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HomeMy WebLinkAbout024-1043-60-000St. Croix County Planning and Zoning Tuesday, September i8, 2007ar! 7:44:53.4M Detail Sanitary Information Page I of I Computer #: 024-1043-604000 Sub/Plat: 40 acres Section: 33 Parcel #: 33.28.17.283 Lot: TN/RNG: T28N R17W Municipality. Pleasant Valley, Town of CSM: 1/4 114: SW 114 SW 114 Owner: Manns, Todd A. W 170th Street River Falls. WI 54022 State Permit 240775 Issued: 08/22/1995 POWTS Dispersal: Mound 24' or more suitable soi Permit: New County Permit: 0 Installed: 09/07/1995 POWTS Detail: NA Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Mary Jenkins Yes Jim Thompson Signed Off Yes Maintenance Scheduled Pump Dale Pumped 9/7/1998 11/21/2006 11/21/2009 Plumbe Other Requirements Additional Notes Money Owed Stang, Joe Midwest 1250 gal. septic to 1000 gal dose tank to $0.00 6' x 84' mound cell 1st Notification 2nd Notification 3rd Notification 04/20/2006 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TO d Yl yj � ADDRESS J��/ U N 2 h � SL 4 d o I SUBDIVISION / CSM# LOT # SECTION 33 T 2 FN-R_L_:�_W, Town of i' / e 4 S A 14 t 1/G {/ t y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 36 , a�` 32 tSl Y, i t'1 I i6 t� st Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 2 BENS t v OC ALTERNATE BM: G� O t-ulq / SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: M C d w sC C" .N Liquid Capacity: i 2 U U Setback from: Well House—_ Other Pump: Manufacturer 2 D e 1 Modelq l % I Size Float seperation 13, _ Gallons/cycle: 3 Alarm Location M t? SOIL ABSORPTION SYSTEM Width: Length y Y 2 Number of trenches Distance & Direction to nearest prop. line: of Setback from: well: House ho o Other ELEVATIONS Building Sewer= ST Inlet. S PC inlet T outlet — PC bottom 7 Pump Off Header/Manifold— Bottom of system_ Existing Grade— Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wiscoisin Department of Industry, Labor and Human Relations Safety and Buildings Division GENERAI, INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permit NS , older's TODD & ELLEN Na ❑City Village IR Town o CST BM Elev : Insp. BM Elev.: BM Description: plaa%zant Val TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (✓ JP G / 1 J Dosing /0(� Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Au Airi tontake ROAD Septic ) f _ NA Dosing NA Aeration Holding PUMPI4NFORMATION Manufacturer o �((% �,� emand (0 +GP Model Number it / L t TDH I Liftj.�tp Friction (,3 S stemLoss�,� TDH3Ft Forcemain Length Dia. cjiI Dist. To Well SOIL ABSORPTION SYSTEM to ounty:ST. CROIX Sanitary Permit No.: State P an 10 No.: Parcel Tax No.: ELEVATION DATA a� STATION BS HI FS ELEV- Benchmark Bldg. Sewer St / Ht Inlet St/ Ht Outlet jo 7L o 1 Z Dt Inlet Dt Bottom ddCa�a/ Man. ` Dist. Pipe 3• Bot. System ! D Final Grade BED/TRENCH DIMENSIONS Width Length No. Of T enches PIT No Of Pits Inside Dia. a th SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA acturer: INFORMATION CHAMB Type e M e System: I -- OR U DISTRIBUTION SYSTEM k{vilw! Manifold Distri ution Pipes x Hole Size x Ho a Spacin3 Vent To Air Intake r Length 36 Dia op Length Dia �_ Spacing (o l VIP SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded I Sodded xx Mulched Bed / Trench Center Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCA ION: Plea ant Va11ey.33.28.17N1, SW/, W, 170 street pe dA.�^ - 9/�7/f 6• Plan revision required❑Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signatifire Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division IL.�IR SANITARY PERMIT APPLICATION Bureau of Building Water Systems 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 Q' than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number I O �� The information you provide may be used b other overnmenta agency programs Y P Y Y 9 9 Y D o9 ❑ Check d revision b previous application (Privacy Law, s. 15.04 (1) (m)l. Staff Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF M TI N 1S4 Property Owner Name Property Location Todd & Ellen Manes SW 1/4 SW 1/4, 5 33 T 28 • N, R 17 Yor) W Property Owner's Mailing Address Lot Number Block Number 16780 2nd. City, State Zip Code Phone Number Subdivision Name or CSM Number Lakeland MN 55043 (612)436-6855 II. TYPE OF : (check one) ❑ State Owned ity Nearest Road Public 1 or 2 FamilyDwelling- No. of bedrooms 4 Towan OFPleasant Vall-v 170 th. III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Num�beer(s) / ` ) q, — � O 1 ❑ Apartment / Condo I 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- Id New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ____ System _____ ___Tank Only __________ _ Existinc�System ___ExistingSystem 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 ® 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq- ft-) (Min./inch) Elevation 600 50Feet Feet V11 FORMATION Ca at in gallons Total Gallons S of Tanks Manufacturer's Name Prefab. Concrete Site Con- Steel Fiber- glass Plastic Ezper. App New Existin structed TankTanksl Tanks Septic Tank or Holding Tank X 250 1 Midwestern f] ❑ ❑ ❑ ❑ ❑ lift Pump Tank /Si hon Chamber X 1000 1 1 Midwestern ® ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility or installat n f the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu r'sSignature. ps) MP/MPRSWNo.: Business Phone Number: Joe Stang d MP6646 1-715-698-2266 Plumber's Address (Street, City, State, Zip Code) 506 Willow Drive Woodville, WI. 54028 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved rotary Permit Fee (ImiudinGroundw.tt Date Issued issuing Agent Signature (No Stamps) Approved []Owner Given Initial M Swchorye lee)dr �5 Adverse Determination 0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO-6390114 OVA) DISTRIBUTION: OrigirultJ Counly, Onr copy To: 5+lely BRYll,il �s Diunion, Ilwnrr.PWm6tr INSTRUCTIONS i. 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: 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 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 7. Vil. Tank information Fill in the capacity of every new/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 1/2 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 1 15 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 contamination investigations and establishment of standards L, - SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 29, 1995 E- ULBRICHT 6 ASSOCIA ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S95-01896 MANN, TODD SW,SW,33,28,17W TOWN OF RUSH RIVER MOUND SYSTEM i dl-1 201 East Washington P. 0. Box 7969 Madison WI 53707 FEE RECEIVED: COUNTY OF ST CROIX The Department has reviewed the above -referenced submittal. Avenue 180.00 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. Since Peter Pagel Plan Reviewer Section of Private Sewage (608) 266-2889 SODA 79K 1R. IYNI 0RjCtNAL ULBRICHT & ASSOCIATES CO. 655 O'Neil Road a Hudson, WI 54016 715-386-8185 Reg. Designers of Engineenng Systems Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. A S95-01896 Owner Todd Manns, Ellen Manns Date 6-29-95 Phone 1-612-436-6855 Address 16780 N. 2nd St. Lakeland, Minn. 55043 Legal Description Parcel # 024-1043-60. Part of 40 Acres. SW 1/4, Sw 1/4, Sec. 33, T28Nr R17W Town of PLEASANT VALLEY, RUSH RIVER County ST. CROI C.S.T. Robert Ulbricht CSTM2482 Local Authority/ Supervision PROJECT DESCRIPTION Installer St. Croix County Zoning Dept. New construction. For a proposed 3 bedroom home with office/den type room. System will be designed as a potential 4 bedrm. sized home with an estimated daily wasteflow of 600 gals. 0 Note: per information and specs given to designer by owner: basement floor will lie approx. 8' below existing grade atNW house site corner. IF THE BLDG. SEWER IS LAID DEEPER THAN 4' BELOW FINISHED GRADE, NORMAL PRECAST TANKS SHOULD NOT BE USED. INSTALLER SHOULD USE ONLY HEAVY DUTY BURIEL TANKS FROM WIESER CONCRETE. Also recommended, site manhole cover on septic tank over the outlet end, to provide for a Zybol tank filter. Soils are fairly permiable, but seasonally saturated at 2611.Design loading rate is .4 GPD/ft2 for beds. A long narrow mound system is proposed. Pg.l PLOT PLAN VIEWS a Pg.2 SYSTEM CROSS SECTIONS A SYSTEM PLAN VIEWS P9.3 PIPE LATERAL LAYOUT Pg.4 DOSING CI P9.5 PUMP PER Any use of this POwTS design ty 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. u k S95-01896 a Li — r�leuht7'o►�S — /3 of ECO R Af E>vO EO lgep V14JAP s y cC-, ILftV 1,9 /S• p= EXISTiv� feAVF e5'/&"r/xu RIVATE F, DEPT. OF SEE /I0 U 4 Sch�E:� • = p rs / n 87,o /2% S-.P. 7-- .s�pric T. /000 P-9 A/c 'i Do eye IDNIIIe lilt 9IN all �blI � III�II IRIS . — Pj , / 0 -4— -- S95-41896 CROSS SECTION of MOOOD wi rti SeD Fl t or 5 V ST RiGoTt o,j G rNiCKSVs3 PiPfNG- oF r'>P sort I , dui FORM TOE' wf N RhTiO M6D. ! �9 //// PIewSO TopSoe L _ \ 13tc of % " ro i� AllecSATE sysreO elevArioo -- . ' � \ uu ► FORM G % SIopE FORCE 61eW1[ioa vu�ER HAi� , f3ev 9 P. is d Fr. — ELEVArlo►-� S — E Fr. INVERr OF �2 F • �S _ FT. /. D • To P o F R cock H /, S FT. s(sjv`To p OF z G� .e. of _*1alll „ - v B IT w-------------- -- - k yl � W IATE-RAIs IATERAIS 717 P3 A Cv F r• Fr. k F r= 10-53 �- F r- cos. a6 T 8 F T. r /y Fr W 30 FT- aen PVC cgppsD To 1. C'SSERVArl0&3 R53PEIATE� Pipes �595-01896 PERN/1,��uT MhQkERS REouiRev BASAL AReh SOIL 10fil'MATIOE !�/ C APAci rY Sa. Fr. PROPOSED BASM Meh = X (A + Z 4�x(4+ /Z/ sQ, FT. D%STRIf3uTioA1 p►pE NErWoRK LAyouT ?oi,fL ti6 T uio.PK !ia/U.aE' 2 � . 3 E*-(S �j FoRcE MAi►3 �5 Fr. of Z MAOk VOLP TOTAL VViD VoluhE 29 6A15. , H olE 'DiAmeTE'R L.hTEPAL � FORCE" MAIN -tr of HOIE5/ pi pE INCHES 2 INtI}�5 Z I,.ICI{E5 Z IucF{ES R\ P g7o Fr R 3.o Fr X Y _ II�cFjF, VARi*Af3LE 1 Pi STAP.3 C a l ZuVERT ELEUATloa OF LATEIN 5 "DETAi L + toD c^P PER FOP, PIPE Q] • ReMovE h11 DRill BURRS \ y S 95 - 0 1 8 9 6 • N61ES IdCATEd o,J BOTT0AA EgU.Ally, SPACED . INSTRi (3orlo,i 'DISC►1AR &E RATE FOR EF^ch LArERA L PsR O 5 GAL Miti1 al. f65 TOTAL l`7iSTR1(30TIo►J 'D15CVJAR6E RATE r-OR NET WOR IC lt->� GA,L JMi'A). /f �.�j' MINI MU M k8.9 3 / ,PO�OSED i°✓ 9pP,eox. 5.o' o.Q .�roc°E \ 2 -79. of &.f eg To 1Se Gu041- �.(%srIN� PUMP CHAMBER CROSS SECTION AUD SPECIFICATIOMS p,4 E 4 of S 9,e,pE- --y-- �T O VEWT CAP 4" C.I. VEIJT PIPE WEATHER PROOF APPROVED LOCKIAIG JUAICTIOA) BOX MAMHOLE COVER 25' FROM DOOR. 12�MIU. �{ ` ^ wl wgolV(� 1A/SE� wIAIDOW OR FRESH G<~ S s A..IR IMTAKE Se0 i�^PE �/E p 19/On/ GR��� • Q� I y 4"MIW. —41 Al I N co �----IB'nlu. flevtrn /4v -7Q, 0, IQws R WLET1 I ----- GO APPROVED JOIIJT I�151 J1� 5 I III W/C IV011JT5 PIPE w/C.I. PIPE 1 oM I I EXTE►JDlub 3' EXTEHDIAIG 3' '06, -10 I II ALARM OMTO SOLID SOIL 0MT0 SOLID SOIL B N I II ' ` I I 3,3 (`o 1 I I ou �S I I LLEV. FT. PUMP --� � � OFF 'gECUW (r o is N k y BLOCK �iEVAr �o,J RISER EXIT PERMITTED OWL4 IF TAWK MALIUFACTURE.R HAS SUCH APPROVAL SEPTIC E SPEC IFICATIOAIS DOSE /�I1ES0 ek��� �• jIUMBER OF DOSES: Z PER DAH DOSE MAUUFACTURER: �J oe TAWK SIZE : �` v'� GALLOWS DOSE VOLUME 2q 3 29 ALARM MAIJUFACTURER: LfVEZ `lG /IMCLUDIIJG BACKFLOW: CALLOUS MODEL WUMBER: D, o -L CAPACITIES: A= /` IMCNES OR GALLOMS SWITCH TYPEil : M E F C v Z IMC/IES OR 5-0 GALLOAIS PUMP MAIJUFACTURER: Z�Cwg -,/-�3�1 IUCHES OR �GALLOMS MODEL MUMBE1. /G� A� 11FAp y5l• HP D- IMCHES OR 22/ GALLOUG SWITCH TYPE: llepevRe�y 141,4r MOTE: PUMP AMD ALARM ARE TO BE INSTALLED OIJ MIWIMUM DISCHARGE RATE��L3✓ GPM SEPARATE CIRCUITS VERTICAL DIFFEREIJCE DETWEEIJ PUMP OFF AMD DISTRIBUTIOM PIPE.. 17, L FEET ���ILATE ` S�CC S + MIWIMUM WETWORK SUPPLY PRESSURE . . . . . .. . 2.5 FEET EACIn 011- y{ i ,/ 7.8 7 + Z77 FEET OF FORCE MAIM X � F/0OFxFRICTIOIJ FACTOR.. FEET f(�Vn'S q JA� �'y r TOTAL DyWAMIG HEAD = a FEET , 3y 57 INTERWAL DIMEWSIOWS OF TAUK: LEWGTH /o ,/ ;WIDTH OV` ;LIQUID DEPTH �U //vST.4//�tTrcyv .uoT� S95-01896 sw,-Tc-& fa D sF s►f7u Aow,- ,�' �.vif L J�iPr1Df P�.sOFIpy HEAD/ CAPACITY CURVE SEWAGE and DEWATERING I 34 tt ro 1O 211 EFFLUENT and ° ItsDEWATERING = 2 Es o F 0 14 12 ,0 e 6 4 0 DIAL MEMO MEMO ►Ns N■■ .■■�. .EMM ■� �\\�►i\\2■MEMO �M■MMM ������_► laM■E■ Now I -PA ■■■■& ■■ NO ME , , E� ►� N■WM■ 69 a so is ■■i�� NEON LITERS 0 so Is$ w aM 400 FLOW PER MINUTE I ' 4 » Q » ' moon E • 32M OM MMNn Law oALLOMO to r♦ n w so MI » ssl se 1es 11/s 1r0 ire 140 100 100 1`e 180 100 L0F.O.. Box 16N7 I I 4 vM•, Kerlh4cky 40216 Lr1M• e so 100 sn tre 4w 4w sse w rre (662) 776.2731 w nowP"Nmww S 95 au7 b HIGH HEAD / "185"-"188"-"189" Series HP) (1 HP) (1 HP) (1 % HP) (2 HP) • Automatic or Non -Automatic. • 'h H.P., I I5V. 230V, 200-206V,1 Ph. or 3 Ph., t�JM( 460V,3Ph. t^" • t H.P., 1'Fi N.P., 2 H.P., 230V, 200-206V, 1 Ph. or 3 Ph., 460V. 3 Ph. • Passes VYl" solids (sphere). sc 1729 • 1'h" NPT discharge standard. • Float operated, submersible (NEMA6) 2 pole mechanical switch. • Automatic reset thermal overload protection, II Ph. only. • Durable cost Iron construction. .l.re wl r r r r In ♦ V N l". N l.. N lY. 0. lw♦ N In lw, IN b If , .. .. •n a >v We W ♦r l Iw In .. IV .. Y. all • »r lam low .. »W w m r m In 111 In I y .. y .•) u )w 'l )lt IS M 111 OI • , IY )1 ZA el Al •» M r N r R >A M )1 Y r In Iw• v✓.. Y r v ,. l.. nl • 2" or 3" flange available. © • 20 ft. UL listed neoprene cord and plug. listed A.W All—W ...n,n4 Na-Automat[ WARNING: Model S5 should not be subjected to less than core No u� elrnu for aa07oavn Ph pumv! I,IMwI rmlurM 30 fell TDH. Mercury hoer awffcha as e.effede I for om-aufomefk model. Wisconsin Department of Industry Labor and Human Relations Qivision of Safety R Buildings .. JENSo,,� 3 k. 'JEvF/. SOIL AND SITE EVALUA/'' \\ IIRZ[ in arrnrri with II WR .J, Page / of 3 ^t N�XNI - � Attach con ete site an on paper not less than 8 1/2 x 11 inches in siz PI PI P P . PI must�it�yde, � o ST �Po/' X L I.D. A not limited to vertical and horizontal reference point (BM), direction and pe, scab or dimensioned, north arrow, and location and distance to nearest road J� /O 3 �o O APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATI��ty+ WED BY DATE PROPERTY eWNERWOY: R OCATION �L �r8E,P 'TOOj7 10if VA/ 1/4,S 33 T 29 N,R 17 E( W PROPERTY OWNER'S MAILING ADDRESS 2 ,,,.,o sr. xo • LOT D. NAME OR CSM it PART of 00 /+cte5 CITY, STATE ZIP CODE PHONE NUMBER G 10A.u. 550V3 (cd24136-Co8S5 ❑CITY ❑VILLAGE OfaWN Rust+ RruER NEAREST ROAD i70*iL- 5T'. [ 'New Construction Use [ 41'l esidential / Number of bedrooms 3 * 014{i CA— [ [ Addition to existing building [ I Replacement g l3-=,Po"s) Code derived daily flow fo o o gpd Recommended design loading rate bed, gpcV t2 S trench, gpd/ft2 '�/ Absorption area required bed, 02 trench, 02 aximum design ing rate 7 bed, gpdM2 • 5 trench, gpdm2 Recommended infiltration surface elevation(s) 5,r-e • 3 ?5 /S" 4as referred to site plan benchmark) Additional design / site considerations ZlS&- 40A3 - Nh- Ro W N «utiON c5 uti0 Parent material 5CS 93 v/A5.4 r - s4Sra-;vF.Jrs Flood plain elevation, if applicable 4 It S =Suitable for system U = Unsuitable for stem CGfJ1r�rTl [IS L'tU g ❑ U N GROUND PR�ssURE ❑ S Lev ATGRADE ❑ S � SYSTEM N FU ❑ S ad HOLD ElS;3 TAW QT- Boring N Ground q el l0- /7-ft. Depth to limiting factor r --X— Boring # 2- Ground elev. i� /L ft. Depth to limiting factor tr 2Ce 5.5.S. Remarks: Name: —Please Print Rd pER1 Z LA P-i Ca ... : 455 0rA1IL- I 1219• 14000-3 1,01 3ftrre: SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell fvbtlles Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. Corr istence Bourdary Roots GPD/ft Bed � / o- 9 io YX 3/3 5//. z f s6,e nMfR 2 -30 /o yk 7�(o s/ 2 4" ct n., o5e 3 o 7 /o yk Vl �' �' sc/ / lc she /►4 fi' � _ z .3 ffo zo v 2.. ,q•,P /o Vie /3 7- ,,+tiO A Remarks: ACT"UE &6-40 SE�i},f,E��3 6 ~ /0 Vie 313 5Ak 40-FR cs z . s .G 2 f - 2& /o uk f// Sc/ �-F shK AV, i 5 /f- y S- 3 2&-Vf /oM 5/ S R SG/ Z�•, 6K n�fR y S `[AAL Phone: 715 - 3 P & ' d /8 sya� y- y- �s- csrM ay�L Date: CST Number: PROPERTY OWNER 7. J*0A.)S,00 SOIL DESCRIPTION REPORT Page of PARCELIAt '%9 Afe,&O — 0 1 OL13 - C4P 0 Boring # ED Ground elev. Depth to Smiting factor —X� :555 Boring # [a Ground elev. Depth to Irnifing factor i/ 2219 5-515* Boring # 13 Ground elev. ft. Depth to limiting factor Boring # 13 Ground elev. ft. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Ou. Sz. ConL Color Texture Structure Gr. Sz. Sh. Consistence Bounclary Roots I GPD/ft2 I Bed rTmnch 0-7 /0y9 3/3 5,, 2- -f :5 be A"fR C5 3rob1 . .'5 , 6 2- 7- z7 lo Y,4eo ,3 7- LeA /0 YR 50" 2- 6K- s 5;C 2. A% bk Au-FK 5 Remarks: =mom mom HIM 111MMMEM Remarks: Remarks: con 61,610, ^U r, , 9 M 1lr� vl O ,,�-,ram^ i✓�`^ '! — Flevhn'oaS — No, P.PoP�.pry L�tit q � w w,? 3; J `'f Ecd �v�E-vvEO �lov,�0 5 y sT�•H /10 6A4 - 10 a 40 u 9G� L �'L O C i � O4 7 170 L IN 9� Scn�E = lrm"E Pir.5 o= /S/!5&-T. TO/ uvp&i 6,1A6P. r1OA.J = - p� . 9 &-f 3 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER(BUYER Cy&,2 �rScrn/� S MAILING ADDRESS �� %Rr✓' % /Y PROPERTY ADDRESS J ^7 /r,<7 t1l (location of septic system) Please obtain from the Plabning Dept. CITY/STATE PROPERTY LOCATION S(a) 1/4, 12LJ 1/4, Section J 3 , T_,�N-R_Z7 W TOWN OF %"/dtr_,�dn7 ��a ll��i ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME j r2 ;PAGE 30 G, LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year a piration date. SIGNED: DATE: J �7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will -only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property Location of property CJ 1/4 -5L 1/4, Section T�N-R­LZ _W Township Mailing address Al tj el, 0`fG Address of site 17 %T�' - /},�Pr ,l'� /�� �✓, ��GGz Subdivision name Lot no. Other homes on property? Yes 'x No Previous owner of property Mom, ,o Total size of property 1�� '4Cr&S 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//?`' and Page Number 3 kO 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 owners) 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. _S 2 9 & $e3 , 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 ffice of the County Register of Deeds as Document No. s�$6-Y� ignattlre of Applicant Co-Applican z/zZrlf� � 12214 S Da e of Signature Date of Signature