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CROIX COUNTY ZONING DEPARTMyiw` ► AS BUILT SANITARY REPORT Owner r e,X sr CFOX'99, Address t a awry *GOFFACE City/State Legal Description: Lot Block Subdivision/CSM # G r C t/4 '/4 /mil', Sec. TAN-R/` W, Town of .g;e- _ PIN # OQ "~06 G SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer Jwes~Pu Size ST/PC 1aeo llAM Setback from: House IV Well /,Vf P/L eo Pump manufacturer .1d 111t s Model ivJic 5 Alarm location Sh o „ 4 (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: 1;1a as Width Length Number of Trenches 1 Setback from: House !Do-'- Well/d'dL P/L 116=A Vent to fresh air intake io/l ELEVATIONS: Description of benchmark Elevation Description of alternate benchmark Elevation 7_ mod, ,46&- 5 e ?G-.,20 Building Sewer-1ko,:~- F1" ST/HT Inlet ST Outlet PC Inlet PC Bottom 73 y~ Header/Manifold ~0 •~!2 Top of ST/PC Manhole Cover Distribution Lines Bottom of System ( ) ~d O ( ) Final Grade O O ( ) Date of installation 9/9/ 9lfPermit number State plan number Plumber's signature Ze'l, aZ icense number -,t? Date 10/17/ 97- Inspector Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW `e ~ vl s o U A co 3 v INDICATE NORTH ARROW a- Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LabIX and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: .GENERAL INFORMATION 262497 Permit Holder's Name: ❑ City [I Village Town of: State Plan ID No.: CST BM Elev.: 7Insp. BM Elev.: BM Description: Parcel Tax No.: /ob l by 7,, 5a "d, TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic OA; d I -boo Benchmark 5 /oS! /e o Dosing , Aeration Bldg. ewer q~p Clq~ $G • a-- 2 9 4'~. Holding TANK SETBACK INFORMATION St/ Ht Vent irnto ke C 0Aerat K TO P / L WELL BLDG. Air it ROAD Dt Inlet c t ~~ti 6S / NA Dt Bottom 67 10. 73 57 g I NA Header / Man. p ion NA Dist. Pip e Z5.77 /D SS- Bot. System 10S_- 21 Holding PUMP / SIPHON INFORMATION Final Grade WAY Manufacturer S Demand &Y.6M - 0 I S(C> 1014 "a•vt Model Number V1507 I'1 ,2-74&PM 4;.-7°1' ~~•~e, TDH Lift31.gS Lrictiorl7a System-7 S TDH~~.sF~ 9M 10j, Ool, 0/$;' 3 9y' Forcemain Length _Va Dia- Dist. To well i&4 V;1 . , J47 ~7 ~3'S~ 8Z • SOI BSORPTION SYSTEM 461► gM B EN :H Width t Length No. Of Trenches !PITI; ( N No.O Pits Inside Dia. Liquid Depth EN I N f DD; Manufa SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI G SETBACK CHAMB odel Numb INFORMATION Type O VA' OR UNIT Sys 6()A DISTRIBUTION SYSTEM Header / Mar<ifold it Distribution Pipe(s) x Hole S it x Hole Spacing Vent To Air Intake Length Dia. Length" Dia. ~ Spacing V4 ScV SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only De th Over xx De 6 T Depth O pth Of xx Seeded/ Sodded xx Mulched Over P Bed /Trench Center '1 Bed / Trench Edges ~cO Topsoil Yes El No Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) ~~5 w eAe- ~ LOCATION: EAU GALLE.23.28.16W, N E, CO RD B 3.? 1 4-1. ✓r17 ! ~~~-C //TT /k e4at no/ v z+ i BS I u'4 il~ ~f'c (~7~ Plan revision required? ❑ Yes VI No Use other side for additional information. Date Inspector's Si atu rt N SBD-6710(R 05/91) ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~aSo 34 70 4,„ pue a ~ 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. r O * X • See reverse side for instructions for completing this application state Sanitary Permit Number 'A~07 211 7 The information you provide may be used by other government agency programs ❑ Check if 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 e-4 S, v4 pie 1/4, S ge T 27 , N, R`9 E (or a Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned 0 !t( Nearest Road ❑ VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town of 'ot- Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) j61- l0 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. (K New . 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _--_____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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation I/0d D Feet O Feet VII. TANK Capacity Site INFORMATION in gallons G otal Ta of Manufacturer's Name cone etc Con- Steel Fiber ass Plastic EAxppepr. New Existin strutted Tanks Tanks Septic Tank or Holding Tank VC la 68 t e_T ~ 1-1 ❑ ❑ 1 1:1 1 1:1 Lift Pump Tank /Siphon Chamber A- I ( ❑ Ij ❑ E] VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature.( o stamps) MPRSW No.: Business Phone Number: Plumber's Address (Street, Clt Stat Zip Code): IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sa (Includes Groundwater at ssue Issui g Agent Signature (No Stan}ps) E] itary Permit Fee Surcharge Fee) Approved E] Owner Given Initial p~ Adverse Determination Cl X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly. One copy To: Safety 8 Buildings Dimsion, Owner, Plumber r s INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever., necessary, usually every 2 to 3 years- 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required 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. • I SAFETY & BUI DIVISION State of Wisconsin Department of Industry, Labor and Human Relatio April 23, 1996 2226 Rose Stre 4- LaCrosse WI " 4-x'03 COI- NTY ~"OWNG OFFICE WEGERER SOIL TESTING 421 N MAIN STREET RIVER FALLS WI 54022 RE: PLAN NUMBER G96-40169 FEE RECEIVED: 80.00 NELSON, BRENT CTH B TOWN OF EAU GALLE COUNTY OF ST CROIX The plans and specifications for this project have been reviewed by the Section of General Plumbing for compliance with the applicable plumbing code requirements. The plans have been stamped "CONDITIONALLY APPROVED." This approval is based on Wisconsin Statutes and the Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. All noted items are required to be corrected. All items required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation is required to keep one set of plans with the department's stamp of approval at the construction site. When inspections can be made, the installer shall notify the appropriate inspector. This approval will expire two years from the approval date. If construction has not commenced prior to the expiration date, new plan approval must be obtained. This approval is for the following: - The installation of the Sanitary Private Interceptor Main Sewer(s). Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sin ly,~ onald Oremus Plan Reviewer Section of General Plumbing, Fire Sprinkler and Licensing (608) 526-4944 CC: KEN PERTZBORN SBDA-7887 (R. 10/84) WEGERER SOIL TESTING and DESIGN SERVICE SOIL TESTING - SEWER SYSTEM DESIGN - MORTGAGE SURVEYS ATTN : DATE CC: '7E f SUBJECT: THE FOLLOWING ITEMS ARE ENCLOSED ' ":il:'7z•.J NO. OF DESCRIPTION COPIES "plu V cj-~) fi4Uuxib Y~:,Lpy~ SENT TO YOU FOR THE FOLLOWING REASONS: '''FOR YOUR USE FOR REVIEW AND COMMENT INFORMATION DESIRED G ~ ~1/~ C IS s c-~~~ LLD ~~Z tSUW rFg T WEGERER SOIL TESTING AND DESIGN SERVICE P.O.BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715-425-0165 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations 9 April 15, 1996 2226 Rose Street La Crosse WI 54F~~ r ~.,a.7a , WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 CT 0 ",vii OUh+1l' RIVER FALLS WI 54022 IVINGo~ricE RE: PLAN S96-40202 FEE RECEIVED: 180. NELSON, BRENT NE,NE,23,28,16W 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 approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section ILHR 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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. SKDA-7997 (K. W94) I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations WEGERER SOIL TESTING Page 2 April 15, 1996 PLAN S96-40202 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown, above. Sincerely, R I _rard M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 SRDA-7987 (R. W94) Page of 6 RECEIVED MOUND SYSTEM APR - 5 1996 FOR A BEDROOM RESIDENCESAFETY & SLf?CS 01V S96-40202 LOCATED IN THE N E 1/4 OF THE N EE 1/4 OF SECTION T '-8 N, R 16 W, TOWN OF Ef~U ~7}L~~ , ST cLZUtX 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 ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR BR.t~1T 1.~C1LSON z t~ 1 S S 't'>t q v , B1~L DLULN Lvj S40 aZ PREPAI= BY ~~~$olaetseeai~i p4(3 WECEFtER O2 ! _ TEST I AND i; I3ES = CN SERA ICE ° R ;1VATE SEWAGE SYSTEW{ ARTHR L. M Y,'FUE^!'R t F.O. 1174 421 K. KAIK ST. Conditionally ELLSF':s. RIVE]? F~LS. ffI 54022 w:s • 715-4~.r-0165 r PPROVED E .a..:.... , qWr. OF INDUSTRY. LAW ~ U E~uCI1oM~ oets~ ION OF SAIT ~ SEE DENCE JOB NO. g 6 - y y ~RGtr Z of 6 c•~ w N ti C~1'P(i~ S R ~3'R't t Z3 'P~.►J 4=02 ~~tE `NOQ`T~N 1~l ~ r~ sty`- - G~v S ~t~ 1.GH W~ ~,p3~' pU~ PIPL ~`-~lwou~ ~-'11'f!1 3u'"1 OF a~ L1L, lOS-b` P loS - Z.o'or4`p~e 0 rfiis appn o dnY plumbiiig tank. See s( Code to dote ? J approval is rep •s, 41p 2 NOTES: ~ 1. Elevations shown are existing grot 2. Install permanent markers at end c- ' 3. Install 4" observation pipes with 4. Septic tank to be 'LOO gallon c 1~'l l p►~l ~s~1Z1V 3T, live 5. Bench Mark SC~~ fovE 6. Divert surface water around mounds Page 3 Of y + Approved Synthetic Covering FIS Distribution Pipe Th') 3 Medium Sand H _ G i Topsoil F Elev. l 5.0 D ` " 3 E b 8 % Slope Bed Of 2 %Z Force Main Plowed Aggregate From Pump Layer D -O Ft. E 1.6y Ft. Cross Section Of A Mound System Using F o-8 Ft. A Bed For The Absorption Area G 1,D Ft. A Ft. H I. S Ft. Linear Loading Rate='1-5 GPD/LN FT B b3 Ft. Design Loading Rate= O•gGPD/SQ FT I )4o Ft. 1 -7 Ft. K 1 L_ Ft. L 8 5 Ft. Df- Ferse l4a - W 3 Ft. Observation Pipe 8 K A I - - - (o ---------------------~1 Force Main M N Distribution \,,'Bed Of 2 - 2 2 Pipe Aggregate I Observation Pipe Permanent Markers (anchor securely) Nci~; wt~vn,,~ ~S c~►.1~-rN~ vPSwP~ PrT 'tti'(~ ~~~`f' ~'D , S nfN- GE Plan View Of Mound Using A Bed For The Absorption Area Page LJ Of Perforated Pipe Detail A3 02 End.View )Perforated End Cop) PVC Pipe Install permanent-marker i • ~c at end of each lateral ~or Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main Q PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I Next To End Cap End Cop P 24.2S Ft. Distribution Pipe. Layout S L/ Ft. X s y_ Inches y S V Inches Hole Diameter I/ Inch Lateral I Inches; Manifold Z- Inches Force Main Z Inches # of holes/pipe 7 Invert Elevation of Laterals N S.-S Ft. k4 = 32.16 GSM ~i Place lst hole Z1 from center of manifold with succeeding holes at S'i% intervals. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTION AND SPECIFICATIOMS ' PAGE C VEUT CAP •~a 0 2 . ti" C.L VEMT PIPt WEATHER PROOF APPROVED LOCKING MANHOLE 10 JUIJCTIOU BOX COVER WITH WARNING LABEL ~ ' FROM ODOR. I2~MIU. WIMIDOW OR FRESH AIR INTAKE I GRADE 18' MIN. COWDUIT-' I- PROVIDE INLET AIRTIGHT SEAL r-F II v APPROVED JOINT/ A Tank construction shall comply I III APPROVED JOINTS with ILHR 83.15 and ILHR 83.20 i `II ALARM b i ~I I I I ON C -f 1 I --CLEV.~1'33FT PUMP-, --J ~ OFF D -1 O • SO COUCKETE -BLOCK APPRWEC, RISER EXIT PERMITTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVALgEDpINQ 5PC CIFICATIOKJS 1 DOSE I-~~~w n rJ PRE>^ sT . OL 3 TANK MAIJUFACTURI`R: NUMBER OF DOSES: PER DAU TANK SIZE: GALLONS DOSE VOLUME Z ALARM MANIUFACTURER: S , L3 ~ M ~t:T 1 S INCLUDING DACKFLOW: 2~ 3 GALLONS . MODEL NUMBER: L ~Aw CAPACITIES: A= 1 6 INCHES OR I GALLONS SWITCH TYPE: ~-AT~LCA.1,;~ Y 5=- Z INCHES OR S Z GQLLOk15 PUMP MANUFACTURER: GOV L Q S V~ LCD 3 , Ltv C. G = I_7,UCHES OR Z 1 3 GALLOM5 MODEL NUMBER: w Er 0 7 N D= `O INCHES OR Z~O GALLONS ~v`~. = \ o I SWITCH TUPE' ~~-Y MOTE: PUMP AMID ALARM ARE TO OE MINIMUM DISCHARGE RATE -1Z''-)b GPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AUD_DISTRIBUTIOM PIPE.. 34. " FEET + MINIMUM NETWORK SUPPLY PRESSURE , 2.50 FEET + '4 ISJ FEET OF FORCE MAIN X I14 FYOfl.FKICTIOLI FACTOR. g .'11 FEET TOTAL D!JUAMIC HEAD = ~S FEET DIAMETER 4 INTERNAL. DIMEUSIOWt OF TAUK: LEMIbTH ;WIDTH ;LIQUID DEPTH 3_ 8 1 Z BOTTOM AREA - - 231= GAL/INCH AS PER MANUFACTURER = Z 6,1D GAL/INCH _ ubme be Effluent Performance Curves PUM S Y P 6 METERS FEET r 90 MODEL 3885 02 25 SIZE 3/4' Solids WE15H 70 Q w = 20 WE10H J H 0 WE07H 15 SAS 4S~ WE05H j 40 10 30 WE03M 3z, b WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L 1 i 1 0 10 20 30 m'/h CAPACITY [gGOULDS PUMPS. INC. SBNEC1 FALLS NEW YLJRIC 13148 METERS FEET 120 MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH 100 30 90 25 80 Q 70 W I 20 J F 60 0 50 WE05HH 15 40 10 30 20 5 1 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I I 1 1 0 10 20 30 m3/h CAPACITY 01985 Goulds Pumps, Inc. Effecbw July. 19a5 C3885 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Labor §nd Human Relations Page_ 1 of . " Division of Safety 8 BtHkfings W in accord with ILHR $3415, Witt tad de < {3 COUNTY ~ 6 Ste. C 62'z e complete site plan on paper not less than 81/2 x 11 inche a+ 6ze Plan st include, 2.0 LK not limited to vertical and horizontal reference point (BM), din n tod % a~f 'scaloL or PARCEL I.D. # dimensioned, north arrow, and location and distance to nears ream. a b a " ) O b APPLICANT INFORMATION-PLEASE PRINT ALL INF ATION REVIEWED BY DATE y~ 1b• PROPERTY OWNER: N T to ~L B(Z1 GN}TSO►~1 % PROBE 1 iq2 : BREIVT )vL1 SON 1/4,S 23T Z'd N,R ) 6 E ( W PROPERTY OWNER':S MAILING ADDRESS f ,LOT BLflCs)( SUBD. NAME OR CSM # 2.111 s S `TI+ Rat; • , CITY, STATE ZIP CODE PHONE NUMBER Y, ILLAGE ®f OWN NEAREST ROAD L3?&K_ L1 J)Aj fN [ S qOo 2 (_)IS) Cat/_ 3i 33 ~~v GPrL~~ C`R1 L3 [JQ New Construction Use [X Residential / Number of bedrooms [ J Addition to existing building [ } Replacement [ J Public or commercial describe Code derived daily flow 60o gpd Recommended design loading rate o y bed, gpd/ft2 trench, gpd/ft2 Absorption area required Soo bed, ft2 Soo trench, ft2 Mabmum design loading rate o - 5 bed, gpd/ft2 trench, gpdtft2 Recommended infiltration surface elevation(s) 1 5 t ft (as referred to site plan benchmark) Additional design / site considerations hov~r.~p wl g' Y- (a 3 ' ~3 IEZ Parent material s ~ 4 S C ` TZ Flood plain elevation, if applicable N - PS, It S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S OU 0S ❑U ❑S ®U ❑S ®U ❑S ®U ❑S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench :ti.l'.r ~ 0-8 tO~t1Z- 313 - S i) Z-'FSb1n; w~'F~. CS o, S o.~, -Sii\4i[vs'-~ Z g~ts ~o4~L Uly si I Zvn sbk mv'Fh cs - o-S 0•6 Ground 3 15 --?-b ~u `-'11Z 3 ( ~ - s Zwt S b k vvt'~1~ ~S V O - S o . elev. cy, 019-sft. y Z$-so ~•S-I \Zviy ~`.SYR S/g sc 1 lc sb>T ►N►`Fi - - Depth to limiting fact z Remarks: Boring # cS o.S 10 • Z;~ Z g_zo to~R. y/y _ S ! I Z►+1 s bk m v fit- cs - o. s `v- 6 v. 3 zo-32 IuyQ 31L - SI Zwtsblt Vq ~I- cs Ground elev. 3 Z -S~ • S `f 2 y/ y re sag Sal l c_ 5 b k we T I - - Depth to limiting factor Remarks: CST Name:-Please Print Arthur L. We erer Phone- 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: S - 3 S S Date:-~ jq. t 1495 CSTNumM005 76 R PROPERTY Bv~ OWNER SOIL DESCRIPTION REPORT Page Z*.bf~ PARCEL I.D. fl 0 08 - l U 66 - 10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends K. 0-8 lo`~tR 313 - S11 Z'FSd CS - o.S o-L 4:;< 4:.>:r 2 8- 9 10 v 0 / s I Z w, s 1~4~ m v-F~. S (I'S O'6 Li P- y Ground 3 19-29 IQ`t(231L - S~ Z*13 D.S 0.6 elev. Cv. vo~ft. 09-V 7-S` D-VI ~;.syR s/ Sc.l ~C- Sblc Depth to limiting factor ,r Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor i LL Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SRn-Aiin(R n5/o91 PLOT PLAN page 3 of 3_; SCALE 1"= 3p ' 2 So'f- ~O SOT C.~►-1P1~-c-T , v2 Ors?v~Zp °t50: `C~t ► s ►~-ti.~q t~1Op - - t*La95 d}~lv t3.3 E3- t Z $ ' 131'1 _ \\)(3.0, dtv S HIGn~ /N Sly DIH. AUC 1°ip~ ~ / w/~voo~ L►~Tff, j i I J B•Z ~2 --L Los 7 0- 01 /OS I ~AWQ SE lU 8E AT L"ST Z S' N=-11011 M OuKib wtL Soy _ 2 FC'1! e(r _ !v sT f_tti t= o 14Qi ) Re Pfn- ceL lC) lg9S (715 ) 475-07 6S M00576 CST Signature Date Signed Telephone No. CST # Vfimcoppft Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1. of - 3 Labor and Human Relations Division of Safety 5 Buik4ngs in accord with ILHR 83.05, Ws. Adm. Code COUNTY Attach complete site on ST' C VZ13 Lx plan paper not less than 812 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. b 5 - ) 0 6 - I APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTYOWNER: 1\36TZAN RL %R.1 G1i'rSWj PROPERTY LOCATION '16RIEMT tiLl. S0t'j -GeW.-I=6T I3F 1/4 N r; 1/4,S 2.3 T N,R S 6 E ( W PROPERTY OWNE S S ILING ADDRESS LOT # JBLOCK# SUBD. NAME OR CSM # Avg. _ _ CITY, STATE ZIP CODE PHONE NUMBER EICITY 13VILLAGE ®fOWN NEAREST ROAD ai4 t-bl,'Jw, W( sqoo2 rm) cay-3033 ~~v Gf'rl.l~ C'r T3 ('Q New Construction Use [N Residential / Number of bedrooms `4 [ J Addition to existing building [ ] Replacement [ J Public or commercial describe Code derived daily flow 6(-10 gpd Recommended design loading rate o - y bed, gpd/ft2 trench, gpolft2 Absorption area required Soo bed, ft2 S ~o trench, ft2 Wdmum design loading rate D S bed, gpd/ft2 0- trench, gpdtft2 Recommended infiltration surface elevation(s) )'3 -S - O t ft (as referred to site plan benchmark) Additional design/ site considerations t-%OVwp wJ 'B' y- b3 ' 9 tS~) Parent material Flood plain elevation, if applicable N 10S, ft S = Suitable for System CONV900NAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 11 S ® U 0S D U ❑ S NU ❑ S ®U O S ®U D S C~ U F I' j SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch <xz 0-8 5O`tli 313 S l) z- F 5bVt rvt F~. CS o. S o.b k mv'('h cs o•s o.b Ground 3 1S-z8 ~u`t~Z3I(, - sl Z Sbk m'~L. cs O.5 0.l, elev. C'k 019-SfL y z~-so ~•S`t\zV/y ~t.Sy2 S/E, se-1 lc sbk wl Depth to limiting - h factoj[ M Remarks: Boring # s b h m c S _ o .5 0. b ? Z S-ZO )Qm1Z. VIy s! I Zt►t sbk rv,v'FI- es - o s o 6 3 Z0 -32 10`1SZ 3JL - S~ Zmsbh cS - o-S o-~ Ground elev. 32-sy • S `f 2 Yl s y I2 S/8 S 1 \ c Sb k vvt ; Depth to limiting factor T_ __T_T Remarks: CST 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: Date_ CST Number: 9 S- 3 S S L>E, lq., 1995 M00576 Bv~-tom. ~,spN PROPERTYOYW+fEfl SOIL DESCRIPTION REPORT Page? of PARCEL I.D. # 008 -10 66 - 10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& 0-8 10`~lR X13 - Sly Z'FSd M CS o•S o-L 3 ~t s~ Zwi M's cS 6's o-b Z $ 9 10Li R. y( l ~ T v`Fh ~M CS O•S o•6 Ground 3 19-29 Ill `1231` - S~ Zw1S~1z w elev. 7.S`1RyI ~•SyR sJ Sc~ ~cSbk w~ goo att. Z9-y Depth to limiting factor 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: can nglinlP n5lo9) 3 PLOT PLAN Page 3 of SCALE 1"= 30 ' 2So`+ ~o ~ipT Cu►-~p~c~- U2 DLSTv~2a °t so `C~t t S t~-~~..~q t3tlOp - - - E'Lq i w . 0, d S N t G t}, N / v 3Iy N DIH• 1~UC 1~)pL ' ~ w/~v o oD L t~Tt~ , r B Z°~ t'2 8 '~:L Los 4 "7 40USE LF4ST ZS' Fit0i MOukib 1- o Fcv e~~ _ ~scL? 5T L►ti t: ot= 14o rmal2-C P41-t2CLJL 9 S- 3 S S (715 425-0165 M00576 CST Signature Date Signed Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER > MAILING ADDRESS PROPERTY ADDRESS /Y (location of septic system) Please obtain from the Planning Dept. CITY/STATE 0 v'`~ PROPERTY LOCATION Vt'_ 1/4, Alh~'_ 1/4, Section 0 3 T a S' N-RAG W GJ TOWN OF 4!~FF'AI-'- C'Q el-4-- ST. CROIX COUNTY, WI SUBDIVISION A010 4 41 LOT NUMBER /~JJ 0-C~r'e 7 CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year date. SIG D: DATE: t5 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER1 y` G .-rT-d.. y iv ~~~.I O i✓ ADDRESS:- ry • FIRE NO: LOCATION: A!!~_ 1/4, N 1/4, SEC. T .2J- N-R W, 7- TOWN OF:. ✓ C..4 ST. CROIX COUNTY Ve- T SUBDIVISION: LOT NO. Nam-~-~ 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 a 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office 911 4th St. " Hudson, WI 54016 i State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED 1 REGISIEKS 0EI'V* '0 _ DOCUMENT NO. VOI_ .1157PAGr -.5 ST CR I,{ CO ~ 0 Rodd for Record Nora Albrightson JAN 9 1996 9:30 A. conveys and warrants to Brent T. Nelson and Lynn M. Nelson, _ lt?t 'l turof GLUC a husband and wife as survivorship marital property i~ 00 10 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETU N ADDRESS I the following described real estate in St. Croix County, State of Wisconsin: II (Parcel Identification Number) 11 Northeast Quarter of Northeast Quarter (NE 1/4 of NE 1/4) of Section Twenty Three (23), li Township Twenty Eight (28) North, Range Sixteen (16) West, Town of Eau Galle. i I,I Subject to land used for highway purposes described in Volume 548, page 324, as document number 337788. li ~ T ~~IER r i i FEE I ~ This is riot homestead property. (brX (is not) +n L sP Exception to warranties: easements, restrictions and rights of way of record, if any. 8th day of January '19 96 Dated this (SEAL) (SEAL) Nora Albrightson (SEAL) (SEAL) • r AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Nora Albrightson STATE OF WISCONSIN SS. I{ T r County. 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