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HomeMy WebLinkAbout040-1053-90-000 ti In O c) c o ~ c I Cc 0. r h CC) o x o N O b O N Y C N m w O co m O O y _O `C O Y r ~ V O O- C z a) (0 O U. C O 0)'0 C C p 00 7 Q N E U ~ V C 0O O Z d m M N z a co c N O o z a N O Z N c Z 2 -Lp h O M Z5 cu I ~J Z5 ~r N C • N O Mi Q U Q z z N o 4) c 'IT Lo w £ 3 N _ m L ` N 3 y N N i O 0 0 0 0 N CL j O LL f- H ~ ) _ N wa a a a Lo Lo O N to ~ U ~ rn rn } Y ►rrry c (o r- 00 T 7 w N U o o E M m M N 0.. 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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J -L - I `o i O Cti, c6 tl1 v j "i hRRO~~' I-NDIC-AT4'; Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. live v9111riffl-t I MOM PeusµtY i'904, JAMES ❑ City ❑ Village E*Town of: State Plan ID No.: TrQy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA s y S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C'ac, Benchmark ,37' O,lPS~ /dd. ~ Dosing ZS// 93. / Aerati Bldg. Sewer F olding, St/ t Inlet g~ p~,~7' TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ae Intake ROAD Dt Inlet le, 20 Septic NA Dt Bottom 7l A4 12 7, _Y6 Dosing NA H wgmtMan ~7 dJ~ Aeration Dist. Pipe 35 0.2 9s~ Ho0 r g Bot. System - 93. 3, PUMP INFORMATION t\( Final Grade ManufacturerDemand /e v. ' AW/ Model Number,`/ GPM j,,Z, Coelu TDH Lift Uf Friction, S stem ;J TDH )r7 Ft Forcemain Length Dia. _ Dist. To Well WWI SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia DIMENSIONS 17 . Liquid Depth DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O e, , i n model Number: System: cup J E ^ (~,D >/CD 44- OR UNIT DISTRIBUTION SYSTEM Header / Manifold > Distribution Pipe(s~ , x Hole Size y x Hole Spacing Vent To Air Intake Length / Dia. Length ~y 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 / T-F L Center Bed / Try dges Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy,.13.28.19W, NE, SW, tyounty oad U,1 s 41 7) K. Plan revision required? ❑ Yes 0-co- Use other side for additional information. 1 /Z1 2f:ZtL1 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. BENCHMARK: - l s ALTERNATE BM: 11 Id= SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: yn,`dwe ~`~e~~ Liquid Capacity: x.26& Setback from: Well 3S House ' Other Pump: Manufacturer Lvhl~-ter Modelg- ~T Size Float seperation 'Y Gallons/cycle: / 6 O' Alarm Location !L o SOIL ~ABS~ORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Id ,.t lar t,11. Setback from: well: _5?J I-,t House ff4~ oe- Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLU11E3ER ON JOB: LICENSE NUMBER: A!,_7 INSPECTOR: 3/93: )L ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 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 Cou than 8 112 x 11 inches in size. Sf . • See reverse side for instructions for completing this application State Sanitary Permit Number x3340 _1` 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 ,IIl.D. Numb 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 63013 Property Owner Name Property Location ; 114.T1i4, S T~~ , N, R 1,9 E (or) W Property Owner's M iling Address Lot Number Block Number e / " f~ lS Cit State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road E3 Vila, - Public 1 or 2 Family Dwelling - No. of bedrooms & Town OF 7V-* CO /Q~ LL 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 Gl L7--106-3 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. ❑ 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 WMound 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 Cedd 93' 2~c- Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic ANew Existing strutted g PP- Tanks Tanks Septic Tank or Holding Tank x ~a~~ / LJ 2~Teo_ Lift Pump Tank /Siphon Chamber ®v f 1~ y~ v t ~ ~ El Q 1 1:1 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: o tamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 407'a :5 01 td " S- it .0 1 a IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sopitary Permit Fee (Includes Groundwater ate Issued Issui Agent Signature (No Stam S) Approved ❑ Owner Given initial ~ p^ Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divi.ion, Owner, Plumber i 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 aSanitary 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 isto 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, numl)e r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a/! ,eptic, pump/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. IMP, 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 _cunty. The plans must include the following: A) plot plan, drawn to scale or with complete dirner•,siorrs, location of io ding tank(s), septic tank(s) or other treatment tanks; building sewers, wells; water mains/wwl,-° re; str(. ams n_! 'tikes; pumu or siphon tanks; distribution boxes; soil absorption systems,- replacement system areas; anti the lo--at.ior c the building served; Ei horizontal and vertical elev<<.tion reference points; Q complete sped fication, for pumps a c controls; do>e volume; e'.evation differences; fricron loss; pump performance curve; pump model a- d ump manuf, c urer,- D) cross section of the soil absorption system if required by the county,- E) soil test data on a 115 form,- a id 77-) al's 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. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations September 16, 1994 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN 594-03812 FEE RECEIVED: 180.00 FEYERHEISEN, JIM NE,SW,13,28,19W TOWN OF TROY 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. Veeth y, 4t;~~ Stiemk e Plan Reviewer Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. thu Fri SBD-6423 IN.0OJI) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants ~1 PROJECT INDEX s~ .L - xD Date - ~e~z.t_J, 939 - DILHR Plan I .D. # 59403612 . Phone 715-425--5587 Ownpr jim & pobin Feye.r-eisen Address Wis. 54022 336 Cty. Hwy tT, River~FaIls, Legal Description Fart of 64 acres. NEE/4, Swl/4. Sec.. 13, T28N, R19W• County ST. Croix Town of Troy Installer C.S.T. Robert UlbYicht CSTM2482 Local Authority/ Supervision Dep1't. St. Croix Cty• Zoning PROJECT DESCRIPTION laceme nt septic c system- For. a 4 bedroom A rn ~.p l.s. sized home; estimated daily waste:flow: 600 9a failing drywel.l system is sited in seasonally The existing wi.tli a design sa.t~~xated soils. Soll.G are permi.able, 1)o every saturated at l_oa6tng rate of .5 GPD/ft.2. Sails are seasonally 30 inches. r e iacetne rit mound system using 12" of sarid fill. is proposf_ A F Pg.l PLOT PLAN VIEWS ~~~ara+rua Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS aa~~ ~sC4N8l Pg.3 PIPE LATERAL LAYOUT Pg A DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS h M410 ~ o ~ IN N o m CIO ~1S k, o7 ~ I I N ~1 W Ny z ~ 0 1 rD c, vp,~'' , riallY Cli G dot%o U V\ -Arl slob. ^ g m 1 ` Q/Q 1' s • ~ b `j ~ W N r f I 1~ z Of 5 JCP05S SECTION of mouAjD wi rtt BELD GtD OF % ro S 94 038 1 ► AggieeSATE ~1 STRi(3t~T1o~ C s ' TN; G ka E S 9 p i p G- sysrEM of Tap SO i L e IEVA rioO UJJ i FOR M To E 4 Ur H n 93. 25' ~ RR~TiO~ • ME1~. 1 e , PIowE~ To P's 0 t i uN FoRM 4 % S'OPE FORCE E1~V/1T~o~ Uu~ER Mhi►~ 92.25' .1~ 1.0 Fr. - MLEVAr10,05 1.3 Fr. iNVF-Rr of ' 1.5" ]ATERMS 93.75' F -g 9. FT. To p o f R O ck 94.08' G 1.0 FT• H 1.5 FT. T°P °F 1.5" IATERA ~S 9:3-gn' P LAW VIEW OF MouAjD wi rti 13E D FoRciz MM J A 6.0 FT'• I I 4 84 Fr K 10 Fr I I T 104 Fr 8 F w F r a. w 28 y l F~ Bev c F PATE SEWAE'E gYST9A Pvc <Appep Tv I onditionajly 0 35E R VATi ON 991QE~ hT pipES BvED pvk TIGNS p ~ NUMAN VELA INOUSTitY, LJ180ii ND BUILD, PERMA0 eoT MARKERS ' DIVISION Of SAF RecgviRED BASAL AQeA 'DAi~y whSTEFIow RRESP0NDEt4CE 1200 .soi 1. loo` JrIQATwE .5 sa. Fr, APAC► ry PRoposEV BAsM ARe,N = X (A t 84' 6' 14' 1680 sq.ft. so FT. D%SM BuTI oA.) PIPE N S Tw oR K LAyOL) r R MA~~F°L° Fr P 80 4.0 Fr R FORCE- Mi4iQ 5o FT 211 Y of Pvc Il~thjEs VAR#'h(3LE TOTAL V(9117 UOIL)h 8.2 •Pi ST^,3 Cft GAIs . H olE 'DIAMETER 1/4 UJGHE5 L.Al EE RNL. " 1 1/2 Ipcl{ES MM N IF=OLD 2 I N c t{ f; S Fopce MA1N " O SVaD~/ 6N1 2 I NC. h4 E S pa1v XOPAS p I P E / -tt) u E RT E LE V ATl 0 k1 Condition o F- L ATE IN S 10NS 93.75' NIAN HO OS/` 1 00soki ,SOO, N • 0~,S10N OF aNpENGE -D E TAi I-- E O D c AP Gp~REgp 1JE R Fa R A,TE P P' P E CL) s • RemovF I 5mil Y Ali I3URR5 . KoIES 10CATED 0n3 BOTToM G' VAIIY SPACED . 7)(5TRiBL)T'loN DISC-hARC>E RATE F=oR t;Rch LATERRL. PER O vs ~~•g~ 15~Z1 Gay ~MiA3. TOTAL 1D STRiBOTIoO j)IScH^Rc->E RATE POR NETW0R K 3 f•Y GArL Ml•A). a~5 1 Mi*N1•M U M 6 ~~hD . . j + Sj94 -03812,, PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS p,41,E oFF j -VEIJT CAP 'i C.I. VE~JT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, w/4V,1A)IN(,-1A13E~ WIUDOW OR FRESH 12"MIU. AIR IIJTAKE GRADE i y"MIIJ. Li' ~ IB" MIu 92.0 COIJDUIT 4.01 ~lEv+n DE ly I 8 8. 0 IM L E T pvk%*4 RRTOG h 1 C I APPROVED JOINTS APPROVED JOINT A ItJ pp K W/C.I. PIPE IONS W/C.=, PIPE Do ® ING 3 yMp~1 EXTEt\1DIIJG 3' 0~ ?~L LA EXTEM0 H 3 U~ IJ O SOLID SOIL ~ ~ ~`so% N~ 8 ~ I ONTO SOLID SOIL O T B 84.7 N~ •sgtl ON 3.3 ~ pND ~EgP I ELEV. 85.0 FT-- KIP vEE S OFF y `gE Pp 1A,)6- ° 1.3' K I BLOCK o~ lE VA f i0,✓ 84.45' * RISER EXIT PERMITTED OUL9 IF TANK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC E 5PECIFI'CATl0M5 DOSE 4 TANKS MANUFACTURER: Mi dWestprn Pra_CaSt IJUMBER OF DOSES: PER DAH TAI.1K SIZE : 1000 GALLONS DOSE VOLUME ALARM MANUFACTURER: S • J. Electra INCLUDING SACKFLOW: 160 GALLONS MODEL 1JUMBER: 101HW CAPACITIES: A= i6 INCHES OR 400 GALLONS SWITCH TYPE: Mercury f l oat B= 2 INCHES OR 50 GALLONS PUMP MANUFACTURER: Zoeller C= 6'4 INCHES OR 160 GALLONS MODEL NUMBER: 98 1/2HP 115V D=15.6 INCHES OR 390 GALLONS SWITCH T9PE:Piggyback Mercury F1at MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 35 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..8 - 7S_ FEET -rAok- + MIIJIMUM NETWORK SUPPL9 PRESSURE . . . . . . . 2.5 FEET cCA(C%_ I 0Ii" + 50 FEET OF FORCE MAIN X o FT.FRICTION FACTOR..l--51- FEET t4oA f S 25 A ~(7 = TOTAL 091JAMIC HEAD = 1A-,;~ FEET /277 INTERNAL. DIMENSIONS OF TAAIK: LEPIGTH 8'2" ;WIDTH 6' 1" ;LIQUID DEPTH dn" S94-03812 HEAD CAPACITY CURVE 3 7/e 6 1/4 MODEL "913" 30 4 5/e -•~•I a I 2 9 j- ' I 3 5/e 6 m 1S 4 3/16 4 4 10 2 1 1/2-11 1/2 NPT s - 0 U.S. GALLONS 10 20 30 410 50 60 7 1 a0 LITERS 60 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAQFLOW PER MnIUTE _ EFFLUENT AND DEWATENING CAPACITY 12 HEAD UNITS/MIN % y FEET METERS GALS LTRS 5 3.5 81 P73 A 10 3.05 81 271 18 4.57 45 170 20 &to 28 9s 3 5/16 Lock Valve 23' ~L 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 IN Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. 1 •i' ' { Si • i I charal switch, no extemal control required. Standard all models - Weight 39 lbs. - 1QUIOE _/2 H.P. 1 '114Wral Ik>at operated 2 pole me 2. Single 98 Series Control Selection piggyback mercury Ikcat switch or double piggyback mercury, Boat switch. Refer to FM0477. Model Volta-Ph Mode Am Sim lax Duplex 3. M echanical alternator 10.0072 or 10-0075. M96 115 1 uto 9.0 1 or 1 &7 - 4. Sea FM071Z for correct model of Electrical Agenwor, °E-Pak". 1 p & Mercury censor float switch 10QW1,usvd. as a control activator .pecily 098 230 1 Auto 4.S 1 or 1 6 7 - 6duplex 13j Or "J float system E88 230 1 fVon 4,5 Q . Fcwr;(4) hole "-Pak", junctiod boxy for connection or wireddn sim- 9L243or4dr5 -glut or duplex operation, 100002. 7. Two'(2) hole "J-Pak", for watertight connection or spllosj For information on additbnal Zoeller products refer to ouabp on Combinntlon Starler, fM0614 CAUTION P'KWbaek Mercury Swk ws, FMO477; Electrical Adern". FM0488; Metahanical Asernato4 Atied N Noons ion of ~eM' prot I* lei Mion I and whits ehouN M dorw ey a quad.. FM048S; Alarm Package, FMO513; SumWSewage Salvos, FM0487; and Simplex CorWal 90x, Me U,a most re"rt Nalbnal EMorrb Coda (NEC) mul IhOccupatarbna~lwSdayar NHIM Act (OSHA), RESERVE POWEIIED DESIGN For'unusual conditions a reserve safety factor is eneered into the design of eery Zoeller pump. { ass' . MAIL TO: P.O. BOX 16347 . Loud, vX.; ~ ~ • ~ . ' " „ ~ • K1' 40756•0347 Manufacturers of... 0 ~E`L f~ 01 SNIP 70: 3280 OE, Millets Lane a, La dsrl~rr; XY 4r2 1s t1, ,Qu~u~r/~uwvs SINar (502) 778.2731 W 0502) 774.3624 4 .xis Tiu~ 9,c~yw~r/ SysTE,y ,s ,N sss soils-e4 ,'f,~v PON _ Habib and Hu man Re Department lati tions Industry, Labor and SOIL AND SITE EVALUATION REPORT Page / of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY _ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but -5 CRS/~ 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 PROPERTY OWNER: PROPERTY LOCATION Jf M GOVT. LOT AIE 1/4 5kJ 1/4,S 13 T 28 N,R 19, E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 3310 1:571y . ,,7- o~ 6V ,¢Cv-s CITY, STATE ZIP CODE PHONE NUMBER f CITY OVILLAGE OWN NEAREST ROADS (-/ou ,~//S SYo (pis) ~~S - Ss~J ~-RO y #w Y. 7 [ J New Construction Use [ Residential / Number of bedrooms [ J Addition to existing building 1 'Replacement [ J Public or commercial describe Code derived daily flow ° gpd Recommended design loading rate L S bed, gpd/ft2 4/ trench, gpd/ft2 Absorption area required Saa bed, ft2 5 00 trench, ft2 Maximum design loading rate 'S" bed, gpdfit ' 6 trench, gpW Recommended infiltration surface elevation(s) S" P g 3 '13-7-5; ft (as referred to site plan benchmark) Additional design/ site considerations ~s~ L°N (r Ni9if.PD~ i yP~ /1ovvZ7 Parentmaterial ScS J13 - S*k5 4-5 /loGtlTp.✓ ,.1 1" W F s Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL M~OU~e IN-GROUNDPRFSSURE AT- S DE f SYSTEM IN FI HO S NG TANK U =Unsuitable fors stem 1:1 S I~ U p'S E] U ❑ S mi Ifd U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Bartdaly Roots Bed rends in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / v-/ /o 511, a ~ /Jr _;~e 5 S 13 ~v -.51. 2- 4" b,l<- 7,ee .75 7C -S Ground J~ 3y 7 /D U~~c' y GdE r f~,^ e S s ,y„ vc~ cC s S elev. 3/,3 ; f s 7~ft joy 4n v-1-1 Depth to ° Ae3 -5' /s u"F7 limiting factor i vS ,~25 ysj~ y7`LF 49,i!5' k'L 41,01!~4, S. Remarks: Boring # K o-i 3 /o y,e s , G _)l 10-yie 7C 3 P?- X /o l 7' s,6,& Sri vii' ~t S y S Ground elev. 4~ iG ft ci Depth to It 33 3 7.5 / f ,e ~{i' i(r ,U limiting factor , S55 Remarks: Lo F' !mot cE••c~.~T . CST Name:-Please Print -PO R E p-I _ZA L-% P_ 1' G T Phone: -7 (S (f>6 _ p 1 s Address: 4~r Q /N E/G ~v. ,yUDSD,) 7' L~Sr-yQ2 ~~2_ Signature: Date: CST Number: -e Ty~~ s ys7Z!'-, Ite,9-- Ad1y1C, , CU~1ec CF.~IE.vTEv y i 7_4~11 ItNL&- C>WS/:u 6- patvv UJ~ p it.° S 7~' c Tic t~ /~u L f ~ I 3 PROPERTY OWNER O ' Y,6-,e lit SOIL DESCRIPTION REPORT Page .7- Of PARCEL I.D. # f' rte T 4-7- 6 4 4C.f5S T Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu Sz. Cont. Color r Gr. Sz. Sh. Bed „u^•i~ 3 2- -30 /d YiP y S~ z 6~ cs /?c . S G Ground /P y 7,5 y S~ ~f v~d,~ /h+7~if' q S / y S elev. _ s 6 s i _j67 /p/~ -F F 1 ~ y/~ Gv T 1~ ~ V~Ip q s' • •S • ~ Depth to o ,e 13 -7. f yr° of ` limiting ~ ?d Ito i'S S, Remarks: 1~if' r 4;jA)S Boring # Z /1-16 /a /,e y61 /7c s Ground 3 ~l y~ Sl / f ye iw► 7~i S- y S elev. - /D yl - s s 4 S S yo,sG ft. Depth to S &,e 74 ~ S. S 4 S _ S limiting c factor _ I AJ N SS Remarks: Boring # Ground' elev. ft Depth to limiting factor I Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Remarks: con ooon,o nc,nnl 0 °41A `r t a v ~ e7 0/ -:9 O o u `p t~ ill ~ A \ ~ `v • ~ ~Io 1L 4V.- W q? o S ~ ~ v Cn ~ ~ o m tl f- _ V 0 ~1^^L V ~ 40 M CE) 14 a v 3 o N 3~ cr SCI ri Ln 0,0 w _ rq s STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County I ~ OWNER/BUYER v 1 VK MAILING ADDRESS G O bt K r /'K S PROPERTY ADDRESS fit Vr,- (location of septic system) Please obtain from the Planning Dept. CITY/STATE { PROPERTY LOCATION 1/4, 1/4, Section T N-R l W TOWN OF ST. CROIX COUNTY, WI i i SUBDIVISION Aa-V r- 4'1l-` LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE LOT NUMBER I 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. j I 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) j 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 expiratio date. SIGNED: /Im DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 r . 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. 11 Owner of property if kn ~e ~r e C Location of propert~1/41/4, Section. ,T 2 N-R_Zy W Township Mailing address e7- 6l-d G~ e z Address of site ~G c7` A e/ 'IL g 4l ; Subdivision name y Lot no. Other homes on property? Yes No Previous owner of property Total size of property 4~,~ Total size of parcel Date parcel was created z, A t-/ d f, 7 Are all corners and lot lines identifiable? Yes No !aC Is this property being developed for (spec house) ? Yes __k_No Volume 2F-~5- and Page Number q,571 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. I 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. 6.42f',!,2 7 , and that I (we) presently own the proposed site for' or 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. 112L,-7:1 -7 ignat e of Applicant Co-Applicant Date of ignature Date of Signature THIS sIACg RCSCRV[D yon "&CORDING DATA WA RRANTY DEED rand.-Jaume UMENT NO ATIk BAR OF WISCONSIN FORM 1--198st 4Z= REGISTERS OFHCE ST. CROIX CO., W tS. his Deed, made between ...Harol-d- $--.Van--Kuster...... Recd f=or Re "d M 10th .............~u....... ban..--.- of Ju-y _ A.0. 1987 t G=ante=, io:4 5- -A Ai► tt.. ai~id...each...ii► the ir L s EFeyereisen and Robin H. Feyereisen a~b . d••-and..Wl.fev,..ae-survivorship marital. ro rt Grantee, . Witnesseth, That the said Grantor, for a valuable consideration...... . RgT RWER FALLS STATE BANK conveys to Grantee the following described real estate in ...St-.---CroiX......... 124 S. SECOND ST. County, State of Wisconsin: D{ I-D{-ALil 1WL- GnQ2==-- The Southwest Quarter (SWt) of Section Thirteen S3), Township T'wenty- eight (28) North, Range Nineteen (19) West, eX- Ta:Parcel No: ce tt Parcel deed to Arthur E..Neuman in Vol. "575", page 306, #3&+9182; parcel deed to Terry A. Roen and Mary L. Roen, in Vol. "553", page 432, #339833; and ALSO EXCEPT: the parcel described as follows: Commencing at the Wegt 1/4 corner of said Section 13, the POINT OF BEGINNING OF THE PARCEL TO BE HEREIN DESCRIBED: THENCE N 89030' 00" E (recorded bearing on the East/West 1/4 line of said Section 13 a distance of 820.91'= thence Easterly on the Northerly R.O.W.of a town road on a curve concave to the South, having a radius of 238.0011 whose chord bears S 65056'29"E 98.281; thence S 35058128"W 33.00' to the cen- terline of a town road; thence Southeasterly on the centerline of said town road'on a curve concave to the South, having a radius of 205.00', whose chord bears S 4603014611E 53.61'; thence S 39000'0011E on said cen- terline 110.001; thence Southeasterly on said centerline on a curve con- cave to the North, having a radius of 607.00', whose chord bears S 550 48'48.5"E 351.16; thence S 0000414411y 2235.56' leaving said centerline; thence S 89053'13"W 1289.31' on the South line of the Southwest 1/4 of This is homestead property. (continued on reverse side) (is) (is not) Together with all and singular the hereditamenta and appurtenances thereunto belonging; And---------------------------------------------------------------------------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except 1 county and municipal zoning ordinances, unrecorded building restricts and easements for public utilities, conveyance to St. Croix County for highway purposes in Vol "315", page 572, #293289, and will warrant and defen the same. Dated this 17.th day of ---July.---.--•-------•- 1E* 19.87... 01, -----(SEAL) • Har-al_d..E... V on_.Kus-ter....------- S ----.(SEAL) (SEAL) Violet Von Kuster • AQTHBNTICATION ACHNOWLBDGMBNT Signature(s) of Haro -ld..E•._ VOn•_Kuster_.. STATE OF WISCONSIN and Violet Von•• Kuster_..--_--.- County. c authenticated this day of._.JUly.............. 19...9.7 Pers$nally came before me is ...17tA..... day of Jul-- 19. 67. the above r-amed fiarolcl. Ion Kuster and Nanc Murr Barkla ..Violet `Von Kuster TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 1 106.06, Wis. Stats.) to me known to be the person -5.......... who executed the foregoing instr ent and acknowledge the carne. THIS INSTRUMENT WAS DRAFTED BY - .1 Y, Nancy..M=.ry...B&rkla.....Atty_................... David A. Gilles River Falls, Wis 54022 - Pierce ~ • ~ ,,,,,,..:.a~11ipR Notary Public :--~V (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, st \ •.•~~•~N are not necessary.) 28/89 date: •Nass.a of persons signing in any capacity should be typed or Printed below their signatures." t-ubk-Stiro of ftwor STATE BAR Or WISCONSIN Stock No. 13001 IcC~lallerCawwra® PORT{ No. i - 1962 iS of said section 13. to the Southwest corner Of said Section 1.331 thence a to the 40 on the West line Of the Southwest N 00004'44"W 2617• 1/ sub ect' CONTAINING 75.20 acres more or less, being POINT OR-BEGINNING, over Northerly Portions of said parcel for town ato uoses to easement. L„ as said roadway Is now ow JAJd and traveled and also being subject easements of record.