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040-1182-50-001
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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - COWLEY, RONALD H & ALICE M RONALD H & ALICE M COWLEY 64 RIVERSIDE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 64 RIVERSIDE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.654 Plat: 03/58-DANATE PARK SEC 36 T28N R1 9W LOT 21 DANATE PARK Block/Condo Bldg: LOT 21 INCLUDES P739 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/31/2001 637767 1581/451 QC 07/23/1997 1218/624 TI 07/23/1997 783/228 2005 SUMMARY Bill M Fair Market Value: Assessed with: 103440 397,600 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.687 55,000 327,700 382,700 NO Totals for 2005: General Property 1.687 55,000 327,700 382,700 Woodland 0.000 0 0 Totals for 2004: General Property 1.687 55,000 327,700 382,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION BUREAU OF PLUMBING P.O. BOX 7969 MADISON, WI 53707 SE14, NW%, S36,T28N-R19W ❑CONVENTIONAL IYALTERNATIVE Stale Plan LO. Number: (11 assigned) Town of Troy ❑ Holding Tank EMn-Ground Pressure ❑ Mound 87-05593 Lot 21-22-23 Danate Park NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER: INSPECTION DATE: C' Ronald Cowley 1530 Centennial Lane River Falls WI 5 022 f t NCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLANREF. PT. ELEV.: PT. ELEV. BE Name of Plumber IMP/MPRSW No., County: Sanitary Permit Number: Carl P. Heise 3378 St. Croix 102857 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.. WARNING LAB L LOCKING COVER PROVIDED: PROVIDED: W~ SLR 1'Lv 0 ❑YES ❑NO ❑YES Q. ❑NO D: PROPE LINE RTY WELL BUILDING. VENT TO FRESH BEDDING. VENT CIA.. VENT MATL: HIGH WATER NUMBER OF ROA AIR INLET ALARM FEET FROM ❑YES ❑NO ` ` ❑YES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP/SIPHON MANUFACTURER WARN ING LABEL FPR CKING COVER PROVIDED: OV IDED: ❑YES ❑NO 75o ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPER ATIONA L: NUMBER OF PROPE RTV WELL BUILDING AER NLOT HESH FEET FROM LINE (DIFFERENCE BETWEEN PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check thesoilmoistureatthe depth ofplowing LENGTH DIAMETER MATERIAL AND MARKING or excavation, (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTR PIPES ACING COVER NSIUE DIA SPITS LIOUIU TMA IAL: PIT DEPTH DIMENSIONS S 0 n GRAVEL DEPTH / FILL DEPTH OIS7H PIPF DISTR. PIPE DISTH. PIPE MATERIAL: NO. ISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES T r' ABOVE COVER ELEV INLET ELEV. END'. PIPES LINE AIR INLET (s FEET FROM NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO " PERMANENT MARK FRS OHSEH NATION WELLS SOIL COVER TEXTURE ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL Nn DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MAHKIN6 ELEV.'. ELEV.. OIA. ELEV. PIPES DIA ELEVATION AND DISTRIBUTION VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL PLANS ❑YES ❑NO ❑YES ❑NO NUMBER OF PROPERTY WELL: JUUI LDING. COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. LINE FEET FROM ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. ITITILE. Zoning Administrator DILHR SBD 6710 (R. 01/82) I SANITARY PERMIT APPLICATION COUNTY T DILHR In accord with ILHR 83.05, Wis. Adm. Code v ' Re/ x STATE SANITARY PERMIT # 96-7 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. 7 -See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES NO PROPERTY OWNER PROPERTY LOCATION had Govj t $ '/4 Wk/ '/4, S -3 4 T 8, N, R i o E (or) PROPERTY OWNER'S MAILING DRESSY LOT NUMBER BLOCK NUMBER SUBDIVISION NAME 15- 30 n en~7~k/ / ~92_ 3 09ro ~'`C ark CITY STATE ZIP CODE PHONE NUMBER CITY NEAREST ROA,Df LAKE OR LANDMARK - Lr F l s - Sib a VILLAGE : 0 R i Gv S~Q e i^. TOWN OR _rr V II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. XNew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2) 1. a. ❑conventional b.XAlternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. XIGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b..kSee a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM EVATION 6. WATER SUPPLY: (Minut s per inch): REQUIRED (Square Feet) : PROPOSED (Square Feet): 0 # ,fit D 4 00 4 , .5 0 ~ Feet ~ Private ❑ Joint ❑ Public 38 cl VI. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks > structed Septic Tank or Holding Tank a~ 11,206 [ Lc Lift Pump Tank/Si hon Chamber ,SO 1 175-0. :ER] ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) M MrP~RSw Business Phone Number: 5~~~- ~7~ Qr/ P I Wel,S{ ~ W Z~ 3 ~ 7 / 8 i ( Plumber's Address (Street, City, State, Zip Code): Name of Designer: 1042 -5, 1'110 S Lv " (k Ult " 51622 4r 7' Vex -vL r Vlll. SOIL TEST INFORMATION Certified Soil Tester r(C-ST) Name CST # 44 e4rtv -5 9 CST's ADDRESS (Street, Ofty, State, Zip Code) ( Phone Number: 't- Go& V: tll IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa itary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial St8pharge 010, eel / 9F Adverse Determination { cW~ 0 v i X. COMMENTS/REASONS FOR DISAPPROVAL- /~1 h & S f~ SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber M tINFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into iaw. This legislation is r c)re commonly known as the groundwater protection law. This change in statute; was .ne l' result of over 2 years of steady negot.ation and pudic debate. The g€ wncwate t:.h Grounc vatet included the creatr~:)r. surcrasges ( es) fo rruntbe° o' egu ec drat ces U r !•in 5 can effect groundw2tP Tno gUrC Fr.: toolf. Ffref"r :ir:.I , A!! of t1P k is used in your <s r ra=; ,n _ _v _ as_r, r., system or the t11,;. C~r tv ~a f}.. r, The terod by .h: , water, gran„ 't's worth pro,4ecimg. , -ti398 R.U3/8&) State 4 Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & 13UILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 WEGERER, WEBER & ASSOCIATES Owner: RONALD COWLEY P.O. BOX 74 1530 CENTENNIAL LANE RIVER FALLS WI 54022 RIVER FALLS WI 54022 RE: Plan Number: 87--05593-S Date Approved: August 8, 1987 Gallons Per Day: 450 Date Received: July 27, 1987 Project Name: COWLEY, RONALD - RESIDENCE: Location: SE,NW,36,28,19W Town of 'TROY County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. 'This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW CONVENTIONAL Inquiries concerning this approval may be made by calling (608) 266-2889. Si cer ly, PE'T'ER E. PAGEL Section of Priva Sewage Division of Safety and Buildings PPP013/0009n/ 8 cc: RONALD COWLEY _Private Sewage Consultant /county _UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health DILHR-SBD-6423 (N. 04/81) I N - G TZ0 Z) l IZE S S UP-E S--/57-E7--l- -?K6e ) o~ 6 • ~vR 1~ 3 $e~~~ uc~Nl Ta.ES 1 D E~ ~ LOCATED IN THE SEI/~y OF THE ►~w /~y OF SECTION 36 , T z'bN , R 19 Wj TC'W! OF TP-C~ c~-• C ~ 1 k COUNTY.* WISCONSIN. LuTS Z1, ZZ ~ Z3 of ZJA1vf~TE l~~Rr Sur3~J1 ULS/D1./ - INDEX PAGE 1 of 6 TITLE SKEET PAGE 2 of 6 PLOT PLAN' PAGE 3 of E PLAN VIEWT-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE ph6E A " C-: ► NWkV'A T 0►u `T'PW1L -=ltrr tc, S P1-~GE L S CG0w18ilQhrNJ `Tt9-)R 7]keTRcLS PREPARED FOR C.owz-~~- 1 5 3 0 ~J~'~iu~ ~ ~ LR1UE pZ V r=A LLS, wl 54~0 ZZ. e~~®~e~ewee~'~Ir PREPARED BY w yos 'Scopi W r33M ER, WEBER AID ASSOCIATE BOX 74 421, N. MAIT, STREET ,wnwR L = WEGERER RIVER FALLS WISCONSIF 54022 9,yP _ E =ORTH. i Wis. d, S I GS ',sw n 87- ZD~j 'JUG 7 198' Job PL~Me~N~' eUP~ -ate I N G rzo k-) KS S URG7 j` sTE-" ~L1R _ 3 S~lc~1~i P.ES ! D EiU C-E LOCATED IN T SE~iy OF THE Nwlly OF SECTION 36 , T zbN, R 19 W, TOWN OF TAU__`y c-*^- G12.u l k COUNTY, WISCONSIN. _Lu'rs Z1, ZZ Z3 of ~/~1v~TE ~,~rz r 5~~3~~ V~si o1.1 INDEX PA GE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN 87055.9 PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of PUMPING CHAMBER PAGE E of 6 PUMP PERFORMANCE CURVE PREPARED FOR 1 S 3 O C ~V~"EI~>>J~ ~ L l.~J~;E R. ~ vim. T=A I.LS, wl s~oz.z o~~oooorber~•~♦i PREPARED BY ~eC0lv'qNq,w w s 7/ 11:1 ASSOCIATES ARTHUR L 301 f 4 4~ 1'~Al \ JTl l m = i W EGERER ?N 1 FALLS, WISCONSIN 5402n i FdLSwoRTM, • wts. i PLUMBING ° t l~ G~zC ,r. GC/M~fl~ ~~♦i IG11A~ %'lot fill DEPARTtAP' 1fFly, l'R A ,E'.ATI:OteS SA at_E 00c,r.t ,P )EreC: Job 7 PLOT PLAN QAG - • Scale 1"='ZO' E~. 1ab•b-r - 111.310 o►.~ o►~ S' . P. 1 ~ «1 PIPE ~-o L►,~B ~JS•00 ~ 13S sl _ 1 O 1 6 Z I TV-e1W-►ifzS ~a N~ R S- MS T P7 00 E3B 10 LP%V-~ TREE W u - tio O Nl M O 2"pV C 17Rtif1 Fps 1~ ~y PO - 4 - - - - - - - X.9 NO' ' 6 LTC Ina,ra , B7 0 o►~ ~tuvi P~aE i ~Z NoT~~ S'am` Pi a--- - 00 Ffl1Z F1131S A r=M tDE WFO • J c. q tia b~ ti Q rl -t o ~o. pLumewo 970 559 i r `,a a R ATION z v~NT i ZO °F v O S E min 0 0 L4 CZ ~ N Isro x To ~a~ ftT L~riST SD' F~y`'1 O1ZP~1►UFIt--LpS. - CIT Lr--~ST Z.S' ~-3 'N1 TD C'SN H>~ ► Ft~~ gC'S~T1 C T/t~v 1t R~vER S i CN _ t^721 U ~ _ NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install cast iron pipe 3' onto undisturbed soil both sides of each tank- 3. Install permanent markers at end of each lateral. ( Z required) 4. Install 4" observation pipe with approved cap. ( Ll required) 5. Septic tank to be izcw/)SO gallon capacity as manufactured by W1S~i CCyVCCZET pi~flyc-TS ~eo8►r~_t'~'S~c_'~?'~?-?~--- 6. Bench Mark- Elevation s,5F2s AAovE pc.A1v ~ ALA N 1 EI/J PNGE 3 OF yi1~5~'i s LE l i t d){1 E LoT LIAi ~ 1k 4 r':c t( T rL~v c► t S 'i.)/3° ttGGReGA•TIE r~r Rl.»,T M ~k.4=i5 2 (4O L' Q t Q ley ~q Z" PVC ~~STR19v`cxYV Pl► 5 Z"puc Y7MJl FOLD 2" PVC.. l=tiiZ=E 1'1RIN yon OBS~.I~►~T7cW I IBS 055 CROSS SECT) 0N ScrtLC - vt~ ~I~-y~ \'~0\2 1n_ 10 ~ F~ 1Sh+r~'D ~ ` STRBI I.IZ-E _ EXCA Vt\T~> ~ 2~"P1 5 rCL 1rJ5.50~ I tL lo4.S 7':\ io3.5o ~ J~ ~ j L+ l l l u 1- SOI L. r-)LL ! _ 6 J O`^~ Q P?fzpvEp S Y/JT~t ET7 C Cox3e RIn+G OR Gof 2kPvc_ T)CST7zlBQ-V&v-/ E'- `19.so ~~~oE-tAt~c~t~ STRA~v TZ i-P E_ b _6F ~~z ~Tn Z~~Z ~~lGGR~6AT£ BEWw p1 STRlBvTio~, P, l'siJCh_2"oF AGGG2EGtrT'e. A~BovE. 9 IPE ~1S`T~1~3UT1U~ 1~- I P~ `10UT PING of 6 4ER~=n c~Tm P~ r~E- bE`r~R ~ n ~.uo Vl t~ VOLTZ oN yo nm Z AV c OEM RRTL~p P1 A~, kttst+~S 5ff6 ~~-i~tf At-T SZ'~ SPAC-S/X.G. ~SZ~ ~L'x:CE _~T._L~Q1-~ -7~ f~- Z ~~PVC 1''l1't1u1 F0~-D t~ Z s' 3tO F-P-Q 1 1bum p SZ " -y.5' Z." PUC LA~'ERh l.S 11 \ O / ~G b~ 3 5 • Z ' PLAC-E FRO" _ 1' Al J) Ffl LZ) 'ttfC3 = IT:1V-T-.fit.:: 1Ot•:SO-~_ e yR~~ PLUMBING - k s • nr~~S cot C o ~ l)v A'T10/.] S e--p-nC -m u tz A4jD [ PUMP CHAMBER CROSS SECTION AND' SPECIFICATIONS ~~GC S OF VENT CAP li"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAIJHOLE COVER > 25~ FROM DOOR, WINDOW OR FRESH 12"MIU. INTAKE ( GRADE C-1 MIN. \ • Zt rat , t I i u ELE1 DUI ,h'9 r IB"MIN. z a Yt A 4I Il - P vl INLET IR~r YL APPROVED .]DINTS APPROVED JOINT A I I W/C.I• PIPE W/C.I. PIPE EXTENDING 3' EXTENDING 3' ALARM ONTO SOLID SOIL ONTO SOLID SOIL B SeP`C1 C `t"~'C~~~C~ DOSE `^'~~I I I ON C ~ I I ELEV.2F''33FT. PUMPS OFF D Q CONCRETE BLOCK 7 ~Le,, -1 S.oo RISER EXIT PERMITTED ONLY IF TAUK MAIJUFACTURER HAS SUCH APPROVAL Gom81 r;rJUN SEPTIC E S PE C. I F I C AT 1011 S DOSE TANKS MANUFACT URER:tQNESE. CONCZZI'IE PRAtJC-TS IJUMBER OF DOSES: 3' Z PER DA-'J TAIJK SIZE: Y7 " Z DSO GALLONS DOSE VOLUME Q) L S.S EL-~C~M SKIS " INCLUDING BACKFLOW.' GALLONS ALARM MANUFACTURER: ~Q J -INCHES OR 306' S CALLOUS MODEL DUMBER: l0 1 VN CAPACITIES: A= V SWITCH TSPE: INCHES OR 3-1-1) GALLONS PUMP MANUFACTURER: IAICHES OR 1b~' 3 CALLOUS MODEL NUMBER: ~ S D= ~b INCHES OR ZS~'1 GALLONS SWITCH TSPE: NOTE: PUMP AND ALARM ARE TO 8E INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE 3Z•SS GPM 79.pvC4 3 T1u~Ctt VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE__ FEET 23.6'1. I-T MIMIMUM NETWORK SUPPLY PRESSURE , . . . . . . . . . • 2 5 FEET 4. Z) SET FEET OF FORCE MAIN X 1250 FjoFT.FRICTION FACTOR-_"Z'Z.S FEET Z9.Ol~- ~T TOTAL 091JAMIC HEAD = Z°Ig2. FEET ~1Slr-I ~'i2 1 ~t INTERNAL DIMEMSIONS OF TANK: LENGTH IL16 -MP ;WIDTH 8o~i~ 7b+~ ;LIQUID DEPTH u~ 1 y I I/z.° Z30T. 76 //Z° • StT. AS P~~Z, 1") P4Vv ~t C~N1~~lZ z. 3 BoTTD►-'1 AREtI = 3• l4/ k^----- _ - 31 = ~-E?• \3____-- G'~L~1h. 6 W V G' ~ Jl H z z w z o CM A H H z E-1 co u1 N O d U 3r 4 H z H p4 (=s 3 H H ae v' x W W W o cn H H W H .a U H O o z a c;, W s - EH-+ a o 3 z A w z w a A d P4 0 U d O .7 3 PO F. O C, 44 C) L~+ H U N O H 0 in x 3 x x N 1-4 U L x po O to U U 04 U PL \ _ - W H W W >4 H H - W _ E4 \ \ E-4 E-4 H -I ~4 N 04 z ~O N M u 1 ~O a 3 W O is U d d r A En En cn i 04 E-4 a z O P4 x A O d A U d O cn W U W a4 O .l H W C9 Z W CD z U - H H 9 H d d 4 C21 LA 'D d z 044 U H z 3 °aa oou x `H W a H N Ad Z WHW H $4 U °U OG A / / ~ J J ~ 1 ~ I i ~ I I I I ~ I ~ i ~ I ~ 0 J)V\3 510 15 • CONSTRUCTION FEATURES of Power Cord- Single phase cord is 20 ft. long with SJTW insulation and has molded Power Cord on grounding-type plug. Plugs directly into standard receptacle. requires no control box. Used with ALC or AWS level controls Cord Seal for automatic operation. Bushing Cord Seal Bushing-Cord is potted into steel I~ connector with polyurethane resin for leak proof Potted seal. A cord nut and rubber grommet clamp the Leads cord into the bushing. Cord can withstand a pull Capacitor Housing of 100 lbs. without loosening connection. Motor - Permanent split capacitor-type is oil filled for best heat transfer and bearing and seal lubrication. Operates at 3450 RPM and has _ built-in automatic reset overload protection. Motor Housing Motor voltage 200 or 230 volts single phase also 115 volts for 1/2 HP size unit. Pump Shaft Capacitor Housing - A separate housing permits mounting of the permanent oil capacitors. Can I Bearings replace capacitors without dismantling motor f ' ` o 5 G Motor $ or pump. I} Motor Housing-Cast iron stator is pressed in for 'f best heat transfer and alignment. Mechanical { Impeller - Bronze, Tornado non-clogging type. Seal ti} Fasteners Has back pump out vanes to protect seal and + reduce thrust. .ncys -s Mechanical Seal-Heavy duty type has carbon - 7-4 and ceramic faces lapped to a flatness of one Motor - light band. Spring and all seal parts stainless Bottom steel. Rubber seal bellows is Buna N. Plate f - Volute Case-Cast iron has 11/2" full open volute c~yH~ to pass solids. Support legs provide proper Impeller clearance for pump inlet. -a' Bearings - Lower ball bearing takes radial and Volute x' down-thrust loads. U Case pper sleeve bearings take radial loads and have thrust washer to absorb any up-thrust. Corrosion Resistance-All iron parts are coated - - - - - inside and out with baked-on epoxy paint. All machined surfaces are re-coated with epoxy PERFORMANCE CURVES after machining. _ WHRH SERIES WASTE HANDUNG PUMPS CAPACITY UrERS PER MINUTE 0 lm 200 700 400 500 I I 1 I I I I _i I 1 tl i f ! I I I a I ~ I I l i j~ A ~ I ~~1 I I I I I ~ 1 i 1 X91 I I + 11 ~ I- SF°OhF.9 l w(: i z Z ~ M09 • ~ I ~ W '0 X F 30 I i 1 I - I.. I e 0 m 10 ! r!! I l i 7 I ICI I ( ' I 0 20 b 6p e0 lm 110 lb CAPACITY GALLONS PER MINUTE -bE DUS' M OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: OWNSHI UNICIPALITY: LOT I BLK. NO.: SUBDIVISION NAME: s~ iJl~/ 36 /TU N/R 19 E (o z► - ~ ~ F>N ~ COUNTY: WNER' UYER'SNAME: MAILING ADDRESS: N v S l~lU S1LlC ~(21VE ST-c_Nzo 1x VER.N R'KshvsSeN -z~vG Fp'%'\~S w 1 s~azZ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: r~ [~W PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: ~esidence N A_ ew ❑Replace 19_ 9- 87 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILLHOLDIING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U DS r"U IS []U DS Ru 0S If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: N Floodplain, indicate Floodplain elevation: 11_V PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- s Gt. 1 of Z B- B- B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P+'~C 1 o G Z P- P- P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION -5 e ! t j I E [ S 1 ~ 1 1 ~ I u'l, 114 Wit. L aLtl: i - ~ fix. ~.L" V!.,.\. ~ I_~ ~ FCZ VAT is 1J I IAJ i - I TN _ cis F I-~- _ - - ~y a L`oZ.is - ; _j 7 _ ~L.1g1.S ~ I ti P" TRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a co ar.I accurate soil test, your repo < . include: 1. Complete lega' ,scription; 2. The use section must clearly indicate wl- Iis is a residence or commercial project; 3, MAXIMUM number of bedroa is or comm 'cial use pla~, -i J; 4, "iis a new cr r lacement - 'm; fete the _j lily I 'r,, A SITE IS SUITI = FOR A HOLDING TANK ONLY IF ALL YSEM PRE RUL D OUT BASED ON SOIL," ONDITIONS; 0. SE use the abbreviations shown here for kuriting profile descriptions a I plot plan; T. iA',,r- A LEGIBLE diagram accurately locating Your test locations. P preferr=ed. A ;ate sheet may be used if desired; sure your benchmark and vertical elevation referer ~ point ar, c e permanent; le1e all appropriate boxes as to dates, names, adc+ es, flood plr %>t exemp- f appropriate; i `ormation flood plain, ;tion) does riot apply, p' wiate box; 11 corm anc -cur cur - > ar;d your certification n.~ 1 i+ble copies id distribUl' --fired. ALL SOIL TESTS ~T TH THE EUTHORITY WITHIN 30 GAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL SRS rtes and Textures Otter Symbols - Slone (over 10") BR - Bedrock - Gobble (3 - 10") SS Sandstone Gravel (under 3") LS Limestoi S„id HG High G C arse Sand I Percolai, - ft -n Sand Well - e Sand Bldg Building Is - Loamy Sand - l Sal,dy i m I ~strn rrt tt k Gy - Cray '1 Y - Yellov, R Red mot Mottles C ~v1 {r - sic - Clay f f f x c pI ;nrn d '=011 t,,. Sri V DEW ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION P.O. BOX HLABOR UMAN NDLATIONS PERCOLATION TESTS (115) MADISON WI 7969 (H63.090) & Chapter 145.045) LOCATION: SECTION: /IgV2!!NSHIP UNICIPALITY: roT NO.: BLK. NO.: SUBDIVISION NAME: sa-Nw 1/ 1/ 3 b Tz$N/R 19 E to ~~Y z I - SAN NTM_ PA%) Z COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS: ~•T- S V~RS1 RUC ST'• C_PZ1x Tom.I vE`Tq- - U-s w s o Z Z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: rbr II PROFILE DESCRIPTIONS: ER AT ON TESTS: [0i,sidiance _ L^JNew ❑Replace 6 -19-8 RATING: S= Site suitable for system U= Site unsuitable for system OUN C~V U • IMEI J ®U IN Gas RORESS UND-Pou RE: ISYSTEM-1 N-F I L L HOLD ING TANK: ECOMM ENDED S SY EM:Io~ptiona .k_ UE 7S IJ~U S (tS~J~N~ -M R If Percolation Tests are NOT required IGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: • I~*'v • L Floodplain, indicate Floodplain elevation: " PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER-INCXW CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ift ELEVATION OBSERVED EST. IGH_EST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 \~•3' \065'._ _ No>vE__ rvwT@.q.~'_ o.~_'atc•Gy~,_~TS;_3-o'~Bn/fis_}©.9'`18 ~5• B= Z_-~'Y S• z.Z' BncS • o.S' 3ncs~si'O3'I3>7C \'-')1-4' tiol`1E. wb~a 8•y' o• E&'D1zGyEn I-'s-rs ;3'6'G'fan 1 S~.O'Bh ►-AQA S_ B' _ _ w /GI_ ' S' W/ S S PlecES 3 C~•S' a•o' Imo, glut I10T (2 z. ' o.-)' p\r Gy 8) 11-~3 ; 1 z,9`Gy$~ J-Fs ;2.9 8h re-JsE BSI B- 14 88,14 ' `1, 103- 2-' Np~ @ > o-% 'Tkt_G$n 1'FS - ' Z.S' ~i !3.1 itch ``'Jfs S \\•'C3' \\I-S' IJO,v1e > )•gS TS; S•z''l~t'~5~3•o'LT.Bh fS;2.S'BAbtn S B- 6 \\•Z' 108-S' )UOij LI• Z' o.'~'~kG $n 1-F%M Z 1- 'fin 1-~S • l.o'~r► ;4.71Lf,N Z. o' )-T 8h trn~ S w/ G P- . B- 7 _2 - W 1 D3 • o' 1.3 ® ut7 YvIdT Q Z. o.-7' Dlz G Bh !'Cs l5 • S. S "a)\ 1 S ow Bh ti'v9S• 0.1% CJ 8 8' \oa. o' NoUE 8. o. DIL6y 8n 1'Fs 7s ; ~.-i'-D can 1 -~S 8n R<Suca y B- ass 1' 3h s PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INOW" AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERT D 2 PERIOD PER INCH ez_ P- 4.1' 1V A S !!z. 1 5! 9/16 3 lOS.(* , P- 2 6.6' S 1 3/ ) `3lt6 1 3~ 3 ma-1 ' P- 3 5- Z' e S I t/ Z l l Z l l/ z toe•z P ~f 14.6' Z Z 3 10.6 ' P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. ~NI'll , ~'Z~PI.RCEem&►T 'P• q ~MeTZT -so SYSTEM ELEVATION ® Boa. g4.so L: 1lt 3 ) y o I T t E tv 3 s y b E? 9 p' 11P j F T?4B S P l 1 t.~ yr R' L' _ . ..1 E iu 01- ES ~ . 030 S - ± T-- - - G _ . ...w _I 1 j _ 1491 I 6E- I, 1 ..t.. P~-&\ VS 'hill' ~ {'1 SAO INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a comply accurate soil test, your t include: 1. Complete I ion; 2. The use s clearly indicate whether this is ,idence tar commerc t; 3, MAXIMUM f bedrooms or commercial 4, Is this ; -ment system; 5, Coy y rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL ~YSTEI ~?E RULED OUT BASED ON SOIL CONDITIONS; 6. ~'L 'iE use the a' ' i -ions shown here for writing profile descriptions and c< ; tho plot plan; 7. LE7'BI irn accurately locating your test locations. Drawing is preferred. A if desired; _ -k and vertical elevation referent ;soint are clearly sho, i air, oerrnanent; 9i C,, .'e tuxes as to dates, names, adc? ~`•ood plain d Lion est exemp tion, if appropr' ; °I0. t informaj', "-iod plain, elevatior) does not apply, pI^c M L_ tapjN,op,riate box; 11, m . Aur current address and your certification nun distribute as recauired. ALL SOIL TESTS N ST BE FILED WITH 'THE 'WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL T _ __,tS parates and Textures Other Symbols ver, 10") BR - Bedrock cob 1011) SS - Sandstone gr ter 3") LS Limestoi. k.s High Grc; need s Well fs Bldg E: ;Iding Is Loa > - C v.. r Than r San < L T7;<r, LO its!; Bn t Loarn Bl - < Cry Loam Y - y y Clay Loarn R - Clay Loam mot Malay IN; - Y L PI N4h+L - 1- jh ~il'cxtr.ares F; 0 ;posal Bm - E nc VRP \ r - APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signed by the owner(s) of the roperty 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 ,V ,d,v 0 G~oa%L.Ey Location of Property IC /v A-' 1%, Section 3 , T N-R AF Township o y Mailing Address 53o ! 0-1U %,6 w.1Al- X AW f Address of Site o~U7T / X1• 3 /y,~TT11= AAA Subdivision flame ~sf ~ ~ ~,y~~ Lot Number 7 Af 2_3 Previous Owner of Property ~ j in cc Ss ,6`Al Total Size of Parcel Date Parcel was Created as~~~7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? _ Yes No volume .'-79 3 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Wartantq 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ` H z H a ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER/ BUYER Q v H ROUTE/BOX NUMBER ~~30 G'i=ti'`Ei✓,~'ist~ ~fl'G Fire Number CITY/STATE Rir>L°2 ZIP 'Vo2- z--- PROPERTY LOCATION: S£ I&, N w ~4, Section, T AS N, R Town of TIZo St. Croix County, Subdivision VA l~.~ fL eAXIC Lot numb ero41/-atz_-.~13 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. yo I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►u ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98` Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. WARRANTY DEED 4112k7 3E17 g Fa,[ n 4 RicCTISTERS OFFICE This Deed, made between Ye.r.nQ.n...1.~ t.._Ra.s.muss.en...aad ST. CROIX CO., WIS. ..Cal:.Ql.yn...A..... A.aamuaz.en.,...hus-band...and..w-i: ej RQc'd. for Record Vifs 95th day of June A.D. 19.17 Grantor, and...... Ronald C_o,wley._-- and Helen. Cowl:ey.._! . husband at 9:00 A , ...and-..w.i-.fe.,.... as..su.r:v_~.v0>r hip..maAl...Pr:oper.tY.......... Grantee, /~blw N DrNs Witnesseth, That the said Grantor, for a valuable consideration...... §..t.. CrOZX RETURN TO conveys to Grantee the following described real estate in County, State of Wisconsin : j Lots Twenty-One (21) and Twenty--Three (23)1 Danate Park Subdivision, Town of Troy Tax Parcel No: i FEB i This ......i-s not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And........ Ve.rn9.n...L-..Ra.amussen.•.and..Carolyn-_-A-__.Ita ueSen......... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to all restrictive covenants of record, easements and rights- of-way, all necessary approvals and permits for a residence construction!! anct 491 lta4r&XMR41tditgpsag4. abstract showing good title. Dated this 23 day of ti711T1e 19.7.... (SEAL) wit ..a (SEAL) * * e.r.non...L_ ..Aa.smuss.en................. (SEAL) yn_..Z _ -s? . (SEAL) * * .Carolyn..A_...Ra.smuss.en......... AUTHENTICATION ACKNOWLEDGMENT Signature(s) er.noxi..7A,...R3aODU_SSen...aad. STATE OF WISCONSIN Carolyn.. A..__Rasnussen_________________•----•-__._-- ss. ..............County. authe a t ' ....day un............. , 19_$x. Personally came before me this ................day of 19 the above named . C. L. Gavlor L-pla, ItWil,Uusdy, SUIL AWU SIl'L LVALUAI1UN - JJ 1449e ( ul t-aiw and Human Relations Division of Safety & Buildings in accord with ILHR 83.05. Wis. ode '4' CO Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan ncludA,•but- I S` not limited to vertical and horizontal reference point (BM), direction and % of sl ale or PARCE dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION rx REVIE f3 DATE PROPERTY OWNER: PROP N ~OvJL~` T~(7nJ t Q GOVT E a14 1 '1 wt, T 2 3 N,R 1`1 I;;r W PROPERTY OWNER':S MAILING ADDRESS LOT # BL U E OR CSM # l04 vt✓r_z) Dr~IVt 21 l ~r f• CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE ZKOWN NEAREST ROAD R\VER Fnu~ ~fJZ 5`!'az.2 O( ) tf2 - t Sbto T o R~v~~es~vE pt~. [ j New Construction UseX Residential I Number of bedrooms _ [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 9 50 gpd Recommended design loading rate 0 bed, gpd/ft2 D. (O trench, gpd/f12 Absorption area required Q00 bed, ft? 7,50 trench, ft2 Maximum design loading rate 0.5 bed, gpd/0n .ln trench, gpd/ft2 Recommended infiltration surface elevation(s) `4o be de-lcrmt .tied It (as referred to site plan benchmark) Additional design / site considerations Parent material of t 5{} Flood plain elevation, if applicable i~JA It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K U= Unsuitable fors stem S ❑ U S❑ U PS ❑ U ❑ S O U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourld3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r Bed Trends Z S Z i C S 0- S 0.6 1:: a 12-Z 'I S -Y ee, 3 z - 15 I.MSbK MJy- S S1 O,s a(o Ground 3 2'7-43 3 K YbV ff- 0S t O'H O. s elev. 'IA ft. 0 41 S DIG Depth to limiting factor u -7 70 Remarks: viP.tZo~~, Z 4 3 s -E `,5 r • xrz-00 Ko-5 5D V ,-rv '5M vck Boring # 1 z :X Kt Fy D%(_ tirov 7 ► 0 `k ~o1i;t ro Cc1 h t~C -To ki Ixx: Ground Mc f+E.S LK -TbA l A)EL a A) ST a ZoAlt ADM AAA ~ 0 elev. It. Depth to limiting factor Remarks: CST ame:-Please Print Phone: 00 LU Q T_ Y, Add ess; _ Signalu Date: CST Number: P age of PLOT PLAN Property Owner COWL", poMALP Legend: Legal Description LOa2A DAApaep»EK BM~eO Wh<<e lbpTED 3auN D 5v_grAce AT LOC A'►ED w -VA F JuJ yy OF-- rtfA E N W I/4 5kc. 31 Cecn Fcr~ce Po 5 f - t- ! ) W beAx1GE MARK~IJCfl At- top 7219, R►q Vjj - OWtj OF - "\I, 5T, cK0►( COUA)-t WISCONSIN - Q = soil boring w/backho j~j¢r~ch MQcy- round@9r 4 ~ O' s et eI Po E, 100.01 01OKANCoE po6n~- an ~ arq~. kree -rop Zy %a sb~pe 6~ woc&A al. of N ex~~,r9:LcpP J 6d s4o ne Wa ( I be-K tick ho~Se ~KISTI h►~, 5(t~ LDCA~~O►J F}OV.~ w ~e Signed CST i M03'70'7 Vu Date MAy 13r19Qb C.T.N. M ix 1jupaluilunkUi111dusu"y, SOIL AiNU SITE EVALUA I.IU li•1. page l ut Z Labe,/and Human Relations 4ivision of Safety & Buildings in accord with ILHR 83.05, UNTY Fr ~.~s` St. C~t)1~ Attach complete site plan on paper not less than 81/2 x 11 inches in size. must k~bo ~ EL I.Q. If not limited to vertical and horizontal reference point (BM), direction and ope, iyr dimensioned, north arrow, and location and distance to nearest road. MAN 2 WED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI R' 1 PROPERTY OWNER: P I . D u )LE g nl fk~Q tl 4,S 3( T 2S N,R 19 tWr W PROPER OWNER':S MAILING ADDRESS L U AME OR CSM # to o t ~~~1 ► - ~~IvF Z► 11 K CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD R~vt R F~L Wz syozz; (71,) 425-SSO(o T R0 ersloe pk. New Construction Use] Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 60 gpd Recommended design loading rate 0.5 bed, gpolft2 -,to trench, gpolft2 Absorption area required 40 0 bed, ft2 760 trench, ft2 Maximum design loading rate L f bed, gpd/ft2 D'In trench, gpolft2 Recommended infiltration surface elevation(s) o be- do e rmi tied It (as referred to site plan benchmark) Additional design / site considerations Parent material ` OLAWA -A Flood plain elevation, if applicable PJA It S • Suitable for system COS MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM In FILL HOLDING TANK U = Unsuitable for s stem 1S ' ❑ U S ❑ U S ❑ U ❑ S f U ❑ S RSt U ❑ S - SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botnd3y Roots GPD/ft Boring # Horizon ; in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench =12 fo L Is 2 e.S c2 0.5- a•b ,s a to Iz-Z '5'YA 1. 3 v - is _ s rn~.~~r s I o Ground . 27-43 3 K NnV-~~ Q_S 08 0.5- elev. It. Depth to limiting factor 770 h &,4 f on-7-00 has b an ve 4-o s e(4 &Y+ s Remarks: o~tZns Z 3 Boring # 4 k Co Cd Ul N 1L Qf~QI I~ v 2X)A% ADM AJis o K_ NC H'P-S 1(5 NL /V I= Al ST Ground elev. ft Depth to limiting factor Remarks: CS ame:-Ple se Prints Phone: 15 ~ Z_S-q(B $ Add 3(a3 (e60~!` (2 F-ALJ_S WT 6 U022- Sign t Date: CST Number: MA &4 6&&,' M &y to lR9 M031D 7 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of" PARCEL I.D. # Borin # Horizon , D in.epth Dominant Color Mottles Structure. GPD/ft 9 Texture Gr. Sz. Sh. Consistence Boundary Roots Bed rend Munsell Qu. Sz. Cont Color Ground elev. ft. Depth to, limiting factor 'Remarks: Boring # karaiw..t~;o Ground elev. ry ft. .,r Depth to, limiting factor Remarks: Boring # U,. Ground elev. Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD-6330(R.05/02) Page of 2_ PLOT PLAN Property Owner CoWL", ROMMA'-"> Legend: ZD exep}- S ~ Legal Description 21 A► pptrK C-re LbTED Lo ~ BM = maw o StkKrmx- Ax LoCR-tED ~/y fiNE -4W yy 0r-THE NWI/4 •3~ C~recn ~Cnce Po5{ ?I 1 ) WAAGE MAPI.%A* At- tOp 7219, R Iq Ul, -DW 0 or- TWZII, ST, c ico 1 x c9uNSy_, W I sComSI N- Q= soil boring w/backho N1aty- sroun(~~9r~ 4100 posh' EL i oo. (Y o"AraE PdLwk+- an i ~+rCe -rop 2y % slope wooded "SA El, J ~P 6d w o re Wa-I I )O h\ nd hour Sxt5-n No SRS u~c~~ofJ }}o~s~ guar ~o a ~ w * A s q Signed CST rv kA z ~no3?o'7 ).e is Date AAA 13T)9'glo CT MI M QC r 9 10 STC - 10 4 AS BUILT SANITARY SYSTEM REPORT ~4~ d OWNER c Co u-) ,e xcfvlz i ADDRESS ~y ~I J PV S f` ~Y /E 'l, /'C l Cl P l SUBDIVISION / CSM$ LOT 9 SECTION 36 T o,? N-R~W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e . D 1V a t ~2 .2. 37 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center nr r BENCHMARK. ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION Manufac er: • Liquid Capacity: Setback from: Well House Other " Pump: Manufacturer Model#Size Float seperation Gallons/cycle= Alarm Location :SOIL ABSORPTION SYSTEM Width: Length i Number of trenches o2 Distance & Direction to nearest prop. line:_ S ~VOY~1 Setback from: well: e 73_ House , other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifoldp 7 Bottom of system ,,o ~i .3Y it /o,fr,Z Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: C,[ s I LICENSE NUMBER: INSPECTOR: I 3/93:jt As gciLt Scup /"=;2o~ FL ~ 111.34 Trap Pip e J-ar~ 7rce { 5± ~~f l Lp'~ ~y x►sf ~h~ Trends r $411 Valu P puss e i'c,/Fuwe SP Ta" K Fo r Ronald Coco ley► 8, Qoreh of c 5~~~19~ Qtown : Qy Pawl ci Stemw _ Qa ~ e ~ 9 //6/qG M P & 790 FL Lar~ 7► cr r e r ~e 1161w, Nl c~, ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Ronald Cowls-W residence located at: 36 JLN T_2 R_J.2,W, Town of SE 1/4, NW 1/4, sec._ Troy Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No(if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known): tv 1191 -S ~V" Ag o ank (if kn n)-. ~7~ 7 Paul C.J. Steiner (Signature) (Name) Please Print Master Plumber 6780 (Title) (License Number) (Date) Form to be completed by licensed plumber (5.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature MP/MPRS 5/88 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor ofd Human Relations INSPECTION REPORT ST. CROIX ' 'Safety and Buildings Division (ATTACH TO PERMIT) Sanitary PermitNo.: GENERAL INFORMATION 268610 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: COWLEY, RONALD TROY CST BM Elev.: Insp. BM Elev.y BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600308 y' f TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ! [ ,5 r2 Benchmark Dosi n Aeration Bldg. Sewer Ho St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Int Septic NA Dt Bottom 0,4 mpg Dosing NA Header / Man. /oS F Z' Aeration NA Dist. Pipe ies,r ion. az ~ov,s oz' Holding Bot. System i4o PUMP /SUO&N INFORMATION Final Grade Manufacturer Demand = e /OS, A6~ Model Number GPM e~ TDH Lift Friction System TDH Ft Loss ead Forcemain Length Dia. H Dist. Towels SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I urer: LEAC ufact SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO MBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold „ Distribution Pipe(s) „ x Hole size x Hole Spacing Vent ToAirlntake Length Dia. 'r Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S n Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulche Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.36.28.19W, E, NW, RIVERSIDE DR an r on required? ❑ Yes [moo Use other side for additional information. SBD.6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r Safety and Buildings Division v, SANITARY PERMIT APPLICATION Bureau 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 C ra; than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application . State Sanitary Permit Number (,d & f ID 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 Property Ow er Name Property Location 1 /4 NW 1/4, S 3 (p T 2 • N, R/41 [0 Property Owner's Mailing Address Lot Number Block Number I r aZ City State Zip Code rPhone Number Subdivision Name or CSM Number Rilleir 1/9 7l- 2,1" Don <7 II. TYPE F BUILDING: (check one) ❑ State Owned it Nearest Road VII s age Public 1 or 2 Family Dwelling - No- of bedrooms Town of 1 -e t Y III. BUILDING USE: (If building type is public, check all that apply) P el Tax Number(s) O 0410-11" z ` 5 Oho - l1~8~ 70 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) New 2. Replacement 3. E] Replacement of 4_ ❑ Reconnection of 5. E] Repair of an y Existing System Existing System A) 1. 171 Sy_stem System Tank Onl - 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 11E] Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 C&Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43E] 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 Eolev. 7. Final Grade Required (q. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) I t Co Elevation 7 7Q Feet Feet VII. TANK Capacity site INFORMATION in gallons Total # of Manufacturers Prefab. Fiber- Plastic Exper New Existin Gallons Tanks rer s Name Concrete strutted con- Steel glass APP. Tanks Tanks Septic Tank or Holding Tank J 2,w 1.2to j +C/Sty ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 76D 1 70 ® ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI tier's Name: (Print) Plu r i nature:( o tamps) MP/MFff5W-N Business Phone Number: :2UIC-1 e~~ad PI tuber's Address (Street, City, State, Zip Code): n2. sr ,ut a X-S WX `yo -Z 2 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater rate ssue A ssuing Agent Signature S ps) Surcharge fee) ~Approved ❑ Owner Given Initial ~~a~i • Adve rse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRI8UTION: Original to County. One copy To: Safety & Ruildings 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. 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: L 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 treatmenftanks; 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) fora 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. Plot EL /o( . 42' FL, ! 11, 34 / ",?"ro h Prp 4 ~y Trenck Z LSrkenei L ctr0 LpL'„~ ~r~s r"'~ Dr opx goose Je ~,L/~uw'P J TQ~tiK For ROA014 Caw leY soreAol c P4,41 cj stcmw pctiP ~ g ~8 ~`IG Se~C,~at ~a~ ~~/9/~7 I/arx R~sKas~n MP&780 R. , a,LVJAki1,i,.;,It UIII iuusuy, SUIL NNU 511 IL LVNLUNIIUN HL-PUH I rage 1 uI L LaWr and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY C 1 ('ti f Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 'ST 1 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ~OvJLE T~bnJi~~~ GOVT-.LOT- ;E 1/4 P)G) 1/4,S3Ga T 2`3 N.R W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE I TOWN NEAREST ROAD R1veR F/~1L5 ~1In' 2 (?r)cl?S-~5oe~ "CROP R~~~rSto~ pie. (J New Construction Use Residential / Number of bedrooms _ [ ] Addition to existing building Replacement (J Public or commercial describe Code derived daily flow 5a gpd Recommended design loading rate 0.5 bed, gpd/ft2. o• to trench, gpd/ft2 Absorption area required. QOO bed, ft2 7,50 trench, ft2 Maximum design loading rate a.42 bed, gpd/ft2 Lt _Uench, gpd/112 Recommended infiltration surface elevation(s) ~o de I rru n ft (as referred to site plan benchmark) Additional design / site considerations Parent material ouA w w,t} Flood plain elevation, if applicable PEA ft S =Suitable for system CO VENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING T K U = Unsuitable fors stem s ❑ U S ❑ U S ❑ U ❑ S )gl U ❑ S NO ❑ S J~U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends a:::: x 12-Z 5 3 v - I s s YY\ - Y- s I a$ o• Ground ' 2')-43 3 K V ~r' C~ y 0,S elev. g7.gt ft. 3- U i° 3~ - S -f~ S Depth to limiting factor 7 70 Remarks: 1041ZV S Z 3 pa-rh Jrj 50 ck"nA f c7t'_IZOf~ has 5D V rave l Boring # z' FOrzf,f)c. cdr ur >✓A3 D Kt F'y ti_ l0 as:<>rtizt<:::.a K -TIZEKIC. Ff< -rasa ~~4s A) sT a 200 A1bM AJ)s ATO Ground elev. IL Depth to limiting factor Remarks: CST, ame: Please Print Phone:(, c{ 7 7 9 r 4~dLUS~#) AddSebSS; Sign at ~ ~ Date:.-~ CST Number: 1-,CI ye of % PLOT PLAN Property Owner COWL", ROM-ALP Legend: eX~C,ep~ l~Jhere. I.bTE D Legal Description LpA 2~+5~/~~}Cl~ Pt\eK, BM = YDWJD SkRFAcr-- PT C~reu1 Ft~ce Posf W~ LocA-iEb im fiNE -J Y4 o rtHE NW1~V S~~ 3~~ o~~GE MgR~.~IJCo t tap -Tzq) R xq k j, -Foy, 0 OF t1eD~~~ S1. CKDI X couA TVI W sOoNS1N. = soil boring w/backho j~,•,ch Mo~~~ s raunrl@gr goo' 'Po k EL 100.0' 010mAr.E. e6m4- on l ~+Tee -top 2y % slope c,0ooc~ed ct.KE EL q''1.04 0 J •60 ufi i w 54o Ae cwa I I e-K nd how aKtt)T% MG Sft: Loc-Prt%oN Hove acsr -ro sc-.cE) Signed CST Zs Date MAy 13 1C'Qb Em QC I .NDUST'MENT OF REPORT ON SOIL BORINGS AND SAFETY & . DIVA ND(1S'fiRY, DIVISION ON LABOR AND PERCOLATION TESTS (1151 P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: UNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: sE-(vw 3 to Tz$ N/R 19 E (o OWNSHIP T14-LNY Z ~ - SAN ^TS A P-rc COUNTY: (OWNER-SMUYER'S ME: rj \U~RS21~E QR1~1C S"C C-FsJ1X ~t.N USS 1V~TZ - U S W S 'JZZ USE DATES OBSERVATIONS MADE NO. B D MS.: COMMERCIAL DESCRIPTION: :?3 LATION S: ~esidence - L~New ❑Replace 8-~ 6-19-97 ~8-S-7 RATING: S- Site suitable for system U- (Site unsuitable for system 9t CONVENTIONA S Q~• MOS•®U JIN 9S EIS LHO QLDINGTANK:RECOS X.L/USYI G.'PptionaM` jCF}E'S - .i _ S ED If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the f "T under s.Hfi3.09(5)(bl, indicate: ~1 • Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH GROUP DWATER-1ND'AM CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH tlf: ELEVATION OBSERVED E H TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B: -1 _ ..19•- ' 10 6.5' N o>v E I^rwT Q'- 9 0.7' attGY Ern TS ; 3.0 `6y $>7 /Fs j o• 9 `1 8 4 '4=5 , Z. 7' Y ~s • Z•z-'n c.S • 0.5' f3,, cssj o'C3~ C) Z g,g' \131•y' NfaQE YAuT 8•Y' o•a~DtzuyBn 1-~STs;3-6'GYBn 1-fs;.Y•o'8h rnez~ S B- w 61- • V j/ S P/ecES 3 ~.S' 99.C' ~iatut Ik07 (2 Z.7' DEcGy & l•~s Ts' ; z,9'Gyb), J~s;z.9 8n D~ ~sl B- 8, ` 02 1-4 IVonI o.g' kz6 $n l~S 7T ' Z- S' i3.1'Bh I s S 11.8' W-S' 13n KS S-Z' `f&fs 3•o'LT•81t fS1z 'h)1in-O S S- S' luoov 11•Z' o-G 8x1fsT~ 1. '~nl~s•l.o'~►►~s;6•~'Y6~ B- 6 \•Z' lt,- Z. o' LT• $n Yn~ S W/ G N . B- 7 1D3• o' 1`1Oru~ 1~~ST @ Z' C>.-7' D\zG Bh 1 Cs TT • S•5'T3h) S•o•a'8~1 hI JS•o.Z'dncl 8 \oa• v' ►.1WKJ o. Dfc6y 8n J ~C-s 7~ ~-s z.Z' $n ,1 ~s:sLicrr, y B- ass I' •8h s PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN6+" AFTERSWELLING INTERVAL-MIN.. PERIOD I PEA I PER INCH EL• P- 1 y•1' rA 1!7 ) S/ /16 3 Io5.6 ' P. 2 6.6 S t 3/ ` 1!~ ! 1/3 me-] ' P. 3 S• Z' S 1/7 - 1 I z I l z l08• P- ~f U• b' Z z 3 Io~•6 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. , 1:N 1T1 R1. , Zt'pl-4\CeM~T 1'~, SYSTEM ELEVATION ~--~~-7 ® 103: oo ' g 4 .so ' I i_. i T i-t E N3S UbIE 9~•OQ~ 4~U il'~ P1 i 0 0 gs- 430 I S E ~.p, E E T CB) S I - ICI I f -r- LIZ, - - r-- 8 _ _ - 11-7 ! I 7-sJ I i:~~" 5 AEP.AITRY~IVTOF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS 'INDUSTRY,, DIVISION LABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 3707 (H63.09(1) & Chapter 145.045) DIVISION NAME:. MUNICIPALITY: LOT NO.: BLK. NO.: 50-,JQA-r-G: st Nw'/4 '/a a6 '~Tu N/R !q E (o -cam zi - Q CO UNTY: WNER AM 2~ S ~~lU~S1 ~R,VE ST•1x VERN ~RSMvsslrr~ Rl\ ep, t=flt-mss w) sya~Z USE DATES OBSERVATIONS MADE N MS, : COMMMIAL DESCRIP PROFILE [DESCRIPTIONS: PERCOLATION 0 I TESTS G~esidence N A- IgNew ❑Replace 76-- 87 C~- he, - RATING: S- Site suitable for system U- Site unsuitable for system CONY I A : MOUND: IN-GR UN U -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ®s❑u ❑sgu 0s❑u ❑sL_yU ❑sou I If an Il y portion of the tested area is in the ` If Percolation Tests are NOT required DESIGN RATE: Floodplain, indicate Floodplain e vation: under s.H63.09(5)(b), indicate: N le I V PROFILE DESCRIPTIONS BORING TOTAL DER H R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION gSERVED HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- s _ P Gt 1 of Z B- B- B- B- B- PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER INCH P. S, i PP.,Ge o;= P- P- P-. P. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 1 I I T 7M 7~IS ~SGTfZFSlu Sti i - rTP P rR_ } 'r I j S CA II STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE / t I C r L~ PROPERTY LOCATION - S t 1/4, _ 1/4, Section 3 4, T- a 4 N-R- l=W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION n,. i'1 d par ~ LOT NUMBER J CERTIFIED SURVEY MAP = VOLUME 783, PAGE a $ , LOT NUMBER o 3 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 requiremeuts 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 W completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. i SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 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 /y Location of property_j,,F_1/4 AtA) 1/4, Section ,T2_N-RlY_W Township 7~ I rD i! Mailing address 6 Al Qr~~Je Dr 81 icv , " & /6 wr Address of site .-6 y ~ ~r Q~d rr FA A9 Subdivision name ale Ark Lot no. a,l0,2,2 , 0.23 Other homes on property? Yes_ No Previous owner of property Vern &2 !E m u s s eA Total size of property___ 3_ Ants Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _ A No Volume 2fA and Page Number a a 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 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. "V2 7 3 B 7 , 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. Signature of Applican Co-Applicant 02~ fe-7 Date of Signature Date of Signature _ I D000MENT NO. STATE BAR OF WISCONSIN FORM 1-1981! T TM's s'A°s 'ISSS"`ISD wa sscoaollla DATA • WARRANTY REED . 'I N. 3 'v 783PKE tvF+o REGISTERS OFFICE - This Deed, made between ...Y.s~nlJ(1..11,....RaWll.astin...aad ST. CROIX CO., WISE Carolyn.. ~►....Raalxuasen_._ .huakzar~d...and.mi.fa................... ! Rec d. for Record *6 ~j y of Jjune _A,0.19.17 j' ,Gr j ' . 4Yi .Y......_.... li at 9.00 A I! husb ' s --Arita}...aa a>~rxi.yQrahipla+alii. al$Dr.QB~x.i~yandan--.tor, I ' Grantee, j: Witnesseth, That the said Grantor, for s valuable consideration - - - - - - conveys to Grantee the following described real estate in 4t t _ - Croix aaruaM TO .,ennty, 3tatt of Wisconsin I: ~I i~ Lots Twenty-One (21) and Twenty-Three (23)1 Danate Park Subdivision, Town of Troy Tax Parcel No: j I~ 1 Ii 00 FEB i i~ This * --not--..__.. homestead property. (is) (is not) I" Together with all and singular the hereditaments and appurtenances tbereunto belonging; And........ Y.ernon---L ----RA.0 ussan---ar d..Carolyn-- A • Aaamuasen warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to all restrictive covenants of record, easements and rights- of-way, all necessary approvals and permits for a residence construction'.. and QIA 4&a2tx"4A4&itAps abstract" slowing good title. Dated this 2.5-------------------------------- day of Juxte........... : ~ -(SEAL) ................•----•-----._..................-----....-•----•-•---.(SEAL) f • • • ftrnon...L.....Rs muse-en-................ (SEAL) ~i,- L3n= n!t.~se+s,+!c!^'..._....(SEAL) . ,Carolyn.- A.-- Rasmussen................. I, AUTHENTICATION ACKNOWLEDGMENT Signature(s) ...•Y-ernoA._L,...RaamuAsAn_..arid. STATE OF WISCONSIN ~141YG~ 1?a~!u$en...._....-•-------------- nn , an ---day . u..e.._.._...... 19.$x. Personally came before me this . dsy of ..........................119 the above named I . • if '---C.,...L-V...Gay-hQ . TITLE: MEMBER ST TE BAR OF WISCONSIN !I (IS not+ anthorissd by 700 06. Wis. State.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY -