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HomeMy WebLinkAbout010-1006-20-000 I Gn, o o c Q` O r N 0 N U r\ O. r E 0 a, C O U') O C O C) 0 E N L LL V c z m LL c ~ o 0-O 3 C Q ~ ° I I Z E U) « O Z a y N F U) a m O N O 2 v N' O CD 2 c fn F- ~ w N Z - E 'o o v Cl) E ~ "v • N N N p N © 2 z z O w N a c N £ N rn m O N N N d C w w LO N y d J o O m O O D a a t N LO E co > T H F- H 3 T p a O O O z O ►rN.~ p a a a ip c o N o o N U rn rn } Z: Z: LO =3 (D o o o > o o M c Q ) N d V O N N s 00 C N O C E a> co -C U . O C m ns CL 0) OO O G O Q O O N O Q N (6 co C 0 F- a 'o = c E a~ CO m I w O Q n L '0 0 O N N O N O N E M 0 N m E L. O O W Y N O N ® ~ I ~ - E m xt c `m a • ce CL a, .2 `m EH 115 .-~33 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 /~y V REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION:'-sue, $Q1., Section -Z , T,3PN, RIto E (or oTownship or Municipality P/, d f, "m~ Lot No. , Block No. Subdivision Name County 4 S TiffAe ' Owner's Name: Mailing Address: t TYPE OF OCCUPANCY: Residence- No. of Bedrooms -lop, Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS 1 SOIL MAP SHEET SOIL TYPE SAW AP PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P r P- P_ j SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) 2 A#javzx.-~O. 1 ,td a 4110 ;ZP b s -34 PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) X c Y Indicate on the plan the location and square fee of ita (e Jas. Indicate ymbe of uare feet of absorption area needed for building type and occupancy. ~t W Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 0' acts 1 40 1V - r4 Fowl "I 5 t N 411 ~S ~ "q . O' ~ 4 ~.t._ ~ . , . - - v t_...... _ - a 'i~ j; a r ~ idiJ ~ j • - - ~ 3 1. , .a d> . s` r ~ > i _ 8 'r d tEm CERTIFIED SURVEY N0. 352 Part of the SE'4 of the SW'-4 of Section 2, T30N, R16W, Town ',901 Dy County of St. Croix, State of Wisconsin. YOR' R.ECoRD ma 8 = N Ox Q Z' 66 ° co F L E I7 -0 g I UNPLATTE D LANDS MAR ,2 1 _ • pft 0, z z I: 3 „Ob ,55 o20 S col*wl o Air N p r° m I• ft cook A o 1S oftb, o r _t&' 0 a _ Z X I v0' on, C N N oA m z I A rn • Z O N Z • g p M Z f ) I ww r rn 0 w \NI w io• O nm N .D;D :Z- n il 0) ~ ° N ~ A ( MO . -4 u i m o V'~ o 0' m•a -1 • C~ '1 aFl• tiT Zo m o my l m N 0 Z- . 0 y po ~Tl t n O d O. • p~ 6'-'Z6£ M Ob N EAST LINE OF SW I/4, SEC. 2 BRG. REF. TO THE WEST LINE OF LOT 1. ASSU%k BRG. S 020 55'40 W' 16, 6' I UNPLATTED LANDS 0 mIOD o xo y N. Z AN 010 • m I, Leon R. Herrick, Registered Land Surveyor, hereby certify: That I-have surveyed, divided, and mapped a part of the SEq of the SW-14 of Section 2,• T30N, R1664, Town of Emerald, County of St. Croix, State of Wisconsin, more particularly described as follows: Commencing at the South 4 corner of said Section 2; Thence West 15.02 feet; Thence 11 02° 55' 40" W 33.04 feet to the point of beginning. Thence continuing N 02° 55' 40" W 392.79 feet; Thence West 358.50 feet; Thence S 02° 55' 40" E 392.79 feet; Thence East 358.50 feet to the point of beginning. Said parcel contains 140,631 square feet more or less (3.23 acres That I have made such survey, land division, and plat by the direction of Jerome Johnson. That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutes, and the subdivision regulations of the County of St. Croix and the Town STC - 104 AS BUILTI NITARY SYSTEM REPORT OWNER ?dG p ADDRESS © tr 42 SUBDIVISION / C~M# LOT # r SECTION TN-R_,ZgW, Town of ST. CROIX COUNT, WISCONSIN ~D ~e ~ PLAN VIEW STOW E RYT ING WITHIN 100 FEET OF SYSTEM m 0 2c 7A i 74t l rz cc. t 0,0 7,2 A 1 -761 Cb O INDICA E (NORTH ARROW t Provide setback and elevation information on reverse of this form. - Provide dimensi-nns- tc--center-of septic 'tank° manhole cover. 3 a BENCHMARK: ALTERNATE t 9, / D SEPTIC TANK / PUMP CHAMBER HOLDING TANK I / NFORMATION Manufacture PkLiquid Capacity: l(le)414--r 6 5?~ a I Z, Setback from: Well S' House Other- • Pump: Manufacturer nn Model# Size-. ~ Float seperation Gallons/cycle: Alarm Loca*pn - SOIL ABSORPTION SYSTEM Width:- Length Number of trenches QstS " Distance & Dir ction to nearest prop. line: -'~17' 10c,-, Setback from: well: House- Other ~7e ~Gc ELEVATIONS Building Se, er ST Inlet: ST outlet: PC inlet- PC bottom- Pump Off Header/Mani o=- d 1Z_ Bottom of system ~rS Existing G Final grade DATE OF INSTAiLATION: /y PLUMBER ON 6B: A - LICENSE f i -4 LICENSE NUMBER: INSPECTOR: 3/93 )t ' Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX ' Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268672 jX_ Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: KARIS, ADOLPH EMERALD CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600376 / TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f Benchmark Dosing Aeration Bldg. Sewer Holding St/ Inlet /4 7 S TANK SETBACK INFORMATION St/~ft Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake NA Dt Bottom Septic (2) dA. Dosing V NA Header / Man. Aeration NA Dist. Pipe 9ZJ1, / ' Holding "sue Bot. System , 56, PUMP 3tNFORMATION Final Grade Manufacturer Demand , 7 33 Model Number aG ~d 46 GPM 64(14 DH Lifts~j~ Friction Syste TDH9q~Ft I Loss Head * orcemain Length p Dist. To Well SOIL ABSORPTION SYSTEM y/,a BED/TRENCH Width Length No. Of T vriches PIT _ No. Of Pits a Dia. i d Depth DIMENSIONS 6 1 / DIMEN I N" SETBACK SYSTEM TO P / L BLDG WELL I_s LAKE/STREAM LEACIING arer: INFORMATION Type Of hens a i C14AMBER 7 Mode Number: System: rno $p'c~), DSO - OR UNIT DISTRIBUTION SYSTEM Wea ec# Manifold s Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Length ~.5 Dia. Spacing yv 3C~ 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: EMERALD.2 30.16W, SE, SW, 170TH AVENUE f R /jn ~h,';.,~.ui` ` /,;-G.✓D°-r-Y'f'~ li~"~ /V~~ ='R.,.,.~3-fir ~~J~ `:cy.i,d. '4 Plan revision required? ❑ Yes alq Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No- ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~i~'r'■: SANITARY PERMIT APPLICATION BuSafetyreau anofd BBuildiuildin ng Waater Systems teri 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. 4 • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check Akvision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prope Owner Name P o ert Lo ation S L`1/4 1/4, S T3 d, N, R 6 E (or Lot Number Block Number Property O~rr's Mailing Address -44 !7/ City, State 27/0/ Code Phone Number Subdivision Name or CSM Number S ( ) II. TYPE F BUILDING: (check one) ❑ State Owned / El City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms E] Vown OF ~J~JL l d „ kL Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 111 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 SystemTank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21$ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Propocse_dq. ft.) (Gals/day q. f) (Min./inch) Elevation Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel lass App- New Existing strutted g T nks Tanks Septic Tank or Holding Tank ~6) I S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 14-,- ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT ' I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plu ber's ame: (Print) Plumber's Sig ature: No Stam s) JQIPPPR W NO.: Business Phone Number: Plu en's Address (Street,City, Sate, Zip Co IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sant ry Permit Fee (Includes Groundwater ate Issued i g Agent Signature (No Stamps) pproved E] Surcharge Fee) 2t Owner Given Initial ~,ol~, Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: M-6398(11 . 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 nevv 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 num*r(s) of where the system is to be installed. IL 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 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) fora 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 i i I awr, ~ I i ~ I I V I I i fi r _ I I t ~ l I L V'% r - _ - 1d m d I I dit 1 I Ji6 f US C.7 IVIS N 9d EE ORE I i DIVI r t-._-- _ ..i 1 I _ ......I _ i~ _ - - 14 ' - I lO t i I ~ , ~ ~ -gig ~ ~ . i.. _ ~ i 1- e ~ti ; JC A. p I ~ I I RECEIVED 13 XA JUN 2-4 IN ..Z, all tw4 , I I 1 , S..9.6 - .8:.5 Page 3 Of, Cross Section Of A Mound Using A Trench For The Absorption Area r-1 H Medium Sand Fill -J1 ° F 6" Topsoil 3 E D Trench Of 40 - 2~" Aggregate. Plowed Layer 6" Below Pipe. Covered With D Ft. Straw. Marsh Hay Or Synthetic Fabric E 1.16 Ft. G, _ Ft. F , 75 Ft. H Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe Permanent Markers Observation Pipe A o W - B _L K r I Trench Of 2s" Aggregate r L A y 1 I~ Ft. K~ Ft. W a= Ft. B - Ft, J ,3y Ft. L J4-,T' Ft. License Signed: _ Number: Dizol Date: J 3o n RECEIVED JUN 2419% S96-01850 SAFETY & BLOCS.. DIV. Page y Of.$' Distribution Pipe Detail For Two Lateral Network Holes LocatJ On Bottom Are Equally Spaced PVC Force Main End Cap IN f Y 1 F-111 -11- PVC Distribution Pipe P P X " Last Hole Should Be Next To End Cap (i ii • f / j P Ft. Hole Diameter Inch lip X 3= Inches Lateral Diameter _ Inch(es) Y _ Inches Force Main Diameter _ Inches # Of Holes/Pipe /Z i• .I, f~,~ Invert Elevation Of Laterals Ft. iI Signed: License Number: to/20l PERFORMANCE CURVES, Date: MODELS 13ARNES PUMP TOT11l M.AO WT. FT. T• N 12 40 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • 20 - RECEIVED • 2• JUN 2 41996 J ,0 6W LUGS. DIV. S96 0 1 10 20 20 40 so •0 70 •0 1a 100 110 120 LITER! rE. w.. 7• 1N 227 302 378 454 Page Of S" SEPTIC TANK &'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER 4" CI RISER W/ PADLOCK & FINISHED GRADE 7 WARNING LABEL 4" MIN. 18" IN. 6" MAX. INLET I' WATER TIGHT SEALS GAS- , TIGHT /APPROVED A SEAL JOINTS WITH APPROVED B ALM APPROVED PIPE PIPE 3' - ON 3' ONTO ONTO SOLID C 1 SOLID SOIL SOIL PUMP OFF ELEV . g YFT. - - OFF RISER EXIT D PERMITTED ONI IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS DECEIVED SEPTIC / DOSE JUN 2 4199S TANK MANUFACTURER : J~,Ic,54,,rj Pic GvJ NUMBER DOSES PER DAY : '~rEtY ~ TANK SIZES: SEPTIC /DDO GAL. DOSE VOLUME INCLUDING Bt.DtiS. D! DOSE, s-o GAL. FLOWBACK: 170 GAL. ALARM MANUFACTURER: SdI cle4ra CAPACITIES: A = .2 2_ INCHES = 37 GAL MODEL NUMBER: to/ SWITCH TYPE: Mere-vrX B = 2 INCHES = 3y -GAL PUMP MANUFACTURER: i5ar.c5 C = /D INCHES = 170 GAL MODEL NUMBER: 3t q/1 SWITCH TYPE: M t rc uD = _1 INCHES = GAL REQUIRED DISCHARGE RATE ,240 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WA VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . po FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . -2.5 FEET + S"0 FEET FORCEMAIN X 00~r FT/100 FT. FRICTION FACTOR . . ,77 FEET It 5.1 TOTAL DYNAMIC HEAD = ~ , 5- FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH .3 X SIGNED: LICENSE NUMBER: Y/~zo1 DATE: X30 7~ _ 1/88 S96-01850 VYisw 0sin Department of Industry, Page of-. Labor and Human Relations SOIL AND 51 I E EVALUATION REPORT Division of Safety Q Buildings / in accord with Il-HR 83.05, Wis. Adm. Code COUNTY 1.~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan nwet include, but . j riot limited to vertical and horizontal reference point (BM), direction and % of slope, Scala or P • , dimensioned, north arrow, and location and distance to nearest road. rt) I W7 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION JEWIMEDBY D r f PROPERTY OWNER: PROPERTY LOCATION I1 Q r i S GOVT. LOT S E 1/4 Slat 1 a T~ ja. ;R %(p ~It SUED. ( , t J3? CC BLOC PROPaER~NaW ER':SMAILOINGADDR~ESS LOT CITY, STATE ZIP CODE PHONE NUMBER OCITY QVILLAGE OWN Emvralct T 540 (7/) - 9 3 •era New Construction Use (KJ Residential 1 Number of bedrooms I [ ] Addition ID existing building j J Replacement (J Public or commercial describe Code derived daily flow 1S gpd Recommended design loading rate D- S bed, gpcW ro trench, gpdAt2 Absorption area required bed, ft2 trench, It2 Maximum design loading rate D bed, gp(W o b trench, gpoltt2 Recommended infiltration surface elevation(s) a lung 94,0' Con ~o tr It (as referred to site plan benctmark) Additional design / site considerations 066 40 1 + " Fo d (.s +U -6 l a v S lT acbdre Parent material QrnurkA f n eS Flood plain elevation, it applicable AI A ft 7,buni tablefor System CONVENTIONAL MOUND IN-GUND PRESSURE AT-GRADE SYSTEM IN FILL lG TANK suitable fors stem ❑ S 1 U 0 S ❑ U ❑ S mu ❑ S U ❑ S ®U ❑ S T U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Woes Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mnch p_ QS 4- (0 la b w D 1416 Ground lu-,A (L H ff" k - d S 640 ~L ft y 1.40-35 1,602 If Ca ~a - l 14, a 10-k= - Al /UP Depth to limiting 0 „ factor I Remarks: Boring # mVM- 0.S a„, 0•S d.m I 02 :r X i%- It lp 4 413 IN~ ~ C,w 1144 NP 3 12 q13 dr-e b C4.10 - 0,5- ( 6-01 Ground elev. It i - 10 " Lf N Mow k M fr. CW - 0 • S Q. ~v 1vYit m a n~P Depth to - S N S+. ; K rUP - ' -5 y -7-5-w2 518 limiting „ factor a Remarks: T Name:-Pleass Print Phone: o Gu 58'- 13 L/ L/ ress: ' 3 L4 SO ,4 ee N t-) a ulou►- n S4 577 Spnaturs: Date: CST Number: a 5- t' P r'f'1 3-70 1 PROPEMOWNER Ad A Kai - L_ SOIL DESCRIPTION REPORT Pape-of' PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure C.onsis a Bourd3y Roofs GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed wxh v , IOY(C,3 N OW 0, m5 mg ~,r a S as 6•.r 6.(0 3 ( 6a Gw II 0•3- o-(a Ground l - 1 144 ? -',(.5-,l rv1 C-vi - 0-5- 0.1P elev. 4 1-7-11P h I 6 q anR Y r I - 0. S tl to Depth to - 1 o Y~ la m S i 1t1 L4 (P CJLA '11 -,J limiting ! wtor l Remarks: Boring # I . Ground elev. It. Depth b limiting factor 4 Remarks: Boring # t Ground elev. ft. Depth to I limiting facto Remarks: Boring # _ Ground elev. ft. Depth to limiting lactOr Remarks: SBD-8330(R.05/92) o m ~ w 0 r 3?-? T e a QQ~ ° 3 0 Ir i ✓ L Ce~a ~ I Z p fl n C/~ n cry "n o c° 3 v Ztz, Pk ti t--~ z c o ~ N a all, 13 Leroy G. Jansi-y, WWG 13 Fast Spruce Street VVisconsin Department of Industry, INSPECTION Labor and Human Relations C, iippewa Falls W_ 54729 Safety & Buildings Division REPORT ianskle mail.State.Wi.us E-mail Bureau of Building Water Systems J, 726-2649 Fax Inspeci~Q C~at+: 3 1996 7 ? `,1 726 2544 !rok: e Name, lgff Priem' es Ad0,r ss WIMP tiQr~, OWTownst ip, Coynty Karis Property Sl~ , , i C W Emerald St. Croix Mast lumber N e d A dress Mas r PI ber F' Na a and Address PI 'N aomasus~um ~us`jum O~um~ingfi-1350 N13450 937th Street New Auburn, W1 54757 Sanitary Permit No. f ~e~v Auburn, W11 54757 NA Journeyman Plumber/Soil Tester Licensed Person's Name(s) and License Number(s) homas D. Gustum, CSTM 3701 Present: T. Gusturn, S. Gustum. Owner's Name and Address Adolph Karis Estimated Dail, Flov/: 150 gpd 2482' 1 0th Ave. Emerald, l 5401 • New - e nt+ l Ot~~-Fto oil -verification at the rnqurest of private sevrage plan reviewer, Dave fusself,'; t3et aujse of Coo Kiel its over the description of-rnodi ng provided by the CST. One-soil pit wai5--evaluatetl this date with tho following rr-sults' C T 00-0118 10YR 4/2 sil, 2.rnshk mfr, as _ B- 084 i=' 1 OYFi 4/4 sil, 2msbk mfr, 6 - 21-25" 7.5YR 4/6 sl till, I m k, mfi; 6, 25-38" . / .5YR 4/6 si till, Gm, n'1fi, W C/--:-3d ' 5YR 4/6 and 7.5YR 5i3 rnot. Estimated highest ievei of seasonal soil saturation is 25 inches. _ Soilconditions at this site are suitaLle for a mound type systern Ustog a rr ximurf sail-loading rate of O5 ft~. bo_d~ and C)F qfd!ft_ fnr fmr,rkn- Ord1 , .-r f It there are any t.t? t4(?rjs ?'Agar~i??c; this report, please c:nhtacf m 3 I_/ 5.. REc~~o 'FF%Cf z~weo Page of r Signature of Responsible Licensed Person (only one needed) / Signs of Plumbing ons Itan vale Sew ge Consultant Original: Co iesto: lthatapply~ rlvN sso-6192(11.1i/go) District ILHR Plumber 0C (r Co0'ty/Local Irk. E) Other STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~[7a N A~ MAILING ADDRESS o? g Z z 7iq 4 AADDRESS 3,0 4j Z 'i (location o septic system) Please obtain from the Planning Dept. CITY/STATE/ C-X44z.-tom /I J1, Z- PROPERTY LOCATION zf 1/4, 6UJ 1/4, Section T 36 N-R_Z~W TOWN OF Z_-~ c~~ t--.::> ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER - 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 expiration date. ` SIGNED: DATE: 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 Xj'm& r,14 e6e. / S Location of property&~ 1/41/4, Section 2 ,T_36 N-R /A~' W Township -~7L511qz- Mailing address ~y$Z /7D -~A 1&a- Address of site y /71-) 4--h 4-tI c t~ a Jlj subdivision name Lot no Other homes on property? Yes No Previous owner of property A7_ "n a2ri1 0 Total size of property (50 Total size of parcel ~C7 4r- Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume&-s2L and Page Number 2 Z 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. 7O 7 , 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. 7 i natur of App icant Co-Applicant Date of Signature Date of Siqnature RJ 4 f"N i G f i C..~- C' ~ ~ ~ ~1 ~ ~ - t ~ ~ ~ ~ ~ ~ ~ ~dJ' c ~ 7~ C ~ r~ DOCUMENT NO. ' ( WARRANTY DEED VOL 389 PA-UE V? STATE OF WISCONSIN-FORM 9 O ry THIS SPACE RESERVED FOR RECORDING DATA 2732 REGISTERF- n!-r-I(:E THIS INDENTURE, Made by Almond....------- ST. CrtOIX CO., wit-. .....-Doro-thy -...Kohn.,.-.His_.Wif e. Rec d for Record this. 3rd day of__ gtoher__A.D.1962 grantor G_ of .............St-r--•C1"Ci1X.... County. Wisconsin, hereby conveys and warrants a 1 -30 A,, M. to A.doIph....Karia---- nd.... Ruth.... Kari.s....... Hu.r and_..a.nd----...._. ......wife.'...as....J.o a.nt.... Tenallts............................. - A------ e~ st f Deeds grantee 5---- RETURN TO of ...................St. CroiX _............_................County, Wisconsin, forthesumOf Richard P. Rivard Two Hundred and no/100 ($20...00)-------------- Glenwood City, Wisconsin ---------------------------------Dollars - the following tract of land in .............St • Cr01X............. -,-•-..,...County, State of Wisconsin; South East Quarter (SE 1/4) of South West Quarter (SW 1/4), Section 2, Township 30 North, Ranpe 16 West. I I _ J II grantor. 5 V.. e tYle 1T'.--.....hand....'.......and seal..''...-. this... 27th I1V WITNESS WHEREOF, the said ia....._.... . hereunto set__......._... dayof...... Septe-tuber.-- A. D., 19.--62•.-• S D A D PR SENCE OF 1 i l (SEAL) _...Almon-d__Kohn -t1Z,~ L'- 6V_ ~`kL1.L• (SEAL) Richard P. Rivard --~J---- DO.:.oh3~ Kuehn '.E-~ /t t L.t J (SEAL) / (SEAL) Zelma-•-Mgy~1_.. • r_.__...... STATE OF WISCONSIN, } ss. St_a..... rO_ix _-........County. 27th September 62 Personally came before me, this day of...--........__ A. D., 19_......... Almond Koh Doroth Kohn the above named