ 4 A v NOS' 57' 03 "E 2672.94' R12671.96') © 33.0/' 233.60' 1200.79' 223!6/.9 4' 1rO~ 'A 10 J6!: 2 02.2 O' /3' NE COR. SEC. Y9, r 29 N, R /9 W, 1 `I 5 02.2307" j 1.47 /COUNTY SURVEYOR'S Afo 3 f 1 i ,.r . effto, COUNTY I I r .Nnprehensive Plannk a i1 1I 1 v k o I I 1 1 W Zoning and i 2 a I I 1 a o Parks Canurd"Go 0 o a I I 1 r ? 3 I 1 I a„ If not recorded Dated: Octgber 5, 1996 0 ? within 30 days of N I f I I 1 i Q approval date W Q a I I ' ..nproval shag be J C 1 1 J W v~ h 1 Z O -11N & Z I i 1 O Q e Owner's Address: a I I o W 1092 NE 625 o I O iI 1 WATERCOURSE Q = Knob Noster, MO x ' I o~ 65336 ca ~ a r LU I til W i tt,w, ► t` Q to vJ 33 I - % N I I 6' 6. IK` ~ I ^ Q a~ . I I ` 2 h Q. N V r J o % tu m I I I I w J o a o I I r 0 SCALE /00' 6 0 25' 50'. /00' 150' 200' 250' I~ ~ I O N O I o e a *Indicates 1" iron pipe found. oIndicates 1" x 24" iron pipe J I I j LOT / weighing 1.13 lbs./lin. ft. set. I f 6.172 ,.-*Indicates fence. I 168,8 ACRES ,.-*Indicates R()Indicates previously recorded I I/ VE WA Y 1 2ee4 So. Fr. data. OR LQCAT/ON 3.317 ACRES EXC. ROAD R.O.W. d QjIIIII ~I F4 0. 312 SO. Fr. 06% 40 040 LAUREN I3 • I This inktrument drafted by m W fiUR 20 b 1 b I n n As ' 0• C CERTIFIED SURVEY MAP DOYNE AND RUTH ANDERSON Part of the Northwest 1/4 of the Northeast 1/4 of Section 28, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. CURVE DATA CURVE CHORD BEAR/N6 CHORD D. ARC D. RAO/US C£NrRAL ANCLF IS 7.7AN. BEAR. 2NO TAN. BEAR. 2 N03.08'59.5"£ 238.79' 1259.19-11341.48' 01'/3" N 08.1/'06"F N02.23'07"W 3-1 S03.08'39.1"W 263.11' 261.17' 1371.18' //•01'/3" S02.23'07"£ S08.1/'06"W Description: That certain parcel of land located in the Northwest 1/4 of the Northeast 1/4 of Section 28, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin, more fully described as follows; Commencing at the North 1/4 corner of said Section 28, thence N 88057'03"E (recorded bearing on the North line of the Northeast 1/4 of said Section 28) a distance of 202.20' on said line to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 88~57'03E 233.80' on said line; thence S 05'00'38"E 859.70; thence S 89°10'55"W 414.27' to the centerline of Townsvalley Road; thence N 08' 41'06"E 604.35' on said centerline; thence Northerly on said centerline on .a curve concave to the West, having a radius of 1341.48', whose chord bears N 0308'59.5"E 258.79; thence N 0223'07"W 2.24' on said centerline to the POINT OF BEGINNING, containing 6.172 acres or 268,884 square feet, being subject to easenients of record. Note: Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the appropriate Town Board for advice. This instrument drafted by Laurence W. Murphy Dated: October 5, 1996 State of Wisconsin) County of Pierce) 1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owners, Doyne and Ruth Anderson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. `,,%`O 111#4 iAl RAI 0V . lA CA~ N_ : CC ~ ~ e= STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 170 Qi LZ,v~t rS a .J MAILING ADDRESS 185- Tow.v S Cfa`rc pQ d 0l.'u«' A2;xRS 4j1 6%e-6 '2 % raw,rs Uc•-!!e- PROPERTY ADDRESS •`Ucr de-"oll,e Gc/,' S^y egg (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION WI 1/4, AW 1/4, Section r , T 2fr_ N-R_W TOWN OF 7-1rd ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER l CERTIFIED SURVEY MAP 5 5.7G`et', VOLUME 1l , PAGE.?/J?Y, 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 ye piration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 064,v A,4 C1 ehSoA--) Location of property.VAL_1/4_/y 1/4, Section ~ZF , T 2-k N-R_2y W Township Mailing address Address of site /,f 7daA;5- j;,, ll,~. °Uecf ~l„S S yda Subdivision name C S -6-S-7 e V9 Lot no. Other homes on property? Yes__Y No Previous owner of property ;.~i~ at/ l~ ,Ud2 s o i✓ Total size of property Gr! c~G1l-c Total size of parcel Date parcel was created ~a y 27 /A` Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume /2 ~Y and Page Number da,/ 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. f 5 7e 3 2. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature f Applicant Co-Applicant Date of Signature Date of Signature VOL ~~29 0t1'i ~iJr1032 STATE BAR OF WISCOHMN KMM 3 - 1982 QUIT CLAIM D® z.. 000UMENT NO. I CRC';: 'z ~ ~ F - ~'f a 111G{te , 2 4 1991 e- oL/1- 10:10 A• quit-claims to M ' Her cr Dee,: , County, r19. ~ =1 a ' the following described real estate M / THIS Svr1CE aES~ FOR WARD 1- pATA - State of Wisconsin: - 1 a A ST. C Mf vAiW NU NN=, Nc. S.0 C O W /13 n~ i.0.Inc 0 M N. M W ST 1 f / 9W w K 171 Jq . V-1 Lot One (1) of Certified Survey NW in vultmte 11 iD&TWICATM tuMeEA a of Certified Survey Map S, page 3184, as document Register of Deeds Office number 552649, filed in St, Croix Canty 4° on November 27, 1996 at 8:30 A.M. FM O y~ i R a d 1 j homestead property This „fa I I (is) (is not) i11 Aatedl ris , • ` day of _ (SEAL) V1 (SEAL) S •S ' (SEAU . p 0 (SEAL) ACKNOWLEDGMENT jl A THENTICA State of Wisconsis, ss. s Coa came bcfoae aw tbis day of 4 19~G PersrnaUY 19 .the above named autltent~ated this dY of II Tnu: MEMBER STATE BAR OF WISCONSIN (if not, to me known to be the person who executed the foregoing. ` authorized by §706.06, Wis. Slats) instrument and ackrtowledgr the satoc, I - ;I uF ~s i~YSTRUMENT WAS QED By l