Loading...
HomeMy WebLinkAbout034-1055-10-000 S -0 o ~ ao i a~ 0 0. a h ~ CD a~ N C L 0 .0 O - ,r a o E 0 =o' E N O h N W O: u! ~ N c T ~w O•m., p Co N M N U C O E' o~ N in uj 0 FL I& O E N O co y 0- N - 7 3U) haw r a o WD E 3 m c a E; W N 0-0 Z:5 co m v Z co -o (L) w m is Momc: L) S5c LL c moo y o• - O O 0 N M c C N C co Q) U N 7 co C) Cl) Q awtnit E E M 7 N z y E Lo W O Z m d rn a m C14 LLJ N H fn c O p N E 0 m O Z d U r to O 3 c Z d Z N (D fA F- 'r E ..O N p CO, E N c Al • ~ .O O lt~ c 7 U 2 z z O O N a) z " LO R E N R N > N d J c 0 CL w p 4 0 co G G a N m N h ~ co c to to m E ;Y o i IV F~ IL O O O C.~ z 0 •N m > a a a u CL Q J-- U) o w 7 O N N M J U co rn rn ti o iz C:) w o N a) o m r.- E o o _ m 0 0 c ~p [L O N O 1 d 6 N Q z m n1 C p d 7 O O c 06 N C 0 3: 1 CJ 7 O O 0 1) c O c c 11 Lo 1>1 15 o o r ap ~ O (n Q 0) 0) 0 © 7_. N w U.) LO N V) L o C N O Q (O rn E° m H m r •jxj L M LO a = of ai E E m y O N cn F- N O Z y fn O C4 \ CC V `m a #t a a r~ CL m u N E c c m o A U a 2 O N 4 ; Parcel 034-1054-70-000 09/19/2007 04:52 PM PAGE 1OF1 Alt. Parcel 24.29.15.384 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - THOMS, STEVEN R & PELEGRINA STEVEN R & PELEGRINA THOMS 3284 80TH AVE KNAPP WI 54749 Districts: SC = School SP = Special roperty Addre3s(es): Primary Type Dist # Description " 3284 80TH AVE 01 SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH 77t::, cres: 40.000 Plat: N/A-NOT AVAILABLE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 893/186 07/23/1997 546/121 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/15/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 5,600 0 5,600 NO UNDEVELOPED G5 1.000 200 0 200 NO OTHER G7 2.000 9,550 43,850 53,400 NO Totals for 2007: General Property 40.000 15,350 43,850 59,200 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 13,900 37,900 51,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 137 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village nTown of: State Plan o.: THOMS, STEVEN -R 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 Dosing Aeration Bldg. Sewer Holding St/Inlet TA SETBACK INFORMATION StfW6utlet 9r TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ?6D/ NA Dt Bottom 33 Dosing NA Header/Man. Aeration A Dist. Pipe Hol Bot. System PUMP /'INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. id Depth DIMENSIONS DIMEN I SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM Manufacturer. INFORMATION Type Of Z_, CHAMBER Moe u System: OR UNIT 171 al, DISTRIBUTION SYSTEM(-"/----, Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD. 25.29.15W, NE, NE, 80TH AVENUE, L ~ ~7 Ire_ Plan revision required? ❑ Yes ❑ No Use other side for additional information. I/ I SBD-6710 (R 0 1) Date Inspector's Signature Cert. No. ' 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 8 112 x 11 inches in size. 1 MeI X • See reverse side for instructions for completing this application State Sanitary Permit Number x407 07 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 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ve- T" N~1/4 Ng- 1/4,S a; T a ,N,R 1SE(or)W -5 4 11 Property Owner's Mailing Address Lot Number Block Number 3 2- 8LL +1L City, t to Zip Code Phone Number Subdivision Name or CSM Number Pte! Z q C? (71.S') ~JZ tkoL II. TYPE BUIL ING: (check one) ❑ State Owned 2 ❑ it Nearest Road Public 1 or 2 Family Dwelling -No. of bedrooms J Towan OF 1% n Pe1 $0 i ~V III. BUILDING USE: (If building type is public, check all that apply) Parcel'Tax Numblr(s) 1055 -/0 1 ❑ Apartment / Condo v .1 (s l ~ l 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. lew 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 R 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) Elevatin "2 3 7 O. /0'j- O Feet /06, 4- Feet VII. TANK Capacity in gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks nn~, 1 Septic Tank or Holding Tank V 2" nt+0 IY rCt 4~ /tE ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber V 6676 S' •E M Q' ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum 's Signature: (No Stamps MP/MPRSW No.: Business Phone Number: H. C->, 1) e,5 /L1 P t 46-6 71C Acf7- ?'72 Z_ Plumber's Address (Street, City,Gsta~te, Zip Co,7u c t 7` IX. COUNTY / DEPARTMENT USE ONLY 1F ❑ Disapproved San ry 30N (Includes Groundwater ate Issue Issuing A n Approved ❑ Owner Given Initial urcharge Fee) .ZS Adverse Determination ~,(7 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SHD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Diviaion, Owner, Plumber 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. 1 All revisions to this permit must be approved by the permit issuing authority- 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s)'of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 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, purnp/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. Com.l:,iete plans and specifications not smaller than.8 1/2 x 11 inches must be submitted to the (CLInty. The plans must the ioilowing: A) plot oian, drawn to scale or with complete dimension;. location of holding tank(s), septic i> O~ at'rer trea',, ,ant i-nk building sevvers, wells; watermains/wat, r e; stre_,,n:,.3rn_a lakes, ourrip or siphon ui~lrioution boxes, soil a'u,orption systems; replacement system are, I oc.atien :.f the bu lding served; ,ori, t i Jnd vertical elevation reference points; Cj complete speci(r is o for pti --Ips a rA ontrols; dose volume,- el ev.t :f':rences friction toss; pump performance curve; pump mode! jrrr 3 ~.mp m ^uf-icturer; D) cross section o, th_ soil absorp.rsystem if required by ie counts; Q soli test daLa on i dorm; at _i F) a~ sizing information- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (`ees) for a number of regulated practice which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 15, 1995 2226 Rose Street A 11 La Crosse WI 54603 -j i \y J WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 3c \.~rl ez q RE: PLAN S95-40557 _ FEE RECEIVED: 180.00 THOMS, GERALD NE,NE,25,29,15W TOWN OF SPRINGFIELD COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Dennis Sorenson Plan Reviewer Section of Private Sewage (608) 785-9336 $RDA-7907 (R. W94) Page of 6. MOUND SYSTEM FOR S 5 6 A 3 BEDROOM RESIDENCE LOCATED IN THE N~ 1/4 OF THE KIP- 1/4 OF SECTION 2S , T Z4 N, R IS W, TOWN OF S l ~ w G C=l EL-p , S`j • C lX COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET RECEIVED PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT JUN - I i9m PAGE 5 of 6 PUMPING CHAMBER i ~ . Dill. PAGE 6 of 6 PUMP PERFORMANCE CURVE $AfErl PREPARED FOR G GV-& LX--') T K O M S 3Z~y go `rrf RV~. ~c1v~p~, w1 S'4-)49 PREPARED BY WECGEE~ZER SO I L TESTING~~°~~y AND r,.°°` `'•.°''z'° i3ES I GRi SI~F~V I CE m ~r °w f 1!'tTN+1. . P.O. BRI 74 421 K. KAIM ST. g 6f.LgtiP:.NTH, RIVED FALLS. SI 54022 '"'715-4~.r-0165 ~j e ~sIG14~' tl® tosaaat'~ 3o, t 9 9 S JOB NO. q S - X 51 i y Q`~Vf~~~f~ PLOT PLAN Page..~,_ f Scale 595-40557 ~ o•°tS w,i To CTbt. W" _ 8O ~ WNW c o ` o 0 ( 7 o ? f-. ~m Lo l 6 v a.Z C'L.I,o4. ~ ~ n l 8.1 / ~ ~ .r~~ e0 t`ioT C`~~•-t P fKj' 6~2 J 'i O 7 s ~ N er1 -E1., oN 0i ~tl-}16H , 3/yOt►~. a ~G Crl X003 PvC 1~1P~ ►v~woo~ lt~TtJ I( (.a~ ? i' ~O/off Z.T. ,r o C r n Q~'~1~Y.rp ? O F-,WH 1~T~ Fiu1St' NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (Y required) 3. Install 4" observation pipes with approved caps. ( 2 required) 4. Septic tank to be1MQJ6S0 gallon capacity manufactured by 1-'1 t D w Q~ S 1k')Z I j Vz- s 7-, 5. Bench Mark STC-:- 6. Divert surface water around mound to prevent ponding at the uphill side. Rage 3 Of S95-4055 Approved Synthetic Covering Frs--wi C- 33 Distribution Pipe Medium Sand H G Topsoil F Elev. VZy'A O 3 E " b I { Bed Of 22 %2 Force Main Plowed r Y A' Aggregate From Pump Layer - D Ft. E 1.49 Ft. r -O'rbss,Setion Of A Mound System Using F 0-% Ft. A Bed For The Absorption Area #A. ( a :!4 A g Ft. H 5 Ft. Linear Loading Rate=9,S-7 GPD/LN FT B Ft. Design Loading Rate= b.4 GPD/SQ FT I lb Ft. J 7 Ft. K 1I Ft. L 6 cl Ft. Fa r- -Kiq-.. WFt.. 41, 1' Observation Pipe 1 U 1---------------------- A ( _ - ---t •I7orce Main Distribution Bed Of 2 - 2 2p Pipe Aggregate I Observation Pipe Permanent Markers (Anchbr securely) Plan View Of Mound Using A Bed For The Absorption Area Page 1 Of Perforated Pipe Detail S95-40557 0 End View Perforated End Cop PVC Pipe Install permanent marker Jo~`OSat end of each lateral Holes Located On Bottom, Are Equally Spaced S PVC Force Main Q PVC Manifold Pipe 4 Distri ution Pipe Last Hole Should Be Next To End Cap End Cap P Z Ft. Distribution Pipe. Layout S S6 LIU C1 S X S ~ Inches 0 Y S6 Inches Hole Diameter 11y Inch Lateral 1 Inch(es Manifold Z Inches Force Main Z Inches # of holes/pipe S Invert Elevation of Laterals Ll0jq-S Ft. S`1-~-\7> S $SY ~l= Z3-~113 Gp" bl'R-L 4 Place lst hole Zc~ from center of manifold with succeeding holes ~ v at Zb intervals. Last hole to be next to the end cap. - Co_mbina_tion.-Sep Tank ;}nd -PUMP CHAMBER CR055 S£CfiIOU- ° MD SPECWICATIOMS ' PAGE S OF VE>,IT CAP WEATHER PROOF JUNCTIOAJ 90X 4'C. I. VENT PIPE APPROVED LOCKING ~!.10' FROM DOOR, MAWHOLE COVER wI"fZi .AmDow OR FRESH wAfT Nl>,1G L I~6EL. A(R INTAKE corapu~T " 4 Q 5 5 7 r Iv / I GAKA I `i~ MIIJ. 19'MIAI. l.- PROVIDE I IIJLE T -'[-AIRTIGHT SEAL _ 1 II v APPROVED JOINT W„ ~AP~LCS A APPROVED J0~ TS Dal I I w/GI. PIPE A'C w/C.I. PIPEaR ,i T t'lk construction I I~I s ia- ,l comply with _ I I ALARM F, ILH .15-and -33,. 20 L I ow r C L .83FY PUMP1 OFF C0IJCRETE tel. BPS, OU DLOCK 3" ARPRovE RISER EXIT PERMI1fED OIJLy IF TAWK MAIJUFACTURE:R HAS SUCH APPROVAL BEDDING SEPTIC F SPECIFICATIOA.IS DOSE ' .~LyJ ~'C•~Sl' NUM9ER OF DOSES: PER DAy TAM MA►JUFACTURCR: TAAJK SIZE: L000 ~CSO GALLOIJS DOSE VOLUME ALARM MAIJUFACTURFR: 2' -.1 SLL .41.46 INCLUDING 5ACKPLOW: GALLONS MODEL wume,ER: 1~L ViW CAPACITIES: A= lg INCHESOR 306 GALLOyy SWITCH TyPC: IRICHES"OR GrLLOUS B = PUMP MANUFACTURER: cz. C= 8 WCHES OR 13~ GALLONS MODEL IJUMBEK* q5 D- 10 I CHE,S OOR bib GALLONS SWITCH TYPE: ~~IQjZC=IJ~'~ NOTE: PUMP AND ALARM ARE TO DE MIMIMUM DISCHARGE RATE 3-140 GPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFEREAICE DETWEEU PUMP OFF AAJD..D15TRI5UTIOKI PIPE.. lS'O FEET + mimiMUM METWORK SUPPLY PRESSURE , , , , . . . . . . . 2.50 FEET H- 110 FEET OF FORCE MAIN X 1.1S F 00fLFRICTI0 I FACTOR. ~'2ID FEET TOTAL OyWAMIC HEAD = A. x4 3 FEET Pump chamber DIAMETER IAITERAIAL DIME ►,ISIOIJ~i OF TAIJK: LEAIC,TH ;WIDTH ;LIQUID DEPTH 3 g'! BOTTOM AREA - 231= GAL/INCH i AS PER MANUFACTURER - ~-1,a GAL/INCH HEAD CAPACITY CURVE 3 7/8-. 6 1/4Pcfslr 1)F 6 MODEL "98" 30 4 5/8 e e 25 3 5/8 m U 6 20 14.L1J O + + a K 15 ® 4 3/16 ~ 4- 1 40 to- 1/2-11 1/2 NK 2 5 S95-405-57 D U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 L_J 3 5/16 j 20 6.10 25 95 - Lock Valve 23' - CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - 1/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Am Simplex Duplex 3. Mechanical alternator 10.0072 or 10-0075. M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FM0477; Elec rical Alternator, FM0486; Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ- FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and FW73Z Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16.'347 O IPt ot6vft, KY 4a2W4W tManufacturers of. . . OEZ Z SH TO- 3280 Old Alliffin LAW Z'M O. Lordsurlle, Kr 40216 Q(/,4LnY/~l/MPS SNCE /9a~9 © (502) 778-2731 0 1(800) 928-PUMP FAX (502) 774--3624 Wisconsin Department of Industry, SOIL AND SITE EV A L U AT ~1 0 RT Page 1 of 3 • Labor and Human Relations DivLsicce!°.of Safety 8 Buildings in accord with ILHR 83.0 i Y t~ COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in n mt~C e, bttt not limited to vertical and horizontal reference point (BM), direction a e or,4j CEL I.D. # dimensioned, north arrow, and location and distance to nearest road. C> 3 . l O S S - t APPLICANT INFORMATION-PLEASE PRINT ALL INFORM EWEDBY DATE PROPERTY OWNER: S q ~L~TG2t `NmjN ROPERTY GQ'NT- C uv ) (vt S gvy V 4,S Z S T Z.°t N,R IS E (or W PROPERTY OWNER':S MAILING ADDRESS #1 S NAME OR GSM # ` 3Z F_~' 8© Tl • CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD tc~t~~P wl sy~~°! nts)~~Z-~6o~f s1~~Zt/uG f 80 `nt ttvQ [uj New Construction Use [Xj Residential / Number of bedrooms 3 [ J AdditiQn to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate o- ~L_bed, gpd1ft2 - trench, gpd/ft2 Absorption area required 3-1 S bed, ft2 31 trench, ft2 MaAmum design loading rate (3. S bed, gpd/ft2 0. 6 trench, gpdM2 Recommended infiltration surface elevation(s) \ p q- O It (as referred to site plan benchmark) Additional design / site considerations 114QX p w 8 'sL q-) ' B VED - t~v 1 0~ 3?Vh'b Fr A-L Parent material S LwL, c~v CrR tt L~ Flood plain elevation, if applicable 1`~• - ft i S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S IN U IKS . ❑ U ❑ S ®U ❑ S ®U ❑ S EgU ❑ S 2]U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w:g o-b ~o~tQ z C z si 1 Z sbk w~v'~'H ~s Q's n. l Y/3 CL~ s I 1 3 sbk m ~l. c~ - o .S 0 . Ground 3 1i 31 l0`1 rL 34 elev. `-12 6 8 `1~t-Y sue`rix owe w►vvn - - 1~0.3fL 31-~~ ~.StiR std l5f Depth to limiting faCtDr Ala Remarks: Boring # a-b tb- _ i.LZ Z.+S bh wt-~- c.L S 6 - ' 2-Z~f 113 1-12 X113 S~ ti Z'Sbk >n~ ~S - o_S 0-1 3 2y_3L t!/6 - Gh L a'n't Sblrc Y17 o:q o.S Ground elev. 4 6-~L 9 ~u 3 5 KQ V7 ~C~ ~W"\ tbl.6 ft. Depth to limiting 1 factor i Remarks: TName:-Please Print Arthur L. We erer Phone. 715-425-0165 egerer Soil esting & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date:. _ T Nun . = . c15-1ST Jr'Y!' 2 Z'1~Zg9 14Q0576 PROPERTY OWNER C1~"lS SOIL DESCRIPTION REPORT Page of . OARCELI.D.# 3-1q- 1'3S3-113 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed d Trench 6 3 zvx o ~-t L l '2._ s b 0-S ` . ` Z 8 -z$ l~ `12 V ~3 311 ( -Z 3 bk m' k c s - o • s a 6 Ground 3 Z$-$2. lu `Z R 31` Z S `-,tt La C 1M `F~. elev. vb _0 ft. Depth to limiting , factor Remarks: Boring # fjf[ 4i Ground elev. ft. Depth to limiting factor Remarks: Boring # AU ..........I Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: PLOT PLAN Page 3 of 3 °i~J 1ti1~ SCALE 1"= y(3' 034- IOSS-10 l o o~ 0 ?ao 6 3Z Loo n zs~,,7 ~ a .3 eo DoT" cn>~Pf~~T biz ~ 6l ,o o\s1vQQ TL~tS ~1z~A. 0 i ~ 'mss / ~ ert - ~L, loo.o' o►~ ~►"!fit ~ 3/y"~~A, o ~G GrL L0~ 3 ~~C l~iP6 w/ wooD L-Orrw Lr J 0 r 2 3 ll~gpl~~7 s~c, c. t27sTtmc:) lli GY'i~ tYv L`3.45 (7 5 ~ 42.5=mAq- ;TgQ_0_57b. CST Signature Date Signed Telephone No. CST # VYtsconsin Departrnent of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety 8 BtAldirxts in accord with ILHR 83.05, Wis. Adm. Code COUNTY . Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S T• C_\ X not limited to vertical and horizontal reference point (BMC), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O 3 - L O S S - 10 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: S'l~V t l l q iELk-GRIkok `7tj-0I j S PROPERTY LOCATION 6Mf~ U'., " S Bvy G99 -tOT- M 1r 1/4 N E 1/4,S Z S T Z9 N,R IS E (a W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE RrOWN NEAREST ROAD t~~vrn?~ wt. sy~1~f°I C7lS)~~2-~I60~f s~~ZttiIG ple-ub 8o `nt ftve [uj New Construction Use [Xj Residential / Number of bedrooms 3 [ ] Addit(~n to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow L` SO gpd Recommended design loading rate gibed, gpd/ft2 - trench, gpdNt2 Absorption area required 31 S bed, ft2 3-I trench, ft2 Maxdmum design loading rate 13 . S bed, gpd/ft2 o. b trench, gpK2 Recommended infiltration surface elevation(s) \ z!' q- O ft (as referred to site plan benchmark) Additional design / site considerations 1" tbV1vO W / S 'x-td-)'8 k L 1 0~ Sn--N F-i,-t. Parent material S QZLIB. EYv 'r ov CM -~1 LL Rood plain elevation, if applicable )y• - It i i S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system El S V9U IK S . ❑ U ❑ S U. I ❑ S ®U ❑ S [9U ❑ S Lou SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft i Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxxbiy Roots Bed Trench o-b ~o~tQ ~LZ sit Z sblrc Yl C- o,s a-l z b-~Z - t,.s o, b I o~ 2 4/!3 - g 1 Z~abk vn a s Ground 3 ZZ 31 lu`1 R 314 _ s I j 3 Sbk M -fk ct.~ o .S n . elev. 618 l ~ ~'s e-l ~ w►~`~r- Zoo aft 3]->~~ ~.s~ta std 5-1 ZV s `ritx Depth to limiting factor` y Remarks: Boring # o- g %-u, Z L Z - s L I Z`FS b~ rn`~1- ok-S 2 z~ tio~2 ~,l t 3 s> 1 Z.~sbk ~ eS - es GA 3 214_3L VA Yl Sbk 'a-S o.s Ground elev. \au `1 R- 8z 3 SL-f2C~ O ~n t' r - - lbt. b It 14 \-sT, Depth to S 0 F SG 6/[ Cam(, limiting I factor,, Remarks: TName:-Please Print Phone. Arthur L. W e e r e r 715-425-0165 ress: egerer Soil esting & Design Service-P.O. Box 74 River Fa1Is ,WI 54022 Sgnatore = _ _ Data Tpmtr PROPERTY OWNER'" lS SOIL DESCRIPTION REPORT Page Zof P'ARCELI.D.# ~31I- LOSS-(O Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trend. J o-8 ~o-~ i z.CZ ~ s l ( Z. gb ~-~.`~t~ as - o•s 6 3 z g _28 to r~ v!s S t~ l -ZS3 bk wt. `F~. cs - o S a 6 Ground 3 Z$-S2. ll~`ZR 31` z S `11Z VI elev. ~6\t-0 ft. Depth to limiting ;factor , Remarks: 'Boring # Ground elev. ft. 'Depth to ;limiting factor -Ij Remarks: boring # 14<s, ,Ground elev. ft. Depth to limiting factor Remarks: Boring # H` Ground ;elev. ft. 'Depth to limiting factor Remarks: PLOT PLAN Page 3 of 3 5 w, SCALE 1"= HC) ~K C?T tr9 S!}oWN ~1 NO. 031- BOSS- l~ C --T-',A W " 8 cl TDB V~v t I a oa ffV O ( 7 e O 8~ n ~ a . ~ eo DoT" Cc~MArr~Z` bZ h 6l e \s'~vQR T*1s N_VLS A. ` o 1 i oPt'1~ ~ ~s erg-~L..loo.U'o►~ a"H-i6H~ 3/y""DlR. 7 0 ~ ~G eL 100 9 • C l~1PE w~ wpoD l STN O Lr J ~ o If% 2 3 S~66tT3'~? weL.l Ua ctM tYv -;;-a W;L c1,S-tS7 114405 ,7b y CST Signature - bate Signed Telephone No. EST # - STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER c{ ~/j M S MAILING ADDRESS g D °~f' A F n a 1~ 1~(J 1 S` K7 9 PROPERTY ADDRESS 3a~3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE K h~ '17 -19 ~ PROPERTY LOCATION N C 1/4, 1/4, Section ~S T 2-7 N-R /J- W TOWN OF 912 ; e_1~~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME, PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating 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 retu d to the St. Croix County Zoning Officer within 30 days of the three year piration date. SIGNED: DATE: Sul„ ! C9~S 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 .Sfi'e v e t T ri►.S Location of property nr& ~ 1/4 N~ 1/4, Section T aLN-R W Township S' Mailing address 3WESft go A, Ave- %j tt.1 S Address of site _ S $ At r 3vst- Subdivision name Lot no. Other homes on property. Yes V--' No Previous owner of property L a u r e h cz rat/ tr i e~ 5 Total size of property Vo +C-A rS Total size of parcel Date parcel was created Are all corners and lot lines identifiable? i~ Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number /466 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. q6 L SDC, , 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 Applicant C -Ap icant C/ 0/6- Date of Signature Date o Signature DQCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA • WARRANTY DEED r S93 PAGE REGISTER' Lawrence Coyer a/k/a Laurence Coy r b S OFFICE This Deed made between Lawrence E. Coyer a/k/a ST. CROIX CO., WI Laurence E. Coyer and Freida Coyer a a re a . ReC'd for Record Coyer, his wife ,aka Frieda Coyer and Frieda M. Coyer; FE B 141991 L A. and teven oPelegrina oms, • Grantor, M of Doe* jointly as husband an wi e, eac n s or er own right. « Grantee. Wltnesseth, That the said Grantor, for a vaIuableconsideration RETURN 70 conveys to Gran-9 the following described real estate in St. Croix County, State of Wisconsin: raw Parcel Nj: 034-1054-40; The East Half (E') of the Southeast Quarter (SE)y) 034-1055-10• of Section 24 and the Northeast Quarter (NEk) of the Northeast Quarter (NEk) of Section 25. ALL in Township 29 North, Range 15 Wes`, Springfield Township, St. C::oix Caunty, Wisconsin. X39 ta This deed is given in satisfaction of a Land Contract dated November 29 , 1976 , and recorded in the Office of the Register of Deeds for St. Croix County in Volume 546 Records, Page i2l , as Doc. #336902 . This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And_ grantor s warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and roadways of record, and except any liens or encumbrance created by the act or default of the grantees herein. and will warrant and defend the same. 4th February Dated is day of 1991 (SEAL) / tic! ,o (SEAL) Lawrence E. Coyer II Frieda Coyer ~ !I (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ~ . authenticated this day of 19 DUNN County. ss Personally came before me this 4th day of February 19 91 the above named Lawrence E. Coyer and Frieda Coyer, his wife • TITLE: MEMBER STATE BAR OF WISCONSIN ; ••,~j~T (It not, to me known to be the person s wQr eivuted III authorized by § 706.06. Wis. Scats.) foregoing instrument and acknowledge tbeSsar4. THIS INSTRUMENT WAS DRAFTED BY n - , 'f- • Thedinga Law Firm i I 54751 _ Ju_d " M. Olson ~•T-j"T Menomonie, W DUNK Notary ubP IIc _ ~aaniy, 111fis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. ill not. state expiration are not necessary.) date: February 27 i9 94 ) ' Narnes of persons sign, nq m any caoac, ly should be Iy Ded or or,nled below their signa lures S81 NTF 0020 WARRANTY DEED STATE BAR OF WISCONSIN i rn corms. P O. Bitri' tWR. Gram Ray. W, 543070208 FORM No. 1-1982 hh, i i I 1 1 f /r