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Home My WebLink About028-1023-10-000 3 0 o O U) c: 0. 0 ~ I o I 0 N o I 2 I ° z° LL O a Z H Z .r O Z d m cj w a m F- z ° o w O z d co w o vi H :!t c a) Z E a ° ch E N ° C N O ° ¢ ¢ w ~ Z Z o C : E N L ° o CL T N d m 0 co d N O m 1 G G a co N N F- F F ° rn N ~1 C 0 0 0 z 0 0 O O O • rv ~ a a a a _ m m Z (0 (0 V1JUi m O 6O 10 O 0 0 E N O u U O N « c _ C O E O > M O ° o m 0) U m 0) ° (D cooo On Sri 0 3 c N c 0 .2 0) a) -C IL o O O _ E a 'L5 N O N r > C C O N _M CO • r] N` =3 co O C N O E rx U ~~11 y~ O 2 N O - Z U7 nw \ xx w I,, E a v ~ d co ~ a ~t EL L n. • CL V r A 0 a '',I 0 in U Wisconsin Department of Indus", SOIL AND SITE EVALUATION REPORT Page ~ of 3 Labor and Human Relations Diyjsion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST. Ctl1,l1 [K Attach complete site plan on paper not less thawl '112 X .1 1flC a ~t i Plan must include, but not limited to vertical and horizontal reference`poirat•($fv1), dire ctio o f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location am distance 1A negst road. J APPLICANT INFO RMATION-PLEA$E'P.iRIK._-AtL'-'li#OfiaG TI REVIEWED BY DATE PROPERTY OWNER: I vc, " tftPERTY LOCATION It'1ll,'TDN l~Alv1 t~101V:• , , NE 1/4 WE 1/4,S 15 T 8 N,R E(01 PROPERTY OWNER':S MAILING ADDRESS ' T # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE P N •ER []CITY []VILLAGE MOWN NEAREST ROAD L3~~DwtN wt Sg0GZ. ) RvStA latyeR C~ N New Construction Use. [,A Residential /Number of bedrooms Z 0 TL [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow q ST3 gpd Recommended design loading rate - bed, gpd/it2 0. L trench, gpd/ft2 Absorption area required 1-)-S bed, ft2 3-15 trench, ft2 Maximum design loading rate o S bed, gpd/ft2 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) k I~Z- O , ft (as referred to site plan benchmark) Additional design / site considerations RZ_UsM t ~vp 1`-15U KJZ~ w~T1 I 5 r X 1 S `VtQt +C U, - M %M. I 'OF SNU6 RLI. Parent material Cz Pc C 1 h t_ Yt Lt- Flood plain elevation, if applicable N - f\, It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S [XI U ® S ❑ U ❑ S IM U ❑ S ®U ❑ S ®U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench C o S o• 6 C'-t0 1O`~V2 3IZ sj\ 2 MSbk Y-"ih S Z 1D-Z \O` 1R 3/6 - S l S Z'FSbh Yrt l~ cS o • S o. Ground 3 Z4-Y3 -).SLIP Bl - S1 C Sbk e1 \..j - o,V U•5 elev. 'r 1l9.5ft. 4 LI3-S9 S L-1 R_ 3/y 5/8 sC.~ a>W mfy--w+Tj _ - - Depth to limiting factor Remarks: Boring # o S o o-$ ti~~lR 3!2 - St Zm~bk wt`F~- cS Z Y=~~ Z 8 z-3 do ~Q. 3l r. _ si I Z~sbk w~~'~. cS u.s o- Cs o,s 3 23 3S ~.S yfZ 31 V - s 1 j, Ground elev. 3 S- 51 S Lip 3 ~ b R S /g s e- OY► ~ r..t i - - tioo - I ft. Depth to limiting factor ~t Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165 drregs: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 eerer Signature: Date: CST Number: 4cj-2qZ lZ.-3p-9 M00576 PROPERTY OWNER \AI\" t" tON SOIL DESCRIPTION REPORT Page ?-'of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouriclary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench LN S Z g -'ZA L~ `1 R 316 - S t) Z S ak m'F►~ cS o . S o- Ground 3 20-3) ~•S`tR ~!y SC.1 1C-Sbk Mir Cw - o-Z a•3 elev. 1o~ft. y 31-S7 S`-1\2 3l l )-3 LIP 3/6 LUG Owe w~`~j - - - Depth to limiting factor 31` Remarks: Boring # 1S 2 wt Ground elev. ft. Depth to limiting factor F-T- Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-6330(R.05/92) PLOT PLAN Page 3 of 3 r+ SCALE 1"= yQ ' ~lco t ~ TN t W Z~ GItT- oF' w ~Y I- , C tvL''k~C~.sT LIME Q;: Z3a ►Yr-2C pAiZcjxL. ~1, ln3 9 B.3 1 CAS, SNP G ` ~ S CTL ~np 3 ' EZ- 99 - T J14 ►lo T aow~ p ft e-T ~ " ~ ~\STv~213 'Sl} lS 1~'zL~q . 8\n- C G~ZOVn,p L~ti~t~ ~rto v S E Be 6T L kEfv ST' ZS' Fitt M j3 V► ,'p_. 9y-Z~Z 715 ) 425 -01 65 _ 11 0 0 5 7 6 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 83.05, Wis. Adm. Code COUNTY ST. Ix, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Y-'1 l l TO N 1ik 1 I" I O N sel~-teT N E 1/4 N E 1/4,S 1S T 213 N,R kZ E (01W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1g&9 eov,~►1 Y N v - - CITY, STATE ZIP CODE PHONE NUMBER []CITY (]VILLAGE MOWN NEAREST ROAD 13f~l.DWtJu col S0400Z (~ts)68y-za6o RuSbA I WeR (2L71-f-1 N" (kJ New Construction Use. [)q Residential / Number of bedrooms Z ° TL 3 [ ] AdditiQn to e)dsting building [ ] Replacement [ j Public or commercial describe Code derived daily flow y, SD gpd Recommended design loading rate - bed, gpdfit2 0' ~ trench, gpdfit? Absorption area required 31S bed, ft2 3Z S trench, ft2 Ma)dmum design loading rate 0 . S bed, gojt2 a • b trench, gpd/tt2 Recommended infiltration surface elevation(s) O ft (as referred to site plan benchmark) Additional design / site considerations R r~ M 0~v0 y-,DV fro wt`ST{ S r x 7 S 12~~ C H . - wf ►N . 1 r of SN~6 Frt. u Parent material G Pc C-1 h L 11 LL Flood plain elevation, if applicable M . N - ft S = Suitable for System cONVENnow MOUND W GROINID PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TAW U= Unsuitable for stem ❑ S M U ® S ❑ U ❑ S O U ❑ S O U ❑ S [R U ❑ S Wit SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ninth 0-10 10`'12 3!i 1 sib Zwtsbk Y~~h CS - o•S 4•6 = .xv\.x,.::`., Z 1 V -Z. ~ l~ ~'t K 3~ S t• ~ Z l S~ R r'1 ~t^ C S O. S O. Ground --)-S`12 51 - S J C sblz Y,4. Cw - o,`/ D•S elev. C a S ft. L13-Sq S `i 3iy ~t--)s `BIZ sus sc~ O~ m4-wt~j Depth to limiting factor Remarks: Boring # o S ' 0 o tidy Q 3 [ 2 - S 1 Z.m 9bk vHjti- CS Z 8 Z-3 tio`IR 3!L _ sl,J Z'Fsbk wt~~, cg - o.S 0-6 x:61:1:4 ci,, 16-S 3 23 3S S YtZ 31 - s 1 Cs bk wt `f~{- Gw - Ground elev. 33-51 S y9 3 ~-i $ bR 5/8 s c- Ow~ wn i _ _ 1m ft Depth to limiting factor rr Remarks: T 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 Fal1S,WI 54022 Sgnature: Date: CST Number: 4y-2qZ 1Z-30-q M00576 3 PROPERTY OWNER VkNt-1M ON SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bow dary Roots GPD/ft in. Munsell ()u. Sz. Cont. Color Gr. Sz. Sh. Bed Trench x;.: t. d.' o . ' o-8 l~ 3li S' Z41 ' m~h ~S o•S 6 Z g 0 LtJ `t R 346 - S 1~ s bk 'E'1- S Ground 3 Zo-31 S`lR 314 SC. 1 ~Sbh Yn~} C~v - o- z. 0.3 elev. 3l 1 S' `itZ s!8 Or+-~ w, `F i _ - L ft. L4 3)-S7 S `I2 Depth to limiting factor,, Remarks: Boring # ;`44M; b3' c ~S 2 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD•8330(R.05/92) PLOT PLAN Page 3 of 3 N r SCALE 1"= Lfp ' Nv IZ\A, tfT- O F- 4v Pilk/ I -vu l C ti L'rC2~sST LW E O F Z 3 a kca- p A ►Z c ev- tR. X03 9 8.3 1 6L- - co*'ti^ Of a S. / ~ 2Qi t S kti?D q5' CTL Leo 3 B•Z ~tZ-99 S c w-%P tt~ T ot~ ✓ , - ' ~ S1v~ZZ3 Tit lS 1~12.~'R . BM1 - • 100-0, Oti BoTTUr1 CA r? nt= •hkrTINC StptluG . C G~Z.ovrvp L~-v~L~ MUSE 'M BE Wr.. L tEk ST ZS' FIltt j m Oufv.b-. vj ELL tt It 4t if SD' tt ~t _ 9y-zqZ t tip-- 3D-`~~ (715 ) 425-a h5 1400576 T Sianature Date Signed Telephone No. CST # STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT # SECTION~T O7 N-R~ZW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1$6~ lam' ~ a , ,b INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Q f (D l Q / C~Z/ S BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Z000 Setback from: Well 3D House Other Pump: Manufacturer 2mh Model#_ Size Float seperation / 0,8 Gallons/cycle: ` a cJ Alarm Location J~ SOIL ABSORPTION SYSTEM Width• 7 Length 9y / Number of trenches Distance & Direction to nearest prop. line: Do / l House Other Setback from: well: -7,5- 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: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR • S,1 v4~ 3/93:jt Wisconsin Department of I1{dustry, PRIVATE SEWAGE SYSTEM County: bOrand Human Relations INSPECTION REPORT ST CROIX foty and Buildings Division N (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262376 Permit Holder's Name: ❑ City ❑ Village J] Town of: State Plan ID No.: L PLEASANT VALLEY CST BM Elev.: , Insp. BM Elev.:! BM Description: Parcel Tax No.: /~r G® C:~, a5 A9600187 ~ 4 c TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic A-'bly1 Benchmark ~7, SCE 7 ef) ' Dosing (y) LLz-, rI'/. Aeration- Bldg. Sewer Ho St /JC Inlet 3 9~ (a TANK SETBACK INFORMATION St/yi Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > 5p' a q!5, NA Dt Bottom 13 V0 Dosing NA Weadw / Man. 2-,/69- , c/69' /03 g,~ AeratioIT_ NA Dist. Pipe 3,. % 3, / Holding Bot. System 423' PUMP/ INFORMATION Final Grade Manufacturer f Demand Model Number It 9y GP TDH Lift ,A' Lriction , 5ystem50 TDH Ft oss mead Forcemain Length a / Dia. Dist. To well >30 SOIL ABSORPTION SYSTEM BED /TRENCH width / / Length / No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth DIMENSION DINIEN I N LEACHING Manuf SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK rer: INFORMATION Type o j o,_ CHAMBER ode Number: W~d > S " SOS 7¢ OR UNIT System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) A x Hole Size( x Hole Spacing Vent To Air Intake l - 1 Y-6 Length Dia. Length Dia. Spacing /t - 1/1P I I k~ , SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only DOver Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched hnL Center ®eVTrench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No ' 4COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: PLEASANT VALLEY. 115.28.17W, NE, NE, CTY N ~ " C'~ Wa-=--~`/~-~-'" q?l a`i 'rislon re~ utred` j Yes 5~ ~ r Use other side for additional information. U( ~f SBD-6710 (R 05191) Date Inspector's Signature rt No d ~ l,?, G77Q iti~C~-o f3° . c'7 ADDITIONAL COMMENTS AND SKETCH Y SANITARY PERMIT NUMBER: ® e_ i Safety and Buildings Division ~~■'~.r■r,t 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. 5 , • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check i r J4St (0..trbri (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Nu ber 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFOR ION Property O r Name perty Location 4 Nf1/4,S 15 Ta ,N,RE(Ole Properly Owner's Mailing Address Lot Number Block Number Cit , State _ Y Zip Code Phone Number Subdivision Name or CSM Number A(7/S' > I. PE F BUILDING: (check one) ❑ State Owned WPa Nearest Road llItyage Public 1 or 2 Family Dwelling- No. of bedrooms own OF III. BUILDING USE: (If building type is public, check all that apply) celTax Number(s) t 1 ❑ Apartment/ Condo c~ 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an SystemSystemTankOnlyExisting 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 UU Required (sq. ft.) Propose d (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation, ls~ N/A fD eet / Feet VII. TANK Capacity in gallons Total # of Site INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic App- New Existing Gallons Tanks Concrete glass Appp. strutted Tanks Tanks Septic Tank or Holding Tank 14)60 /000 f ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber o0 60 8 I hl ❑ ❑ ❑ ❑ ❑ 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 's Signatur . (No Sta p MP/MPRSW No.: Business Phone"Number: 9W V Plumb - s pkddress treet, City, State, Zip Cocle)- L , ox 1 - a IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San3py Permit Fee (Includes Groundwater ate Issued Issuing Agent Signat a (No Stamps) Approved ❑ Owner Given Initial t~tl7 /o Surcharge Fee) i. 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 INSTRUCTIONS I- 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 bya 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. Compete 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. Private Sewage System Plan Index/Checklist All plan sets should be legible and pamaoeat copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long aS the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID a r O.rner s Leaal r 5 1S 2- 19 9 le 17 04 Address / /lJt CNil own G , County Contents ommeats/ pecW InstMCtiQU3 Page • Included Two copies needed for all I Plot Plan 2 Plan View/Lateral Retum by Mail 3 Cross Section 4 Tank & Pump/ Fax Getter to (County) (Submitter) Siphon information Circle One and Provide Fax { ) S System Siring (Public) 6 Q Call for Pick-UP: { ) Other I, the undersigned, hereby certify that the Seat (if applicable) plans and specifications submitted berewitb were prepared under my direction and control. MwnSerlDesiRnct Li M A City sum !~r ob s~ PR1vAM ~IfYSTEM Attatkaaet.ts: Conditionally Soil site evaluation Fcc Needed for Hsldiea Task %btaitta l: APrn One copy of notarized hoidint tank OVED aveetaw. (Originals to County) DEPT. OF INDUSTRY, LABOR & HUMAN RELATIONS VIS ON OF SAFETY AND BUILDINGS Needed for Ac-Grade StabttKttal: DI Or*hal siaaed and notarized Az, Application for "Use of an At- Grale" SEE CO PONDENCE County on-s{te One additional set of plans SWAM" (W.tf!/9ti) S96-201"75 , NJ S96-20175 V r' kj~ ~'p- ~o f ~ 4 w- 7"~l 1r IN, a- -A-c ,c jape < 71, c~.~ c fit loo e a ' 0/V u tiN VC#LT CAP A!~ 4'C.Z. VENT PIPC WEATHER PROOF APPROVtO LOCKIUfw f r-- T" .tUUCTIOU ISOX MAbmLC COVER C7~ AS' FROM DOOR. gA WINDOW Olt iRCSH AIR INTAKE GRADE i y+1KMJ. r 4L -mmoomm CONDUIT - - 'PROVIDE i tAJLE T AiRTIGMT $CAL I I ! I I ~ APntovED J, APPROVED JOIN V A ~ l•L~ C~ ~ I l i l W/t.Z PIPE w/t.z. 11rF. IY~ P EXTEMOIuG CXTCNDtI1t+r 3' ALARM OUTO SOLID C-JC`~C OIJTO 601-30 SOIL d I 1 I f Ou C f i F` Install ,n oPF i:LCv requirements. O - K t v a 3" di yj$rled bedding coucRETE aLot:K . itISCR EXIT PCRMIlrE0 ONLY If TALK MANUfALTURCR HAS SUCH APPROVAL 5PC GIFICATIOAJS SEPTIC E DOSE JaCSO-K COnC+tT-, #JUMBER OF 004ES: PER D"R T^UK MMUUFACTURCR: TAWK WE: 0 4100 GALLOWS 0069 YOLU14C L,gi= IQICLUDIU(s BACKFL.OW: GALLI ALARM MA►JNFACTUIILR: .299 .~071G 1~L CAPACITIES. A=~.^_IiiC1JES OF, "LL( MOOCL N11M6tR: SWITCH Turc: 4 a :2 INCHES OR ~ CoALLC PUMP r\Auu>=ACTURC,, MODEL AIUAWL: 9$ On /L IMCHES OR~ GALL SWITCH TUPE• A,~OT' PUMP AfJG ALARM ARE TO OE 3 GPM 114STALLED ON SEPARATE CIRCUITS MIUIMUM DISCHARGE RATE VERTICAL DlffCREUCE DETWI:EII PU" OFf A#J0 015TR%bUT1044 PIPC.- FEET .5 FEET + miu1KU14 MCTWORK SUPPLY PKEMILC 2 + -ft - FE CT OF FORCE MAI#J z LFyO FtFRitTlou FACTOR. ..1 n FICET CC TOTAL Dy1JAMiC HEAD = FEET ;WIDTH ---.;LIQUID DEPTH 111TERUAL. DIMEIJSIOPJS Of TAWK: LF-J&TH /d'0~00 b / 91G DATE:.__.- LiCf.USE ►JUMSER: IaE 0: - rnu.• ' ut I ',wsponsin Department of Industry, SOIL AND SITE EVALUATION REPORT ® age J of 3 Labor-.and Human Relations 1 Divsion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code JIEWEDB Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION DA7E° 5T ~rGr1c PRO R WNER: PROPERTY L ZONiy ' G GOVT. LO 1/4 1 T j ~FFikt-R ~j PROPERTY OWNS ':S MG AgDRESS LOT # BLOCK # SUBD. NAME bRL# S( U C TY ATE ZIP CODE PHONE NUMBER Y G N EA ST ROAD [vQ New Construction Use [ ] Residential / Number of bedrooms -3 [ ] A xisting building [ ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate t Z- bed, gpd/ft2-Z,-;? -trench, gpd/ft2 Absorption area required 37.5 bed, ft2 3 7S r trench, ft2 Maximum design loading rate / Z_ bed, gpd/ft2 A Z trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site co 'deratio 4 44 Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem ❑ S E U & S ❑.U El S aU El S ®U ❑ S O U ❑ S E U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& Ground ,3 6_y s-YW Y13K C Z4 mw elev. / ft. Depth to limiting factorN Remarks: Boring # Ground elev. /1t ft. Depth to limiting factor 4 30 Remarks: CST Name:-P s Print, Phone: i 1-, X E- 4 Address: 37 z 7yo T. T- rywtc Oo Date: CST Number: Signature: ss-s~ PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z ofd. PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmr& Ground 3 21-Yi- S- t~ S SQL elev. Depth to limiting factor .3j'• Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) i I i I I 1V y! n1'Tpl R 1'7 - - I~- ~3 ' I I I I ; _ ® - rn. Sue -..1 I I I F - - f - / - - - c ' - - i ~ i ~ I I I ~ , I I I i i L I ne~►- - _ I _ i E- - - :F I 1 I_ - , ' r~ i f i I I i i t { ~ i i I ; i- r I I I i ~ ' r ~StS I ' I I I ~ I ~ I C i I ~ f~Q 1 civ I I I I { ~ I I I I ~ I 4 'G-- ' I I i I I I ~ ~ I I i' I ~ N I ~ , I I f- i I I ~ I I I. { I -1- 1 I i B,4;/to 2' • ' ' y' - - t ' r ww- f I , 1 1 ~g I - - - , I { I { $ to ~ I ' I I I I I ~ I I I ~ i I ; 1 I I I I ~ ~ _ f 1-- ~ i ~ i I i ~ _ _ - _ i _ _ - - - r _ - _ _ I _ - - - - _ , T _ _ _ _ - - _ _ - a-- Y - - - ' i _ _ _ , I - _ - - - _ I ' - - STC-105 SEPTIC TANK MAINTENANCE AGREEMENT ii St. Croix County OWNER/BUYERc i~U h Q I'1'1 1'Yl MAIIdNG ADDRESS I p b I I N f" Q IG~ Ll~ c W S~ 00 PROPERTY ADDRESSS I . c y I W n (location of septic system) Please obtain from the Planning Dept. CITY/STATE R 6- o (_U~ A V~ 1: S~~ Z PROPERTY LOCATION r~ 1= 14, 1/4, Section 1 SI T ) b N-R W TOWN OF I?J-4 ~ ~L J r ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expir//a~~tion date. SIGNS : / j'tn' ► 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 % n kct ma cttt Location of property Section I C7 W Township P u S k k' e r Mailing address Address of site C I CI LIJ 1 S c~ U z Subdivision name / Lot no. Other homes on property? Yes No Previous owner of property Total size of property //ll Total size of parcel V at,.r e Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house) ? Yes No Volume 55~ and Page Number-Q-LLJ- 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 th ofice of the County Register of Deeds as Document No. , 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. Signature of Applicant Co-Applicant '~-/q_qb Date of Signature Date of Signature .~..-.~...e~_ - t I, DOCUMENT NO. 4 pp STATE BAR OF WISCONSIN- FORW 2 li 'VOL 5J0 FQ~EZ4 9 WARRANTY DEED 7 a~ .Hr i 34 11.9 2 THIS SPACE RESERVED FOR RECOROINt7 oATA REGISTERS ,CE Delmont Annisr a widower► ST. CROIX Co., WI$, : BY THIS DEED, Recd, for Record this ,__~8th day ofd„1 Y_' I►. Dr 19?? i Grantor conveys and warrants to Milton Hamman A Grantee for a valuable consideration RETURN TO # 1 the following described real estate in St. Croix County, State ofWisconsin: East Half of Northeast Quarter (E~ of NEk) of Section Fifteen Tax Key yr (15), Township Twenty-eight (28) North, of Range Seventeen (17) This is homestead property ax West, St. Croix County, Wisconsin,subject to,,the right to live for hislife.on a part of said real estate that is fully described in the hereinafter r.;; described land contract. ''Said Delmont Annis and Myrtle A. Annis, his wife, now deceased, executed and delivered to tr_ i.said grantee, a land contract dated May71, 1974 and recorded May 23, 1974 in Volume 511, page 341 in office of Register of Deeds for St. Croix County, Wisconsin, of the above de-''. scribed real emate; that said Myrtle A. Annis was also known as Myrtle Agnes Annis, and -,Vl that she is now deceased, and that the consideration for the purchase of said real estate,i has now been paid and that this deed is given in fulfillment of said land contract. 1 SF I f,. tl Exception to warranties r .r' a Baldwin Wisconsin 27th i Executed at r this day of July 19 41. SIGNED AND SEALED IN PRESENCE OF d~ (SEAL) Delmont Annis (SEAL) y F .,iSEAL} (SEALk y ~ t IF Signatures of H t authenticated this day of 19 Title: Member State Bar of Wisconsin or Other Party s,. Authorized under Sec. 706.06 viz." STATE OF WISCONSIN ii St. Croix county. } sa.~. j r 19Z-z Personally came before me, this 27th- day of ` July j! the above named Delmol.t Annis a' WidOWel `a to me known to be the person- who executed the foregoing instrument and ackrn~ol ledled the same. ~ - A