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HomeMy WebLinkAbout036-1032-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. 183 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax No: Stricker KES Enterprises LLC , Karin E. Ms. Stanton, Town of 036-1032-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No 14.31.17.205B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer %,7 ~P Holding St/Ht Inlet 16Z.-~ 715-17 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S I / Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number hem Z / TDH Li Friction Loss System He Ft n . Forcemain Lang la. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ' No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS rw it SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of Ski: UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 i : Yes No i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2138 County Road T New Richmond, WI 54017 (NE 1/4 SW 1/4 14 T31N R1 7W) metes & bo 6 ds Lot Parcel No: 14.31.17.205B 1.) Alt BM Description 2.) Bldg sewer length = Z I ' U -amount of cover > 3 a,,.. a. Q0 Plan revision Required? ❑ Yes No Use other side for additional information. SBD-6710 (R.3/97) Date nsepctor's Sign re Cert. No. County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT ` Personal information you provide may ec*Lsecondary purposes ST. CROIX COUNTY GOVERNMENT CENTER a [Privacy Law. S. ( 1101 Carmichael Road Hudson, WI 54016 7710 L(715 386-4680 Fax (715)386-4686 Attach complete plans for the system on less n 8-1/2 x 11 inches in size. County Sanitary Permit ❑ Check if revision to pre " s application Application Information - Please Print all Information Location: Property Owner Name APR 2 5 2013 iF_ 1/ /4, sec N, R E (or Prope er's Mailing Address / ST CRUtX COUNTY Lot Number ~ Bloc 6~ '41. ~ sm: A*i) ity, State Zip Code Phone Numer Subdivision Name or CSM Number e4 i 1~4!~L II ype o Building: (check one) Dk LFity ❑ Village wn of 9K 1 or 2 Family Dwelling - No. of Bedrooms: da- ❑ Public/Commercial (describe use): C{iyL ❑ State-owned Nearest Road 1. Type of Permit: (Check only on a A. Check box on line B if applicable) / Parcel Tait umber ) 20 S A) 1Repair f8' Reconnection Non-plumbing . ❑Rejuvenation Sanitation B) Permit Number Date Issqed tate Sanitary Permit was previously issued o/~J- IV.. Type of POWT System: (Check all that apply) L'1 Non-pressurized In-ground ❑ Mound a 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating Dispersal/Treatment Area Information: ~C 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. it Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min.Anch) 'In - S Elevation Z 1. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Ab Concrete strutted glass Tanks Tanks ! f Co LV ❑ ❑ ❑ ❑ ❑ 11 ❑ ❑ ❑ VII. Responsibility Statement 1, the undersigned, assume responsibility for repair/reconnenction/rejuvenationCnstallation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the instal tion o non-plumbing sanitation system. Plum er's Name (pri t) Plurn ignps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City tate, Zip Code . Vlll. Coun se Only , Disapproved Sanitary Permit Fee ate Issued suing Ag nt S' a o stamps) Approved Owner Given Initial Adverse~J J~ 7~Z Determination X. Conditions of Approval/Reasons for Disapproval: y L " 9- alkal Jr~ SYSTEM OWNER; 1. Septic tank, effluent filter and Dh~ dispersal cell must be serviced / maintained as per management plan provided by plumberCk a-P_ ^ 2. All setback requirements must be maintained a4td eAcw as per applicable code/ordinances. , r . Rev: 8105 (/YL S~G~C~ c.~~'•- .QD Cltn2,G~u~/(~~(r ~Q~t~-~ ~~.0~ cL~~O"1'~ PLOT PLAN Page of SCALE 1"= 3p ' t~CC~.Q•~f ~ `~'R 1i't'y'^i'Y P~Ct-~J L~`C LO ~0. a3 b, L03Z-- V0 TL Col C, p 8-~ _ ov'~'L.r9 N x oTYUM t4., tg I Z's as ~~,R ~'w+uu. s► r ~,;:n 3~' tTi,, S f WV%A- q,i Silt Fence 90' Lle` ~vct~uz 7-163 - T. • s~vTt c 5~S /119, m ~inkZ;:fi„ J - - I f i j~ 1 Site Plan and ES En[jerprises LLC Organizational & Structural Re-engineering Soil Erosion Chart Karin Stricker Created: 4/23/2013 PLOT PLAN Page ? of SCALE 1"= 30 ' ~ l 4 awo. 03 b _ l.O~ Z - lfJ y ~,eg ~loT Lla► ~ Lit.~lY~ S' MIA. 04 $otTvrl t't.. 3b S Z i b $.'L Silt Fence 90, 3y"= - - t~O.A et}~} LT7.1.9~ SuQ.i.~P+tCE 54pT1 a ~~S c+1^K~WN. 3oYtp ~ ~ /119, a°o a N ~ a i Site Plan and ACES EnCerprises LLC 4rga+nizatit~nal & Structural R"ngineerinp Soil Erosion Chart Karin Stricker Created: 4/23/2013 o (D °o h O v h > o t3 C' 7 N > q O O t N c 75 N, 2 6 (0 N p c t ~ c 3 ~ •Op N 01 N o Oi 'd ~ C N Y w O S c a) c a) I O a °c m "0 o. o ._~N~ C z a =m z > E ro m LL C M D N O N • c c s E E Q o E 3 a U M N ~ y z ~ ~ y v C') Z a m C O O z d v c d 2 c to F- rn O z c E u ~ N M N 01 0 ~N co N c j' L) 0 o N Q z m z o N z E C N O N > d - N d ~ N vi O a U c D O d ~ ~ U Z C Fy- F F = o w 0 3 3 d a z 0 0 0 • uIL IL CL y a ir u: c0 co z Oi Oi O fA J U O O ~ Cl) O (D C) CD O ~ O O E ~ O N N N N T m d N O h.i CJ d o Cr" O N N O O M N C N 0 j N CO 00 O O CO C O 0 3 Z' N c C x 0 0 0 N N N O cNn N~ c d c c l c 1 _ N N_ O O O CD ' C Q) O CO f0 N N O y p co tt U Cl) (n Q N O y z Cn • y~,~' O O C4 ~ w r ~ _ I a; o `w a. m L: a • RS CL d •V (D y C A 0IL 0(n0 STC - 104 y, ` r J~z AS BUILT SANITARY SYSTEM RE T OWNER ~ ~ ADDRESS SUBDIVISION / CSM# LOT # SECTION T N-R /,?'W, Town of .5Q ydCnn, ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM tb- ,`r ~a' 0' 37 INDICATE NORTH ARROW A Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tangy; manhole cover. BENCHMARK: -4b y" ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (,3jja , Liquid Capacity: Setback from: Well House ja Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM Width: Length .3 Number of trenches - Distance & Direction to nearest prop. line: ~f6ZVU /a Setback from: well: House-j,?~ Other ELEVATIONS Building Sewer 7, pt ST Inlet. %.5, q / ST outlet qS, PC inlet PC bottom Pump Off Header/Manifold 70, & Bottom of system 70?,~ Ore Existing Grade ` Final grade oZ DATE OF INSTALLATION: A 7 /to PLUMBER ON JOB: IZ %.01 LICENSE NUMBER: INSPECTOR: /)?a 3/93:jt Wiscon .n Etepartment of Industry, PRIVATE SEWAGE SYSTEM • County: Labor and4urrranR6lationS LftOIlC Safety and B INSPECTION REPORT ST. _ Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No_: Permit Holder's Name: [I City [I Village [I Town of: State PI_ AREND T. LARRY X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic, o Benchmark Dosi ng Aeration Bldg. Sewer Holding St/Ht Inlet SO qs„9 TANK SETBACK INFORMATION St/ Ht Outlet / So Verit TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic 7 1-2 S-' NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe /7 Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 9 Manufacturer Demand ?q 96, Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width al Length, No. Of TrQnches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~G ✓ DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK CHAMBER INFORMATION TypeO 1 OR UNIT Moe Number: System: > / a 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.) -LoCA ION S`T'AN'TON.14.31.1 VW . NE SW. COUAYPY 'T' Plan revision required? ❑ Yes (ErNo , / Use other side for additional information. t,,) 71 r ' F ~1 SBD-6710 (R 05/91) Date I `pct 3 Signature Cert. No. A&IONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division V~ ~ R 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 1/2 x 11 inches in size. S T CT-o • 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 if revision►o previb--1P4-tiV [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propertfwner Name Propert Location IrCA r IT AX1 /4 g;," 1/4, S 1 T 3 I N, R E (or/ Property er's Ma ling Address Lot Number Block Number wn nuvrt T~ - City, State Zip C e Phone Number Subdivision Name or CSM Number II. TYPE BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms _„3 Town of S III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo v 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 OnlyExisting 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' 210 Mound 30 ❑ Specify Type 410 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) Elevation .V.Z 1 4. 43 6 k i Feet Feet VII. TANK Ca ac t 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 6m WA.R.dL/~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst tion of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri PI b 's Signat re: O Stamps) rP/MPI~SW No.: Business Phone Number: A3 Q,- l~ . 1 O J ( ts -,a (0 5 /3-5 Plumber's Address (Street, City, State, Zip C de) : IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved A itary Permit Fee (Indude5Groundwater LDatelssuecl ]is gent Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial 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 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 nev, 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. Ili. 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 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. , ,~-.tea °-.v- -3....._.._. 4...... q.., ._...a _.6-._. _ 1 4 } ! ~ t lest. , ' i 5 1 I _ t , 1 1 } 4 i a T } } t , 1 } 4 ` 1 t r i t Page of 3 3 PLOT PLAN v XM • _ SCALE 1"= 30 ' L~z.t~~t fl `C~ wtk't4 aT 10 ~vo_ p3 b_ l,o3Z- l0 y K . trL..g1'_ S' Miles. 8.3 3oV tR.wt 8 oThiwt Nl.. 25' t~ '~QZS w~u~. 0 36a-t Z, BD R..1~ Zt tz o ~ 6 5 W~L ~~iqg? lb -%~F~-cll ~x CQ Flo` ~ect'L~ - ~ _ t~0.~ chi ~ Ls7-1,9 a s v ~2.t-~Pc~ SLs'PTl c ~\S ~-t~~lr 3oT fpr~ F J \~ouS~ SAP lru[ , 5 2i. u _ C~ f I~ 0 N 0 ~~-~~-Cy ►~►~KtrnuM 4.Z" cr~v~~ avt`~zJtsZiuavl~ou t~l At.s I SIv~~E F~rv[srfN1~ Ge-A-bE FotZ 1~( tN► C c~ o>z ~l,t'c~` ~'NDIROI~►t-l- t`~GGR-C.~~1'f~ C~tv\~~~'(t lit 1~LS"~i~18l1Tiuly t 8 Y- Zu ' BLz`b \,S `Tt 1~ M-~ti r r"7 Uw1 l L l ©p 1-U 2 Z $D\2Y'1 1`~U wt~ . ~ r"► w't ~ ~ 1 rt1 S Tt~t.-~ l.w ~ ~ x~ l ~1 ~ ~-3 t,' 1 i-o >7 F w CE~I wt DTs ~'1z ~R [Z~' Q v 2 N M ~7S R k- H 3 M Al °1S_~s6 6-9- (715 ) 42-~-01 6-. m 0SQ_ 76_ CST Signature Date Signed Telephone No. CST PAGE OF CrCUSS Sec~IOn o~ A Sysfen Fresh Air Well; And Observation Pipe _C~> Approved Vent Cap Minimum 12" Above Final Crode 20- 42" Above Pipe _ 4" Caet Iron To Final Orad• Vent Pipe Marsh Hay Or synthetic covering Min. 2" Agaregote . Over Ptoo Olitrlbullon - Tea Pipe 0 0 0 0 p• Benelh a Perforated Plpe Below Beneath p e ' o -Coupling Terminating At Bolcom 01 System PI^u oSeD ~If1c..I c~rr:.~l< ~'~,..5' ~ ~ACJr1 ..T SOIL FILL DISTRIBUTIOIJ PIPE APPROVED S4WTHETIC COVER MRSU NAy9,OF S TRAW 2"of g6GREGA'i~ r o OR. O ✓o.0F -2f/z AGGREGATE DiSTRIg1JTiO1J PIPE TO BE AT LEAST WCHES BELOW ORIGIUAL GRADE AMU AT LEAST20 WCHES BUT L10 MORE THAI.I 42 IUCHES BELOW FMAL GRADE MAXIMUM DEPTH OF F-XcAVATIOIJ ROM ORI MAL 6KADR WILL BE IUC14ES MINIMUM 9EP71i OF EAMIATION FROM. 01KI(AWAL ORaOF WILL 6E 34t IMCWES SIGIJED: _e.-OA-Z \Ij LIGEIJSE IJUMBER: _ IS- a DATE:"' 6 Wiscomen ijepartment of Industry, RLAND SITE EVALUATION REP R T Page of 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 81/2 x 11 ' 90 6 e. st include, but ST L` LZO ~X not limited to vertical and horizontal reference pant (B ~lirectio' o ale or PARCEL I.D. # dimensioned, north arrow, and location and distance It nearest road. 3 6 " 1 3 Z - 1 APPLICANT INFORMATION-PLEASE PRINT AL y1`INFQ N REVIEWED BY DATE ' PROPERTY OWNER: ROPER ATION F 1/4 SW 1/4,S IlT 3 N,R 1 E( W PROPERTY OWNER':S MAILING ADDRESS N :y K# SUBD. NAME OR CSM # ZL3 Gou - CITY, STATE ZIP CODE PHO ILLAGE NjfOWN NEAREST ROAD a Ivy Z C_lA h u><. bi'm s Vot`i (-)Is) Div K3 Cam' T [ ] New Construction Use [JQ Residential ! Number of bedrooms [ j Addition to existing building pQ Replacement [ ] Public or commercial describe Code derived daily flow 3~ O gpd Recommended design loading rate o 1 bed, gpd/ft2 0, B trench, gpolft2 Absorption area required ~-).'L bed, ft? - trench, 111:2 Maximum design loading rate _ 0.1 bed, gpd/ft2 0 - $ trench, gpd42 Recommended infiltration surface elevation(s) °l Z • S ft (as referred to site plan benchmark) Additional design / site considerations S ►y UT -eS OQ P" E` 3 a F 3 . Parent material S1 t D u~`~ S % Q- Flood plain elevation, if applicable N- j\• ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN.FILL HOLDING TANK U = Unsuitable fors stem S 00 ®S ❑ U EIS ❑ U ® S ❑ U MS ❑ U [I S Pat] SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rer>ch 9 1.0 `t z_ I j Z - 1 Z s b k wt T_ a, S o. 5 0. Z 9 Z6 1o~-IVY ~l6 sil Z~sb1~~f'~ ~S o_S o-~ -1-5 L•I.R-Y/6 `Fg o ►trv el- o c> S Ground 3 Z~-~ 6 s bvc elev. _ Sft k)6 tkz-31(, - S ~Gy o S) m l o-'~ o-~ Depth to limiting factor Remarks: Boring # O-~Z 1D'-iR 3/Z 51I Z'Fgb~ m~t^ G.S U•So•~ h t Z Z 12-~1~ 1v`i2 316 - S! 1 z'FS~k m~~ ~ S O•go. :'ihs... o S~ 3 6-109 t o~ 3l~ - S ~Gt- - o• D Ground elev. Depth to limiting factor , 7 lociRemarks: CST Name:-Please Print Phone: Arthur L. We erer 715-425-0165 dress: _egerer_Soil Testixig & Design-Service-P.O. Box 74 River Fa11s,WI 54022 - Signature'. Dafe: CSTNumtier:-"--- °)S-LSD 6_~j-~S M00576 PROPERTY OWNER ~T IL DESCRIPTION REPORT • P9 age 2.0i - PARCEL LD.# 1,b3Z--Co Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench' Ground UI;-I IL) `22 elev. 0a'a ft. Depth to limiting factor 3" 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 i I Remarks: SBD-8330(8.05/92) • PLOT PLAN I& Page of SCALE 1"= 30' 03 b- io3Z- 113 G~1vc.~' ~A< 1.l►a tL ctl l S' mw. g'3 3o t'tiw1 . 8 oTTtii►^1 i g .-qZ s wiu~. 0 36 s• i Z. eo tz.w~ 2~ iz ~ ~ b 5 ~ Z~~LDQ7 c,E a.Z z S L~P11 c S \~o~SF SSA l~uG, J tj Ct-~1 _ C~ W b,l j ~ r6 N ~ a "I'vKtHum LLV' c0QL3n 6uo:N'e_ pipes SLUICE F ,kj I-7 Qb C e Atle F-biZ t~V_~N>rGL2- Gk ~l-t'~c-L , 1'<DA1,RO1~ ~tK- EGG RL~~'f~ C~rv~:3'R 1~~_ DLS'~`R-L~UIL~ty ~'LP To~'}^f~liv 1"'1~yc.Lr COUL2, - - - two` L 8 K L u' BVD VS `T~- M 6AJ 1 M UM l l~m.b F-0 It R_ Z $D\\Zj'1 ME, s &JIfUSTABLl~G A!U Q wt~i CE~1 S ~A 2~~ u I Q_G M@U`fS Fo 2 3 Q D01 1tt m 6-9- GY S (715 ) 425-01 69 _ 1400576 CST Signature Date Signed Telephone-No. CST # ~ K A STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER. t` I MAILING ADDRESS R scow O +e vt PROPERTY ADDRESS - (location of septic system) Please obtain from the Planning 15ept. I CITY/STATE < mo l~T U D 1 -7 PROPERTY LOCATION 1/4, S k3 1/4, Section 1 TOWN OF ~C v~•1' r~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 1 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.;i 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 Y 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: DATE: r , I C7 , 9 jO St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 . • sTC - ioo ^ ! 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 Location of property Nali-1/4 1/4, Section ( `f IT _LN-R~W Township S r\ Mailing address -a" 3 k' ~ Address of site Scc VVOL Subdivision name Lot no. - Other homes on property? Yes_ _>C No Previous owner of property Vj IQ V.~ le 6_,_ Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X_Yes No Is this property being developed for' ('spec house)?. Yes _ X No volume 7_~;and Page'Number as recorded with the Register of'Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING:. A WARRANTY.:DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER.CERTIFICATION I (we) certify that all statements on this form are true. to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by .virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. U, uo S , and that I (we) presently own the-proposed site for he 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 0-q tv Date of Signature Date of Signature i ClJAtEN7 NO. 1 *S SPAC( RESERV[O FOR RCCUROINQ .DATA i ,1• WARRANTY DEED 42 pn~ i STATE BAR O~Ff WIISCONSINQFORM 2-1982I' i~ REGSTERS OffICE ' 'i ST. CROIX CO., WIS. ~ ! Walter..E...Andersen..and--Rita-.M...-Andersen.......... Recd. for ReooM ft 11th husband_-and_-wife - ~ dap of Aus• A.D.1987 conveys and warrants to 8: 30 A. AL Lawrence 6..-- x--end-t--and---Key:IMP-40 -Arendt,-----------. • ...husband--and-.wifo,---as.-joint---tenan.ts--------•--------------• i Vemik 1 RETURN TO the following described real estate in ^a-t.--•1vYaoix.................... count] , ` State 3f Wisconsin: Tax Parcel No: The South 150 feet of the North 766 feet of the East 235 feet of the NE4 of the SW; of Section 14-31-17. Subject to recorded easements, reservations, and rights of way. This deed is given in fulfillment of a Land Contract dated Dec. 6, 1985, recorded Dec. 6, 1985, in 1172811, page 06, as Doc. No. 407621. ~ IRAN FM 1 This ZS----------------- homestead property. (is) (is not) } i Exception to warranties: Dated this 6------•-----•---••-- day of Aug-ust.......................................... 19.-87... G G /-.._.._.(SEAL) y~f 6~? (SEAL) yWalter E. Andersen Rita M. Andersen ;I I (SEAL) (SEAL) ' AUTHENTICATION ACKNOWLEDGMENT I' Signature (a) STATE OF WISCONSIN II ss. -•-.....>Sea.._~i~Q X---.----County. authenticated this day of........................... 19 Personally came before me this 6th----- day of kl 19__87_ the above named ! i Mclerse Andersen and - Rita ! TITLE: MEMBER STATE BAR OF WISCONSIN (I not s o E 7nR AC W;► . i h