Loading...
HomeMy WebLinkAbout040-1235-30-000 Q° 3 0 3 0 ~ p e» p u> d M ~ o ~ y l~ p I OJ 0 3- ~ a a~ ~ o o0 y o O to , C) O I. v ~ U c y0L c o O X 3 a~ x C c a E N 0) 0 w~„ y C ~ U p 7 U C N O _ N 0) ~ N ~0 c a)" y N O y O; E O C (0 Z_ a z p Y 7 O O 3 o LL C C y LL C f6 y W zs3 b coo. Q a c Q m coo N 3 co 3 Cl) y m Z O w C i E p z co w a m a m M I- Z C i o c z a 0 2 c d' c c w v, o a> Z d c c o fA F- r m CD O O Z ~ c E S E a N d O N Q) m a O N U N a'. N a) N I N C 0 .0 CL L) - i C C Q C C Q U O O Q O Q w Q Z H Z Z H Z o N E E Z N C l9 ~ N a _ N = ar _ c CL M CL - C: CD U) 0 LA ID ca 0 O c o a a E o C a E N D E E U t fn N N t _ 76 U' LO H H H u V) H F- I- u = o 3 0 0 0 0 0 0 Z° • rv a a iL a o. a a g N y a a ca co o m > rn o rn rn o to -j U 2 rn Z S rn rn Z r- -0 r- !Z LO a AV O M O co C14 U) c) o N N y 04 O > > _ _ 2 :2 m N :.i In ~ V1 Q ~ to N (D p N Q Z 0 -p 41 Q} U)f 05 d d y d y O O L A C Y y C O _ N f- 00 d O i5 (n a) a) r O O C O C C C N C C % 1 0 0 0 Lh of 3 M o c 3: Y aE`i Y c n O M O N N C F- LO CN! O >>2 00 0i N p 0 0000 0, t0 p t43 U O • yam„' O O H > N O N Z N O N Z (n rc~y v~ 4) M Vin. ~ a m a y a w a Q, m u y c d d C t E L c c 0 c o A U as o v, 0 o A 0 w 4 M E M O R A N D U M TO: FILE FROM: MARY JENKINS DATE: OCTOBER 31, 1996 RE: KENNETH WEIDE Bill Schumaker went ahead and installed this system on October 25, 1996 as no one from the St. Croix County Zoning Office was available to do an inspection. pe STC - 104 AS BUILT SANITARY SYSTEM REPORT - x~ OWNER TL. GJ~ ADDRESS",,,' ~ev.~ILr ~ ~Ois ~ w SUBDIVISION / CSM# LOT # ~%L SECTION 3 T-;LF-N-R1_W, Town of ? Y a ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~r T r'Frv~j'/pG' r ~ /V awQL k v n y w~ P fir,' ✓ tw a~ a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. - Provide-- 2- -dimensions---to center of, -septic tank manhole cover. - BENCHMARK: 5a p' S l ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: f_~fonj ;,~w~ !g Liquid Capacity: /dcl(J Setback from: Well S6 a' House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length .3-7 Number of trenches Distance & Direction to nearest prop. line: xjoy 7-4 -To Setback from: well: ~f- House yS Other ELEVATIONS Building Sewer .3C ST Inlet: 99 0 2 ST outlet: ? PC inlet PC bottom Pump Off Header/Manifold 6 Bottom of system Existing Grade Final grade z/o? ~CaUey. DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ,~flJ~'3r~2 INSPECTOR: Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 284165 Permit Holder's Name: ❑ City ❑ Village 51 Town o : State Plan ID No.: WEIDE, KENNETH TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA AQAnnAl? TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Model Numer: 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: TROY.3.28.19W, NE, SW, LOT 42, TOWER ROAD Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division r.•■~■■■,. 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 ci than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Numb The information you provide may be used by other government agency programs ck if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. tate Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location X1/4-S-, S T r ,N,R~Q E(orCW Property Owner's Mailing Address Lot Number Block Number / 4We c r T 1_(.2 City, State Zip Code Phone Number Subdivision Name or CSM Number 5' 16- S O ( > w t 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ityage Nearest Road ❑ r E] Public [kL1 or 2 Family Dwelling - No. of bedrooms Vill own of it a 2si d~7 Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Nur s) 1 ❑ Apartment / Condo 6 ef 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. &a 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 I00 J Date Issued 7 3. 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 12J4 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 Feet Feet Ql' Z> VII. TANK Capacity in gallons Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank lef d r R ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature No Stamps) MP/ PRSW No.: Business Phone Number: A ~'L< !2 .S ~ ~ v l C.~ Plumber's Address (Street, City, State, Zip Code ('c o d cc Ct~~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nit r Permit Fee (Includes Groundwater Date Issue ISSUI g Agent Signature (No Stamps) Approved Sur arge tee) App ❑ Owner Given Initial Adverse Determination v X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Divi ion, Owner, Plumber a INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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 lice-ised 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. IL 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 experimentai 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. C b~ C, ri we r to I I 4 a e_v_✓v_- F 1 ~ 1 ~ i Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa e 1 of 3 Labor and Human Relations g - ,Division of Safety & Buildings In accord with ILHR 83.05,~yViS' d~ O, L. COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in si l ~ti aatn must Jude, biii, ~`N St. Croix not limited to vertical and horizontal reference point (BM), direction a d slo A ilemf ' 'a PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ° i ` 040-1235-30 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMN,; r 9W EVIEWEDBY DATE PROPERTY OWNER: PROPERTY`tE3CATION Dick LaCasse GOyI't 1/4", 1/a,S 3 T 28 N,R lgor)W PROPERTY OWNER':S MAILING ADDRESS !i~# BLOCK#:; NAME OR CSM # 1220 Oakwood Lane 42 _t ountry Wood CITY, STATE ZIP CODE PHONE NUMBER E7OWN NEAREST ROAD 0715) 549-5693 Tro Tower Rd. New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface devation(s) 98.00 ft (as referred to site plan benchmark) Additional design / site considerations na= Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ® S ❑ U ® S ❑ U ® S ❑ U 0 S ❑ U C3 S❑ U ❑ S 9] U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Baxxiary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 1 0-15 10 r2 2 none 1 2 15-29 10 r4/4 none sil lcsbk mfr w if .2 .3 Ground 3 29-92 7.5 r4 6 none ms os mvfr na na .7 .8 elev. 102.OQt. Depth to limiting factor +92" Remarks: Boring # 1 0-19 10 r2 2 none 1 1 sbk 2 2 19-35 10 r4/4 none sil lcsbk mfr if .2 ` .3 Ground 3 35-90 7.5 r4/6 none ms os mvfr na na .7 .8 elev. 101.9 ft. Depth to limiting factor +90" Remarks: CST Name:-Please Print Gary L. Steel Phone: '715-246-6200 ddress: 5 200th. Ave New Richmond, WI. 54017 m02298 Signature: Date: CST Number: -~25'µ~6 PROPERTY OWNER Dick LaCasse SOIL DESCRIPTION REPORT Page 2 of , 3 PARCEL IA # 040-1235-30 Lot #42 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-15 10 r2 2 no w if .2 .3 2 15-29 10 r4/4 none sil icsbk mfr gw if .2 .3 Ground 3 29-92 7.5 r4/6 none ms os rrvfr na na .7 .8 elev. 101.8 ft. Depth to limiting factor +92" Remarks: Boring # 1 10-11 10yr2/2 none 1 fill gw if 2 11-35 10 r2/2 none 1 icsbk mfr gw if .2 .3 3 35-48 10yr4/4 none sil icsbk mfr yw na .2 .3 Ground elev. 4 48-96 7 , 5 r4/6 none ms oscQ mvf r na na .71: .8 101.6 ft. Depth to limiting factor +96" Remarks: Boring # ` 1 0-24 10yr2/2 none 1 lcsbk mfr yw if .2 .3 2 24-36 10 r4/4 none sii icsbk mfr gw if .21 .3 3 36-9 10 r4/3 none ms os mvfr 9w na .7` .8 Ground elev. 101.3 ft. Depth to limiting factor 90 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Dick LaCasse 1554 200th Ave. CSTM2298 NE4SW4 S3-T28N-R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246-6200 lot #42-Country Wood N1~ c 1"=40' BM.= top of NW lot stake @ el. 100' t ~0 w oy Gary L. Steel 8-25-96 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT C~'I s Safety and Buildings Division (ATTACH TO PERMIT) nitary rmit No.: GENERAL INFORMATION 268549 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: WEIDE, KENNETH TROY ( ~1. CST BM Elev.: Insp. BM Elev.: BM Description: Pa TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft Forcemai n Length Dia. FFii Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING manufacturer: SETBACK INFORMATION TypeO CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil C] Yes C] No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.3.28.19W, NE, SW, Gilbert Road Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water 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. 5 • See reverse side for instructions for completing this application State Sanitary Permit uqer The information you provide may be used by other government agency programs Ct gi r(/e~vJ,(o,~in to r vious P application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location Ar o rh e e- E 114 1/4, 5 T , N, R P E (or) Property Owner's Mailing Address Lot Number Block Number e e -e 14 4 P- e_- y2 City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYP OF BUILDING: (check one) ❑ State Owned ❑ Cit~ Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms o Tovil wg OF o- 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo J `Y a - Ca3~~ 3 d 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 _________ExistingSystem 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) Elevation ~ro .5_4i --q % ~ r Feet 9Q, G0 Feet VII. TANK Cat) ty in gallons Total # of r Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel plastic p New Existing strutted glass App. Tanks Tanks Septic Tank or Holding Tank X_ QOO l ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature o Stamps) M / PRSW No.: Business Phone Number: /1141 7! G- r~C Plumber's Address (Street, City, State, Zip Code): + IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee (Includes Groundwater ji e Issue M g Agent Sign ture (No Staonps) )(Aroved Surcharge fee) pp ❑ Owner Given Initial 1 A dverse Determination /a 9 1 L.01~ If X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 41 VV SHD-6398 (R. OS/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber I INSTRUCTIONS ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. 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, numk far of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all s _ptic, 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 appropria-:, 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 anc sF ecifications not smaller than 8 1/2 x 11 inches mt;st be suf -pitted to the (,cnty The plans must include the fo! owing A.) plot pian drawn to scale or with complete cimensio location .,f ol inq tank(s), septic txinl<.a~ r;; r __3tr7ent yank bui'aing sewers; wells,; wat?~ main>%vvater s. e; stre.wi, d I _ke>; pump or siphon sc.` orption systems; replacement system area.; . I the loc.; -_7. ~f the building served; -)I A V, '"'in s i r nce points; Q cc) r'itie speofik 6,,m IUr pJ'T,'2> 0 '-)1_r.ji5; dOS2 VOIUme; . eIt _ r friction IC,.s, r limp pe-formarice curs >~amp model and ,_-:_)mp rt` --..f - - -rE r; D) cross section of tti _ s.w ;at,snr plw!, k i2m if requi e< try the county; ) s it ~est data uri a 1 1 t1 orm, ur;:i ; 1 sizing ~nformation_ - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated p-acbi =s which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contaminatk::n investigations and establishment of standards. low, 99C , TARIR T rk" C0B►1 LOT IADI05 CHIRAL CBOtD CBOID ABC TAIGHT TUG91T IXT1 LINTtt ' BAIIX 1111116 NO. 10 LIICTI AIGLI IUIIIG LI1B71 LIICTI IIAl11C IIAIIIG l.if' 1;1.6{' 0Ti0Il'16'I 111141'17'1 11.10 ID 267.00' 11021'10' SI)°00'16'1 171.11' 111.51' S11041'06'1 S04016'26'1 7.25' 15).)1' 111/19'7)'1 111011'51'1 51 267.00' 72020'33' 515013'69.5'9 111.71' 150.11' S0011106'9 503°2)'37'9 y r 9.11' 19.15' 117/11'51'1 119051'01'1 53 261.00' 05007'01' 506019'59.5'1 21.86' 23.15' 509023'31'1 501016'26'1 = p 1.11' 196.11' 17toS)'11'1 5670S5'11'1 61.11 RD 111.00' 52031'11• 521059'10.5'1 369.00' 312.21' 501016'26'1 SWIV17'1 D N 1.51' 1)1.57' !)2011'16'1 563011'12'1 57 117.00' 21055'49' 506011'21.5'1 192.11' 1{1/1111}11 151.61' 655.61' 501116'26'1 517019'77'M 6.70' S1{077'1{'Y 51 117.00' 10015'24' $12057'05'1 220.00' 222.61' $17039'23'1 51101147'1 1.92' 113.11' fi3061'12.1 SIS057'02'9 43-11 SO ' 313.00' 14059'55' 525016'19.S'1 291.13' 300.80' 51101/47.1 S03°14'S2'Y nl ()9 1.90' 1l.EI' I)SCS1112'1 Sl6°11'16'1 45-16 19 717.00' 16001'12' 126010'26'1 271.21' 111.11' 101006'0S'l 118011'17'1 r 1.11' 62.11' f90/11'00'1 911O5S'S0'1 1.00' 771.11' //11SS'SI'1 11.11 BD 111.00' 52011'13' 921059']0.S'1 627.60' 162.71' 111011117'1 101116'26'1 Q 111°55'50'1 1.05' 69 MAP 02027'22' 111003136'1 10.00' 20.00' 11101/47'1 115052'2S'1 11.11' 911015'51'1. SIS0l1'21-1 11 611.00' 11021'00' 116011'25'1 155.00' 155.67' 115052'25'1 127021'2S'9 Z O Z .00' $6.15' IIS/31'11'1 SIS011'/1.1 67 611.00' 21036'IS' 116036'11.5'1 191.06' 117.11' 117°11'25'9 MOS/11'10'6 .00' 50.15' f15Oll'I1'1 S0I0S3'29'9 46 613.00' 10001'36' 100015'51'9 00' SO-IS' 11.11' 11.95' 105011'10'9 101016'26'1 f11/51'71'1 127131'11'1 49-50 to 333.00' 37027'10' 123000'16'Y 213.16' 117.72' 101016'1611 111°11'06'1 Q y D .00' 50.15' 121011'61'1 S610S6'55'1 IS 131.00' 09027'11' 108051'2'1'1 SI.SS' 56.61' 101016'26'Y 111010'11'1 .OS' 99.70' S610S6'S5'1 IIIOSS'50'1 11 313.00' 2100312' 127012'10'1 161.11' 163.11' 113010'11.1 111041'06'1 1.12' 62.11' 14 I0S5'51'1 110000'00'6 SI•S2 41 167.00' 105021'18' 111000'11'9 265.13' 107.16' :62016464 163011'12'9 m ~ 99' 169.12' 101011'11'1 511011'06'1 S3-51 31 250.96' /1010'26' 112051'29'1 171.541 112.51' 16301142'1 112004'16'1 O m 6s 55 REQUIRE FIT WHEN ,p • ~ MATCH y \ O .IS' 1194.94' y ~ ~ . =424.09' 1 m m N ~ 67.00 R O N y° • u _ O O i s= Z 5. IN JJ 44 / NA m ~ N ~ O J rr, is rr) ~ r yZa \s N L N ~ Y Y yp N 144 \ \ m (J M - 01 00 .4 J 0 \ 4` Yt \ Nµ ~ N H ~ ~ ~ 4►v . M J M a ~ m y Rev z /M 401 ~~6 0'6 u \ 00 ti 1?' a , (n 3~ n Sti 92N Z \ y9r 3Sir?•J BB 0` •9Z'' \ O Ir- 167. I~ / In 8 A co IU N~ o V ~ ~ 1ro U A I U1 m ~ ~ O 2 ~ m D eI. f O . m n N 1 r Zr N 2 ° 6y IQ y BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SWIi4 OF SECTION y 3, ASSUMED Tp BEAR N89'09'24"E. T? O ~ Z W ~ y Z p e ~J r/ dJ e 7 2 l~~ Zl2 eo T v r w✓ a ~T .SV FOP, 0 o p ! .61 S~cyL e I, V2 ,BS 6 DDB dg~ ~G fir' a~ • Ypi 'ya© 4 ` ! {L/ r ! V I/a 1' ` Wisr or+.SinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT ~~r-,Page 1 of 3 Labor and Human Relations .Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Qar S ~Co 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 CEL I D.'#`-`°' t dimensioned, north arrow, and location and distance to nearest road._ e3~dfi r APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION AI=VIEWED-BY PROPERTY OWNER: - PROPERTY LOCATION ~,,rJ. NG OFFICE Richard Stout , GOVT-LOT NE 1/4 SW '$t4$ T 28 or) W PROPERTY OWNER':SMAILING ADDRESS OT OCK# SUBD.NAME~4~ 1353 Awatukee Trl. Countr CITY, STATE ZIP CODE PHONE NUMBE []VILLAGE DOWN NEAREST ROAD Hudson, Wi. 54016(715 549-673 Troy Tower Road New Construction Use [ x] Residential /Number of bedrooms 3 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.10 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft F table for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK suitable fors stem 13S ❑ U (2S ❑ U [3S ❑ U ® S ❑ U KI S ❑ U ❑ S ® U 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 Trench 1 0-18 10 r2/2 none 1 lfsbk mfr cs if .2 .3 - 2 18-28 10yr4/4 none sil lfsbk mfr if .2 .3 Ground 3 28-36 7.5 r4 4 none sl lcsbk mvfr na .4 .5 elev. 100.0 ft, 4 36-84 7.5 r4/6 none s os mvfr na na .7 :.8 Depth to limiting factor +84" Remarks: Boring # 1 0-16 10 r2 2 none 1 lfsbk mfr if .2 i. 3 2 2 16-37 10yr4/4 none sit lfsbk mfr if .2 ~.3 Ground 3 37-42 7.5 r4/4 none sl lcsbk mvfr n 4 :.5 1 elev. 4 42-80 7.5 r4 6 none s os 99.6 ft. na .7 1.8 Depth to limiting factor +80" Remarks: CST Name:-Please Print Gar L. Steel Phone: 715-246-6200 Address: 54 2 M02298 Signature: CO Date: CST Number: s~ 4-19-96 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of, 3 PARCEL IA # pending Lot #42 " Depth Dominant Color Mottles Texture Structure Consistence Baxday Roots GPD/ft Boring # Horizon in Munsell au. Sz. Cont. Color Gr. Sz. Sh. Bed Trench *3 1 0-18 10 r2 2 none 1 2m .1 } 2 18-24 10yr4/4 none sil lfsbk mfr if .2 Ground 3 124-32 10 4 os mvfr c1w na .5 .6 elev. 7 ;.8 99.3 ft. 4 32-84 7.5 r4 6 none . Depth to limiting factor +84" Remarks: Boring # 1 10-21 10 r2 2 none 1 2msbk mfr if . 5 .6 4 2 121-34 10yr4/4 none sil lfsbk mfr if •2 •3 3 134-40 10yr4/4 none sl lcsbk mvfr C1w na .4 Ground elev. 4 140-84 7.5yr4/6 none s os mvfr na 98.9 ft. Depth to limiting factor +84" Remarks: Boring # 1 10-17 10 r2/2 none 1 2msbk mfr 2 17-24 1Oyr4/4 none sil lfsbk mvfr if .2 .3 3 24-31 10yr4/4 none sl lcsbk mvfr cfw na .4 .5 Ground elev. 4 31-80 7.5 ' 7 : .8 98.6 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NE4SW4 S3-T28N-R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246-6200 lot #42-Country Wood 1 N 1"=40' BM.=nail in fence post C el. 100' Alt. BM.= top of fence post C el. 103.7' 1 h~ T, 'vc n ~ Ala -ITO 14- Gary L. Steel 4-19-96 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Gilt • MAILING ADDRESS 1~j yu f L%j=e el a d S -y PROPERTY ADDRESS C /h r'~{ (location of septic system) Please obtain from the Planning Dept. CITY/STAT9 a d ! fg ,,d f` PROPERTY LOCATION _Nil 114, .5 LU_ 1/4, Section 3 T_j2j._IV-R_L~,_W 'OWN OF py ST. CROIX COUNTY, WI SUBDIVISION C.0 tg j, LOT NUMBER Z CERTIFIEDSURVEY 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. Tlie 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) aRer 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: ~✓1~~%Lt~)"1 DATE: ~~l q~cl St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r S T C - loo the This application form is to be completed in full and signed bywill owner(s) of the property being developed. Any inadequacies only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), 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 l/4 _1/h, Section ,T~1N-R--~--W Township- Mailing address /L113~.4_7 A G 1-111! ems" ~ Address of site Lot no. _ya Subdivision name Y ty~ Other homes on property? _Yes L---*' No ' Previous owner of property Total size of property 1 Total size of parcel 2 e Date parcel was created Are all corners and lot lines identifiable? l.-I Yes No Is this property being developed for (spec house)? Yes _L,,-,,-No Volume //fP and Page Number / 6 9 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 the best of my (our) knowledge that I (we) am (are) the owner(s) of property, described in this information form, by virtue of a warranty deed recorded in the office of the County Register of presently Deeds as Document No. yc14 3 and that own the proposed site for the sewage disposal system or (th) obtained an easement, to run the above described property, for construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. _ Gt,~ - Signature of Applicant Co-Applicant q1 q b;ito of Slinn:it ii I f RirinntiirP GC ,UNiENT NO ~ STATE BAR OF tti SCONSIN FCRY .--582 wECORD,IW, DAf % WARRANTY DEED 5•~~~~ CC9 q REGISTER'S _ - = j ST. CROIX M., I~ I Fwd br Ij Richard n~srn t,r MAY 3 0 1996 j~ at t t : 3o A. conveys and warrints to -Kenneth H- We de and qh---Lr ---Wei de ~.b u s band- .end. j~ - i~ RL "JRN TO li t^j following described real estate in St ~.rQix __;,nty, j~ State of Wisconsin: II Ta, Parcel No: Lot 42, Piat of Country Wood First 3:=f_-ion, Town of Troy, St. Croix County, Wisc=-sin. ii i it II I f ;I T4A ZFFR ~i ~I r ~i ~I Ij This 1S ROB homestead property. fill (is not) Excepti,ntoWarranties: Easements, restrictions and rights-of-way of record, if any. j Dated this o_ day of jl (SEAL) _ISEAII li I I - R--;=hard 0. Stout- Ij I~ (SEAL) (SEAL) II I I t Ij AUTHENTICATION ACKNOWLEDGMENT Signature(s)- =-=-e CF WISCONSIN I ss. I j Croix county. authenticated this day of 19 P-2rsonally came before me this- 29th day of May 19 96 the above named _ --lichard 0. Stout I _ TITLE: MEMBER STATE BAR OF WISCONSIN Ill not, -i? n to be the oerson_ .rho executed the -'h--A -F Jnc M .A- c..... 1_._..-__. I_.__