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HomeMy WebLinkAbout040-1221-40-000 .O O m o C_ : u0 o: ac ~ a ~ C r, N N x O.O ~ I 3 c O v a (D O 3o _ _0 'O O (6 y w= 0) C6 Q) O co U n O cn C U C z y y _ C LL C O m U O N Ol c: _ O O 0 04 Q N E 3 ~ v ~ z in rn z o v £ co Z a m N F (n O O N C C7 O U O z d' m co N _ O d z d c z CO H I', y CD y E -o O N c7 E M1~ c N C O OS o z z z C T~ N O i N C N t6 E m N N O N i ii d E t O. m w O (O O 0 O O 15 = 7 - o c a n C) M N N O m (A w 3 co N N 3 3 a 0 0 •w~ LL a a a 0- m M (n (n ° 0) rn 0 !Z ~V rn o va oo N LO oo N N N Y. E O O O O ml a. n N O N Q Q l~l ~r O (A w O C F~ O U_ N O N O G N (O 00 O o O O O N O C c a- o 0 c) r C N N N C C ~ N ~ l\ In O N~ O ~ N N ~ n (N m Q) (D O _ O ry~ 03 N U • y' O N H co N O 'h o d a 5 a L (L • ce a m L) m E L c c l 1 I STC - 104 i AS BUILT SANITARY SYSTEM REPORT r OWNER ' era ADDRESS SUBDIVISION / CSM#-~AQ42~'~' 0 J LOT SECTION _T dy N-R-W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (DES )ADD ~~.ISeP~~C ']~D al Se~~►c a3, 3a, p • INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: S TIC TANK / PUMP CRAM / HOLDING TANK INFORMATION Manufacturer: AI ~k)e~ t p6`oeo f Liquid Capacity: ,~b(~ Setback from: Well" 5/0 House r 30 Other Pump: Manufacturer Model# LLC7lfbize Float seperation Gallon%cycle: Alarm Location / :SOIL ABSORPTION SYSTEM t ~ Width: Length Number of trenches 6 Distance & Direction to nearest prop, line: M Setback from: well: House '~DQ Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATIO PLUMBER ON JOB: LICENSE NUMBER: J INSPECTOR: 3/93:jt -Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX FA Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262370 Permit Holder's Name: ❑ City ❑ Village XI Town o : State Plan ID No.: _B TRC)Y CST BM EI v.: Insp. BM Elev.: 71BIVI Description: Parcel Tax No.: TANK INFORMATION U ELATION DATA ~U> TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,r7 ~aQO Benchmark r 60k 0 v Dosing 16 n /0U, GU Aeration Bldg. Sewer Holding St/Ht inlet S, q, TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Sao i Septic r p r 'o2s ' NA Dt Bottom p. / Sq Dosing rw r '"0( "jt~ NA Header /Man. op, GL Aeration NA Dist. Pipe 60, 6 / Holding Bot. System Gjc, 7s PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number G~JEb3///~' GPM -LL TDH Lift )~pti Friction System,,z o TDHcA~y Ft oss Head Forcemain Length Dia. ~y Dist. To Well > SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _38; DIMENSIONS LEACHING Manu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O CHAMBER Mode Number: r System: l1r~~r~ 710' a..o0 /j OR UNIT DISTRIBUTION SYSTEM I-Fea C.r,/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia LengthAc5 Dia. Spacing 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1/ Depth Over t, xx Depth Of { xx91" Seeded /3edded- xx Mulched Bed/Trench Center I Bed/Trench Edges Topsoil Yes [I No E!ryes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.21.28.19W, LOT 4, COUNTRY OAKS ROAD AZ r f Plan revision required? ❑ Yes E~No n 6 Use other side for additional information. I 1(7 ~b ~~s SBD-6710 (R 05/91) Date Inspe or's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r SANITARY PERMIT APPLICATION ~~i ~~i~ COUN r~'~L■7■Z In accord with ILHR 83.05, Wis. Adm. Code Oro J STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ? ~ 02 3 f76 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION n ~t f~t 0 'T S~ E'/a, S d T N, R / 7 E (qff usu. PROPERTY OWNS 'S MAILIN AD ESS LOT # ` BLOC~~ v ~,l( C T , STAT Jc ` ZIP ODDEn PHONE NUMBER SUBDIVISION NAME OR CSM NU BE `J 1 d C 7f C4 E3 CITY 3 VILLAGE Po a NEAREST ROAg ~S 11. TYPE OF BUILDING: (Check one) El State Owned C0 ❑ Public ©1 or 2 Fam. Dwelling- # of bedrooms ~ PAR ELTAX NUMBER( `/jY1 d III. BUILDING USE: (If building type is public, check Z11 that apply) 1 ❑ Apt/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 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. N New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 P Mound 30 El Specify Type 41 El Holding Tank 12 El Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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 nn~~ REQUIRED (sq. ft.) PROPO ED sq. ft.) (Gals/day,/sq. ft.) (Min./inch) ELEVATION 6 V 150 'D t ~5 Feet . ~v Feet VII. TANK CAPACITY Site in al Ions Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank W N57 S Lift Pum Tank/Si hon Chamber O P F1 M F-1 F1 F-1 Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system show ached plans. Plum per's Name (Prin PI Signature: (No S mps) MPRSW Business Phone Number: Plumber's Address (Street, City` State, Zi ) C~ e): 4; p r IX. COUNTY/DEPARTMENT USE ONLY Groundwater a e ssue Iss ing Agent Signature (No Stamps) ❑ Disapproved San*tary Permit Fee (Includes Surcharge Fee) Approved ❑ Owner Given Initial `tff/, Adverse Determination ~ OM I X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber a INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new arid/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% 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 13, 1996 2226 Rose Stree La Crosse W 3~ 4 ~ cE, s WEGERER SOIL TESTING C%j J 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 .r 00N N7 RE: PLAN S96-40545 FEE RECEIVED: ~6 BERG, BRUCE SW,SE,21,28,19W TOWN OF TROY COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at.the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Dennis Sorenson Wastewater Specialist Section of Private Sewage (608) 785-9336 SBDA-7987(8. 19/84) Page l of 6 596-40545 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE S 1/4 OF THE SE 1/4 OF SECTION Z , T 'Z5 N, R 11 W, TOWN OF -rya&f , S't'•CVAIX COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER ' PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR eR~ CE e tECE~yEp C,1- cl R N . ' z L 1 21v~ s~tozz JON 0 cgs &4.FEry,& or PREPARED BY WEGEFQ-EF2 SO I L TEST I NG AND. ~ ~S.C0Pi P.O. B01 74 421 N. MIN ST. ~ ~ ARTHUR i WEGERER = 6975 P RIVEF FALLS. NI 54022 6LLSWORTH, 715-i2`.r-01b5 j~ Wis. 6-36-96 JOB NO. °16-48 PLOT PLAN • Page 2- of - 6 Scale 1"= HQ ' 596-°40545 315.00• Nom: wCL.L 'T0 %3 i ffr LET Soy Fi om movn,D R+v~ AT LzttsT ms, ~A,K O R P~1 r~ G ~ ~ fy C~~LOPosC~ A12..W~~ t2ab _ 10 OF r..) OT Cowtip h-C-T ~ on. O i9Tu~R l~ X All' o~ `S?t'l5 'P(Rl~'41 0 _j D ~~s,i,a8 q-q'15 t~ O 8.3 Ci+ F CL 99 s 3~.'l lob , J l I tt " S 100.0 0*> > iR av ~IpC ~ 4c~p61 [ p~NGE YN ESP SE CIO NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Y required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be \1So -15 gallon capacity manufactured by w t e~ ~ c~r~ c~~ ~ sz.el0v cTs 5. Bench Mark St?"e- "Out-. 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of 6 Approved Synthetic Covering c.3; Distribution Pipe Medium Sand _ H _ G Topsoil F Elev. °t°t..15 -J D 3 E t, 3 % Slope y Bed Of 2- 2 %2 (Force Main Plowed Aggregate From Pump Layer Q ~V P V; i C®W~ D Ft. E \-IV Ft. Cross Section Of A Mound System Using F f3 -16 Ft. 5tM A Bed For The Absorption Area 110 G \-o Ft. ~¢~A g Ft: H V 5 Ft. L aiS ing Rate= 9 S GPD/LN FT B 6-3 Ft. Design Loading Rate= o y GPD/SQ FT j 16 Ft. fol J 8 Ft. Lj .r: K ~O Ft. ro • ~ l to at 4- S :S Ft. Fare-Mai-ra- - W 3 Z Ft . L . d Observation Pipe W Force Main OAP08l Distribution Bed Of "22-.- L Pipe Aggregate I Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page L1 Of 6 Perforated Pipe Detclf ' End View )Perforated End Cop PVC Pipe Install permanent-marker at end of each lateral ~rn Holes Located On eottarn, Are Equally Spaced Q S PVC Force Main P PVC Manifold Pipe +1~~ * - Ree Distri ution S eJ Pipe Last Hole Should Be I Next To End Cap End Cap P Z9•S Ft. Distribution Pipe- Layout WAS'. SYSt S Ft. p~~~~.~e S'E• ally X Inches c rt0ton Y Sy Inches C folp Hole Diameter JIY Inch u AP? Lateral ~ Inches' ® 1l1US ( gWIA 0 SkiEt'( Manifold Z Inches pIVISIQt~ Force Main 2 Inches `G- ~oNp~NCE See CoRRESP # of holes/pipe -t Invert Elevation of Laterals M.Z_r~, Ft. '2x1•n. g.~gxY. 3i.~6 rzPsi Place 1st hole from center of manifold with succeeding holes It at Sli intervals. Last hole to be next to the end cap. - Combination Septic;Tank and 6 PUMP CHAMBER CROSS SECTIOM AMID SPECIFICATIOMIS ' PAGE S OF -VEWT CAP WEATHER PROOF JuUCTIOW 80X 'i'C.I. VEMT PIPC APPROVED LOCKING 10' FROM DOOR, MANHOLE COVER wI IMDOW OR FRESH wAR1vI>JG L tN6EL AIR I AI TAK E colapul r I, ~ I ff-L 9. S 6RA I bp fAl U. 18"MIAI. ~ ' r ~ ,h PROVIDE I INLET IRTIGHT SEAL I I I ~F s APPROVED APPROVED JOINT JO11JT W/C.I. PIPE bit s r N('~ I III W/C.I. FIPE~P' _ .;v I II ALARM J II II !S I I .20 ON sE~ C I I 0..S I r LLCY.g . FY h PUMP 4:- t~ OF -`w CONCRETE ~p D L Z.O6 9LOLK 3" APPRO RISER EXIT PERMITTED OMLy IF TAWK MAWUFACTURE:R HAS SUCH APPROVAL- BEADING SEPTIC SPEC.IFICATIOKJS f DOSE LU1~trR CplJ C\Z-~TL~ WUMBER OF DOSES: 3-~9 PER DAU TAI,IK MANUFACTURER: , TANK SIZE: Y2 SS) 1 SO GALLONS DOSE VOLUME t StLS)'s INCLUDING 5ACKFLOW: x-1"1' GALLONS ALARM 1+1A►,IUFACTURER: MODEL NUMBER: I Nw CAPACITIES: A= Z S INCHES OR y0l 3 GALLONS SWITCH TUPC: w'1`C~1Z~12'~f B= INCHES°OR 32 1 4LLOL15 PUMP MANUFACTURER: C.O U ~--OS c z r INCHES OR GALLOWS MODEL WUMDER: 38 $ S wF03 M D= 21 INCHES OR ISS-Z GALLONS I"leJ.l~L(' MOTE: PUMP ARID ALARM,ARE TO DE 8.Z SWITCH TYPE: 3Z•~6 M1IJIMUM DISCHARGE RATE GPM INSTALLED OW 5EPXRATE CIRCUITS VERTICAL DIFFERENCE DETWEEL! PUMP OFF AUD-015TRIBUTIOU PIPE.. N7'22 FEET t MINIMUM NETWORK SUPPLY PRESSURE . . . . . 2.50 FEET 3.oD FKICTIO>v FACTOR-. FEET -1- FEET OF FORCE MAIM X 2F~ 100 FL TOTAL 09UAMIC. HEAD - Z3.oo -FEET DIAMETER Pump chamber _ 141 ILITERUTAL. DIMLIJSION~ OF TAUK: LEMCYTH ;WIDTH _-;LIQUID DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = 16-t3 GAL/INCH 17 4; . iipji . Submersible Effluent .Performance curves pumps QF 6 i METERS FEET 90 MODEL 3885 25 80 SIZE 3/4' Solids WE15H a 70 z 20 WE10H J A O -WE 07H 50 15 WE05H 40 10 30 WE03M 23.00 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 1 1 • 1 L 1 i 0 10 20 30 m3/h CAPACITY [qGOULDS PUMPS. INC. SMECA FA115 WW rows t ae METERS FEET 120 MODEL 3885 35 SIZE 3/4 " Solids 110 WE15HH 30 100 90 25 80 O 70 x 20 J H 60 0 ~ WEOSHH 15 50 40 10 30 20 5 1 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i i i 0 10 20 30 m'/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 r11- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relatwns Division of Safety & Buildrgs in accord with ILHR 83.05, Wis. Adm. Code . COU Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P D. # dimensioned, north arrow, and location and distance to nearest road. s r l - ~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION/BY DA PROPERTY OWNER: PROPERTY LOCATION `3~ v CE t3~G eeff. E T %V3 va StZ' M, Z T,'1 , N,R 19 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. 9R•CS ~~F~~~ Cwt Iv: ~ ~:1. y - C.ov o CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WrOWN 1c.tuk2 L"-~'SL _S W1 s ~o ZZ (~/s) LIZS _ 6q~ a 'tR~`-f ~kS tZD. [J4 New Construction Use M Residential / Number of bedrooms [ ] Addition to ebsbng building j ] Replacement [ ] Public or commercial describe Code derived dally flow 6093 add Recommended design loading rate a-•`4 bed, gpolft2 trencth, gpd/ft2 Absorption area required Suo bed, ft2 S oo trench, ft2 Maximum design "ing rate o - S bed, gpd$ 6 trench, gdlft2 Recommended infiltration surface elevation(s) 0i.-) S It (as referred to site plan benchmark). Additional design/ site considerations +-~,ov y-% w / V X X (31' B(Z' b • ►^'t' 1 ' OF SAvA-b R Parent material I- o tEXs Qu T(L L t- Flood plain elevation, if applicable NA- It S = Suitable for system COWENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDWG TANK U= Unsuitable for stem ❑ S W u ®S ❑ U ❑ S W U ❑ S 0 U ❑ S ®U ❑ S Erl I SOIL DESCRIPTION FI•EPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary - RootsGP Boring # Horizon D/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tw& s 1 l -LSbh s - o• S o. Z, ~Z Zt; 10`1 2 31 - S l) 3 sbk w~ `Fh G s o . S o.%' Ground 3 U 14 7.5 `1 R 31y - S I cSb1,, w,.'Q- CS p,l( o,s elev. cl 8.yR ~f 1,~q_SZ -7,S R Y/V ~~•Sya s!a sel OWN vn'~- - - Depth b limiting factor 34 Remarks: Boring # 0-11 1.wty_ 31Z Sl` ZMSb12 '''L~^ CS o.b Z Z t193`tR 3)L - si) Z- 8~k MfF_ Cw _ o.s o. 3 3D,1o l.S`tRY/ f-,) S`lm S/?,, S~ C) `M InA U`~h - - - Ground R 3t3 , caw, n,'Fi Sc~ elev. C°~il.l hJ S Z•S 11 Depth b limiting t factor 30" Remarks: T Msne:-Please Print Phone' 715-425-0165 Arthur L. We erer egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Sign*we: 6 -98 Date: CST Number: R~ M00576 PROPERTYOWNER 8Q2G SOIL DESCRIPTION REPORT Page? of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench El 0-1Z. 1p`-tR 3! z s Zw, s bl-C vn aS - o. S o. 6 Z \z -',~0 1 tS %-I ft- 3/ L - s i) z` Z 6- c s ~ b- S o 6 Ground 3 3U_SS -1.312R Y/ elev. Y s y~ 313 s 1 or-, ?,,~fr- _ _ `t4~S ft. S t'CI"1 F.JO~CT h-S- B 2, Depth to limiting factor 3b" Remarks: Boring # Ground l elev. ft. Depth to limiting factor Remarks: Boring # 13. Ground elev. ft. Depth to limiting factor F-T- I I Remarks: Boring # x Ground elev. ft. Depth to limiting factor Remarks: r Dl~ q'7'1 (1/R n5!Q 71 PLOT PLAN Page 3 of 3 SCALE 1"= 3~S.OO' wZ L '110 `aE 1}T x- VvsT So ' Ftzo mpukvt) ~ Q rr C~~Pns~n A12..tU ~~f J W oR AV ~ ~ ~ ~ ~mg t'SRl4't~ 0 y~ ~ r a8, n a.a eLaq ~pr~ - tL ~vU•o arl 1~'~~CiJ PtP~ . q6-°t8 S-f (715 ) 425-0165 - 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations - Division of safety s Buikings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, INA \X not limited to vertical and horizontal reference point (BNf), direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION QR"l cE 12'Ev-G eeV:F Uff SW 114 --e U4,S Z 1 T ZZ NR 19 E (or)(k) PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SURD. NAME OR CSM # GIL/ M. a ~ y - Covw,'%w-f oP, rz- s CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®rOWN NEAREST ROAD l~c.w~lZ. ~ ~S,W► s ~o ZZ (its) ~lZS _ 6g~ a 't-Ru~t ~~-5► OR1~-S tZD. P4 New Construction Use [X] Residential / Number of bedrooms [ ] Addikn to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 6NO cgid Recommended design loading rate bed, gpolft2 trench, WW Absorption area required Svc bed, l? S60 trench, 112 Maximtxn design baling rate o - S bed, 6 trench, Recommended infillration surface elevation(s) °t 1 S ft (as referred to site plan benchmark) Additional design / site corusdu'zatiorts w~ r v~~ w / g' X 61'11Q-t- M I Ju , OF ShMi =It-t. Parent material I- o e-Xs ou `M Y Flood plain elevation, if applicable N-4. It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for ❑S ®U ®S ❑U ❑S ®U ❑S oU ❑S ®U ❑S &$U SOIL DESCRIPTION REPORT i Depth Dominant Color Mottles Structure GPD1ft2 Boring # Horizon Texture Consistence Boundary Roots. t in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed - I o-~Z Zo`CR 31 Z s j I Zm S~~c w~'~~- c s - o• s o.:,. Z Nz l01't2. 31 ro S 1) sbk mph e-S - o..s 0.4~ . Groumd S 281y 7.5 `1 R 31y - s I C- w~'I'4• C-S o.S. C18NfL 3V-SZ -7-S `1 R V Ise -f; . S y R Z IS s c 1 orh vn Depth ID limiting factor Remarks: Boring # 0-~1 tio~ttz 31z sit Zrnsbk M cs - 0.S10.b Z t1-3o l0`1R 31 re - st l Z-wi al~k yn'F~ cw - o-s l 0.6 3 3v 10 l.S~tay! f~`~sti2 sle, s1 ow. IVAv - Grou d elev. IL cul >v S Z S R 3 l3 d h, i 5 C_ ' Depthb Gmitirug { tactor 30` t: Remarks: CSTllane:-Please Print Phone: Arthur L. We erer 715-425-0165 eg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 6 -98 Date: CST Number: M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o~~Z ~o`-lR 3~Z _ s'~ Z-►"►s~ M k ~s - o.s 0.6 Z ~z ~o tio~►z 3!L - si 1 Z `Psblz rz fh e S a.s o.>o. Ground 3 ~b.SS 1.SkR SyR ~1 S1 Mufr - - elev. q.4,5 ft. S KM tJ~C~ .11-5 ;~C'P Q 2,, Depth to limiting factor Remarks: Boring # • I { Ground elev. ft. Depth to E limiting factor # i i Remarks: Boring # Ground ` elev. ft. Depth to ` limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: cMn n')'tnrp nF!n91 P LOT P LAN Page 3 of 3 SCALE 1"= ~1S.Oo' Kadrv- w~L to Wi kT LLrhsT Soy F-RoM mouk;D P E ~ Co~e.oPos~ l~R.-tu~M( BDR.►I - y oa r.30T Co+h.Ptrc.T ~ oR 0~91~-D h~ ~ ~s t'tRl4't1 r ~ by / a S. LL 00 1 3 ,0 Co'`' of e~ ~ tzggs ao~ 3 16' ~t33~') - C'L Ivu.o a►..1 1,~lRCiJ P1PC'`' - Cl C° 8 C/~~ S-3o 6 (715 4L-0165 M00576 CSTSignature Date Signed Telephone No. CST # .,AGE //57 LOT 4.,_.CS.PAGE 1157 ® N88 & 50' 46 "E 375.00' WATER COURSE 00 7 NOTED COURSES AND O/STANCES FOR \ 1\ ARE ON CENTERLINE OO.E SB9. 0/'36"E O \ \ \ \ 129. 44' m 3000 WATER COURSE EA SEMI hl 44'4 X8'-5 /O' p SOIL A6 SORB T% NNSYS 10, 4 a v 2.092 ACRES 9/, I44 $O. FT. NO 7 8 1 © 3S 5 , O } ALL 06~ 0; ~,1 N 75. 40.00 THE h LEF. OF rNls~~ \ N c a THE FOR p WI REST 1 z TO T EM ` I o~j W ~h 1 a Q1 NEI 0 t, C , FOR - 04 ,~i\ O b O t 5 N of 1 a 1 • r1 2. 00 3 ACRES ~•.1 o e M ? Nt 1 87, 2 4 2 $O. FT. ;i 2 ~ 1 O • J «E 390.50' 18.89' N 1 N 8,9 35' lB 1 1 • 1 to it v 1 1,33' 33 o ~~1 w LOT / 1 1 ►i • N 1 ,1 , , f O 1 1 1 ~ j~ p C ..J 111 l~~l 2.008 ACRES N 1 _ 87, 47 / $0. FT. 3 N N 30' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS P 4' Apd lr PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CM/STATE fl'0 (7el C OX PROPERTY LOCATION 1/4, S 1/4, Section ~-2 , T N-R. _W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION rl 7 ~Qt` S LOT NUMBER - 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 dis system. St. Cro' County residents may be eligible to receive a grant for a maximum of 60%. of the cost of replacement f 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: &VO DATE: J St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 • This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property ~/r C C ~ C r "fq Location of property l/4_1/4 , Section 09( IT ~N1-R Z9 _W '7 tt Township /D Mailing address /W ! er 6263 tKJ" Address of site a O Subdivision nam9 I 4 Lot no. Other homes on property? Yes No Previous owner of property Total size of property 3 rQ Total size of parcel 34, Date parcel was created &Carc 1 ~26 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes _X_No Volume icier 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 YIM6 e 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 q fi~ce of the County Register of Deeds as Document No. Signature of Ap licant Co-A pl'cant Date of Signature nata of Si"natiira 541876 STATE BAR OF WISC SIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. VOL x..170PAG:58'U ISTER'S v'.,.,,. r,, Ray Gale Robert L. Macke Laurence CROIX C If, Norwood klund, as partnershi_ r &rty. APR 8199E cones and warrants to Bruce D. Berg and Kathy J. Berg, 10:00 A. It husband and wife, ~ , , • ~.t.~ r . 'rQ THIS SPACE RESERVED FOR RECORDING DATA f I NAME AND RETURN ADDRESS f U I, the following described real estate in St. erOi.X County, i State of Wisconsin: 4A C-C~,111 W T s cl v to 040-1221-40 PARCEL IDENTIFICATION NUMBER Lot 4, Country Oaks in the Town of Troy. j TRA 5j--VR FEE i I~. i This i3 not homestead property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. I Marc'n 96 Dated this day of A.D., 19 ,vz oil, ooooe (SEAL) (SEAL) - 4 .tt~a urence Murphy * Norwood Ecklund I' (SEAL) (SEAL) li ii AUTHENTICATION ACKNOWLEDGMENT Laurence Murphy, State of Wisconsin, i Signature(s) ss, Norwood Ecklund A County n.. _,.....,.l L. l.o o rhie (iaV 1l{ Ali) 1 Myrrh 9r, o