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HomeMy WebLinkAbout022-1065-10-300 a ) o r,. O e» 0. r_ r I r. I °o N c i z C E r- x v ~ O ~ I CD ~o I ° Z 0 'O c -Fo O U. c in U. C O -C C) a I 3 Cl) ~ N z N 0o Z O z y y 00 m N W d CO N I- z _ ~ o y - c C9 ~ o z w d Z j z N N E! N ~ I E p ch E N m c • ~ '0 V O p a a z z o N E CC) d ~ -°c I N Cl) to L 0 CL M « Y M d i O O O D d nl E m C-4 a o N N N 2 v w o Z cn > a U) z o 0. CL CL CD (o fp J U rn rn N Y r E rn ~1 J O N O 7 0 0 L N ` n n a N N N m a } 16 U- 4D -ra ~i C N y O O 3 i. CO N C y O O O E N CO Lo a U Y+ Cl) C N c c N -'r m 06 C Y co - am N c^ N O O O W U O w a) a) ~ L5 v1 m m CO U y~,~' O N Y Y N O N"R 2 U) O l CQ V w m a L a. w O N 7 3 O O A v a m 0 in C~ - 1 U O C i a o a I o I N ti I ~ i v I I I = Z I li c 3 :p I a z a E o c , ~n c a m D U) o , oza c c~ 0 Z a 2 w o M d N 7 N ~0 CL L) C C Y 0 l6 z F- D z C-4 04 y E N ` m m 75 a a c M 3 0 o a` a a~ o z m LL O a 0) 000 z° >aaa a •1~1 a m (D m o ° 0) 0) o tq J U o ° Z o I Z 3 0 00 a to cm ti m Q z iA m a Cl) ` N N U 0 W c O p (a0 ~ C 0) - 0 0 V L A N c a 0 0 M O N N ~O y c6 Y C co O N C 00 C ao y c y n rn l N N C L N ~6 L 04 U) ~O O Y U N O Z c z r2 fA v~ a 5 a d o 2 d = 0 o 4z (3 CL 2 0 V) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~'e l~i.~ ff re /~e~ ADDRESS SUBDIVISION / CSM# --?/0/ LOT SECTION T2_N-R fW W, Town of d/~ ti r' r ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G C e tv t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: _S_',t ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~~G~ Liquid Capacity: /~QQ Setback from: Well 3S ' House Other Pump: Manufacturer ~Y /yj~~Jy~'y`odel# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/.Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: j - PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT S-11. CRv.~ (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 26,083 5:U3 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: KRELLER, aU-A,lis Y~ ris1a.azisii l~ CST Tlev.: Insp. BM Elev.: BM Description: Parcel Tax No.: , l -I C~ 14 G , TANK INFORMATION ELEVATION DATA " TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 142.1- UDC. CiG rt- /610-0 Benchmark Dosing. 1/ 01 q, 7 Aeration Bldg. Sewer 7_ qp qa~ 75 Holding St/ Ht Inlet Zia j qj. 9 5 TANK SETBACK INFORMATION St/ Ht Outlet Vent irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Ar Septic >/pr 7 J T,2 S NA Dt Bottom /~•t'v~ 9c_,~ ) ` Dosing /0 v S 2. I' 17S NA Header / Man. , Aeration NA Dist. Pipe Holding Bot. System 171 7' R, 7/ r PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand GPM Model Number I TDH Lift Friction Systerl S TDH j4Ft oss me ad -7 ' Forcemain Length JG/ Dia. Dist. To Well 750 SOIL ABSORPTION SYSTEM BED/TRENCH Width f l Lengt~ S , No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O CHAMBER Model Number: System: >(b ' N OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) „ x Hole Size Tx Hole Spacing Vent To Air Intake 1 t t~ ~ Length Dia. Length ~ Dia. J Spacing ~U du i. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over , Depth Over xx Depth Of 1- xx See ed / Sodden"` xx Mulched Bed /Trench Center I Bed/Trench Edges0 ) Topsoil - Yes ❑ No 3o"Yes ❑ No r COMMENTS: (Include code discrepancies, persons present, etc.) n- A ia.d'f m 7V 1V : %.L 1Y i 41 1i11Y 1. . el el Q O Mf y V4 ~ y 1 L y 11 . s..&..ZISI . L k_1% v r ~u r 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: Uh S/1A77 G Safety and Buildings Division v=`~n 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 8 112 x 11 inches in size. .5i~. Oro f )iC • See reverse side for instructions for completing this application State Sanitary Permit Number &4?5°3 The information you provide may be used by other government agency programs ❑ Check it revision to previous 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 t.e ee_114,WXr114,Sg& TQF,N,R F E(o Property Owner's Mailing Address Lot Number Block Number City, State 'Of Zip Cod Phone Number Subdivisioonn Name or CSM Number AV (Z I 15-lorl-10V ( ) s An II. PE F BUILDING: (check one) ❑ State Owned o qty vilae Public 1 or 2 Famil Dwellin - No. of bedrooms O Town OF N ,cl` 6[. 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) d'a2 - !e rd ~3Dd 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..W] New 2. ❑ Replacement 3. ❑ 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) ~dQ. o Elevation T~ 1/175 e Feet 3 Feet VII. TANK Caa in 'al Ions Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass [Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank l~ r~ S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber C A'! ~C .tf0 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (MP PRSW No.: ~j Business Phone Number: Plumber's Address (Street, City, State, Zip Code): C 6' r~ ~ l IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sarytary Permit Fee (includes Groundwater ate ssue~ Is wing Agent Signature (No Stamps) pproved E] Owner Given Initial Surcharge Fee) n C~ Adverse Determination / / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber k INSTRUCTIONS s Y 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. lll. 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 i. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) 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. SAFETY & BUILDINGS DIVISION . State of Wisconsin Department of Industry, Labor and Human Relations June 25, 1996 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S96-40577 FEE RECEIVED: 180.00 KRELLER, KELLIE 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. Since ely, rard M. Sw m Plan Reviewer Section of Private Sewage (608) 785-9348 6054R/ 1 SHDA-7997 (K. 10/94) e r S9fi-4 f 6 MOUND SYSTEM : FOR RECEIVED A 3 BEDROOM RESIDENCE J U N 2 4 1996 SAFETY & BLDG& mv. LOCATED IN THE N E 1/4 OF THE N E 1/4 OF SECTION Z 3 , T~ 8 N, R l n W , TOWN OF 1N)v l0- 1 -/Aj.► 1C , ST• CRQ C X COUNTY, WISCONSIN. INDEg PAGE 1'of 6 TITLE SHEET PAGE 2 of 6 PLAT 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 _ 1~ k'Ik~.O)vl~. ~ k~ l 5 ~ 015 PREPARED BY Loh, WECCEF;ZEF~ SO I L. - TEST S NG ~ ~0.41~ AND . DES = GW S~RV I CE jv i i ~ ~ AF1TFtUR L. ' WEGEr:._A. { F.O. BOX 74 421 K. WAIN ST. s 0-1 F • gl&WOkTH. RIVET FALLS. NI 54022 a w~. sIGIA 6-Z1-9~ JOB NO. 6 b PLOT PLAN Page Z. of ~o ' Scale 1"= q~ ~ S96'- 40577 ~r- ><v o`rs' w~t,L Zo 3E ~N'R s r so Ftzo►~t w-► ov~v~ a ' ,K-T LMST -2s, !=,z M 1'r~~vizs ,,AA NBA'/ • en, Q,6~ 4' Z 5' G~ _ Z 5' S Oo >voT co►" lPl} T s OiL DlS1vRQ Ts+~s ~2~A 1 ~ I~► I to or- 4 4vc 1 a1 1 SP i o I ~ 1-1foF 2~Dv C u1 I Q' ~ d I B.3 ZS, El.. °t 4 6 z s CANhu12 ~'1-, q~..p' I BuT. aF ~-t~c,N E'Z- . 1 o 0 . (3 1, _c>> 3 ~s r~e,c..~ ~?rriZ e~2~ ~ 6 1S-78 i 36 vq.1 )-o ofN\rl- %Z-QPVD S~t1Zwo~~ ~Z-esT ~i 1Z. NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( z required) 4. Septic tank to be \OOO 6 So gallon capacity manufactured by 5. Bench Mark L'z. l 00 -0I mA3 'M 5' of ? It kflCH , 3jV" p/11 . pU.C alPe w/L ft-rA 6. Divert surface water around mound to. prevent ponding at the uphill side. Page 3 Of Approved Synthetic Covering t~sT*-i c 33 Distribution Pipe Medium Sand H ~ Topsoil G F Elev. V130-0 I~ E p - 3 b Z % Slope Force Main Plowed Trench of -2 2" From Pump Layer Aggregate Undisturbed D ~•a Ft. Soil E 1.1 Ft. Cross Section Of A Mound System Using F 0J6 Ft. 1 Trench For The Absorption Area G N • o Ft. A S Ft. H i- S Ft. B --)S Ft. I `Z Ft. Linear Loading Rate= 6,o GPD/LN FT g Ft. Design Loading Rate= 0-3.~;.GPD/SQ FT K 10 Ft. L qS Ft. P,I te..^.- te Position of Force Main ~a W I S Ft. L d ~ Foree, B K Msia A ~c- :rs W i" Distribution Trench Of 2 - Pipe Aggregate Perm1 Observation MarPipe s ' (anchor securely) Mound Using 1 Trench For Absorption Area Pi3ge Of Perforated Pipe Defoil End View Perforated End Cop) PVC Pipe i Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cap Q ~-t * PVC Force Main i Distribution Pipe Last Hole Should Be Next To End Cap Distribution Pipe Layout P 3 S Ft. X S Inches Y S Inches Hole Diameter "Y Inch Lateral Inch(es) Manifold Inches Force Main Z Inches # of holes/pipe a Invert Elevation of Laterals Mb.S Ft_ gX~•l1. a•3bS~ Z_ 18.~z GP►~ Place 1st hole ~a4from tee with succeeding holes at 5 6"intervals.. Last hole to be next to the end cap. Combination Septic- Tank and PUMP CHAMBER CROSS SECTION AUD SPECIFICATIOkIS, PAGE S OF -VEIJT CAP WEATHER PROOF JuIJCTI0IJ 90X 4'C.I. VENT PIPC APPROVED LOCKIFJG lO' f ROM DOOR. MAIJHOLE COVER wl-W -.huDoW OR FRESH u-'A(tN11J~. L.P.BEI. Atp, INTAKE r,~o \T s 1 ~ 1l PROVIDE I IAILET AIRTIGHT SEAL I I I ~ I III v sgFFLCS I I APPROVED JOIIJTS APPROVED JOINT I i I w/c.z. rlrE, WIC.-J. PIPEOR Tank construction _ I III ALARM shall comply with I II ILHR 133.15 and 33.20 e I 1 ow C ~~•9z CLEY...-_ FT. PUKP -1 OFF D Cow- ETE LsL g B . 0 0 , CLOCK 3" APPRovc[ RISER EXIT PLKMITrED 0ML'J IF TANK MAJJUFACTURI~R HAS SUCH APPROVAL gEDpt SEPTIC SPECIFICATIOKJS f _ TASWK MANUFACTURER: F'll~l~t?51~~1\1 IJUMbER OF DOSES: ~'$1 PER D" TAWK SIZE: )Af i 1 650 GALLOWS DOSE VOLUME r l,q• S. . I;L SKZ S IWCLUDIIJG BACKFLOW: 6ALLOMS ALARM MAIJUFACTURCR: MODEL WUMBER: HW CAPACITIES: A= 18 INCHES OR X00 0 GALLOAIS 3wITCH TYPE' QN-1 elu 5= IIJCHES'OK Gj►LLOU5 PUMP MANUFACTURER: Cu C- RUCHES OR GALLOUS MODEL UUMBER: S-7 D=_ I--INCHES OR GA4LOWS 1"1~1ZCEJ1~-~' IJOTE: PUMP AND ALARM ARE TO Dtb SWITCH TYPE: _ MIMIMUM DISCHARGE RATE Yi'21 GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWCEIJ PUMP OFf ALID.DISTRIBUTIOU PIPE.. 1\•S13 FEET + MIAJIMUM METWORK SUPPLY PRESSURE . : . . . . . . . 2.50 FEET + » FEET OF FORCE MAIN X y`- 6 F 00FEFKtCTIOLI FACYOR-. O' FEET TOTAL 09UAMIC HEAD = ZI -FEET DIAMETER Pump chamber . It IMTERWAL DIMEWSIOW~ OF TAUK: LEW&TH -,WIDTH --~;LIQUIO DEPTH 3= BOTTOM AREA _ 231= GAL/INCH AS PER MANUFACTURER = GAL/INCH . - _ ~s~ b of 6 4% 6% - HEAD CAPACITY CURVE 4v° W "57" - "59" SERIES - *4 111 ~ s 5 _11h-111/2NPT 16 6 20- U 15- )y•Z/ z } 4 gu/~s D J Q F 0 10 $ .Z Z 33/32 -f 2 5 TOTAL DYNAMIC HEAD/ FLOW PER MINUTE EFFLUENT AND DEWATERING HEAD CAPACITY UNITS/MIN 0 FEET METERS GAL LTRS .us 10 20 30 40 50 5 1.52 43 163 GALLONS 10 3.05 34 129 LITERS 0 80 160 15 4.57 19 72 FLOW PER MINUTE 19.25 5.87 0 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS . Piggyback Mercury Float Switches a Available with special cord lengths of 15', available. 25', 35' and 50'. *Variable level long cycle systems *Alarm systems available. available. a Duplex systems available. Standard cord length - automatic 9 ft. SELECTION GUIDE Standard cord length - non-automatic 15 ft. 1. Integral float operated mechanical switch, no external control required. 2. Single piggyback wide angle mercury float switch or double piggyback mercury 57/59 SERIES Control Selection float switch. Refer to FM0477. Model VoHt-Ph Mode AMPS x Duplex 3. Mechanical alternator 10-0072 or 10-0075. M57/59 115 1 Auto 8.0 1 or 1 & 7 - 4. See FW712 for correct model of Electrical Alternator, "E-Pak". N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10.0225 used as a control activator, with "E-Pak" D57/59 1 Auto 4. 1 or l &7 - duplex (3) or (4) float system. E57/59 230 1 Nov 4.D 2or2&6 3or4&5 6. Four (4)hole"J-Pak", junction box, forwatertightconnection orwired4nsimplex or 2 pump operation' ,10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice, l0-0003. 57 Series - Wt 27 -.3 H.P. 59 Series - Wt. 29 -.3 H.P. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, AplnsfalyUonofconkok,probeUondevices and%*kgdoildbedone byagwllfle l FM0514. Piggyback Mercury Float Switches, FM0477; Exectrical Alternator, FM0486; Mechani- ekctrlgan, AN Naetrlcel and safety codas sM W be followed MdudhV the cal Alternator,FM0495;AkmlPackage. FM0513;Sump/Sewage 8asirls,FM0487;and Simplex most mood National Electric Code (NEC)and the OxupatlonalSatNyand HgMhAct Control Box, FM0732. (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Lou SPOT, KY 40256-0347 Manufacturers of... O SHIP TO. 3280 ON MHers Lane OE~~E~ Oi Lofdsvllle, KY 40216 r~p a (502)778-2731-1(800)928-PUMP Q 4W-Y )44" SNCE 1,9JJ FAX (502) 774-3624 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations [vision of Safety & Buildings in accord IL Ali .d5,/)FLis~Adm. Code COUNTY Attach complete. site plarti on paper not less than 8 1 t4' incl)0 ip<s[ze Plan mt ,isi ludo, but PARCEL I.D. # not limited to vertical and horizontal reference poin , c ire6t'on qod % of,tiope,` *1114 or dimensioned, north arrow, and location and dista a o;rnearipist read. j' fi APPLICANT INFORMATION-PLEASE PRI D41. INFOR'MATfON REVIEWED BY DATE PROPERTY OWNER: P ATION , 10 PtV l D Y- ljb St~1J` ( ~L r N E1/4 NE 1/4,S Z3 T Z$ N,R P S E(0 PROPERTY OWNER'.S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM # 50 5, ZL.wji ST. " : p~pos~ c S r-I CITY, STATE ZIP CODE PHONE NUMBE F~Q~3Q~Q~QWJLQ []VILLAGE MrOWN NEAREST ROAD naQ-Es CiSM w[ S140Z1 (-)is) z6z_ Solz 14M40bt> P6f,'Reyfl p(J New Construction Use [A Residential /Number of bedrooms q [ J Addition to existing building (J Replacement Public or commercial describe Code derived dally flow b 0 O gpd Recommended design loading rate o _~J bed, gp02 trench, gpd/ft2 Absorption area required Son bed, ft2 S o o trench, ft2 Maximum design loading rate Z) s bed, gVW 0.6 trench, gpd/9 Recommended infiltration surface elevation(s) l 00.0 ft (as referred to site plan benchmark) Additional design / site considerations 1-1 %,\j N,% w/ Y- 6 3' L3 Z t> Y-1 IYU . I ~ Gj:! S r, ►,A3 F/ L. L. Parent material W~Ar~Ct_~f Ct;`l~fTl~ S P~I~n~SlU~1L Rood plain elevation, if applicable • R • ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM W FILL HOLDING TANK U= Unsuitable for stem ❑ S W U OS ❑ U ❑ S ®U ❑ S 1~1 U ❑ S IZ U ❑ S NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourriaty Roots GPD/ft Boring # Horizon in. Munsell QU. Sz. Cont Color Gr. Sz. Sh. Bed reach OL- Z 3-3 S 10`f (Z 316 `~S I C S bk tin V'~i- c S d S o• Ground 3 33Sb t b 7 2 WL c S ti 2 s18. ~S ovn elev. q 8 It. w *o- C -:~U`-VD hi (-:71 WQ ~p L c Depth to limiting factora Remarks: Boring # 0. 0 7 o t 0.3 lo~1 Z31Z Is ~sl~►~ W1 vi►- s z- ` Z 3-3z 10y2 31(0 - S CS b)r vn vii,- Cg o. 5 o- 3 3Z-V1 vo\j R Wt c S y fL S/g ~S C~'^^ m v-~>^ Ground elev. 3 WT+•t S G~ I Iv L-~ C 98-S ft Depth to limiting factor 3 Z' - Remarks: TName.-Please Print Arthur L. We erer Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number. 9S-3V3-3 11-z7-C M00576 PROPERTY OWNER ~TCS SOIL DESCRIPTION REPORT Page 2 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDlft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench El 3`~s Yn v ~ 01-S - Z g-33 10yR316 `nFS ~es bk V)U'f~ C5 Ground 3 33-SO t0`1fZ `A C Z 5 `i R S/U 1'S C~ elev. S 11 Pv iAu h~F q~ft. 3 w n S Pr KA' Depth to limiting i factor3 „ 3 i Remarks: Boring # i , i 13 Ground elev. ft. Depth to limiting i factor i , Remarks: Boring # i : Ground elev. tt. Depth to limiting factor i Remarks: Boring # f Ground elev. f t. Depth to limiting factor 7-1 Remarks: SBD•9330(R 05/92) PLOT PLAN Page 3 of --3 SCALE 1,,= yc ' 1 o v s C? `co B E Rr LO*sr Z S i= iZG r4 +j ov)VA . B?"1 -EL 100. o, ON -7 ti IGIf, 3/y`biR PUCP~PE• ~t48~ W/LPG I e•1 k 3 L r - Zs ' ~ DO NoT cowl f-cr Oiz D\S tvR IS P/fLQA. i ~ o Q ~ J z~lo ~ w i -0 00 OD 5-Z LLR8S G g~3 32 fD B°~'~ ~t of 8 t'p kw"Z4 A) 1 se-T'swcVc- UNN _ i S~t~Z~voo~ ~Q~''ST D R . v 3 e ~ TO Wes or~lr [Z.o~-D q S -3~3 - 3 715 AL-0169 _ M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Departrnent of Industry. SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 1 P s s~~ej 'laa nclude, but not limited to vertical and horizontal reference point (BM), sand % of slo _ or PARCEL I.D. # dimensioned, north arrow, and location and distance to road. ` [REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT E ] i,NFORATION PROPERTY OWNER: PROPERTY L N PyV l 17 Y~ivb St-Zj'3Y pi a7 4014-t8~ M 1/41VIr 1/4,S Z3 T Z 8 N,R 18 E (01 J PROPERTY OWNER'S MAULING ADDRESS l (xl B SUED. NAME OR CSM # So s. --Ll. sT. p~pns~ c S r-f CITY, STATE ZIP CODE PHONE NU a C ~IkWGE OFOWN NEAREST ROAD pt Qs~rrr:~[ s~uzl (~ls1z lctz.lM"L(Z FoRIZEYT QQ New Construction Use [k] Residential / Number of bedrooms [ j Addition to existing buildatg [ ] Replacement I ] Public or commercial describe Code derived dally flow b O O gpd Recommended design loading rate O -q bed, gpdAt2 trench, gpolft2 Absorption area required Soo bed, ft2 S o Q trench, ft2 Maximum design loading rate o - S bed, gpd/ft2 0.6 trench, gpcw Recommended infiltration surface elevation(s) L 00.0 It (as referred to site plan benchmark) Additional design / site considerations 1-1 uy rW ',Q1 y- 6 3' a t~b . Y-) VU • 1 ' c F S it k/Z) F/ L L. Parent material C.~FMLJT tS~, S h XX,S_TW Qz Flood plain elevation, if applicable N • A • ft S = Suitable for system CONVD TtONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system [IS I@ U 0S O U DS O U 0S O U 0S IZU [is Mu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Colo Texture Gr. Sz. Sh. Cor>sis~nce Botinday Roots Bed Tench ~.k b_3 10`1tr_ 31-L - I's a_` . 1`~S 612 ~ v fit- a-S - 0 1 0 'd L 3-3 S LO-f (Z 3 l 6 `~s i s bk m v~~- c g o• s o• Ground 3 3S S J b Y 2 6l~ C S y R 5/8. ~5 0i"l Y~ V ~t^ - elev. B fL w Y>-L C tiv`i' I7 ~L L CA&- Depth to limiting faccttors I Remarks: Boring # j ~_3 10`1Z31Z ~ IS. 1 `~Shk 4vtv~'~ 0.S - 0-7o~S~ t z- Z 3-3Z 10`12 3A - S C5 bit %M vTl_ CS 0- 5 o- 6 3 3 z yb toy R ~/t c S y R S/8 M vit.. - Ground elev. 3 C) 8_S ft yv V_, CL_ t S t Ili P LTA- C Depth to limiting facto 3V Remarks: CST Name.-Please Print Arthur L. We erer Phone. 715-425-0165 Vg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signadue: 9 S -3V3 - 3 Oate 11-Z7 _ qs CST N 00 5 7 6 PROPERTY OWNER C~ S SOIL DESCRIPTION REPORT Page 2of` 3 PARCEL I.D. # Depth Dominant Color Mottles LStructure exture Consistence Bouncuy Roots GPD/ft Boring # Horizon In. Munseli Qu. Sz. Cont Color . Gr. Sz. Sh. Bed Trench I 1 is ~s bh v" v f a-S 0~7 0•~ 3 O - $ 10`1 Ft 3! Z _ Z $-33 10yR3I6 Ts I CSbk Y1r Uf - CS 0 S o•6 Ground 3 3a -SO t0 R `A C Z S Lift S/U T.S elev, qg u. 3 w S rv iAJ Pic Depth to limiting factor Remarks: Boring # ; ! Ground elev. ft. i Depth to limiting I factor Remarks: Boring # i Ground elev. ft Depth to limiting factor Remarks: Boring # i I Ground elev. R. Depth to limiting lactor Remarks: S5D•9330M 05/921 Page 3 of PLOT PLAN SCALE I"= y C ' l uv3C "M BE R>r LL4~1` ZS' FjZZ M yj U)VD . Ry 1 -LR. IDO. a' ON MGM, 3/y`biq PUCP~PE Rai I s 1 t 3Zr . - z.S ' „1~ti DO NOT cAwt f1-C~- OI2 I ICATTUVII-b 1S PrfLQR. I ~ o Q ~ J Z~1a I W i ~ ao 00 W ~ g.Z L n 3 Z' ~ 8.3 ~t 9 4 6 c o,~r-~v~z e-. 99 .O, ~ 6 B°~'N t►q (3 r- 8 Np ► yr f ~ jam- $b«\-X n) 6 1 se-rVtreFt Lwe 1 1✓ o S~t~Z.►Vool~ FvQ-~T O R ots 0 SRI r' To zomv ezo+~n ~1S-3~3- 3 (715 ) 425-0165 1400576 CST Signature Date Signed Telephone No. CST # ~UHC N 6 C 1996 ReOiVer N All K'ALSH St. Croix C0.,EWI 545925 ~ ,o CERTIFIED SURVEY MAP LOCATED IN THE NE-NE OF SECTION 23, T28N, R18W, TOWN OF KINNICKINNIC, ST.CROIX CO., WI. I PREPARED FOR: DAVE PETERS NENER OF SECTIN 23. .UNRLATTED..LAND.S. (COUNTY MONUMENT FOUND) NORTH LINE OF THE NE-NE S 89026' 1 'E 678.63' NOTE: BEARINGS ARE 329.41' 349.22' 6 REFERENCED TO THE EAST 316, 22' : 33. 00' LINE OF THE NE 1/4. (RECORD BEARING). 33 331' HIGHWAY SETBACK O LINE y y H o LOT 4 1 LOT I o ~I ° ° 5.00 ACRES 't w 5.02 ACRES 2 18, 798 So. FT. (217,585 SO.: FT. - O OI UNPL.•..•.....AT.....T..NDS.. c) - v 4. 54 AC. EXCj R/W- °o E. D... L...A....... ti ml00 m ( 197, 657 SO. ; FT. ) O co l AREA OF DEDICATED ROAD 1.80 ACRES °47' 04"E ( 78, 274 SO. FT. S 69 ) HIGHWAY SETBACK LINE 1,00'_ , y s « 91. 31' g . © o 318- 13' 33.20 O w l 0 3 APPROVED 307.95 51.33 3037' O'yV ' 659.28 ;66.40 g0 io DEDI __D S 83°37' 50'W 651.97 ml 344 2 33.2 m JUN 2 6 N 69047'04 W 307.39' 31 1.38' : w N o O c 9 1. 3 1 ~ ST. CROIXICOUNTY Comprehensive PiarWu Zoning aml o LOT 3 Parks Comrritte• o LOT 2 5.00 w UNPLATTED LANDS °w ACRES w _ (2177,,75 751 So. FT.) 5.00 ACf2ES if not 2 17, 765 SO: FT.) co within 30 days or "4.50 AC. EXC. R/W approval data ( 196, 185 SO.:FT. ) N Approval 'S`hi b* mull & %'6W v o co w _ I Rll y SOUTH LINE OF THE NE-NE 33 33' _ 30 4 33. 00' 366. 10' 342.. 50." N 89041' 25' 708.60' 2 O : C. S. M. VOL. C.'.Sr.M, E 1i4 CORNER OF A,W SEC. 23 (P. K. t O t71 R O NAIL FOUND) -cnt STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St''. 'tCroix County OWNER/BUYER l k 1 e ,tt ~tiS~~ r19~ k2 , t `ef- MAILING ADDRESS S56-6 lZA.stm©no A )1' '57 • PAO ( -.Z-//Y PROPERTY ADDRESS t e) 3 QI 14 2 -ti C. k h&j !3 F (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION NE 1/4, O-1/4, Section a.3 T aN-R_I_e _W TOWN OF / n n le-k- 1 1c, ST. CROIX COUNTY, WI SUBDIVISION 3 Y ~ C~ CS /)7 LOT NUMBER - CERTIFIEDSURVEYMAP s e-l~~VOLUME,L,PAGE .z~LOTNUMBER_ _ 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 com feted and returned to the St. Croix County Zoning Officer within 30 days of the three ar expiration dat SIGNED: DATE: 0 ' Q n 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. ownerofproperty kr- UiE. C,~lP-tS4-1WF P LLea _ Location of property_K E 1/4 14 F, 1/4, Section 1,3, TIZ_N-R_IB _W Township k►ny\ic. Mailing address ~a✓,,~.y~~ Address of site FQ (AR . 'Tuc Subdivision name Lot no. Other homes on property? Yes__)<_No Previous owner of property MA % n e_M .,1 (IJC Total size of property PSG 1' E S Total size of parcel 5 R CkE S Date parcel was created r1R L, p F /9 qs PfGe Ro r-n q Are all corners and lot lines identifiable? ( Yes No Is this property being developed for (spec house)? Yes _&_No volume 11tW- and Page Number d~ 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 Document No. S'Applicant Co-Applicant `f-27 Ct 2 Date of Signature Date of Signature - 546290 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED r~~ DOCUMENT NO. _ -wL 118SPA 34 REGISTER'S OFFICE Mai Pri, Tric _ _ n Wi cr•_nnGi n C ; an - ST CROIX CTY., W1, Fedd for PAA 'JUL' _3 1996 conveys and warrants to Ke 1 i P C. Kr PI 1 r 9.30 A ' rJ M. ReIster Deeds.. 9 n; ~i THIS SPACE RESERVED FOR RECORDING QATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, State of Wisconsin: EQUITY TITLE SERVICES 400 SOUTH SECOND STREET HUDSON, WI 54p1 _ 022-1065-20; 022-1065-10 PARCEL IDENTIFICATION NUMBER Lot 3 Of Certified Survey Map filed June 6, 1996, in Vol. 11, page 3118 as Document No. 545925 being a part of the North East of the North East Quarter (NE1/4.of NE1/4) of Section Number Twent -three (23), Township Number Twenty-eight (28) North, of Range Number Eighteen (18~ West, in the County of St. Croix and State of Wisconsin. T FER S FEE This is not homestead property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this M_ day of July , A.D., 19_26 den, Inc. ' (SEAL) B (SEAL) * enifer L. Peters (SEAL) (SEAL.) * 'PPPPPPO _PP F C? ` ~7(- NSON SUSAACKNOWLEDGMENT PUBLIC N ESTATE OF WISCONSIN ^~'~`State of Wisconsin, Signature(s) ss. St. Croix County. _i_:_ J_.. _t in Ppr -Ih, ramp hprnrp mp this v _ day of