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HomeMy WebLinkAbout008-1060-70-100 -0 o w o I N O c o^ 0. o C n h ~ o x 0 `V d' I I a N O 3 4 O E U I 0 C z L Li c L°n o co o u Q N m d ~ Z E z o a z a 4) N F- Z _ O O U C O co O 2 .0 w m 'Z m o U) CD E '2 O v m E ~ o ~ I N U O z z _ Z N li -0 N _ N NII U) E m O W .4)" Y c (O i y co g O O G a E E ~ N z °O FN- (n ►0)- a Sl u' O O O Z ° •uy m a a c_ 7 0 3 (o 'D } to U co rn rn m co M o o o 0 a~ O N I. ~ O O ~ E N Q Cn l m c V O d ~ Q ~ Q O O M _N N O m 3 co 0 N C O E N O O O 1- N N C C 0 0 O In VOj C N N O O CO H O ~ N N N 06 co w tx, O N = C CD E CD Co 0 CD 0 Co co 0-0 ^^ll O N W N O z- I- 1'~ y E N V C~ I Y `m a Q L: a r • (9 C d .V N E 3 i C C w O o A U (L O to U t ~ ao STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ST C pax COUNTY ADDRESS ~cll_! zo~!«acaGFFCt.;r:. ~A SUBDIVISION / CSM# LOT # SECTION T N-R/j~W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET O SYSTEM Maw ~ -2 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 1~~ >7t C? a v j l S ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: , c~6Je~7`Zp~i,~ Liquid Capacity: l d o? Setback from: Well _,gl'~2 House ' Other Q i Pump: Manufacturer f -ems' Model# Size Float seperation Gallons/cycle: Alarm Location -.SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line:_ Y4 Setback from: well: House 74 Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin 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 268566 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: JOSLIN, TOM EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark w 3, 3s~/ DD<D~' ell Dosing / A-1 06 Aeration' Bldg. Sewer /,y5'~D Holding `ii,St/ Ht Inlet 9S' i TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ' /o , -50, D ;Z NA Dt Bottom yy' b7. b " Dosing NA Header/Man. C , 6q, 6o,r4 Aeration NA Dist. Pipe 2,W 160, fq, Holding Bot. System 110,6- PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number L' GPM TDH Lift /.:~,14 Friction l~( System TDH Ft Loss Head rForcemain Length ov' Dia. _2., Dist. To Well DSO " SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (q DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM INFORMATION Type O CHAMBER model Number: System: `7'WWP' ^ ~/O< ' 7,1 4)1A OR UNIT DISTRIBUTION SYSTEM r Manifold Distribution Pipe(s) x Hole Siize x Hole Spacing Vent To Air Intake Length Dia. ~ Length Dia. I Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over Q xx Depth Of xx Seeded/ ceded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil - [des ❑ No Er/yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.211:3 8.16W, NW, NW, 30TH AVENUE PIa% revision required. ❑ Yes ©'No , 71 __1 P Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH « SANITARY PERMIT NUMBER: > a-S ~cG 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 _ ~1,~ i x than 8112 x 11 inches in size. c' Q • See reverse side for instructions for completing this application State Sanitary Permit Number 216 S(a ( 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 7-e W 114 6d 1/4, S ~ T , N, R E (or)o t0 r Property Owner's Mailing Address Lot Number Block Number /7,9 -1 Ga Xd City, State Zip Code Phone Number Subdivision Name or CSM Number A/10457 ( ) 1U Cr f.~ I. TYPE O BUILDING: (check one) ❑ State Owned ❑ City Nearest Road / 14 1 or 2 Family Dwelling - No. of bedrooms E] Village F Cc 44 aA //,10- 1 "Pen Public III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 6'a F- 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. U&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 11 ❑ Seepage Bed 21,® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade _ Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 66 Elevation 'YS O d1d Feet dl, Feet VII. TANK Capacity gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank Gd ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber s a G' fi,b .G ~7 ~/i ❑ ❑ ❑ ❑ ❑ VIII. 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: (No S lamps) MP PRSW No.: Business Phone Number: S' a Plumber's Address (Street, City, State, Zip Cade): C l X. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue sluing Agent Si s) Approved ❑ Owner Given Initial Surcharge Fee) ® Adverse Determination $6 t! A. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD•6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- 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, nurr.ber of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, purnp/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 numberwith 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 by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations May 18, 1995 226 Rose Street Crosse WI 54603 n'1 WEGERER SOIL TESTING 3 X95 421 N MAIN STREET PO BOX 74~.. RIVER FALLS WI 54022 RE: PLAN S95-40397 FEE RECEIVED: 180.00 JOSLIN, TOM NW,NW,21,28,16W 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. Sincerely, erard M. m Plan Revi. er Section of Private Sewage (608) 785-9348 8493R/ 1 SBDA-7997(8.10/94) r r , Page of 6 MOUND SYSTEM A 3 BEDROOMRRESIDENCE 895-40397 LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION Z1 T Z8 N, R W, TOWN OF EPcy GPcI.L~ , ST. C-~ZUlX COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER RECLTIV PA GE 6 of 6 PUMP PERFORMANCE CURVE E~ MAY111995 PREPARED FOR SAFETY & BLDGS. DIV. TOM --ST3 SL1N ~a+n►~~~~ awl s~o~S PREPARED BY L~lFEE- CGERER E3 C3 I L TEST I NC ao~ e\S 'A" , ®©e AND. DES = Gh! SERA I CE c," ; ~ APTHU R L. 4 v.,.t ,=a ! m P.O. BUX 14 421 N. SAIN ST. ~ a ago FALLS. NI 54022 rte`.` tiT" 715-42°-0165 1 1-~c y 3, [ 9 R 5 JOB NO. S -9S PLOT PLAN Page 2 -of 6 ' Scale 1"='30 895-4039'7 C . Z wL i Td Diu t~ Yi2 6'~ T U lv e W= Z3o Tit ST. ~-►v Zoo' t-rzort wtuu~v~ , 4 i w oo~~ 0 D O ►v or Qowt p r~ r up DtsTutZg 'RfiiS t~~1q B~► ~uo.o' o+~ spticE Z' bout GROC>rW 1r.~ p" Q1i~.'C1u Lul`>?t touuL~ Lh-T)4) Or 8 s.1 1 y-0' Lp'pF Z~ PU C `-i, Luc' o►= Pt.~:. +~aLZc.F ItiRtM 30~ bF `CR cXK 6-1 • G1 = 5 ~ jRG i ~.lOO,Z B.Z f W.' .,,LJ Z ~o t't~19 6 w~ U l•pr s &#i,3i4RIS OF IHj)USjR`l SAFE IN R~3iL€ @ i aS w~LL v--E trT LC-WST So J--M" ~tvtsto wl ovh,U A~ 2 s' Tt~t~.tcS . _ NOTES : 1. Elevations shown are existing ground el va io s otherwise noted. 2. Install permanent markers at end of eac ateral. ( required) 3. Install 4" observation pipes with approved caps. required) 4. Septic tank to be luac) ASO gallon capacity manufactured by "gyp LST 2>V V:1 1`s~;A3 7, 'Ajc. 5. Bench Mark S - "Oulr 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of Approved Synthetic Covering 895-40397 ~S~wl t 3 3 Distribution Pipe Medium Sand _ H - G Topsoil F Elev - Wo I -L D „ E Z Slope Trench Of 2~- 2~2 Force Main Plowed From Pump Layer Aggregate Undisturbed p `.O Ft. Soil E 1.%-►2s Ft. Cross Section Of A Mound System Using F 'W-% Ft. 2 Trenches For The Absorption Area G t-D Ft. A q_ Ft. H x-S Ft. B X11 Ft. C ZO Ft. Linear Loading Rate= g19GPD/LN FT I 16 Ft. Design Loading Rate= O•IIGPD/SQ FT i ES Ft. K \ \ Ft. L Ft. W S Ft. L g K A - Observation Permanent C Pipes ~-Markers eeji%,V-s kT (Anchor securely) Force > ----Main W w~F DisIribution -,~~Trench Of 2 - 2 2 PPeE.u Aggregate . ; w~ tittS w & nV: ound Using 2 Trenches For Absorption Area Page q Of Perforated Pipe Detail S95-40397 0 End View Perforated PVC Pipe In stall permanent marker End Cap. zv\, at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe Distri ution Pive Last Hole Should Be I Next To End Cop End Cap P ZZ Ft. Distribution Pipe Layout ~ S Z13 Ft. X 't8 Inches Y 4 8 Inches Hole Diameter Inch Lateral Inches 4'~4 Manifold Z Inches ,OF NNausSR p Force Main Z Inches # of holes/pipe G~ Invert Elevation of Laterals1p6-1 Ft. x t1 = . v Z z lj . o B 61wt TUrA-L Place lst hole 24'rfrom center of manifold with succeeding holes at L46 intervals. Last hole to be next to the end cap. Combination Septic Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE 5 OF VEIJT CAP WEATHER PROOF JuuCTIOU Box . -I'C.I. VEAIT PIPC APPROVED LOCKING - - MANHOLE COVER wCM _10FROM DOOR. I,~,~I LABEL 'dIUDOW OR FRESH 12~M111. -4 0 3 9 AIR INTAKE Cor~DQ11 ay 6 r I MIN. WAIN. PROVIDE I IAILE T --7"' AIRTIGHT SEAL I I • e~.w: 1 I I " ~AFF~~S I I APPROVED JOIAIT$ APPKOVE003bIMT I III W/C.I. PIPE4PbC w/,C. i►1o~o y construction I II ALARM 1 comply with 'I 11 L 15 and 83.20 ° ON ti+~ONdDSt~~• f LLEV• FT. PUMPS --j OFF C OA1C RETf ~ G g $ U Z) r DLOGK 13' APPi<2ovE K15EK EXIT PERMITTED OMLy IF TANK MAUUFACTURIT.R HAS SUCH APPROVAL. BEDDING SPECIFICATIOtJS SEPTIC f DOSE L TAWK MANUFACTURER: "1bL-jC1S'MIU is 'r WUMBER OF DOSES: PER DAy TAWK 51ZL : ti~~l~ 6 SO 6ALLONS DOSE VOLUME t GALLONS S S S~lSTegs INCLUDI1JTa aACKPCOW: 13 6 ALARM MANUFACTURCR: MODEL 1JUMBER: NW CAPACITIES: A= $ INCHESOR 3O6 GALLONS SWITCH T31PC: ~R Y B=-- Z IuCHES'OR T C, ►LLOA15 PUMP MA►JUFACTURCR: zb A C~ lhlt►yY C= IUGHES OR `D GALLOLIS MODEL UUMBER: D= INCHES OR l,D GALLONS b~ LstZ.CURy MOTE: PUMP AUD ALARM ARE TO bCb SWITCH TYPE: MIAIIMUM D15CKARGE RATE Zg'' S GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEN PUMP OFF AUD-015TRIBUTIOW PIPE.. 11.8 FEET + M11.11MUM METWORK SUPPLY PRESSURE . . . . . . . . . 2 5O FEET -E ADO FEET OF FORCE MAIN X fi'b` F 0C f,FKICTIOW FACTOR-. 1' 61 FEET TOTAL 09WAMIC. HEAD = ~S'9a FEET DIAMETER Pump chamber INTERLIAL DIMLW510M~ OF TAWK: LENGTH ;WIDTH ;LIQUID DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = ~`1.~ GAL/INCH . HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "98" 30 4 5/8 8 6 25 3 5/8 6_20- -i- U O a ~S 9$ 4 3/16 9 15 4 o Z6, D8 F 10- 1 1/2-11 1/2 NPT 2 5 895-40397 0 U.S. GALLONS 10 20 30 40 50 60 70 W UTERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 3 5/16 20 6.10 25 95 - Lock Valve 23' ' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1/2 H.P. 2- Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex: Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM071Z for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- E96 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 Alex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FM0477; Electrical Alternator, FMO486; Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ- FMO495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AL41L TO. P.O. BOX 16347 O SH/P TO. 3280 KY Mi Lane 1Manufacturers of... OEZ Z ZE~ O. Louiavr7b,lcr 40218 QUAL/7Y PUMPS S~cE /9a~9 p (502) 778-2731 0 1(800) 928-PUMP FAX( 502 774-3624 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and HVman Relations ~Qivision of Safety 8 Buildings in accord wi tt II HFI 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than '1t2 x 11 inches m sib PIust include, but not limited to vertical and horizontal reference 9diotS ~1314 dirINtio ind /o scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to near4t i o APPLICANT INFORMATION-PLEASE PRINT ALL=1411`01`10k60N REVIEWED BY DATE PROPERTY OWNER: w ` > P P TY LOCATION ~ ~Uy~z ~wti ~sl.1N f~ll~) 1/4 NIc11/4,SZ1 T N,R 16 E(oryW PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM # N ~1ZZ. Cow tV - RCIPOSk~j Um CITY, STATE ZIP CODE PHONli~ N f F3) R f ti CITY ❑VILLAGE (MOWN NEAREST ROAD 11\x" 1HOhm I,U 1 S g o l s I s) 6 ~'~PN G t~ L L-LS 3c> Ttt i N t; . pQ New Construction Use.[X Residential /Number of bedrooms [ ] Addition to existing building j j Replacement I ] Public or commercial describe Code derived daily flow CO gpd Recommended design loading rate o--14 bed, gpd/ft2 - trench, gpd/ft2 Absorption area required S u o bed, ft2 S 0 o trench, ft2 Maximum design loading rate o - -S bed, gpd/ft2 0. 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) °l 9.- S r It (as referred to site plan benchmark) Additional design / site considerations ~ pwtr~tLvO 1" 10Ukj1J w/ 6 Sf ' B Ib - M "'j, 1 "a F--- sn ip 1=r Parent material Lo NZZS QQ m e- ~ TtLL Flood plain elevation, if applicable 'N • A • It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem ❑ S ®U ZS El U ❑ S ®U ❑ S ® U ❑ S Mu ❑ S [RU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends }?ar •v.?.......... J ~I o - b do M. -t zC z. - s i Z `F-s h 1-c w, h a-S Z o • S ° Z 6-1$ ~o`1R y/.I - Sl ~Sbk ri 4, cS Zwl 0.5 0.~ Ground Ig- Qs -I fZ V/ - e1 z gbh es o S elev. 0,8 ft. 2$-3Z 10`1 R- L ~-i. tIR S/6 S O S°~ ~^l cS Depth to 5 3 Z-3 2 3/6 a b4c 1Nt ~ i - _ limiting factor Remarks: Boring # S 1 tR- Z L Z - s Z S ~1Z '"-~'F'~. a- S Zt, t u S o. 6 Z>` Z S-ZS xw-m W3 - s1I 2 'sbh mfv C-S o.S 0.6 : Ground elev. ,3c Depth to limiting factor Z S" Remarks: T Name:-Please Print Arthur L. W e e r e r Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: t/ 3 [3 l Z- °l~ M00576 au~•c ~2 PROPERTY OWN" Sgt-t►~ SOIL DESCRIPTION REPORT Page WL df 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed d Trench 0-6 ~~~tR z-L2. - s i I Z sbk Yet ~t.S Z o. S 0- 6 t~ 3 Z b-is LoL1R- v/~ - sit 2'~sbk wt~H cg zn o- s o-6 CY, Ground 3 2S S to ye 3!6 G s tz s!$ C 1 tin ~,1ak Yyl `Fj - elev. a,.9 ft. Depth to limiting factor Z S , Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev, ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1 30 ' ~`Ae~T RS sHUw>u -TN Pru e, - Z BO Tit ST. i w oo~~ 0 D 01S1vRg `this t*t-~~q , ' gam" E. W00.0oti sPt1l Z' govt G►ZO u►-)D 00 R Z tjvus E rb i3~ py~- Llv Pf ST- 2S' X,bu►vb . Fu'Tu 1 L ~e UT- 1.1%v e-S Tu k3 F FtT Ll t\ ST S ' P z-o -I 1"J Di»vD . q y-3l 1Z-:,I-9~ (715 1 42.5-0169 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of -3 Labor and Human Relations bivision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm.,Code COUNTY ST . ~~n ! x 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 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 $V~ Z, -T-f.~wl ~ S 1_ \ G&T. E8T- IJA 1/4 N W 1/4,S Z1 T 2.8 N,R 16 E (or 0W_ PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # , SUBD. NAME OR CSM # \n Z7- cou t t-,3 ~ - - RC1P0Sv!b USm CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [ OWN NEAREST ROAD Y*P)Hb1v~Lul S\IOtS FAS)794, Z3q ~''PCt) GftLL.Ls : C>T* hue. New Construction Use. Residential / Number of bedrooms [ ] Addition to existing building j j Replacement [ ] Public or commercial describe Code derived dally flow 013 gpd Recommended design loading rate o • --'A bed, gpd$ trench, gpolft2 Absorption area required S u o bed, ft2 S 0 o trench, ft2 Maximum design loading rate o • S bed, gpd/ft2 0.6 trench, gpolft2 Recommended infiltration surface elevation(s) °I q_ S I ft (as referred to site plan benchmark) Additional design / site considerations O►~rtLvO M12jU v4-'s w/ 6 `x-8V ' B Lwb - Mo\j . 1 ` o t= swab 1=-r t-t- Parent material Lo S UQQNN.- C_ Y tt,L Flood plain elevation, if applicable TQ - A • ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN 7FRILL HDLDING TANK U = Unsuitable fors stem ❑ S E1 U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S VI ❑ S C$U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bouiclary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iench ='4 I o-b tio~tcz z CZ - "S o,-S Zw, o• S o-L Z 6-I8 10 `1tZ ~!/3 . s o `t o S Ground 3 to'-l 2 V/ e1 ZMabh m C_ elev. 0Q.8 It. 2$-3 Z f 0 `1 tZ 3/ L ~-i. t f R S/b S O g i^ t CS - Depth to 5 3Z_3 I, to `t 2 3/6 t C \ 1 WX a bk tin i - - limiting factor Za 4 Remarks: Boring # 1 0- s la~Q ZCZ - S~ t Z~s~~ a-s z~, ~-s o. 6 Z U. Z S-ZS IU~tR `~l3 - 511 2`F'sdk wt~t. C-S 0.5 0.6 3 2 S-31 LU`i-(2- 31~ ; , y fL 518 c°_( \ YYt a \~k w► 'F r' - - Ground elev. 99.6ft. Depth to limiting factor Z S4 Remarks: T Name.-Please Print Arthur L. W e e r e r Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number: CL/- 3 [3 1Z- C- °l~ M00576 a~~cQrn ; PROPERTYOWh"R SOSLIN SOIL DESCRIPTION REPORT Page? 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 €4f { ~ ~ o _ ~ ~.p ~ Q. Z L 2. s l I Z Sb Y~1 S Z o. S a 6 Z s 4t V~1 ~H e S Z 0 . S o, b ` 2 6 -'LS t o L-t 2! - 'S cy, Ground 3 2 S $ L13 `1 Q. 3 !6 G s R s/!; C trot q.~}t Yv1 j - elev. Depth to limiting factor 2S'' Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # O:hQ\L>i:'L:k S:n Ground elev. ft. Depth to limiting factor Remarks: Boring # Kai ; Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 3C) ' RS S1{ti1wN o.i. rni Ta Z B0 Ttt ST. 41 i w oopQT~, i 0 D Ov iv or enw1pRcr- vR olslv~2g `fl`FIS ~1u~q Et- woo.ooN sptK-e z' msoue GVZO c,"* Np" ~tR.~u ~w~ wuuU ~fl`T~I~ I~L 00 e glb_s q01 of tis t'Lq-) 9 ~o`~' S u ~~•ICBL~. 'l'CRL+~ FOQ W! tX~s~lO . Z B Z e'L 0, b ~sF ~1~~ Per Ll-7 Pf sr zs' Fu1v1L` wT io 6 iNT LLiNsT S' P1wvi 'r-jowAl . gy_3l~ awL,k:~2~- - 1Z-.9-9(715 4 5-D1 3 _ 1400576 CST Signature Date Signed Telephone No. CST # FILE APR 2 7, 1995 KATHLEEN H. WALSH RegisterotDeeds 521 8 ry SL Croix Co., V'Jt Cv N CERTIFIED SURVEY MAP LOCATED IN THE NWI/4 OF THE NW 1/4 OF SECTION 21, T28N, R 16W, TOWN OF EAU GALLE, ST. CROIX CO., WI. PREPARED FOR: DUANE AND LUCINDA BAUER b NOTE: BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NWI/4. ( ASSUMED EAST) . NW CORNER OF SECTION 21. N 1/4 CORNER SECTION 21. ( COUNTY MONUMENT FOUND). U.N. P L A T T E D LAND. S. (I 112" IRON PIPE FOUND) NORTH LINE OF THE NW 1/4. M EAST 30,TH m EAST 613.00 AVE;, WEST ti . 622.13 m .139166' m EAST 613.00 0 ? o 0 0 0 M I_0 M `HWY. BUILDING SETBACK LINE z' o z' d. O Q. J. p J, c; r, O L I'l LOT I Ip r 10-00 ACRES 0 n (435,598 SO.FT.) n c3• = Ip 9: 54 AC. EXCLUDING ROAD R. 0. W. ID W w w l 415,369 S0. FT.1, e d' o Q r.: a' a: z' Z, M. W- -E S _ WEST 613.00 UN. ...PLATT. ED L.A. N. . . D S. . STC-105 SEPTIC TANK MAINTENANCE AGREEMENT - St. Croix County OWNER/BUYER J / r) MAILING ADDRESS PROPERTY ADDRESS 11 3(~'~` SIT( E/J6 /~l C.y 0 1 (location of septic system) Please obtain from the Planning Dept. CITY/STATE _~Q Gfw i W `w~ PROPERTY LOCATION Q 1/4, 1/4, Section T g;N-R W TOWN OF Arl_ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY VOLUME LOL, PAGE 6 I , 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: DATE: ~U St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - loo 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 10M "t:D (Qr)49, T~(~l Location of property 00114 1/4, Section ,Tag-"_N-RA_W a Township (Sall Mailingaddress~ ~,tp} Boa-- Address of site 30"L' rP Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Ci u'~r Total size of property /0 ACfe5 Total size of parcel Date parcel was created v Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes X No Volume L and Page Number OS-5 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 fice of the County Register of Deeds as Document No. _7 ~5g , 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 the County Register of Deeds as Document No. ignature of licant Co-Applicant `2 -'30 _`>G '7 A 0 14 ~ Date of Signature Date of igna ure • 5%9544 State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED DOCUMENT NO. 55 EGIWERZ OFFICE ST. CRom n' 4 I Redd for Rz::,;aJ Duane J. Bauer and Lucinda C. Bauer. _husband MAY 3 1 1995 ff __and_ 1fe (-A 9:15 A. , conveys and warrants to Thomas J Joslin and Diane K. • f e..., Jos : n 1ws_band__and wife, as survivorship - --mar-i tal_-prop e ~poa THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS , WJ 60 the following described real estate in St Croix County. State of Wisconsin: (Parcel Identification Number) Lot One (1) of Certified Survey Maps filed April 27, 1995 in Certified Survey Maps, Volume Ten (10), Page 2912, as Document No. 528247 Grantors reserve the rights of easement for drainage tile installation over that portion of the above-described property described as follows: Commencing at the Southwest (SW) corner of Lot one (1) of Certified Survey Maps filed April 27, 1995 in Certified Survey Maps, Volume "10", page 2912, as Document 528247, then North 100 feet, East 100 feet, South 100 feet and West 100 feet returning to the point of beginning. This is not homestead property. (is) (is not) Exception to warranties: 'F'h M0. R Q.~ Dated this _ (O day of y 19 (SEAL) ;•(SEAL) I Duane + J Bauer (SEAL) - (SEAL) + Imrinda C Bauer AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. County.