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HomeMy WebLinkAbout022-1067-60-000 j' a)o h o w o ao -r 4 ~ cco I 1 G 0 00 p X o ti c O N O ~ I v7 ! i rn I o I s o I c z (D LL c m O O)'0 ~ D a E I v a y I z y co a ~~I' T o z N F- z a m o o _ z ':!t aVi z cn c to F- e- ~ °D E -o I o m 0 ~ I I N N V p s _ N c CO O N O Q Q w N ~ Z Z _ z N N R 0 li m - d z a LO ~ > w m ~ ~ U ~ °o I CU a G a a) N ~byy/~ o U) U) m m co CL Z: 0 0 0 z o N ~-aaa I ~i O y LL LO LO CD W J V Q T O O i CD C LO O _ E O LO r- E "'"'"1111 fn O O O M CO N a N .0 N Q c0 N 3 c C 0 o N c o 0 0 o E O H co - 06 co co .2 a) cn 5) O _ N ` O M V O coo co c (7 c N N c °0 3 06 U a) O In Z O 'O n c a) N N c c 't -6 (Y) E O N Y co N 0 y F- M Cn L CQ ca ik w LC +LO-' Xt G CD d • cl C Z .V a7 a w E i c C w j "~1 A (o~ a m 0 in V Y Rrau STC - 104 ~j AS BUILT SANITARY SYSTEM REPORT G L ;j OWNER 0 > r ADDRESS. j~ 8G5 G-1a5i, C'~ ~IYc > 7 1 n. Ali Nw S,S/Z4 SUBDIVISION / CSM# LOT # SECTION -'),4 T 29 N-R I $ W, Town of ICS w w'c ~1.~ n ►vST. CROIX COUNTY, WISCONSIN 0 t,,t PLAN VIEW S IOW EVERYTHING WITHIN 100 FEE OF SYSTEM a \rL0 ~t i 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 : S,r~,`~C 1 e c h i r f F1 D G r ALTERNATE BM: l0Z, 9 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Ujkee C.d~t (12rG0+ Liquid Capacity: 126,6 1 Setback from: Well 2~ $ House 12 Other Pump: Manufacturer 'Z vtAl tv Model# h) - 97 Size Float seperation Z,,, ~3 Gallons/cycle: 41,53 Alarm Location q a,~Wd,. r, c v-" d SOIL ABSORPTION SYSTEM Width: Length Q} Number of trenches Distance & Direction to nearest prop. line: 1400 s Setback from: well: Z~ House g~ Other ELEVATIONS Building Sewer 17, 43 ST Inlet ST outlet ql,. $D PC inlet Q $,12, PC bottom q / 9 Pump Of f Jr'7, g 9 Header/Manifold 9 > Bottom of system Existing Grade q7,G G Final grade_jp0 ?,j DATE OF INSTALLATION: %1_1 S PLUMBER ON JOB: LICENSE NUMBER: K pas ~ 3 7 p I INSPECTOR: 3/93:jt L Wisc~psin`epartmentofIndustry, PRIVATE SEWAGE SYSTEM County:,,T~ Labor and uman Relations ST. INSPECTION REPORT CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 213402 Pe4gyt,kial `'s IdEEN DONNA ❑ City Village [Town o : State Plan ID No.: 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 Dosi ng Aeration ( Bldg. Sewer 93 ' Holding St/ Inlet 6,39 27 TANK SETBACK INFORMATION St/IX Outlet 6, TANKTO P/L WELL BLDG. Air] ke ROAD Dt Inlet 17' 53~~ Septic > NA Dt Bottom Dosing NA Header / Man.- Aeration Dist. Pipe 2" Howin-9 Bot. System .ir- 9 ~7 PUMP / SfP "FORMATION Final Grade Manufacturer Demand Model Number q, J GPM TDH Lift131 Friction qy System TDH(; ,31 Ft Forcemain Length3c/ r Dia. 3 Dist. ToWeI SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches P No. Of Pits Inside Dia. iclu pth DIMENSIONS / DIMEN I SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN anufacturer: SETBACK CHA R INFORMATION Type O 9 Moe Number: System: NIT DISTRIBUTION SYSTEM ,a,., der / Manifold Distribution Pipe(s) x Hole Size V 11 x pacing Vent T 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 S' Topsoil 6 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Kinnickinnic.24,28.16W,.NE, NW,,140t Street 9761~, Plan revision required? ❑ Yes No Use other side for additional information. SBD-6710 (R 05/91) Date spector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: ~ILHR SANITARY PERMIT APPLICATION ~~9, In accord with ILHR 83.05, Wis. Adm. Code Co R STATE SIPER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than /`ji4 O^-" 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STAT PLAN I.D. NUMBS 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 5-4o) 2% PROPERTY OWNER PROPERTY LOCATION C to d ~~,na -E YVrtV(,l%,S Q TaN,R ) A(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1 3 865 G1 N-Z i t r- UT. l!J C 51 IV J¢ W !f CISTATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER /-F I r tlall~ S51 L4 1ol 2 43i- I9/6 rU 11- 11. PE OF BUILDING: (Check one) El State Owned VILTMLAGE NEAREST ROAD klwi~K.,ww« 004 5~. ❑ Public 541 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX N B R( S) III. BUILDING USE: (If building type is public, check all that apply) O 6 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 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 Vault Privy 14 ❑ System-in-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. 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) p f ,t ELEVATION o Soo w+ q D l~ beet ( oaf I Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 250 - ) 25v L '1 te~ >C. el - H Lift Pump Tan r/ V p" o o U 1 r , K+ Vlll. 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/ Business Phone Number: 4 :3 32 41 4aS -_212j_ Plumber's Address (Street, City, State, Zip Cod IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee ncludes Groundwater a ru-te Issued Issuing Age mps) Approved ❑ Owner Given initial ^ Q/\ ` urcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: r~ C i e v~ Q 6C totiG Zvi Ur.' n .fTC /d O .S 0 2. " SA<C1`~ r.1 701 C~ h /01 SIO ~C p/L L✓/ ~ UlS! SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. Your sanitary permit may be renewed before the expiration date, and at th a time of rer = i.al any new criteria in the Wisconsin Administrative Code will be applicable. ;1. All revisivn-s to this permit must be approved by the permit issuing authority. 4. Charges in ownership or plumber requires a Sanitary Permit l rsnsfer/Rn-ewal Fora € tF' 6399) to be subr,tiit d to the county prior to installation. :i. t :te : ,wage systems must be properiy maintained. The _'c; tank(s) rn.:ct be t+ r. c .,y a 'icensed purr!per whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code adrrtinist-ator 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 nrimber(s) of where the system is to be installed. IL Type of building being served. Check only one and complete of bedrooms ` 1 or c l"amily ')welling. III. Building use. If building type is Public, check all appropriate boxes that applN,r. 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. \rl. Absorp.tlcn s-v!:tPrn information Provide ail information requested in ##1-7 \,I 1. ' arlk irJ' frr!2J:r)G F:l; in the 'apa6ty of '4v_ new c,n~!rJ? x .tl°. ! t3r;k 'IS. t f .__I Cs ilumber of tanks ivid .-amJc Cturer~. name. Indicate prefab or site l.oo ArUct3d and tank rlatef i . t ! tom' ~Or 8//_ septa, rr_- ip~si,rhon and ;raiding tanks rue zhis system. Check (.ixperimc:i, : ,provai r if ±arks received expe + .,u; apprt>vai from DILHH. Vlll. Responsieiiity statement Installing plumber is to fill in name, license rt--nher with a-n-op^i rfe )rf- x (e.g. MP, etc. , address and phorie number. Plumber must sign application for,n. IX County/Department Use Only. X. Ccunty/Dtspartment 'Use Orly. Coo f. e r,d rr:r ,;t,Eatior:_ not smaller than 8Y2 x 11 inches rr.: bE :ubn it1 _,1 tt-, courl!v. The Ftl?r!S rn? S° I.'L 1~• frl , ir;g: -''t) plot plan, ~J!awn to scale or with i' :file t)r . "cat C,,-,, of holdirq r , (s), t;« - or ,;her treatmP-it Oaf ks; huildingg se =Mite, service-l =:iphr.,,~ tanks; distr lhotion boxes; Soil ~?t,5','..: • , -=VS?E?rTl~ t :.?ray ,""`t SySterrl bu :?-..g served, P) hcrizontal and vertica. G) complete sueciticattio;,:, for pumps and controls; dose volume; elevatiui, c: rerenct,~: :.",i_n loan; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absor3tion system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 tWlsconsir Aut 410 inclIuderj the c,eation ;4{ =-.urchar(jes (fens) for a numbe, r,t rf 3u!a,ted pracilices ~,vl ich a . ef°`;ct groundwater. T-lP vrfQ~ _ ! r"i;tld r 3t': ~ir`'hargcs#re A;3cd fi:r 'l~r.,r~t', V wafer C.ontarf,, inatiw, ins/f3S ~(.t 1~<r"?S and estab!k4i er!s of start+' arZ!F~- Z SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 20, 1995 2226 Rose Street La Crosse WI 54603 HEISE, CARL 1042 S MAIN RIVER FALLS WI 54022 RE: PLAN S95-40186 FEE RECEIVED: 180.00 BADJE, GLENN & DONNA NE,NW,24,28,18W TOWN OF KINNICKINNIC 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. Sincerel , era M. wi Plan Reviewer Section of Private Sewage (608) 785-9348 8144R/ 1 SBDA-7997 (R. 18M) MOVE THE EARTH CARL HEISE EXCAVATING v1042 South Main n RIVER FALLS, WI 54022 CARL P. HEISE (715) 425-2175 Owner MOUND SYSTEM FOR BEDROOM RESIDENCE LOCATED IN THE _ OF THE N W4 OF SECTION, T_?j N, R_L~ W, TOWN OF K1wyyC{ wyjiC.__ ► 57' , '(0k 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 LAY-OUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR GLemw 4 po NNA 13ad j e RECEIVED 13865 Glazier Ur. WcST APR 19 1995 Applc Ueiler Y,'W. 55/21 612 -43) - I q 18 =SAFM & 8LDG$, Dw. & PRBPAI~ED BY Carl P. Heise CST 3314 MPRS 3378 1042 South Main Street River Falls,WI 54022 Qg 2 0-4'!0 895-40186 400' I To P,vge,'r y LiwE aa3 4 M I ,q s5 k w~ r= ~L. J ray, v' a~# 2 W7 ~L L 102.4 ' io00GAL Wic- 12 2 50 GAL T/~w ~o 7 C, W e sir C~ 4 3033 Q P►`P°wE o o q v~L 4 4 O t ` 17 ay T 4 ~ ~o ft 14o'?N ST ~L ,97 ~r~O; ~j (3 2 d ' SCALE I g4 QIM'~ ~ S~,~,s 181~Gavt ~ von@ So4`f~+ S,~(r b^~ DI~kT~.~~i~ El_ioo.o f3 i'1~` s(~rke IfS bo~~. a is Ac. Sow4 Stjr of w0,. p141, T2gE ~1,142,4 7{,i % r 1f 71.r~ YUrc.( 0 bc. rc r ov t~ i ~'+`ovn~: Ott K1 °t f~cy,,,~ Cw"~_ q~( ~laae 4 51 rn~7a "v r "7 ~ yf;. re f_ ~ iy i 5 e i 41-M S` or St-row; Morsh Hay, Or S 9 5 " 40 186 App~v~ Synthetic Covering • -Distribution Pipe A <.>T1\! C-33 Medium Sand Topsoil - I D ~ it . 7 °/4 Slope plowed Bed Of e- 2 Force Main From Pump Layer Aggregate D E' J.g211-• ~ross Section Of A Mound System Using F 15 - A Bed For The Absorption Area G r q Ft. H B Ft. r.. X2 Ft. ' vao s J.: Ft. K Ft. A; L J Ft. SSE W - Ft. L Observation Pipe-- I A t ' Bed Of Distribution Pipe Aggregate Observation Pipe Permanent Markers Pion View Of Mound- Using A Bed For The Absorption Area F off Of DI td Pipt Dololl / Ent: Vir• ( FtrlorotcG .J/ ~ • Enp CoD- -PVC Fret ~PrA11j1?J=uY rr~FtV•_ts•'Y ,o pct err.: L of Oltd (51, bottom, O' ~Cp^ err [ ouotty Spoccd S 1 Q PVC fbrcc Uoin From Pump P ~ PVC Monildr, plot ~[1rSlr It)U11Dr• Plpt Lost Holc Should bt I 1o End Cop ' V d Cnn! NoribOliorl FiDt LoYou► ' P 91__ S 3_ X Y S7 „ Hole Diameter -4_ Inch Manifold 3 Inches Force main " - Inches Lateral " 14 Inch(es) Holes Per Lateral 9 ?9-87-195-203-2G1-Iq-3~9-435-43 ii g e t It 1al3 i r-t, VE1J7 CA!• ' S 9 5 4'Q 1 8 ;;L. . N :.VENT PIPC n=s WCATNEK PKOOF APPROVED LOCKING JUIJCTIOW'BOX MAWHOLC COVER 5,1901A 0009, W'WboW OR FRCSH It MIU. AI.1IL1TAKE I ' GRAOC~ y LMlurCOQDUIT 18' Mlu. 3 } Q -rT a' p, IRTI#"y 'se-Al" : APPROVED JOIUT tA I III APPROVED JO ' W/C: z: IIPG C t"'~ 01` w I I W/C.x. PIPE CXTCfJ01NG 3' b I 'y~ ~e0~ ptl I I ALARH EXTCIIDIIJG 014r0.,60610 %OIL s ti 6 UctR`l'~, c~('l I I I ONTO SOLID I C TO Ow FT. ~'2' ~F1 I 1 uGr M:. rjt~ PUMP " - J OF F. D 6LOGK = 1. COAICFLC7C140 RISCK EXIT PIrRMIYTEO OlJt.y IF YAIJK MAl,1UFAG7URZR HAS SUCH APPROVAL, QEQ^~A' Ct° 3d !r tiuir,~ J . a•}~ + rs c ! r• 8 PCC.IFICA710 S t,,,StPTIC ~ ; ~ • TA K ` 1►WUFACTURGR',- W I IrsF2 CoitL i4vd WUMEiCR OF DOSES' P E R DAy TA1JK L12Jr., ••GALLOIJ$ DOS~r,VOLUMC 4, ~ 11.cc-rvR Iucl.uotuc. 6AGKlL.OW1--151, 2- Ae, !lAlIUFALTUKFa: 10 DL v ~~yA ~^^'OOCL IJUM6CK: CAPACITICSI A n_ 1 P,.7 ,,,IUCHCS F. -sLL GALI.Ou r . , s ~~`si.SwITGH• TyPKS v~KVy 8 >r._Z`...IIJCNES OR~.. G LLOIJ KNUMP M1l)JUFAG'TURCR: i' UFLZ f t y C~ ~,IUGHES OR CrJILLOU t s y «y1~1001rL {JU.MBR: - l'J - Q' p s _ 1 2 I►JCHES OR -36 ' 'GALLOI.. rx crew+~ •;,~;~<~;...r.;;i.,,SWITCH 7yPE. uore: ,'PUMP AUD ALARM ARC TO 6C s,•' ~"`~Y 'INSTALLED ON SEPARATE CIRCUITS MIIJIMUM DISCHARGE.' RAMC t GPM' v'e:.. 'NERTI,CAL DIFFEF-EWC6•CETWCCIJ PUMP OFF AIJO,.0ISTRIB4TIOW PIP;.. FECT 99 n:-{-'_{;KIIJIMUM IJC'CWC)RK SUPPt.y PRC55uRC 2.5 FCET 7 . -i- _fCET OF FORCC MIN X -AZ--'v'00fj'.FKICTIOw FACY0R.►-L!1- FEET TOTAL. D~►JAM. IG~(~J FF- ET :?•,k~, G .,.~r...L7.. Q.._ :,nvvK,r,,.,...•r..._.. ..-:na:::~i: IQTERIJAI. DRALW6i0fJA OF TAWK: L.EI.IG7H " 1 ...._.........;wIDTN° ;LIQUID OEPYH tiw •f Zvi ;1 ) ~ 2 S(,4 G~.t/1w ~k: • SI}GWEp: Ict USE .lUM13ER; D&-r~. ti  S95-40186 N F- cc w W 115 34 110 Z 0 CO.. 32 10t - 30 100 - 95 28 90 26 85 80 I 1 24 MODEL Q 75-,MODEL- 189 W 22 G 165 = 70- 2 20 ~ ss" Q Z 18 60 55 J 16 - 1Q- 50 MODEL O 163 MODEL i- 14 45- 188 12 40. 35 10 MODEL 30 137, 139 MODEL 8 185 25- 1 6 20= - _ MODEL 15 --MODEL 161 4 97 10 2 5 53, 55, 7_7 57, 59 0 GALLONS 10 20 30 4050 60 70 80 90 100 110 LITERS 0 80 160 240 320 400 :4 -4-1 z-- FLOW PER MINUTE I~ onsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page l of 3 x alsid Yuman Relations ,sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION G/ear J9ohn ojc G GOVT. LOT Yu f; 1/4 IV W 1/4,So?4 T a b N,R i X(or) W PROPERTY OWNER':S MAILING ADDR LOT # BLOCK # SUED. NAME OR CSM # 1 2 Quo S Zt C r C,7 We- r ►v 14 hr 44-tyA CI7Y, ;LT E ZIP CODE PHONE NUMBER []CITY []VILLAGE XFOWN NEAREST ROAD I~ rn s (G1Z)43i -19 ; Utv 'Wk' I4o Yh 57' New Construction Use (}d Residential / Number of bedrooms 4 [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow el, 0 0 gpd Recommended design loading rate Q , 4 bed, gpd/012 S trench, gpd/ft2 Absorption area required d 0 bed, ft2 4/~L trench, ft2 Maximum design loading rate 0. 4 bed, gpd/ft2 0. S trench, gpd/ft2 Recommended infiltration surface elevation(s) t1IR6 It as referred to site plan benchmark) Additional design/ site considerations K 0 ug d W ,rk i 2 a n~ r-A "'t" 4:11 Parent material 1-ill ou z,r SaHIs7ow e. Flood plain elevation, if applicable ►U 0 ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S R9 U © S El U ❑ S ®U ❑ S 23 U El S ® U El S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rBe Tre & 3 -7.Y vu k 3-14 7.S R z wn, 'tl Drs Ground 3 )4-34 7:SY241_6 wc~,.~ CS t f d•4 a.~ el"ft. 34-66 -7- 5 Y2 ~ 2) S YR ~ ifs f up'jti I _ _ - - Depth to limiting factor a Remarks: Boring # t} 6,3 -2,5 tC 4f -L VVtlwt L 5 vn ~ S 2 Z -1 -7, S YR s z hJ o n I I m h. Irti l o, S :Ground lb-33 _7.-.5 (-(L s W 0 1, a- f 5 r» 3 Yr, l C S [ 4 d G, S lev. Y u t h~ r1► _ 4 33-7 L 7. Y{~' L~ f ft. Depth to limiting factor H 33 Remarks: CST N : Ple se Pri t Phone: meI 'e ttet e 71 -42s-z17S~ Addres 04 Z 5. vvxa~N F,Al 4,►' S o -&7. Signature: Date: - gS ST Number: PROPERTYOWNER Gltnn ~I l~anno & je- SOIL DESCRIPTION REPORT Page 2 of 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 0-3 7. 6 L jZ 4/z w 5 b~ I 2 G d G s - s Y R SJ ►v N i s (r►, s l a, s Ground 1 3 7, Sc >v o nC 5 l y„ 5b hti c 5 'F 6,q o. y %oev. ft. 3 -q 5 YR rs R 4 AS I sti{. Depth to limiting factor,, 3 Remarks: Boring # rv: 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: SBD-8330(8.05/92) Pg 3 Gf 3 PL o-f ~L N J ~ b '1 ~,is s►+1e ~o~ ►k,,t 120 JQ~CZE, 5 A00' TO 'No Pro C►~7 w t N a3 ELg7 1,4 2 U F S~ " At Q a / ~c Y IAOJH ST, -t 97 © Q a•2 S cal e 4o Om Sp;kr ►S"it4x,ve Crrdc~e SowYk .24 `palLTrct ei%,O Spec IS'above Gifje so,.,tk silt aI 2o'ook Ti4c ~'1~~'S 15 a. woo~e~ s',T,e ~oi,,aevzr fwown~a,YCa iS frceo~'T~ets 1+ Tl tVc Are am Tirno ►r vtowaof 0.0c t They M1457 be, ckT a"r J6 ).AT PLAAJ ~>!PA ",b FO,e: o IC /IV/U l C.~1'.~A.lA.11G. 7aWiv3z!lP ~ - o 5T. Cpo~~t eo•~~u~ - c I 1t tPAP& lay : - .LUti1A 8U 1 LDS -ZlitlC, ~~'ov.►v~rJny ,eri,c 21 KP. R 'FALLS , WI _ Sao ' 7'~ , F%~s T PeOPCtT!q r et ~ o ZOO, ~ ~7bo'l~orVf'h/ j 'l~ GQE ~ 2t.~?i_ 'v rtk.2 d P,~ ezx t` • / //f)JzZD 00 W, d rte. p \ / /'ZD -r 4A-1 ley , C5 /I t J20kh STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER t ; J-EIV W + J)p N N a8_016- MAILING /~,P~ -2Nc, ADDRESS 38 6 ~z /s► ; F ~2 C,o,, ~1' , t~/~ t(~/lE y m/V Ss/a PROPERTY ADDRESS 2, 63 I9ERwoor,! rc~+26Sf ~o ~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~P, FP .SyD22_ PROPERTY LOCATION 1/4, w 1/4, Section a y T_? `_N-R W TOWN OF K i N Nick i ed W, L ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER - CERTIFIED SURVEY MAPSa7Y'8' VOLUME IWO , PAGE 5_03 , LOTNUMBER 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 expi on dawe. i SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 cv 4 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 C AIVtj t- !~bNNR 8ADTe Location of property N 1/4 NvJ 1/4, Section d,T a 8 N-R_IL W Township K~rvNiokiNN', c Mailingaddress 139&5 6JgZ;CR courv"~) PeNE U - Address o site_ ,_4 5-66 ,wood ro,,'E5~ , oA4) i(,~),Ek i iffj S~eo22-' subdivision name - Lot no. Other homes on property? Yes No Previous owner of property dk*Rl&S L. wh, Total size of property /o?o AckE,S Total size of parcel 20 40ieJ Date parcel was created I - S /n_s' Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes v----No Volume jj/~ and Page Number 503 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. Sd 7jc)(b , 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. i Sig ure of Appli ant Co-Applicant S - - 9s✓ '5- a ~'S Date of Signature Date of Signature * State R::) ,I 'vi,con,in 1 ,rni I`IK. 08WARRANTY DEED REGISTBUFFiCE ST. CROOM , W! DOCUMENT NO VOL Roca fir Rzc:,a.I APR 4 1995 Charles E. White, as Trustee of the Charles E. White Family Trust dated March 29, 1993, at 2;30 e1,i CJn4an, ~ Regl;ter of Oec rs a)meNs and warrants to Glenn K. Badje and Donna R. 8adje, husband and wife, Glenn & Donna Badje 13965 Glazier Court W he following described real estate in St. Croix Apple Valley, MN 55124 County, State of Wisconsin: j IP:/reel Idcnltitcauo❑ \t: n)~,eri o z - l o~ ~1 60 -000 The N1/L of the NW1/4 of Section 24-28-18. This is not homestead propcrtc. XKK its notl Exception it) warranties: Easements, restrictions and rights-of-way of record, if any. Dated this ~1•si~ dar o I March . I') 95 . ISE \LI is[ \1.1 Charles E. White, as Trustee of the Charles E. White Family Trust dated iSF:\I.r March 29, 1993 ISE. \1 i AUTHENTICATION \ChVO\\ 1.EDG%IENT s~pnatu ~1 Charles E. White, as Trustee of S[ W. l/I %%ISI O\SIN 1 - Ctle Arles E. White Family Trust dated ` March 29, 1993~~ t T71 day of March ly 95 pcr,onalls came h0ore ntc thn da\ 01 authenticated this the.Ih„tr named Kristina Ugland TfiLE: MEMBER ST:\fE RAR OF WISCONSIN (if not. authorised h} §706.06. Wis. Siats.l o e)C Anowit to hi the r, on \,ho C%c.uted the lorreome iu,uumrnt the -.mic. rms INsTHUMENT WAS DRAFTED By Kristina 0glarld Attorney at Law tSianalure, Ina% hC authcnncated or acl.nowledecd Roth .oc not \Is .on:nu„n n r I'Lini,)nent ill n. t. '1310 r\p)raoon dAtt . Iy lick C-ar%. I I nt t u IF I,( U\%IN vx~