Loading...
HomeMy WebLinkAbout034-1018-70-100 2 ro O ro O O O O O ° M 0 0 eq 1 C t~ bq 0 Q) C: c O O C O (D L a v 0) o ° > ° m o ro 0) c; I ~ n I I O N ro it i ~ ~ ~ N I O O i,. C ro O O l0 cu 0 C Z O X C Z E N 7 (6 +_N 7 (9 ) i LL C m U. c O tlJ O 2 O O y o. z1 y ~ a (n E d ¢ w a M Cl) Z N Z N E E (n _ O O v E Z v (D IL m H a M 00 c o 0 O ro O Z ~ c c c m Z c c O O O (A F- r O) Z C E c E - N Q1 'D -a M - N N ~ N 7 O cu co CL CL N N N O O O C •IV d U a . ~ r O Q O iq O o N Q O N QI. Z m z Z m z o N Z ro co T M N T N E a~ o ~o E ~ N R 3 N Lo N 3 W LO O. M L > a w O CD (D O ~j N a L O > N d L N 0 0 a o o a 11 U) > O G a a N cu N N 0 N V) U) E c N N (n c C-) 6 Z j Wyk U F~ F~ H O (6 U H H F' (9 N N ~i Q LL Z o O o 0 0 O ° 0 0 0 • *Ali ca 3 a n. a 3 a a a N N ° y N J U W c)) O3) 43) W (D Cl) (O ro O M M O O - O O O 01- M E ~ N C O O O C O 3 M :3 :3 tSl m 0 in ~ m a) O N O ' O F 'O Q J? CC) N Q Z ~s lCf C: 00 U) O 3: N N C co N S F= 04 (D 0) L 00 -6 m N E C m m E E N N N w o o t o L N :1 of c w iu H fn (o y F- LO 'o aro • co a E n £ m N E o 00 (0 LO y O O (A O N O - O (N O Z V) CC r \ ~ *a ~ I, E E I v ~ 4) 0) L: CL u CL ce a ° E c i'c c `~1 A v a II' 0 m V 0 v) % 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER-e(~~i/'/!~ S o~G/ ADDRESS / 77y 7;9 5r ' I% V SUBDIVISION / CSM#LOT # 1 S~l,6ECTION__T~N-R d~ W, Town of /ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF /Y$TEM APO rv~ ///~vf 1~--~ ~ LUG ~ C3l r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: /,Z„ll/lv ,77 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_ -IV-/, f Liquid Capacity: Setback from: Well ~clz-L~ -House c,15i Other Pump: Manufacturer Model# Size Float separation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: Length / Number of trenches Distance & Direction to nearest prop, line: Setback from: well: l House ` Other ELE 1..67/ NATIONS Building Sewer ST Inlet. - G ST outlet y..~' PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade - Final grade DATE OF INSTALLATION: PLUMBER ON JOB: Jf[~~~~~is(~ LICENSE NUMBER: INSPECTOR: 3/93:jt WiSonsin4QartmentofIndustry, PRIVATE SEWAGE SYSTEM County ST. CRO.1_ La`oor and uman Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 26247 Permit „oeN.r; Ne~AN El City ❑ Village C] Town of: State Plan ID No.: SPRTNaFTRT.n CST BM Elev.: Insp. BM Elev.: BM Description: 7C Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark Septic Dosing Bldg. Sewer Aeration St / Ht Inlet ~3 > 7' Holding TANK SETBACK INFORMATION St/ Ht Outlet 4 3 /a TANKTO P/L WELL BLDG. vent to ROAD Dt Inlet Air Intake Septic y /ob 3 NA Dt Bottom Dosing NA Header / Man.! Aeration NA Dist. Pipe Holding Bot. System 10'V7 YU U ~ PUMP/ SIPHON INFORMATION Final Grade 8 " 90• 7 Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft L n~Dist Forcemain Length Dia. ell OIL ABSORPTION SYSTEM S BED/TRENCH Widt h Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION a DIMEN I N Manufacturer: SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING SETBACK CHAMBER Model Number: INFORMATION yPeO system: L"_, OR UNIT C 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 r xx Depth Of xx Seeded /Sodded xx Mulched p ~Yes ❑ No ❑ Yes ❑ No Bed /Trench Center Bed /Trench Edges Topsoil E] COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD.8.29.15W, SW, SE, COUNTY E "I Ia Plan revision required? ❑ Yes [f(No [~7 a 6 Use other side for additional information. 3/ 9>0 Date ns ect& sSignature Cert. No SBD-6710(R 05/91) Safety and Buildings Division Zvp`ri ; 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 n r than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State a itary'Peerrmmiit Number The information you provide may be used by other government agency programs ❑ check l rev4~~5 vi s a p[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION- PLEASE PRINT ALL INFORMATION /`%4 Property Oner Name Propert Location ~ 1 /4 , 1/4, S T . N, R W ,,,,1/4e Property Owner's Mailing Address Lot Number Blockmber 7 ZMI;'l Sr- l X1 1A Cit Pt? to I Zip Code Phone Number Subdivision Name or CSM Number I f 2.2 (7 iS') p,5~'-s /a o?9Y S 11. TYPE F BUILDING: (check one) ❑ State Owned ° C~iyage earest Road I v Public 1 or 2 Family Dwelling - No. of bedrooms C-7 Town OF.S III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo d 3f -/o 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 IdNew 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 11eepage 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) Elevation ~-7I~ / ,0 , Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper_ INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ®Q - Q~ . ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ El ❑ ❑ VLII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibili for installati o he onsite sewage system shown on the attached plans. PRSWNo.: Bu iness P one Number: Plumber's Name: (Prin.11 Plum a 'sSignature- o St ps) M7. Plumber's Addr ss (Stre t, City, Sta e, Zip Code): UG G IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater ate Issue Issuing Ag nt Signature (No Sta s) pproved ❑ Owner Given Initial Surcharge Fee) % / Adverse Determination el1 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for tvvo (2) years. 2. `roi.ir sanitary permit maybe r.enewec! before the expiration date, and at a time of rE,iewal ary ne ~ riteria in the Wisconsin Administrative lode will be applicable 1 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-6339) 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, 608z266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),, address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 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. Wiscorissin r ,,,partment of Industry, SOIL AND SITE EVALUATION REPORT Page _ of t4bor and M*Man Relations d z 'XN Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Co Atac oo a efte plan on paper not less tha 12 x 11 inches in size. Plan must inc)6,";,buf LLD. not limited to vertical and horizontal reference point (BM), direction and /o of slope sca~tE or' dimensioned, north arrow, and location and distance to nearest road. s > RVIEU; BY .}4 k DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION NER: PROPER ION EROPE /1 , S 0 GOVT. LOT 1Ifi, s~,~t113i T N,R E (or) W NER':S MAILING ADDRESS LOT # BLO NAI>~F. , , ZI C DE PHONE NUMBER []CITY []VILLAGE OW I" NEAREST ROAD ~ i ) sidential / Number of bedrooms [ ] Addition to existing building [ ] New Construction Use[ ] Re j ] Replacement [ ] Public or commercial describe Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Code derived daily flow gpd Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design !site considerations ~9RfAr ~ ~ It Parent material u wN.ve-e A Flood plain elevation, if applicable S =Suitable for system 7-coo NVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE FSYSTEMIN FILL HOLDING TANK U = Unsuitable fors stem S El U E] S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT P D/ft rDe th Dominant Color Mottles Texture Structure Consistence Boundary Roots GBed Trench Boring # Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Z tii b e46-1 Z - ~ jO JK ~ Ground /~y~ -lGa--' ~ elev. ft. Depth to limiting factor- A Remarks: Boring # Ground elev, ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: PROPERTY OWNER /'l5O/l,1 SOIL DESCRIPTION REPORT Page `af PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . x Trench Ground elev. Depth to limiting fact 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) EWEY FANSLER EXCAVATING -zz~ CST S07 MM-3177 . i I I I I I j I i i I i i I I ~ ! ~ I I I I I I ! rr 11 I ' ~ I - - rA: f I ~ 4 I N Q QZ Tr- r- - - { ¢ 1 I I I I i f I I I- -------------t I I ~ ~ I I I ' I I I I j I I I j I i i I j - I I II I I I I ; ! I ' I I i j I I II j ~ ~ I I i I i I ~ + M1 ' I I I I~ j II I I ~ ~ I^ ~ I I i i I I ' I I i ~ I I ! I ' ! 77- 4 I `y~~` I I X ` I I ~ I I I I I I i I I fi 1- i i - - 1I I! , j I I i I I i I) - , ' LI I ~ I ~ I I i t I I r I ' I j L. I I I I I I I I I , . I ~ ~ I I I I i _ - ~ v V - - - - ; rr DEWEY I"ANSLER EXCAVATING T 507 MPRS-3177 I I I I I I i I I ~ ~ i I I ( I I j ft f I I 1' I i I I I c C I t~ XII rt I ~ - I ! I I I ~ j --j--- I l i l f j I i I~ j I I -I - i- i- I-- - I I I 1 I ~ I~I I ~ I I I ~ ~ i I I i j I I j i m A f i I i T I r _ i O M 7 -r- - - - - - `z- rt f2 I I I _ A j..-i i slVistOnsir,RppartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Laborand4,!!hanRelations INSPECTION REPORT ST' CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State PIA %W ORMSON, BRIAN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ► Dosing Aeration Bldg. Sew Holding St/ t I *et TANK SETBACK INFORMATION St/ Outl t 1.0 TANK TO P/ L WELL BLDG. Ventto ROAD et Air Intake Septic NA ottom Dosing NA deader Aeration NA Dist. i k Holding Bot. S em PUMP/ SIPHON INFORMATION • a Grade Manufacturer EQ nd Model Number PM TDH Lift Friction System Ft oss Forcemain Length Dia. H Dist- to All SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tr Is PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG ELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of 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.) LOCATION: SPRINGFIELD.8.29.15W, SW, SE, CTH E Plan revision required? ❑ Yes ❑ No Use other side for additional information. I F_ SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: • H 9 r } y ~ 4. A ` I Safety and Buildings Division 'SANITARY PERMIT APPLICATION Bureau of Building Water systems 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. j CJQD% • See reverse side for instructions for completing this application State Sanitary Permit Number a.6q 4(~;, ~ 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 WA Property Owner Name Property Location F 911 SOAl SW 1 is 1/4, S 8 T Z, , N, Rk5' a64tar) W Property Owner's Mailing Address Lot Number Block Nm~r 8 1:9 7y 7I xt •SP; Cit State r Zip Code Phone Number Subdivision Name or CSM Number hog. C2 9 9,1~ II. TYPE OF BUILDING. (check one) ❑ State Owned D Vity e r / ' Near oad „ Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ~S'PR/ ~ ~h~ CT_1` III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. 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 Al. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Reqtyll ed (sq. ft.) Proposed (s ft.) (Gals/day/sq. ft.) (Min./inch) Elevation '7 50 90, Feet Feet VII. TANK Capacity site in gallons Total # of Prefab. Fiber- Exper. INFORMATION Gallons Tanks manufacturer s Name Concrete strutted Con Steel glass Plastic App New Existin Tanks Tanks Septic Tank or Holding Tank 000 --0- 1do0 I r! GL1! t9__ El El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber goo "-0- d© R El VIII. RESPONSIBILITY STATEMENT El I El 1 1:1 1 1:1 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb Signature: ( a ps) f*WMPRSW No.: T~ness Phone Number: eve v4.US L f3r 77 ~0 7 31318 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate slue issuing A ent Signature (NOS Surcharge Fee) Approved [:]Owner Given Initial p Cb Adverse Determination 0V ~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One urpy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. Ityou 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, re, onnection, 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, rumb of tanks and manufacturer's name, indicate prefab or site constructed and.tank material. Complete for al( siiptic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experiments 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. Compete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the c( t inty. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of f-~i Iding tank(s), septic tank(sl ccrher treatment f inks; building sewers; wells; water mains/water service; strew. ,)r -lakes; pump or siphon tanks; clistrib~jtion boxes, soil absorption systems replacement system areas, anC the loca '_M I f the building served; 33) `'vr_c j: , r= ~rt;cal elevation reference poiots; C) completes pecI{ications Fir purrr,, ~ ntrols; dose volume; elev 3t'on di s'}rer friction loss; pump pe,(ormance curve, pump model and pt mp :mar : u-er; D cross section of the, soi1 absorption system if required by the :oumy; soil test data on,) 11 ` rm a, sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regul ated practice which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination ivestigations and establishment of standards DEWEY FANSLER EXCAVATING CST 507 mm-3177 I I I i i I I o I I W P- _ i I --t I'D I ~ I► I L; ~ ~ i j j , 1- I I ~ I I I --r - -1 - I It I I I ! I i I I I ~ ~ I I I i Ir~V I ~ I I I l ' C ILA I I i jam--- I - 1 - -i - I I I • ' ' Wisconsi6 Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of .3 Labbr aril Hutnan Relations division of Safety & Buildings in aCC .05, Wis. Adm. Code COUNTY 1/2 x 11 inc s in si must include, but DiX Attach complete site plan on paper not less jh t (BM), dirrd % e, scale or PARCEL LD. # not limited to vertical and horizontal referent oin dimensioned, north arrow, and location and tance to 416aresfitt8dy REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL (APO M~CTION L PROPERTY OWNER: ERTY LOCATION 1; So^, 9r ~Ejy `r LOT SGtJ 1/4,5 1/4,Sg T 2 9 N,R W c O # SUBD ~ NAME OR CSM # PROPERTY OWNER':S MAILING ADDRESS T # BL ~A ~ NIX K N. CITY STATE ZIP COD~jE PHO E / [-]CITY [-]VILLAGE MOWN NEE~ARRE~ST ROAD J~ New Construction Use PC] Residential / Number of bedrooms 3 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow WO gpd Recommended design loading rate .7 bed, gpd/ft2_trench, gpd/ft2 Absorption area required Gy,j bed, ft2 Jr4_trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) S/ / ft (as referred to site plan benchmark) ' Additional design / site considerations}-+~'~3~.S/t.~ ~P /L~~.'~'f Srpr,✓ %N~ o.✓ TA.✓Z pGfrc~eivT WFlood plain elevation, if applicable v/ ft Parent material wKwcw a~ S =Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem S ❑U VIS nil XIS ❑U ®S ❑U EIS RIU ❑S OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # rorizo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground 33-yz /o /51 s / cup 7 8 elev. / ft. rP My i? ct.~ , 8 Depth to -7 limiting factor w,// e~ cY7- P7x ~B T .e /u Remarks: Boring # _ / O- o --O Z~ 5 My R CuJ 3.ti , ~ 27 ;7, Z CZ'0 3 zbe,40 /0 Of 1-;7154 Z _,7 :J? Ground elev. ft. Depth to limiting factor Remarks: /7Z~8~ / CST Name:-Please Print Phone: ll Address: 7y /77.~ vc rP S _of Signature: Gtr Date: / X93 CST Number: 2b 7 PROPERTY OWNER ?F, OV~yspw/ SOIL DESCRIPTION REPORT Page~of'.3 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 Trench X44 ti}~v::ivvi4 Z ~M sb iy y~ eccJ ,3 4<~>}<>~ Z 7,S 3~ -O - •s'/ 2 CM .~bK •yv~R C'c~J 2-~ -5 ~ Ground elev. f" ft. s s Os - „ 7 ,.6" Depth to limiting factor ll~~ ~ /.~.~Pf wLGF3 cK Remarks: 7-v ~8 LC c r g ' Boring # Ground 4l 3 3- ~ /p -~z~ /S Os C .7 el v. ovo-,* /B 7 ft. Depth to limiting factor y~ Remarks: Boring # GroundM 8le ft. 7 0 y6 - S ~M I, /Ox Depth to limiting factor Remarks: G/q eA/ifz Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) DEWEY FANSLER EXCAVATING CST 507 MPRS-3177 i ! I I I j I i i N I I j I I I ' i ~ i ~ i ! I ! I I I I j kKTT I i I I I I( I I I I ~ I i I I I I I -10N tL- O x i ~ ~r I ;M f -~v„ I -~--1 I I C,, i I --j--~ - i I - i T-- I I I 1 i rt 4 I i I I I !N r~ i I n l i I I I ~I~ I I j I i _ zor I i ZJ I i I I j k cn I - 1-- - ! o~ t i i f` I C I 1p I - _I 1l Ni„ I I CCC111 I I ~ ~ I~ ~ ~ I i O I Q I I I a, PAGE OF PUMP CHAMBER CROSS SEeTIOIJ ANDS SPECIFICATIONS ' VENT CAP 'i"C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE COVER JUNCTION BOX ZS' FROM DOOR, IL"M11J. WIMDOW OR FRESH AIR INTAKE I GRADE ( H' MIN. NOW I8" MIAI. C IWDUIT •'PROVIDE I IAILE T AIRTIGHT SEAL I III . ~ I III / APPROVED JOINT A ( III APPROVED JOINTS W/C.I. PIPE I III W/C.I. PIPE EXTENDINI. 3' ALARM LXTENDIIJG 3' ONTO SOLID SOIL I II ONTO SOLID 601L p I I , I I ow c I LLEV. 180 FT. PUMP OfF D CONCRETE BLOCK APPROVED RISER EXIT PERMITTED OWLy IF TAWK MANUFACTURER HAS SUCH APPROVAL gEDOING SEPTIC E SPEC,IFICATIDKIS ' DOSE TA IJ I KS -clct - NUMBER OF DOSES: < PER DA:i TAWK SIZE: 0O GALLOWS DOSE VOLUME ALARM MANUFACT URCR' S lJ£ LQ~~ INCLUDING OACKF~L(OW: 30D GALLONS MODEL WUMBCR: ,D6, V CAPACITIES: A r WCHES OR /2,,0 GALLONS SWITCH TYPE: M ..~u!~,Z 6 = INCHES Olt 60 GALLOW5 PUMP MANUFACTURER: 7n£ L, /,,f - G. INCHES OR 1360 GALLOWS MODEL NUMBER: N- D- INCHES OR 10 GALLOWG SWITCH TYPE: you lis- AiRCLC/Y MOTE: PUMP AMD ALARM ARE TO OE MtWIMUM DISCHARGE RATE GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND PISTRIBUTIOW PIPE.. FEET + MINIMUM WETWORK SUPPLY PRESSURE / FEET ♦ _ ~_0 FEET OF FORCE MAIN X 317R..FYo ft.FKICTIOU FACTOR.._I=*✓- FEET TOTAL DtWAMIG HEAD = .~L= FEET Capp,¢Ls/f~/r~/~ IIJ7ERWAL ZLWSIiOWS Of T_AWK: LENGTH ;WIDTH -..;LIQUID DEPTH SIGNED: LICEIJSE Wt1MBER...~ DATE:._.-_ a . W HEAD CAPACITY CURVE 3 7/8 MODEL "98" 30 8 25 m 6 20 15 1 ! 4 10 2 5 0 J.S. GALLONS 10 20 30 40 50 60 70 80 JTERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING FGGAA ITY 12 HFEETMETEERRSS MIN LTRS 273 231 1 IS 170 15 t C JUN 9 :1995 Register of OeoOs , Si.CroixCo.~1m 3068; 'tERT IF I ED SURVEY MAP L OCA TED IN THE SW 1.;4 OF THE SE 1,4 OF SECTION 8, T29N, R 15W, TOWN OF SPRINGFIELD, S T. CRO I X COUNTY, WI. NOTE: BEARINGS ARE REFERENCED TO PREPARED FOR : V I L L MAN FARMS, INC. THE SOUTH LINE OF THE SE 1 ,14. (ASSUINED NI/4 COR. OF SEC. APPROVE 8. (COUNTY MONUMENT FOUND). VIVP4AT.TFQ.,4AND$ S00° 53' 17" E I 2 V95: r 3959. 18' NORTH LINE OF THE SW-SE I ST. CROIX COUNTY Comprehensive PlaWk S 89052'11"E 1327.05' Zoning and -Pw*s Comn'41Ilot z 00 p If not recotd6d 0 v, within 30 days of w approval date v, 0 y -tpproval that be W -%A Z vM 379.42' U' o: S 89015'24"W LOT ° o: Z: J; 31.68 ACRES a J: z 1,379,793 S0. FT. 00 O O: W 0 30.66 AC. EXCLUDING R.O. W. m I-- I o 1,335,404 SO. FT. Q: Q O J: J: N W Z CL: p 2 W - 9 I ~ ~ Cn J 0 H I A HIGHWAY SETBACK INE 50. 19, _886. 12'_ _ 50.00' - ~M 90° 00 00" E~°n S 90° 00' 00" W I _ S '90000100,w. 445.80' _0 -_S 90° 00' 00" W- 889. 58' _ 1331. 92' I SOUTH L I NE OF THE SE li4 C. T. H E" $1i4 CORNER OF SECTION 8. SE CORNER OF SECTION 8. (COUNTY MONUMENT FOUND). (COUNTY MONUMENT FOUND). a ~5 "Continuedb C)aSCF2 I .PT I OIL. A parcel of land located in the SW 1/4 of the SE 1/4 of Section 8, T29N, R15W, Town of Springfield, St.Croix County, Wisconsin, more fully described as follows: Commencing at the S 1/4 corner of said Section 8: Thence N90000'00"E along the South line of the SE 1/4 a distance of 445.80' to the POINT OF BEGINNING: Thence N05002'53"W 914.33'; Thence S89015'24"W 379.42' to a point on the North-South Quarter Section Line of said Section 8; Thence N00053'17"W along said line a distance of 415.55' to the NW corner of the SW 1/4 of the SE 1/4 of said Section 8; Thence S89052'11"E along the North line of said SW 1/4 of the SE 1/4 a distance of 1327.05' to the NE corner of said SW 1/4 of the SE 1/4; Thence 501006'07"E along the East line of said SW 1/4 of the SE 1/4 a distance of 1318.58' to a point on the South line of the SE 1/4 of said Section 8; Thence 590000'00"W along said line 886.12' to the point of beginning. Contains 31.68 acres subject to conveyance for highway purposes as recorded In Volume 397, Page 417 over the southerly portion as shown. Also subject to any and all additional right-of-ways, easements, restrictions or conveyances of record. SL RVF-YX' 2 ' S CF-F2T I 1= I F - I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County Subdivision Ordinance and under the direction of Villman Farms, Inc., I have surveyed and mapped the above described parcel of land and that this rrrap is a correct representation of the boundary thereof. Dated this "2.%'T` day of P.~~\%.- , 1995. SG0Na S~ ip James M. Weber S-1804 NELSEN-WEBER LAID SURVEYING `.~~sEA ~o - Zoo- 9 t WEBER ' ~g S-1804 SPRING VALLEY Wis. { Q' P,vyre. -rte - STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER H t,/ qM.1 7,01W441.~ ~ a."so n MAILING ADDRESS 1V8018 7,17 t c Sf . /S -ye, wr S• ya a z PROPERTY ADDRESS 2 V 6 y G' . ,U 6- (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION S w 1/4, S E 1/4, Section 8 T 2 9 N-R 15* W TOWN OF_~,v~, h9 f'~/aJ ST. CROIX COUNTY, WI SUBDIVISION eve rt e , LOT NUMBER CERTIFIIEDSURVEY MAP 536,6 83 , VOLUME /0, PAGE 2,9 VS:, 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 expiration date. SIGNED: ` ~~~7 DATE: d 2 - 2 9 - 9-C 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 and 7*w,gra CJrr►gSoh Location of property_,5 w_1/4 SE 1/4, Section $ ,Tj_~N-R _Zt W Township Mailingaddress Npo : g 9'Y7 tk St X //s w r S-ve Address of site „Z F6y Gf,, Subdivision name GS/y/ Lot no. Other homes on property? Yes K No Previous owner of property VII//w,an Farw~s ~".rc. Total size of property 3/. 6 Ej ACA'cS Total size of parcel Date parcel was created 66- 79-,95- Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house)? X Yes No Volume L15// and Page Number ?S*-~' 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. Signatu e of Applicant Co-Applicant y a-41- 9G Date of Signature Date of Signature V t ~ it I I'I .I I ~I' DOCUMENT NO. WARRANTY DEED ' THIS SPACE RESERVED FOR RECORDING DATA 1i STATE BAR OF WISCONSIN FORM 2 -1982 I ----534.`71 REGISTER'S OFFICE ~ - - ST. CROIX CO., WI Qrppat,oD - Redd for Record II Villman--_Farmsr I. S EP 2 5 1996 - ~t 9:15 A. M cony s and warr nts o -..Brian J. Ormson and Tamara IC./a_ I ]j rmson 1us..Ap and as_ survivor_ marit al ship_____... Register of Deeds pro ---•Pe•-•-- t i e --y. r D ETURN TO~„- J 1 the following described real estate in ._..-S t..._. cr0.].X .....................County, State of Wisconsin: Tax Parcel No- Lot One (1) of Certified Survey Map #2945, in Volume 10 Maps, page 29452 Document #530685, Office of the Register of Deeds for St. Croix County, said parcel bein a part of the Southwest Quarter (SWk) of the Southeast Quarter (SE ) Section Eight (8), Township Twenty-nine (29) N, Range Fifteen (15j W., St. Croix County, Wisconsin. * M. This is__.no-t------- homestead property. (ic) (is not) Exception to warranties: Subject to easements, rights- of- way of record, municipal and county zoning ordinances and conveyances for highway purposes Dated this 28th August 9x day of 19.. VILLM#N FAREd . (SEAL) EAL) * -By Leon ...,_...rPs.i.~lent ------..(SEAL) - (SEAL) * --.June Rings tad.:...s:ecretary AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN (2GM X ss. I'-...________ County. ^