HomeMy WebLinkAbout004-1029-50-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER / 1/ I V 1 `e r e A?
ADDRESS O L U G y t ~t
SUBDIVISION / CSMI LOT
SECTION 13 T 2 N-R W, Town o f ~ t{ 9G
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
a
INDICATE' tJORTH ARIROk~
1
Provide setback and elevation information on revel-se of this form.
Provide 2 dimensions to center of septic tank manhole <=ov("
BENCH14ARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Ml'd ►v 4sGte•r n Liquid Capacity: ~a 0
C,
Setback from: Well L House ! Other
Pump: Manufacturer ~?oe ~le~p Modell 1-3 Size
Float seperation /S- Gallons/cycle: ,15,-5'
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 5 Length S- u Number of trenches
Distance & Direction to nearest prop. line: _9 4'
Setback, from: well: '4'10 House~;*'00 Other
ELEVATIONS
Building Sewer ST Inlet. ~sri G ST outlet
PC inlet PC bottom 9,2,~ Pump Off
Header/Manifold 7 Bottom of system
Existing Grade Final grade
DATE OF INSTALLATIO
PLU11BER ON JOB:
LICENSE NUMBER: 4!
INSPECTOR:
3 /93. )t
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM 3°9 County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitNo.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of. State PI
NIELSEN, AL X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
Verit
ir Ito ntake ROAD Dt Inlet
TANK TO P / L WELL BLDG. A
Air
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Loss Head Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Di;. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Cady.13.28.15W, SW, NE, 325th Street
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710(R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
E
Safety and Buildings Division
■■_r■R SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Cou
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sa~a~r~jNumber
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. State PI I . Number ~rr
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION -40
Property Owner Name Property Location
Al Nielsen SW1/4 NE1/4, S 13 T 28 - N, R 15 (or) W
Property Owner's Mailing Address Lot Number Block Number
Box 325 Apt. 4
City, State Zip Code Phone Number Subdivision Name or CSM Number
Hammond, WI. 54015 1(715) 796-2498
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms 2 r;ilTown OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s
1 ❑ Apartment/ Condo 002- - l (jU ? - Ll - G O U
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System 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 U Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORP STEM INFORMATION:
1. ons er Day Absorp. Area 3. Absorp. Ares Loading Rate 5. PO c. Rate 6_ System Elev. 7. Final Grade
)equired (sq. ft.) Proposed (sq!ft.) (Gals/ ay/sq. ft.) (Min./ ch) Elevation
(JU u 250 250 .t 98 Feet 100 Feet
TANK Capacity
Prefab. Site Fiber- Ex er.
RMATION in gallons Total # of Manufacturers Name Con- Steel plastic p
New Existing Gallons Tanks concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber X1 1 750 1 Midwestern ® ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT -
I, the undersigned, assume r nsibility r install n oft e sewage system shown on the attached plans.
Plumber's Name: (Print) Plumb 's Signat P/MPRSW No.: Business Phone Number:
Joe Stang t MP 6646 1-715-698-2266
Plumber's Address (Street, City, State, Zip Code):
506 Willow yDRive W ille, WI. 54028
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Iss g Agent Signat a (No Stamps)
roved tQ(~ ® Surcharge Fee) I-
~f I pp E] Owner Given Initial Adverse Determination
CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
X.
SOD-6398 (R. 0"4) DISTRIBUTION: original to COunly. One copy To: Safety & Ruildings Division, Owner, Plumber
J
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage 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 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
manu°acturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2: x 11 inches must be submitted to th,e rounty. The plans must
include the following: A) plot plan, drawn to scale or vvith complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells, water mains/water service; streas7u and lakes, pump or siphon
tanks; distribution boxes, soil absorption systems; replacement system areas; ane the location of the building served;
S) hoc izontal and vertical elevation reference points; Q complete speci fications for pumps and (ont, ols; 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, l:) soil test data on a 1 15 orm, and F) al sizing information.
GROUNDWATIER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards-
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
June 15, 1994 2226 Rose Street
La Crosse WI 54603
i r'y.... X
WEGERER SOIL TESTING
PO 74
RIVER FALLS WI 54022
w
RE: PLAN S94-40499 AE RECEIVED: 180.00
NIELSEN, AL
SW,NE,13,28,15W
TOWN OF CADY COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
SiOerard cerely,
Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
4314R/ 1
sun-6423 (K.61/si)
01
• L. Page 1 of b
MOUND SYSTEM
FOR
A Z BEDROOM RESIDENCE
LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION 1-1 ,T28 N, R tS W,
TOWN OF ST• LJC COUNTY, WISCONSIN.
INDEX
PAGE 1'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
YMPARM BY `cam ONS+
a r'f 'ti i
WEGEFtEFt SO I L TEST I "(33 ARTHUR
WEGERER
j
w, i D-915, p.
AND
. •~,~EAI9WORTFi •
LIES = Gi SF-=RV I CE ~
P.O. BOX 74 421 N. MIM ST.
RIM.. FALLS. MI 54022 I G
715-425-0165
S -2~-qty
aECEivEo
JUN 0 2
sAFM & euo~. ow.
JOB NO. q - l l 1
PLOT PLAN Page Z of
Scale 1"= Y3 '
PRon o S~
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8•Z
tL 9,S Z
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted..
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( f -required)
4.-Septic tank to be XVUU bSO gallon capacity manufactured by
Y~\ 1~w ~ST~J~ 1~2~r,,4-ST
5. Bench Mark S~ P~$pU~ Ptrfhv
6. Divert surface water around mound to prevent ponding at the uphill side.
S( yk~r Page3Of 6
Y{ s ti
Approved Synthetic Covering
Distribution Pipe
Medium Sand _
Topsoil lH
F Ele
3 E p
b
1 % Slope
Force Main Plowed
Trench of 2"-2 2" From Pump Layer
Aggregate
Undisturbed D 1- 0 Ft.
Soil E I.bS Ft.
Cross Section Of A Mound System Using F 0-8 Ft.
I Trench For The Absorption Area G N•a Ft.
A S Ft. H I- S Ft.
B SO Ft.
I `Z Ft.
Linear Loading Rate= b,'Z~ GPD/LN FT J $ Ft.
Design Loading Rate= 0 3S GPD/SQ FT
K 10 Ft.
L -70 Ft.
l+e"ate Position of Force Main W Z S Ft.
L -
~ ~ Fvtce
B- K Maur
A
w
Distribution ~ Trench Of 2 - Z 2
Pipe Aggregate
{ Permanent 1
Observation pipes Markers ~
(Anchr securely)~4~~~~~
V,- O' a Y A 4 ~ p@
S, D.
ONS
I" " I?
NU R
911pN
Mound Using I Trench A ides R 0 ~V01.~Sl~raS
. q~V , gp
f1
f o/ • S 4
Page Of
Perforated Pipe Detail
0
End View
Perforated
End Copt PVC Pipe
t 40-. Gnu`
Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q End Cap \
S PVC Force Main
Dist rout ion
Pipe
Lost Hole Should Be
Next To End Cap
~AG~ pis ytt~j~¢n Pipe Layout P ? Ft.
p~~`IA lly X 30 Inches
Coll ltt®~~ • Y 3o Inches
Hole Diameter ~1 y Inch
iSc1~ IN Lateral is t l Inch(es)
%ABUO H
of 110STRI, pov, A~►4 Manifold " - Inches
ptvds~ Force Main " Z Inches
# of holes/pipe 10
Invert Elevation of Laterals R5.5 Ft.
Place lst hole Sal from tee with succeeding holes at 3e intervals.
Last hole to be next to the end cap.
Combination Septic;Tank and
PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS' PAGE S . OF 6
S 94-- VCWT CAP WEATHER PROOF
4 V: JUIJCTIOLI BOX
4"C.I. VENT PIPE APPROVED LOCKING
-"'10' FROM DOOR, MANHOLE COVER I'VI'ZH
.JINDOW OR FRESH u'ARIJIUG 1-AgEI.
AIR INTAKE 12"MILT. co~apu>r
'f" MIN.
L - M
W LE T '0Rbvl -
RE~~ION
84<=F~~S k) 0 ZxS APPROVED JOIAITS
APPROVED JOIUT •~~tpN. ",may 1► W/C.I. PIPEoRPOC
W/C.1. PIPE aR Tank construction pF 1 piE `"M EXTELIDIUG 3'
EXTENDING 3' shall comply with ONTO SOLID WL
OWTO 50LID SOIL ILHR 83.15 and 83.20
q 3.ZS I
CLCK FT PUMP-~
Ofd
D COLICKETE
DLOCK
3" APPR%W6C
RISER EXIT PERMITTED ONLY IF TANK MAIJUFACTUR6K HAS SUCH APPROVAL. BEDOIN4
SEPTIC E SPEC.IFICATIOA.IS
DOSE
TANK MAIJUFACTURCR:M I bW Q ZtW pRff=L . WMBER OF DOSES: PER D"
TANK SIZE: 1b00/6S0 GALLONS DOSE
6ACKPLOW: r I~ Z- GALLOWS
ALARM MANUFACTURER: S' S"-`iI20 S`~S S
MODEL NUMBER: 10 N \6w CAPACITIES: A= S INCHES OR ZSS GALI.Oin
SWITCH TYPE: `~2CU~-Y B c Z IUCHES'OR 3`1.. G~ LLOUS
PUMP MAAJUFAGTURCR: zU LLt Cd'1PRAJY C IUCHE5 OR ~~Z^ GALLOWS
MODEL NUMBER: 53 Ds 1S INCHES OR ZSS GALLONS
NOTE: PUMP AMD ALARM ARE TO 5E b
SWITCH TYPE:
MINIMUM DISCKARGE RATE Z,'3.40 GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEU PUMP OFF AIJO..DISTRIBUTIOU PIPE.. 5 *15 FEET
t MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . 2 5O FLET
1.~5 FT 1.b°I
+ qS FEET OF FORCE MAIM X /OfLFKICTIOU FACTOR.. FEET
TOTAL OyNAMIC HEAD = 8. FEET
Pump chamber DIAMETER
INTERNAL DIMEWSIOkIt OF TANK: LENGTH ;WIDTH ;LIQU10 DEPTH
BOTTOM AREA 231= GAL/INCH
AS PER MANUFACTURER \1:D GAL/INCH
twit
W' W HEAD CAPACITY CURVE 61/4 -
"53-55" SERIES 45/e
25 e
TOTAL DYNAMIC HEAD/ I 4%
FLOW PER MINUTE
EFFLUENT AND DEWATERING e
HEAD CAPACITY + 1
UNITS/MIN -1 -
Q 6 20 FEET METERS GAL LTRS 43/18 111/2 NPT
W 5 1.52 43 163 e
V 10 3.05 34 129
15 4.57 19 72
Q 15 19.25 5.87 0 0
} 4
D
J 10 I
0 S. 8 y
~ 2 z3.4o
5
915/18 l
0
US 10 20 30 40 50 33/32
GALLONS
LITERS 0 80 160
FLOW PER MINUTE
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Piggyback Mercury Float Switches • Available with special cord lengths of 15',
available. 251,35' and 50'.
• Variable level long cycle systems • Alarm systems available.
available. • Duplex systems available.
Standard cord length - automatic 9 ft.
Standard cord length - non-automatic 15 ft.
SELECTION GUIDE
M53/55 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required.
Model Volts-Ph Mode Am simplex Duplex 2 Single piggyback wideangle mercuryfloat switch ordouble piggyback mercuryfloat
M53155 115 1 Auto 8.0 1 or l &7 - switch. Refer to FM0477.
N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10-0072 or 10.0075.
D53/55 230 1 Auto 4.0 1 or l dr 7 4. See FM-712 for correct model of Electrical Alternator, "E-Pak"
E53/55 230 1 Non 4.0 2 dr 2 & 6 3 or 4 d 5 5. Sensor mercury float switch 100225 used as a control activator, with E-Pak (3) or (4)
float system.
53 Series - Wt. 23 lbs. -.3 H.P. 55 Series - Wt. 25 lbs. -.3 H.P. 6. Four (4) hale "J-Pak". junction box, for watertight connection or wired-in simplex or
duplex operation- P/N 100002
7. Two (2) hole "J-Pak", junction box, for watertight connection or splice. PM 10-0003.
For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; CAUTION
Piggyback Mercury Float Switches, FMO477; Electrical Alternator, FM04K Mechanical Anema- All Installation of controls, protection devices and wkh% should be done by a qualified
nator, FM0485; Alarm Package, FM0513; Sump/Sewage B"kW FM0487; and Simplex Control licensed electrician. AN electrical and safety codes should be followed in addition to the
Box. FM0732 most recent National Electric Code (NEC) and the Occupational Safety and Health Act
(OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
AINL T0: P.a BOX 16347
Z Louisl*, KY40256-0347 Manufacturers of...
Sh7PTO. 3280 010 MO'ers Lane
Louitift KY40216 a pp
® (502) 778-
FAX (502) 2731 a 77 006248-PUMP QUALITY PMMPB ~NCE s917
4roainDepabmntofIn usVy' SOIL AND SITE EVALUATION REPORT Page k of 3
Division of•Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
ST- (Z.tzo cx
Attach complete site plan on paper not lerPQM), i ' e. Plan must include, but PARC EL I.D. #
not limited to vertical and horizontal refeirectio f slope, scale or
dimensioned, north arrow, and location a st road.
~REVIEWED BY DATE
APPLICANT INFORMATION-PLEA ~FOMATI
PROPERTY OWNER: s OPERTY LOCATION
L ~11~TLS tN rLL Y > f 4~- SW 1/41 Y 1/4,S \'~S T Z~ N,R 1 S E (ore
PROPERTY OWNER.S MAILING ADDRESS ' OT # BLOCK # SUED. NAME OR CSM #
8 So X- -o cu S T
CITY STATE ZIP CODE 8ER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
ST.
'k31'~ L~ W W w 1 S ~10o Z l 6q: V:8 9 C_ O 3 2 S T*
[)q New Construction Use NJ Residential / Number of bedrooms Z [ J Addit n to eAsting building
j ] Replacement [ 1 Public or commercial describe
Code derived daily flow 30o gpd Recommended design loading rate - bed, gpd/ft2 0-. trench, gpolft2
Absorption area required Z S 0 bed, ft 2 2 S O trench, 9 Ma)dmum design bading rate -.g L- S bed, gpd/ft2 0 -6 trench, gpdtft2
Recommended infiltration surface elevation(s) 1018-0 It (as referred to site
So' ITC~J CII - plan benchmark)
Additional design/ site considerations ` IO`y- ~ w/ S 'K M IAv . I 'OF S'" F L.L. .
Parent material SouER s K Gt- Flood plain elevation, N applicable N A. ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM & FILL HOLDING TANK
U = Unsuitable for system ❑ S 19 U [us ❑ U ❑ S I~ U ❑ S ®U ❑ S L~U 1:3 S Al
SOIL DESCRIPTION REPORT
C4nsistence Boundary Roots GPD/ft
Boring # Horizon Depth Dominant Color Mottles Texture Structure
in. Munsell Qu. Sz cont. Odor Gr. Sz. Sh. Bed ter>ch
1 o-9 X0`1 R 31Z - si 1 Z`~sbk m'~1• e-- S _ o.S o.6
Ground ?-q- 3y l w- m- (1/b - ~s >tG>^ o g 9 lm 1 CS o S o. 6
elev.
qb ft 34-So ~.Syt> 3/y ~l1-Syli' s/8 se. 0h-, `v) iv - -
Depth to
limiting
factor
&4
Remarks:
Boring # , -
C-A lb`-LCZ31Z stl Z.`~3bh wt`F~ ~S 0•131o.6
z Z Z3 ~oK y/y gj I z ~s \,I \y rn il,-
3 23 3S S,Ps>sr6t, O s9 e S - o•S u•6
Ground _
elev. y S-60 S -I 2 31 Y ~ ~ y tz spa S e-1 ar., w► _ '
Do to
limiting
f ►t
Remarks:
TName:-Please Print Arthur L. We erer X18. 715-425-0165
egl~rer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
Signature: Date: CST Number:
94-JI1 5-Z-4-~~ rt00576
PROPERTY OWNER Sel~j SOIL DESCRIPTION REPORT Page~of
PARCEL I.D. # , y
Botx>~y Roots GPD/ft
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiendi
~.aY o_ 9 t o ~-l 2 3 I Z s l 2 'F bk C S o. S o• 6
Z 9-11 I$ `1 fZ 4// s 1 k c w _ o.S u b
Ground 3 1R-33 ib`Z2 3 j` - GasSb4t vnv`c-h Ctru n•S
elev.
gl- It ft. 33-119 lO`tRy/6 - S~PsrG►. u S9 w, 1 ~S o-S
Depth to S ~f9-6S SyR 3/ ~i-SyQSIB sal o~ Yn`F~. - - -
limiting
factor 4
l' 01
Remarks:
Boring #
E3
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
S13D-8330(R.05/92)
Page 3 of ~
• PLOT PLAN
SCALE 1"= 4QJ '
EX.e~T hS 4ltowN
I
i
I
Su6c3NS7» ~
Ebab
wMu lA~/1'nnrJ1~
3ob~~
• N
a 3i'1- Nt Z0000 ON
G a4~t(GH
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L",t C P 1 Aq
D
0
W I 70~
^l
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CIA
Ov ►a nT Cor~►p RCT OR
3yv iz-8 `rm S Mz~A
T'weS ~1.J TlZ►~* 5
9S z
UL
G? ~j- 1 l 1
S- Z4l q~ (715 ) 42.5-n1 n5 M00576
CST Signature Date Signed Telephone No. CST #
STC- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
i
OWNER/BUYER Al Neilsen
MAILING ADDRESS Box 325 Apt 4 y,~ -
PROPERTY ADDRESS 3~ 1 3- 5~ 5l'Lc-v-~
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Hammond, WI 54019
PROPERTY LOCATION SW 1/4, NE 1/4, Section 13 T 28 N-R1 _9_W
TOWN OF Cady ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME/1*/ PAGE ?,LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement. that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
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.
UWe, the undersigned have read the above requirements and agree to maintain the private se-age
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: C~ -
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, %VI S4016 1 Ir`)3
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 Al Neilsen
Location of property SW 1/4 NE 1/4, Section 13 , T 28 N-R 15 W
Township Cady Mailing address Box 325 Apt. 4
Hammo'pd, WI. 54015
Address of site
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property e~ {'o tj r1 lau U .e.. &V_X ~LA~
Total size of property Acf~s
Total size of parcel
Date parcel was created 5 ~o - to - q14
Are all corners and lot lines identifiable? L--Yes No
Is this pro erty being developed for (spec house)) ? Yes ~o
Volume /07 and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 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
6/', -a. A! 5
Date of Signature Date of Signature
e
. DOCUMENT YOl PACE 3~7 a
No. STATE BAR OF WISCONSIN
FORM 1 THIS SPACE RESERVED
S1,75O6 WARRANTY DEED FOR RECORDING DATA
This Deed made between Kelton Greenway and Michelle 74
Greenway. husband and wite individually and ':er•d+brPeoo~a V:
each in their own rich`
Grantor, JUN 6 1994
and Allan E. Nielsen a single Aerson 12:30 P.
Grantee,
Witnesseth, That said Grantor, for a valuable fRn
consideration conveys to Grantee the following described RBTURN TO
real estate in -Lt. Croix County, State of Wisconsin:
The Southwest Quarter (SWU) of the Northeast Quarter (NE14), Section Thirteen (13),
Township Twenty-eight (28) North, Range Fifteen (15) West, TOWN OF CADY, St. Croix
County, Wisconsin.
z•
e This js not homestead property. J FED
Mm~'s V Together with all and singular the hereditaments and a
' ppurtenances thereunto belonging; And
Grantor warrants that the title is good, indefeasible in fee simple and free and clear of 4
z encumbrances except easements, restrictions and roadways of record, and will warrant and Y'
defend the same.
s
Dated this 2nd day of June, 1994.
"l
* (SEAL) (SEAL)
Kelto G eenwa xr
* (SEAL)
(SEAL) _
,'r * Michelle Greenwa
x~
AUTHENTICATION ACKNOWLEDCMNT JJ
_
STATE OF WdSCOq$IN )ss.
r. * Signature (s) of Kelton Greenway and Dunn= Coi1wy )
'4 Michelle Greenwa and and wife ;Z;
f individually and each in their own right c•
authenticated this play of June, 1994. Personally came before v, J ✓ j rind
mW this day of ,
June, 1994, the above nried• K 1 o Greenway
* and Michelle Greenway hus and'and wife
individually and each in their bhm right
to me known to be the person(s) who executed the
TITLE: MEMBER OF STATE BAR Or WISCONSIN f instrument a acknowledge the same.
(If not,
~ authorized by
§706.06, Wis. Stats.)
* Mar A der so D.
THIS J.NSTRUMENT DRAFTED BY Notary Public County, Wisconsin
my commission is permanent. (if not, state
THEDINGA LAW FIRM (WHT) expiration date: 119195 )
*Signatures may be authenticated or acknowledged, both are not necessary.)
Y.,~ Names of persons signing in any capacity should be
typed or
r
printed below their signatures.;-
STATE BAR OF WISCONSIN
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