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HomeMy WebLinkAbout042-1040-20-100 0 o c M O 6 ti V C b C G rte. O M O v - 04 ell CI) . T o LO N Z C N Oa O N O E U O i i[> O 10 Z C M C .L N x ao E O O LL LO In Y N > C ~ 0 O V) V) 0 o O O E zU~oo m o w m 0 i, LL o c C) ~ macD 0 3 0o p - U co (n Q w w O ~ Z N a0 C 2 V £ OL z ~ d d rn a co L] N H Z c vO O O Z d a v U N O m Z d c N H ~,I N CD Z E V ~ • N C aJ MOIi -0 L O Q m Q Z Z z N L _4 c O N L-I £ N M N Q. CL O (O (O CO A p G G n. .a W O N N Z v> `O H H H O E_ N N 0 0 0 d H Z o O •IV a a a a 0 o o co Vl J U 0) C) o u~ Z M ~2 I'D o o to ~q N O co CL M N U) Q) ~ M d Q 1' ~ p p O o E Q o Wd 3 0 0 0 0 0 0 r _ G'i N C O a to a- 64 O .O CN N V s p F- o N E E o O C C, N C: L L 'L7 M E N o F- E- o + m n E E It U') 5 00 C) N cOc ~ r w ! E X& _ f d M d *k ° L + •cl CL d p N y C rr~ E C C oz `1 A 0 at', 0 NV STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER j6w4e~ d w/ ADDRESS gy~ /0?4~~ A SUBDIVISION / CSM#i1f LOT # SECTION 1:5 T ?j'N-R 1t4 W, Town of 44,o~e ffe#-iJr ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I i i ! ✓e_ wiz. oat( N INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. vr'. BENCHMARK: ~Q,~ G~ ~C CF SS ~,yq ALTERNATE BM: %v 1,q.," el.Tla/ ~'cari2F'/ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: lJ1ejj2.e- Liquid Capacity: / t'oo i Setback from: Well House Other Pump: Manufacturer 46,L"P.9 Model# Z .IoIVZJ Size . y'o Float seperation 75 J/ Gallons/cycle: ' Alarm Location D5A; L SOIL ABSORPTION SYSTEM Width: Length 5e Number of trenches / Distance & Direction to nearest prop. line: trips 35~ Setback from: well: House ivoOther ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: ll° / t'T r PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisccrn4n Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284228 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ULLOM, DENNIS WARREN CST BM Elev.: Insp. BM Elev.:}}~~ , BM Description: Parcel Tax No.: y'J- f/~ GV CQS ~d"~ f 177 - TANK INFORMATION ELEVATION DATA A9600481 51;;7 _ -s TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r It.Yl Cr Gr Benchmark Dosing L~rn Lin, Aeration _ Bldg. Sewer Holdin St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA htoaow/-Man. 3 i U ~y Aeratio NA Dist. Pipe Ho Bot. System PUMP / FORMATION Final Grade Manufacturer Demand o' 5-7- ty-,! CG Model Number GPM TDH Lift Friction System TDH Ft oss ad Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEAC Manufacturer: SYSTEM TO P/ L BLDG WELL LAKE /STREAM SETBACK INFORMATION Type O A, 6w 2n 3 Mode Number: NIT System: Yl~ ~"~144. OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN.15.29.1 NW, S , 120TH ST 0 0 O QW111 01410 J64yl. ZAA or 1 11 c~-z yo 44,4- eh 6,0-, Plan revision requir ❑ Yes ❑ N Use other side for additional information. SBD-6710 (R~05/91) Da a Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: e SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildiinWater System, g Water 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. :5(-. Cro I • See reverse side for instructions for completing this application State Sanitary Per it Numb l ~ ~f~C;Z;29 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 LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property caner Name P operty Location t 1/4 S j 1/4, S T y , N, R ,r♦(Or W Property Qjruner's Mailing Address C~ Lot Number Block Nurrt~~ Gf ~ 1204A, d 0" City, tate Zip Code Phone Number Subdi Sion Name or CSM Number i-a ( ) 3 I )1 ial II. YPE F BUILDING: (check one) ❑ State Owned ❑ Cityy Near l Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF or irX 4,4 Sf III. UILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 40y2 _/0 Vo - 20 - "O-q 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 1314 Other: specify 06e ie. T&-e _1k9&4 IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an SystemSystem Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 h;LIMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Ito otte 14 140 14~• ~ Feet /D/, Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper Plastic INFORMATION Manufacturer's Name Con- Steel New Existing Gallons Tanks Concrete strutted glass App Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ lift Pump Tank /Siphon Chamber 6 / ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name: (Print) , Plumbe 's Signature: ( o Stamps) MP/MP ujo o.: Business Phone Number: 7t5- 772 -3 z j Plumber's A dress (Street, City, State, Zip Code): 7 -3 / I-h 0?ve IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa nary Permit Fee (Includes Groundwater Date Issue Issuing A nt Signat a (No Sta 711s) Approved F1 Owner Given Initial Surcharge Fee) Adverse Determination OC/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 015/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS . . 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the F 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 p 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 systern, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system into be installed. II_ Type of building being served. Check only one and complete # of bedrooms if 1 or2 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, reconne--tion, or repair. V. Type of system. Check appropriate box depending on system type. Vl. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, numk,ar of tanks and manufacturer's name, indicate prefab or site constructed and tank material Complete for all septic, oump/siphon and holding tanks for this system. Check experimental approval only if tanks receive,) experimental prod-ict approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number wi .h appropriate prefi t (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX_ County / Department Use Only. X. County/ Department Use Only r , 1 ; )CCi iCat IC rIS r P y;r,t ari x i ncE,_ ited `.c . ..nty Fhe plans must T__ a (s), septic nc ij plot G!ari, c ?v gale Or uVlth conlp'Er : lO,utl :.:1 .+:j -tank Ise"..,. pump or siphon Sc Orp fehl~iCr ~c'rlt SYS_. the Ic'c.. 010 billlding served; wo n.s, } r, pie s.pc_, s; dose volume; ,c~r _ _UC ors; N - rrn,, pump mo If- i1m_ r_ (ross section O C` :,0 fE'qU c CU1 ltySCII teStdut.+ ci _it.g information. t GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number o` reg::lated p acti~,~ whi ::r. can effect groundwater -1 he monies collected through these surcharges are used for monitoring groundwate; ,Ontamimfli.; mve,tigations and establihmer:t of standards. 4'. St. Croix Tree Service - Mound Syn 596-41336 4Y 3 3 6 Location: NW 1/4, SW 1/4, Sec. 15, T 29 N, R 18 W Town: Warren County: St. Croix Date: October 22, 1996 Owner: Dennis Ullom Address: 943 120th St. Roberts, WI 54023 Plumber: Roger Timm Signature: License # MPRS 3224 Attachments: 6748-Plan Review Application SBD 8330 page 1: cover 2: calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: sizing calculations SYS-TL page 1 of 8 . `~dJRGE • ,$C, t~Y; ~ ,;'sicJ ~ ~W 6t $1 {fit ` l9USTR.Y, ~pgQR _ D3V15t ~ SR~~~ SEE System Calculations b,o ~r a.e. S aJrv~ C~ ~Ta Loading rate gallons/sq ft per day Depth to ground water ?Z-~ in Depth to bedrock in Cross slope % Force main length 3f ft of in manifold/header length ft of in Drainback gallons Lateral length @ • ° ft of in Lateral elevation q4'~ ft (bottom of pipe) Lateral hole size in @ ('0.0 in ( S'0 ft) spacing holes/lateral, holes total Lateral volume l.9 Z gallons i Total lateral discharge rate gpm @ 2 ft head Elevation difference ft Friction loss 0.06 ft @ ~ gpm Total dynamic head O4•gI ft Pump/si~on Z% gpm @ ft of head Manufacturer Model # Sw Z Dose volume ~(O gallons Lift/si\p4on tank (9 O -co gallons Septic tank 104-0 gallons Measurement pump on & off in Height alarm from tank bottom 1O•~~ in Reserve capacity 6-7.1, A- gallons talcs page Z of t s ~ c ~r f e r-'~1 ~ fl N `OA E A r C4 d Z J ~ 0 ~ n X &,L-4 3 _ `I v t Q I tX fN . ~1T►1 ~ ~ O~ t ~ g4..1 n 4,91 4.01 bk i 4.0 3~. o r w l ( a•4 4rM• .wli •t ~r w.:.r..~ S a i ~ o w. O+~ o i 1r o~ t, ' c Sa. - Oro i I S~•~~1~ ~•O~ f ~ S•o~ l S O~ ~ T 1. ~ ~_.1 ~ 1 111 l , a MAIN* • wE~~n1ER~ROUc JLwrrraN IOCKIwG COVER 8orc WAWW" A-44W, C. . Q>rltK o~~cor~KT--~ 4" C.T. 1v*%PUM f1w6"%•6 A --I . PIPE No1bTug"a 4"C.1. . SOL. 20" 2.D. 1 VAwr LOAN MIN. rtllf~l,tr wlty N0~ A'IAOVLQ A C.I.rw °T ~ONFS FI.ES 1AL two VIPIS a Zoe _ VM%Q -%T%ow Ec~rlw+i ~ Glwu~w C. Q4 , OW ' pw4p D 6 Cavf:~tETE . ~v, ='6~oGC 8Ie•S 1~• T~o ~1:~A EPTIC ! _SPEC. IFff-ATIOLJS ost ANK MAIJUFACTURCR: LAs kwM&ER Of DOSES: PER D" 1TANK SIZE: GALLOWS DOSE VOLUME LAK0% /111iACTV1LCR: 1T 'E1 a`~ IIJCLYOIWEr OAGK/I.O1~/: b ~iA~LOA15 AOOCL IJUMIDCR: ° Hw 2.~.z~~ L3.~°I ' CAPACITIES A = WCNCS Oft W►LLOLIS SWITCH TVPIL: 0 r.- 'A. INGNES OR ~3-r~ (ALLOws lump MAIJUFAGTURCR: "`°"P' ~ G. IuCNCS OR 4-e CALLOUS MODEL' WUTADLR: S~ Z~` 0• ~O INCHES OR ` GALLOW6 SWITCH TlIPC: JJOT€ PUMP AWO ALARM ARE TO DE M1141MWM o14CK+1► tac RAT'C GPA INSTALLED OW SEPARATE CIRCUITS EKTICAL OIFFCREWLC DETW69V PUMP OFF AND OISTIMUTION PIPC.. \Z`- FEET r MIN~/►1UM QICTWOKK"'SOPP1.1 VRCSSURE 2.5 MET ~S FEET OF iORCC AAIW X ~i~poRFR1CT" WTOR."" /EET k4 A k FEfT TOTAL abWAMIC. 'NEAO s TERWAL DIMCNSIOW S Of TAWK: LEW6TH.~ ;WIDTH ;LIQUID DCPTH ~3g f Performance Data 32 Pump Characteristics Pump/Motor Unit Submersible Manual Models SW25M1 SW33M1 LL sa Automatic Models SW25AI SW33A1 04 1/3 HP W - _ 2 Horsepower 1 /4 1 /3 0 t6 Full Load Amps 8.0 10.0 y 1/4 HP Motor Type Shaded Pole (4 pole) a R.P.M. 1550 o s Phase 0 1 Voltage 115 4+,+ . . . . . . 0 Hertz 60 0 10 20 30 40 50 60 CAPACITY-U.S. G.P.M. Operation Intermittent Temperature 120°F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 1/3 NP 47 45 43 40 37 34 30 26 22 16 10 Discharge Size 1-1/r NPT Solids Handling 1/2" Dimensional Data Unit Weight 30 lbs. I. All dimensions in inches Power Cord 18/3, SJTW, 10' std. 3-1/2 2. (omponent dimensions may (20' optimal) 4-1/2 wary ± I/B itch T 3. Not for construction Purpose 1-1 2 NPT unless certified 3.1/2 DISCHARGE Materials of Construction 4 Dimensions and weights are approximate 5 On/Off level adjustable Handle Steel 6 We reserve the right to 3-1/2 wake revniarn to our Lubricating Oil Dielectric Oil products and their Motor Housing Cast Iron specifications without notice Pump Casing Cast Iron I / - Shaft Steel f( f Mechanical Seal Faces: Carbon/Ceramic - Shaft Seal Seal Body: Anodized Steel _ Spring: Stainless Steel •.r 11 ,,a Bellows: Buna-H PUMP i Impeller Thermoplastic 10-1/8 ON 9-1r2 DtscHA f Upper Bearing Bronze Sleeve Bearin HEIGHT Lower Bearing Single Row Ball Bearing 3-1/2 Strainer/Base Plastic 3 PUMP OFF Fasteners Stainless Steel AURORA/HYDROMATIC Pumps, Inc. 1840 Baney Road, Ashland, Ohio 44805 - (419) 289-3042 r Sizing Calculations Estimated Daily Load: 8 FTE x 20 gpd/FTE = 160 gallons/day Septic Tank Sizing: Estimated Daily Load = 160 gallons Public Minimum = 750 " Septic Tank Minimum = 910 gallons Use Wieser 1000-600 Combo Tank Drainfield Sizing: 160 gpd/1.2 gpd/sq ft = 133.33 sq ft minimum for rock bed Use 4'x 35' = 140 sq ft rock bed Basal Area: 160 gpd/0.6 gpd/sq ft = 266.67 sq ft minimum A 4'x 35' rock bed on a 4% slope yields 497 sq ft basal area 160 gpd/497 sq ft = 0.32 gpd/sq ft loading Page 8 of 8 Wisconsin Department of Industry, SOIL AND SITE EVALUATION T=abor and Human Relations Page 1 of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Supplement to. Previous Report Attach complete site plan on paper not less t I size, n - Bounty St.. Croix include, but not limited to: vertical and horiz and 'i percent slope, scale or dimensions, north arro o t d n neaac: P~►celtil D. # APPLICANT INFORMATION -Please print all infor n. ( 1 ~P` ReviewQd by date {,1 Personal information you provide may be used for secondary purposes (Privac 1_a s. 15.04 Property Owner ProOkt~l i0loation .Dennis Ullom / St. Croix Tree Service ° 1fC" FIB ~i,1 SW 1/4,S 15 T 29 N,R 18 444 W Property Owner's Mailing Address L q bd. Name or CSM# . 943 120th St. Sta C'Noberts, WI 540ZS to Zip Code Phone Number ❑ City El Village Town Nearest Road ( 715 ) 425-2006 Warren 120th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building M Replacement MPublic or commercial - Describe: 8 FTE Code derived daily flow 160 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 320 bed, ft2 267 trench, ft2 Maximum design loading rate '5 bed, gpd/fF '6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 99.1 ft (as referred to site plan benchmark) Additional design/site considerations install 4' x 35' rock bed mound on 98.1 as upslope edge of rock w/ 1' sand fill Parent material loess over SS Flood plain elevation, if applicable NA ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S S U © S ❑ U ❑ S ®U ❑ S M U ❑ S ®U ❑ S Eau SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Additional site work reveals that the young trees upsl pe of B-3 re of po r quality and can be remove to allow the insta lation o a small mound in soil which b wrings i dicate Ground will be locat d on undisturbed so 1 althou h there is nsufficien room to install a large elev. ft. system - B- area has been exte sively harvested & r planted w/ significant dist rbed-soils while B-2 are is also unharvested but has higher qual ty - more expensive.. trees Depth to limiting factor in. Remarks: Boring # 1 0-9 7.5YR 3/2 - sil 4 2 9-39 10YR 4/4 - sil - 3 39-47 10YR 4/6 - is Ground w/ some gr elow 42 elev. 98. 1_ft. Depth to limiting factor hand boring 47 in. Remarks: CST Name (Please Print) ! Signa Telephone No. Henry F. Grote 1 715-665-2681 Address PO Box 57, Knapp, WI 54749-0057 laV6196 9a mber PROPERTY OWNER St. Croix Tree Service SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GeDM2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 0-1 7.5YR 3/2 - sil 2 15-27 10YR 4/4 - sil Ground w/ occasional gr below 22 elev 8.1 ft. ' Depth to limiting factor , > 27 n. Remarks: hand boring Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/#t2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) D f ~r H s ~ d ~Z f-T, ~o f t -s f C4 d 1 c Cl A r3 0~ v d Y 1 ~ r 90 ~ d 3 ~ J s 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION E4bor and Human Relations Page 1 of 3 Division of Safety and Buildings in accordance with s. I is. Adm. Code Attach complete site plan on paper not less h n si must County include, but not limited to: vertical and horiz nt r ion'anc' St. Croix percent slope, scale or dimensions, north arrow; and location and dis ton4 paAce(D. # `.w APPLICANT INFORMATION -Please print all infor n. a Revi"Od by Date Personal information you provide maybe used for secondary purposes (Privacy a . 15.04 (1)Iffiv Property Owner Prod r Jt!on Dennis Ullom / St. Croix Tree Service Coyt. Lot NW 114 SW 1/4,S 15 T 29 N,R 18 4,w f Property Owner's Mailing Address LDtk 91ock# I'Subd. Name or CSM# 943 120th St. City State Zip Code Phone Number [:1 ge >0 Town Nearest Road Roberts, WI 5 23 715 425-2006 City F-1 Villa ~ ~ Warren 120th St. ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building XQ, Replacement a Public or commercial - Describe: Tree Service & Nursery Code derived daily flow 160 gpd 8 FTE Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ff2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Holding Tank only without significant variance procedures Parent material loess Flood plain elevation, if applicable NA ft Eu = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank = Unsuitable for system ❑ S ~y U ❑ S P U ❑ S q u ❑ S )p U ❑ s U q S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Site is replacement in the sense hat there is a long-standing bu iness wi h well there is however no ex sting on-site septi system o be replaced rathe there i a por -potty Ground which has wor ed well given that ,ost of the business nd employes are ge erally off-site elev. ft. Employment of a secretary has necessitated the constru tion of so e type o on-site system other than a orta-potty! Depth to limiting Shallow soils preclude an in-grou d system platy soil preluce a mound or at-grace in area factor of B-1; distu bed soils exist with fill of varying qua ity all ov r the si e wher tree$ are in. Remarks: grown; chosen by customers on-site; dug with a tree spade; and the hole then plugged with Boring # soils of varying texture on nominally 12-1.51 centers; site is further com licate by very large areas o gravel drive and parking an heavily traveled are where tees an mulch' are stored; All-in-all there are ssential y no undust rbed area of suffi Tent a ea in,which Ground to install a eptic drainfield an all tree lanes are regularly traveled b heavy equipment elev. to access and service the tree nu sery aspect of the business ft. CST recommend a holding tank via approval from the Town board a-ld St. Cr ix Boa id of , Depth to Adjustment limiting factor in. Remarks: CST Name (Please Print) Henry F. Grote Signature Telephone No. 715-665-2681 V~ "~-u Address Date CST Number PO Box 57, Knapp, WI 54749-0057 9123196 3065 PROPERTY OWNER St. Croix Tree Service SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Geptft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 1 0-1 10YR 3/3 - sil 3 m pl deh cs 1f/m NP .2 2 12-26 10YR 4/4 - sil 2 m sbk mfi gs if .5 .6 Ground 3 26-48 7.5YR 4/4 - sl 1 c sbk mfi cs 1m .4 .5 elev. structure is ften Om; w/ inclusions 7.5 4/6 is 0 q,~ tt , , , g, ml; likely fill NP ; NP 4 48- 7.5YR 4/6 - is 0 m mfi - - .3 , .4 Depth to limiting w/ significan inclusions 7.5YR /4 sl & / horizon complica by a dip ing (50 8011) factor horizon o 10YR 8/1 s whi h is generally wea ly cemented and resistant to pe etration -effective BR - 26" in. but which includes pocketes of weathered loos s & is ; fill & disturbed ground Remarks: Boring # 1 0-13 10YR 3/4 - sl 2 f sbk mvfr cs 1f/m .5 .6 2 13-2 10YR 4/4 - sl 1 m abk mvfr cs 1m .4 .5 3 28-4 10YR 6/4 - is 0 sg ml aw - .7 .8 Ground 4 40-6 10YR 8/1 cemented s eff tive SSB elev. w/ 7.5YR 5/4 s O,m bands C 38-42, 50-52, 57-59, & 64-65 99.8 tt, Depth to limiting factor 40 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ' 1 0-4 7.5YR 312 - sil 2 f sbk dsh cs 2f/m .5 ' .6 3 2 4-1 7.5YR 3/2 - sil 2 m sbk dsh cs if .5 .6 3 14- 10YR 4/4 - sil 1 m-c sbk mfr cw if .2 .3 Ground 4 39-L7 7.5YR 4/4 - sl 0 m mfi as - .3 .4 elev. w/ pockets 7. YR 4/4 is (O,sg,ml 97.9 tt, 5 47-49 7.5YR 3/4 - sl 0 m mfi as - .3 .4 Depth to 6 49-57 7.5YR 4/4 - s 0 sg ml cs - 7 8 limiting factor 7 57-59 7.5YR 3/4 - sl 0 m mfi as - .3 .4 39 in. Remarks: Boring # 8 59-63 7.5YR 4/4 - s 0 sg ml as - .7 .8 9 63-65 7.5YR 3/4 - sl 0 m mfi - - .3 .4 Ground Not : while not mo tled the re etitiv bandin extural variations at de th ar ue a ai st elev. ft. the future success of an in- and s s in this area Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) s ; n 3 VA r-TI 2 as f C4 O o J ~ ~ r3 0~ _ ~ v I r` ~ f 3 J s ri y Jf 11 01~ 8 FILED FEB 8 1996 to KATHLEEN H. WALSH L Register of Deeds S'r; Croix Coy yh 539394 Cn C ER T I F- I ED S UR V E Y MA P Located'in the NW 1/4 of the SW 1/4 of Section 15, T29N, R 18W, Town of Warren, being part of Lots 1 and 2 of that Certified Survey Map recorded in Volume 5, page 1308, St.Croix, County, Wisconsin. 1 1, Owned by: Dennis Ullom O fh"~ W 1 /4 Corner Rtr 1 NSA iis~ Section 15 Hammond, Wi. 54015 T29N,R 18W + HARVEY 0 SCALE IN FEET 1 ' 100, JOHNSON L ° _ ad OD o Ioo 200 3® N HUDSON • q N UNPLA7'TED _ LANDS_ 40, Wis tf N ( N89052'3)"W) ~j 9 N..N..••• {0 0 S 89'54'54"E 489.75' 4i~o suaJ 60.01 :t 429.74 (60A0') L ® T 3 ~I lLJ) I o x WI c I 'z M y 141,660 Sq. Ft. (3.252 Ac.) ~I 3 I - Including right-of-way. w =1"I W 125,993 Sq. Ft. (2.892 Ac.) a amt - m ~I Excluding right-of-way. a v 3 v & ol. o; > m I a N m WI'a' Zi S89°58'1 1"W a MI :y 49.20 > - ~ N ~ i --Z ~I N G NI ° w _ Lr) 01 o,o N~II.-~~~ cw w -i z 1 cow I o 0 ..a o wa~ I (n w c~ ZI N89°58 I I"E cn 149.43 41 W S 89' 44' 11 "E 489.91 ' '---'r-* W 047.13 0 442.78' CY) ~ji to Q o1 I M 04 O ~w0 w ey •O Z 1 - O O_ • 1- O 1 O O of W Q pole shed ~I cn p ~I m N ~I ° W: 00 j I a) N 1 w' 01 > I N 45' m o-4-100 !L ® T 4 o v w olO~ 150,416 Sq. Ft. (3.453 Ac.) QI =I 45, o cv Including right-of-way. W1 I-~ of N LL ° 136,567 Sq. Ft. (3.135 Ace) W OI ~1 Excluding right-of-way. W~ I J 'I (45.00') I of ($89°45'20"E ) u 4.96 295.20' 149.91' ~I w io AI' 00•ee144"W eon r)7' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ot1tyt ~G/I,~ , - MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE It-C- zkjr PROPERTY LOCATION 1/4, S i<) 1/4, Section 1:5 T_21_N-Rh? W TOWN OF re•~- ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME ) t , PAGE LOT NUM 3ER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years, or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: 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 Location of property_#,~d 1/4 S t 1/4, Section 1J~ , T_ ZJ N-R j8 W Township l~u• v/ Mailing address Address of site /1-p f4 5--1- Subdivision name Lot no. Other homes on property? Yes ,&No Previous owner of property II~ Total size of property 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 - Volume -9d) and Page Number *r5t as recorded with the Register of Deeds. I SOS 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. y7 /Af , 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 Applicant Co-Applicant Date of Signature Date of Signature WARRANTY DEED STATE BAR OF WISCO\SIN Firs" 2-1982 471369 VOL 910PAA 1J2 REGISTER'S OFFICE James A. Quilling and Debra, L. Quilling, husband and ST. CROIX CO., WI wife Recd for Record JOL''_ ,391 con%r~< and ,.,,wants to Dennis A. Ullom and Diane M. llom, Ci 4:50 P. M husband and wife as survivorship marital property c Q Register of Deeds the following, described real es'ate in St. Croix County, State of Wisconsin: Tax Parcel No: A parcel of land located in the NW 1/4 of the S 1/4 of Section 15, T29N, R15W, Town of Warren, St. Croix County, Wisconsin, being part of Lot 2 of the Certified Survey Map recorded in Volume 5 of Certified Survey Maps, Page 1308, being more fully described as follows: Commencing at the S: 1/4 corner of said Section 15: Thence SOUTH along the West line of the SW 1/4 a distance of 218.57' to the POINT OF BEGINNING: Thence S89°52'31"E 490.00'; Thence SOUTH 595.90'; Thence N89°45'20"W .49.83' to the East line of Lo~ 1 of the Certified Survey `lap recorded in Volume 5 of Certified Survey Maps, Page 1308; Thence NORTH along said line 262.17' to the northeast corner of said Lot 1; Thence N89°45'20"W al-nK the North line of said Lot 1 a distance of 340.17' to a point on the West line of the SW 1/~ of said Section 15; Thence NORTH along said line. 332.17' t-, the point of beginning. Cont-ains 4.65 acres subject to 120th Street right of way and any and all additional easements, right-of-ways, conveyances or ordinances of record. Seller retains easement over the existing septic system area and replacement system area as tested and approved on the soil test report. ' b This is not hone=tend propert-.. XXX t is lint) E:xr-po-, t., warranties easements, restrictions and rights of way of record, if any. Jul „t 91 (h,ted th~~. 15th daN• of y . (SEAL) EAL JaziesA/. Quilling _A 1. D6e3ra L. Quilling AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF WISCONSIN County. - c ~ dad of Iy i -rzonall}- carte before me t'nis _ - o authenticated this day of_------ J4aIy 19 91 the above named James A. Quilling ' TITLE: NIEIIBER STATE BAP. OP WISCONSIN Debra L. Quilling (If ^ot... authorized by ; 706.06. Wiz. Stat.:.) ~ - wil to he the p,'r>,,n s art-„ exceAed tike in~triinwnt ;ind ;,rknmrlyd r t~-e sawe.