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HomeMy WebLinkAbout004-1056-80-000 STC - 104 T AS BUILT SANITARY SYSTEM REP ADDRESS o~oZZ /-4 ] / ' f ~ r~~~~~ rte` S z SUBDIVISION / CSM# 61ze,, h'kre& LOT SECTION d 4 T,-2g _N-R /,_W, Town of .ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Y' 1a X. -•f-_._. ~ _ ,.k: O ~I II n. o s\ 33 - ~x1f g'l y 4v~~4~w~C av~ i66>o INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK LG'GCc~t / j'ea( rY~_ ALTERNATE BM.., r L~ SEPTIQTANx / PUMA AMBER / HOLDING TANK INFORMATION Manufacturer: lcf<p~~,v Liquid Capacity: 1606 W 7 ,e p Setback f rom: Well 140 House 3 ~-Other Pump: Manufacturer Model #S Size J Float seperation~.~ v~ Gallons/cycle: Alarm Location P/X%- SOIL ABSORPTION SYSTEM Width: Length W Number of trenches 7 Distance & Direction to nearest prop. line: A/mJ-A •a- ' i Setback from: well: House / 37 Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: 6-- 1"6 PLUMBER ON JOB: LICENSE NUMBER: ^aes INSPECTOR: 3/93: jt /"-f Wiscansin Department of Industry, PRIVATE SEWAGE SYSTEM County: bor and Human Relations fetyand Buildings Division INSPECTION REPORT ST ® CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No_: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI ELEGEN, DENNIS X CST BM Elev.: Insp. BM Elev.: BM Description: Catty Parcel Tax No.: /00. TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark __4 41~t /vSaq 100. ' Dosing Aeration Bldg. Sewer Holding St/Ht Inlet S ~ /v2, a i ' I TANK SETBACK INFORMATION St/Ht Outlet 33 ~ of ya, TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake G, 5o' 9g.79' Septic ~So 3 y ~a >as-' NA Dt Bottom q 9~ p 9 Dosing >Sa • ,~d0 . ,j C) , NA Header/ Man. a, 3 /007"9>' Aeration NA Dist. Pipe 37' ba 9 a' Holding Bot. System y /"2, s PUMP / SIPHON INFORMATION Final Grade /o q, 79 Manufacturer lad_ Demand Model Number g2,, a S GPM 77ift 4, , SstePD,,tToTWell Hg `3' Ft Forcemain Lena.o2" >,2oo SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 'y 9q DIMENSIONS SYSTE TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Mode Number: System: I)W440 /o ' X37' o?y N44 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size T Hole Spacing Vent To Air Intake Length -LIS' Dia. Length 90 ' Dia. / ~y a Spacing 41e„ >s0 ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over „ Depth Over xx Depth Of xx Seeded/ 5edded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil lO - R` es ❑ No [ es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Cady.24.28.15W, BE, BE, 330th Street - / / - 1 17~J - ~ S -/8- ~ .t f~ idu :3-' -3 'IL Plan revision required? ❑ Yes W"No Use other side for additional information. ~ ~ t . e. tit SBD-6710 (R 05/91) Date InsOct 's Signature Cert No. l ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: II I, s .;r, SANITARY PERMIT APPLICATION CO r~'~~■7~7 In accord with ILHR 83.05, Wis. Adm. Code STATE SANIT~j 2Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than S a D3a 8t% i x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION h n e(~ ,e 5£ Y., S °A T r)_S, N, R 15 (orQ PROPERTY OWNER'S MAILING AD S LOT # ~ BLOCK , o?G?gt 3~r ~ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER /sa w 6 7 10/5 )77,;',- 31/7 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned V ILLAGE cz 40 ¢A STL JOWN OF: ❑ Public N1 or 2 Fam. Dwelling-## of bedrooms, PARCEL TAX NUMBER( 111. BUILDING USE: (If building type is public, check all that apply) -6'4 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground' 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. ck I~ Replacement 3.E1 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 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 R Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 A') 2- 00" Feet Al Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New istin Gallons Tanks Concrete structed glass App. Septic Tank or Holding Tank Tanks Tanks / Y Lift Pump Tank/Si hon Chamber El 1 0 F-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 15 77 z- Plum e s Address (Street, City, State, Zip Code): 3I Fs ofd 4tV IX. UNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing A nt Sign a No Sta s) Approved ❑ Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 1, 1 5. Onsite sewage systems must be properly maintained. The septic tank(s) must teepumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the'legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete Fine B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system typa. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information Fill in the capacity of every new arid/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'/s x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. I GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 1 c w l RECE/QED Dennis Blegen - Mound FEB 13 1995 595-40068 SAFETY & BLpGS DIV. Location: SE 1/4, SE 1/4, Sec. 24, T 28 N, R 15 W Town: Cady County: St. Croix Date: February 13, 1995 Owner: Dennis Blegen Address: Box 222, 330th St. Wilson, WI 54027 Plumber: Roger Timm Signature: 1,14rf, License # MPRS 3224 Attachments: 6748-Plan Approval Application 115 ,age 1: cover 2: calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve page 1 of 7 System Calculations S95-40068 one family residence bedrooms Loading rate O's gallons/sq ft per day Depth to ground water in in Depth to bedrock Cross slope 96 Force main length 3 ft of Z in Manifold/header length ~y ft of - in Drainback gallons Lateral length @ f t of in Lateral elevation ft (bottom of pipe) Lateral hole size '1¢ in @ in ( 4.-4 ft) spacing to holes/lateral, z holes total Lateral volume S.7~ gallons Total lateral discharge rate Z I A gpm @ Z' ft head Elevation difference ft Friction loss ft @ Z' gpm Total dynamic head `g q 19 ft Pump/si0on ZS gpm @ ft of head i Manufacturer ~r~Ya Model # Dose volume gallons Lift/siihon tank , gallons Septic tank gallons Measurement pump on & off S.~ in Height alarm from tank bottom in Reserve capacity 4~`0 ~ gallons talcs page Z of It i ` C.,. Ye ` f I Q-t 44 1 ` ct Ck -D _ ~ ~ 1 V77 f Y 0 16 ~ ~I~~FC~~ t1 t'lf;ku„vC~ C:F 'Ct11:. AGScf~PilGr3 a~ . t i...~ TltAC f--x ICS P+T ' ~ ~ ►T~c , "ILI cs 6b•. k het : ~ f.. I~ Qty 10 L 4T \p a~.~~ ~ Y Rl d CIA. Glr e_ "C _ _ ' y{}~}Q~ ,Ry E}~y SS't 5405 I ' S 9 5,o4 0 0 6 H a ve 46~t (o" ~a~ow Z / \ 3 ,4s( You . 1 a Z. Y]C w . ( R~TM laZi~' vNa ~X \ ~o i c o A 1 3 Ow Q„~fLN b C O T 0, Uk SYSTEM ,F 7, fl FM4 iv ra y DEPT. OF USTRY, LABOR & HUMAN RELATIONS Di Si OF SA Y AND BUILUINGS E ESP(O)NULNN(;L U 40068 4f low- z 1, ct 4.0' X: `/L s AY.f(\ s1 ~~OrV ~O ~r °O~.►:V' 1 QJV ~.vYILGw.` ~y : v a... To T : o; PvC .9 ob'SC.b.,.c~.0 ..r4.` k- VJo~`o..., o~ v0C~ - b., o N O~: \ w.`1ax .►X.1 }Q.r.w; w.X 2 ~ i v o w. 4+~ o ~ V o ~ `c 1 ~ ~ y~ Qv c S ~ tv,g`~ ~ I S b.g" Izi~ic- rs!+-~( Sb.k" I ~.K I S b.Y' q t'.o 43 . o • +/4, Ko1st oti AQJbfta cpy.1W X00 0~+. `-AL- ~J 5 (o.1S ( ~t J 1 t pPtVA 0 it.ionallY , Otis DpK. Of hIDUSTRY, U►SUR Y A DIVISION S C /v\ V z" 595-40098 VEUT CAP `"C.I. VENT PIPE WEATHER PROOF AFFROVED L0CKIAJC, JUUCTIOW BOX MAlk.IHOLE COVEF. 25' FROM DOOR, WIMDOW OR FRESH AIR IAITAKE GRADE I 4,, COWDUIT PROVIDE I AIRTIGHT SEAL I I i I V f.,-q", CBS C2v QT ZS. Z," I I I i APPROVED JDIU W/C.I. PIPE I I EXTEUDIUG ' i ALARM ONTO SOLID SOI. t S I O►J OFF BLOCK V's C~a 4~ S-i J V i I . y r ~ 95 "40 0 16 L LAIN 40 1 t ~ Performance Data Pump Char teristics 32 Pump/Motor Unit \ Submersible Manual Models SW2511f,, SW33M1 W 24 LL Automatic Models SW25A1 SW33A1 a 1/3 HP x Horsepower 1 /4 1 /3 " 16 Full Load Amps 8.0 10.0 2 1/4 HP Motor Type Shaded Pole (4 pole) ° a F' I I I lid R.P.M. 1550 o e Phase 0 1 Voltage 115 o Hertz 60 0 10 20 30 40 50 60 ,CAPACITY-U.S. G.P.M. Operation Intermittent Temperature 120-F Ambient Total Hood (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A G 1/4 HP 44 = 41 36 33 29 26 23 18 12 6 0 Insulation Class A 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Discharge Size 1-1/2" NPT Solids Handling 1/2„ Dimensional Data Unit Weight 30 lbs. I All dimensions in inches Power Cord 18/3, SJTW, 10' std. 5-7/8 - 1 Component dimensions may (20' optional) vary r 1/8 inch 3 Not for construction purpose ~ 1 1 2 NPT unless ceitibed 3-1/2 DISCHARGE 4 Dimensions and weights are Materials of Construction uppiaaunure S On/Off level adjustable Handle Steel 6 We reserve the right to 3-1/2 nwl~u icvnwm to out lubricatin Oil Dielectric Oil g produus and then Motor Housing Cast Iron speubmlions without notice Pump Casing Cast Iron Shah Steel Mechanical..-- Seal Faces: Carbon/Cero c Shop Seal Seal Body: Anodized S I I` Spring: Stainless Steel s,r H Bellows: Bung4 POMP ON 10-1/8 9 1 2 Impeller Thermoplastic Upper Bearin Bronze Sleeve Bearing DISCHARGE HEIGHT - Lower Bear' Single R Boll Bearing T i 3-1,2 POMP Strainer/Base Plastic `I OFF Fasteners tainless Steel AURORA/HYDROMATIC Pumps, Inc. _ } , + 1840 Baney Road, Ashland, Ohio 44805 (419) 289-3042 S25 1/4 Horsepower Submersible Sump Pump i ADVANTAGES BY DESIGN DURABLE MOTOR WILL DELIVER MANY YEARS OF RELIABLE SERVICE. ■ Oil-filled motor for maximum heal dissipation and continuous bearing lubrication. } ■ Shaded pole motor eliminates starting switches. ■ Recessed vortex impeller operates completely out of volute. Provides free flow Through possac e for solids and liquid, and has minimal radial loading for long bearing life. C THE S25 IS ENGINEERED FOR MANY YEARS OF 3r MAINTENANCE.-FREE OPERATION. [ ■ If service is ever necessary, positive seating, quick-disconnect power and switch cords make r %I replacement simple. ■ Choice of wide-angle mercury fret; rnechanicul float switch for maximum drawdown, or proximity switch which allows it istullation irr small 10" sumps. ti PRODUCT CAIWAll11.l 111. Capacitieslb 7.8gpin Ifl',Il,in Heads To 2311. Pump Down Range Float Switch 7111 I'M nun (Except PS Models) Proximity Switch 4 in 101 nun Solids Handling Capacity 1/4 in. 6.4 rnrn Liquids Handling drain water Intermittent Liquid Temp. up to 140-F up to 60-C SAVU Motor 1/4 HP shaded pole ✓ . / 3000 RPM U~ C10- Electrical 115V, 9 Amps, I ph, 60 Hz HE F.E. MYARS 1/4 HP S25 SUBMERSIBLE SUMP PUMP - TBUILDS ON THE MYARS TRADITION OF INNOVATION Acceptable p1I Range 6-9_-..__--_ AND QUALITY WITH FEATURES LIKE OUR INTERCHANGE- Discharge. NPT- 1- 1/2 in. 38.1 rnrn ABLE, POSITIVE SEALING SOCKET DESIGN FOR EASY Min. Sump Diameter REPLACEMENT OF BOTH POWER AND MERCURY-FREE Float Switch 18 in. 4,1)'/ rnrn MECHANICAL FLOAT SWITCH CORDS, AND OUR RECESSED Proximity Switch - 10 in. 254 mm IMPELLER. This 1/4 hp pump achieves a shut-off head of 24 feet and a maximum flow of 28 gpm. Its 3000 rpm oil- Construction Materials filled motor provides superior heat dissipation and built- Motor Housing cast iron in overload protection. Accurate shaft alignment and easy Motor Cap flame retardant thermoplastic serviceability are assured by this self-contained motor, volute Case thermoplastic which is protected from water damage by a carbon - ceramic mechanical shaft seal. The operating mode is Impeller recessed. thermoplastic easily switched from automatic to manual, without removing Power Cord 10 it. 16/3 SJ'ro/s,rrow-A the motor cap, by inserting a shunt plug. The S25 is also or available with a vertical proximity switch. In this configur- 20 it. 16/3 SJOW/S.low A__ ation, the S25 can be installed in a 10" diameter sump. For Mechanical Seal carbon and ceramic _ more information about the S25 and Myers complete line of residential wastewater pumps, please talk to your Myers representative or call 419/289-1144. WHERE INNOVATION MEETS TRADITION 1 S25 - Y4 Horsepower Submersible Sump Pump POWER AND FLOAT CORDS DIMENSIONS Quick-connect, water- S25A1 and S25AIC S25A1-PS and S2;5A1C-PS light fittings are ink;r- S25 with Mercury-free S25 with Vertical changeable, replaceable Mechanical Float Switch Proximity Switch from pump exterior. ,IElln 716nM 1~ 1/4 HP MOTOR a Oil-tilled for best heat . e , transfer and bearing and O seal lubrication. Built-in overload protection. rn w, MOTOR HOUSING _ ~~~<if mm Cast iron for efficient heat I I transfer. a m. ` MERCURY-FREE - w' MECHANICAL ur... [l f 1(1(~ L 1 ❑ FLOAT SWITCH I. (S25A1 and S25AIC) - - - (°M"0N 1 90 degree operation. 1 ORy,~/,~,~LYl1 ~ 1 r I VERTICAL PROIY r va,.. UWlwax f I © SWITCH I I I I { (S25AI-PSarid S25AIC-PS) f; allows installation in nNiNOFF T, small sumps. fin inn fiti nmm r 235- t ;26n1c: 2bAk~ 1".; '111111On 101, 26/ aun 8 2r1S Ilan '111rn Oft 31,/," 89 rnrn 4" 101 111111 Draw Down Range 179 mill 41, 10111)111 PERFORMANCE CURVE. I 11A 1111 1:11 „ CAPACITY LITERS PER MINUTE LkLAU 15 30 45 60 75 90 105 t-r MECHANICAL SHAFT RECESSED IMPELLER 24 SEAL Operates out of volute - - - - - Carbon and ceramic passage, allowing maxi 20 6 faces. mum flow of liquids and w w solids. U_ 5 z 16 o z Q 4 0 = 12 W J 3 = H J O 6 _ 2 0 H 4 1 0 5 10 15 20 25 30 CAPACITY GALLONS PER MINUTE K3141 1192 F.F Myers, /1 Pentair Gurnl)any PrinreA In u s a Myers 1101 shl Myers Parkway hshL•1nJ, Ohm 44805 1923 419/289-1144 1 AX: 4 19/289-6658, 1 LX: 98 -7443 Witevonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 -}.tabor and Human Relations DiVisioifof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less tharv81i2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference paint (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE kifNT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: ERTY LOCATION Dennis Blegen LOT SE 1/4 SE 1/4,S 24 T 28 ,N,R 15 XW W PROPERTY OWNER':S MAILING ADDRESS` # BLOCK # SUBD. NAME OR CSM # a Box 222, 330th St. CITY, STATE ZIP CODE PHO , []CITY []VILLAGE QTOWN NEAREST ROAD Wilson, WI 54027 (715) 7 - 4t1 Cady 330th St, [ ] New Construction Use rx] Residential /Number of bedrooms 3 [ J Addition to existing building ~x J Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .2 bed, gpd/ft2 .3 trench, gpd/ft2 Absorption area required 2250 bed, ft2 1500 trench, ft2 Maximum design loading rate • 2 bed, gpd/ft2 .3 trench, gpd/ft2 Recommended infiltration surface elevation(s) 109 3 ft (as referred to site plan benchmark) Additional design /site considerations install 4' x 94' rock bed w/ 12' downslope gnmed nP on 1 nn 7 as i,osl nnP PrigP of rock Parent material loess (extra sand required beneath & downslope) Flood plain elevation, if applicable NA ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S BU EIS ❑ U ❑ S O U ❑ S ® U ❑ S ®U ❑ S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 7.5YR 2.5/1 - sil 2 m sbk mfr gs 2f/m .5 .6 2 6-11 10YR 5/3 - sil 2 m sbk mvfr cs 1 f/m .5 .6 sbk ccasionally par Ling to pl Ground 3 11-16 10YR - elev. w/ common Gy s' coats on peds 101.5 ft. 4 16-28 10YR 4/4 f1d 10YR 6/2 sil 2 m sbk mfr gs - .5 .6 Depth to 7.5YR 8 limiting 5 28-46 10YR 4/4 c3p 7.5YR 5/8 si 1 c abk mfr - - .2 .3 factor 1QyR 6/2 some mots w/ & some w/out roots Remarks: this pit upslope of system area Boring # 1 0-9 7.5YR 2.5/1 - sil 2 m sbk mfr as 2f .5 .6 sbk parting to 2 f p 2 2 9-15 2.5Y 4/1 - sil 2 m sbk mvfr gs if .5 .6 Ground elev. 3 15-22 10YR 4/4 - sil 2 m sbk mfr cs if .5 1.6 99.2 ft. w/ common Gy i coats on peds Depth to 4 22-42 10YR 4/4 f2d 2.5YR 4/6 si 1 c-m abk mvfr - - .2 .3 limiting 2.5Y 5/1 factor 2Z_ 1 1 - -1 J Remarks: thorough plowing required to break up fine platy structure in A horizon CST Name:-Please Print Phone: Henry F. Grote 715-66 - Address: PO Box 57, Knapp, WI 54749-0057 Signature: Date: CST Number: t 3/21/94 3065 PROPERTY OWNER Dennis Blegen SOIL DESCRIPTION REPORT Page _2 _Of 3 PARCEL I.D. # a A Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxivy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trees 1 0-5 10YR 2/2 - sil 2 m sbk mfr 3 2 5-14 10YR 5/4 - si 1 m sbk mvfr cs if .2 .3 Ground 3 14-20 10YR 4/4 - sil 2 m abk mfr gs 1m/c .5 .6 glev. 99.5 ft / common Gy si oats on peds 4 20-30 10YR 4/4 f2d R-Gy sil 2 m sbk mfr cs 1m/c .5 .6 Depth to limiting 5 30-43 10YR 4/6 f2d R-Gy si 1 c abk mvfr - 1m/c .2 .3 factor ~0! Remarks: horizon 2 weak structure mandates trench type mound Boring # 1 0-4 10YR 2/2 - sil 2 m sbk mfr cs if .5 .6 4 2 4-9 10YR 5/4 - si 1 m sbk mvfr gs if .2 .3 3 9-20 10YR 4/4 - sil 2 m sbk mvfr gs 1m .5 .6 Ground w/ common G si coats on peds elev. Inn- 7 ft. 4 20-40 10YR 4/4 f2d R-Gy sil 2 m sbk mfr - - .5 i.6 Depth to limiting factor '?Off Remarks: horizon 2 requires trench mound; 20" limiting factor (along w/ pit 3) means extra sand fill Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) s,..r►:S - ~ 1 ` - 1. 1.., Q% - sti -t4 • w~ . AL- C-46 i 1~•'3 t ~ city ~j~.o) ,L- ¢ Z~m Gl k Q ~-L -40 1 ~I } Ct elk Q. 40-Itc. rhr Q b - o~ jarr' CA o C', Co.. a- -Io 3 dS 3 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1t~/Z/1 6,7 MAILING ADDRESS PROPERTY ADDRESS ao~ ~CJ h Sf (lo/cation of septic system) Please obtain from the Planning Dept. CITY/STATE lr/~ 1,5i1'n 7 PROPERTY LOCATION 1/4, S(r 1/4, Section o? , T_ N-RW TOWN OF C~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 4 ~ CERTIFIED SURVEY MAP VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper- What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60%. of the cost. of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. 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: 7 1 1 g 5 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,5L' 1/4 YE- 1/4, Section ,T~! N-R 15 W Township Cc,ua Mailing address a a 3~~ t.h 5't ; /ten r~,~ y'v -7 Address of sitee Subdivision name Lot no. f~ Other homes on property? -Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes k No Volume (4(q_ and Page Number -loo 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. 3 4 , 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 Ap licant Co-Applicant 1.t ';o' /9 9 Date of Signature Date of Signature I DO.CUMENT NO. Q ~J~j STATE BAR OF WISCONSIN-FORM 1 VOL 619 PAcE i v WARRANTY DEED 366944 THIS SPACE RESERVED FOR RECORDING DATA THIS DEED, made between Dennis Blegcel't_ also latown as REGISTERS OFFICE Dennis L_ Blegm ST. CO., Wt& Reed. for Record d* 10th and L. B egen and Barbara K. Blegen, Grantor day of Oct. A.D. 192) nusoan( wife, a Ii-it tetzants, at -00 A Grantee, wowf w ~w~u Nit n e s s e t h, That the said Grantor, for a valuable consideration One dollar and other valuable consideration R URN To conveys to Grantee the following described real estate in St. Croix County. State of Wisconsin: Eric J. Lundell, Box 157 New Richmond, WI 54017 8 ! Tax Key No. The SEk of the SEA of Section 24-28-15; The South 373.5 feet of the NWk of the SEk, EXCEPT the West 2 rods thereof; and the SW,. of the SEk, EXCEPr the West 2 rods thereof, ALL in Section 24-28-15. f Subject to recorded easements, reservations, and rights of way. This conveyance intends to convey to Grantees' all of the real estate EXEMPT presently owned by Grantor in St. Croix Cotnty, Wisconsin. This- is homestead property. i! (is) (is not) I`. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Dennis Blem _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except no exceptions. i~ r and will warrant and defend the same. Dated this 9th day of October - . 19 80 (SEAL) ('~L (SEAL) - - _ - _Peppi s Blegen - (SEAL) (SEAL) AUTHENTICATION9th ACKNOWLEDGMENT Sigr.a authenticated this- -day of STATE OF WISCONSIN Ober` _ .19 80 ss. (c County. !I Personally came before me, this day of J Lundell Eric the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by s 706.06, Wis. Slats.) - This instrument was drafted by Eric J. Lundell to me known to be the personwho executed the fore- ~ going instrument and acknowledged the same. New Rithmond, WI 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public- _ County, Wis. My Commission is permanent. (If not, state expiration ~l date: 19.) 'Names of personF signing to any capac.ty must be typed or printed below their signatures. IWARRANTY DEED-STATE BAR OF WISCONSIN. FORM NO. 1-1977