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HomeMy WebLinkAbout022-1005-80-000 C) o~ o r. 00 p x O N O N p O Y L C ~ e~+ I N O ~ O yj O O h O _O 6 O Z N C <O N - Lo . LL C C4 N U _O O) O 7 O Q N O E V ? . z N 0_0 Z = O W v p Z - d N °0 (L o0 N M F- U) _ N C co O z d Q aUi z d c ° O 2 M E O O ~ C C N 0 (q O O Q Q z z o, ~ N E C N ~ M N 4 O y _ df LO Q ~ + . '41 N C ZF)~ N N d a o ° c o a a~ ~V) (n (n E N FL z r 3 3 3 0 O O O z • Sri ~o a a CL z (V p N CO (1 N ~i T 7 O) "D v U O O N N NO O O ? N 7_ m N IL W N ~ 61 C o 3 a8 a c L ►iri OO C 0 N t0 O_ co N N I O O C) O O OD' cm •(,j C N C C 0 0 0 L M C N Y Y 1 V L0 C ~ C C C vi d' N m V_ O N N O U C "U r O H N C N O N N M C ~ ~ N N (0 Ui yam' o o Y z N o U}I i a v~U I ~-1 A 0 a2,'0 o G) CD o p c o w ~ I h O N n o I I i ~a I I ~ I ~ I h I I 0 z aai I o z° Q0E' Z N 04 O O Z w d Z v ~ ~ ~ o I 0) cc N ~ c a W Z U oe ch v N a o co a L O °wa co zSz z w N o N V N N ~0 O CL LO LO i C O d °o °o FS N N 0 U) U) U) Z fM O S _ O O d~ O E 0 0 0 z o o l w a a a IL o CO o rn 0 !n J V ~ O O~ } COOD "fto-l N N C d O o N o -o ~ ao I c m c U> P d cn Q 164 CD o as H U) E O U c v v o `m c°'i a o° C) \ L. N O CD 'O N N Cl) co co O O N n N O N O W d N N 'O C n +0. 'a c L ~O O N S:3 cc > M O Z c Q°' (n I € a o a a • a m ;V m rr`w1~i r.. E _1 A c°ia~ OACi STC - 10 4e AS BUILT SANITARY SYSTEM REPORT OWNER ~yvyL ` ~oU ~al~ /NGO ADDRESS V SUBDIVISION / CSM# LOT # SECTION 7 _T~g N-R_ZZ ~W Town of Ir / /V/y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SY TE~M~ c~ a tiaSF ~o I , - 7 8 INDICATE NORTH AR OW 0/ CG4 / Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: fEVi ~O0, 0 0 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMA ION 41-_f /000 Manufacturer: Gll~~ GD Liquid Capacity: /~©O i Setback from: Well g8 House 3? 1 Other Pump: Manufacturer Model# X37 Size Float seperation Gallons/cycle:_ -305- Alarm Location- SOIL ABSORPTION SYSTEM Width: Length 19 Number of trenches / 7/ Distance & Direction to nearest prop. line: Setback from: well House S 8~ Other r '~3 ELEVATIONS Building Sewer ST Inlet Q/- ST outlet 9/- 20 PC inlet QQ.971 PC bottom 7. 99 / Pump Off g S 1cl? Header/Manifold 7,P9 Bottom of system 9 6 ,S S ~I3o Existing Grade Q~~ S Final grade gS q Q.9 DATE OF INSTALLATION: ,9 9 2 13 PLUMBER ON JOB: ~ LICENSE NUMBER: ©3~ INSPECTOR: G JA 3/93 i Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor ar Human Relations INSPECTION REPORT ST. CROIX saffety rte{ Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268681 ~ Permit Holder's Name: ❑ City ❑ Village XI Town of: State Plan ID No.: NELSON, DENNIS KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r ° r q rq. p -AV ~ TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1a S2 4 Al- - Benchmark 3' . 13 ' /00, r,) 0, Dosing ~-d o i Aeration Bldg. Sewer Holding St/ Ht Inlet cq/, G ' TANK SETBACK INFORMATION St/ Ht Outlet Vritto TANKTO P/L WELL BLDG. Ae Intake ROAD Dt Inlet 2„34I 010;'7 Septic g q NA Dt Bottom S 75/ 39 Dosing , /0, ' - NA Header / Man. Aeration NA Dist. Pipe G 5, Holding Bot. System PUMP / SIPHON INFORMATION Final Grade ,g( ' S q7 j 3 Manufacturer Demand 5 Model Number 1,1311 (4A GPM TDH Lift q \a Friction S Sy Ft Head stem 5' TDH ')_)y Forcemain Length Dia. Dist. To Welly 0 SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length ( No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu acturer: SETBACK CHAMBER INFORMATION Type O Mode Number: System: / cj& OR UNIT DISTRIBUTION SYSTEM H'e'a3ZT-/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- .l Length ~O Dia. _ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Seeded" xx Mulched Bed /Trench Center Bed /Trench Edges- Topsoil ®'Yes E] No Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC.3.28.18W, SW, NW, HIGHWAY N Plan revision required? ❑ Yes [R"IN0 Use other side for additional information. ?`,to p6i~p SBD-6710 (R 05/91) Date Inspector's Signature Cert . No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code mn. Sr 6-01-1 I STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ,~f(~(/O 8% x 11 inches in size. ❑ Check if►evision to pious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION S 1-SOAl ltd %Nlv%,S 3 T_'29,N,R f8 E(o PROP RTY OWNER'S MAILING ADDgEP LOT # BLOCK # W / ~z :K /V CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ,Sy0-,;k3 1(_2 Ar) 71&:3307 II. TYPE OF BUILDING' (Check one) 11 State Owned CITE' ~ N N c c NEAR ST ROV ~ WILLAGE ❑ Public 0 1 or 2 Fam. Dwellin 7 g Of bedrooms - PARCEL TAX N UM ( ) III. BUILDING USE: (If building type is public, check all that apply) 6 2 l D d5 = 8 Q 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 1120 Service Station/Car Wash 50 Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check o y one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressure ed Distribution Experimental Other 11 ❑ Seepage Bed 21 L Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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) 1 ELEVATION 600 .5'Od _"$®D ''S J Q6 . sO Feet 78,13s- i Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank /;too Co pp Lift Pump Tank/Si hon Chamber -`~F WIA4" C.-441A Fj F1 F1 [j VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb is Signature: (No Stamps) M RS o.: Business Phone Number: A~5e_kk., jkx ~ Plumber's Address (Street, City, State, Zip Code): 7 Otl~3 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitag Permit Fee (Includes Groundwater Date Issued u' g Agent Signature (No Stamps) " Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber T INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. , 2. Your sanitary permit may be renewed before the expiration date, and at tho tlrre of rent-v,al 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 (S'- 0 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 years. % , 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815_ To be complete and accurate this sDermit 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. It. 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallon:, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Con^plete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only i 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% x 11 inches must be submitted to t'ie 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; wel!s; water main; /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 refererce points; C) complete specifications for pumps and controls; dose volume; elevation differences; Eric ion loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil abso ption 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 coliected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) L ~ fO0.vgp SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations July 1, 1996 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S96-02273 FEE RECEIVED: 180.00 NELSON, DENNIS SW,NW,3,28,18W TOWN OF KINNICKINNIC 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. , SinterEl'Pige e Plan Reviewe Section of Private Sewage ORIGINAL (608) 266-2889 SBDA-9666 (B. 05195) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR PLAN ID # S96-02273 DATE July 2. 14gr, OWNER Dennis Nelson PHONE. 71-9-749-3307- ADDRESS 1224 Hwy. "N" Roberts, Wis. 54023 LEGAL DESCRIPTION Tax. Parcel #022-1005-80-000. SW 1/4, NW 1/4, Sec.3, T28N, R18W. TOWN OF Kinnickinnic COUNTY St. Croix CSTM Robert Ulbricht CSTM24R9. LOCAL AUTHORITY/ SUPERVISION St. Croix County Zoning DQnt- PROJECT DESCRIPTION: Replacement septic system, for an existing 3 bedroom home with office. Estimated daily wasteflow: 600 gals. Two existing drywelis set very deep in seasonally saturated soils shall be abandoned (along with an older septic tank of unknown'size and condition) per ILHR 83.03(2). Soils are fairly permiable in the upper 121, of soils (.4 GPD/ft2) but seasonally saturated at 34". A mound system using 12" sand fill, as long and narrow as possible for the site, is proposed. VERY IMPORTANT NOTE: The installer shall divert surface water runoff (from a nearby culvert just north of the mound) away from the uphill side of the mound system. This may be accomphlished in several ways. (1) Culvert could be filled in, and drainage ditch created along the north side of the blk.top drive, around the mound site, terminating into the road dit.ch west of the Or (2) the culvert could be extended with a new le$ of flexible culvert piping, laid around the mound and~~ ght lynto the road ditch (cleanouts would be critical). 0TJJ ngly recommended, for the longest possible the septic tank be provided with a Zabel pre-treatment of the effluent entering H g©~ p the pump chamber. .4I 'r. 4`iPg. P VIEWS ~`SCO~Sl N SPSY EM CROSS SECTIONS & SYSTEM PLAN VIEWS c A f* iOlw a Pg.3 PIPE LATERAL LAYOUT UD1 Q HUDSON.IM1 • u P9.4 DOSING CHAMBER CROSS SECTION M lj S I G~ P9.5 PUMP PERFORMANCE SPECS :W11111111 k%"`~` a O a o ees ° tQ 11 ct q (D ct (D M Soho (A eeff ~ Z O ~-h H _ ►Q th H O o in O O N ct O r fi ►-►a~ O a O (D ~ UI 9 r( ® • W f Ul ct H P mrPi • M H 94 45 (n n (D c't a 417 (D H. a C H- (D 1 c W 1 m c a (D ct co (D 0 >C ct I-+ O aw rfi w . LQ ((D e • N o a c to o rn o ° T 0~ t G t=i H O A ~c r0" o - c n ^ i Ul O m m II • 0 W H a" b ~ O (D y 0 (D M ((D o o ► \ i n ► ~ \ w r ~ ~ ~ rn :w r • a e. z ars rat i ~ a. -Cis up AT, a... W~ Z ofi 5 [CROSS SECTION OF MoU~D wi rti BeD BPzD OF jro 7.y Ail ec-5ATE- 'DiSTR~(3uT~n,v G -rkt ckxs ES 9 pip G-- F To SYSTEM o P s'oi L EIEvAriok7 U"i FORM 'roE H 1X0.50 ~ RrtTp MEIN. • ' • ~ @ • • ' • 9 ii' SAap ' ////Plowao TopSol'L 1 ~ b u>, F R►N a °7o SIopE FMR ACE" l 1=1EVAT100 Um PER BEV 75. 50 o Fr. - ELEVArlo/J S E 1.5 Fr. lmvERr of 2.,~ IATGRA(S 97 0 F a s FT- /o Top of Rock 9736 G FT• 2t, , 77 18 , H FT. TOP OF IATERA IS PLAN VIEW of Mou.AjD wirti 13EI7 FoRcE MAW A (0 Fr• K II Fr - a /0 w Fr o w 30 f r l S96-02273,. Bev aF PVC- cAPPep To A ee erc I~rF 3 o-f 5 D+STRIBUTloA1 PIPE OS -WORK LAynuT- Total volume capacity of network: 26.24 gals. \ \AI -r o P g 0 Fr 3 R •0 Fr FnRcE MAi N X - INcNE5 Fr. « 2 5 of- z PVC Y 8 WC N ES VARi'A(3LE TOTAL. V f9 1 D V o j V yj E G A 15 . V ST^,3 C L- Ho1E Dt' I~1 /4 N E TE R ~T I"C. L.hTERA,L ~ Z' INC lieS MAWF-OLD " Fopce MAW _ IN C I} ~S 2 I Nc.~4E5 :#7 'OF Ho.IEs/PipE a~ I.UvERT ELEVATIOk) OF LATERM S 770, P~ PE -DE TAi l- pup CAP PE R Fo R f~TE \ ReMouE- A S96--02273 11 DR;,l BURRS ! y PUMP CHAMBER CROSS. SECTION AND SPECIFICATIONS P,4 1E f of 5 -VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAIG JUNCTION BOX MANHOLE COVER P-5' FROM DOOR. w/(v,#A;1,0&- /A13E/ WIIJDOW OR FRESH 12"MIU. AIR IAITAKE VADr- 111-41 IV GRADE I I 4" MIN. z' ie"MIN. q5' So CONDUIT-- 1.5~.~ ~IEU~+n nN O PROVIDE I 11l WLET 1- - AIRTIGHT SEAL I i I I I APPROVED JOINT A ~N5,1{~NK I I~I /APPROVED JOINTS 1J/C.I. PIPE 1 wM I I W/C.I. PIPE EXTENDING 31 0( I I ALARM EXTENDING 3/ OIJTO SOLID SOIL B 84.75 ONTO SOLID SOIL ~ I 39" (3.251) I I ON C I I ELEV. 85.75 FT 1 PUMP '_j ~ OFF nvi~ 6- H 1.01 ° k '~E N BLOCK ~CIEVAfiOA) RIStR EXIT PERMITTED OfJLH IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFI'CATIOKIS DOSE TANKS MANUFACTURER: Wieser Concrete Co. IJUMBER OF DOSES: 4 2 PER DAy TANK SIZE: * I9Afl * GALLONS DOSE VMLDIIME LOW: 305 GALLONS ALARM MANUFACTURER: Level Alarm Co. IMCLUDING BAC4P1 MODEL IJUMBER : DVL CAPACITIES: A = 1 S _ 6 INCHES OR 400 GALLONS SWITCH TYPE: Mprr»ry F1 na1- B-2_INCHES OR 51.2 GALLONS PUMP MANUFACTURER: Zoeller Co. C=1.1_.21NCHE5 OR 305 GALLOLIS MODEL NUMBER: -1_3.7 1 /2HP D=4.5-INCHES OR 244 GALLONS SWITCH TYPE: Piggyback Mercury E1 oat NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE ~O GPM INSTALLED ON SEPAR/~ATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 11 .25 FEET fiANF SPt; S 4- MIAIiMUM NETWORK SUPPLY PRESSURE , 2.5 FEET cAC (A- 7-D P A, i + _ 95, FEET OF FORCE MAIN X 3 Y 8 FyOFFRICTION FACTOR... 995 FEET _ I OT. -t-40r I S _ A ~S. ~5 6 J TOTAL DYNAMIC. HEAD = 14 _ 75 FEET r INTERAIAL DIMENSIONS OF TANK: LENGTH 104" ;WIDTH 8611 ;LIQUID DEPTH 39" * Note: Recommended: installer should order Wieser heavv duty HEAL)/ a 115 3411° CAPACITY 32 105 30 0-0-- CURVE- 8S 1- 28 90 28 85 --So - EFFLUENT 24 MODEL and Q 75 MODEL 189 DEWATER/NG x 22 70 185 U_ 20 --65-- Z to 60 C 55 _ J F 18 5U ODEL O 183 MODEL 14 4S 188 12 40_ 35 10 MODEL 30 MODEL 137, 139; 185 SEWAGE and ° 25 117 DEWATERlNG a 20. MODEL 15 MODEL 181 4 7 r! 10 - ¢ rjj 2 MODEL _ 5 53,S5, 57, 59 0 •p 24 GALLONS 10 20 30 40 SO 80 70 80 90 100 110 75 LITERS 0 80 180 240 320 400 22 FLOW PER MINUTE 70 20 T5-- 0 18 so- - MODEL Q 295 Yi 55 x to V So 11 MODEL Z 45 294 L1 12 40- J 3S MODEL F 10 293 30 MODEL a 2c4 - - 25596mO2273 MODEL 8 20- 282 15 10 MODEL 4 ~ OELLE/~ O_ ZZZ 2 5 _267,269_ 1 ° 3280 Old M/llem Lane GALLONS 10 2d 30 40 so 60] TO s0 19o 100 1110 120 '130 140 iso 180 1So ISO 190 P.O. Box 16347 1 l 4 I I I 1 Louhvllle, Kentucky 40216 LnM• • •e ISO 240 zee 400 4.0 No 140 720 (502) 778-2731 FLOW PER MINUTE "137" Cast Iron Series 11139" Bronze Series * HEAD CAPACITY ! . nu~tcnu.. Wi'sconsi Department of Industry, SOIL AND SITE EVALUATION 2 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 57 C eo k percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 21- ~ ~vo8o- 000 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 Property Location v 'D_VA115 /V4-SdiV Govt. Lot j G(J 1/4 Nw 1/4,S 3 T 1d N,R E (or 11 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State ' Zip Code Phone Number 71jF-- Nearest Road wn ^Y. Al PT5 w/. -WO2.3 (7w) 33 0 7 El city ~,El c TO New Construction Use: [~Kesidential / Number of bedrooms 3 Addition to existing building L~lieplacement ❑ Public or commercial - Describe: Code derived daily flow G` 0 d gpd Recommended design loading rate J/ bed, gpd/flz _ trench, gpd/fI2 Absorption area required 560 bed, n2 5NOO trench, n2 Maximum design loading rate bed, gpd/fl2 •r trench, gpd/ft2 Recommended infiltration surface elevation(s) s~ I 3 ?(0- 50 tt (as; referred to site plan benchmark) Additional design/site considerations S/TE 5viT~(jlE" ~NLy ~*A A!PaGl P 7)~O-=_ Sy5T~~ Parent material SGS Flood plain elevation, if applicable 1V1 n S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = unsuitable for System ❑ S Chi U-go u ❑ s Chi ❑ s ❑ S 19-❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench / 0'/L io y~e 3/3 - /o~tM afsbe'' ~S Cs 3 , S ; ' Z - jo io ye L - f4ft` s/ 1_ Ff5k e Nvt V75-;' .5 Ground 3 - /D 7 '7 7 ~i1+1 (ie J • Y J RIeV 0 "1. A~ L10 scL 2-,*, s~e ~f~ - . y ; •s -01 Z5 41//11 /M I I? Depth to , limiting sy~p S/ factor 3.&-in. 4l 455 Remarks: Boring # -0 /brie 3/3 ~o~}~ /~5~/_' v` C'S Z~ • Ground 14vp /40 -7 Gw fve elev. G /M 3 19 Sc 40 limiting Depth to ' factor Y--in. Remarks: CST Name (Please Print) ~Or i Signature Telephone No. (1 7iy 366- 518 Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure G=ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots / NO 16 YX 5/3 OEM / Bed ;Trench Y 14YAt -~S~j CW 3 'F • q . S Z 0-/7 to 3/y elev. nd 17 -If AO 0? 3 U s ~3.eft. 7.sY,e '4t, &.72- s 5 5^ c ~ Depth to -SO 7-5- x x; limiting f10 actor in. S$,s. Remarks: Boring # Ground elev. ft. Depth to , limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD/ft2 Gr. Sz. Sh. Bed Trench Boring # Ground , elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) L ~ 9 Q o T a A ~ P cn 3 rn m ^ C d y y a d M ~ ~ u> . ~ L~ 2 fi o ~ o ~ fn c o p Il ~ -77 z m m U" o w z lo r, tl 1 I Q ~I 0 n h m o ~ O 3 ~ ' P 1 n ~1 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER f~ ~/UN /S / xnal MAILING ADDRESS PROPERTY ADDRESS ee0hX1 ' is Gy-- ~a 3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE /1' 0 0 Et -t-s 6&r-r -5 Y02-__3 PROPERTY LOCATIONS W 1/4, IV V 1/4, Section T oP- 9 N-R f g TOWN OF W'~M I. h, X 'g 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 afl'ect 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 piration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - loo 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 1~ENKoj s~ o~+/ Location of property .S W 1/41/4, Section T_ p$ N-R-4jKj(a) Township L,),d LkE- l/ Mailing address _ /,',t;t y f{u~y Address of site J AZ #w Subdivision name ~J¢ Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel , Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes VNo Volume -11~14{ and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND 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. .2 ¢ 341 7 , and that I (we) presently own the proposed site or 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. ignature of Applicant Co-Applicant 9-1de 196 Date of S gnature Date of Signature DOCUMENT NO. WARRANTY DEED B~~It 444 Pi~cC S'FATP; ()I' %%ISCONSIN-I~ORNI 1 THIS SPACE ItI.SERVI.D FOR RECORDING DATA 1'1115IN.DEN'1'140" M thi day of J A ~c' l ~f i 1 r~ OF !Cl'. A. 1)., 11) l~ct:~,c❑ j ..t'1 atla Jl,_! 1T ~.,C~?'?>l. .i2 71i: CO., tld~S. ~i of the find pall and Gt--- -----l-~ rrlr r _ iaN f~, I:r LI 1' in :,I the al 1I, RETURN TO t I) r s . r t h, I ii„1 Ih, ~'Iid put - " of the liret part, fur -d in (mv,idcration cl . i c m hand t lul t~ taco! ~ isle t i 1.ud IN the 1),10 of tu' scrond I)a rt, t c rrici1it to i. ) r ul,- , .:n,I I, n,nti l,,la L h.i ncn, f; r.ullcd Lar ;;uncd, sold, n um od, rch-coil, .licnc,l, come)! d and i nulu iu::l, illd I tht x p:i ants du ic,-, I_I.ilit , :I 1, II, nmim" Il Icarc, alien, ton vc)' and (Unhiill unto the -"oil pall, of the -Utl1d 1,.a1 I,uI~ 'Ind 'l ign, h, k, ,l rc d situated ill the COlln(}' Id _alld State ul i x,11 ill, to -tcit: i I i ,I I (if, Nix:E'SSARY, CONTINUE; 1)ESCIZIPIAON ON lu;VLRSE SID!:) 'Fo,ticlhcr •..,h .,i❑I ~iir,ul;ir the hcrcdilamentsand appurtcn.nucs Ihcrcunto hchmcu)t; or m an) \rr~c at,l~.a t,,uun)'; and ail 111l I'll,, I i ht, w l'.• inlLra, cL:i n ill Ild %t hat'occer, (if the said part of the flat part, either in lax\ or equily, either ill p-t-i,tn or c\pcrlanc)• ill "lid Li 11, 1 , lull plcmi~c~' and their hereditanients and aplutrtenmi(c 'fo ILItr "Ild '1'0 11"I'l Ih,..,.'id I>rcmi=c~ a:: ahove described %6th Ilw ll led it:uncnte and appuitcnnncam, wily the _'Aiil I,.irl: „f the ;I --nd '-d t ~ h. .ltd ❑sil;ns I OHI':~'h;R. And the :,.lid I,., heirs, esc•cutols and ❑,Iniiniar.itur., du ,-nccu.uit, i.nit, I, ~i, .iin, :nnl .ip,n I„ .,nd ! 1 ii it i,. •,I l..,i hcir, and a;that at the lintsof the on ,Morn nt ILr~r Ins.--cold d the prcnti=( oboes described, as ''I I ;.u„d, '-Ill 1., pcrlclt, lk"'lutc "Hd illd'!; ild, ,-I.itc I,f inlarit.,mc in Ih ill(' ~anu me fire and cle.lr boil .ill ill, u.. br.uic, M'h I v' l - - - III! ml II i Iii' ni-tom 1 the gale! and pa ucahlc po c- mum f t he ''id pill rd thr c<uull I nt _ hrir .ul,l I I i ul . t.. i.. m lacv1IIl chiming the whale ur Iln --ihtcltclI mt-o l, t N%iI1 1'i~ ~~,t A\ \I It:VI I A i M I 1,M). ~ I In \Vitncoti 11hintof, ill, -id I nt,.: ~ of the flr.5t: part ha _hand nl i , slt,'~I:It .A\11 ~f:ALEU IN PIZESENCI" OF ("I Al.) I~ 'd AL) ! i i S'1'A•I L OF MSC NSIN, tii Q Count}-.