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Z I L CL N J V z z z ~ o M I O O 0 O N N E ml NO2 C: ul d n N Q O Q D Q Z in Z cn O z U) m D ~j O o o ~l Q o ° E O N w O O M (O O~ c ~ C U a 0 0 0 S. ~ N 3 j~ C C -O N N N w M O FO- O N N 7 C N R F~I O M O .4; N E C N n I~ 0 0 cc -1 • °p U z c z 2 d U) ~ m m I 0 a • C, a m E 'E a~ A 0 d nn PAGE 4718 R Z Z ZOOS' N AT1NLE$A H° REGISTER OF AP DEEDS g j ST. CROIX CO. WI c„ m APPROVED RECEIVED FOR kZCORD $ n g o~C ST. CROIX COUNTY j 03/24/2004 11 z 40AN _ I Pbwwom Zomnp amd Parks Cam CERTIFIED StMV P " MAR 2 4 2004 SU iLr Y 'S P! CUi RfiC FESs 13.00 I PAGES- fit 3.00 z ff not reoofded within 30 days O Rj I mppny4WdaWSPPrQV8I •-t fwll and vr*4 j MLYIP _ 1M©3 ' bo II O~GILD [3S'I_ G?dC1°__44C~G3 ~I it BEARINGS ARE REFERENCED TO i u II THE ST. CROD(COUNTY GPS g Q II NOO°27'18"E 214.26' g'r~_ j~ NETWORK/NAD1983-91 6'+ I it }S.i J N 1 ! u is r II IlJ D N 7 X 3 f it S.` I L-4 I c 4mi 0 I r ul~ ~j 11 IpQOom I" p. 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CROIX Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Per `aEAN E] City El Village ©Town of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: CYLON TANK INFORMATION ELEVATION DATA~a - ctc7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,1-- j Benchmark Dosing i ~ ~C~ Ce l Vii/ AerathDrr- Bldg. Sewer Holding St/ Inlet /D.57' TANK SETBACK INFORMATION St /,Of Outlet 7 TANK TO P/ L WELL BLDG. A e rntItontake ROAD Dt Inlet 3 7 Ai Septic 3 NA Dt Bottom 3 ' 9 dT Dosing >,5-6' NA HZOMF4 Man. 7^$~ /Gtr. NA Dist. Pipe ycr x{93 c,0, 70' Aeratacar~ - 9 s; S gyp' 77.9 Bot. System Holdi PUMP / SLJ$N INFORMATION 61 , ;4 Final Grade 7 ^ r,n t~F e~+ Manufacturer- errand Y Model Number ti 4 61-GP dr"I TDH Lift ppUl Lriction34a` Syetem~~ TDH ,SSFt 55 Forcemain Length9s Dia. Fog " Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width/ Length MBLDGWELL PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (D DIMEN I LEACHING nu urer: SETBACK SYSTEM TO P / L LAKE STREAM CHAMBER Model Number. INFORMATION TypeO n.ew,'-iSkj OR UNIT - System: DISTRIBUTION SYSTEM Fie l Manifold Distribution Pipe(s) x Hole Size r x Hole Spacing Vent To Air Intake [Length _S6' Dia. Length Dia. I ~7 Spacing A~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only [Be th Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched ❑ /Trench Center Bed /Trench Edges Topsoil L] Yes Yes No COMMENTS: (Include code discrepancies, persons presen , etc.)~5 LOCATION CYLON.17.31.16W, SE, NE, 224TH S / J`~'J fL 7 PIaS~ revision required? ❑ Yes io Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Per it Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 1/4 AIE 1/4, S /7 T , N, R E (oQ~p Property Owner's Mai[ipg Address Lot Number Block Number rile Ci y, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ity Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms J Town OF CAI Zzo III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number( f) 1 ❑ Apartment/ Condo d3~to- YO 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. W New 2. ❑ Replacement 3, ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repai r of an System System Tank Only Existing System _ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 210 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) ,p Elevation yrv 3X5_ Z 9f .1 Feet Feet Capacity VII. TANK in gllonTotal # of Prefab Site . Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel plastic glass App- New Existin structed Tanks Tanks Septic Tank or Holding Tank ~j ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber - L(j ® ❑ ❑ ❑ ❑ ❑ /_922r/ I VIII. RESPONSIBILITY S ATEMENT I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the•attached plans. Plu tier's Name: (Print) Plumber's Signature: t ps) fdFRIMPRSW No.: Business Phone Number: PI ber's Address (Street, City, State tip Code): 1 2 ellu v 3 IX. COUNT / EPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial Adverse Determination I ?s U Surcharge Fee) I low X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD•6398 (R. 05/94) DISTRIBUTION; Original to County. One copy To: Safety & Buildings Divmion, Owner, Plumber INSTRUCTIONS - .f 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 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 bythe 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 May 17, 1996 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S96-01332 FEE RECEIVED: 180.00 GEHRMAR, DEAN SE,NE,17,31,16W TOWN OF CYLON 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. Sin ely, Peter E. Page Plan Reviewe Section of Private Sewage (608) 266-2889 ORIGINAL SUD-5524 (R. OWN) Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page / of Divisioul of $afety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot .SC 1/4 1/4,S TN,R E (ortV Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 06 c~ City State Zip Code Phone Number E] Nearest Road City ❑ Village [4lTo Z New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow yso gpd Recommended design loading rate ---_:--bed, gpd/ft2-Z. -2- trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd$ trench, gpd/ft2 Recommended infiltration surface elevation(s) /OQ3 ft (as referred to site plan benchmark) Additional design/site considerations A/z0 2 ' Lx FT amff 7-o 501 gEey 12=0T 6C. 699, A& - Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u= Unsuitable for system ❑ S 0 U [Z S❑ u ❑ s 0 u ❑ s O U ❑ S[Zu OS ❑ u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ' Z - yJeE6 S S 3 Ground elev. Depth to limiting ctor in. Remarks:3 Soz ENE L ✓ ~oX~SmGL f~i5t TE il .ZA/ ~L i'9~CE . Boring # 1 0-/0 io -3 1 .rG JZrAaX V 2 - o L WK 611 ER CS 3M S-' .4 -2 46 3 Ire 5__ es V 0/5 Ground elev. y~ft. Depth to limiting factor Q~T 2-in. Remarks: > /Z C gF Iolxge. CST Na a (Please Print) Signature Telephone No. Address Date CST Number PROPERTY OWNER 99219/yl" SOIL DESCRIPTION REPORT Page -2 of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench p - 1- 5124 T GG S ' Z - G I AA 5~&A-- 44 SA 45- 3 Ground _ D p O elev. wft. Depth to limiting factor OZ. Lin. C& C Remarks:,*.:? > C jp Lr E Boring # TQ~ / d 1- G l/ Z .SLL q,16 o G i; - L? q-1 ng v .3 Ground elev. ff Depth to limiting factor 9 . Sin. Remarks: Z 7 Sa ~R C l3 NEw)el-y Cowsa aATE/, -r)v LAC Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # h~ S j!~ vd~ Z4, - L Ev ` Ground L/- ' Ga/VIJ r 2Y~-r- P70" 1A) elev. ft. T-zv f ST' o /VT 7'H- Z Depth to C limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in.. Remarks: SBDW-8330 (R. 08/95) I I -ZQI vie k ~ ~ \ h_ ~ A ~~C 4 v o O o ~ o o ° 3 r V3 Iq Ilk- o Q Z o- CO w 'Flo Y ° ~ I y b ~ - I 1 1 ,Z.2'o Yl' I ~ ~N~ h - ~ ~ ~ ~ ~ L ~ M ~ ~ r' N - a ~ a - 'o - 1'T e m i r ~ F ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, Wl 54016 Reg. Designers of Engineering Systems 715-386-$185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # S96-01332 Date may 17, 1996 Owner Dean Geh r /f f2/A4410 Phone 715-246-2834 Address 806 150th Ave. New Richmond, Wis. 54017 Legal Description Tax Parcel # 006-1036-40. Parcel #1 40 acres. Se 1/4, NE 1/4, Sec. 17, T31N, R16W Town of CYLON County ST. CROIX C.S.T. David Fogerty CSTM3233 Installer Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION New Construction, for a proposed 3 bedroom sized home. Estimated daily wasteflow: 450 gals. Per soil test, soils are permiable (.5 GPD/ft2) but soils below 24" are excessively stoney and gravelly, consisting of materials that are greater than 50% rack & gravel. Because of excessive permiability and a lack of sufficient soil materials for sufficient treatment, a mound system is proposed. 12" of sand fill shall be used in the mound system. Recommended: since treatment tanks shall be connected to a deep building sewer, from below basement floor, if soils are saturated,it would be important to use precast tanks rated as "Extra heavy duty for deep burial in wet soils". Also recommend e$ nstall a zable filter in outlet of septic tank, to , v the highest quality of pretreated effluent before en t um chamber. e%-j✓ p S '0111 *.16coly V4-40.' Pg - l PLOT PLAN VIEWS A-Z ms;J` 4tGc~Y~ _f . ROBERT W. Pg.2 SYSTEM CROSS t`ECTIONS & PLAN VIEWS ( UD1~6r0 : HUDSON, WI Pg.3 PIPE LATERAL LAYO 4', ` 4 Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS lobs R fog rrE N ti U / - Ole l 1 IS\ p O ~ O o 1e Cl. ~ 70 o~ N t m n N p e4 --C 2 of S CROSS SECT100 of MouND wi rti BeID Bev ~F % ro 17iST Ri(3uTt nk3 AygQcSATE' G, rl~~ckaE'ss pipto6- sysrEM of T°P so( L EIEVArioo % k~9.U7 ' 00i FORM Toe E 3 F o~ a<<< ~i RATIO MED, 9 Um FdRM 2 % SIopE. FORCE" ~ E'IWAT100 UAJDER REP l•O Fr. F-LeVAT*100 S Fr. 1MVFRT' of IATERM S /00. 35 GS . 8a FT Top goo. • OF Rock /3- FT Top OF /y IATERAIS PLAN VIEW OF Mou-~JD Wert{ 13Eo FvRm MAiN A Co Fr. I B (,3 F r K ~a Fr - - a • i h P3 6.~ Fr 12- K I- - T a W Z7 N F r T- I F Bev eF To " PVc. cAppav _--y- . . Ct rOTRAt_• MA,)i Fot- p DtSTRiBOTt0N pipe UET-WOR k 'P 1- _ PVC cEK)TRAL 9t5~Rtt3uTlo►1 fZ. LATERAlS M A N t F o ~ t7 - ENS CAPS Z,. I Y A K i pVG FoRCE LAS-F VAO I E 5 H A II [3E NEXT To END GAP VOID VoIuME FoR 7S Fr. d F Z Fo RcE MAW ~ 2.3 gaffs, 1NvERr I- levgrtoA-) /00,35.1 VOID V010,44,e~- O'r AlRr4lipK :77 d"-` 5 PERFORATED (PIPE DET-Ai L ('3O-rroM SHAM BE Y-I VAPt A61rE Y Ec~u~lly sp~cED. UtsTn~NCE' I P HOE: Di AhE Te R L aTERA t- ti ~N R 3( MAQl FOLD ' 2 X 3 - ~NchES r-URcE MAC u 2- ~N. 44z- of liOIE5/ p; PE - PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ,41E of 5 -VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM Door„ W/tv,41.0~u(r1A13E~ 12"MIU. WINDOW OR FRESH AIR INTAKE UA1/On/ GRADE I y.. MIA.I. 18" MIIJ. COIJDUIT /r 144 r, PROVIDE I - jDJ AIRTIGHT SEAL I i i I f ~~•0 APPTjA INh WPIC IVP PEOINTS 1J/ CtA EXTAARM EXTENDIIG 3' ONTO SOLID SOIL OIJT~~' I 11 ~I~~ 1 I ( 3'1 /I c I I ELEV. FT. ' PUMP OFF 1 t t D P I'J 6- D ~r (1 ,f AP BLOCK ~E VII f RISER EXIT PERMITTED OIJL j IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E low /ES 3PEC.IFFItA/T10KJS DOSE pp-, eowA.,- t `9 • 3 TANKS MANUFACTURER: IJUMBER gF DOSES: PER DAH r 0 TAWK SIZE: GALLONS DOSE VOLUME Z. ALARM MANUFACTURER: LC UEL rC7 ' INCLUDING SACKFLOW: GALLONS MODEL HUMBER: O'yL • CAPACITIES: A= INCNESOR 30-0 GALLONS SWITCH TYPE: /ICPCU/e y (7- B = /2- INCHES OR Z GALLOUS PUMP MANUFACTURER: /ZOEAc-Ad C = (o'q3 INCHES OR lee ZGALLOUS ~ INCHES OR 0(04GALLOIJS MODEL NUMBERy:~JiyA /,ICAO (te' y2" IfP 0 SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO BE 5'z GPM INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTION PIPE.. / FEET -rAA.) S f tC S 4- MINIMUM NETWORK SUPPLY PRESSURE , . • • . . . 2.5 FEET -CA O(A- 75 FEET OF FORCE MAIN X F j 100 FLFRICTIOIJ FACTOR.. ' Z FEET /,Ur' S ``i y~ ~I TOTAL 09MAMIC. HEAD FEET a tg ur rn n.ur.•~.... r l.r r..v c..~ Tu / ~ •\./1 r1TV + 1 IA111I1 rl~PYl-1 P .Sm~S ~ P , HEADI CAPACITY 34 - 11° 32 105 CURVE 30 9S 28 90 26 85 EFFLUENT 24 MODELI and Q 75 MODEL 189 DEWATERlNG 3C 22 70 185 V 20 65- Z 16 80 55 J Fa- 16 MODEL O 163 MODEL F- 14 45 1S8 12 40- 35 10 MODEL 30 MODEL 137, 139, • I 185 SEWAGE and 6 25 DEWATER/NG , 6 20 I MODEL A.61 4 7 . 10 - MODEL LL { 2 5 53, 55, - ! 57,59 0 GALLONS 10 20 30 40 50 SO 70 so 90 100 110 24 73 LITERS 0 SO 160 240 320 400 22 FLOW PER M NUTE 70 20 I I 59'-` ~.p.l~. G 13 go- - MODEL ,a 295 W SS x to v s0 MODEL Z 14 45 294 12 40- _ a 35 MODEL F- 10 293 O 30 MODEL 234 6 251 MODEL 6 20- 282 15 ~ 10 287 MODEL ZffzLLE/~ O. 2 , 283 5 0 3280 Old M/llem Lane GALLONS to zo 30 40 so so 7o so 1 9o 100 110 120 i30 140 Ash 1so lyo 1so 160 P.O. Box 16347 --1 -.4 Loulsvi le, Kentucky 40216 LITERS 0 8o 180 240 320 400 480 560 640 720 (502) 778-2731 FLOW PER MINUTE S96 -013 32 HIGH HEAD "161-"163*"-&(16,5*" "185"- "189" Series (%2 HP) N~ HPI M NPI / 11un1 1411 "ns ,n A in& vVisonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations t DIVISIOA of Safety Buildings in accord with ILHR 83.05, Wis. Adm. Code C TY;^c~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ry not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or CEL I.D. dimensioned, north arrow, and location and distance to nearest road. ` VIEWED BY ~.TE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION ikA& G'am' /V ~2 /H GOVT. LOT 1/4 T R =f', r (cOV PROPERTY OWNER':S MHII.ING ADDRESS LOT # BLOCK # SUB D. NAM CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD -.9 04 4 e4zoAl 21 I'vew 94Z&'Wayl) S o ( 1 New Construction Use Residential / Number of bedrooms [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow _ 6egpd Recommended design loading rate _7 bed, gpd/ft2 ~trench, gpd/ft2 Absorption area required W bed, ft2 7SD trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 - R trench, gpd/ft2 Recommended infiltration surface elevation(s) 3PY•S' ` ft (as referred to site plan benchmark) Additional design / site considerations 1 ' e, 4- 26wr , lrite5<.. . Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for stem OS ❑U EIS ZU ❑S ❑U EIS OU ❑S j~U ❑S ZU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoUndaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground z / - SG , 2 elev. /0~s- ft. 3 ,&F-5 • s L S i d G ALS Depth to limiting factor Remarks: ' s v i' Boring # '0 FXO 46-A,' F-9-0 Zb-/U RS' IF C- t<A& 44 F_& CS 3 X9.9. 3 Y z- s- f` S a v e- M L- t - Ground elev. 9_ _ v G G - . P ft. Depth to limiting factor Remarks: 7 > ru/t= CST Name:-Please Print Phone: Address: , D ws p 3 Signature: Date: CST Number: PROPERTY:OWNER 1,-kde/USOIL DESCRIPTION REPORT Page of 1Y PARCELI.D.# OZZ•-GOllo -Flo GPD/ft Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounx Roots Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench i ~7~z oz,E S 6-10 IAO Ground 2 O 7 Q Z FSXA, F e S z .3 elev. ft. 7 M Z> Depth to 5'2_ 6 S ®S~ M i limiting factor Remarks: TL-LffT S7`.~ /~~:Lou~ F~/e ~~EiD !~~'~T/I`: Boring # 14 ssle C5 :~70 4-S s-- G Ground + elev. © SG L /1,7 J &L ft. Depth to limiting factor Remarks: - > Boring # sc -Z s -r Ground elev. /D ft. Depth to limiting factor Remarks: v Boring # .ry4k •:t.... l4?iv. Ground elev. ft. Depth to limiting factor Remarks: y I b m h r 0 rn m A oz 4tNI s2 fir ~7 ' 'Y. I . ry v r L ~ c r' N Pl, lT 12e - Al- n 1~1 F r h STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER- J)Z4,4J ~r~~J~/►//¢QJ MAILING ADDRESS PROPERTY ADDRESS &I ^2 2O ST (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~fviie ~'~x . rvv~ PROPERTY LOCATION 1/4, AJ 1/4, Section 1_Z, T 3/ N-R-4.W TOWN OF t/ O/V 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. SIGNED: rte.. /.1C'.-».~ DATE: 3 9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property ?,(/~/~i¢i(J Location of property~1/4 JU~ 1/4, Section /,T N-RW Township Mailing address Q _)/57 , P__ A45__&1 11Z uzk S-V4917 Address of site 2/S'a Subdivision name Lot no. Other homes on property? Yes / No Previous owner of property /1.1-1 O Total size of property Total size of parcel La z6o4Fs, Date parcel was created ~/P,[2C Z99~o Are all corners and lot lines identifiable? _1_---'Yes No Is this property being developed for (spec house) ? Yes _JZNo Volume 1174 and Page Number 1 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. (0 S , 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. 2 Signature of Applicant Co-Applicant State Bar of A t,conga Form 1911_ WARRANTY DEED DOCUMENT NO 56 i 11 I~ra~t lei Jean Ann Doth, a single person I APR 2 4 '_y3b 1 1::00 A. consct, and warrant: to Dean A . - Gehrman , a single person - - rHw; APACE RE°E~ ED FOP aECOA Di NC. DA rA NAME ANO REri.RN AC-.^=-.1 421 r ,he following described real estate in St Croix Counts. State of Wisconsin: L ~'D 2 ..,I ST 006 1036 40_ _ (Parcel Idcnuficauon Numher) The South Half of the Northeast Quarter (SZ-NE4), Section 17-31-16, St. Croix County, Wisconsin. TR ~ $ [!o°00 - E is not This - _ homestead property. (IS) (is no[) Exception to warranties: Municipal and zoning ordinances of record and recorded easements restrictions and reservations. ril 96 Dated this - 22nd - day of - Ap 19 - - - - - (SEAL) (SEAL) • Jean Ann Do th, _ (SEAL) - (SEAL) AUTHENTICATION ACKNOWLEDGMENT ' STATE OF WISCONSIN Polk C ount%. authenticated this day of 19 Personall came before me, this 22nd day of April 1996 the above named Jean Ann Doth • ; TITLE: MEMBER STATE BAR OF WISCONSIN A (If not. - - - authorized by §706.06. Wis. Slats.) to ^x known to be the person who executed the EKS-180A EDWARD KRAEMER & SONS, INC. REV 7-95 ONE PLAINVIEW ROAD, PLAIN, WI 53577 . (608) 546-2311 "An Equal Opportunity/Affirmative Action Employer" LABORATORY REPORT Test Date 7 1-3 96, SOURCE OF MATERIAL: t Pit or Quarry Name (JYIJ)-~AA, C]JAAIA~ County U SOURCE OF SAMPLE: Taken From '2 -t-~ Date Time Remarks: TEST SPECIFICATIONS: --(n~ Material Type: C~ /lnt'1~C State TEST SAMPLE No. SAMPLE No. SAMPLE No. RESULTS Total Dry Weight \57 • it Total Dry Weight Total Dry Weight Sieve Specifications Weight Percent Percent Weight Percent Percent Weight Percent Percent Size Retained Retained Passing Retained Retained Passing Retained Retained Passing 3g 0% o% % % % % % 5 % % % % % / % qg.1% 09% % % % % ,5, 7. (0O % 5-.4 % % % % % CWC) % % % % % % REMARKS: Tes B Checked By__ Date