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HomeMy WebLinkAbout008-1078-50-000 Q c O b p 69 I a c 4, 0. 0 ~ I r ~ © x © ~ I n ~ ry c 7 E U C V N = O c N 0 Z o c U 7 O LL c c O (O O U I 3 r> v ~ I (O W C Z O L Z 3 m 00 4) 04 z l a co N v° U o z ? Z U y o I N H N z E `o Cl) E `o a~ I • }y N N p c_ 0 Q Q w O Z Z E z LO _0 N of ° H N "".4 L4 CD CL C14 rL (D E :z E .-N LO cca` 0 c> Z > F- N I- O O O z ° • N~N = a a a I ►i EL g o N °o W (o to J v 0) m } ~V o U) (o ~ _ E L o o c ~ I p i°n -o C0 a~ N d Q } V1 N O ~y o Cc) m 3 a o c c E N V) M LL N a s n- O O p N N O 1 O U O S O O e O (0 2 a s L -p r N N U H F- N ■"i O' N 7 i ~ N z s U) E E U co C: • O N W Q N O N R3 O Y a.+ c r v ~ E y I dt o m a IL r rr~~ `~1 A 0 IL o in Ci M STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM9 LOT e~aaee%~~ S ECTI ON,,AJW _T gFE _N-RZw-"_W , Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~Qp 2 e Aa -f.) v INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tan}; manhole cover. BENCHMARK: Ce Gn -e Q / ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: leo5rd Setback from: Well,&M_House 2' Other Pump: Manufacturer-:;'A Ch e y Model#_ Size Float seperation Gallons/cycle: Alarm Location 'c 6' Spa :SOIL ABSORPTION SYSTEM Width: Length Number of trenches 2, Distance & Direction to nearest prop. line:_ f6Q ` Setback from: well: House 0e)4 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: 3 INSPECTOR: '?f 3/93 : j't Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ST. CROIX Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262498 Pe~rp'JF 2, der& e_ ,ARRIN ❑ City ❑ Village [ Town of: State Plan ID No.: r✓ AAIIVVUU~~;KKSS l1VV EAU G LE //t CST BM Elev.: Insp. BM Elev.: 7 BM Description: / n Parcel Tax No.:< , d10 /00 C6 6a ~^Q O' ~"~~'t /"&1_1 A9600157 2/ - TANK INFORMATION ELEVATION DATA 7// ~ 9 c' TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1,17 Dosing Aera Bldg. Sewer Holdin St/ inlet TANK SETBACK INFORMATION St/ y~f Outlet TANK TO' P/ L WELL BLDG. Ae Intake ROAD Dt Inlet Septic > SD NA Dt Bottom Dosing NA F# lgadei- Man. Zell, 3 Aeration NA Dist. Pipe Holding Bot. System V5 0 T i PUMP /INFORMATION Final Grade Manufacturer y,- Demand <`,y, SL Q6 9~,~~ Model Number ' 4S GPM UJI c1 kd TDH Lift 16~?' Lrioss ctionl Syetem , TDH ~q,34Ft Forcemai n Length/~, Dia. HH Dist. To Well > SD SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1-17 DiME(aSl SYSTEM TO P / L BLDG WELL LAKE/STREAM L Man SETBACK R INFORMATION Type Of n~ CH ModelNumb,-T.- >50 System: !s%~„_d t "`/6 /I RUNIT DISTRIBUTION SYSTEM Header / M'a/nifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length c~ `t r Dia. Length -7 Dia. Spacing , 14 ,P r/ SCE SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLS 27.28.16W, NE, SE, 250TH ~~~r'tc..s.._ ~`h..lrr'! ~y~- ~fLt''e" ~~'~'t....l..r~-•....v'Ci/ Plan revision required? ❑ Yes Koq`o Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E r Safety and Buildings Division ~~■~r■r. SANITARY PERMIT APPLICATION BureauofBuildingWater System, 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 8112 x 11 inches in size. 5t... C/'-o/ • See reverse side for instructions for completing this application State Sanitary Perm/it Number The information you provide may be used by other government agency programs ❑ Check iI';vlkib 9.jv ous(appli~at' [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location vs e1/4 114,8 7 Ta17 ,N,% E(or Property Owner's Mailing Address Lot Number Block Number / F,4 7-4 City, State Zip Code Phone Number Subdivision Name or CSM Number < ( ) v d t r-eY57.?3 II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms 6X Town OF O 6,2,11 ~75-6 7`4 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo D o r 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. WLNew 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 [kMound 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 ) d, r7~5_ t~Q c 2 t~-- 7 Feet 42, Feet VII. TANK Capacity in gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ~Q~ p~ T@I^✓ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber G~irt~j0 ` ¢S 7"BY~ ET ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt Sig ature (No Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination r CONDITIONS APPR VA LOR NS FOR DISAPPROVAL* c~ C 4 L/ 6e 610 SBD-6398 (R. 05/94) 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. I 11. 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 al] 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 specifications not smaller than 8 1/2 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. SAF & BUILWGS DIV 1 C; fy. 4i J State of Wisconsin elation ` I Department of Industry, Labor and Human Relation'-- April 30, 1996 2226 Rose Street La Crosse WI 54603''_' ` WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN 596-40307 FEE RECEIVED: 180.00 ANDERSON, FARRIN NE,SE,27,28,16W 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, and M. Swim Plan Reviewer Section of Private Sewage (608) 785-9348 SHDA-7997 (R. 10/84) Page of 6 MOUND SYSTEM S96--40307 FOR A 3 BEDROOM RESIDENCE LOCATED IN THE NE 1/4 OF THE SE 1/4 OF SECTION -n ,T ZB N, R 1 6 W, TOWN OF G ` Gt~LL'C 41 ST- C\Z01~C 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 w Z, S-) / 8 4 0 T)+ I°)- u E, SpZ!>~G va~~~f, wJ s~1~67 PREPARED BY WEGEE;tEF-Z Si7 I L TEST 2 NG e~®~Q AND . ell WSZCN SIEE~VIGE $ ..1., G 5 ~E P.0- B0I 74 421 N. MIN ST_ • ~ ARTHUR R pA~VP onally RIVED FALLS. VI 54022 4lb = EL~1, F 4 R?H, ltt 715-4ri -01 s ; _ wts. Cott( V ~ V .mss .•.a ..N., REV► ~I ~SIGO ~~~p~l ~ %Dgsvj j, pA0 ap1►A of ~ Z6- ~ 6 N SpONp~~yGE . SEE C'O I JOB NO. PLOT PLAN Page Z- of Scale 9oT~D►•1 OF S L'~. ~ • lOU ~ I I rMl I agS4 i z°lo I ~ u ti oT eo►~t. P 1}t~' ~ ~ I ~ ~\s'w\1 69' ~ i I I ( 69' ~ ~ ~ MAR -~L~ I III t 1 1 1 25' O ~ 121 U3L. loo. o' OU 0% l6N 3/V4 01R. l'uC P1PIZ V-,)/ kjou'h Lttl'tl °l0~ OF Z l'p j Fo~CE v-1 Pis Iv P S l0 OF 14 PUC LuCR'nu~l S 1~'TCN 3 ~ p X P~POSI~~ N~j S 1`t•~ 00 N~TlI HRIl~W 1 7 %t o' oM mOvwp ti~~rsr 1,t~1E of 1 U.63 PA->Z.c~: 1 s _ _ _ > loo' Mov►v4 ~p Tw MwE . I NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. required) 3. Install 4" observation pipes with approved caps. (-cam required) 4. Septic tank to be \w3 I6SO gallon capacity manufactured by ~ L~w~sT~Z►J PAZ-~~tsr. ~~v e . 5. Bench Mark ST~_ 1 Wie 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 0f Approved Synthetic Covering ~s~r~t C 3 Distribution Pipe Medium Sand Topsoil F Elev. 1Oa.-7 D + E 3 Z% Slope Trench Of 11"-:2-1" F Main Plowed From Pump Layer Aggregate Undisturbed D 1-0 Ft. Soil E ~ •`4g Ft. Cross Section Of A Mound System Using F o• 8 Ft. 2 Trenches For The Absorption Area G l- o Ft. A .Y_ Ft. H I. S Ft. B _-7 Ft. C ?JJ Ft. Linear Loading Rate= LV9GPD/LN FT I l~ Ft. Design Loading Rate= 0-zy GPD/SQ FT i S Ft. K Ft. L Ft. W 48 Ft. B K A ` bservation Permanent C Pipes - ti--Markers (Anchor securely) FOrce~ _._______________--_1__ L- - - - - - - - - -j Main W Distribution Trench Of 2 - 2 z Pipe Aggregate I Mound Using 2 Trenches For Absorption Area Page Ofb Perforoted Pipe Detail 0 End View Perforated End Cap) ~e . PVC Pipe Install permanent marker t ~ot~OS°o°` at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S~ PVC Force Main P PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I Next To End Cap End Cop P Z Z Ft. Distribution Pipe Layout S Z ~ Ft. X Ll $ Inches Y 413 Inches Hole Diameter Y Inch Lateral Inch(es) Manifold Z Inches Force Main Inches # of holes/pipe b Invert Elevation of Laterals L 01- Ft. C~ x 1.11 = 1.0 Z• x. Z8- b ~ G p y.-) tt Place lst hole Z~ from center of manifold with succeeding holes at ya4 intervals. Last hole to be next to the end cap. Combination Sep.tic;Tank and PUMP CHAMBER CROSS SECTION AKID SPECIFICATIONS' PAGE S OF -VENT CAP WEATHER PKOOF JUUCTIOM 60X 4"C.I. VENT PIPE APPROVED LOCKIAIG 10' FROM DOOR, MAWHOLE COVER k4jil" •.JiuDOW OR FRESH WARNING L.f4gEL A.(K INTAKE S Coubu1T rI ~ I ~I' MIN. El- ~r3r~) t: ORA06 I lo'Mlu. PROVIDE I IAILET 7AIRTI&MT SEAL I III . I III ~AF~'`~S t I APPROVED .IOWTS APPROVED JOIiuT A I I W/C.I. PIPE';xPL'C- W/C.I. PIPE tIZ Tank construction I II ALARM shall comply with I II 10 ILHR 83.15 and 83.20 d t I I I oN C 8~,$3 I LILLY. FT. PUMP-1 ~ OFF D CONCRETE_- 88- 00 I DLOCK - 3" APPRave~ RISER EXIT PERMi1fED ONLU; IF TANK MAIUFACTURER HAS SUCH APPROVAL gEDfl1 SPC C,IFICATIOkJS SEPTIC f DOSE MAIJUFACTUILCR: Mtt!-01T~ P NuMDER OF DOSES: PER DAy TANK SIZC' 1o0O ! LSO GALLONS DOSE VOLUME x \ ~l,~ZRcp S`is'Tt l S INCLUDIIUb 5ACKfLOW: 1 GALLONS ALARM MANUFACTURER: S.S• MODEL NUMBER: CAPACITICS: A= IMCHES OF. 3Ok-' GALLOUs SWITCH TyVC: ~1 ~1Z y 8= Z INCHES°OR 3y G%kLLON5 PUMP MANUFACTURER: ZO~L~IZ L°s'1PIt1V`-/ C:-~-INCHES OR X36 CALLOUS MODEL NUMDEA: ~g D~ 1 INCHES OR V3 GALLONS 1v'tvh. b y, ~ SWITCH TYPE: M`~ cUR-I•f MOTE: PUMP AND ALARM ARE TO DE Zca O`~ MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS \ Z . 37 VERTICAL DIFFERENCE DETWEEU PUMP OFf AUD_DISTRIBUTIOU PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . 2-50 FEET LIo FEET OF FORCE MAIN X F~oFCFRIC71oN FACTOR.. 1'~S FEET t . = TOTAL O4UXMIC. HEAD = 6 Z FEET - DIAMETER 1 4 Pump chamber IIJTERAIAt- DIMLIJSIOIJ~ OF TANK: LENGTH =.._;WIDTH --=..;LIQUID DEPTH BOTTOM AREA 231 GAL/INCH AS PER MANUFACTURER = 1-1 D GAL/INCH y' pp-, 6E or W • 17x~ HEAD CAPACITY CURVE 3 7/86 1/4 MODEL "98" 30 4 5/8 8 6 2 I 3 5/8 6 20 + + U O !6 3 15 4 3/16 o 4 O t0 Z 1 .O$ 1 1/2-11 1/2 NPT 2 5- 0 1 50 60 70 80 U.S. GALLONS 10 20 30 40 LITERS 80 160 240 0 FLOW PER MINUTE I TOTAL DYNAWC HFADIMOW PER VDAM EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITSIMIN 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 r•• 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 aternators, 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. - '/zH.P. 2- Single piggyback mercury float switch adouble piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. MN90 Volts-Ph Mode Am SimpWx Duplex 3. Mechanical alternator 10-0072 or 10.0075. 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM071Z for correct model of Electrical Armor. "E-Pak". 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 230 1 Auto 4.5 1 or 1 & 7 dtuplex (3) or (4) float system. 6. Four (4) hole °J-Pak'•. junction box, for watertight connection or wired4n sim- 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plea or duplex operation. 10-0002. 7. Two (2) hale "J-Pak". for watertight connection or splice. CAUTION For Wonnalkin on additional Zoeller products refer to ce" on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a qua6- Piggyback Mercury Switches, FMO477; Electrical Aftemator. FM0486; Mechanical Alletnstor, Pied licensed electrician. All electrical and safety codes should be followed includ- FM0495; Alarm Package, FM0513; Sump/Sewage Basins. FM0487; and Simplex Control Sox, ing the most recent National Electric Code (NEC) and the Occupational Safety and FM07W- Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. Z MAJL TO. P.O. i=18347 Lome, KY 402564347 Manufacturers of... SW TO: 3200 Old 110m o Of~<'M 0. Loubillille, KY 40218 'Qa~urrBPS SIA14F /9~9„ ® (502) 778-27310 1(800) 928-PUMP FAX (502) 774-3624 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 jabot and Human Relations Oiwsion of Safbty & Buildings in acc 3.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less th @ x 1l inches in si ust include, but not limited to vertical and horizontal referent (BM),r aq% scale or PARCEL I.D. # dimensioned, north arrow, and location and a to lgre~st~ APPLICANT INFORMATION-PLEAS @I NT AI~FOR ON REVIEWED BY DATE PROPERTY OWNER: tv~nL BiLtr RTYLOCATION e-j F r`'1 v~ '`~S )Jr 1/4 S~ 1/4,S Z:-) T Z-8 N,R l 6 E ( W PROPERTY OWNER':S MAILING ADDRESS # BLOCK # SUBD. NAME OR CSM # 22.88 Taftkwopb - - CITY, STATE ZIP CODE PH []CITY []VILLAGE [.jfOWN NEAREST ROAD "f6z~'c u~~ I MN Ss1 V3 (LIZ) ~~fcv Gk" . Z s 6 ` w ST. [~Q New Construction Use [,cJ Residential / Number of bedrooms 3 Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 4.S 0 gpd Recommended design loading rate - bed, gpd12 A Z trench, gWt2 Absorption area required 31 S bed, ft2 _'ZS trench, ft2 Mabmum design loading rate 0- Z bed, gpd/ft2 0 trench, gpd/ft2 Recommended infiltration surface elevation(s) ~Ob • 1 ft (as referred to site plan benchmark) Additional design / site considerations VnVa",~, col Z `M&vt tf-%,rS _ L' fC_t;t y *K 14`1 ' Lwv 6. M-i 11U, 1 'o v= s h4_4" Fr Lt. Parent material Lu ez s ou kEg l1 t. t. Flood plain elevation, if applicable - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN ALL HOLDING TANK U= Unsuitable fors stem ❑ S E) U ®S ❑ U 1:1 S ® U El S [R U El S El U ❑ S [$U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends o-S `o~R z!Z - sit Z~sb~Z w,`F~ S Z S-1~ 1u~R4/!3 - St1 Z`~Sbk wtt. CS S Ground 3 16 -21 U3`1 IZ v/(. - c L% b k wt'~k C S o. Z U. 3 R9 L ft 2--)-4S lb`iIZ4z/6 c S LINI-VIL e. oY" yo j~. - - Depth to limiting factor-, Remarks: Boring # au 2 1pyR. V13 - s t 1 Z~S~k wt~h ~S o.s 0J. cS ~ v~ Z ~ 3 i 3 1~-z6 1 u~ R tiA - c ~ VVI m `FV Ground elev. Z6 9l 10`1 R Y/6 cZS y2 yob C v►-~ `~1- - - - 99--) ft. i Depth to i limiting l factor Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165 egerer Soi Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number. ' i 01 S-u0 19 Ts M00576 PROPERTYOWNER•- SOIL DESCRIPTION REPORT Page?- of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Gu. Sz. Cont i(.4or Gr. Sz. Sh. Bed Trench .:<n: o - b do ~-t ~Z z L 2. - S 2 3 bk v-, c, g - Fs- S c,. L 21 A~-t Ground 3 Zll 3S ~O`~tZ v16 wx 3~1Z vv,` - CS p.Z °•3 elev. 01 ft. y 3S•-*4 S lp Ii {t q/f. cZPS`l R YIL Depth to limiting fact S h I Remarks: Boring # u h; ~Y'•K Ground elev, ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # I Ground elev. ft. Depth to limiting factor Remarks: PLOT-PLAN Page 3 of SCALE 1"= -331 c.'l. w. lou ~ V a l `a1, OLq I----- z S - 3 I I 1 I a q13 4 z°1o ' 13.2 I I I I u tioT 0-0v"1.DItiT 0 t i 11 I bq, ~ `s'tv\t 1 6q• I !I 1 1 f 1 2S' a•1 r1. R4 6 o , 3114" \ 6 - V - PIPft w/ wooO Lent NkoUSIC_M tE f LoT Z S'. F=-94".. P-it)vkN I LuCtu>J S1zTCN JC f ` \ F J0 r'C~O ~Qf V~ e, N<Tll. ARLTT1Ya~ cn I N 1. _ C2~z q s - ~t L, Lq is (715 ) 42.5-0165 M00576 CST Signature Date Signed Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /A . A ~ -e J MAILING ADDRESS W a S :2,$ SgD ti S , t 11-~ ✓ w S PROPERTY ADDRESS 13 a S> " S>(W a I I< w l^ '5-9 n a 8 (location of septic system) Please obtain from the Planning Dept. CITY/STATE LV o„ l u; l l z w r. PROPERTY LOCATION _ 1/4, A0- 1/4, Section ) `7 T a 8 N-R / 6 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION S / LOT NUMBER t CERTIFIED SURVEY MAP ~3s--7OLUME Z, PAGE ddS, 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: L . C(_~ DATE: 3 - P51 r b St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property_ &111 r , h L . c, n a /y, zif A A °cs , Location of property jE 1/4 k' L 1/4, Section -.)1 , TAN-R / b W Township G~.II-c_ Mailing address Lo `/76 7 Address of site ) 3 LI SC) Sf. wo ~A SLl 03 8 Subdivision name ,10 V i;- Lot no. t Other homes on property? Yes_,y No Previous owner of property.{ pr; ~~o Total size of property _ /1 Total size of parcel /6, 13 Date parcel was created 0 I ,(d b er f / y 5~'S" Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes) No Volume /170 and Page Number /yl as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S9jkgy , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. 591694 /A~IL/WI t lam(/;~~a a_Signature of Applicant Co-Applicant s_ Al _ J9911 1~ - a3- I ~ Date of Signature Date of Signature 8 FILED ~ 535723 Noy' 0 1 1995 ► _ L KATHLEEN H. WALSH Repistef of beds SL Cfoix Co., M CERTIFIED SURVEY MAP LOCATED IN THE NE 1/4 OF THE SE 1/4 AND IN THE SE 1/4 OF THE SE 1/4 OF SECTION 27, T28N, R16W, TOWN OF EAU GALLE, ST.CROIX COUNTY, W1. PREPARED FOR: NEAL BRITTON ff NOTE; BEARINGS ARE REFERENCED TO THE EAST LINE OF THE SE 1-'4. E 114 CORNER OF SEC. (ASSUMED). 27 (COUNTY MONUMENT FOUND). ilul s ti - - ;~JNPLATTED„LANDS WEST LINE NE-SE to EAST LINE SE 114 0 N 89°37' 52"E 1327. 59' 1294.55' : 33.04' O HIGHWAY SETBACK 100' 33 33' N L 1 NE ch ~I~ m w n' LOT I o yl a 16.63 ACRES I w (724,494 SO. FT.) N 89-36'40"E 424. 64 ' 6 rol I. 40 AC. EXC. ROAD R. 0. W. 391. 60' ; 33. 04' (714,290 SO. FT.) Z LOT 2 o y mI w 3.79 ACRES ro (165,189 SO. FT.) w w _ 3. 47 AC. EXC. R. 0. W. rol cn - GARAGE ~ r'I DRIVES - N A ~ Li 900.29' 212. 36' HOUSE S 89036'40"W 1112.65' 33. 04 N 03021 ' 15" W 1 x9.24' 80. 1 I ' 212.28' 3 WEST LINE SE-SE UNPLATTED„ LANDS s ss°3s' 4o•w r . N, O I SE CORNER OF SEC. 27. _I z (COUNTY MONUMENT FOUND)-~ ai~q®1401/900►~OI O SET X 24" IRON PIPE WEIGHING 1. 13 LBS~0~`So~~~dp PER LINEAR FOOT. u f n A ' SI \rF B \R OF N IS( ONSI. FORA I 19K2 WARRANTY DEED r,. ` !-',,'C UtitENT Nt: MOW: 1.91 C ' Cr .OIX CTY' This Dised, ho,w,n Neil Britton, a single APR 4 1996 person 9:35 a• tnd Farrin L. Anderson and Carla M. Anderson, husband and wife as survivorship marital property Witnesseth. I hat the .aid ranter, for a yaluahle eom;deraiwn nr E. coney, to Gra,.!ee the following de%crihed real e,tate ut St. Croix Ct .!nt%. State of Wisconsin: Lot One (1 ) of Certified Survey Map dated October 16, 1995, revised October 26, 1995 and recorded November 1, 1995 in Vol. 11 , page 3005, as Document #535723, located in the NE4 of the SE,i, and in the SEk of the SE=, of 008-1078-50 Section 27, Townsnip 28 North, Range 16 West. (parcel Identification Numlxn S T A~~O~'~Fi 4 g This --is nOt_ homestead properly. s (is) (is nut) rogether with all and singular the hereditament.s and appurtenances theret:ntu Nlonging: a. And Grantor warrants that the title is Rood. indefeasible in fee simple and free and clear of encurc!•rances except all easements, restrictions and rights of way of record. s' and will warrant and defend +he same. Dated this 29 day of March 19 96 . (SEAL) (SEAL) ` ' r ~_SVeil Grf tOn (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signaturetsl STA7E (iF %k ISC•ONSIN a s. oil - - Dunn County. e% , authenticated this day of F t _ . 19 Pc.--.:riiy came before me ..his 29 day of March . 19 96 the ahocC named ~ - - - Neil Britton, a single person hITLE: MEMBER STATE HAR OF WISCONSiN (If not, _ authorind b} §70606. Wis. Stats.) ne iLn-n to he the person who C.cCCUtec the 7 ~umegt anal: Ikn w4'd1_1e the name. THIS INSTRUMENT WAS DRAFTED BY