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HomeMy WebLinkAbout010-1081-70-000 N O °rn v I h 4 c 0 I ~ I r_ m 0 o I M ~ ~ ro ~ m I -Q a s a) v N - Y U ;g c 7 U O y E I N W ro 0):;t 0 O = z 00 I O ~ O LL c a c j 'p N N N _ N E Q "O U Co m v ~ I ~ II! (0 w ;j E zt 1 o Z l' d d CL m o') F- U) N O O Z :!t m U N H N w o Z E a N c O m co w N ~ I O a) c • = O m O Z Z w z N 0 0) 1 r- '0 d c N 10 £ N N ~ W O) O y - y LL O Q 16 V It 20 -(D i O c Q ° o o a A O O N Z. > F F- F- 3 :U o 3 0 0 0 Z O 2 m m m a I m I g cN Lo Lo m J U rn rn N M a) O (D (0 O .5 = M C O c 3 m N CL 0 O ~ N N Q ro VV w 4) m N N O O O N N C °O c O O > 00 00 © ° rn o a~ c c a m 0° L m~ N c N m o o l O 0 g c a) a) c Q) 22 C2 _ N m CD E c t • 7a O N co dtil O L„ O M W N O N H 1n cQ j \ x~ I y ~ E N D M d d CL 0 a. -y 'U y `Iv E m 3 'D uCL O 0) LO) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ ~►.ci n Il "S S .e, + ADDRESS 3 S 0 Ql)y ~I D bi S'4160Z SUBDIVISION / CSM# ypl y 11 s~ 1199 LOT # ' SECTION 33 T_S 0 N-R~W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J~- n D~ 'to 01 ~hMl1 ~tA61 110 3 .J i I {v C + H D J INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~ n G O rl 0 US e 1 ALTERNATE BM: SEPTIC TANK / //PU//MP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~ e./fell Liquid Capacity: /ooo 7,SO Setback from: Well o°2 x'04 House //,s l~ Other Pump: Manufacturer 1-7 o Model# WCOS»L Size Float seperation 7~L Gallons/cycle: /7-; Alarm Location 1f4s1;1fn c e- -:SOIL ABSORPTION SYSTEM Width: -27 Length /-2J / Number of trenches Distance & Direction to nearest prop. line: vZ O Setback from: well: / House G3 Other ELEVATIONS Building Sewer ST Inlet. 9e2 7-7 ST outlet Z6 PC inlet 9,20 S PC bottom O 5i Pump Off Header/Manifold Bottom of system /U/ Existing Grade Final grade /Oat 79/ DATE OF INSTALLATION: PLUMBER ON JOB: De C ~/ka t fd LICENSE NUMBER: le6 .2 9 INSPECTOR: -7-7014A j / V eIP-, 3/93:jt f sin Department of Industry, PRIVATE SEWAGE SYSTEM County:ST. CROIX id Human Relations INSPECTION REPORT Aa a and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 77 peogg Na`ANE ❑ City ❑ Village Town of: State Plan ID No.: UV Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION ELEVATION DATA ~7: ER ~3° 9"cc?' TYPE MANUFACTURCAPACITY STATION BS HI FS ELEV. Septic Y Benchmark ( /s 1 Dosing Aeration Bldg. Sewer St/Ht Inlet 7j Holding TANK SETBACK INFORMATION St/ Ht Outlet ` Vent to I ~ 5~2 v,S F TANKTOT P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic t 7 NA Dt Bottom Dosingf 17 NA Header/Man. i Aeration NA Dist. Pipe Bot. System Holding PUMP / SIPHON INFORMATION Final Grade JB Demand d ~sr~, /~f J ,•i GPM $ ~Jv r✓ 3 ' ction System TDH Ft He Dia. D ist.TOwell SOIL ABSORPTION SYSTEM BED /TRENCH VVicj$h Leg No. Of T enches PIT No. Of Pits inside Dia. Liquid Depth DIMEN 1 N w(( DIMENSIONS Manufacturer. SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING SETBACK CHAMBER Model Number: INFORMATION TypeO OR UNIT System: DISTRIBUTION SYSTEM Header,,, Manifold Distribution Pipe(s) / x Hole Sx Hole Spacing went To Air Intake th Dia Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over F xx Depth Of xx Seeded/ Sodded xx Mulched To soil Yes ❑ No ❑ Yes No Bed /Trench Center Bed /Trench Edges P COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD.33.30.16W, SW, SE, CTY RO D Plan revision required? ❑ Yes ❑ No 3 , Use other side for additional information. Date Inspector's Signature Cert No. SBD-6710 (R 05/91) SANITARY PERMIT APPLICATION 1~ .HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY 101111111111111111 s-7 . cf~ STATE SANITARY P MIT # E-9: -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 2~ 8% x 1 1 inches in size. cn k. rev✓ision`to prevwus application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 9 .304 92 PROPERTY OWNER PROPERTY LOCATION -L>" u n G u SL0'/4 SES 33 T 30, N, R .G6 11 (or) PROPERTY OWNER'S MAILING ADDRESS LOT # CK # 2358 Ct) , BLO h°of l AM At4 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER e,Gy j~'Sct L ao i r [J,~ sya'i Z.~ 7/5' ?il -zZZ (f r7 -7 GL / o / II. TYPE OF BUILDING: (Check one) El State Owned 0 VILLLLAGE ' _ NEAREST ROAD =W RF ~erct~~ Ct a/ - 3 El Public .1 IIC~II ~1 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TAX NUMBER 111. BUILDING USE: (If building type is public, check all that apply) Q[ Q -~Qg~ _ 70 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 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 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.,0 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ~ff Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 El In-Ground 42 11 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 (s q. ft. PROPOSED s ft Gals/day/sq. ft.) Min./inch) ELEVATION '`f 5© 375 S-7,K . 3 /VA LO SFeet X63-ZS Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 1JU - /DD P "re r Lift Pump Tank/Si hon Chamber 7~0 / 1 VIII. RESPONSIBILITY STATEMENT 1, 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) P MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): z<:) /Y?a r- sl-, 1 IX. COUNTY/DEPARTMENT USE ONLY / Disapproved Witary P rmit Fee (Includes Groundwater Date issued Issuing Agent Signature (No Stamps) ►q~ y~ /1~ ~p xyJ Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 000 (([BUJ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber J ti 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 Sar itary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by .a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 61018-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/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. Vlll. Responsibility statement. Installing plumber is to fill-in name, license number with appropriate prefix (e.g. MP etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s septic tank(s ) or other treatment tanks; building sewers; wells; water mains, water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; (dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. i SBD-6398 (R.11/88). { -3 a tiN a 6 a.. i~ ❑ C9 `1 ~o [ `lam v I I a _ o M i x W ~ i n3 ra Q M A~ ~ , u r O 1 Is. P Ail, \ I~ ~N o-A J 4 ~ v VN , n N M Gy, N '`I q a tl ~j o n 00 00 , \1 ~ M a -is ~ o o !L ~ N of ~ C -3 o h a" I E3 c _ ti ♦ I N (Q(` N N j Y ' E z Cl -Vi n M A ~4 M ~ mil ~ r^ N v' C] P 714 -4Ojv.A _J i ♦ ~ U O O OO 07- v ~ ~ I I ftl Q 3 o p p a -Its ~ N O n ~ A-2 \4 i. 3 00 rc 00 Page_Of~ Cross Section Of A Mound Using A Trench For The Absorption Area Medium Sand Fill ~I O F 6" Topsoil 3 E D Trench Of z" - 231" Aggregate, Plowed Layer 6" Below ;Ripe, Covered With D 0,0 Ft. Straw*-,M~rsh Hay Or Synthetic Fabric E 2-0 Ft. G /.o Ft. L01 F - Ft. H A 5 Ft. Ark '4~ ~ X00 `~Ot Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe Permanent Markers Observation Pipe W I" B K \ -"Trench Of - 2:" Aggregate I C' L A `t. I « Ft. K i3 Ft. W Ft. B Ft. J Ft. L 12 0 Ft. 95-31499 License Signed: Number: l'%~ ~ ~ 7 Date: S- 30-9.5 Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap 2 1-T - I ==h PVC Distribution Pipe 'Y X 7IT17X-7 P P X F. ~e- * Last Hole Should Be Next To End Cap 'al P L- Ft. Hole Diameter Inch X Inches Lateral Diameter f Inch(es) Y ` Inches Force Main Diameter Z- Inches # Of Holes/Pipe 12 Invert Elevation Of Laterals /a/. 75" Ft. Signed: co ~ U License Number: /YJP ~6 Z 9 ~5`~~P ~0~~ tip`' !`0 Date: %Y c ' ft~ 595-30499 r F PA r. F L PUMP CHArAF,CR CR.uSS SCCT!O:J AkjC. =°ECIFICATIO"!c VENT CAP 4"C.I. VEUT PIPE r-T WEATHERPROOF APPROVED L7CAIA;G L~ R:rM DOOR, JUNCTIOU BOX MANHOLE COVER WINDOW OR FRESH AIR INTAKE I ' GRADE I I 4" NIIN. ~ • couDUIT 18"MIN. INLET Y ~AT~ SVN) GEA RT GHTESEAL I III - APPROVED p~7•~~ly I III JOIMT A Corldi[j I III APPROVED JGI w1c.T. PIPE I III ~EXTENDtUb 3' ppvk ~ I I I ALAR W/C.I. PIPE M EXTEUDIUG 01JT0 SOLID SOIL lov II 0MT0 Soup 5 HUMAN fl~ . I 1 Lp808 pNO BUILUItiGS I SAfEjY I I OlJ C t,r.T. 0~ V S1OON Of ELEV. FT-' ``\J I I r[ -©ClrT1P~ OFF cG~ CoFk to D PROPS y rs CONCRETE BLOCK O[ ~tHR 83.15 (4}/~~ ~n- ANCH~ R15EK' 1T PERMITTED OQLy IF TAUK MAuUFACTURER HAS SUCH APPROVAL SEPTW$31SASNE CESSgR° SPECIFICATIOhJS DOSE (4)(b) Wq~r y TANKS MANUFACTURER: NUMBER OF DOSES: PER DA.., TANK SIZE: - Q CALLOUS DOSE VOLUME ALARM MAUUFACTUREft' -J J ~e-G7f,_o INCLUDING 6ACKFLOW: 13Z-,Y5 GALLON MOOCL LIUM6ER: •,4 -q CAPACITIES: AIUCHES OR ry 56 GALLOI; SWITCH TyP[: C u rv 5= Z INCHES OR 3577- GALL., PUMP MANUFACTURER: C = 7 '1121uLHES OR 1-?Lq GALLO►. MODEL NUMBEX. D= /Z Z/1/ 37- ITCHES OR GALLOA SWITCH TYPE: n2e- u-ry NOTE: • , PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE-2:9102 GpM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE ISETWEEU PUMP OFF AND DISTRIBUTION PIPE.. '12 FEET + MIKIIMUM NETWORK SUPPLY PRESSURE . . . , 2.5 FEET + _ 7110 FEET OF FORCE MAIN X ~'--.L-FJo0 ft FRICT10U FACTOR. FEET 5-30499 TOTAL OyWAMIC. HEAD 4i 5Q FE . ET IIJTERMA.L DIMEUSIONZ OF TAWK: LENGTH J,n • ;WIDTH ;LIQUID DEPTH CICEt1SE AlUMBER: DATE:` 0 - ' Performance Submersible Effluent Curves Pumps' METERS FEET - 90 MODEL 3885 25 80 SIZE 3/a" Solids WE15H ° 70 X 20 wE10H J H 60 -WE07H 15 50 WE05H 40 10 30 WE03M WEIM 20 5 10 - - - - - 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L i I 0 10 20 30 m'/h CAPACITY CgGODU)S PUMPS, INC. SBECA FALLS INEW YM i3we METERS FEET 120 ; MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH I 100 ' 30 90 1 25 80 i Q 70 w X 20 J I 0 F W -OSHH 15 40 10 30 4+ 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 - 10 - - - -~------t'i ~1-..s~ V CAPACITY ~ V1 V ///RRE 0/985 Goulds Pumps. Inc X95 Etlectwe July- 1985 C3885 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations June 15, 1995 1340 East Green Bay Street SUITE 300 Shawano WI 54166 BOLDTS PLUMBING 820 MAIN ST BALDWIN WI 54002 RE: PLAN S95-30499 FEE RECEIVED: 180.00 RUSSETT DUANE SW, SE, 33, 30, 16W TOWN OF EMEROLD 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. - The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. Also, the area within 25 feet of the mound's downslope toe must remain undisturbed by anything, including the force main. 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. SBD4928 (R. 01/91) I a SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations BOLDTS PLUMBING Page 2 June 15, 1995 PLAN S95-30499 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Karl Schultz Plan Reviewer Section of Private Sewage (414) 424-3311 1166R/ 2 SBD4928 (R. 01191) DILHR ter, ` 1VI4 rlCt-url I ` L~J v v , in accord with ILHR 83.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1 p- in size. Plan must include, but •st' to ro %X not limited to vertical and horizontal reference ( ' r li % of slope, scale or PARCEL I.D. 0 dimensioned, north arrow, and location and t neares APPLICANT INFORMATION-PLEAS T ALL ly A REVIEWED BY DATE PROPERTY ONNER ROPERTY LOCATI ON /GfQ ✓l C° ~/,lSSL' f f 3k~! ° VT. LOT S GJ 1/4 SL-L 1/4.S3-3T 30 AR /6 if W PROPERTYOWNER:'S MAILING ADDRESS 9 T BLOCK N SUBD. NAME OR CSM x 23s8 cty, o{, .ab ~S ~t/A CIA CITY, STATE ZIP CO HO UMBER ❑CITY ❑VILLAGE TOWN NEAREST ROAD a CtY' g• 1~b (J New Construction Use p!( Residential / Num s 3 ~tJ Replacement ( ) Public or commercial describe Code derived daily flow '150_ gpd Recommended design loading rate • L bed, gpd/ft2 • 3 trench, gpolf~ Absorption area required .37 5 bed, ft2 3 75 bench, h2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations _Reco r>gr;gW GXf'ra 5a~a/ uno/ r s y-.5-71p Parent material 5i V 3e~,'M e Flood plain elevation, if applicable NA It S = Suitable for system CONVENTIONAL MOUND INGROUNDPRESSURE ATGRADE SYSTEM 14 FILL HOLDING TANK U= Unsuitable fa system ❑ S N U D~ S❑ U ❑ S U ❑ S U ❑ S AN ❑ S ,,Wu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.`' Roots Bed ~Tt,a-d i'•~ ~ ° " S /oYR ~Z /l io c. s, ~ .2 MS r? -~r CS Z 5- Iq yoY 53 None 5/1 2 CW 3"y) Ground 3 9 SyR. 4/1 C2 75YR5~6 Ct,v 3~ •3 I •c~. elev. /66,19 ft. `f 29 -36 5YR c 2 d 7, 5 Y,e SG I SC / C s 6 j M' C; f • Z 3 Depth to limiting T~ factor Remark's: Boring # / - D-y' /oyK VZ .Zm56 , C 3 ao 5 ~.6 a.~ 2 Z 4-20 le y X S/3 f 's No►~e s,l Z,y,s~ r, -~v- C 3r~ ~ $ • G Ground 3 2017 5y,~ y Zd 7.5YR ~6 I S rn Cw -.3 elev. 27-38 S YR CZo/ 7,5 YR 96' 1 SG~ fC S~ Depth to limiing - factor Remarks: CST Name:-Please Print Phone: Address Le £ 1~~~ta/sc►.` 7IS- ~R-J -3-3 - 600 090"--v Si nature Date: CST Number: -T-24 - 9!5 34)1 Boring # fiorizo Depth Dominant Color Mottles Texture Structure Consistence BaxxJary Roots GPIJitt1 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trcn 3 3 L one r►~sb1~ M r CS 3eo -S /4YR '~3 /✓D Si' Z m 5 mfr 3, ' s , to Ground 3 i f ,25 s R Y C 7-d 7-5Y1e % S/ -F ' c w 3-~ • 3 • y elev. 99-, 6t- n. 495-34 5 y~e yG c 7-AYR % 5c S z-~ • L • 3 Depth to limiting factor Remarks: Boring # Ground elev. n. Depth to limiting lactor Remarks: Boring to t--- I Ground elev. n. Depth to _ limiting factor - I ~ Remarks: Boring # Ground elev. ' - n Depth to limiting l factor Remarks: r T. II Q N a" E ~ r I i a =_s ~ N a(c vi h ~ S r W _ 42 n a~ of d Ln F-- Z U Z 0 ~ r^ N vl b P A aN-~ PA / v 0 0- 00 0 0 O cy ~ A of -a N N O N 7 T. ` h 00 00 z M Q 1 M 3 N (J i Z L n h r ` U ! L h in accord with ILHR 83.05, Wis. Adm. Code COUNTY Atiach complete site plan on paper not less than a 1/2 x 11 inches in size. Plan must include. but St' C ro %X nZit4;mited to vertical and horizontal reference point (B". direction and / of slope, scale or PAACELI.O. t dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY 0NNER PROPERTY LOCATION c!a ►n c fu%vra- / GOVT. LOT S L) 114 S4, 114.S.3_3 T 30 N,R ~6 d ( W PROPERTYCWNER:'S MAILING ADDRESS LOT Jr BLOCK t SU 30, NAME OR CSM r z3sa cty' Rd, 'bkb AvA CITY. STATE 21P CODE PHONE NUMBER ❑CITY ❑VILLAGE TOWN NEAREST ROAD 13a/01" 1--)i" 5'q049Z (715)e 95/-ZZ2Z z!F a CtY ral• -,bb New Construction Use Residential / Number of bedrooms 3 ~c( Replacement ( J Public or commercial describe Code derived daily flow `150 gPd Recommended design loading-rate ' Z bed, gpd/n2 • 3 trench, gpd/tl2 Absorption area required 3 -7:5 bed, n2 3 75 tench, ft2 Maximum design baring rate bed, gpoln2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design /site considerations /,'eGo Mri7er9r G>cf YQ 5a U~,o/ s ys7~p r~ Parent material S/14 col"M e /1 / Flood plain elevation, if applicable-NA n S =Suitable IOr System ooNverr$ NAL MOUND NGRow PAESSI RE AT{iRADE SYSTBI tr FILL HOLOM TANK U=Unsuitable tors tern ❑ S ,d U JRS ❑ U ❑ S R U ❑ S N U ❑ S TU ❑ S '9U SOIL DESCRIPTION REPORT Boring #t Horizon Depth Dominant Color Mottles TE; ure Structure Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrerd l o-s /OYR %z No fit s Z Ms I ~r CS co • 5 . I - Ground 3 1?-2.q 5 YR.:4/ /1 C2 01 75 RV4 S~ /•'I i CW -3 •3 ('y elev. /do, 19 fL 29 -3G 5YR `l 6 Czol 7,5 Yf S~~ I Sc l c s 6 .r, 2-4:' .2 1,3 Depth to limiting (actor I T i Remark's: Boring # Mc ~ /OyR 3/L O Si~ .ZmSb~ 3 C.. 2 Z 4-20 0 yX 5/.3 AloiC Zm S rh-~r c 3.~ S• L Ground 3 2617 Sy,~ T5Y ~6 sl />7 c,w 3-~' • 3 y 99 lev8 n. 27-38 S YR y~ c al 7,5 YR s~6 scl /c S6 Z4, 2- 113 Depth to limiting factor z o'' I Remarks: CST Nwnc-Please Print e- L Se vim. Phone: Aad,ess 1 / - 7/5- 61? -3375 5 nature 9,70 -'r✓L s! • A 01cui' f _5 Z T Dale: CSl Nu nbo, 30499 Depth Dominant Color Mottles Structure GPDMI, Boring N Horizo in. Munsell C!u. Sz. Cont. Color Texture Gr. Sz. Sli. Consistence Bouidary Roots Bed :Tres 3 / o- 0 3 L nc .5 M r CS co S 6 Z S3 ~✓o•,e s~ 2r►, s r~ 3.,. • S . 6 Ground 3 d- 2 S - X/ C Zod 7•5YAI4S/ -F; C&) 3-~ 03 elev. Depth to limiting (actor Remarks: Boring 11 Ground elev. n. Depth to i - limiting lactor Remarks:--- Boring #1 Ground elev. n. Depth to _ limiting (actor Remark's: Boring #t Ground ~ - - - elev. n r Depth to limiting facto( Remarks: A FORM NO. 985-A • Y + HCMiWCa FM9 CERTIFIED SURVEY NUMBER 1189 Part of the SW 1/4 of the SE 1/4 of Section 33, Town 30 North, Range 16 West, Town of Emerald, County of St. Croix, State of Wisconsin, described in Volume 4 of Certified Survey Maps, page 1189 as Certified Survey Number 1189 38;'7 I I SI/4COR.,SEC.33 CERTIFIED SURVEY MAP I T30N, R16W 211 I. P. WITH CAP BEARINGS REFERENCED TO THE SOUTH LINE OF- 0 SET 3/411 x 3011 ROUND IRON ROD THE SE 1/4 SEC. 33, T30N, WEIGHING 1.502 LBS/L.F. R16W, ASSUMED BEARING F5251 • SCALE. I" = 1001 S 87° 551 531 E 0 eDzu 100 2001 UNPL A T TED LANDS . I S 00° 09' .3811 E 580.681 , 40.03 540.651 to o ? coil o ~ w W cn _ rn r •I rn 1 • rn A Z .r O Z I o :a EXIST. BUILDING C/)' 0 . R1 (o cn WI I ~ I m . LOT I ; O I = OD 12.08 ACRES' INCLUDING R/W 44 o (526, 205 sq. ft. e ) oy Ln -4 11.16 ACRES, NOT INCLUDING R/W p (486, 118 • sq, ft. I m C- APPROVED I J U L 2 61982 I ST. CROW COt)NTy COMP"+ftT151VE PAW MANNING AND tOmNG commirru • o: t~s s 8 s W1•,r~~ FILED G I •,,ti~ J UL 30~198~2 I JAM:; bower of Dead$ Croix county, I I Jk 45.031 535.651 I PUB. N 000 091 3811 W 580.681 w E. LINE SW 1/4-SE 1/4 W U SE COR. SEC.33 UNPL A T TED LANDS I 2.1 I.P. 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CITY/STATE -Y t,~ I c o r~ r'~ . .5-5~D1~ PROPERTY LOCATION Q4,) 1/4, Sk- 1/4, Section T 30 N-R /t/, W TOWN OF C r o /04 ST. CROIX COUNTY, WI SUBDIVISION Ali LOT NUMER /t✓/4 CERTIFIED SURVEY MAP , VOLUME `l , 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 stunt. Me, 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 Cro» County Zoning Officer within 30 days of the three year expiration date SIGNED: - DATE: ~f? - - - St. CrolX County Zoning Office Government Center 1101 Carmichael Road Hudson. WI 54016 1 1~ 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. «Q A e- -55 f Location of propertyS [.0 1/4 1/4, Section ? ,T Sl0N-R _,&_-W Township Z~e-rg /a Mailing address 0350 C fU, 7~'~ .L> ~ Address of site _ Subdivision name ZZZ Lot no. 11~ Other homes on property? Yes X No Previous owner of property r- Total size of property Total size of parcel Date parcel was created LJu Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes X No Volume,,~Z' and Page Number ~e 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 o fice of the County Register of Deeds as Document No. SO -3dS I, 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 ~f~ Date of Signature Date of Signature u 'I ji • 1 ~ i i til DOCUMENT NO. II THIS a►ACC Rcscltvcn FOR RccoROlNO DATA - .I WARRANTY DEED j STATE BA4 OF WISCONSIN FORM 2-1982, 503039 YOC 1024PAGE348 REGISTER'S OFFICE ST. CROR CO., %M '.Mal. .colm.. .nger. and Mari. . A.....Goet. . zi. .e...Goet-zinger Rec'dforRecord I i{ JUL 2 9 1993 f 9.20. q.:M conveys and warrants to ...Duane S..RuSSett••dnd•Anr}••L.••--..•_ Russet & i~]C"" ^~•.K. t, Am? ind..and-vife Q, P i t~SardOeeda RETURN TO II I~ the following described real estate in ................................................County, i State of Wisconsin: Tax Parcel No : II i' Part of Southwest Quarter of Southeast Quarter (SW 1/4 of SE 1/4) l~ of Section Thirty-three (33), Township Thirty North (T30N), Range Sixteen West (R16W), described as follows: Lot 1 of Certified Survey Map filed July 30, 1982 in Vol. 10411, Page 1189. i This deed is given in fulfillment of that certain Land Contract i between the above parties dated October 5, 1982, and recorded in .i the office of the Register of Deeds for St. Croix County, Wisconsin, i on October 7, 1982, in Volume 653 of Records, as Document No. 380171. i I II " NYfTE FEW II I' is not This homestead property. n (r'Ris not) ~I Exception to warranties: Easements and restrictions of record, and except any liens or encumbrances created or suffered to be created by the acts and defaults of the grantees, their heirs, successors, or assigns. l I Dated this .......................14th................. day of .J.1AY.............. 93 i i1 (SEAL) e~ ~ ..(SEAL) • Malcolm A. Goetzinger • (SEAL) / ....(SEAL) ii • ...Marie-- Goetzinger............. - ~I r AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix ss. ----.--.County. authenticated this ---.----day of 19 Personally came before me this _ --.-14th day of ul.Y_. 19--93. the above named Malcolm A. Goetzinger and -Marie Goetzinger................................................................. TITLE: MEMBER STATE BAR OF WISCONSIN I (If not, authorized by 1706.06. Wis. Stats.) wn to be the person w o executed the ~.•~Gy 4 trument a acknow ge e a THIS INSTRUMENT WAS DRAFTED BY ?~'•••••e• Thomas A. McCormack ~Y - - - . - BaLdwin, WI 54002 s _ St. C ix i 'I ~-1 r PL>hc ..i ro C----- • County, W18. ~f (Signatures may be authenticated or acknowledged1liotl, P1~l.'' ;_s permanent. (If not, state expiration j are not necessary.) t A ,.dace.. T--)I i; er . I~ •Namea.of persons sicnins in any capacity should be typed or printed be7i6-su $#8*k1ures. 1 I ~ WARRAN TT DEED STATE BAR OF WISCONSnr Wisconsin Legal Blank Co., Inc. FORM No, 2 - 1982 Milwaukee. Wisconsin ,N s r y i1 . t jf\{f g 7 i \ I /d \ a. 1 4 DO` 7.3 3,sG 2 ~