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STC - 104
AS BUILT SANITARY SYSTEM REPORT
I
OWNER
Qr~ci S h1U 1'IYzSSP.~/
ADDRESS '?Q IIoD'`''' ~7
f4finwilt7d, OJI 5a)1,5~
SUBDIVISION / CSM# LOT #
SECTION 30 T_aq_N-R__tl_W, Town of ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
a K
~33~57~
i a/11 7
INDICATE NORTH ARROW
I
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:.
JJ,ec- 7 /Z
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: lCie--v 04 1 Q.
`
Setback from: Well House Other l ~ 7-e
Pump: Manufacturer Model# Size -Y Float seperation Gallons/cycle:
f
Alarm Location -e-
SOIL ABSORPTION SYSTEM
Width: Length c _ Number of trenches Z--e.-e-_
Distance & Direction to nearest prop. line:
Setback from: well: 74r) House Other
ELEVATIONS
Building Sewer ST Inlet; ST outlet
PC inlet PC bottom Pump Off 2 2° 3_
Header/Manifold C G Bottom of system
Existing Grade , Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR: Jrt
3/93:jt
J
Wisconsin Department of Industry, PRIVATE SEWAC1tt SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION -2594 4
P KU~g~Ll NaTRANCIS & MYRNA ❑ City ❑ village R Town of: State Plan o.:
Hamond
CST BM Elev.: Insp. BM Elev.: BM Description: ~C 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
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
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
mead
Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM
INFORMATION Type of 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: Hammond.30/29.17W, SE, NE, 160th Street
r
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710(R 05/91) Date Inspector's Signature Cert. No.
IlllnpEs Safety and Buildings Division
~~■~r■r. SANITARY PERMIT APPLICATION Bureau of Building Water System-
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. L' iC 6 / X
• See reverse side for instructions for completing this application state sanitary P~erm~Jit Number
The information you provide may be used by other government agency programs ❑ Check i(revision to previous p lication
(Privacy Law, s. 15.04 (1) (ii State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Ow r Name t S P o4erty ~Q5/4 S c T ~j' , N, R E (or
Property Owner's Mailing Address Lot-Number Btock Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
All p /7 $z 1 - /_~p 7 l
1111. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Nearest Road
❑ Village e) 7-
~o s'
❑ Public 1 or 2 Family Dwelling - No. of bedrooms own of
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo tL
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.,KReplacement 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 g[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. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
/ Required (sq. ft.) Pro 57,-, sed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
47 S0 3 7 , ! 5 eet /Q/ Feet
VII. TANK in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank l l~ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
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 S' n`t ire (No Stamps) MP/MPRSW No.: Business Phone Number:
it ~S 3
Plumber's Address (Street, City' State Zip Code): / /
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
Approved F1 Owner Given Initial Surcharge Fee)
~ d Ili -q5
Adverse Determination
R. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBO-6398 (R. 05/94) DISTRIBUTION: original to county, One ci)py To: Safety & Buildings Division, Owner, Plumber
1
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit: issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
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
VII. Tank, information. Fill in the capacity of every new/or existing tank, list the total gallons, numocr of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for a/( se,: tic, pump/siphon and
holding Minks for this systern. Check experimental approval only if tanks received experiment .l ;)rod,Act approval from
DILFIR
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appro:3 late prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX_ County / Department Use Only.
X. County / Department Use Only.
Com»le e ~.r,d specifications not smaller than 8 1/2 x 1 1 inches riu~' sul):,, tied t t e .ci my -he plans must
- IF f:~iicwirr): A} plot >lan, drawn to scale or v~ith complete d. eras;c,;t-,, loc..,tic, ~f c :dir~c tank(s), septic
161 r° pump or siphon
.•i; i'1 ;soy pPIGl1 f-'placesve'_ yet4eCa;
e u CL; oss section
Lo . ) . i z rg
_ 11 nforr~a ion
s- r
GROUNDWATER SURCHARGE
i )83' .sc,~n ;n act 410 included the creation of surcharges( ees) for c number !.,,f {~r<:.tl(_e; ,vhi,:h can
effect groundv~,ater
>~...~!,)vec.t.J 31 :on,
and es.abiishmer . of standards.
SAFETY & BUILDINGS DIVISION
III
State of Wisconsin
Department of Industry, Labor and Human Relations
October 27, 1995 2226 Rose Street
Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S95-41345 FEE RECEIVED: 180.00
RUSSELL, FRANCIS
SE,NE,30,29,17W
TOWN OF HAMMOND 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.
Sincerely,
G and M. Swi
Ian Reviewer
Section of Private Sewage
(608) 785-9348
3121R/ 1
SUDA-7987 (R. 18184)
Page of 6
MOUND SYSTEM
FOR S95®4134-5
A BEDROOM RESIDENCE
3
LOCATED IN THE SF 1/4 OF THE NE 1/4 OF SECTION 30 ,T 291 N, R VI W,
TOWN OF ST c-CwLX 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
= C S ADZ w► . ~ ~ Ac -Q s S~F.L RECEIVED
)q1 16~) Ts 5r.
vlF A "yl O-'-l,n, k, l S u o 5 0 C T 16 1995
SAFETY a BUM. Div.
PREPARED BY
~o®~®4C®i@~@OOB
, 1r1EGEI~ER SQ I L TEST I NG
AND wa
4~7 i3ES Z (E3tV SERA I CE •i
p k W
i ARTHUR L.
P l 8' !3' - WEGERER • aQe
.,0 D-915 P P.O. anz 74 421 x.aix sr. i ,
6LLSWORTH,
R FALLS. MI 54022 • s wrs.
715-CM-0165 e
I G 14
y• $ o'~ f to--) -9 S
JOB NO. S - Z O
PLOT PLAN
- Page 2-- of (o
Scale 1"= L4D'
tip.. ~ r Q~~ ~r~ a uc
02 O ka lvtL3 i B•3
-nH S 32 .
~ i lo'r1w. (s~r~g ~STR-~~t-vp
e.z '
r /
B~D6, r r r o to u~-w'P,c`-f
s219
3 3 8~1ZF1
0 0 ~ #"1 6 Z ~uT ~ 3 I
00 e
w LL
J
0
~2p P X1"'1 L I K. F
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be lWulbso gallon capacity manufactured by
5. Bench Mark SEZE- "r U
6. Divert surface water around mound to prevent ponding at the uphill side.
` Page 3 0f b
Approved Synthetic Covering
~s~ wi 33 Distribution Pipe
Medium Sand
_ H G
Topsoil F Elev. Ot c1_
-J E D
3 `
b
% Slope
Bed Of 2~- 2 Force Main Plowed
Aggregate From Pump Layer
D 1- Ft.
Cross Section Of A Mound System Using E 1.3Z Ft.
A Bed For The Absorption Area F o.$ Ft.
G k. 13 Ft.
A 8 Ft. H 1.5. Ft.
Linear Loading Rate= Q• 6 GPD/LN FT B Ft.
Design Loading Rate= O-j GPD/SQ FT I Ft.
J S Ft.
K ~p Ft.
Position L 6-1 Ft.
of
Force Main IJ 3 Ft.
L
Observation Pipe
8 ~ K
r J-'
A I -
I.----- .I
Distribution Bed Of 2 - 2J2
Pipe Aggregate
1
Observation Pipe Permanent Markers
(Anchor securely)
No'~'•, 'hovrvD `S Sl.t6ltT'~y ~rVCt~-l~E vps~.n>>~~ .
s 1~ t.Ol' l~l. - t Z o r- ~
Plan View Of Mound Using A Bed For The Absorption Area
Page Of
Perforated Pipe Detoil
/ 0
/ End View
Perforated /
End Cop) b\e ~r PVC Pipe
i . _10.1% once
o~S Install permanent marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q \S
Q
PVC
Manifold Pipe
Oistn PVC Force Main
4
ution
Pipe
Lost Hole Should Be
Next To End Cap
End Cap
P Z 1.$ Ft
Distribution Pipe Layout
S y Ft.
X 40 Inches
Y '4 b Inches
Hole Diameter Inch
Lateral Inch(es)
Manifold Z Inches
Force Main Inches
of holes/pipe
Invert Elevation of Laterals Q 9-°I Ft.
Z-16 6P"
Place lst hole from center of manifold with succeeding holes
at 4b" intervals. Last hole to be next to the end cap.
Combination Septic;Tank and
' PUMP CHAMBER CR055 SECTION AND SPECIFICATIONS ' PAGE S OF 6
VEAIT CAP WEATHER PROOF
JuuCTIOU BOX
4'C. I. VENT PIPE , APPROVED LOCKING
.lO' FROM DOOR. MAWHOLE COYER lVIV
wARriIIJG LI~eEI..
dimoow OR FRESH
A1R IWTAKE coupulr
Lr. ~bO S * to
18' Ml u.
Ib~/'~IIJ.
- \ lh
PROVIDE I
IfJLET -j"A1RT16HT SEAL I III
1 I III
A = III APPROVED JONTS
APPROVED JOIAIT I III W/C.I. PIPE«tPUC-
W/C.I. PIPEaR Tank construction I II
shall comply with -I II ALARM
ILH~ 1;3.15 and 33.20 !s I I
I I ou
C I
I
LLEV. q(J' FT J'
P OFF
Nh,
0 COUCREr
qo.0~ DLOCK
3" APPRWEI
RISER EXIT PERMITTED OWLtJ IF TAWK MANUFACTURER HAS SUCH APPROVAL- BEODINCO
SEPTIC SPECIFICATIOAIS
f
DO51EK MANUFACTURER: M~O1w PR ~~T IJUMbER OF DOSES: 3S~l PER DA4
TANK 51ZC: ~p00 ! IPSO GALLOIJS DOSE VOLUME r
S.S. T-LQr-- S~IS~~"lS INCLUDIAIG 6ACKPLOW: lab GALLONS
ALARM MANUFACTURER: C2
MODEL DUMBER: LOV CAPACITIES: A= ~y 11JCHE5OR 6 GALLOWS
SWITCH TUPC: 5 = z' FICHES OR Cv ~LLOU5
PUMP MANUFACTURER: Z oELL'J`'st COI"Ep}~111~{ C= S ICHES OR GALLONS
MODEL NUMBER: D- INCHES OR GALLONS
`Ni l ChZLf WOTE: PUMP AUD ALAFLM` RE TO 5L
SWITCH TYPE:
32.'16 IN5TALLED ON SEPARATE CIRCUITS
MIMIMUM DISCKARGE RATE GPM
VERTICAL DIFFERENCE GETWCEU PUMP OFF AUD-015TRIBUTION PIPE.. Ot-S, FEET
t MIAi1MUM METWORK SUPPLY PRESSURE , . . . . . . . . 2-SD FLET
+ FEET OF FORCE MAIM X Z'l F~oftFRlCTIOU FACTOR_ Z-S1 FEET
TOTAL DylJAMIC. HEAD - FILET
Pump chamber DIAMETER
~I
IMTERIJAL DIMLWSWLJ~ OF TAUK: LENGTH ;WIDTH --~;LIQU10 DEPTH
BOTTOM AREA - 231= GAL/INCH
AS PER MANUFACTURER \-1. O GAL/INCH
'G~ 6 or 6
HEAD CAPACITY CURVE 3 7/6 6 1/4
MODEL "98"
30 4 5/8
8 9
25
3 5/8
6 20 -I-
U p
a
15 4 3/16
J 4
H
0 10-
's 2•,6 1 1/2-11 1/2 NPT
2
5
0
U.S. GALLONS 10 20 30 40 50 60 70 80
UTERS 80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEAD/FLOW PER MINUTE
EFFLUENT AND DEWATERING
CAPACITY 12
HEAD UNITS/MIN
FEET METERS GALS LTRS
5 1.52 72 273
10 3.05 61 231
15 4.57 45 170 3 5/16
20 6-10 25 95 -
Lock Valve 23'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
• Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float , operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - '/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float
98 Series Control Selection switch. Refer to FMO477.
Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075.
M98 115 1 /Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak".
N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify
D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system.
6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim-
E96 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10-0002.
7. Two (2) hole "J-Pak", for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by
a quali-
Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical Afternator, fied licensed electrician. All electrical and safety codes should be followed includ-
FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FMO487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FMO732- Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO. P.O. BOX 16347
LoedsvOle, KY 402584347 Manufacturers of .
"
`o ZZY-1,1FR O. 1(501,2) 'p TO 3280 Ol KY 40 6 ` ane
Z778-2731 • 1(900) 928-PUMP QUAL/TY /SUMPS ~NLf
FAX (502) 774.3624
Wiistonsin Department of Industry, SOIL AND SITE E V A L UAT1 ON REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHRy0 05rWiS. Adm. Code
COUNTY
' Ste- ~°.I2-UIJC
Attach complete site plan on paper not less than 81/2 x 11 inches ine PI st includes but
PARCEL I.D. #
not limited to vertical and horizontal reference point (BIM), directioft and %ef scale or
dimensioned, north arrow, and location and distance to nearest r o.'
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERV, ATI
F-LZ-P'C1uC-LS Nub +I 'MLA ~,L1 'S S e L " ~ %,Wv 17 - ~ 1/4,S 3O T Z c) N,R E (we
PROPERTY OWNER':S MAILING ADDRESS • ~L'Ol . OL SUBD. NAME OR CSM #
CITY, STATE - ZIP CODE PHONE NUMBER CITY ❑VILLAGE [MOWN NEAR, EST ROAD
l Cl't~'►lv~sp6)1 S Lit.) IS (CIS)-196_z6zI vi o 1bo" ST,
[ ] New Construction Use [J~ Residenti al / Number of bedrooms 3 [ ] AdditiQn to existing building
Replacement Public or commercial describe
Code derived daily flow LSD gpd Recommended design loading rate O • bed, gpd/ft2 trench, gpd/ft2
Absorption area required 371 S bed, ft2 - trench, ft2 Maximum design loading rate G • S bed, gpd/ft2 0 L trench, gpd/9
Recommended infiltration surface elevation(s) o t q • L4 ft (as referred to site plan benchmark)
Additional design / site considerations Moy►~ 1,J1 'd K- W1 ' 8lA , 'M. I Iu .1 n C5 t=- SRKt
Parent material S t %.-T4 ovtM e. \ T I LL Flood plain elevation, if applicable 1V • It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem ❑ S &U [3S ❑ U ❑ S NU ❑ S [0 U ❑ S ®U ❑ S ( U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Z 1-z-3 to `7 R 316 - S i J Z f Sbh Y►~'F~- - o. S o• 6
Ground 3 -SS Iw-t v?_ y16 ~.S`~tzS7$ - -
1o~ttL 61 Sic O~ ~1
elev.
fL
Depth to
limiting
factor
3 S"
Remarks:
Boring #
\oKR Z-tZ - 5 tl Zn~sbk 'YA L\j
IMIZ I Z 9-Z~3 lu`I R )LL sbk 1Nt'~1 e w o- S o. l
S 10 `'L R Sll6 ~ t ~ ~'s ~t a s/$ s t e-1 0~ vrt t' -
Ground 3 ~ ~ t~ ~ ►Z b !3
elev
a&• L ft.
Depth to
limiting
factor
Remarks:
T Name:-Please Print Phone:
Arthur L. We erer 715-425-0165
egerer Soil esting & Design Service-P.O. Box 74 River Falls,WI 54022
Signature:
apD~~ of- 9 S -ZO b Date: L~ `C 5 CST Number: 5 7 6
PROPERTY OWNER 71 LiJ >sL.L SOIL DESCRIPTION REPORT Page -2,of 6
PARCEL I.D. #
Boring # Horizon in. Depth MuDominantnseii Color Qu. SzMottles Cont. Color Texture Structure Consistence Bair>dary Roots GPD/ft
.
Gr. Sz. Sh. Bed Trench
0-LO tio~t.~ 31Z 51.1 Z-►~ S b vv'L ~ e,w - o. s o. 6
,f.. Z tb Z S loy fL 3!6 - S 1~ Z. Sbk lti► ~w - o. S Q• L
Ground 3 ZS 3a . lv`L(Z ~~(e - S1cI Z'F3bh wl~' C. S - a `l S
elev. f lF Z. S ~tQ slf3
otg.O ft. V-s6 irs4 RR Y!L ~ LiaLM 6 ! S1C~ U~-•-~ yet ~t
Depth to
limiting
factory
3
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
I ,
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
~Rn a~1nIR n5!~?~
PLOT PLAN Page 3 of 3
SCALE 1"= 0 '
t2gs°
oR O-t,3-NUa3
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-cls (715 42A-0165 1400576
CST Signature Date Signed Telephone No. CST #
Wiikonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & BuikSrxgs in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Sr-
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL LD. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
FULMiC-IS Nub ~'1~l`Z1JF~ N>_L3 S'SeL tOVF-te SF1/4 N1E1/4,S30T V) N,R 1`) E(or We
PROPERTY OWNERS MAILING ADDRESS , LOT # BLOCK # SUBD. NAME OR CSM #
°I I 1 b o `N %-r. - -
CITY, STATE . , ZIP CODE PHONE NUMBER EICITY []VILLAGE RrOWN NEAREST ROAD
l~Pcl1}r'► Owl 5 V l S i ►S }-1 °t 6- Z 6 z~ Rio 1 b o nt sT
[ ] New Construction Use IM Residenti al / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow \ASD gpd Recommended design loading rate O .~bed, gpd/ft2 - trench, gpdtft2
Absorption area required 31 S bed, ft2 - trench, f12 Maximum design loading rate Q. . S bed, gpd/ft2 0- L trench, gpd/ft22
Recommended infiltration surface elevation(s) `1 `t • y ft (as referred to site plan benchmark)
Additional design / site considerations 'MOViv-~, 1,,J1 '6'~L LI-l r tM ' -A I NJ A' pj=- SrtK-jb F1 LQ
Parent material S t t-T4 ovtm e ~ T i _ Flood plain elevation, if applicable tv - f\ - ft
s = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN f111 HOLDING TANK
U =Unsuitable fors stem L IS 9U INS ❑ U ❑ S ®U ❑ S LOU EIS ®U 0S 911
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench
o-~Z l~`t2 z-12 si 1 Zv~Sbl~ v~ 'F1 c•., - ~.g o.6
Z lZ-3$ ltJ`tl~ 3110 - Sit z ~Sb}t Yh F1- t~ - o. S o• 6
Ground 3 - 10`tt?_ Vl6 ~~lo~~~~t31~ siC-~ ~v►1 vh - -
elev.
0"tfL
Depth to
limiting
factor
36
Remarks:
Boring #
0-4 ~o~-t.cz ~-LZ - stl zw~sbl~ w~`~~. - o•s o.~
Z Z 9-2~3 tukR 3L L ~ Si I Z`F sbk e~ o. S o. L
S l0 ~Z ~l6 t~ Lj ►i b 8 s i o~ vrt 1
3 Z$- 2
Ground
a6 r fL
Depth to
limiting
facto
Remarks:
TName-Please Print Arthur L. We erer Phone. 715-425-0165
egerer Soil esting & Design Service-P.O. Box 74 River Falls,WI 54022
Sgnature: 9 S _Zo(~ Date: LQ 5 CSTNumM005 76
PROPERTY OWNER ~,LigSLL SOIL DESCRIPTION REPORT Page 2, of
6+
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
~ o - LO ~O `-1.1~ 31 Z S l ~ Z-►~ S b vv~ e,w - o • S o. 6
Z ~b ZS lo`~ 2 31`
Ground 3 2S-a8 1v`tcL vlte - sic.l Z'F3bf2 r1~' c. S o.S
elev. FlF 1•SKQ Slf3
018.0 ft. 3$-S6 lo`l2 Y/L LttM b [ Q) 1M i - -
Depth to
limiting
factor,
3 '
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting `
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
1
Ground
elev,
ft.
Depth to
limiting
factor
Remarks:
cnn nninrn n5io,~
v
• PLOT PLAN Page 3 of 3
SCALE 1"= fit. q $
D o rv ~Z- !-Otr►P ~T r ~ 2S ~ ~
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l~--l-c-LS (715 425-0165 1400576
CST Signature Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BuYER Frclx aj s -%-Ru Y rx& kAAS5eLL
MAILING ADDRESS lYN006._l (5UO
PROPERTY ADDRESS 7 ,0 2 - Q ~S /?7z
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, AIL 1/4, Section T_Zg _N-RLZ_W
TOWN OF Mfy' >rXj ST. CROIX COUN'T'Y, WI
SUBDIVISION LOT NUMBER
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 conditioq 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.
SIGN
TE:
St. Croix County Zoning Office
Government Centcr
1101 Carmichael Road
Fludson, Wi 54016 11/93
" 8 T C - 100
This application form is to be completed in full and signed by the
ik 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 _ F(-ar\CAS w MY P-0 A Q ,I S "
Location of property ~_i/4N_1/4, Section T Z_N-R__W
Township Mnunnrvi' Mailingaddress '74l -lLo05-t-
hn mDr1d~ f .e ~ 5 i-b 1 ~
Address of site s
Subdivision name A o NE Lot no.
Other homes on property? Yes__k,-"' No
Previous owner of property
Total size of property y/j 4G AZ C S
Total size of parcel
Date parcel was created G. T
Are all corners and lot lines identifiable? _ILYes No
Is this property being developed for (spec house) ? Yes ~No
Volume 4 / 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 PAQE
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.
PROPERLY 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 n th office of the County Register of
Deeds as Document No. _ 7 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
29/g7g
Signature of Applicant Co- plicant
Date of Sig ature Date of Signature
No. I Goo-Warranty Deed-Joint Tenancy _Miller-Davis Co., Minneapolis _
291979
x made this .17 th.......... r11..............................:.::............
94is *nbienturr, ...............day o f
in the year of our Lord one thousand nine hundred and. ...Rixty..7neight between
Mrs. Mary Russell
of the County of .....S.t......Or.Q.ix.................................. and State of........Wls.c.o.mq.n......................... , party....... of the
first part, and .......F.Xa.I?.GS...K.r....R4?se11...apd...Virgil.... Russelle
...................................................................................................................................................................................................
...............of the County of
St.-....Cro,ix...........T ..............:.........and State of..........Wiscon.sin...................................... , parties of the second part.
Ten '1TizJ=t 11A st quid QgrtO~...,. of the first part, for and in consideration of the sum of
to_..........her in hand paid by the said parties of the second part, the receipt whereof is hereby
acknowledged, do hereby Grant, Bargain, .S'ell, and Convey unto the said parties of the second part as
joint tenants and not as tenants in common, or their assigns, and to the survivor of said parties and the
helps and assigns of the survivor, Forever, all tract or parcel of land lying and being
in the County o St. Croix Wisconsin
and State o , described
as follows, to-wit:
The Southeast Quarter of the Northeast Quarter (SE-14 of NEµ) of Section
number Thirty (30), Township number Twenty-nine (29) North, of Range
number Seventeen (17) West, St. Crc6x County, Wisconsin.
The Southwest Quarter of the Northeast - Quarter.(SW"i of NEu) of Section
number Thirty (30), Township number Twenty-nine (29) North, of Range
number Seventeen (17),West, St. Croix County, Wisconsin.
The Southwest Quarter of the Northwest Quarter (SW4 of NWu) of Section
number Twenty-nine (29), township number Twenty-nine (29) North, of
Range number Seventeen (17) West, St. Croix County, Wisconsin.
1
Xv *Ittttr and to lRold t1le *amr, Together with all the hereditaments and appurtenances there-
unto belonging or in anywise appertaining to the said parties of the second part or their assigns and to
the survivor of said parties and the heirs and assl~sns of the survivor, Forever, the said parties of the
second part taking as joint tenants and not as tenants in common.
./I nd the said Urs.......Mai'y...RU S-9.e.11
part_..y..... of the first part, for........ hexself.,....her ......................heirs, executors and administrators
do e.4 covenant yvith the said parties of the second part or their assigns and the survivor of said parties
and the heirs and assigns of the survivor that she-is .....................................,.....well seized in fee of the
lands and premises aforesaid and ha.s:...... good right to sell and convey the same in manner and form
aforesaid, and that the same are free from all ineumbranees
and the above bargained and granted lands and premises in the quiet and peaceable possession of the said
parties of the second part, and their assigns and the survivor of said parties and the heirs and assigns of
the survivor against all per8ons„ lawfully claiming or to claim, the whole or any part thereof the said
parry-..... of the first part will Wd1RR✓LN'T ✓ XD DEFEND.
F,
In Irrstimong 11114ermt,' The said part .jy....... of the first part ha....s,.... hereunto set.....her
hand..... and seal..:. the day and year first above'written.
Signed, Sealed and Delivered in Presence of 2 (SE4L)
li ssell
• Nlrs. ary
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