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HomeMy WebLinkAbout024-1022-60-000St. Croix County Planning and Zoning Tuesday, September 18, 2007 at 7:40:43.4.0 Detail Sanitary Information Page 1 of Computer #: 024-1022-60-000 Sub/Plat: 40 acres Section: 17 Parcel 0: 17.28.17.125 Lot: TN/RNG: T28N R17W Municipality: Pleasant Valley, Town of CSM: 114 1/4: SE 1/4 SE 1/4 Owner. Bradford. Robert 330 1701h Street Hammond, WI 54015 State Permit: 233426 Issued: 05/30/1995 POINTS Dispersal: Mound 24" or more suitable sot Permit: New County Permit: 0 Installed: 07/31/1995 POWTS Detail: NA Bedrooms: 4 POWTS Pretreatment: NA Nolc. Issuertlnspeclor As Built Plumber Other Requirements Mary Jenkins Yes Nechville, Henry Jim Thompson Signed Ulf Yes Maintenance Scheduled Pumo Date Pumped 1st Notification 2nd Notification 3rd Notification 7/31/1998 8/25/2003 — 04/01/2005 8/25/2006 4/20/2007 4/20/2010 WI Fund: Additional Notes Money Owed Wieser 1250 gal. septic to 1000 gal. dose tank to $0.00 6'x85.6call STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS .33o I i D SUBDIVISION / CSM# SECTION/7 T,78 N-R / 7 W, ST. CROIX COUNTY, WISCONSIN LOT # Town of �Ita4'0". L)4 PLAN VIER SHOW EVERYTHING WITHIN 10 FEET OF SYSTEM LA LF I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- 6..4A 141: Je ].LG 5-rb,. ► 3.38 �To ►3.4 ST tW--PA- 10.77 rcj", &A.0 ► S M BENCHMARK: ,OO , ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION a Manufacz er GJ AS u<" Cori, eo9 Liquid Capacity: Io?50_ rC . , •` .• •� / O v O Setback from: Well_y317 House /.2/ Other �?fo� /', f 3,7 'A A Pump: Manufacturer2&.,P� Model4 /,37 Size yR? 14 Float seperation Gallons/cycle: //o Alarm Location SOIL ABSORPTION SYSTEM Width: ,-�1,9 Length / o S/ Number of trenches & k 6"/ r" , Distance & Direction to nearest prop. line: f 7111' Setback from: well:- -35/House 23 Other Ar" r G3 ELEVATIONS Building Sewer ST Inlet. ST outlet 87,06 PC inlet .5,6P PC bottom 83.(g Pump Off 6 y•IF$ Header/Manifold q Bottom of system ?Q 70 Existing Grade 59, %Q Final grade nj _:3, Opp DATE OF INSTALLATION: PLUMBER ON JOB: Xt:� —A, ` LICENSE NUMBER: C> 3 INSPECTOR: 3/93:jt Wisconsin Department Of Industry, Labor and Hulnan Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit Holder's Name: ❑City ❑ Village ❑❑ Town o : BRADFORD, ROBERT L. X CST BM Elev.: Insp. BM Elev.: BM Description: &') TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aerat oldiTsg' TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto Au Intake ROAD Septic ��� ' S' 3 1,4 NA Dosing > 160 3 ' o?s ' ��1� NA Aeration NA Holclin� j )11\1D LttlW/Vu 1u1C^n&A ,Tl^u - _. - — - --- • --_-- .._. G,t, Manufacturer e—g/v i Demand Model Number 7 <j-_'5'GP TDH I Lift t�4 Friction ��' S stemead�� TDH .d5 Ft LossForcemain Length, W Dia. 3 r Dist. To Well _N< SOIL ABSORPTION SYSTEM County: ST. CROIX Sanitary Permit NO.: State PI Parcel Tax No Y� •a, « <, ELEVATION DATA STATION BS HI FS ELEV. Benchmark IM-' ale. Bldg. Sewer Stl,�WlnIet St/ I�Outlet Dt Inlet Dt Bottom ��' He jjdk /Man. Dist. Pipe I o ,� �'oq y-/ Bot. System 62 fp' Final Grade I BED/TRENCH Width / / LengtDIMENSIONSh, / NO.Of renches PIT No. Of Pits Inside Dia. Liquid De th SETBACK SYSTEM TO P/L I BLDG 1. WELL LAKE/STREAM LEACH nuacturer: INFORMATION CHA R ype 7,7 System: /��' ' 3 ' Model Number: /Y; , e2 (0 UNIT DISTRIBUTION SYSTEM HBO" / Manifold Length 3 r Dia � Distribution Pipe(s) � Length � Dia x Hole Size,, /� x Hole Spacing Vent To Air Intake Spacing <%' SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth Of xx Seeded! Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No LOMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Ple nt Valley.17.28.17W, SE, SE, 170th Street - (�ei° Plan revision required ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05191) Date InspectorsSignatur Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: == \ SANITARY PERMIT APPLICATION `S< <�K% In accord with ILHR 83.05, Wis. Adm. Code C (J'-Y -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITARY PER1A k 8% x 11 inches in size. O^pF''/, ❑ t�eck3-3 -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION b„to evlousappllatlon ST�TF PLAN I D,f1U MKB - PLEASE PRINT ALL INFORMATION.J' PROPE ep Q k � PROPERTY LOCATION '/.5� o6Ewt . aL l-,: S'r %, S / 7 TZ9, N, R E (Ora PRO�TY OPINE 'S MAILING RESS LOT # BLOCK # CITY,TAATE ZIP CODE �S PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER a Al 1#10A� SYoEl IL TYPE OF BUILDING' (Check one) ❑ State Owned EJ CiLL4GE Pl� E x�AIT NEAREST ROAD ❑ Public L�J 1 or 2 Fam. Dwelling-# of bedroomsFAMULL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ APUCondo 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 PERMIT: (Check only one in line A. Check line B if applicable) A) 1. RNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit## Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pres�s�urr d Distribution Experimental Other 11 ❑ Seepage Bed 21 Mot. 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq, ft.) (Gals/da /sq. (Min./inch) ?Q / ELEVA ION Feet Ctz. 0 Feet Exper. Plastic App. VII. TANK INFORMATION CAPACITY in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. ConcreteCon- Site Steel Fiber- glass New isti Tan Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber Op0 Ll ! // 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' Signature: (No Stamps) MP Business Phone Number: h c�vi/ � p3aS8 15" Plumber's Ad real (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY Approved ❑ Disapproved ❑ Owner Given Initial San Permi�ee (lnc`udeseGrounndwater a eau Issuing Agent Signature (No Stamps) Adverse Determination' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R-08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber is 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. 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, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. 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. Vill. 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. SBD-6398 (RA V98) r ago - SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human RelationsS4 S -(}Jq Z 3 April 28, 1995 ULBRICHI 6 ASSOCIATES ROBERT ULBRICHT 655 O'NLILL ROAD HUDSON WI 54016 RE: PLAN S95-00983 BRADhOgp.._Bvo SE,SE,17,26,17W TOWN OF'RLEASANi:-VALLEY MOUND SYSTEM. M Last Washington Avenue P. 0. Box 7969 Madison WI 53701 FEE RECEIVED: 160.00 ;,..COUNTY OF Si CROIX The Department,has reviewed the,apoyp-referenced submittal. Con4fi�ional 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 oapter145,'Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Cade, 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,j he initial sanYtary permit expires.} The licenseq plumber responsible for/ this installation shall keep one set of plans with the ff6partment's stamp1of approval at the construction site. The instal-ler thall notify the appropriate inspector when inspections can,be spade:, }� _ All permits required by the city.,vjllige, township or county shall be obtained prior to installation. i Inquiries should be directed to me at the number listedn,below. Please refer to the plan number shown above. Sin ely, e y. eter Pagel Plan Reviewer Section of Pr ate Sewage ( 608 ) 266-2889 ORIGINAL ssw►awr�s.�wu r' I A 1� it rri" I iq 0 ULBRICHT & ASSOCIATES CO. 655 O'Neil Road a Hudson, WI 54016 715-386-8185 PROJECT INDEX DILHR Plan I.D. I S95-00983 Reg. Designers of Engineering Systems Private Sewage Consultants Date April 28, 1995 Owner Robert & Jayne Bradford Phone 612-436-6468 Address 2121 Oakgreen Ave. Stillwater, Minn. 55082 Legal Description Part of 40 acres. SE1/4, SE1/4, Sec. 17, T28N, R17W Town of _ Pleasant Valley/ Rush River County St.Croix C.S.T. Robert Ulbricht CSTM2482 Installer Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION New Construction, for a proposed 4 bedroom home. Estimated daily wateflow: 60C gals. Soils are permiable (.4 GPD/ft2) . but seasonally saturated at 25 inches. A very long narrow conventional mound system with..1101i sand fill is proposed. I,ty Co \� - �a`U�IYIIII/llUrya4ryry SCONS \►� u.� � yeti..-----.,,.j7, � gOP ND Vj IILJIitGff U\�\umm min mo Pg.l PLOT PLAN VIEWS EgPO gh.Sl GIAt; Pg.2 SYSTEM CROSS S Pg.3 PIPE LATERAL LAYOUT .,--Go ''SYSTEM PLAN VIEWS Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS Any use of this PORTS design by any licensed plumber, or any related unlicensed parties or persons (excavators, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet/frozen soils) by any such parties or persons. S95-00983 rwm CEIVL�u APR 2 3 1995 nLi—REAU OF RATER SYSTU" /o 4cte s 2�. /aft, D1 area P511, below the dowoslopl will of Ibl $Ili 64 NI kta No Roil 1010106 ,ma's �g1 B3 � • i rl pew O. 'o' /100 J,4 Preec tsr ' SET%C Tif�✓K ro SEwr<'12r e co v' c�le VATI OA3 S - (31 g9.70 (32 ofs 70 33 ge. z O is ' Toni/ of 3 '• pvc foRtE t/,4/� AGE SYSTEM 0 VNTS $ 'e"111d VE 01•- �" natty iti°-.Von SOc�(oEST@D M ov.�p S ySTEM ElEv�ro� w/ 9p.70 �f /19Leo X , So . IocgTFo tdaoJ edneovA--7e F6,v(E PaS T &q So r. 7of of /% X.P. 4�71&114 io0.0 895-00983 SCALE : I = VO . x !3,¢c,-6we_ P i'TS RECEIVED APR 2 8 1"5 BUREAU OF BUILDING WATER SYSTEMS r T� fo,e ¢a il-4!S 33 CROSS SeCT10k) of Mc)oAjD wir f3ED r 1.. c v 5 G, rkick',ses3 of To 5o(L UMi FORK Toe 9-1 A-) E 3 ` F `y e— RRTIO M6D e . p ' SAN D . lli llll plowto TopSa� L /• 0' F r. E / 2S t F r. F . PO FT• G /.0 Fr. H 1.5 FT. % SIOPE Oeo g5F 4 " ro ' A53er5ATE 'DiSTRi(Jt]T%o,j Pip6- sysreM Elevhriok3 90.70 111 i// iiq rl uu i FORM F'oRcE' Eir-OAT100 Uu0ER MAW BED SP 9. 70 " ELEVArlo►J S — • lmvF-Rr OF Y IATGRA(5 • ToP of Rack • Top OF ~ IATERAIS PLAN VIEW OF MouK)D -- wrrlt BED ORCE MAW t L - --- - 0 T I 0 G ` CAPPED Eta l! f35ERVhriok) off'\v\ 9/ 33 _ F T• Fr FT FT - Fr Fr Fr „ S95=00983 Bev of 02 To I F N RECEIVED �J9REyhTE APR 2 8 MS y��RMJ4UeuT MARKERS R�`,NAJ 1R s si> '�REAU OF � REcgviRep BASAL- hReh - 'p^''cy w/tStE Flow a SOIL r,)i,IrlQAT►uE 7 Sq, FT, C AVACi ry PROPOSEV BASH AReh .2 '� C + = 1 !G JeD s R. FT. �,. �.' � � � • ���� '` . , ` . � ; ..,�., . �•, ..1 t'�'��. �; � . . -� ; •CP-MTRAL MAA,3i FOLD DiSTR; 13U TIO AJ pipe uE1-woR k vi pvc CENTRAL ' MAO%FOLO '2----4" ENO CAPS —� Y. Y Z LAST lioIE 5 KA 11 RE NEILT' TO END CAP xuueRr 61eVAtloAJ �/. Z0, -p►STR► puT Io rJ LATERAIS puc FoRCE MAW R VOID VO (UM E FOR 1S Fr. d F 3 „ FORCE M Ai N g�►S. RECEIVED APR 2 8 1"S PERFORATED PIPE D E rA i L BUREAU OF BUILDING - _t_YATER SYSTES'S II VARiAZLE Y Y DISr^NCE P R x Y yo Fr 3.0 � � GE ally' ea�v Ale sCori "ove �►h J� z� DISTRi (5oTIVN Stt�^RbE Holes IncATFo oN B d'rrom SH A11 BE EgURlly Sphc.&D. S95=00983 Ho IE Di AKM Te R _ 10 L ATERA L 11 AN1 FOLD 'ca MA(o " OF liOIE5/ P j p E RATE PER LATERAL ' GtiI/MI>v TOTAL, l)15GkAR &e RATE / ►JerwoR IC ToT.tL o for- fr13o vE /o. Z y S-&Qs . S� y� GAL/ M,•,V 4"C.I. VENT PIPE �: 25' FROM DOOR. WINDOW OR FRESH AIR INTAKE �pnPr ��E U411CAl 90 3� If flEvAn cIv INLI-TI ET S�r O APPROVED JOINT w/C.I. PIPE EXTENDING 3' O%JTO SOLID SOIL ELEV. O'FT. ��N k '&E pid o IJ � IB vs1 r PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP WEATHER PROOF JUNCTION BOX GRADE PROVIDE AIRTIGHT SEAL r 3.3 PUMP -� BLOCK pA yE I of 5 APPROVED LOCKING MANHOLE COVER c w/ 4v VA) IA)6- IA S c / `I" MIN. ). ` le^ Mlu. ---------- - - - - - - - - - V APPROVED JOINTS W/C.Z. PIPE EXTE/JDIUG 3' ONTO SOLID SOIL 93•y�' RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOfJS DOSE IJUMBER OF DOSES: 3 PER DAS TANKS MANUFACTURER: /50 TANK SIZE: If 6AALLOAIS DOSE VOLUME 9.L //--o ALARM MANUFACTURER: I Fx4gL A i�lp/K MODEL NUMBER: �' U' L SWITCH TYPE: Maw YJV Ale r PUMP MANUFACTURER: Z��/l`�rV n L MODEL NUMBER: / 3 7 Vy INCLUDING BACKFLOW= GALLONS CAPACITIES: A= /'�' INCHES OR 42V GALLOWS 2 INCHES OR J o GALLONS C . �' v IUCHES OR /ao GALLONS D 60 INCHES OR 0 GALLONS SWITCH TYPE: nJ9yBAt4t rtfmt&RL r/gh- NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE SS GPM INSTALLED ON SEPARATE CIRCUITS SPlucs VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..6.Z FEET A�R , + MINIMUM NETWORK SUPPLY PRESSURE �/. . . . . .. . . . . 2.50 FEET EAC(4, + E FEET OF FORCE MAIN X •jd F/O0rr.FRICTION FACTOR.. ' /o FEET tgOA'S Z� — TOTAL DYNAMIC b' 9 HEAD = FEET 4rf INTERNAL DIMENSIONS OF TANK: LENGTH /d ;WIDTH "6 ;LIQUID DEPTH �leo ell PRIVATE SEWAGE SYSTEM conditions Y I SEE 995-00983 RECEIVED APR 2 a 1"5 BUREAU OF BUILDING WATER SYSTEMS P� . s ©F 5 Pj HEAD/ rit s CAPACITY e CURVE SEWAGE and DEWATERING 24 22 M is is ,9 12 to • S • mlua tf"m • 20 2• n EFFLUENT N and DEWATERING x U 20 is F O 14 12 ,0 • • 2 e MEN 11 MENEM 0 NEON a ON POP ME 1211 No M, CNN EMEME MULE M ME NONE m M 1M 2M "a 400 4" 9" so 720 FLOW PER MINUTE "137" Cast Iron Selves so ,•0 260 320 M• FLOW PER MINUTE 595-009.83 ZffZ1 4ff 3260 OM MMaa Lam P.O. Bat 16347 LouAmMai KwMuekr 40210 (507) ""731 "139" Bronze Series * ape 2 a F • Automatic or Non -Automatic. �>SIRrER • 'h H P., 1 Ph. 115V, 200-208V or 230V • 'h HP, 3 Ph , 200-208V or 230V • Non -clogging vortex impeller design. • Passes'j inch solids (5phere) HEAD CAPACITY UNITS/MIN stars Gal Ll,s 152 to 39a Sj O 3 0a 79 300 I5 a 57 6a 242 20 6 10 36 136 25 762 9 30 Lock vale 26 • IV' NPT discharge OlNled ca„l t,a„Sla�da ,n • Float operated, submersible (Name 6) meth- •,,, •hln V.+' anical switch • Automatic reset thermal overload protection. (apenf 137 Serla. SC 2225 • Stainless steel screws, bolts, guard, handle and 139 Sarl•a 9•4115 arm and seal assembly. -010naa motor and pump hoosing. switch NO] E No UL listing Ini A10 208V' 1 Ph cast Mae and impa7Nc Pm111's Mercury ]bat switches we avadaeN lot rrpn-automatic modals Yvlsconsin Department of Industry. Labor and Human Relations eLt1_— .I CAI—n. 1 O. iLi.w. JD tiQ Nt L.Lh hP'z pa„ of SOIL AND SITE EVALUATION REPORT 10 S' ^c1es Pap —Lof 3 ST GRd%X Attach complete site plan on paper not less than 81/2 x 11 inch -s an must include, but '6)t PARCEL I.D. ! not limited to vertical and horizontal reference point (BNB, cJi �r;d scale or dimensioned, north arrow, and location and distance to 8(e REVIEWED BY DATE APPLICANT INFORMATION -PLEASE PRINT F PROPERTY OWNER: Ro13ERr 3 SAyvE �iPi4%� FR 2 I} PROP ATION �� J' . C- 1145E 1/0 7 T 2 9 N,R 17 E(W^J PROPERTY OWNERS MAILING ADDRESS 2/2/ o�4it'G�Pt-E�✓ Aae • 7fo z s, � ,, LOT! OCK! SUED. NAME OR CSM! �° er o 4o AGLCs Cl STATE ZIP CODE Pl. E I • .. • �1 i%/GrikTle /�1N• S d Pi (G/aJ-layG00 ®rr-Y JOVILLAGE &MN , /Eh NWT UM/FV NEAREST ROAD 1 /70 I Oew Construction Use I y'Residential / Number of bedr` I I J Addition to existing building I I Replacement I J Public or commercial describe Code derived daly Ilow &oo gpd Recommended design loading rale T bed, 91XW ' S trench, 9PdMt2 Absorption area required 5?IV bed, trench, n2 Maximum d" loading rate -bed, gpd/n2 ' S trench, WW Recommended infiltration surface elevation(s) S.e t 3 - 96.7 e n (as referred to site on benchmark) Additional design I site considerations S%TE u % /E 0.; e-lc:ie Parent material $CS iRE O.v . S. tT S-Di ew Flood plain elevation, 'rf applicable n S e Suitable for Splem CONS ❑ U IDS ❑ ROLx 0 P SSURE AT -GRADE ❑ TSBA _ FLL [� ANK ❑ StNG� U = Unsuitable IOr stem Boring # 13 Ground elev. �9•zn. Depth to limiting law 150' Ground Depth to limiting �1T5 I $SS Remarks: J>toTiv� S�DEk�il!/ .S'EEp�i GE R:—Please Print I`2• o(3ER1— 74LI3R jCLiT— Ce55 O'OeiL '?D. HURSo,J 4.9t . 5g01 !o ORIGINAL SOIL DESCRIPTION REPORT in. Dominant Color Munsell Moules Clu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence � , Roots GPD/ft Bed e io � 3/z- i/ Z Z s,6,e lwy, eis' Izoepth /oYN y y �- s,/ 2,m sAe 4mf/?- 7c, 2 /o Y,v 4 s z 5ie 4„vt cs /vf . s - /o y G S/ 24.., Ae infe CS 7• 5- W rsemarres: -� --• . — — - — 0-7 /o Y4 J/i rd . 2-F Sik ufR S 5• i . 61 3 s- j-51 to vie y/- s s _ /o yf y C z y S/ Z,W Sbk 4.47T CS — S •G Sc/ z,,,, b� f, — • 5/ S Phone: 7/5- 3PG d / c95— y-17— 947- C5r�z y i'z IINAL PROPERTY OWNER RAWFO RDS PARCEL I.D. # SOIL DESCRIPTION REPORT Page Z or Boring # v:, Ground elev. 99. io ft. Depth to limiting factor , r 24 Horizon Depth in. Dominant Color Munsell Mottles Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. Roots GPD/ft Bed ranch o o yje cZ ek so AJ Remarks: ^ CT/"UE f T- Pep •• Boring # 13 Ground elev. 0. Depth to limiting factor Remarks: Boring # 0 Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to gmiting factor Remarks: cnn n�on•o nc nrn I � j 8� 8j s� �3y' 90 c /0o� _ 33 134, If Ic I F/ev4r�o.v 4O 1aE Iv CIE VATI DK)S (3 1 g9.70 (31 1y70� sac�� Sr�t7 M ov.�p S y STEM ElEv�r�o� w/ I�'� Ss1�D Fill = 90,-70 �I o,e Iac77to �vaov �o.P�Eie F6.vtE ,00sr - 9r T� f r •I � J.4 G SCALE FOR QUARTER SKTION d Each side large blue squares . 10 chains, 40 rods, 660 feet. area of square 10 acres. 400 FR=1 Inch Each side small red squares — 2.5 chains, 10 rods, 16S feet. area of square .625 of 1 acre. gg311a5 g51/ 35 2- I � F/.z v Ir7 3�/// ra9z14.v 7v NeLA b I Wf--- — — — wf 1 g'73//// � loaz/�3r I /zs T� J Me ft /n Cr ✓✓ e� o, SCALE FOR QUARTER QUARTER Each side Jorge blue squares . 5 chains, 20 rods, 330 feet. area of square 2.S acres SECTION, 20OFt.=1 Inch. I Each side small red squares = 1.25 chains, 5 rods, 02.S feet. woo of square .15625 of 1 acre oo^uT^ rAmn 'n An u'n rurr+ --- STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER /T © ,OjFQh 7' 4 A.O aOL Id __!F© hd MAILING ADDRESS a 1 a l 0 AK 6,k1=fN A v ►—�. SQ11[")SATE A MAL PROPERTY ADDRESS 33Q % 7 / yX "J r (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION _9 j �1//4, s 1/4, Section t7_, T;2 9 N-R / 7 TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME_, PAGE , LOT NUM 3ER 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. VWe, 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: DS-aa—� [�•� St. Croix County Zoning Office Government Center I101 Camiichael Road Hudson, WI 54016 1 1 /93 8 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 p,6 OF /'-r I,/ - 41� 0-61 fO /•, Location of property j� 1/4 94: 1/4 , Section T ;R TN-R_Z 7 W0 Township / L.+a-S,4'/7Lailing address Address of site 3.3 D / Subdivision name r Lot no. Other homes on property? tYes ✓No Previous owner of property j O �[ 6k to a IyAl Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house)? Yes ( No Volume V 13 and Page Number 3L 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. _4'�P 93 �, 5' , 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. CiIS Signature of Appli nt Date of Signature Co-Appl Date of Signature