Loading...
HomeMy WebLinkAbout008-1064-60-000 o m O o p N c 0 0. 0 ° I 0 0 N N y . I ~ I C Z c LL O 3 ~ I I ~ I ~r v (D Z y U) « o Z co d 0 N f- C14 m fn O i O Z a U v ~ ~ w a Z N H r j N E -0 1 (U M WAIN) r p m Q z z O co z 04 _0 N E N H > L C U) CL 0 d N d N~ O O D d 0 CD -0 U) U) U) m o w CL IL M IL a (A J U rn rn Cl) 04 N CO ,..0 CU N f O O ? co N O] d m O M C (n Q O c _ J d O O O p ~ H C ^l O N E N CO Q G C V o- O O M N C r- -0 N N N C m O CO (0 m Cl) O p C v O c6 (D m (n ~ O N= 7 CO p rn N A v M • Q O N W !n co O Z c (n y 11 r \ ~t v ~ I a € .2 V CL • a m m tt~~ 3 `~1 A 0 a2 'i0 NU a 1 l STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~LG2 d l 1'I ADDRESS o/ SUBDIVISION / CSM# SECTION 91a T (9e N-R W, Town of ^ ; 1 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM let,.~~.~~. ~a a P4 ~ev' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. lob BENCHMARK: ALTERNATE BM: / S ANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: A'1410e-5 / fffe4, Liquid Capacity: ~~G' _~ddd Setback from: Well ~>5d House 351 Other Pump: Manufacturer ~GLti /C` -Model &CL ,2Ilzsize .3 Float seperation Gallons/cycle Alarm Location GN~JOII e dE SOIL ABSORPTION SYSTEM Width: > Length ~i Number of trenches Distance & Direction to nearest prop. line: Setback from: well: ~~40 House ~~d0 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:1 ~,3 ~1 PLUMBER ON JOB: > c,_4 LICENSE NUMBER: C~ / INSPECTOR: 3 / 9 3 : j t i Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildfbgs Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268593 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: STURTEVANT, MARK & LINDA EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: D /Dv ) TANK INFORMATION ELEVATION DATA A9600280 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic Benchmark Dosing /Jo 0 Aeration Bldg. Sewer r Holding St/Ht Inlet a•~~ ' TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet rl Septic 'l0 -351 NA Dt Bottom Dosing NA Header / Man. 2 y Aeration NA Dist. Pipe .91 4y, 2 L Holding Bot. System q9. 72 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain I Length/,Q Dia,, i- Dist. To Well 3 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 00 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. li Length kL_ Dia. GrY Spacing APL V L Sd SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ~ r xx Depth Of t xx Seeded 1§edded xx Mulched Bed /Trench Center 1b~1 Bed /Trench Edges I2 Topsoil 01y, es ❑ No J'Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.22.28.16W, SW, SW, COUNTY BB Plan revision required? ❑ Yes [f No n Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: Y ` I I s r^r.krilr''• SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuilBuildinWater Systems ng Water 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, Wl 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County q~-i than than 8112 x 11 inches in size. I Y. • See reverse side for instructions for completing this application State Sanitary Permit Number b 6~ 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 PlaQ LD Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION X76~ ! 0 Pr e y O ne Na , Prop4ert Location V 1/4, T N R tG! 3 r r 1C E (or )o Property er's Maili dd es Lot Number Block Nu LeLl Ci suletev 6l ` Zip CQ ea~ (Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned El V ila QU ) Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Towne OF lk 1.~4? III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) x 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. N 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 466 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) S Elevation S06 Feet /400.Q Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks manufacturer's Name Concrete Con- steel Plastic p New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank e C ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber fOQ C ! ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. P m er's Name: (Print) PI is Signature: to ps) /MPRSW No 3 Business Phone Number: Plumber's Ad ress (Stree Cit, Stat ip Code): t" tj f, Y, FA J/S k)l > IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater aIssuing Ag nt Sign ~ Approved El Owner Given Initial 00, Surcharge Fee) p~ Adverse Determination Q X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. OS/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Di-ion, Owner, Plumber c INSTRUCTIONS 7 t 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. a To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. P"ovide 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 isto 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 specificationsnot smaller than-.8 1/2 x 11 inches must be submitted to the county. The plafis.oust 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. f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 8, 1996 2226 Rose Street La. Crosse WI 54603 WEGERER SOIL TESTING I. ~"t 421 N MAIN STREET CF PO BOX 74 c~ couNr,RIVER FALLS WI 54022~rvcoFr~~~~,~~, RE: PLAN S96-40903 FEE RECEIVED: 180.00 STURTEVANT, MARK SW,SW,22,28,16W 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, &ard'M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 SUDA-7997 (R. 10/84) .:S96-40903 ' Page ~ of 6 MOUND SYSTEM RECEIVED FOR A BEDROOM RESIDENCE AUG - 5 1996 SAFETY & BWGS. DIV. LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION 2-Z,T-Z8 N, R 1~ W, TOWN OF D y ST. CVb1X 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 Pv`N~~~ iti®llally 1`-~ t~Ctt~ prNO ~1Nb1~ 3T~2YEV At~1T ED''3aNs ® R t ~ RMp41 -L S 8 co V 0--S S ~ ~gl1a ~1~1RGS 21-v ~R, rKL~S, W 1 S y u22. I of opus ~ t 01 P N,O~~yGE StiE Goy PREPARED BY LJEGEF;ZEFZ S;C3 X L . TEST I I%IC-3 ~No. nES = God S~FRW I GE i ~ ~'.•NMrrrrrrrrti6r F.O. BOI 74 421 C MIK ST. g I ARTHUq L. RIVE? FX-LS. V154022 z wcza=R } axis P ~ 715-4L r01b.r ELLSWORTH. i g i WIS. i rrgpNrr O~o~O~~B s I G IS E4'~ ~Qa10~t98~* 6-3 -96 JOB NO. q 6 -18 PLOT PLAN Page Z. of 6 f Scale 1"= U1~)' o w Ett_. ~a BE F)-T l TV T S 0' 1= 1~►'1 Y,100)ut~ 9~A IAI;p s~ C` ~4PUC 5 \ OF Z `~P L z9 . r-ZS- - gt9(,6 8.1 i I I I , 6'le I O O QL 4 `b a I-~ 0--- gwl - t?Z . No0.~~ ati $~@}t GHQ Do Ivor T i I 314 pl R • Pv C ~l PN w/uf ota ~ t ~'TUttt3 , ~ C 5 ~ ~ - ~a 1~1pT b \ S ~►ttl3~ ~-►~-ts t°r-cz~~,n -.-t-+ III zS z, ~ ~01~0►~ p~ 'T1t1..e.h ls.L~. q~. S ~Z h1► ~ ~U w }rv d Q y CN 5r u"t or- 4 ~3 t1Q. P WR-C-a) - - 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. ( Z required) 4. Septic tank to be x-7-00 gallon capacity manufactured by `M ~pt~ ~i 1~1 -~,2er-AYr - ?yr-tiP `1`K►.~~rc `M $z }~tt ~4s1~~~~ttN I OOD Gt~t. ~Vt'\ulrc._ 5. Bench Mark Stz,87 'HY~DUPS 6. Divert surface water around mound to prevent ponding at the uphill side.. Page 3 Of Approved Synthetic Covering S~sTM c 33 Distribution Pipe Medium Sand ~G Topsoil H - J i F Elev-. S 3 E D ~ b % Slope Force Main Plowed Trench of 2"-22" From Pump Layer Aggregate Undisturbed D 1• C) Ft. Soil E 1 • 3 Ft. Cross Section Of A Mound System Using F 0-$ Ft. I Trench For The Absorption Area G -a Ft. A S Ft. H S Ft. B IVNd Ft. I \S Ft. Linear Loading Rate= b.0 GPD/LN FT J $ Ft. Design Loading Rate= 0.3 GPD/SQ FT K Ft. L 1'Lo Ft. Al o airy W Z8 Ft. L Force B K Main - A - - - - - - - ~SUt~ZST o~ cos t~ W Distribution Trench Of. Pipe Aggregate I \\~Observation Permanent Pipes Markers (Anchor securelyi Mound Using 1 Trench For Absorption Area I I I page 1 Of .(-3 y ~ Perforated Pipe Detoll 0 End View End Cop. )Perforated j oboe y` PVC Pipe Install permanent-marker at end of each lateral Holes Located On Bottom. Are Equally Spaced Q End Cap PVC Force Main * Distrioution u Pipe Lost Hole Should Be Next To End Cap Distribution Pipe Layout P Q U Ft. X SQ1 Inches Y SO Inches Hole Diameter Inch Lateral J 1'/Y Inch(es), f i Manifold Inches Force Main Z Inches # of holes/pipe \,,Z Invert Elevation of Laterals 99.0 Ft. Place lst hole from tee with succeeding holes at SDyintervals. Last hole to be next to the end cap. i ' PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOMS ' PAGE S OF 6 VEIJT CAP ti" C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE JUIJCTIOW BOX COVER WITH WARNING LABEL 10 FROM DOOR, I2•MIU. WWDOW OR FRESH I AIR iMTAKE I - q IRS DE i 40 )4 CONDUIT-- • PROVIDE ~ AIRTIGHT SEAL INLE=T _T I I APPROVED JOIIJT/ A Tank construction shall comply I lil APPROVED JOWTS with ILHR 83.15 and ILHR 83.20 I ~I I II ALARM a I it I I I ON c I I CLIV. F7 PUMP ~ OFF D a COIJCRETE 5LOCK 3" APPROVE - RISER EXIT PERRMPTED OML~J IF TAWK MANUFACTURER HAS SUCH APPROVAL. 860pthK, 5PEGIFICATI0MS DOSE TANK MAIJUFACTU0.ER: ES) nW p J- WMBER OF DOSES: 3~~3 PER W.4 TANK 51ZE: ~~bd GALLOWS DOSE VOLUME 1 ALARM MA1,IU.FACTURER: S'S' 0 S".ST'tJ1S INCLUDING 5ACKFLOW: GALLONS MODCL IJUMBER: C>`PACITiES: A= IMCHESOF. W GALLOtJS SWITCH TYPE: ~~L°-U17~' B= Z IMCNESOR S GALLOWS PUMP MANUFACTURER: zee- C= 7 ILICHES OR `SI CALLOUS ` MODEL IJUM9ER: 1 3~ D- I~ZIAICHES OR 3S ~ GALLOAIS MOTE: PUMP AND ALARM TolaE SWITCH TYPE: MINIMUM DISCHARGE RATE GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEILLkILE DETWEEW PUMP OFF A►JD_OI5T1ZIBUTIOM PIPE.. N-8 FEET + MINIMUM NETWORK SUPPLY PRESSURE a . . . . . . 2•5O FEET -F \`80 FEET OF FORCE MAIN X 1-61 FYoFtFKtCTIOU FACTOR.. FEET TOTAL 09WAMIL HEAD = ZO.Z FEET DIAMETER - IIJTERLIAL DIMLWSIOW~ OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH 3$ t l BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = 2h. CO GAL/INCH 4 3/4 7 3/8 W W HEAD CAPACITY CURVE TOTALDPERIAINUTfrLOW 4 MODEL 137-139 EFFLUENT AND DEWATERING L 6 1/8 Feet Meters Gal. Ltrs f20 SERIES 137-139 g 5 1.52 104 394 ° 10 3.05 70 300 0 ° 4 3/4 15 4.57 64 242 - 20 6.10 36 136 zo _'z FS = 6 25 7.62 ' 8 30 ° ° 26 7.92 - 0 0 r 15 o I 1/2- - 11 1/2 NPT 4 Z8. 08 o t0 2 5 12 3/4 I 0 U.S. GALLONS to 20 30 40 50 60 70 80 9o 100 110 LITERS 80 160 240 320 400 I I 4 0 - FLOW PER MINUTE n CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V or 230V. • Mercury float switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an alarm. • Double piggyback mercury float switches are available for variable • Mechanical alternators, for duplex systems, are available available with level long cycle controls. or without alarm switches. • Long cords are available in lengths of 15-25-35-50 feet. • Combination starters are available. • Over 130'F. (54°C.) special quotation required. Standard all models - Weight 47 lbs. - Y2 H.P. SELECTION GUIDE 137/139 series control Selection 1. Integral float operated 2 pole mechanical switch, no external control required. Model Volts-Ph Mode Amps Simplex Duplex 2. Single piggyback mercury float switch or double piggyback mercury float M1371139 115 1 Auto 10.4 1 orl &8 - switch. Refer to FM0447. N137/139 115 1 Non 10.4 2 or 2 &7 3 or 5 & 6 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. D137/139 230 1 Auto 52 1 on &8 - 4. Combination Starter. Refer to FM0514. E137/139 230 1 Non 52 2 or 2 & 7 3 or 5 &6 5. See FM0712 for correct model of Electrical Alternator "E-Pak". `H137/139 200-206 1 Auto 8.2 1&8 - 6. Mercury sensor float switch 10-0225 used as a control activator, specify duplex * 1137/139 200-208 1 Non 82 2&7 3 or 5 & 6 (3) or (4) float system. `A37/139 200-208 3 Non 42 2&4 3&4or5&6 7, our (4) hole "J-Pak", junction box, for water tight connection or wired-in F137/139 230 3 Non 3.0 2&4 3&4 or 5&6 i` 37/139 ,460 3 Nan 12 2&4 3&4or5&6 simplex or 2 pump operation, 10-0002. X1 * G1 molded plug - 8. Two (2) hale "J-P2k", 1--r Watertight connection or splice, 10-0003. Three phase units require a control switch to operate an external magnetic or combination starter. CAUTION ForinformatibnonadditionalZoeller products refertocatalog onCombination starter, FM0514;Piggyback All installation of controls, protection devices and wiring should be done by a qualified licensed Mercury Float Switches, FM0477: Electrical Aftemator, FM0486; Mechanical Anemator, FM0495; Alarm electrician. All electrical and safety codes should be followed including the most recent National Electric Package, FM0513; and Sump/Sewage Basins, FM0487. Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 F ` Louisville, KY40256-0347 Manufacturers of Aff f SHIP TO. 3280 Old Millets Lane ~s Q Louisn7le, xY40216/- r7/~~ AN /s7Vi7 1W (502) 778-2731. 1(800) 928-PUMP jf' FAX (502) 774-3624 Wisconsin Departrnent of Industry, SOIL AND SITE _ EVALUATION REPORT. _ Page L of Lahr and Human Relations Division of Safety 8 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 T' l . 1X 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. Op$ - M614 - 6 O APPLICANT INF TION-PLEASE PRINT ALL IN N REVIEWED BY DATE PROPERTY OWN R: r't Z, S \-LT-Q~ V N-yV PROPERTY LOCATION U l 0 A Q U Er t3AYi t8T S W 1/4 S W 114,S 11T 2-8 N,R [ b E kwj PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD_ NAME OR CSM # 2- 16 zso `nt ST. - CITY, STATE ZIP CODE p PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROAD wWb\31"IRr WI St(oLC, (-)Is) 648_ z8Z8 l"~ GNJJ h 2- C) Tt} f}v~. [~Q New Construction Use [DC) Residential / Number of bedrooms L/ AddrtiQn to existing building I 1 Replacement Public or commercial describe Code derived dairy flow bow gpd Recommended design loading rate bed, gpolft2 0_ 3 tr er)(M4~~ RECD)` Absorption area required Soo tied, 112 S oo trench, ft2 Maximum design loading rate O-S bed. gpd/ft2 0,,_- tr r Recommended infiltration surface elevation(s) ''18• S It (as referred to site plan benchmat) /r~f.~~ Additional design/ site oDnsiderations)-I W/ S'x-leo1~ ~vC ~'1 LN . I' o S Nkit, F ~ Parent material S I L~" o U ENZ- SC-L_ -P LL Rood plain elevation, if applicable Ju- R ft y S = Suitable for system CONVENTIONAL MOUND &GROUND PRESSURE AT-GRADE SYSTEM IN RLL uaG FCC U = Unsuitable for tem [IS RJU ®S U [Is ®U 11 S U S [$U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed rends w:; Z .z q-l~ S'-1 I S1 [ 2-"~sbk CS o.S o. L o ~l o• S Ground 3 \1-3 2 1. S R- 3 L - L \ G s bk f►t 0-3 elev. 1 ~.SYRS7$ °l 6-O ft 32- y [ S L j 31 sc t t~ r S CA wt wl - Depth to limiting factor 3Zt~ Remarks: Boring # 6 t o ) °-9 lzmKz- 3IZ Y•1'(1 CS o,S:O. z z 1)-16 ~4`LtZ Y13 S 11 Zwt Sbk w►'F~ cs - d•S €o, 6 3 t6-31 ~.SYf2 ?ly - Sal 1C-s1~k m~L C.S - o_Z€0-3 Ground S y R SI p, - ` elev. t{ ) -q I 5 `l R 31 -~I- - ~8.~ fL Depth to limiting factor Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer So'1 Testing & Design Service-P.O. Box 74 River Falls,WI 54022 *nature: Date: CST Number- l _ qS-303-Z 17-1L 95 M G057,6 s PROPERTY OWNER SOIL DESCRIPTION REPORT Page .of ' PARCEL I,D.#i DOE?- \bbq, 60 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh, Bed Trench 711'v 0-9 1o-I%Z Z Z 9 - L7 1 u K I'L V 13 S 1 Z" sblz vn'Fh C.S - 4. S o. Ground 3 11-Z~, 1. S't R 3l y sc l ` c= gbk V+1`F'ir C$ o. Z o• 3 elev. 1 ~.SyRSlg O in1 Mfr q rt. y Z$ -47 S y tz. 3 L t c b/ 3 C. Depth to limiting actor f z a i Remarks: Boring # i E.- 3~- i Ground elev. ft, Depth to limiting factor i Remarks: Boring # i i nw-w Ground - elev, i ft. Depth to limiting factor f Remarks: Boring # [31 Ground elev. ft. Depth to limiting factor Remarks: cnr).n3gnvA ()5X10) PLO 1 PLAN Page 3 of SCALE 1"= yp ' owN UVuLF\ ~o©U~37i - i>> D NV, Dos- 1Z16V- 60 [ i~, a 6 6 zs' li 8.3 j t I 6 ,l~ IN, i o O tTL°!a 8 cJ'• - 13.Z ~s 8'h- L~L. Loo.()' ON, 8yL~►GH) ~f Sty " bl R • ~v C v-t Pe w/LA-M t R bo ~~T ompfi~-T i C S ~UL - l~0 NOT b 1 S'i~►~~ ~l OR b SZVRi~ i 01 l~ ZS - za J, E ~ 0~►'"1 O F 112. e.{~ L1.~V • 4 ~ . 5 t ~l 1JovSE 'N BE ftT UNk;5T ZS -FZOM H0Q%l • ~ ww-L.Lr 4 11 CC so' 't A a w► nv ~ w L'Tw R S' x -1 S `rRkh,c~ i s R 1►"t ra E~ a~ FAR A 3 Q~~4►`1 ~}uti" 1E~. - • R.O.w. L)ivc o.Z _ l~ zc~ `rtr . _ - °iS-303- Z VZ,.-Ll-`IS - (71 ) 425-0169 1400576_ CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor.af l Human Relations Page __L of - Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code y COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S T• C ll lx 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. 008 - lOby - 613 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION V l A \__1 Q~ Q Uk~_ - Ir G&ff. LGT S W 1/4 S W 114,S 17ZT Z$ N,R I E, E (or W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Z 16 Z so `Ttt ST. - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROAD WI St~Co2-a (its) od' 2 87-g k` ~ 5NA_. _k8 2- c) rk Hve. [Jd New Construction Use [DC] Residential / Number of bedrooms L/ [ ] AdditiQn to existing building j Replacement [ ] Public or commercial describe Code derived daily flow h%o gpd Recommended de4n loading rate bed, gpd/ft2 0- 3 trench, gpolft2 Absorption area required Soo bed, ft2 S uo trench, ft2 Mabmum design loading rate O-S bed, gpd/ft2 a 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) C18. S It (as referred to site plan benchmark) Additional design / site considerations)-I1 u►.~ w/ S'gjo( ' r" 1 Uy . i' 01= S JN~ Ft. (-I-. Parent material DU L-InL SC-L -y't. Ll Flood plain elevation, if applicable ti- ft S =Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable for s stem EIS RJU OS U S ®U ❑ S ~U S CWU S Ku 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 Tutdt \O `1 i_ 3 Lz - s~, Z sdl~ +v~ Fh C g - o. S o. to Z q--~1 -),s`1R31 - Stf Z-wtSbk ►n'F~ om US a.V Ground 3 \-1-3 2 1 S `1 lL 3( L O S Uk y►t F~. c g o u o• 5 elev. 1 ~•S~IRS~$ 0►6-0 ft. 3Z_y[ S ctR 31 ~C t 2 t Scl O Vj ► - Depth to limiting facto 3 Z.t~ Remarks: Boring # 6-9 1 Z-j \i 31-e- 1 S 1 Z S M'~'~, CS o, S n. 6 z Z q-)b lo`~2Y13 - sil Zw►s~k w►~1- ~S - o.S0,b Ground l b-31 . S Y f2 ~l y - S c~ 1 C_ S b>z m ~f tir C. S - o, Z a• 3 elev. y ) -U I 5 `t R- 31 &l L ti ? R~ 1 SC) O >n~~ - 9$. L ft. Depth to limiting factor Remarks: T Name.-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: ` ` q S_~~ 3 Z Date: 1- CST Number: M00576 PROPERTY OWNER \--ODU ls'T~ SOIL DESCRIPTION REPORT Page -of PARCELI.D.# 008- ~13bq-60 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 BIZ 0-9 0~11Z SLI Z`~s~~ w•`F►~ CS o.S o.b o Lt (Z- f3 s sbk v~~►- S - o. S o, b Ground 3 v) -7,F, -1. S `l R, 3I v - Sc 1 L Sbk ~''ti`Fir o_ "Z. e• 3 elev. I ~.S`!RSlg q~ft. y Z$-~E7 S Ll1Z- 3L vn'lp-. 1.3 $C Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. , Depth to limiting factor Remarks: Boring # ~a Ground elev. ft. Depth to limiting factor Remarks: - F,Qr).A11nIR n5lQ91 PLOT PLAN Page 3 of 3 SCALE 1"= yQ ' i D ki 008- rpby- 60--- 7-B, `zS- 8.3 I ~ A I I 6 ~l• n ff I c+ c' 8 o o_ -'s I Bwl - ~--L. too.o` of~, 8~~~~ GHQ _ fly" D1R• Pv C ~iPe w/c'rM I ~o wuT- pncT C S UL DQ rvoT b\STk3p-rzs) Z3 o1~0►h D F ~•R~'~. e-1•~ L , ~A.► • q ~ . 5 ~f \~ovSE 'To_ 8~ L~~t~T ZS'~:.1~k'i4i''1 K-i~v~. w ~ 4 so• .4 a a cv "i t W mA A S' x l s' 'TtZ~w~1~t i s [2 N'1► a~D T---4R A 3_Z,~NLQ0"1 I,\%"Q:. o . 2 ►r, ~ Tp ~ l~ ZC) `r?i- ifiyN . °1 S-3 0 3 - Z 'r^ti L4.' 11 cis ( 715 ) 425-0165 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor dnd Human Relations Division of Safety & Buildings 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 L.'~ZtlX 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. 008 - 10614 - 6 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION V l t t- A t_ Q U eeYT-[: S S W 1/4 S Lc31/4,S 11 T 7-8 N,R 1E (o PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Z t 6 Z Sb 'Ttt ST. _ CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD Woo~v~~LF, ttil SttQ1Z_; (71S) LQg,z8zg viiU GN1L.k8 zo TT1 Avg. [SQ New Construction Use [oQ Residential / Number of bedrooms L/ [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 6~o gpd Recommended design loading rate bed, gpd/ft2 a- 3 trench, gpolft2 Absorption area required S 140 bed, ft2 S uO trench, ft2 Maximum design loading rate O-S bed, gpd$ ! , 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) °l8• S It (as referred to site plan benchmark) Additional design / site considerations 'F-1o w~ S'X-ld~` '1~Z~vC~I • P'1 L►y . 1' o•F S NtiD FE LL- Parent Parent material S ~ L`T 4 Cx U L~Ibi2., SC-L -nL-L Flood plain elevation, if applicable N- ft S = Suitable for system GONVENriONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U =Unsuitable for stem ❑ S U ®S ❑ U El S ®U ❑ S 0 91 U ❑ S RU ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence BoLr>dary Roots Bed Trench ] b-~ 1O`l L LZ S\ Zi 5M'~ n1 FH 0-5 0-S o, K< Z-i1 ~.S`1R3IV _ St[ Z-wLSbk m'~~ CS US o.l. tt v. 5 Ground 3 11-3 2 1. S `I R. 3 ( - L \ C s bIT r►1 ~y, c g 0' elev. ~1 -x.gYIZS~f3 SCE Y'1~N 016-0 ft 32.4) S `1 W 31 ( 2 r. - Depth to limiting factor 3Zt~ Remarks: Boring # 0-9 1,3 -12 3(i SLR Z`FSb MCS Zvz Z q_16 lo`m Y!3 S 1 l Z+l 4k vjV cS - d.S €o, f~ 3 t b-31 . S Y 12 ?l y - s 1 s ~>z'~~ C S - o- Z€ Q 3 Ground elev. q Uft. t{ )-yI S `tR- 31 & L ~Z ~l,~ SCI O„, m~~ Depth to limiting factor Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 Ad: egerer Sol Testing Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: C) S_JO 3- Z Date: ] l l- CST Number: M00576 PROPERTY OWNER ~O©USOIL DESCRIPTION REPORT Page of PARCEL I.D.# 008- lbbq,60 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Banx~ry Roots GPD/ft In. Munsell Ou. Sz. Cont. Color . Gr. Sz. Sh. Bed Trench 3, I 0-9 10~-t~Z ~!Z - sil Z`Fs~ w.~H CS a.S o.b Z 9-11 1 u KR- Yf3 S t Z Sbk w,~~. CS - o. S o. 6 Ground 3 n_-t,P, 3I y s~ 1 1 c: sbk vn ~g o, Z. o. 3 elev. l ~.SYRSlg 9 ft. N Z$-~7 5 tirz 31 t~~ ~r3 sc O+^~ tn1'F>r Depth to limiting faoZ a Remarks: Boring # Ground elev. ft, Depth to limiting factor Remarks: Boring # z Ground elev. ft. Depth to - - limiting factor i Remarks: Boring # „ ~fP Ground elev. ft. Depth to limiting factor Remarks: c.nn.a?~n~r~ nvo?~ v Page 3 of 3 ' x PLOT PLAN SCALE 1"= 110 ow+v tEVL; U VU LE\ w © U LZTt`I~ _ D 1v(I, Dos- )pbv-- 60 ~zS- 6.3 II 1 1 I 0 O s*t - 1-L. to o.o' dam, 8it~t+GN~ S Oo ►1-+uT- Co npff--T i a ~51UR1~ + C S ~UL - l7Q )UpT b1SZUt~tt) 0a zS ?a, 21 J, C-Ok)' Uu'k t--LtF . q~-S ~oTTOw~ OP ZRL~a~Y LL~• 4~,5 " f 13ovSE 'To Bl F2,1rT LEk;5T ZS'_ FIw91 MOvklb• W~tL 4 k ti Al SO" 'a w►~v wLTw A S' l S 71w~'-t ! s R►'t►h6~D ~--UR ra 3 Big-oor'1 ~t~►~c. Zy `rtt tfi~~ . _ qS-303- Z 1`,3 S (715 425-0165 1400576 CST Signature Date Signed Telephone No. CST # x STC-105 SEPTIC TANK MAINTENANCE AGREEMENT ix County St. Cro owNER/BuYER Lwa MAILING ADDRESS uJu.O Jf(a PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CTTY/STATE PROPERTY LOCATION P.'~:>u:) 1/4, Section ZZ. , T Z-?-~ N-R_jj..p_W TOWN OF GT 1 ST. CROIX COUNTY, WI SUBDIVISION N LOT NUMBER CERTIFIED SURVEY MAP % VOLUME _ J 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 tRis 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. ry SIGNEE( Gk DATE: ~I 21Q S,O St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 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 L~Odv S~kl( TCyaf) Location of property 5 l/p~,y ~ 1/4 , Section ZZ- , T Z~ N-Rj(q_W Township-taL L-ZQMailingaddress Address of site, ZOO' PAX, 5LF0Z.9" Subdivision name NI~ Lot no. Other homes on property? Yes__, No Previous owner of property V1Qk3- V. e Ul('_ti Total size of property SO OTC L1 Total size of parcel CLCJ~ Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _~L_No Volume Wj and Page Number _ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING. - A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAQE 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 of~fof the County Register of Deeds as Document No. - idmtr i n tore of licant Co- g PP PP Date of S gnature Date of Signature 539-387 _w.. VOL 1161PAGE 14 FEB 8 1996 WARRANTY DEED it r 10:00 A. ! 4 J IN ~.I ry av3.ncj -U t sufficient consideration, VIOLA R. ROQUETTE, a single woman, does hereby grant and convey with warranty of title, to LINDA STURTEVANT the real estate legally described as: The South One-Half (S 1/2) of the Southwest One-Fourth (SW 1/4) of Section 22, Township 28 North, Range 16 West, St. Croix Coun- ty, Wisconsin. The tax numbers are 008-1064-70 and 008-1064-60. This is not homestead property. T ANSFER $ boo VIOLA R. ROQUE E STATE OF WISCONSIN) ACKNOWLEDGEMENT ST. CROIX COUNTY ) Personally came before me, this 30th day of January, 1996 the above-named VIOLA R. ROQUETTE, to me known to be the person who executed the foregoing instrument, and acknowledged the same. fu Notary Public, Wisconsin. Ja a Terkelsen My co fission expires May 9, 1999 This instrument was dr' fte by Clarence W. Malick, 413 Brookwood Drive, Hudson. JANE TERKELSEN Notary Public State of Wisconsin