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HomeMy WebLinkAbout028-1042-10-000 p Gen o (D 0 0. 0 ~ I b I O O N N I I I I e Z c LL c O 3 ~ I a I M a CD e Z y d d M H LU a m _O O Z :!t d 2 Z N H r E -o Cl) o I c • N N p ° L I 0 z z O z N N C E c E L m d .yam, ` C c (O ca w y m am 0 g °o I 0 0 0. .0 U) (D g 04 w p ° ({A~ U) U) a = N 0 0 0 z o •N ~ ~aaa ~ U.) LO a _ sc ° S y (A J UN m rn rn } 22 ~l } o o 0 D co o w O E co ° g p m p c (L p N 2) c ~ ~ Q ~ (n i0 v o U y c Ai o Q p o v c E° o y c r°n v a r c 04 v a p~ y` y t ay+ ° 7 co y r° H C • O M U) N° Z 2 19 2 (n € a v v~ EL La m CL 4, +r E •c A ciaa2 OU)U ~ J wnconunDeoa•v-/ntOf lndustry. :)UILUL':)%.I%Il IIV1e ItLI v1% 1 Labor and human Relation% : U 401 •^d (Attach Soil Profile Location Map • To Scale • On A Separate, Signed Sheet) Nladlton.: . Page C AWrr 10l aVAL,OAta elHM01TWOVW V[O GOVex1 ►Ane11T WIeA4A KO/bAVKT I~Oryp nl.N LLL A0011CSa crrr TAT( L/ C/~/1 ft/ • iviTLWO►OOrdH. Ca.':Qer < A (r e- i ✓ , CCAIC" DORM ! f67WMSN/A1t►M[I/jfry tAxlAnCe\ U l ✓"t^ 1 L 1'7 id CSUr lW IIeeLACI # LoT al_oclc SUBDIVISION L-11 - 3. Horizon Depth Dominant Color Mottles Structure Limiting Factod Loanng.GPD sv Boundary Depth Trench Bed In ) 110 Munsell u. St. Cont. Color Texture Gr q. St. Sh. Consistence L7"OFO" ls 6 d _ :lcv - uJ ~ 5 c G5 • Q Horizon Depth Dominant Color Mottles Structure Limiting Factor/ LoAang.GPDYsc In. Munsell u. St. Cont. Color Texture Gr, St. Sh. Consistence Roots Boundary Depth Tnneh old -1o~ • Elev = (7~~ Ley srL r f c d -2 rh r. rench GPUC B_ /Horizon Depth Dominant Color Mottles Structure Limiting Factor/ '.Trench Bee In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bounda Depth P 31-' as ►I a('0 Elev v;. C / !5 G i C 3q -y T B, IHorizon Depth Dominant Color Mottles Ytructure Urnlling Factor/ Load-ngGPDs In. Munsell u. St. Cont. Color Texture Gr. S't. Sh. Consittence Roots Bounda Depth Trench Be< Elev 16 If J 3L 0 19-V ~ c- ~Jd i c B.. Horizon Depth Dominant Color Mottles structure Llmliing Factor/ loan^9aPty' In. Munsell u. St. Cont. Color Texture Gr. St. Sh. Consistence Roots Bovnda Depth Trench B1 Elev ca Additional Rcmarkt: RECOMMENDED SYSTEM TYPE: Other Site Features: .System Elevation CSTSIgnatur Date Signed Telephone No. CST Name (P(int) City state ;-,ip ( moo' . _ . f ~U I 1 ~ BY os- V/. STC - 104 R AS BUILT SANITARY SYSTEM REP OWNER ADDRES,,,(o7- SUBDIVISION / CSM#/ LOT # SECTION 35 T N-R W, Town of_ PL ST. CROIX COUNTY, WISCONSIN -i~~' PLYip VIEW S OW EVERY RING WI HIN 100 FEET OF SYSTEM `C4 vr' . a C ' W `Gam i I, 4,71 ( . i /t'f a'a INDICATE NORTH ARROGq Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: [7_ ©v ~I ~(t~ ~/o ALTERNATE BM: SEPTIC TANK PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer:{120~L4-)ccs e~ ~yecG~ Liquid Capacity: Abe ~S-c~ 74 Setback from: Well [;:~O House 36_' Other Pump: ManufacturerModelt~ Size Float seperation Gallons/cycle: 14!Z 2 Alarm Location SOIL ABSORPTION SYSTEM Width: Length -7'5-- Number of trenches Distance & Direction to nearest prop. line: /75 Setback from: well House 3 O Other ELEVATIONS Building Sewer ST Inlet. 3 ST outlet g 7 i PC i n 1 e t PC bottom 0C)__2_) Pump Off Header/Manifold Q Bottom of system g Existing Grade Final grade DATE OF INSTALLATION: _ (1) C' PLUMBER ON JOB: e 1~ 2 O~~ 4 LICENSE NUMBER: r~'/zS INSPECTOR:- Q-1 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State SMITH, MARK X CST BM Elev.: Insp. BM Elev.: BM Description: RIVER Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 'cl S e, f co_ G?D Benchmark s Dosing ~.em /JP '4 Aeration- Bldg. Sewer Hold St//Vf Inlet 6. -7 7~ g5l d/' TANK SETBACK INFORMATION ifiu* Outlet Y3, ~O TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > SO' V NA Dt Bottom J-30, NA / Man. Dosing Aeration Dist. Pipe ' `0 6 2r Holrg _ -fY_ Bot. Syste ?70~ PUMPS INFORMATION Final Grade Manufacturer Demand -f 3~ r PG 9a' Model Number ZZ y~ GU TDH Lift Lrictiorb / H Systema TDFt Forcemain I Length Dia. " Dist. To Well S /d / SOIL ABSORPTION SYSTEM h BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside - 'd-Dept DIMENSION S Zs- E SYSTEM TO P / L BLDG WELL LAKE/STREAM , LE Manufacturer: SETBACK INFORMATION Type Of h eta BER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole /Size x Hole Spacing Vent To Air Intake Length i Length.3&_~5 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 No Bed /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes El COMMENTS: (Include code discrepancies, persons present, etc.) P ' LOCATION: RUSH RIVER-35.28, 17W, SE, NW, CTH Y A ~5- ~9s5~9 C~x-d a 4, 'S ~ .X ~ ~ ti? ~ / K~~C~ ~ cif ~.c ~1 x~~'~/✓ ~~~IYY,~ dY~ ~/'f [lc~~ ~%ti~ ~ ' 7 Y /7y t 77 Plan rebrision requiredE] Yes [D.,116 c Use other side for additional information. el I O SBD-6710 (R 05/91) Date Inspector's Signatu Cert. No. MIL ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I Safety and Buildings Division 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 than 8112 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanitary Permit Number a334'E The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S95-40427 Property Owner Name Property Location MARK SMITH SE 1/4 NW 1/4, S 35 T 28 N, R 17 f#P/W Property Owner's Mailing Address Lot Number Block Number 522 CEDER DRIVE N, N. HUDSON WI 54016 N/A N/A City, State Zip Code Phone Number Subdivision Name or CSM Number N HUDSON WI 54016 ( 715)386-7479 N/A II. TYPE OF BUILDING: (check one) ❑ State Owned E] City Nearest Road Village RUSH RIVER CTH Y Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment / Condo o a g ! ! U 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. EX New 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 Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 M 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 450 375 375 1.2 N/A Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber Ex per. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks Tanks Septic Tank or Holding Tank 1000 ]0® 1 MIDWEffERN PRECAST ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 650 650 1 MIDWESTERN PRECAS XQ ❑ ❑ E] ❑ El 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 Signature: (No St ps) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON L IPRS 3215 715/772-3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater ate Issue , issuing A e r Stamps) Approved ❑OwnerGivenInitial ~(I)~SurchargeFee) 4!~'~j Adverse Determinationp jj~~JJ . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Ruildings Division, Owner, PlurnWr INSTRUCTIONS - 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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: t. 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. VII. 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 VII!_ Responsibility statement. Installing plumber is to fill in name, license number wi .h 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. CornIrlete plans and specifications riot smaller than 8 1/2 x 11 inches must be s - Itte(-j ' tr; F c•~ my The plans must `_he follovvinc; A) plot plar, drawn to scale or with complete d rr~._r r c; ;acr!IC l ':nt1 tank(s), septic 'i i-,O_rnent tanks; bu' 'Inc, sewers- wells; water rnalns,v, _ pump or siph©n O'1 t)ox°5; sOll cigoion SySt°_Cl1S, reply erT En; syst" l tlilding served- -A I V SptC i._:9 5e vol Ume, .:c 5(-,Lton M 1, qL. Irg .nformatlon. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges ('`ees) for a number ,f r, :--elated pr, ctice which can effect groundwater. The mcrzies ol'ected through these surcharges are used for rionitoring groundu,,it>r ~.on+ m investigations and establishment of standards n ~ V 3 C o Q 1 _ ~ 44- _a .J ~ YK P y~ v x - ° LIP tt 00 Kl~ vx Bolt j o~ ego F Y ~ us of RECEIVED MAY 19 1995 SAFETY & BLDGS• DIV. • . 1111Jd~_t / 1 Ql~l~ n,. \ 4- ~I. C _ OP sc~ ~'i l'1<S 1 895 -40427 J~~` o-11JSTAlI ~~RNAIJ~J- )!'AR.1"~-'T~ AT CUD OF E11C}:. Lr:TL`-P-AL I -~t» to P II Q I I 14U~E5 LU ti pIJ cV"`DH CF + _ PIPE RtJ~ ~R~ ~~i uFL`.y SPA.'.:t~ . n i K ~ PV G / 4=-r-pp-CE N H 1 Q FR-OT-t T-~► f'1 P ~-PUC- ' L1iTc~tJ~LS Pl.hCt:. LhS'i' ROLE t~ExT lb Eu'~ CRP "~J\STR1BuT70f`I: PIPE .13~+treuT--- V ~a P ~c S FT. O T P 1 well. ~11~1S1 r 11y_ ~ottc~. n At►J ~ + OP 1~LES/P / PE S 11JV, El£V.OF LITGZALS S 7+~-3 ~T. ~l sT LE ~Rorl TAE wj-1-H Sv cc-E~~)A1 G HOLD - JJ'T~NUK .5 . L. PcST HOLE -i-O R E EX l" ?D -T~-F E E~1 DCJ~- P- Page Of S95-40427 Cross Section Of A Mound Using ATrench For The Absorption Area H ~ ~e2- :9 7, c~ Medium Sand Fill JI F - opsoi 3 E D Trench Of hu " Aggregate, r Plowed Layer 6" Below Wi;~~vered. With D Ft. Str mj,4W'sh Or Synthetic Fabric cc, E /.3 Ft. G_ Ft. F y17Ft. r ~ DUS~~Y p FOR k 0"Mound Using A Trench For The Absorption Area SSE G Force Main Distribution Pipe i Permanents-Markers Observation Pipe W A o - r' B - I K \--"Trench Of lu" - 2z" Aggregate I L r A 't. I 1 I, 3 Ft. K f 3 Ft. W 3.5 Ft. B 7 5 _ Ft. J 7, 1 Ft. L Ft. , Y License Si9ne4 O~ --Plumber: -301/ - Date: 5 /-7 SEPTIC TANK 8 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 895 -4o42,7 4" CI VENT PIPE 12" MIN. ABOVE GRADE b WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVE. FINISHED GRADE W/ PADLOC & 4" CI RISER ~-WARNING L.A.,.. y 4i MT N. 18" IN. 6" MAX. t INLET , WATER TIGHT SEALS GAS- TIGHT i ~JAPPROVED ~~'dJ1 A SEAL JOINTS WITH APPROVEp ; ALM APPROVED PIPE PIPE S' 1,7 B' ~ ON 3' ONTO C I SOLID SOIL ONTO OL SOIL OFFELEV .AFT. OFF " RISER EX7 D PERMITTED ON s IF TANK MANUFACTURER . OF Q HAS APPROVAL ~~~i~~0 OVEISB DDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE M TANK MANUFACTURER: NUMBER DOSES PER DAY: 14 TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING DOSE GAL. i4.9.2 -,FLOWBACK: 1/7.GAL. ALARM MANUFACTURER: ( c-J~U S ~,SICi„SCAPACITIES: A = 'y INCHES = 303,5. MODEL NUMBER: ~(-N 44jk) SWITCH TYPE: B = 2 INCHES =_GA_ PUMP MANUFACTURER : C = INCHES = 1 , 7 GA MODEL NUMBER: SWITCH TYPE: D = N a INCHES = -M. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 wi VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~ 3 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . 2.5 FEET + Q_ FEET FORCEMAIN X 1.f~ FT/100 FT. FRICTION FACTOR e y7 FEET TOTAL DYNAMIC HEAD = no FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 55, ; WIDTH DIAMETER LIQUID DEPTH _ SIGNED: LICENSE NUMBER: ,U7f,,S 0/DATE: ,t5-1'7 1/88 Submersible MODEL. 3871 SIZE: 3/4 SOLIDS Effluent Pump RPM: S95-40427 METERS FEET 25 7 o ~ a 6 20 U ' z 15 0 4 J I 3 10 2 5 1 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m'/h CAPACITY GOULDS PUMPS. INC. SB,E{A FALLS tEW `rC rX 0148 Effective October, 1988 01988 Goulds Pumps. Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. -Y~-•~ SOIL AND SITE EVALUATION REPORT D I D I H R in accord with ILHR 83.05. Wis. Adm. Code 11L,.M,IMAHIIAM.MPRM COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST' C K's" 1-Y not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. 0 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTYtR:c, y er'. PROPERTY LOCATION • M a 4-k GOVT. LOT E 1/4 N 1 1/4,S.39 T N.R i 7 E PROPERTY GWN6A-'6 MAILING ADDRESS ky r LOT BLOCK I SUBD. ME OR CSM it Se?~ Ce~y 1~ri~e F /t),4- CITY, STATE ZIP CODE PHONE NUMBER CITY [];VILLAGE 9fOWN NEAREST ROAD • o L'o r S yet (`ors) iA2L 71J ✓tr G1 14 k\y ( New Construction Use ( J Residential / Number of bedrooms 3 j J Replacement ( ] Public or commercial describe Code derived daily flow ySy gpd Recommended design loading rate / bed, gpd/ft2 trench, gpd/ft2 Absorption area required Y75- bed, 112 'xl ~ bench, 1`12 Maximum design loading rate / bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96. It (as referred to site plan benchmark) Additional design / site coTiperac~rticons Parent material a,c t a l r~,1 Flood plain elevation, if applicable A/ ft S = Suitable for system CONVENTIOw MOU INGROUNDPRESSURE AT-GRADE SYSTEM W Fyk HOLDING TAti. U= Unsuitable fa s stem O S Lr-3'U p U ❑ S ©'U 11 S 0 U ❑ S ❑ S CN'[1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f1 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tre .2 P Ground -?y- /0 ~lc . S7 t2 s (A > sb h1~ i ► S- lev. h• 3(,-S6 / U s ~a~ s f C s6k - . S Depth to limiting factor N ~Sf Ft,GW Remark's: Boring # ssx / i✓~ 1U JC z_ Sa 3 sb~ oL L,% 3 S~ Ground SC e lev. s_ C s tk v" - C I S 93 d Depth to limiting ' factor - Z -7 t I 6mr 01 Remarks: GC'UNTI CST Name:-Please Print Phone: `,tS 77~- 3a Address: Signature: Date: CST Number: SOIL DESCRIPTION REPORT Depth Dominant Color Boring Mottles Structure GPI # Horizon in Munsell Texture Consistence Baydary Roots Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer . 1 ~'a s t Ec Lo ?'<:i:`.k?]G`\0.'R r / 5 C. V 1 7 Ground ~S' IL uhf i z :5bk w, I (o . el v. y- - 932ft. Depth to limiting Remarks: Boring # Ground 3 - 34 \I -4- F S S 6k Uj e6VCh. SC( Depth to limiting factor T77 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting 1 factor Remarks: r 7 I I I ~ ~ ~ 1 I i I I ~i I I i ~ ' I II 1-1 v I i i I I ~ ~ ~ I j l I ~ I I II ~ f---±~ I - - - I 44- ' I i ~ I I I I y I I I I I i I 1 I f I i I Z I j I ~ i ~ I I I ~ ! J I ` I 4 - - L-J- I , I i i I I I I I + ~ I r -1 + i I ~ I ~ I L I ' i I j I j~ I ~ I I r I I , t I I I j -r- i , I I { I t ~ ~ I I I I I I 1 -r I- -1- t 1 I I I ~ C~ I I ~ I I ~ r I~ I r k I ~ ~ I ~ I ~~-j I ~ I I I i - 4--j 4-- -1---~-i-- -I- , t-~ - f i i r r I j- I t- 1 I I I _-1 _ i I I ~ I I I _ _ i I 1 , ~ I ~ I I I ~ ~ I I , I I ( ~ ~ I I I I j I I I 41 rL I I I ~ ~ 1 1 1 - - - I i ~ I I ~ I I I I I I ' ~ I I it I II I l , f I + a 1 4 t { fi I I I I I I ~ i ~ i I I w ~ I I I -r- I I ~ I I I i t I I , I I I I I i I ~ t~ I ; V I I I ( ~ i ~ ~ ~ I , I SOIL AND SITE EVALUATION REPORT - D I L H R in accord with ILHR 83.05. Wis. Adm. Code MMI, i,,, u.• .w.n.a COUNTY Attach complete silo plan on paper not loss than 8 1/2 x 11 inches in size. Plan must include, but ST' C RO I_y not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. r dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTYGWNER e.yor'. PROPERTY LOCATION Ct r- {G S GOVT. LOT S C 114 JU' 1/4,S.S T .ZR N,R % E ( YJ PROPERTY QWN fi4) S MAILING ADDRESS 9-y •e r : LOT,, Mrr if BLOCK 11 SUED. NAME OR CSM x Ce, AC~ITY. STATE ZIP CODE PHONE NUMBER ❑CITY. VILLAGE 2MWN NEAREST ROAD O (.~i Sy~~1 (7r$) ~8(c.- 7N7 rtS rJfr- (!-T: t4 " r~ (6 New Construction Use ( ) Residential / Number of bedrooms _5 I J Replacement [ J Public or commercial describe Code derived daily flow v gpd Recommended design loading rate / bed, gpd/ft2 trench, gpd/ft2 Absorption area required T7,5' bed, ft2 _ ?j,-75 trench,112 Maximum design loading rate / • 1 bed, gpd/it2 trench, gpd/ft2 Recommended infiltration surface elevation(s) S~ . It (as referred to site plan benchmark) Additional design / site coi$ideiations Parent material e, i t'0'r- 1 Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAje MOU "AOUNDPRESSURE AT-GRADE SYSTEM IN FlUk HOSING Tqy, U= Unsuitable fors stem OS M L'd'S ❑ U ❑ S el ❑ S 0 U ❑ S U p~ SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/fl Boring # Horizon Texture Consistence Barxfary Roots in. Munsell Ou. Sz. ConL Color Gr. Sz. Sh. Bed I Tr2 t o t6i MI, 'I. SIA 2A Ground 0 3~ S- yX c"{ elev.. Z2_1 h• jr^ -sin i -4 l ar s i s 6 r h - C_ C Depth to limiting factor 1 " Fst itGW Remark's: Boring # ::.:£'f: L~ 1 u Jc~ 3. S i 3 1, o~ lW 3 S I. :a L r Ground >C~ I c% ~I Q L6 S c w. S b ' w I ~l I elev. It " 7 s~ J S L_ C 5 b Irk C Depth to - limiting factor _ _ ,~-7" L 0) CEI Remarks: J 1 W , CST Name: Please Print [ ST Qhuirl Phone: v. C- e C' COUNT) '-r I S 7 7.)- 3 a 7 Address:n4 ( l t r r r ec r r L7 • Signature: 9 oat CST Numbor• • _Sd ,P L ,Gy----- c~ ~ 12 `I SOIL DESCRIPTION REPORT Boring # Horizon Oeplh Dominant Color Mottles Texture Structure Consistence Dotrrlary Roots GPDitt: M~,{( L in. Munsell Qu, Sz• Cont. Color Gr. Sz. Sti. Bed Trey ;ti'k' fO:C:O Y(Z c Ground 2S' 3 /U m d d i z s 6 (c 77, K- 'Y tZ eley. -r, .2 CL Depth to limiting tac s,% Remarks: Boring # rL yn L p• 14 a M Ground 3 -.3y 0 \/K 9' S, c S c ~ s 1, ~ . ~ elev. C Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor' . Remarks: Boring # u S:ww I Ground elev. h. Depth to limiting factor Remarks: is I! I I i ' t t _ I I i ~ I ~ a ~s d, o V ' s I 9 vi CA, k~ o sV, j I ~ ,I i I . I I L ~ s I I a ~ I i J i - I I I i c i 4 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ' ST. CROIX COUNTY COURTHOUSE T . - 911 FOURTH STREET • HUDSON, WI 54016 * - (715) 386-4680 June 18, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Mark Smith property, located in the SE 1/4 of the NW 1/4 of Sec. 35, T28N-R17W, Town of Rush River, St. Croix County has been conducted. This onsite revealed suitable soils at a depth of 24" making this site suitable for a mound septic system for new construction. Should you have any questions, please feel free to contact this office. Sincer ly, ames K. Thompson Assistant Zoning Administrator cj STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MARK SMITH MAILING ADDRESS 522 CEDER DRIVE N, N HUDSON WI 54016 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE ba, 1 c{ W~ p► W i s S YO o 2 PROPERTY LOCATION SE 1/4, NW 1/4, Section 35 T 28 N-R 17 W TOWN OF RUSH RIVER ST. CROIX COUNTY, WI SUBDIVISION 1y -A " 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 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 expirations date. SIGNED: Cc t.~C t'd J DATE: 'J r S_ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 sTC - loo 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 MARK SMITH Location of property SE 1/4 NW 1/4, Section 35 T 28 N-R 17 W Township RUSH RIVER Mailing address S2-2 C cda r /fee, No c(su') 5 y o 1 to 11 Address of site AJo, L) C+:I Rci YY Cast o~ eta{ ~d Subdivision name N ft Lot no. J other homes on property? Yes ✓ No Previous owner of property /,ty P ,jd E, I ee.J 04 j.q Total size of property / 4 f a e rs Total size of parcel s Arx a aS a 6o vs Date parcel was created J A ^j 65 Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? ✓ Yes No Volume b~ and Page Number Z139 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. q B(8 q"1 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of pplicant Co-Applicant Date of Signature Date of Sianat,ira r THIS SPACE RESERVED FOR RECORDING DATA DOCUMENT NO. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-1982 486847 VOL L 96 REGISTER'S OFFICE IL_ ST. Mx Co,. WI T1_mo-th,y_• P_._ _L•aF_avo-r_..a-nd---E_i_1_e_en__-M_.___La_Favor_,,__ Redd forRQCOfd husband and wife, holding as surv,ivors•hip QUG061992 marital property - - at 4:15 P. conveys and warrants to Ma.rk_.-W....-.Sm-i.tb.-_a.nd__.Ch.ri.-S.t.trte--_--- ...._----.--K-.---S-m i.th_,---h usb.an d---a-and---w i -f-e-,---h-al 4n-g--.a-S--------- -•--------...s-urv.i-y-o-r.s.hi-p---m-ar..i.ta-l---p-rop-e.r-ty---------------- o Z w of weds RETURN TO the following described real estate in St...... Cno.7_X .......................County, State of Wisconsin: Tax Parcel No: All of the Southeast Quarter (SEI) of the Northwest Quarter (NWi) of Section Thirty-five (35), Township Twenty-eight (28) North, Range Seventeen (17) West, Town of Rush River, St. Croix County, Wisconsin, lying Easterly of C.T.H. "Y"; EXCEPTING THEREFRRM, the following described parcel, Commencing 1315.0' West and S 17 42'E 1681.00' from the Northeast corner I` of Northwest Quarter (NWf) to a point on the centerlin8 of C.T.H. "Y"; thence S lb 42'E on said centerline 507.0'; thenceN.80 55'E 170.0'; thence N 0 42'W 451.0'; thence N 89°05'W 316.6' to place of beginning. The above described parcel contains 19.0 acres, more or less being subject to easement over Westerly portions of said parcel for C.T.H. "Y" R.O.W. purposes, being subject to easement over Southerly portions of said parcel for C.T.H. "YY" R.O.W. purposes and also being subject to easements of record. "ANSFEb $ y .oo This i-S _Q.t homestead property. FED YOXY, (is not) Exception to warranties: Easements and restrictions of record. . v~ Dated this day of - 19- 9.2 --•-----------------------------------------------------------(SEAL) --------------------(SEAL) * •------------------------(SEAL) (SEAL) * Eileen M. LaFavor . AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. C r o i x --------County. authenticated this day of 19 Personally came before me this day of (2y of 19.9 2___ the b e named Jfimothy V- LaFavor and Meen a- - o - -------a-- F -------M--- TITLE: MEMBER STATE BAR OF WISCONSIN ' (If not, authorized by § 706.06, Wis. Stats.) to --e known the executed the me. 1 foregoing instf• enp'ty.ea 4 , THIS INSTRUMENT WAS DRAFTED BY . Thomas A. McCormack . -_------•-------•------•------------------------------•-••----------------------Gtsi \ ZY t _ Bat dwi n , WI 54002 Notary Public - +r Wis. (Signatures may be authenticated or acknowledged. Both My Commission is per/nxent(If, Sqt~' atiate Ax piration are not necessary.) date: 19 . ) = F--- ONames of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co„ Inc. FORM No. 2 - 1982 Milwaukee, Wisconsin i