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HomeMy WebLinkAbout008-1037-80-200 o c v ° o a n O p x O in N N N O y Y -D C I 0 y 0 e ~ ~ o i ~ h 0 N S2 1 o a LL c LL C (6 O O 01'D 00 O ¢ E V 3 M z E co Z _ 0 E z M co Z a co c y O , C ~ N (6 O ~ Z to Z e`- v7 CD O E `0 m ~.•y Of • •+w1ri N N 0 ¢ ¢ p z z N a Q) -a C N E M ~ N a a c O G Gam. ~~yy Z > FN- H N N 3: 3: 'i O O O Z • Nti ai a a a Z) ►+i a g '00 7 O W O 6) O) N tq U rn rn } Cl) V ~Y) 'd N N _ O N N O ~ 'O N 0 c [(3 a- O a O N 0 0 U m Y ¢ ~ G O C m N C O CO N C) O > 6 rn 0 0 0 0 0 O O f- I, C O O O 00 Q j~ O- -O N N N p co O O O C O O O V o `0 ;r,w O m r- ^ M L n N O N F" (0 -0 N Q) c It -C • 00 M- W cn N O N Cn O L v~#.a as a w • 'as c m .2 rr`M~w E c c `1 A v a t O in v M14 'A D r STC - 10 4 ay RECEIVEO AS BUILT SANITARY SYSTEM REPORT MAY 0 5 1997 I ST CRW t~ OWNER (f)4 V2'r '6i~7j011! j COL*M- C ZONE' ADDRESS -2 'PI y obaD~~ W/ SUBDIVISION / CSM# /'1 3 X5-6 LOT # l SECTION _TO~ N-R_(~, W, Town of ST. CROIX COUNTY, WISCONSIN p P VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f IX~ C 1~ 35 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. } ~ Pv o `p/ c7 nQ 1~ BENCHMARK: O p v c CC r m ALTERNATE BM• ~o Bti-. act ygz5c.P fa ,!4 S 99 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: G-J ~tl Setback from: Well NC) House Other Pump: Manufacturer Model# Sizeo Float seperation Gallons/cycle: Alarm Location n ({a /-/e P"j 0 SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: 33~~ Setback from: well: IVA House Other ELEVATIONS ppG~ Building Sewer G• y~ ST Inlet: ST outlet: PC inlet PC bottom 76 Pump Offs Header/Manifold S Bottom of system C.~7 Existing Grade _2 y,U Final grade Z7. /7 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: a p 9 INSPECTOR'S w. psi 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 'Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST- CPnTx (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 284217 Permit Holder's Name: ❑ City ❑ Village M -Town of: State Plan ID No.: SANDVIG, OLIVER EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ad ~d.G as ' TANK INFORMATION ELEVATION DATA a /97 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c (,c105 '~r1 Pca's'it Benchmark /,:P0, &0' Dosing -/0 ~ d,-vlx,, 13,1q. Aeration Bldg. Sewer S-~c/' Qp c8 r Holding St /f Inlet 5,851 U,/8 TANK SETBACK INFORMATION St4,4 Outlet v 9, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 766 ~Septic NA Dt Bottom 91 -77 Dosing 160 ® S NA hex / Man. 91465~( Aeration NA Dist. Pipe ' Holding Bot. System S S' 9e,.07 PUMP/ SVtM INFORMATION Final Grade 27 cd-1141C_ Manufacturer ~ Demand r'3 • ~(o~~ t , Model Number H Ll (0 4-11 C'a /U: /G r•%` TDH Lift4', (pe Lriction fig/ Syetem ~ TDH .311 Ft Forcemai n Length 351 Dia. H9 Dist. To Well 3 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of T nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t ' DIMEN 1 SYSTEM TO P/ L BLDG WELL LAKE / STREAM L ufacturer: SETBACK CHAM INFORMATION Type O nz-Zo- , 3 Mode Num er: System: W..,,, 33 C . ~ ~ O IT DISTRIBUTION SYSTEM -HLC&dzr / Manifold Distribution Pipe(s) „ x Hole Size Er x Hole Spac ing Vent To Air Intake r l~ Length ~ Dia. ~ Length z9 Dia. Spacing ~ V y /r 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 t^ Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes No ❑ Yes No COMMENTS: (Include code discrepancies,~ersons present, etc.) A! d' LOCATION: EAU GALLE.13.28.,-OW, LOT 1 CTH B 9p g7 f~n •Sl -7 Grr,)L , "yA it JP -4 j r Plan revision required? ❑ Yes Q_0 Use other side for additional information. 7 14& H~' SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r e weaa° Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number , ~~l 7 The information you provide may be used by other government agency programs heck ~ if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S96-41467 Property Owner Name Property Location OLIVER SANDVIG NW 1/4 NW 1/4,S13 T28 N, R 16 E Iny Address Lot Number Block Number Pro 39OCOeROAD 1 jj City, State Zip Code Phone Number Subdi on Name or,SSM plumber WOODVILLE WI 54028 (715)698-2038 m u ` /l 3156 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City arest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF EAU GALE C.T.H. B III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 008-1037-80 -200 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. ❑ 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 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 900 900 .5 N/A 90.8 Feet 93.09 Feet VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Ex er_ INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 1000 1000 1 MIDWESTERN PRECAS ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 750 750 1 MIDWESTERN PRECAS ® ❑ ❑ ❑ ❑ ❑ 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 Stam s) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON RS 3215 1 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Y Approved E] Owner Given Initial Surcharge Fee) U\~ Adverse Determination (0 Z) X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 0VV SBD-6398 (R. 015/94) DISTRIBUTION: Original to County, One copy To: Suety & Buildings Div, 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. Vl. Absorption system information. Provide all information requested for numbers 1 through VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, nL mb - r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete foci-,ell s~ ~otic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experi:-neat:: product approval from DILHR VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropr ail. -)tefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. inr! specificatio:ris not srnaile~ than, 8 112 x 11 inches sr ~ =:i!tcd tc) `I, e ; rnty The plans must r Vl;-: A) pot elan, dra ; scale or with coml _ , ,r>si ca~ic;n dii"ic; nk(s), septic: bu idin pop-r,p or siphon .i it _ t ..th uild ng served, c, _levu „ at,ir,ts, C) CO cs* Cos, volUm p perfor-n-,n( car. a C-SS sec:1on Lhe COW ~t~•; °I1 ( : information. GROUNDWATI=R SURCHARGE 1983 Wiscc;ns1n Act 410 included the creation of surcharges tfees) for a number of re.,p-lated pra( tic whit-) can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater ,:ontam nal!o, investigations and establishment of standards SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, WI 54603 Visconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary November 11, 1996 2226 Rose Street La Crosse WI 54603 HELGESON EXCAVATING W1229 770 AVE SPRING VALLEY WI 54767 RE: PLAN S96-41467 FEE RECEIVED: 180.00 SANDVIG, OLIVER NW,NW,13,28,16E TOWN OF EAU GALLE 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. Si6rard cerely, M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 1077R/ 1 SBD-5524-E (R.07/96) File Ref: Private Sewage System Plan Index/Check lT l t;~ o All plan sets should be legible and permanent copies, organized into sets, bound with staples and covere4cP66° by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID # Owner's Name S96-41467 OLIVER SANDVIG Legal Description 1 Address NW4f NW 1 S 13, T 28. N, R, 16 E 399 CTH B CityNillage/fown County EAII.GALLE ST CROIX Contents Comments/Special Instructions Page # Included Two copies needed for all plans 1 X Plot Plan 2 X Plan View/Lateral Return by Mail' 3 Cross Section 4 Tank & Pump/ Fax Letter to (County) (Submitter) X Siphon Information Circle One and Provide Fax ( ) 5 System Sizing (Public) 6 F-1 Gall for Pick-Up: ( ) 7 Other I, the undersigned, hereby certify that the Seal (if applicable) plans and specifications submitted herewith were prepared under my direction and control. Plumber/Designer License/Registration # gBENNIE HELGESON MPRS 3215 State W12e1T9 770TH AVENUE City SPRING VALLEY WI 54767 Signature c. . cff;For Offga ° ly Attachments: F Application ~ 4k Soil & site evaluation Rr ti ae. Fee 4t 4 c -jr Needed for Holding Tank One opy of notarized holding tank E l~ l G agreement. (Originals to County) Needed for At-Grade Submittal: Original signed and notarized, Application for "Use of an At- Grade" County on-site One additional set of plans SBD-10268 (N.01/96) i~ a t J ~ I Iv ~ v I LA FS ,-a Perforated Pipe Detail 0 End Vlew End Cap )Perforated .f PVC Pipe " Permanent End Markers mmj g'. JAN s Holes Located on Bottom are Equally Spaced .a" PVC Force Main y * From Pump /Q PVC C p Monllold Pipe p £Nb 1" Pvc biciribullon.•• Pipe Lcrl Hole Should Be Next To End Cap Distribution Pipe Layout Py R S x q Y 3/ Signed:. Hole Diameter Inch License Number: ,C~_S Lateral " Inch (es) Date: /D~o79~9~ Manifold " Inches Force Main " Inches hales Per 1-oJer4 xv~ver~ G ItU. 9~,3 I'I O 1 PUP%P CHA.IA.BER CUcS SEC'►C,.; AND SPECIFICArIC) j~ i, VE WT CAP -7 - 4"C.I. VENJIT PIPE WEATHERPROOF APPROVED LOC.K:".;(. MAIJHOLE COVE F. 25' = RO.M DOOR, JUNCTIOIJ BOX WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I 41, 4" MI►J. I I 18" /MIN. COWDUIT-- WLET PROVIDE I AIRTIGHT SEAL ( III ~ J/ I II APPROVED JOINT A I (I I APPROVED JOINTS W/C.I. PIPE I III W/C.I. PIPE EXTENDIWC9 3' I II ALARM EXTEMDIUG 3' O►JTO SOLID SOIL 5 I II ONTO SOLID SOIL I I ON C I i I ELEV. S•~ FT. PUMP---- OFF D CONCRETE BLOCK RISER EXIT PERMITTED OIJL`J IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFfCATIOUS DOSE nn TAWKS MANUFACTURER: NIAIJL)es~.v " 4e_(_a4 NUMBER OF DOSES: PER DA-4 TAWK SIZE: 7 1 5n GGALLOWS / DOSE VOLUME ALARM MANUFACTURER: C ~Fle,TVo 1:71~S IMCLUDIMG BACKFLOW% SGALLONS MODEL WUMBER: / /-/LL) CAPACITIES: A=IUCHES OR GALLONS SWITCH TYPE: ~ B = a INCHES OR I CALLOUS PUMP MANUFACTURER: t CJ& / C= ~ ~ INCHES OR 1ZZu Z~GALLOIJS MODEL WUMBER: 0- ~i INCHES OR 'ALLOUS SWITCH TYPE: rcutn 'Fhb NOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE yy GPM INSTALLED OW SEPARATE CIRCUITS t.7. ' VERTICAL DIFFEREUCE BETWEEN PUMP OFF AWD DISTRIBUTION PIPE.. FEET • MIIJIMUM WETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET _30 FEET OF FORCE MAIM X 3"~ F/pprr.FRICTION FACTOR., 093 FEET TOTAL 09WAMIC HEAD = FEET 9,'2.3/ / it ) II n IUTERWAL DIMEWSIOWS OF TAWK: ;'LE`.j6TH 6 3 _;WIDTH ;LIQUID DEPTH 41CI- 8. 7s 6a). pe, :r C G` SIGIJED. L.iCE.IJSE r.JUMeER: ~~s~~~ DATE: ~ `j~ Page _ Of Straw, Marsh Hay, Or Synthetic Covering t~Si 1yi C -53 Distribution Pipe Medium Sand 3.09 H L G Topsoil F 'I D, 3 1 E D b % Slope. Bed Of 2M- 2 Force Main Plowed Aggregate From Pump Layer D Ft. Cross Section Of A Mound System Using E ~.yq Ft. A Bed For The Absorption Area F d 7`/ Ft. G / Ft. A 6 ~S Ft . H j, S Ft. Signed: B &C) Ft. License Number: K Ft. Date: /o% 9 L ~I Ft. j 6•`/SFt. Alternate Position T ),9.3 Ft. of Force Main W ate, S Ft. L u Observation Pipe A ! i ----------------------•I Force Main W ° - ------1 7- Distribution Bed Of 2"- 2'2 ~ Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area MODEL: 3871 Submersible 1w s SIZE: 3/4" SOLIDS RPM: .4550 HP: Effluent Pump METERS FEET 8 ~ 25 i I 7 - o ~ g 20 I - n 5 <t 15 0 4 J i 0 3 10 2 5 p pp 10 20 30 40 50 GPM p 2 4 6 8 10 12 m'/h CAPACITY RGOULDS PUMPS. INC. SBqECA FANS fEW YCW 0148 Effective October, 1988 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. 0 1988 Goulds Pumps. Inc. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page f of 3 Ldlzr and Human Relations Division'of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • . ~ 11 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or CEL dimensioned, north arrow, and location and distance to nearest road. O0 7 REVEWED BY TE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION fy 3 PROPERTY OWNER: T„-, $ ~zrz i/!5 PROPERTY LOCATION rat - "r CI GOVT. LOT N, E (or PROP PITY OWNER':S MAILING ADDRESS LOT BLOCK# SUB OR t ~C C'r)q 46 CITY, TTE ZIP CODE PHONE NUMBER []CITY []VILLAGE 2FOWN V A OAD CA _j [L4146 Construction Use [,+-F esidential / Number of bedrooms [ J Addition to existing building J Replacement [ ] Public or commercial describe Code derived daily flow LfC.> Pd Recommended design loading rate S- bed, gpd/ft2 ~trench, gpd/ft2 Absorption area required loo bed, ft2 760 trench, ft2 Maximum desigV ading rate - bed, gpd/ft2 ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) 90.8 $~m dk Koch (as referred to site plan benchmark) Additional design / site considerations VS 6- BL 6 0` x 6 ss Parent material S` I, el Qwe Flood plain elevation, if applicable ft S = Suitable for system CONVENTIIONy1, M~OUyD IN-GROUND P SURE AT-GS DE / SYSTEM IN FILL HOLDING U = Unsuitable fors stem S 2'0 f~'S ❑ U El S kQU ~U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourldar)/ Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground S CF) S C st k ,nX v 0. LL) elev. ft. - .s 5'L 1 uc Depth to limiting factor • G. uJ Remarks: ) 'c -e o~ lJ~e~~ Cevv~ e~ / OY Boring # t c' 6- J elev.nd Q-3 y V 5 q64' ft. ~aA Depth to limiting factor v Remarks: CST Name:-Please Print Phon 4e kj vt r-e T E' v Address: u'~ /.p v Signature: Date: - CST Number: PROPERTYOWNER %tM SOIL DESCRIPTION REPORT Page.,-'~- Of 3 PARCEL I.D. # 0 0 g - ! 015-7 KC Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench . Q fv 3 ('4 -5 6~ vv~ r W U s 6 '7 :5 v LL) Ground 3 -3 o -I- ~J~ S elev. S f-3- ft. (c7 ~ T S L v c- S 0k k u c3V Depth to -3 1 c~ 2 / o y 2 5 v (L 5 - 5- limiting factor~ J~ N 6. t). Remarks: Boring # v~r sbk >i I C)-1 LL) Ground I!n 3 c~ \ elev. S I c s 6~ V, u Depth to limiting factor? Es H ~ LA Remarks: Boring # DL pn LO `Ground... ~ v y /z R a 7• s ~ 5 i ~ s~ ' I ~ ~ . ~ , 3 D 'Y -7. S- C- VIA ft. Depth to limiting fact- o Remarks: Boring # r Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) rt ii (r,T11 ,L3 ' C/n2 ~ b 3 `1 l(v G r n - 'm 2 3 r -411 ro ~ G S 1~ o S _ rd rn do c o A co) n~ 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code CO Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but lr not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or C E L I.D ; dimensioned, north arrow, and location and distance to nearest road. REVIE Ef7 V' ATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: o PROPERTY LOCATIO T,/! vim: r} GOVT. LOT T~ j N, E (or1~ PROP RTY OWNER':S MAILING ADDRESS LOT. BLOCK # ~1$t~lAtvfE;2R # --3'f C'T t 1 ~t fv CITY, STATE - ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE off OAD 03g f C % 1c4-iqe'w construction Use [-~-Residential / Number of bedrooms _ 3 [ J Addition to existing building [ ] Replacement [ J Public or commercial describe Code derived daily flow SLR pd Recommended design loading rate S bed, gpd/ft2 trench, gpd/ft2 1-.,5 4 Absorption area required 100 bed, ft2 75-~' Ex trench, ft2 Maximum design loading rate _'7 -bed, gpd/ft2__ ~-trench, gpd/ft2 Recommended infiltration surface elevation(s) yC bi G~bY~- lock 6`~ (as referred to site plan benchmark) Additional design / site considerations C_ x Parent material / Flood plain elevation, if applicable LZ .E~ ft S = Suitable for system CONVENTIIOONgL M__OU~to IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S 0"U ❑ U ❑ S Ot ❑ S ©'G ❑ S ❑-d- ❑ S ~U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I / C-/O 3 5; C Ground " C 5 7K S C 5 o h v r u' elev. L) C Depth to limiting factor c- c ti G Remarks: Boring # S J ez U~ Ground y _ elev. C ft. Depth to limiting facttor „ L-T i i F_7 Remarks: CST Name:-Please Print - a / Phon : !S , " i1 rl!•{~ c"0 Address: Signature: Date: CST Number: 6 -3n, 9 4/ PROPERTYOWNER SOIL DESCRIPTION REPORT Page Af, 3 PARCEL I.D. # CO S - 1 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trends r) ~R t4 Ib l 3 S, b' n W tJ{ (c~ y~ Si 2 L .~bltir 1 S Ground 3C Ll lift. ~C-- S ~k ,L 5 3V i o y 2 S (L 5 r - S Depth to -.5 I o 2 61 limiting factor , Remarks: Wc,«kl Boring # I Ir ~cs Vii'( r u 5~~ 6vt, C~1i> t,f s (v Ground... , ~1 S S 5 c c, b yv~ 6 G« 1 1 v S Vh 3 ~ elev. C -yv 6- o -S I c S 6~ Vn u ft. Depth to limiting factor l~Remarks: Boring # i b io12 c-, -5 L3 (aE f ~f~ lof Ground ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) stn < ~'rocA~,~- L ~ n e r i n ! ! A M1. I ft U T 0 m G + 1\ oo h - po~ c~ c T C~ c-l 1. ~ U 1 O 0 ~ , C) i e - - It STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OVvNER/BUYER. OLIVER SANDVIG MAILING ADDRESS _ 399 CTH B, WOODVILLE WI 54028 PROPERTY ADDRESS 375- 00 o v r' oa.8 (location of septic system) Please obtain from the Planning Dept. CITY/STATE O tr 9' V► I w PROPERTY LOCATION N W 1/49 W 1/4, Section (3 , T~ N-R__j~ W TOWN OF EAU GALLE ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME H , PAGE31 LOT NUMBER l 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 3,0 days of the three year expiration date. , SIGNED: DATE: 2 St. Croix County Zoning Office Government Center 1101 Cannichael 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 OLIVER SANDVIG Location of property 1.4'W 1/4 NW 1/4, Section /3 S' N-R It, W Township EAU GALLE Mailing address 399 CTH B, WOODVILLE WI 54028 Address of site 3-7S- CAN '3 K(A u'. 11,2 Subdivision name A '/A Lot no. .tl A Other homes on property? Yes No Previous owner of property 1 4, a h a 1.i , ✓ ig Total size of property aZc (Z,,- Total size of parcel 39, Date parcel was created 4'1!; 19y4' Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes A No Volume _ ( and Page Number j(5_6 as recorded with the Register of Deeds. RJP 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. / , 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. 4 3 i X , Signature o Applicant Co-Applicant Date of Signature Date of Sianatiiro CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 1/4 OF THE NW 1/4 OF SECTION 13, T28N,R16W,TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN OWNER OLIVER SANDVIG R.R. NW CORNER WOODVILLE, WI. 54028 SECTION 13, LEGEND T28N,R16W 3/4" RE BAR O 1 1/2" IRON MONUMENT WEIGHING h AT LEAST 1.502 LBS./ LI N. FT. SET 1` • 111 IRON MONUMENT FOUND O O_ POINT OF BEGINNING = C.S.M. VOL.6 PAGE 1619 0 I (REC 37 . PREVIOUSLY AS S 88° 06'47" E '401.57') 1 I N 8801614711W 401.57` I I I W I s o' 07 364.50 a m to I p~ !--HIGHWAY SETBACK LINE NI J MI 01 Z 1 = 100.00' --4 w I o Qil m (o ' LOT I 11 M IM AREA INCLUDING R/W 1 oF_ cn z I 3.00 ACRES / 130681 SQ.FT. a 0 = I AREA EXCLUDING R/W W M tLi 1 f-I I W w 2.71 ACRES/ If 8269 SQ.FT. - v z ~1 - z G~ o w i w° Q 11 Z W O N I-- i (n I0 I jn JI o w (]r I I ZD1 W u Z 1 O : I 1- R/W LINE IL Ww w 160 r Zi a3 3 42.66 i Z (n z I 387.55' z W = ir- = F_ 1 S870241 u- 0 35"E 430.21' mo I MONUMENTED SOUTH LINE OF THE NW 1/4 - NW 1/4 = o C.S.M_VOL_ 4 -PAGE 1193 I- N SCALE IN FEET C) I'n W 1/4 CORNER 0 100 200 -aoinpU Joj oogjp gutuoZ fqunoD xtoiD -IS aqi lovluoo laoird Cue 2uidol3nap jo 2uisugoind aiopg -(-ola `loozud of ssaoou `ozis lol wnunuiuz `spuull3m `-a-i) suoiluingai pue salni `smul S unoo puu alnls of loafgns st (juld) dew stgl uo umogs loored gong -ours oql 2uidduut puu guix3mns ut xto D -IS jo X4unoD oql jo aouruipip uotstntpgns puu7 agl pun salnlnls utsuoostM oql jo t£-9£Z -raldugD jo suo[s►notd lu3juno aql ql!m poildutoo ~l lnj anuq I IugI `pagt.iosap puu paXan ms Xirpunog .toi.talxa 3qj jo aluos of uoilnluasa.idat loa-uoo u si duW XomnS p3giu3D stgl Iugl Xjiuao oslu `I -piooa.t jo suotloulsai pun sluMas>'a .taglo XuV oI puu X'EmJo lg2ii „g„ ,Kumqi?tl-I jun1Z ~ClunoD of Ioa(gns -.utuuiR3q jo luiod agl oI &W XanmS pagiuaD pauotluaut Isrl 3qj jo autl glnoS 3qj Suolu IaaJ LS-IOV IsaM spuooas Lt, solnuiui 91 saai23p gg WON aouagl `-6191 32nd `9 aunlon ui pap'ooat d W X3AjnS pogtuao INTJO .tausoo IsuaglnoS 3T of I33J 96.61 £IsaM spuooas OZ salnutui SO saaBap g quoN oouogl `.dnW Xc)nmS pogpioD plus jo auil quolq oql oslu,',?utag `.tal-inno IsomquoM oql jo .tauun6 ls3mquotq aql jo auil glnoS poluauinuoui 3qj 2uolp Iaaj IZ-0£t, IsUg spuooas S£ salnuiui t~Z s33t23p Lg glnoS aouagl `£6i 1 30ud `l, atunlon ut paptooat su dLW kan-inS pogjjjQZ) lugl jo lautoo ls3mq:voN aql of laaj 0£- I I £ glnoS Butnuiluoo nimm `RilimuRno in mind nun ni imir-n?i 1cnMITlrnr.T nine Tn nnrr Wnnn nrn rRTini'D 1nnT VOL 1. ~J549961 STATE BAR OF WISCONSIN FORM 2 - 1982 JV WARRANTY DEED DOCUMENT NO. FF1 OFFICE j Timothy Sandvig, a/k/a Timothy C. Sandvig O., WI and Sylvia Sandvig, a/k/a Sylvia J. ord Sandvig 1996 cones and warrants to Oliver J. Sandvig and A. M )Xorence A. Sandvig, usband and wife , holding as survivorship marital propertyTHIS SPACE RESERVED FOR RECORDING DATA I NAME AND RETURN ADDRESS the following described real estate in St. Croix County, State of Wisconsin: e--~- MC C.r m o rrm ~Ct-~Vjt0 i PARCEL IDENTIFICATION NUMBER Part'of the Northwest Quarter of the Northwest Quarter (NW-14 of NW1-4) of Section Thirteen (13), Township Twenty-eight (28) North, Range Sixteen (16) West, Town of Eau Galle, St. Croix County, Wisconsin, more particularly described as Lot 1 of Certified Survey Maps filed August 29, 1996, in Volume 11 of Certified Survey Maps, at Page 3156, as Document No. 548863, office of the Register of Deeds for St. Croix County, Wisconsin. FEE -EVE I This _ is not _ i.omestead property. _UX (is not) Exception to warranties: Easements and restrictions of record. I I I Dated this day of 'L+ A.D 19 96 j' (SEAL) (SEAL) I!. Timothy C. Sandvig !iI . (SEAL) 41v \ (SEAL) ia J andvig I AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. ,I St. Croix Count