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HomeMy WebLinkAbout020-1112-40-300 IrF 4 STC - 10 4 AS BUILT SANITARY SYSTEM REPORT G 13S~ OWNER ADDRESS D' -Ald lwae 4- SUBDIVISION / CSM LOT # 3 SECTION /2" T_3_~ N-R 1'0 W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW ' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~67 -e=>e1_ IW57~~4W I~V;. INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. l ~ r T bra BENCHMARK: ALTERNATE BM: Ste, p ~7- p ~Jo d _ n SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION 10 Manufacturer: GC' &-ZF'ts®. Liquid Capacity: Setback from: Well House I S' - O/ G Other Pump: Manufacturer 2d/~ Modell „ Size Float seperation ~•Z Gallons/cycle- /67 Alarm Location ':SOIL ABSORPTION SYSTEM Width: J~ r Length 1,13 Number of trenches Z Distance & Direction to nearest prop, line: CO Setback from: well: 7 House 31 Other ELEVATIONS Building Sewer ? ? ~'~•3~ / ST Inlet. ST outlet r~ Gp d f PC inlet 749- .3 Z PC bottom 0(a ' pump Off / • T 1 ~~Header/Manifold 6 7 2.5 Bottom of system ~5- 01G7 IL4ff s Poor Existing Grade Final grade n DATE OF.INST ALLATION : Id-- ljt rnrn PLUMBE 14 4J Gtr ~l LICENSE NUMBER: 33 a 7 ; Cong a paeoc iatss Consultants V"o Sewage INSPECTOR: 055 O'Neil Rd. Hodson, Wis. 54018 3 / 9 3 : j t 3A-9/~ t l R1 w 1A v kA ~c l~ 3A o u. W k U °4 °V` I I I -fv c I -0 c i0 ? I i I v an i °o I ~C) \ I I I -17 ~ ~a I C2• ~ d I ' ~ ~ O Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Laitto-r and Human Relations INSPECTION REPORT ST. CROIX SafetlFand B:iildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268563 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BARNES, GREG & LANETTE HUDSON CST BM Elev.: 1 &191 Insp. BM Elev.: BM Description: Parcel Tax No.: ~ r s - .>a• ,p TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Q y ov Dosing; Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet r Air Intake a• 9C7. 8G ' Septic 8, yd NA Dt Bottom 15.59, Dosing NA Header /Man. al q G 3Z Aeration NA Dist. Pipe Holding Bot. System 9' S PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number99 s GPM TDH Lift 4~ 5$' Friction HDi SysteTDH q$rFt Forcemain Length ' Dist. To Well y SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth '17 - i / ;k DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: 4 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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: HUDSON.12.29.20W, NE, SE, LOT 3, BRANDON DRIVE . 671 / r U ki 41 Plan revision required? ❑ Yes eNo Use other side for additional information. a 1(. b~u k",- [41d 41 SBD-6710 (R 05/91) Date Ins ct . s Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: r ^I^ Safety and Buildings Division r.~■~■•■~ SANITARY PERMIT APPLICATION Bureau of Building Water System: 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 than 8112 x 11 inches in size.~_T ciPO!`~ • See reverse side for instructions for completing this application State Sanitary Permit Number rt✓/-si-o. 4851P.3 The information you provide may be used by other government agency programs gl-<..k I revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION PropertOwn r Name .t Property Location &RE`6, /4 ,s 114, S j2-- T Z , N, R Z e E (oro Propert Owner's Mailing Address Lot Number ,7 f RP iV 'D~ •a/P . Zl t~6j5f~ .3 -j7_ City, Sta Zip Code Phone Number Subdivision Name or CSM Number /w/~ v ~o~ 5y©/ c > le5,tf 53&753 if A • Shy IL TYPE F BUIL NG: (check one) ❑ State Owned ❑ it Nearest Road E] Public or 2 Family Dwelling - No. of bedrooms 3 O vows of 11U~o~ fj 54AIJW~v III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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. 2-Kew 2. E] Replacement 3. E] Replacement of 4. E] Reconnection of 5. E] 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) SoiG TEST La,~Ip~wG' /P~¢T E= 6~OP /T , Z- Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Se page Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [ Se Z page Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit y ~E~J Eif & 43 ❑ Vault Privy 14 ❑ System-In-Fill1 x fQ•~'" VI. ABSORPTION SYSTEM INFORMATION: sa rrsi 1,c4D. ~eAr&' = !rAA1,41'- T 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5.-Pe.c-Rarte• 6- System Ele . 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (IbFnrhnt-h~7 ® Elevation Feet -7,5`0 /L • & 60D 96.0 Feet F7 VII. TANK i Can elloacitns Total # of Prefab. Site Fiber- Exper. INFORMATION g Tanks Manufacturer's Name Concrete Con- Steel Plastic New Existing Gallons strutted glass - App Tanks Tanks Septic Tank or Holding Tank O'Qv ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber Nei • ❑ ❑ ❑ ❑ ❑ 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 AMID MPRSW No.: Business Phone Number: Roll Z~/6~~~~1~ / 330 Plumber's Address (Street, City, State, Zip C e):U~So~ ,,,1,1S ` IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Age t Si atur ( St ps) Approved ❑ Owner Given Initial Surcharge Fee) /~il ~Gd ~/QS' p Adverse Determination / U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 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 licerfsed 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 13 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! sep ic, pump/siphon and holding tanks fdr this system. Check experimentaF-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 witlycomplete 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 -:he 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 bythe county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 19831Nisconsin 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. ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants Owners: Greg & Lanette Barnes REGARDING LOT#3, Hartland Subdivision, CSM Vol.11, Pg.3010: The area soil tested and approved for the owner/developers by us on Oct. 4, 1995 has been voided and destroyed by careless placement of the house, the gravel drive, location of the well, and heavy equipment (excavating). All of this encroached over the original area (see attached plot plan, pg.4). The original soil pits and B.M. were all routinely marked with lathes and numbered warning flags saying "SEPTIC AREA. DO NOT DISTURB. DO NOT COMPACT". A small part of area B1-B2-B3 not underneath the gravel drive was also ruined by careless excavating after being heavily wetted by a very rainy spring. Excessive water was shed off of the roof, and from the driveway uphill, infiltrative water was held within all the rough equipment tracks and furrows. In fact, a large area downhill of the original test area was also destroyed. NOTE: areas examined by St.CRoix County Zoning Depart. upon request of Kroll's Excavating were-NOT conducted in natural undisturbed soils within the original test area. The only small area undisturbed by excavating equipment immediately adjacent to the original test area available for verification was pit #10. A new area was soil tested uphill of the house on July 2, 1996. This may be the one and only sizable area left undisturbed by excavating equipment. It was not at all surprising to find moist (puddled) soil conditions in certain fine weakly textured stratas. These moist conditions (in some stratas) are not mottled (no reduced chroma conditions). Moisture is not the result of perched or active high ground water tables. Soils are not saturated, nor was there any observed sidewall seepage indicative of actual saturated conditions. Moist conditions, rather, are the result of abrupt changes in texture and structure, which has been described in the literature as a "wetting front' Walter H. Gardner, Professor of Soil Physics, Un. of Washington, 1962, accounted for this in his paper How Water Moves In The Soil. A loading rate of .4 GPD/ft2 is recommended. Trenches only with drop box distribution should be used. A lift station is required. Trenches will need to be carefully curved to match the slopes and contours. It will require extra careful planning. Some suggested system elevations are shown below. Since lot#3 is very typical of soils in the other lots within this subdivision, the same soil conditions and soil physics will apply. The most critical point: the trench excavations MUST BE prepared with the upmost care and detail, so fine textures and structures are protected and left intact, not smeared. If not, then through careless preparation and installation, the system can and probably will fail prematurely. Craftmanship and planning on sites like these is evervthincr_ BRANDON DRIVE pg. 4 of 4 i M 3 lg. Oak trees O' 61' No. lot line IP NOTE: If BM#2 were 100.0' then BM#1 would be 95.14' if the 2 were compared. LoY 3 GSA o r BM#1 from 10-4-95 Q. Top of 3/4" thin J wall pipe. For B1 - B5 west O ~Q to line 50, g s' ti .0 WELL 3 ' ~n $o ` "muddied" DIS URBED AREA E-- O Q fro drivbway/house construction. I-A 00/0 3 Bedrm. Home/ Constructed) 'q1 1 p 10 Septic T. Outlet=90.10' r~ I AI X \ c '~k,,~ % qf i~ ► ` x ` Fresh Air Inlets And Observation ape / i ce , Approved Vent Cap Minimum 12".Above Final Grade 4° Cast Iron /g Above Pipe Vent 'Pipe' -to Final Grade Marsh Hay Or Synlhetic Covering rn.. Min. 2" Aggregate Over Pipe Distribution - Tee Pipe 0 0 0 0 0 & Aggregate o PerfOraled Pipo Below Beneath Pipe 0 Coupling Terminating At Bottom, Of System s sr~~ ~ Y w 9 / Ulbrlcht & Associate. PrlvNe sewage Consultants e55 O'Neil Rd. Hudson, Wis. 54018. Fresh Air Inlets And Observation Pipe GDS 7"~f'~•ul~c, Approved Vent Cap Minimum 12" Above Final Grade ~;7 4'~ Cast Iron Above Pipe - Vent Plan PUMP CHAMBER CROSS SECTION AND SPECIFICATIOUS P,416- of S -VEMIT CAP 4"C.I. VEHT PIPE WEATHER PROOF' APPROVED LOCKIIUG JUAICTIOM BOX MAMHOLE COVER - 25' FROM DOOP„ 1A EI WIAIDOW OR FRESH I2"MIU. AIR IUTAKE I t v,1710111 GRADE l I 4" MIN. 18" MIIJ. q3 COAJDUIT 0 ~ - 70 r li l/4T "4./ 1-1 89.0 PROVIDE I IAII_E T AIRTIGHT SEAL I I IpE I III APPROVED JOIIJT A INy~ N I I I APPROVED J01MTS W/C.I, FIPI- I IUMI I III W/C.I. PIPE ZXTEMMUG 3 30, II ALARM EXTEAIDI"G 3/ JAITO SOLID SOIL. / J i 1 I II ONTO SOLID SOIL I I o1J I ELEV. FT. 1 I PUMP OFF D I.~ y k ~E nnI^' 6- a IE V jI , io d BLOCK RISER EXIT PERMITTED OAJL9 IF TAMR MAAIUFACTURER HAS SUCH APPROVAL g SPEC-IFICATIOUS oosE ' TAAIKS MAIJUFACTURER:Q~~ J K/~ l e IJUMBER OF DOSES: .3 PER DAy TAAJK SIZE: 000 GALLOKIS DOSE VOLUME ALARM MAIJUFACTURER: L-~UL~f_~(A'~/~t ~Q IAICLUDIAIG BAS K'/FLO W: ~W GALLOttIS MODEL IJUMBER: d~L CAPACITIES. A= H-'/ IAICNES OR GALLOAIS SWITCH TyPE:1~ B u~ 2 IAICHES OR GALLOIJS PUMP MAAIUFACTURER: Zo~ll~iT C = 2- IMCHE5 OR SL7 CALLOUS MODEL DUMBER: D ~ TyL =I 7. Z INCHESOR Z.f 2- ,.-p~'// GALLOIJS SWITCH TYPE: P'~~,' //MOY ; `g'fr---IJOTE: PUMP ARID ALARM ARE TO BE MIMIMUM DISCHARGE RATE 2-i5- GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFEREMCE BETWEEU PUMP OFF ARID DISTRIBUTIOU PIPE../•~ FEET *AoL 5TEC5 ' + MI"IMUM AIETWORK SUPPLY PRESSURE , . , • , , , , FEET EA C(AI< I O~' J~ r~ I L 1 + /0'0 FEET OF FORCE MAIM X t/,) F 0 rr.FRICT1oAl FACTOR../- /0 FEET . '~"~vr ~ S 20•~ . - TOTAL DyAJAMIC HEAD = 12 .C00FFEET EET J ~ fuD oa ~-1 / 2 /yam .J / f HEAD CAPACITY CURVE 3 7/6 MODEL "98" 6 ~ 30 1 5/8 a- 2 J S/e I t 20 6 o + + 31! 4- 15 S%k'4 6 4 3/16 10 2 1 1/2-11 1/2 NPT s 0 . •U.S. GALLONS 10 20 JO 10 Sp LITERS _ 80 70 60 e0 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC NEAWLOW rill 11fr1UTE . EFFLUENT AND DEWATEIYNO " CAPACITY 12 HEAD • UNITS/Mill LFEET METERS QALS L'rRS ~ . Lee 72 273 a.os e1 231 + 4.51' •s 170 e.1o Zs 0s 3 5/16 vslw CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. .!..Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are avails • without. alarm switches. ~ ble for . variable level long cycle controls. SELECTION GUIDE Standard Sit models - Welyht 39 Ib• - '/2 H.P. 1 'Ir egral float operated 2 pole mechar" switch. no external control required. Ye 8erlss 2. Single piggyback mercury host switch or double p!agybeck mercury, boat Modell YPb as qNon4.5 Control selection switch. Reler to FM0477. M d 11S Sim lax Du 'ex 3. Mechanical alternator 10-0072 or 10-0075, ' 1 Auto go 1 or S - 4. See FM0712, for correct model of Electrical Alternator, "E•Pak•, M 230 t 6. Mercry «nem a switch 10-02a uesd a control activatm ,Pecily tm/R7 duplex (a) N sys ~gS 230 t 1 oof. r 16 7 oW,(4) hole 'J•Pak', Junction box, for _ 3 of 4 S 6 S. :PM Flex r"W84,101,14 conrNldion or wired in skn• x or du ' . ti ~ 'Z ' 7. T,..,, •n~ w..r_ " opeaUon, 10-0001, , , ~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION t Latest and Human Relations' Page of L Division of, Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Buyers: Greg & Property Location Bjornstad Homes Inc. Lanette Barnes Govt. Lot NE 1/4SE 1/4,s12 T29 ,N,R20 X)or)w Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Site address: 285 Brandon Dr. 3 CSM Vol. 11, pg. 3010 City State Zip Code Phone Number Nearest Road 715- ❑ city ❑ Village M Town Hudson W' Hudson Brandon Dr. ® New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: N/R = Not recommended. Code derived daily flow 450 gpd Recommended design loading rate N /R bed, gpd/ft2.4 trench, gpd/ft2 Absorption area required N/R bed, ft2 112 5 trench, ft2 Maximum design loading rate NR_bed, gpd/f12_. 5_trench, gpd/ft2 Recommended infiltration surface elevation(s) see notes & Dcl. ft (as referred to site plan benchmark) Additional design/site considerations Refer to notes attached. Parent material SCS 49 Amer sl. Fine loam Flood plain elevation, if applicable N/A ft S = Suitable for system Conventional Mound n-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S❑ U P S ❑ U ®S ❑ U ® S El u ❑ S ® U ❑ S Yu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 6 1 0-6 10YR 3/2 SIL isturbe mfr. ai 2f n/p: n Ground elev. V-99 1nYR 3/4 STL lfsbk _mfr. Cs if .2 -.3 98-415--ft. 3 2-42 lOYR 4/4 SIL 2msbk mfr. cs lvf .5 :.6 Depth to 4 2-9 l 0YR 4/4 SL l c r mfr. .4 5 limiting ; factor 9-5-in. Remarks: East side of pit, closest to house, has been disturbed. Boring # L 3- LOAM 2fsbk mfr. as 2f .5 A IL7 2 4-1 10YR 3/4 LOAM lfsbk mfr. gw 2f .4 ;.5 7-4 10YR 4/4 LOAM lfsbk mfr. cs if .4 .5 Ground 4 5-6 10YR 4/4 moist puddl d L. lvfsbk mfr. as / .4 -.5 elev. 99 .-3-9-ft• 02 10YR414 SL 1 rar mfr_ .4 -.5 Depth to limiting factor 4-04n. Remarks: CST Name (Please Print) Signature Telephone No. Robert Ulbricht 715-386-8185 Address Date CST Number July 2, 1996 CSTM2482 Ulbricht ASSOC18181111 Pdvat* Sewage Consultants SOIL DESCRIPTION REPORT PROPERTY OWNER page 3 of PARCEL I.D.# IA~~CSM 11W 3 3 , Pg.3010 Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 8 1 -8 10YR 3/2 LOAM 2msbk mvfr. cs 2f .5 .6 2 8-14 10YR 3/3 LOAM lfsbk mfr. cs if .4 :5 Ground 3 14-4 10YR 3/4 SIL. 2fsbk mf i . cs / .5 :.6 elev. 96.12ft. 4 2-6 10YR 4/4 LOAM lvfsbk mfr. as / .4 ,.5 Moist, pud led Depth to limiting l c r mfr. .4 :.5 factor 104 in. , Remarks: Boring # 1 0-4 10YR 3/2 LOAM 2msbk mvfr cs 3f 5 ;.6 9 2 4-1 10YR 3/3 LOAM lfsbk mfr cw if 4 .5 3 P-41.3 10YR3/4 SIL. ifsbk mfr. cs lvf .2 :.3 Ground 4 8-6 10YR3/4 LOAM lvfsbk mfr. as / .4 .5 elev. 98.4-2-tt, Moist, pu dled. Depth to 61-109 10YR4/41 limiting factor 10 5in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 2m 1 0-7 10YR 2/2 LOAM 2msbk mvfr cs 9f .5 '.6 10 2 7-2 lOYR 3/2 SIL 2fsbk ds cs if .5 ;.6 3 20-40 10YR4/6 SL 1 gbk mfr cs if .4 -5 Ground 4 .40-E9 l 0YR4/6 - SL 0 r i1i MFR / . 3 .4 elev. 93 2 . SL lm r mfr. .4 .5 Depth to (stra 'ned a mixture of both ma sive limiting an weakly struc ured, grangu ar SL texture ) factor 89 in. Backhoe it Remarks: p #10 verified by L. Jansky (DILHR) on 7-24-96. Boring # 11 2 8-1 10YR 3/3 LOAM if 1 mvfr cs if / ,.3 3 14-25 10YR3/3 SIL 2msbk mfr ai if .5 .6 Ground 10YR 5/2 Silt coats along pe fissures. elev. 4 25-38 10YR 4/4 SIL 2msbk mfr cs lvf .5 98-32tt. ;.6 Depth to 10YR 5/2 Clay skins a on we 1 defined eds.- limiting 5 38-5 10YR 4/4 ISL ifsbk mfr cs .4 .5 factor 6 56-85 10YR 4/4 SL O,m mfr .3 .4 8-9 in. Remarks: SBDW-8330 (R. 08/95) Backhoe pit #11 verified by L. Jansky (DILHR) on 7-24-1996 TMPnumni`Tm mnrr mn nT.TT,Tr. nn [ TLiIm~ t , _ _ _ _ . BRANDON DRIVE pg. 4 of 4 3 lg. Oak trees 61' t~ No. lot line IP N NOTE: If BM#2 were 100.0' then BM#1 would be 95.14' if the 2 were compared. 90' h 0 BM#1 from 10-4-95 j Top of 3/4" thin W wall pipe. For B1 - B5 J O west 5G • cL to line p ^Q 501 • WELL 111 go OD / DIS RBED AREA" fro drivbway/house t-- 70p construction. 13.1 9/0 3 Bedrm. Home Constructed. Replacement 1 0 area. 3 nJ 1(. Septic T. Outlet=90.10' O ► Oil N V Leroy G. Jansky, vvws 13 Fast Spruce Street Wisconsin DF(pa,Iment of Industry, INSPECTION Labor and Human Relations Chippewa Falls, ,l'e'i 54729 Safety & Buildings Division REPORT janskle@maii.state.wi.us E-mail Bureau of Building Water Systems (715) 728=2549aX Inspe tin t ,~u" 1995 (715) 726-2544 Voice qy Name of Premises Address or Legal Description City/Township County Barnes NE; SE, 12, 29; 2_0W Hudson St. Croix Residence Lot 3, .-Hartland Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D. No. Sill Schumaker, MP 6362 idA NA 1 070 Scott Rd. Sanitary Permit No. Hudson, W1 540-16 Journeyman Plumber/Soil Tester Licensed Person's Name(s) and License Number(s) Robert Ulbricht, CSTM 2482 Present: R. Ulbricht, J. Thompson, Builder. Owner's Name and Address Greg. Barnes Estimated Daily Flow: 450 gpd 285 Brandon Dr. Onsite soil; acid site evaluation at the request of the soil evaluator, Robert Ulbricht; CSTM 2482 The onsite'was deemed necessary due to a change,in house and.diiveway_location that eitheer disturbed or eliminated suitable soil area for the Proposed private Sewage system. In addition, a:county onsite investigati , its a . area of possible expansion indicated unsuitable soil conditions for subsurface; sewage disposal. Two soil pits were evaluated this_date, and both .were suitable to a depth of apptoximately5.5 feet.._The better suited of the two vas located to the rear of the house and consists Of a silt loam cap over very fine sandy loam. The CST and this inspector are in agreement as to the depth, texture and structure of the = :ii i izors in the second soil pit-. A ,onventional pi ivate sewage system appears to be an option for use all this site. Recommendations include the 'use of a shallow below grade trench type soil absorption system to the teas; of the home and outside of setback from, the well, building foundation and property lines. The designer should attempt utilizing a trench design at a depth of 20-24 inches below grade.' The soil conditions at this depth and to abet 3:5 feet:seem to be the most well developed and thus permeable. Theactual depth of installation ma~~ vary slightly due to topographic differences. The recommended wastewater loading rate to the soil is 0.4 gpol111 2 due to the nature of the substratum. A higher loading rate is possible, but not recommended An attempt to locate both the primary and replacement systems areas to the rear of the hcmrte is r coirimended. _ 10 I, t if there are any questions regarding this report, please contact nee. Co _ . _ REGE~~1~0 J 2 X996 ST CROtX ZONINCz Page Of ' Signature of Responsible Licensed Person (only one needed) Signature f Plumbing ConsultanUPri Sewage onsultant Check all Original: Copies to: `that apply SBD-6192(R. 11/90) District O DILHR Plumber ©0;d_er~ Coun Local Insp.; Other t 1 5~ , o b all 410V 2 7, 1995 KATHLEEN H aftisteixror' " CroCDeft 536'753 U, o4~ D D O D O z Z 0 o cn = y z z z z (A M Bearings are referenced to the N3 r to 01 M p N °oo .1 p N N oo °o C7 East line of the SE1 /4 of Section N ° m + o c ao o ao° w r o m o IoV° o no° H 12, assumed to bear S01 18 02 E. Q, Z =a. oN °o to ow °oo °ow °ow ~1 i T --t -W -N -to -N -N a rn rn rn m ::E :9 m a rn -1 N x ® © O O~ z -4 CL 0 L" 40 ON .0 C) to M 4D at S PA is i L TRACT A eye ~i G ~A p x West line of the NEk of the SE>4 0 ° j ~ N010121 36"W 660.22\ ° the ~a~'ti,•,... 589.35' 18.87' I-h 608.22 52.00..,.. w \~d• .r.• tt IC: x; N30°47'52"E f(D o,-R( ! IZi 61.14' \ CO • t•o..• Idaa_ ~ N - rK ld 1Y \ L o f Inl r a O oho x - - c 3 C) IQ m -0 m It 0 _ m r I~ Q. N C-r a Z T jo p crI Q Z 10):! ~ 1r n -n C-) C- 00 z 0 o a 0 7 7 N~ O H Z o I ' H. ;I Tl N M co TI -n a cr o co z \ p 10 I- I O i710 cr --a o o c to _ n f(D CAD a G 0 S o eo' I C,1 i T1 7c ' j m -j 0 1 0 N Irn 0 CD m trJ It I -h M 1-3 • ! ~p 't= CD N 3 6\ i ~ m Z< do o KFI 1 1 Q. I m N io W °N05°07'07" m CD I J 320.76' NI I •°o i-I oo a O H > ° , (w o - -Q o -P M Ct 14 .0 #A y N o a O N CO cn 0 to tn' m M O o : o 4.1 to I N r 0 N ov Oa. T 1-11 Ct :4 -n 60. a N =11= W V_ ~O Ate,' = It> ro Ap _LA 10 d Cn 12 0 l~ c3o puB`\C w RO to o®O a ~r rt, 0i 01 N N ( .may 0 IL7 ° N 1. W 1w 00 00 I SEPTIC TANK MAINTENANCE AGREEMENT D St. Croix County OWNER/BUYER Q"/`f L ~~cI,~TT ~'"~s MAILING ADDRESS PROPERTY ADDRESS . (location of septic system) Please obtain from the Planning Dept. CITY/STATE _ PROPERTY LOCATION /(/e 1/4, SA- -1/4, Section T N-R Z W Yu U pjo / ST. CROIX COUNTY, WI TOWN OF SUBDIVISION ~'9~T G~1ti1~ , LOT NUMBER CERTIFIEDSURVEY MAP 3 3 ~'753. VOLUME PAGE SS LOT NUMBER 3 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. 1, , SIGN D: ~Q DATE: St. Croix County Zoning Office GoverameaCenter-- I 10 1 _ 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 Location of property N~ 1/4 S9-114, Section /2- , T 2"f N-R 21~9 W Township Mailing address Address of site Sin-e-- Subdivision name] Lot no. .3 Other homes on property? Yes No CS/~'1,~36753 Previous owner of property _13f0I?NST e2 - 3010 -v--- Total size of property :Z. D f ftG~E'f Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes Not----No Is this property being developed for (spec house) ? Yes Volume and Page Number 2-3 C9 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. - 22 , 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. " If, r r J L4 l S` i nature of Appli ant Co-App ant Date of Signature ate of Signature 1(alc Hal of Wisconsin f 1982 C) 63- t7 WARRANTI" DEED - DACUrVIIN'4 NCI'`" YOL RgPA~E` O Michael C. Lundberg J U L 10 c. o,at 11:30 A.' cor.seys and \\arrants to Gregory L. Barnes and L anette E. , Barnes, husband and wife, as survivorship -arital property T-- '-.'E R,~ERCEO FnR RECORCWG eaTA NAME ANP RE'. : % A;'F REDS SI the follo\%ing described real estate in St. _Croix Counts. State of Wisconsin: (parcel Identification Number) Part of NzNE4SE4, Sec. 12-T29N-R2016t, described as follows: Lot 3 of Certified Survey Map filed Noverlber 27, 1995 in Vol. 11, page 3010 as Doc. No. 536753. s'RAq FEP This is not homestead property. Xk.U (is noll Exception to \\arranties: Existing highways, easements and rights of way of record. Dated this 28th da\ -f June ly 96 . (SEALI ISFAL) . '•lic'nael C. Lundberg (SEALt (SF \L) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix count. I authenticated this da_v of .19 Personally came before me this 28th day of June l9 96 the abo\e named aN,SH~Michael C. Lundberg TITLE: MEMBER STATE BAR OF WISCONSIN.' If not, 2 NQTARY authorized by §706.06. Wis. Slats.) = 2WIpt known e e per, n \\ho e\ccuted !hc A~~L,nV ic~„Ing I i / m t an ackno%%ledge tye , me. < f THIS INSTRUMENT WAS DRAFTED BY $~f1 n- _ Attorney David J. Estreen Of W, n71 Cornnrl Ct- Pivlcnn fl7 ■~rMM _ r -0 C) -0 0 o a o c CE, 3: CD 0 (D., 0 69 O o 0 I o w N m 0) N m L 0 N c E c •cO- h . > E ti ~a o 33i c 0 0 o Z m y C Z C 7 N G N'- LL c U. O O O 3 ; E 3 70 Q U) a Q I 3 Cl) 3 M v o Z y Z Li N fn = 00 z '0 CV N W I d m d m H Z c O C ~ p -p U O Z:!t c c w V r p N O w O m Z C rn C Z N F E E N ~ N N M C CC N O N 0. N O C N n a w LLj N N C a L L d U L ~i c c c O Z H Z Z H Z O O N Z d E CV E 3 a CO E `tea tY0 O y a co A wG1 CO N C O N O o G C a E co D D IL E N h Q 0 ,Lip vr, vrr~ rmr s o rm rrn tro 2 ZM> ~r 355 OOO ° Zo a a a is ~an.a ~ a c 0 N :3 co co co 0 U) ~l N V = rn o rn rn (D N 00 V ; O N -0 O 0) O N a) 0 O O = j r CO V O "a 0 co c 0 co c d m v O N co p d Q Z cA d Q } c~ o _ d d to O Sr. CO 3 ) co N N O M O N N C 00 N C E 'D cli 04 LO C? <r C C:) CD O O , 3 C C C a U N N i. F- c9 C m v r- W N C N n y N M n co y L lA N N .O N C N 0 .0 N m L • x N O N f6 ~7 U r=V) p 04 2 J N O Z c z M N O Z C Cn w @ € 1 E a V • ' a 0. m C> IL C d d c 'i~j o c c c w O . r~~►1 o ca ~3 `.4 0 o f.) CL O co) FUD ,2 p C ~C OWR 1 NO V 7, 1995 ► DEC 1 1 1995 ~Cr Of S36'~53 ST. t~t0ix COUNTY _ G~ ~ URVEYOR' RECORD W 0 0 0 0 0 2 0 °o cn z m z z zin z z to cn M Bearings are referenced to the P) 14 -j °o nNi rI3 OD °o d East line of the SE1 /_4 of Section N e m ° N 12, assumed to bear S01 18'02"E. Q, ° m !o c ro o oo° w r o ~r~ ° m o ~o° ~ > g - y Z .w t '0m.°°vi ocn • o0 OW oW Jy• t -02 -N -10 -N -N t0 nm'I m fTl L77 f f n'i f;1 ® O O \ ~ z CL -44. ~.~J 1 G a O tp C W II c - A A N A S iNI AL L ► PA 1 p e\ A 1 \ 06 oaf i' z West 1 i ne of the NEkF of the SEk. / ~c ted 6 ~4~ N01°12'36"W 660.22 ° 60 ~0 { 589.35' 18.87' fh 608.22' S2.Ob'' .w \dlc.. "x., ' rt IC I~ N30°47'52"E \ ,o,„ el 0 F-0 61 .14' N Ir ~ N - tIj ICI am o u, N 3 a r -:-l w n1 OD x - - c 3 C) IC) Q, r0- h M .0 > rn co r ~ r fl H a ct a Z d w ° r n a ct Q z 0) Icy Ir oo z n 0 'o m 0 c °c O to o ft iC7 C o -n •+i 'o. cot o Z \ o Ct i Ti I k W IM aD ct v o o c~0 -'I O= G> I- O o• - - c c ct ,p . o, 010 o o cn s o n a Ct d1 ed -h Ct (D -h C m tij d coo $ -h N m~ S H ct ::r4 ~$1~\~ - ` r- CD N 0 1 c I y `p Nti~ 5 16 I I N z z ~J • Ln tG ~,x• 3 o, m o v n Zo I-, 'ad -G 0 33 tP ° N O 3 " °o N05°07' 07"W •06' N I O m 320.76' 4XI co CA 1.0 -h 000 -4 P* 42' 4' Ct N 0 > (D 00 00 y A m ti m W o c N 'n ~d,.1r~! : o .cU can (tea" o ~i x O 1-3 :4 m nO ' A O IZ Ic> IDA W ` y W cn A l to 0 I-1 N C tip "',~~crr m f v. 0 ct ° ® © z IQ n. i ~ ` O N ~ co 10 ICS (gyp I~~ O y N ~ N ",o = I L7 rn W N1`. ~1 oo C I 0i_ I C1.I 13' Sc~mrin Department of Industry, Labor afd Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) sanitaryPerm itNo.: Permit Holder's Name: ❑ -City El Village ❑ Town of: State PI UTNbBERO, MICHAEL/BJORNSTAD H ME X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATIO A9600019 ATA TYPE MANUFACTURER CAPACITY BS HI FS ELEV. Septic chma Dosing Aeration Holding JI/d"g. Sewer St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air In Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: iETBACK NFORMATION Type o CHAMBER Moe Number: System: OR UNIT ISTRIBLITION SYSTEM ,ader / Manifold I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air intake igth Dia Length Dia. Spacing I I )IL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only )th Ove:Center ~Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched /TrencTrench Edges Topsoil C] Yes E] No ❑ Yes ❑ No ,MMENTS: (Include code discrepancies, persons presew-., etc.) ATION: HUDSON-12.29.20W, NE, SE, RANDON DRIVE~k-T3 4(2e a-o r'_q ~evision required? ❑ Yes ❑ No ____1 = ther side for additional information. ' 10 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH a SANITARY PERMIT NUMBER: _ Q '~calpQ-`1t SANITARY PERMIT APPLICATION Bureau o oand ff Buil Safety uildinWater System: ng Water 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 C! than 8 12 x 11 inches in size. S7 . C-Q j • See reverse side for instructions for completing this application State Sanitary Permit Num r The information you provide may be used by other government agency programs ❑ Check if revision to pre sous 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 4 C 4 41414 eY Jar es ' 1 /4 _5 l- 1/4, S T g Q , N, R W E (or)Ny Property Owner's Mailing Address Lot Number Block Number h u ds~ /J , ` 1? 1 City, State Zip Code Phone Number Subdivision Name or CSM N gn_Ler II. TYPE F BUILDING: (check one) ❑ State Owned o ~t~ Nearest oa ❑ VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF wd$o,r/ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) _"776G 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- I New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) -4 91evation94 y` Capacity Feet 7 o Feet Ail, 402. Ic VII. Mot- in gallons Total # of Prefab. Site Fiber- Plastic Exper. RIC0IATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App- New ` Tanks Tanks Septic Tank or-Holding Tank LtJCS7`~y,✓ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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) P PRSrW-No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): YO/6 -7 d a A? el IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Ag t Signature (N am s) Approved Surcharge Fee) ❑ Owner Given Initial Adverse Determination ' ~d'D~/64 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information- Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, 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 mcid6l'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. S 3l~ t 5 ~I fo-~' Ell 1 I WiscoAsin Department of Industry, SOIL AND SITE EVALUATION 2 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. IL , Wis. 18 Attach complete site plan on paper not less than S 1/2 x 11 Inches in size. P(in r 5T. C 0 X I incIude but not limited to. vertical and horizontal reference point (BM), dimrtion and percent slope, scale or dimensions, north arrow, and location and distance 16.iiearest rged. 'arc -_J P APPLICANT INFORMATION - Please print all informat Of1!: 1=l ` Y µ evleWed Date Personal Information you provide may be used for secondary purposes (Privacy La ;.'.f5.04 7~ij (in)f .•,f" p o" Property Owner i Df 1 i(/jE/SEA r Prop Oty Locatioh 2WV-el-eya"~ u/S BfOPN5T~1 96 M. Ldt NE 1%d 1/4,S/2 T 2'? N,R ZO E (off Property Owner's Mailing Address ~c(ckf Name or CSM# HApr L AN D City State Zip Code Phone Number Nearest Road f/v1~So~ w/ S yU'(o (7/5 )3~G ❑ city ❑ Village Lid' Town [O New Construction Use: Residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 7~~ gpd Recommended design loading rate bed, gpd/W / trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 '_trench, gpd/ft2 Recommended Infiltration surface elevation(s) P 3 i. It (as referred to site plan benchmark) Z/S~ 7~~>uGLr~s O,vL _ Sic ,voT ~S Additional design/site co erations ae loco ~ Parent materials y ~M~~ y / • ~o~~ SDi/f ov~ Flood plain elevation, if applicable ft 5 N ti I Conventional Mound In -Ground Pressure AT-Grade System in Fill Holding Tank S = Suitable for system U L7 S ❑ U ❑ S ©U ❑ S ❑ S U = Unsuitable for system U ❑ S 0161", Efi fSi-~~ 133 ExC SSA"vim S/0-e SOIL DESCRIPTION REPOR~` ""/.U ~3 Boring # Horizon Depth Dominant Color Mottles Structure GPD/tt2 In. Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence FBoun Roots Bed Trench a ~ ~yO ~ o-s 1 3 ~0 Y,e 3/ S/ 1, -~sd,~ ale L f , y s Ground 3 / ' 7SY~/~O/~i'SdJt` /rYl7ie Gt SCI ! S G elev ye ft. 715 y& Depth to ; limiting In r) I factor , In. INA Remarks: Boring # ~10,11-f 2fSdi(' ~v+-fp s .2f . S 61 Ground / ~(_J 75 V 1-74 ,~e pelev. iAJ zr S Depth to limiting factor -In. Remarks: Aof- CST Name (Please Print) Signature Telephone No. Z~d ° / - 3-06as 1RoB1eRT- uL_aRT r Address Date CST Number I W,ri,.hi it Assectet89 D~i~. W 47 05'7,_Y 3 V V 2 PROPERTY OWNER. ~7~J~ ut=;~C:N' ION REPORT PARCEL I.D.ff fi P Page - of Boring # Horizon Depth Dominant Color Mottles Texture Structure GIVUH12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots 3 / to vle Bed Trench Ground elev. y l0 ✓ Y ~j j 1 Depth to limiting factor Q/ O Remarks: Boring If sxe 5-/7 1-~fle 7eJrZle ,f elf /o Me : cam' i,,,~ s Ground elev. fop h. y . S- Depth to - - limiting factor Remarks: Horizon Depth Dominant Color Mottles in. Munsell Texture Structure Consistence Boundary Roots G D/ft2 Qu. Sz. Cont. Color Gr. Sz. Sh. Boring # _ /aye J/~ Bed , Trench s ' . C Ground 7,Syj~ y ~i1N S/✓~ ryvrTjf S elev. , S . ~ 100,-5 Depth to limiting + factor In. Remarks. Boring # Ground elev. tt. , Depth to limiting factor in Remarks: SBDW-8330 (R. 08/95) tib7~S CO-v ri~v~~ V~k C.1. - ---ram--- - - Z3~ . ,vw LOT fo 7- ~ ~ l7~i TGi1`,v~ b ~ b 3 Al V1. 1004 1 ~ ► 1 ► I 767o 1 1 i i 1 1 11 ►I ~ 1 I 1 ~ ~ t ~1 I 1 i Igp ~11 la 1j ~rl 1 .3.0 1 1 I , 7,Loew 44, SyS7r'M AfV007- CUB r~S of&tdvte~~ ?a ~l~vy4-Tio~, S - ~i4-tt~ ~oti+5~ov,~ S' . B3 53.30' (3 y /00.yo' I i I Z - • - - . v .i ~ ice- _ a 0 F} to lilt, !ill~ili4~11 VIN If "i ` ~ cIJ 556 s LC) C\j CaL • 7 ~ J rte" ,T ~ , ; : ~ f', ~.~J r t i ~ , \~I; CID W ,z FILED ~ NOV 2 ~►n~cE N. 1995 1 g R~l~e'r~ 'usH St Cro Of 536'753 w 0 0© <q> 0 0 0 H " z 00 °o n z c z z z z cn (n M Bearings are referenced to the N W > A 0 oD 0 N OD O N N 00 °o d East line of the SE1 /4 of Section ((D 00 o r a- to o V o L n o 00 o to o Ln C1 0 O)N o 0 0 0 12, assumed to bear S01°18'02"E. M !o 0 o o o w ~ o o ~ a. o a o 0 o ifl _ o o _ y z oln oln o0 ow ow N M m m m ME J rnn rn rr ® © © (D N z ^nf rter' w ° \ 35,E d' °o _ oa cm Ne \a 4 L~Ar4'a~j 40 S~'AA LL TRACT A eye jG O Z. z West line of the NE7~ of the SE>r, ob71cd~@dy may` N01012'36"W 660.22 ° X60 ~O~''~•.. A r l; "Z"O" r t-h 608.22' 589.35 19.. 8z Y 1-3 x 52.0 rt i~ N30°47'52"E \ 61.14' fD OD . y M \ ~ o N o> -I w a n n 0 M x - - 3 C IC) o, 1 Fh > > a I CD > > > m w M a H cr 3 Z a ro v m p Q z (0) It'dIr- N W o 0 N °c °c C. ~ t~0 0 ~ I<n IO c0h C-) CD Z \ o fi t Z I t y f'', 'R'I N -n -n a Ct o~ Ct j 'G C 1< ~ ~p O T I I~ O I~ n N N G. 0. W OO , I 7r 0) K o m m 80 o I t~V o ~o °c~ m - 10) m 0 =r to D' °y~ ;o 2:0 Nti~31ti16 r-: M ` z W 0 . _ 4 - N o a W S c , 33, 33v` o N CD °o N05°07' 07"W ° N I r X M 320.76' 1 ' c ' w o I H t W V 'v V7 Vt m -P 4- Ct 0 > NO 00 n I r cn c a y o° w g' ' o FOh -n ct ~O ' A Z 12 rt -4 w W A I~> N pU8L1C w ` o®© i Ib m• N 1--90 N ' Ir.. n t STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County f r es OWNER/BUYER A_2,'j.Sret0 MAILING ADDRESS/3 /1=` ~~1E✓✓S~'J, l lSy~~~ 711- / O~ C~ o n w v4// r, PROPERTY ADDRESS e /7c1C~S o'I~ ~S-y0!(c (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section /Z , T Z S N-R ZC W TOWN OF CI SO~ti ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER .3 CERTIFIED SURVEY MAP 5?S3 , VOLUME //,PAGE-76/e,1 , 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. i 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: tiC/ A~C~~u~l~1' DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 1/93 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 WSJ _,~/AUST4) 11412)e S n i Location of pr/o/perty /.c 1/4 SE 1/4, Section 1,T 2 N-R ZU W Township /~v~fSaN Mailing address 10/3 ,S4 Al, Address of A/. S~lc>~6 Subdivision name CE5 r/ .30/0 Lot no.. Other homes on property? -Yes X No Previous owner of property A/ Z1j-1)61 y ~ rnznT Total size of property / acre, - r-Total size of parcel 26 Gcre S Date parcel was created ,JL'~,,•, /yyS Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes X No Volume _L/ and Page Number 30U 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. 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 Documen No. S3~75 3 Signat re of plicant App ican 2-/y/4& Date of Signature Date of Signature Statc Bar of %*Lscrrm .rr Form 2 - 1982 539.0 1161 DOCUMENT NO. - 1 B & N Land Development,_ a_ -~Rcrrl Limk~d__ ..J ----Lia _ _ ~ ty_Company i-- - F -E B 9 1996 1 11:45 A.',' convess and warrants to Michael THIS SPACE RESERVED FOR RECORDING DATA NAVE AND RETURN ADDRESS the follow ing described real estate in S~ • Crop.- County, State of Wisconsin: (Parcel Identification Number) Part of NI/2 of NEl/4 of SEl/4 of Section 12, Township 29 North, Range 20 West, St. Croix County, Wisconsin, described as follows: Lot 3 of Certified Survey Map filed November 27, 195'x, in Vol. "11", page 3010, Doc. No. 536753. : ANTS ER This is not homestead properti_ W (is not) Exception to warranties: Easements, restr_ctions and rights-of-way of record, if any. Dated this Any of January 19 96 B & N Land Development, a Wisconsin Limited Lib' ty Company ~i _ (SEaLl1 By:; .drrae- _ (SEAL) . Denni M. AD tad (SE-AU _ (SEAL) .-Thomas K. Niel AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dennis M. Bjornstad, STATE OF WISCONSIN - Thomas K. Nielsen County. SS. authenticated this ` day of January 19 personally came before me this day of 1 _ • 19 the above named Kristina 0 land TITLE: MEMBER STATE BAR OF WISCONSIN (If not. - authorized by §706.06• Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland a OG'Xi4V Oc+ OG 3a46 Z W IP.~{bOL ~GVKODWt I Q Igo wel &l?N-3 ~ D i k ~ ~ o~ of i f i S 4 e i ~ASTL~ P~.p~oolwl I~EDRDph - Z , oc 2A K: ~ SELT~on/tltl ~ I. f i j y z I Q A t1 - If) v'll 1 k S l J i' - - ..mac l: ss ~