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HomeMy WebLinkAbout022-1065-10-100 Q c o p » ti M ac b -2 .2 V 'O O O p li .O c £ E C Y U O n N ~ U N N Se Q w" y C) O '0 zo O C O n E Cj 30 N O N 0 0 o.= E v C)- O Y c Z N cO N o0 c ~ o E 3 c L 0 C I- N ~ E" 3 M V Z uJ Z = O Z C y co w a co co N N Z _ O O N O 2 d I n v o I to H r n Z N E 'O o 2 ch o ~ 8 j N • N _0 O Q Q o w O Z Z 'o N z W N cC O N M Lo N m CT y lU E 1I d w O CO CD CD d tU H p O O O N p O a .0 ZT N N N 0 0 0 Q o m ul M V1 CU Z LL. F- H F- d _ N N N Z O O O O O O rv m ~aaa a a~ g c 3 0 U J y J U 0) 0) O Z O (1) o N ° N ~ O O ~ E N_ LL m ~ to CL D1 M 'p N d }(tI C N U) O O O 3 5 N C 0 0 d F- U) o c E O ca U O N ow O N M C) 0 Cn U O N C CL 0 0 . CL L tf') M C Y E C N N o (D v ~p C C N w Y CD 4F N E ~ F- N M C >O O en E N U y' O N Y > N O N (n O ~ y 0 a EL L CL • CM CL y .V N y C rr~~ E i C 3 `~1 A V a 0 N V j STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER /I ) r^ G A - J ! ADDRESS f C it SUBDIVISION / CSMI LOT SECTION T ~9?U N-R Ada W, Town of (/7G1( ST. CROIX COUNTY, WISCONSIN PLAN.VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM o 0 O i b 3 ~ ~ INDICATE NORTH ARROW k. Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Q 0 All ALTERNATE BM: SEPTIC TANK / PUMP CHAMB R HOLDING TANK INFORMATION Manufacturer: We$ S c Liquid Capacity: /~DDCJ'' j Setback from: Well House Other t Pump: Manufacturer 6014,14 Model # ?V. Size Float seperation Gallons/cycle: / IF Location r ~ 6vto D r :SOIL ABSORPTION SYSTEM Width: c~~ Length Number of trenches _gf Distance & Direction to nearest prop, line: ~JD(~ tee Setback from: well: House 0 / Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system t Existing Grade Final grade DATE OF INSTALLATI O' ~e PLUMBER ON JOB: LICENSE NUMBER: 3 INSPECTOR: 3/93:jt Wisconsin"Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST`. CROIX Safety and Buildings Division Sanitary Permit NO.: GENERAL INFORMATION ATTACH TO PERMIT 268516 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: J,T X7 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA f7'.9 _ r ^ 2 r_ Q b (mot J;t w TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark S~5 /j,CU Dosing ~SO504, o4(- •~•M• Aerati Bldg. Sewer 9,Ho St/ Inlet TANK SETBACK INFORMATION St/X Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom /a Dosing NA Header / Man. Aeration- NA Dist. Pipe Holdi Bot. System PUMP / INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO CHAMBER Model Number: System: 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.) LOICA I Olv ~.i1gNI1C_~SlNNIDr.2l3 C2 8 '18-41 1- FRIAR c:lACK T 'A rUlE (~CfC.. a (R79! ~vJ C-- r Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH . ' SANITARY PERMIT NUMBER: Safety and Buildings Division 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, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. JCS . Crol-x • See reverse side for instructions for completing this application State Sanitary Permit Number r 2 012-5 The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope y O ner N e operty Location / ~P ll lv~~'+ l 1/4 /I F 114, S a 3 T Nr R E (o Propefty Owner's Mail},ftg,AAd7o' r~ . Lot Number Block Numb ~Q l ~ll L , I -'0, 2 Zip cJe C, ( hone NU) er oO 3~ Subdivision Name or CSM Number Ct (-A II. TYPE F BUILDING: (check one) ❑ State Owned ❑ !t Ne st Road Public 1 or 2 Family Dwelling - No. of bedrooms 0 Toiag of e h t ~^r Qi A j III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Ta v P 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. f,rNew 2. ❑ Replacement 3. E3 Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an ___System --------System Tank _Only Existing System ---------Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requiret~sq ft Prop os d s . ft.) (Gal sa (/sq. ft.) (Min/inch) Elevation 5 c ✓ Feet /iwo Feet TANK capacity VII. INFORMATION in gallonTotal # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New Existing Gallons Tanks concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank > 1A/_) r Cr i W Z° J~C°(G S' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber O l,~ ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibili for installation of the onsite sewage s s shown on the attached plans. Plu ber's Name: (Print) P m s Signature: (NOS mps) MP/ WNg Business Pho Ny e S 4 Plumber's Address (Street, Ci t e, Zig,Cod tj(1A t l S' C l IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing A nt Signature (No t ps) t roved Surcharge Fee) pp ❑ Owner Given Initial ~ 7/~$ Adverse Determination CO DITI'OQN ~F AP V L / REASON~FO~PPROV~ SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Dim-,ion, 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. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume,- elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county,- E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. i • I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations 1101 May 30, 1996 2226 Rose Street La Crosse. WI 5 WEGERER SOIL TESTING 421 N MAIN STREET A' PO BOX 74*` i, RIVER FALLS WI 54022 RE: PLAN S96-40505 FEE RECEIVED: 180.00 WARD, MARK NE,NE,23,28,18W 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. Sincerely, Dennis Sorenson Wastewater Specialist Section of Private Sewage (608) 785-9336 SRDA-7997 (R. 10/94) Page of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE N~ 1/4 OF THE N(~ 1/4 OF SECTION Z 3 , T N, R W, TOWN OF `CC 1 KlW 1Q \t-l IJ 1,1 VC ST- e-ITC COUNTY, WISCONSIN. RECEIVED INDEX MAY 2 4 1996 PAGE 1'of 6 TITLE SHEET SAFETY & BLDGS. DIv• PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION. PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR Zo 18 Tti Fue souv S96 405.0.5 PIMPARED BY 0 *veeNee~WEGEEZER SO I L - TESTING ~S~04Vs`B -wool ' AND - s DES I (3M S~F:zW I CE a i AWRTHU ELF. i ;i F.O. BOX 74 421 K. MIK ST. ',=H' RIVES FALLS. VI 54022 wrs. ~ 715-42`x016 i . ~ ~SIG1sE ~akN~ s-23-q(I JOB NO. 6' l PLOT PLAN Page 2 of 6 ' . Scale 1"= L1 O ' 6 u . 3O ' - - - - - - - - ---1 3 L~96 Z ?A ~voT ~tt~l?CT OR irj c) r3vYNy'! C+F "([LUNCH ~q79 4qo P o IZ.,-L 48 e s • -uj of Z,'' pv c , - ~00.0aN 7 ~}lGb~ 3/c(k 1~! W, QU C PIPE w/ (,k~ • SSoF 4"due F1w , A1" cav~2 0 e°~ c CD s~ ~X N o N(SE , ti~ K P fV'r~Y1A T`PctS~ TE:M Conditionally ROVED APP DIVISION OF SAFETY AND BUILDINGS r, , SEE CORRESPONDENCE 60S. 8q o sNt letwoun QAK Rs~ NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( ? required) 3. Install 4" observation pipes with approved caps. ( 2 required) 4. Septic tank to be \bw AS gallon capacity manufactured by 5. Bench Mark S' "-aG%j ti 6. Divert surface water around mound to prevent ponding at the uphill side. Page 30f Approved Synthetic Covering 1~3~M c 33 Distribution Pipe Medium Sand _ - H ~G Topsoil F Elev. g G- • 0 3 E ~ e % Slope . (Force Main Plowed - Trench of k"-2k" From Pump Layer Aggregate Undisturbed D 1.O Ft. Soil E 1- -L Ft. Cross Section Of A Mound System Using F 0,& Ft. Trench For The Absorption Area G Ft. A S Ft. H I- S Ft. B --)S Ft. I `S Ft. Linear Loading Rate= "0• 'cJ GPD/LN FT U Ft. Design Loading Rate= o.',sGPD/SQ FT K 1~j_ Ft. e Ir ~9 F L q 5 Ft. ^ t Position of Force Main W 7-8 Ft. L , J . ~ -itortee =B K Meier A 5t- - - - - - w Distribution Trench Of 2 - 2 2 Pipe Aggregate I 1 Observation Permanent Markers Pipes (Anchor securely) PRIVA Con j%c nally " APX VE Oc and Using I Trench For Absorption Area ~`'~DIVISi0 4 01' SAWY AND BUILDINGS P \l oz- .ALE CORRESPONDENCE Page L Of Perforoted Pipe Detail 0 End View Perforated End Cap. ~`o~`` PVC Pipe l _ ~ as,~ Install permanent-marker, at end of each lateral Holes Located On Bottom. 'ore Equally Spaced Q End Cap d PVC Force Main * I Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe- Layout P 36. Ft. 3U PRr%; F,' f SevVAGE SYSTEM X Inches y 30 d Inches oil 1,tl®1~ally Hole Diameter 114 Inch D Lateral Inch(es) P mpft 2 KOVE r, Manifold Inches INGS i)IVIS10N OF SAFETY AND BUILD Force - Main Z Inches # of holes/pipe 5 SEE CORRESPONDENCE Invert Elevation of Laterals 99-S Ft. 1sx-1- 1- V-)-Ss X 2.= :ml CP++j Ll Place 1st hole \Sfrom tee with succeeding holes at 30`' intervals. Last hole to be next to the end cap. - Combination Septic;Tank and PUMP CHAMBER CROSS SECTIOM ARID SPECIFICATIOIJS ' PAGE S OF -VE►JT CAP WEATHER PROOF JuUCTI0IJ 80X . 4'C.I. VELIT PIPE APPROVED LOCKIMG 10' FROM DOOR. MAQHOLE COVER wi'M 4IMDOW OR FRESH u-'AttN1NG L.I4eEL. ALP, IWTAKE Cor~putT ~ 9 I 6RA I 4' 1AI M. I6' I"11IJ. 18~/'l I AI. PROVIDE I IAILET AIRTIGHT SEAL I III I III ~RFFL~S A I i ! I APPROVED JOIW1 APPROVED JOI T $ $T I I W/C.I. PIPE-~Ka w/tg construction I it ALARM p pridel comply with ' I I I . '3.15 and 33.20 e la I I oIJ p GS p $UILDIN ELEV. °►1~-°!Z. FL P --j p PUMP -1 OFF ONC1. CONCRETE • T S G~~R P Nd , oo DLOCK g 13"_APP%Zc RISER EXIT PERMITTED OAJLy IF TAWK MAMUFACTURER HAS SUCH APPROVAL. UDDINf SPEC.IFICATI0k1S SEPTIC f TNSNK MA►JUFACTURGR: MID1~~~t'SZN 1~'-►? 3T WMBER OF DOSES: 3'$9 PER DAy TAWK SIZE: SO GALLOIJS DOSE VOLUME r 5 t~~ S~S7~'1 S INCLUDING BACKFL.OW: I GALLDNs ALARM MANUFACTURER: MODEL WUMBER: `DL 1~ CAPACITIES: A= I23 INCHES OR GALLOWs 3WITCH TYPE' ~CQC~~Z `1 B= I IWCHES'OR 3t _ G(LLOMS PUMP MANUFACTURER: C= -7 INCHES OR 11 GALLOW5 MODEL WUMBER: 3a"1~ D- 1 INCHES OR A") GALLOUS Y`'1`2CLn~-~( MOTE- PUriP AND ALARM ARE TO bCb SWITCH TYPE: _ MIL11MUM D15CKARGE RATE 3 S' GPM INSTALLED-OM 5EPARATE CIRCUITS \(ERTICAL DIFFEKEWCE BETWEEU PUMP OFF AIJD..0I5TRIBUTIOLI PIPE.. FEET + MIIJIMUM METWORK SUPPLY PRESSURE . : . . . . . 2.50 FEET -I- Z-~ FEET OF FORCE MAIN X 2'4ZYoFLFKICTION FACTOR. 6'49 FEET TOTAL 0 JAMIC. HEAD = -FEET Pump chamber DIAMETER - 38 ry IWTEKLIAL DIMLWSIOLI OF TA►JK: LEKI&TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = \~1 0 GAL/INCH b S Ubmersible MODEL. 3871 SIZE: 3/4 SOLIDS Effluent Pump RPM: 1550 HP: 0.4 METERS FEET 8 25 7 a D w 6 20 v' U a 5 S ° z 15 } 4 D J ta- 3 10 O 2 3 5 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY CQGOULDS PUNS. INC. SEWrA FAILS NEW'CRK BMS Effective October, 1988 01988 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. Wisconsin Department of Industry, SOIL AND SITE EYWO"AT)M EPORT Page of 3 'Aor and Human Relations Division of Safety & Buildings in accord with fLjHR 8 05, WIS.1dta e r ! COUNTY Attach complete site plan on paper not less than 81/2 x 11 jnches insize. Plan 'must •irlglud i S~'. C 0 t X not limited to vertical and horizontal reference point (BM), direction and'% of slope";,scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest'•road. ~Pv ,r APPLICANT INFORMATION-PLEASE PRINT ALL' ,"'MAMN REVIEWED BY DATE PROPERTY OWNER: )?gMRTY, N ~ ITV l D if lvb St=a,),-f" 1/4 NE 1/4,S Z 3 T 2 8 N,R 18 E PROPERTY OWNER':S MAILING ADDRESS ` LO OCK # SUBD. NAME OR CSM # 50 5- LZL~113 ST. t'U-oP03kM 0- S" CITY, STATE ZIP CODE PHONE NUMBER 4CITY []VILLAGE OrOWN NEAREST ROAD PZR__*aldr'-n w~ S4oZI (-)IS) a6z_ S61Z t- kMQ\c~.INN1c 4e%40UdF6RR pQ New Construction Use [kJ Residential / Number of bedrooms q (J Additigq to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow b 'c413 gpd Recommended design loading rate ° • y W. gpd/ft2 trench, gpd/tt2 Absorption area required SoO bed, ft2 S o o trench, ft2 Maximum design loading rate o - S bed, gpd$ 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) q9_0 ft (as referred to site plan benchmark) Additional design / site considerations I"toOK-)D tv / 6'K 8y' B QD . M) N , t ' 0 F S )MC) 1=4 (L• Parent material V-3t CEHEWTtS*_'~ S N JAS TQPQ t Flood plain elevation, if applicable N • A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S o u 0S ❑ U ❑ S ® U ❑ S ~1 U El S [Z U ❑ S Mu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisterice Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench x{ 0-y vz 4 v- -5 L - 1s ~-3FS \0 12 4// - S ~CSbrz `n1U ~.S o-S o.6 Ground 3 3$-SS `I [Z l Z . S ti IZ 5 /gp ~S O ti-t `n►,~ V _ - elev. 98.8 ft. 3 2 ~,ST s L - C S ` Depth to limiting factor 3 ~ `r Remarks: Boring # : -y \o~~ 3tz `S \-~sb►~ a,S _ a.-I a ti Z h # 2 L4 314 1" R vj6. ~g \ C S b lz Wt u jIl,_ 3 sb t o~ R 1 ~~•sy R s/~ ~s oVVj wtv`~~. - Ground elev. 3 w c_ C S p S1-o KAZ I KJ iz~ C13 A ft. Depth to limiting factor 34 Remarks: CST Name:-Please Print Arthur L. W e e r e r Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: 9S-31,13- ~ Date: 1 Z~-qS CST Number: M00 5 7 6 Y PROPERTY OWNER ~lT "IZS SOIL DESCRIPTION REPORT Page Z-.0f PARCEL I.O. # GP D/ft2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed d Trer Ej ICSbk mvi~ cs o.s o.6 Ground 3 31-3 9 1 y \Z 7 l `~S C, N 1#I U i- C g - O- S I, elev. ft. y 3 9 -~t $ l 0 `1 R ! • S R S M C:~ I.-, Depth to w L "bvt `TLl7 S 1V fU limiting f3°I Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ter:. ':M::..: i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: 6Rr)-8330(R 05199) PLOT PLAN Page 3 of 3 SCALE 1"= y O ' 6 u . 30 rasr cQnv rrc r OR ~,3 N LqG 7 IN 3U `I-HS RA~R it ZOV' N L- M-emVI cF 'fib 9 I Cam-. °l 9.0 ' WV , d.l mil, °t8 $ I V°/o 31gk ton'. QvC P!pE ►U/LJVY7+. w4 I i I U) y _ 1 ~ I I~~v ~ tw C o N s gt~c~ Lw e 1 . ~ L -t-~oi,s~ 1o QF .1'rT .C.._~m=s 1T Z S ~'tZ.0►y t"~U~jvD _ ~P r 605.8q a o . 3 S M If lb) s!} ~R t,~ oon l -U Sz IZ-CST' ~1Z~ u oNYz R-vhD ~1S-3V3- i 715 ) 425-n1 n5 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 8 a_Wis. Adm. Code r COUNTY z s K, S'1-. C'Z.O l X Attach complete site plan on paper not less than 81/2 x 11-};°size. Plan must de, but not limited to vertical and horizontal reference point (BM)/d retffon and % of slope, she PARCEL I.D. # dimensioned, north arrow, and location and distance to ~i e'st rood. ~V~' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. ~ REVIEWED BY DATE PROPERTY OWNER: PROPERTY1 N 1/4 Nf 1/4,S Z3 T Z• 8 N,R ! S E (ot W~ PROPERTY OWNERS MAILING ADDRESS- ; # # SUBD. NAME OR CSM # S s.--~~~,,, CITY, STATE ZIP CODE PHONE NUM IL AGE MOWN NEAREST ROAD PZf;`S~Tfit wI SvoZ1 (-)Is) tvlClzlti)l~lC QQ New Construction Use I Residential / Number of bedrooms q [ ] Addttign to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow b Z 0 gpd Recommended design loading rate o • Y/ bed, gpd/ft2 - trench, gpd/ft2 Absorption area required Soo bed, ft2 S Q~ o trench, ft2 Maximum design loading rate o. S bed, gpd/ft2 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 0 ft (as referred to site plan benchmark) Additional design /site considerations "WK-10 W/ 6'3-Sy' 8ND . MW , I' OF SMAA~ FILL, Parent material W ~ArYc~.~( CkEmEWTtg~, S A M~SlUR1 L Flood plain elevation, if applicable N • A - it S = Suitable for system CONVENTIONAL MOUND "ROUND PRESSURE AT-GRADE SYSTEM IN RILL HOLDING TANK U= Unsuitable for stem ❑ S W U 0 S ❑ U ❑ S O U ❑ S O U ❑ S IZ U ❑ S all SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerlCh t _ 1 0-y 1p `ttz- -3 Z - is ~b my ~h O's - o.-t o 4< Z 3 b \ 0 `1 (Z 4/ / 6 - ~S CS ~lrz V ~t S - S o. Ground 3 3$-S$ b'1 (Z l Z . S 4 2 S /P, 'tS O vv~ V - elev. 99.8 ft 3 2 ~,STs L E~~h 1 - w L C S Depth to limiting factor 3g'r Remarks: Boring # NOM 1 o-y to`t1Z 31Z - 1s 1`F sdk v+1v~►. a S _ o.-~ 0.8 Z Z L4 3y I" tz vA. ~'S l C S b1~ rn U J1,. c S _ o. 5 0. ~ 3 LI Sto 10~ R-7 I . S 'j R S ~s o w, v`F1r - Ground elev. 3 w C S p S't-O tvr; I K1 q11 - 9 ft Depth to limiting factor Remarks: CST Name.--Please Print Arth-ur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Si nature: Date: CST Number: GS-3y3 - J l l- Z?-qS M00576 . PROPERTY OWNER S SOIL DESCRIPTION REPORT Page ?-of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends o_ s toy-t~Z 3IZ ~s 1`F5b~+'~►- a.s o.i~ Z s- 31 tio`~ Y!3 - ~s 1 c s b k m v'1- c s 'S o. 6 El Ground 3 31-3 9 10 \2 7 ! ~s vh lnt U C S O_ S o, b elev. LL-1 ft. y 3 9 -4 f1 10 7 IZ '7 ! . S `i R s ~ O wt V ~h - Depth to w L, "W) S tirJL ti limiting f3q Remarks: Boring # i • i r3 Ground elev. ft. Depth to s limiting I factor i Remarks: Boring # t • •c;,~ha i Ground elev. ft. i Depth to limiting factor Remarks: Boring # s ti i Ground elev. ft. Depth to limiting factor Remarks: sgn•81, O(R OSW) PLOT PLAN Page 3 of 3 I L e-j SCALE 1 q O ' 6V .30 m IvoT CUY►Pt?cT ()R - - - - - - - - - - - ~ 3 ~oi6 7 1J 1g7U R.S `i~F•1 S P11t~JA (A it toV' r1 N a19 I ~ • °t Q.O ' wV' C3.1 ~'l, q$ S w0' 3/c~'` L111~. pU C P 1 PE w/ LJ~`R} . I I f r G CP (1} 1 %p N t S~T'~BftC•ht. Ll/~J~ V I - - - - - - ~Eous~ 1a Qh I-)-T .l._Lc*s r i s F:ftom m iwp~ D R r 60S. 84 1 X0.38 Mj 770 , s~r\~c.►ouQ 1=v~2csr ~tZ~U~ o Ariz ~ Q ~1S-3~l3- l!-. (715 425-0165 M00576 CST Signature Date Signed Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1 MAILING ADDRESS C' PROPERTY ADDRESS s! ! i I m-C-k k. (loc tion of septic system) Please obtain from the Planning Dept. CITY/STATE F l h~ C 1 f(w PROPERTY LOCATION 1/4, 1/4, Section T N-R W TOWN OF ~C r,~h 1 Ct 1~r y~ i1 f C ST. CROIX COUNTY, WI SUBDIVISION ~I~ • LOT NUMBER CERTIFIED SURVEY MAP, VOLUME !L, PAGE LOT NUMBER Improper use and maintenance o 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 ye exp' tion date. a 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 ( C: C Location of property l~l 1/41/4, Section T N-R W 1 r C Mailing address C ~ T`-, /PI/ S Townsh' p h ryJ/11, ~l J ~'A Address of site 3 ~rt C id ~t F Subdivision name -Lot no. Other homes on property? Yes No Previous owner of property e fie /6-s Total size of property Total size of parcel 5 Date parcel was created . Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ? Yes !k- No Volume and Page Number cq/ 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 t e office of the County Register of Deeds as Document No. 1 , 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 o e of the County Register of Deeds as Document No. 'r~~ Yy . ignature of Applicant Co-Applicant ~//o l Dat 0 f Signature nata of Cinnat„ra . a • • 'cry 546 (1i , STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. VOL R89 p PO 01_ - - - REGISTER'S OFFICE Maiden, Inc., a Wisconsin Corporation, ST.CROIXCTY.,WI Seed {or Reeard J U L12 1996 conveys and warrants to Michael J Ward and Sally E. Ward, at 8:15 A. M husband and wife as survivorship marital property,,,.,,-k 04i k. Register of Deeds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, State of Wisconsin: EOUIT'Y TITLE SERVICES 400 SOUTH SECOND STREET HUDSON, WI 54016 022-1065-20 PARCEL IDENTIFICATION NUMBER Lot 1 of Certified Survey Map filed June 6, 1996, in Volume 11, page 3118 as Doc. No. 545925 being a part of the North East of the North East Quarter (NE1/4 of NE1/4~ of Section Twenty-three (23), Township Twenty-eight (28) North, of Range Eighteen (18) West, in the County of St. Croix and State of Wisconsin. This is not homestead property. )OM (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of A.D., 19 qrs MMa' en Inc. (SEAL) BY • (SEAL) ' David G Peters (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, 'Signature(s) ss. St. Croix County. lob in T>--rally rnmv hefore me this day of - ) - i l1S~~, ~ /U dt_. h h s 0 s` ,I~ Ca eke a UIV 2 XnrIIcEEN 61996 r Z R~DLSENl pWACsif 9 SC CroixC0, WI 545925 CERTIFIED SURVEY MAP LOCATED IN THE NE-NE OF SECTION 23, T28N, RIM TOWN OF KINNICKINNIC, ST.CROIX CO., WI. I PREPARED FOR: DAVE PETERS N SECTION E CORNER 23OF .V.N RLAT.T.ED-LANDS. (COUNTY MONUMENT FOUND) NORTH LINE OF THE NE-NE S 89026' I 'E 678. 63' iLl BEARINGS ARE 329.41' 349.22! REF RENCED 70 THE EAST 316.22' : 33. ' z LINE OF THE NE 1/4. (RECORD BEARING). 33 3 HIGHWAY SETBACK LINE yl y y 2 8 rnI ° LOT 4 L OT I el ° 5. 00 ACRES w 5.02 ACRES ( 217, 585 SO.: FT. OI UNPLATTED...LARDS (2I8,798 so. FT.) 4.54 AC. EXC! R/Wn;lcb m ( 187, 657 SO. FT.) rn w A ~ I ch o co I AREA OF DEDICATED ROAD 1.80 ACRES S 69°47' 04"E I•. y. ( 78,274 ..50. FT.) , HIGHWAY SETBACK LINE .::ezx.. 91..31 7• • 18. 13' 33.20 g © 0 3 - iI n ~gg~~~ 0 0• 351.33 cry '1 ~ Y 307.95' ° . 659. 28' : © ® 66. 40~ ® 88337 OW 8Q io DED 1 CATED S 83° 37, 5 • W 651.97 I i 344.55' 33.2 m ' ro JUN 2 6% N 69°47' 04" W 307.39' 311. 38' 4 Q 01 8 91:31 tu m §T. dRO1X-60UN1iY • • " " Comprehensive Pie"* Z Zoning m d s g I~ Parks Caws $ LOT 3 o L OT : 2 UNPLATTED LANDS w 5.00 ACRES 5.00 ACMES (217,751 SO. FT.) - v if not _ ( 2 17, 765 SO.jFT.) within 30tav%of 4.50 AC. EXC: R/W °f- approval daft a ( 196, 185 SO.:FT.) NI 11I IMpprovz1I b* (b $ O null, & V616 ° ~ rriI 33 33' SOUTH LINE OF THE NE-NE 309.50' 33. 00' _ _ _ 366.10' 342.50! N 89041'25' 708.60' Z C. S. M. VOL. 5 Ct.S.►.Mr.. N E I i4 CORNER OF p SEC. 23 (P. K. n l I ) _ . _ Ald 11 F!)IIAIA) -n~~