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HomeMy WebLinkAbout040-1173-90-000 S 0 C) m 00 o p °cn p ~ M C 4 O O C C n O N O ~ ~ O O Q) 6 O C C 2)N LL b 4 CL Co Y O Y U 'O (n U N 'N C .'J N N 'I C .0+ <6 U O p, O) C O O E Y N C CL O C N 3 L L a O fD O (p 4) C a 3 ~ o m I m w "0 0 0) co a mNyn~ O (6 CO j O Q) L N z N '6 O Z 'O w E O OI C _ N L C O '.0 O 7 N O L "Q f6 0 C U. O 00) N LL E O U N N .N. S 'c cD .O c a •E c -0 C) 2 2 (D a) d c) C7 E d ~n m- cn n U I O f6 ~ z y y N z O O Z co W a m d m N H Z O C z U O Z 'a c C - U a r ~ O N y- I O N m a fn F- r z E E 0 co CL ~~V Y = N C C O = a) N in (D co U) 1~lly N C • 0 C L L L a U - t6 'D O ~ C O U O o d d o d Szz v z~-z o z N Cl) w~ m co `m ~T E U m E N x C. F) a R a co 0 <j O O IL a E O O a .0 (D N rn m FN- H FN- 0 m H FN- IN- a in .4U- N cn o o 3: 3: 3 o 3: 3: 3: z C) • a a a ~ a a a u o N V) J U o m (o z o rn rn U) 7- _ v c) ~ = o m O = r) r- _ Ln LO E 0 0 0 0 0 .U _ N O C7 O co C G! m a y N 0) -6 O ~j • d d z > a~i d .r 0) E 00 r-- O 9 p N O C N O y y O O O 0) CD 0 O C C O C N C C 4- _O N O C) C 0] N 2 C N N N~ r- I 04 00 (N S) -2 7 ~ ` N vs co O D M N m m U • y?,~' O N I- LL O N S z LL N O N U? V m a a CL d a CL L: (L • a m d E G c c `~1 A L) a 0 in 0 0 Z Ci STC - 1o4 AS BUILT SANITARY SYSTEM REPORT V ICJ OWNER C,r ADDRESS SUBDIVISION / CSMJ CT(21k ~F~V 54)3. LOT SECTION T N-R W, Town of IUD V ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITH.LN--l EET OF SYSTEM "7G A fore t`~ n S /a~a ~•f ~uc+t N Cheer c er m 5-6 34 sylie a T<Kk 0{ ~y•( ~Oay 6M pn C cticrr4r Pert 1 13rcpro©~ to ® ~J tDAte INDICATE' NORTH APPO~~ Provide setback and elevation information on reverse of this foam. Provide 2 dimensions to center of Septic tank manhole c-ov(" BENCHMARK: 7-6i2o 1 COn e e Q C ALTERNATE BM: SEPTIC TANK I/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~e13'~'i^ Liquid Capacity: Setback from: Well S~ House Other Pump: Manufacturer S ModelV _ Size Float seperation Gallons/cycle: / 7.4 -3 Alarm Location- SOIL ABSORPTION SYSTEM Width: Length 7 -1- Number of trenches 2 Distance & Direction to nearest prop. line: Setback from: well: (a0 House A/_-` 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: PLUI'IBER ON JOB: OZY 1, LICENSE NUMBER: (tee 7~rj INSPECTOR: s~c)3 )L STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 117( h, f4p /QO ADDRESS_. o yo h'aw / YO/ SUBDIVISION / CSMJ .S7 cro jy CDDe EUL LOT # elo~` ~ SECTION c2y T-28 N-R,,~W, Town of T l V JL ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i p loco l~P,sQr ~w~Frt k Z4 5'b Ule15er.5ef4eC'7a„ k 03' 1 ,8M , ~ ~ . lUD~~}3.6nry~ 13-f 19 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover. 19 BENCHMARK: TC~oO t.-6t cile~e Ac f m A/c ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: !~e(~e✓' Liquid Capacity: ~Z d Setback from: Well-K6"_ House & 3 Other Pump' Manufacturer ~I.A C. Model#`?S7%44_ Size Float seperation Gallons/cycle: l 7 z Alarm Location e rh !7[:l(a,5 -k- SOIL ABSORPTION SYSTEM Width: Length 7 Number of trenches Distance & Direction to nearest prop. line: I + k0dk Setback from: well: z ~ House 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: 7 PLUMBER ON JOB: LICENSE NUMBER: 70~ INSPECTOR:- 3/93:jt G ~ ' z i `WisconsirrDepartmentofindustry, PRIVATE SEWAGE SYSTEM County: , abor and kfumV Relations INSPECTION REPORT ST. CROIX SafPty.and,Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PRAR 0.4 FIELD, LITTON X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing r Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet O,SS TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet tJ rl /0, lO6 3- 7 Septic NA Dt Bottom / ~p a 3 Dosing Ya S $ v ' 3 NA Header / Man. S, ~3 99• o/ Aeration NA Dist. Pipe 5 3 e q9, 7K Say 9 Holding Bot. System 3 98; PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 5 i u n 1-7,9 ?6 Model Number o GPM I Loss Friction S~ System Ot'V TDH j~ Ft TDH Lift $,5t- H Forcemain Length; / Dia..~7'1 Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~S DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO Mode Number: System: y~ /O S j SO 'A- OR UNIT 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 p~a Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, //p^^ersons present, etc.) 13 p ov't: Lot 1, Lots 7, 8 and 9, Cove Road LOCATION: Troy.24.28.201w, ? i o , ss r 3 7 "P(bin revision required? ❑ Yes ❑ No Use other side for additional information. &11L SBD-6710 (R 05/91) Date Ins ector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r - • ~ e. j Yom, ~ ~,-•r~~ - SANITARY PERMIT APPLICATION MUM! In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATE S^ANITAR PERM # -Attach complete plans (to the county copy only) for the system, on paper not less than pt 334a 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION GOVenMjent jot 1 Litton Field '/a S 24 T 28 , N, R 20 ZqWW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 290 Oove Road 7 8, & 9 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER T-Tiir1Qr-in WT 54016 715 386-9254 St. Croix Cove Subdivision NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned Cove Road ❑ Public ❑ 1 or 2 Fam. Dwelling,## of bedrooms 4 PAR EL TAX NUMB (S) III. BUILDING USE: (If building type is public, check all that apply) 040-1173-90 10 Apt/Condo 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 in line A. Check line B if applicable) A) 1.0 New 2. ® Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 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 600 750 750 •7 98.0 Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank %MM&S&Rk - 12 50 1250 1 Wieser X Lift Pump TankftimipedoWt 1000 1000, 1 Wieser VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): P e s igna rej (No tamps MPS No.: Business Phone Number: P;4111 r-J. Steiner 6780 715 425-5544 Plumber's Address,(Street, City, State, Zip Code): N8230 945th Street; River Falls WI 54022 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitgry Permit Fee (Includes Groundwater ate Issued Ias ing Agent Signature (No Stamps) /0 Approved ❑ Owner Given Initial $/:~e) Surcharge fee) Adverse Determination S X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS - , 1. A sanitary, permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 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 in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. 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. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE ~i 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Qwt eras nazne_ San. Permit No. ' H63.05 PLOT PLAN Show: Ea Location of building served DI Dosing chamber F71 Septic tank B Vertical/horizontal reference point Building sewer System elevation is °t g. y, Effluent system Well U,hi Replacement system area F ~i Property lines w/in 50' of system u R• Distribution boxes F-I Scale = `u =y.%31 , or dimensioned ' Pump and controls: "'IEZS ^ S S ri Mfr. & Model No. Vertical Lift Size Force Main o . q2 8 . Z S ~l0 6~tt~. 30 1-t Z_ 3 Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: ~ toz ~ e•2 3'lo p /n~~ ~ g.3l''L. to l 4 Y ~r~ 5' bo C1F Z~Pv C F.wt. LI g. ~ i ~~.too6 it 1 2 X000 6M.. tN«S~ ~ pvv~p Ct~iRMtB@R~ 30 or-4 PbC t2So GAL. L4XP,4 t oF 4 Qno ~ B D Rr~l ~ ~~s t fl Caw ~B w ~L By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, St. CroixCounty and theSt.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or aft 'nstallation. P um r signa ure icense NO. otJ N s I- 0-on e -1St - s - 14 \b C. 4" cT vet-i`c PIa~S y'` ~ ~ ~ ~CTR~ct~ Ptfit'B PIK 3 I~c~aczoveo CAPS GZ~SS S~CT10N 4 cr vouT ~~1PC w/'PtPP~v~ ARP ~1T LC~S~- \•Z.yRBou~ t'-rJUISl4~D 6R-f1-AE K-N f=}ZI,S~1~-t 6 G C~PCD Z s o t L FI L L ~~1~/ E~-PnC2UV~~ S~rn1'jT}-~Tl C a a o CpUL~ZIN6 V V 6 a u ~L.L3L . a~~ b LL.dJ. 8. b c• ~ o ~ aF Itz "lv Z I Iz k hGC.zea"-R- O~Ciw ~~911Z1 gV`hOYJ l-Al PF C'1t+.1~ Z'' Ot` 1~GGRfi' 611 `f` 14-BOv ~ p 1 PE DISTRIBUTIOU PIPE TO BE AT LEAST Z.6 IMCHES BELGIJ ORIGIIJAL GRADE AUD AT LEAST GO 1"CHES BUT 1.10 MORE THAI) 42- IMCHES BELOW FIAlAL GRADE MAXIMUM DEP-1-I4 UE 1-XCAVATIOIJ FROM,ORIGIUAI- GRADE WILL BE 4 IMCHES MINIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRAW1 WILL BE 3~ 1NC1lE$ 51C,uc1) LICEIJSE },UMBER: 'j. DATE - PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOMS PAGE OF VEAIT LAP 'i"C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE 1:: r-T JULICTION BOX ' COVER WITH WARNING LABEL ~ 10' FROM DOOR. 12~MIU. WIIJDOW OR FRESH AIR WTAKE GRADE I Lq- C1 40 MIIJ. I 18' MIIJ. CONDUIT 18"MIN. • PROVIDE i IAILET AIRTIGHT SEAL ( i i I /I t . ~ I v APPROVED JOUJT~ A Tank construction shall comply I I i APPROVED J011JT5 with ILHR 83.15 and ILHR 83.20 ALARM II e I I I ow C I I ELEV. FT PUMP ~ OFF O £L `i:0 •00 COLICRETE 9LOCK 3" APPRav~t gFpptµ~ RISER EXIT PERMITTED OIJLy IF TANK MAIJUFACTURCR HAS SUCH APPROVAL. SPECIFICATIOMS 3.. 005E Wts Cp~IeCL 3.6 TANK MAIJUFACTURCR: MUMDER OF DOSES: L_PER DAU TANK 51ZE: 1000 GALLOWS DOSE VOLUME z ALARM PJ"FACTURER: INCLUDIWCs DAGKFLOW: GALLONS S S . Tel..-T RA Sri S~T1"1 S `"1 Z • 1J MODEL NUMBER: 1~1 Hw CAPACITIES: A= IL4" WCHESOIL L116'3 GALLOIJ3 SWITCH TYPE: 1'1trT1LC•lJ1Z~f 8= Z INCHES OR 57.1 GQLLOAIS PUMP MANUFACTURER' C= 6 IAICHES OR VIZ. 3 GALLOWS SS 1'133 D- INGHESOR 'LSII"9 GALLOWS MODEL WUMDER: W'1 tC UR-Y MOTE: PUMP AMD ALARM ARE TO DE SWITCH TYPE: MINIMUM DISCHARGE RATE GPM INSTALLED ON 5EPARATE CIRCUITS r-~prvj CFA. VEKTICAL DIFFERENCE OETWEELI PUMP OFF AUD_ PIPE.. , '33 FEET + MILIIMUM NETWORK SUPPLY PRESSURE FEET 100FLFRICTIOU FACTOR. 0-ff FEET 60 FEET OF FORCE MAIM X ~'S4 Fy TOTAL DyUAMIG HEAD = 8,Z S FEET DIAMETER ti t IWTERAIAL DIMLWSIOW~ OF TAWK: LENGTH ;WIDTH ;LIQUID DEPTH I? BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = -8.ZI GAL/INCH _ TOTAL HEAD IN METERS oO t` co U v co N r O O O T O - 100 M O O QO O M O C~ N O - CC) C) N A' N O V N W UJ U-) V~ co E2 'r- 0 W w o a a i G1 to °v Z J ° o► $SM33 Q ~y P~licpPpC, ° L'3 000001- 0o G~ N 525 00 Q' P o G P,O N C) cn o Pj W V 0 NT _ 4IT o r O / O N JI Q O 0 N N O OO Cfl d' N O o0 CO N O N N N f /88- TOTAL HEAD -IN FEET K3066 Z"V , ME40 DIMENSIONAL DRAWING MW50 DIMENSIONAL DRAWING ~i i E "OFF" " 14.76 - - r-n --1 v co Cl) c~ E ( I •T 6.25 I 1..._.~ 216 E 1-1/2" NPT (38.1 mm) Discharge / 9.04 Cl) 5.66 5.44 " (144mm)`---.j 11.68 11.42 (296.5mm) ME40 PERFORMANCE MW50 PERFORMANCE CAPACITY LITERS PER MINUTE CAPACITY LITERS PER MINUTE 0 100 200 300 400 500 0 50 100 150 200 250 300 350 30 10 40 12 25 35 8 10 ~ F 30 R W 20 W W W W z LL B w ~ LLI Z 6 25 2 - Z ? Q - 15 C W 20 6 Q = _ = W_ Q 4 J F F O 15 4 10 O 10 2 2 5 5 0 0 10 20 30 40 50 60 70 80 90 100 0 0 0 0 20 40 60 80 100 120 140 CAPACITY GALLONS PER MINUTE CAPACITY GALLONS PER MINUTE 238 11 MYERS LIMITED WARRANTY F.E. MYERS warrants that its products are free from defects in material and workmanship for a period of 12 months from the date of installation or 18 months from the date of manufacture, which- ever occurs first. During the warranty period, and subject to the conditions hereinafter set forth, F.E. MYERS will repair or replace to the original user or consumer parts which prove defective due to defective mate- rials or manship of MYERS. This remedy is exclusive and is the only remedy available to any person with respect to such MYERS product. Contact your nearest authorized MYERS distributor or MYERS for warranty service. At all times MYERS shall have and possess the sole right and option to determine whether to repair or replace defective equipment, parts or components. Start-up reports and electrical system schematics may be required to support warranty claims. This warranty is effective only if MYERS supplied or authorized control panels are used. LABOR, ETC. COSTS: MYERS shall IN NO EVENT be responsible or liable for the cost of field labor or other charges incurred by any customer in removing and/or reaffixing any MYERS product, part or component thereof. THIS WARRANTY WILL NOT APPLY: (a) to defects or malfunctions resulting from failure to properly install, operate or maintain the unit in accordance with printed instructions provided; (b) to failures resulting from abuse, accident, or negligence; (c) to normal maintenance services and the parts used in connection with such service; (d) to units which are not installed in accordance with appli- cable codes, ordinances and good trade practices; or (e) if the unit is moved from its original instal- lation locations, and (f) unit is used for purposes other than for what it was designed and manufac- tured. RETURN OR REPLACED COMPONENTS: any item to be replaced under this Warranty must be returned to MYERS at Ashland, Ohio, or such place as MYERS may designate, freight prepaid. PRODUCT IMPROVEMENTS: MYERS reserves the right to change or improve its products or any portions thereof withotdut being obligated to provide such a change or improvement for units sold and/ or shipped prior to such change or improvement. WARRANTY EXCLUSIONS: as to any specific MYERS product, after the expiration of the time period of the warranty applicable thereto as set forth above. THERE WILL BE NO WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PAR- TICULAR PURPOSE. Some states do not allow limitations on. how, long an implied warranty lasts, so the above limitation may not apply to you. No warranties ,1i epr ,tations at any time made by any representative of MYERS shall vary or expand the prow -foof'. LIABILITY LIMITATION: IN NO EVENT SHALL MYERS BE LIABLE OR RESPONSIBLE FOR CON- SEQUENTIAL, INCIDENTAL OR SPECIAL DAMAGES RESULTING FROM OR RELATED IN ANY MANNER TO ANY MYERS PRODUCT OR PARTS THEREOF. Some states do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation or exclusion may not apply to you. This Warranty gives you specific legal rights and you may also have other rights which vary from state to state. Direct all notices, etc. to: Warranty Service Department, F.E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805. Myers@ F.E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805-1969 419/289-1144, FAX: 419/289-6658, TLX: 948-7443 Printed in U.S.A. 5/94 23833A275 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 1 C~ l5( Attach complete site plan on paper not less t Plan must include, but S`r. not limited to vertical and horizontal refere (B directio slope, scale or PARCEL I.D. # dimensioned, north arrow, and location ancp tt road. O LLO - APPLICANT INFORMATION-PLE RI ')k OR AT REVIEWED BY DATE PROPERTY OWNER: F,A OPERTY LOCATION L.t'~-'Tp1J ~~I`~ r4 t;F+A! OVT. LOT 1/4 - 1/4,S 2,q T 2,» N,R Z-o E (oro PROPERTY OWNER':S MAILING ADDRESS crw OT # BLOCK # SUBD. NAME OR GSM # 2 °10 SUE ~ZZN-D a 4~ - CALIF Sva0lv~Sll)N CITY, S$TATE ZIP CODE ❑CITY ❑VILLAGE MOWN NEAREST ROAD [ ] New Construction Use [pC] Residential / Number of bedrooms y [ ] AdditiQn to existing building jJq Replacement [ ] Public or commercial describe Code derived daily flow 6133 gpd Recommended design loading rate o -l bed, gpd/ft2 o a trench, gpd/R2 Absorption area required 8 SS bed, ft2 1 SO trench, ft2 Maximum design loading rate o-, bed, gpd/ft2 0-~ trench, gpolft2 Recommended infiltration surface elevation(s) C8.0 It (as referred to site plan benchmark) Wj ~UF't P Additional design / site considerations' Z ~Q C*t' S - eftCt1 S~ x -is' Parent material S rr►~-o ~EL Gum tpet. Rood plain elevation, if applicable tN -.N. - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem 0S ❑U ®S ❑U 19S ❑U MS ❑U 0S ❑U ❑S OU 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 -7. s 11 R z s f I - 1 S ti. v~ u a- S o,1 0 git n~~ Z S-3b ~.S~.e zs/ - ~s ~ s r-► ~ ~S o.l o. ~ Ground 3 36-Z Z S `iR y/6 - S ~G1 b 39 ti 0_1 0, 8 elev. %u , ft Depth to Nmiting factor 9 a Remarks: Boring # 1 Ca -S 1.S`IR 2.S/I 1S 1 `)v MAui~' 0.,S - b•7 Z Z S3S 1.5~tR Z.Slt - ~S ~S vnl ~S o_-to.$ s-n' 3 3S_8y ~.s yrz LI/6 - S X61. U g9 wt 1 - 0.8 I Ground i elev. W2.. ) ft. Depth to limiting f factor Remarks: T Name: Please Print Phone: Arthur L. We erer 715-425-0165 errs: Soil Testing &.Design Service-P.O. Box 74 River Falls,WI 54022 Signature: - -Date: CST Number. - 6L S= 13 YLIH [I MIS M00576 . I, r , PROPERTY OWNER SOIL DESCRIPTION I3E.P•ORT Page? of PARCEL I.D. # oy,0 - 1 `-13 - 9 0 Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. ~Cture Consistence Boundary Roots Bed Trench Munsell Qu. Sz. Cont Color ' Gr. Sz. Sh. O_S ~.g`1tt 2•S 11 Z S-3S ~.S`~Q i.S I2 lS Ogg w~ CS Ground 3 S-81 1• S `it2 -fl Gh O S vn 7 0 elev. ~b ft. Depth to limiting factor Remarks: Boring # .....s< . i Ground elev. ft. Depth to limiting factor Remarks: Boring # 4 •'~S+A,k Ground elev. ft. Depth to limiting factor I Remarks: Boring # - 'may?.:::.:v: •::}i: fi J Ground elev. ft. Depth to limiting factor Remarks: - - - " PLOT PLAN Page 3 of 3 SCALE I"= y) ' ow►.~c.~ LlYztvv ~-t~~ \o ti+u. 040_l\-13_9o _ "oq r 1O ~?LtcCE ~ow1►SWPt. Tti-OtiC~} 36 ` h3' `RtF oo~.,►.~ S Lti PE BOG ~ . T~ CSI ~-~V s . _ ~ 8 , u' ~6upG 0 , i e-L y ~•2 3°lo p N g.3 p ~ S ~L.1,o 1 y - 5 b. ~ 1!I 5, i5' g•1 ~~.wp•6 Z 1 S@PTI C \be, b' oto L B D ILM w ~L °tS_~3 Kl~ 1~► E9.9.5 - (T15 1400576 Date Signed Telephone No. CST # CST Signature Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety 8 Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY S'T' C_~ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (Blu), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 qr qO APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION IE-1 t_1,Z~ GOVT. LOT 1/4 - 1/4,S Z T -?-b N,R Z D E (oro PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Z °l0 C v;z ~Z Pl -D -I,8 ELI - ST- C.~2UL~t eAUF SUaOIVtSIUN CITY, S$TATE ZIP CODE PHONE NUMBER []CITY (]VILLAGE ®fOWN NEAREST ROAD `"N~gofv, wl ~!6 (71S) 386-qZS [ ] New Construction Use M Residential / Number of bedrooms 14 [ ] AdditiQn to existing building Replacement [ I Public or commercial describe Code derived daily flow, bU3 gpd Recommended design loading rate O.1 bed, gpdV 0 • a trench, gpd1l Absorption area required 8 SS bed, 112 -1 SO trench, ft2 Maxanum design loading rate bed, gpd/ft2 trench, gpdAt2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) y~ ~U►~l P Additional design/ site considerations Z 'T2 C - C`f cC~} Sx Z S ' Parent material S W-b ~IL G "L)EL Flood plain elevation, if applicable t'.1 _K - It S = Suitable for system cONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S DU ®S ❑U CC'S ❑U IDS ❑U ®S ElU DS OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrxialy Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 0- S 7.S-1 R z.sl t - 15 mU~~ a-S o app Ground 3 36 Zq Z S `iR V& - S ~G► b s9 elev. Wo , tt Depth to limiting factor 9 a Remarks: Boring # p-S 1.S `1q 2.S /I ~S 1 9~ VA U'~1~ a-S - e 7 :04 Z. Z S -1s -)•5`tR Z-S/Z ~S u S wt~ ~S a ~ o.$ r~~azv"S -3 3S$y yrz 4/6 - S 6~ U99 wr1 d.1 0.8 1 Ground elev. I bbl - I ft. Depth to limiting ha~c 8q 4 Remarks: CST Name:-Please Print Phone. Arthur L. We erer 715-425-0165 erer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 ge $gnature: - Date: - q S=73 _ CST Number ~7 .7 J,jJ4 l 1~ ~g~S _00576 PROPERTYOWNER ~-~►y ~~`~D SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. `-l - 9.0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bumlary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxfl. S 2•S 11 o. $ Z- S (t S d g Y, ` C S - o. 0.8 Ground 3 3S-81 1• S '1Q Y /L - S Ell. Grx- O s vn _ 0.7 0. 8 elev. ~b ft. Depth to limiting factor 1 v Remarks: Boring # Ground elev• ft. Depth to limiting factor Remarks: Boring # S 5 Lti;ti Ground elev• ft. Depth to limiting factor Remarks: Boring # Ground elev• ft. Depth to limiting factor Remarks' - - PLOT PLAN Page 3 of 3 SCALE r= 40 ' ~~p Ivu, o~10_Z~Z3_90 -o -M LIU T t lCR - L ~ mw1~SWPE 'tcs-OvCt► 36'' ' rt~ It o+- S Lb PF ~DG e . 1~ +CV GeV s . _ -t fa . o' p ~Ij B.3 ~p l'_1, Lo 1 V 5 10 L g•t L-L IO 2 _ 1 sep~ c r ~ 1 wo q SDIz_" w ELL °~S_~3 - PI", k, l`t g S ( 715 ) - 425-016-5 - 400576 CST Si 9 natu re Date Signed Telephone No. CST # STEINER PLUMB & ELEC INC 7134238818 P.03 f STC - 105 r , e SEPTIC TANK MAINTCNANCE AGREEMENT St. Croix County OWNEWBUYER Litton E. S. Field N9,1NG ADDRESS P. 0. Box 64016 PROPERTY ADDRESS 290 St. Croix Cove Road, Town of Troy (location of septic system) Please obtain from the Planning Dept. CITY/STARE St. Paul, MN 55164-0016 PROPERTY LOCATION 1/4, 114, Section 13 l 28 N_R 20 W 'T'OWN OF Troy ST. CROIX COUNTY, I SUBDIVISION St. Croix Cove IOTNUMIIER 7'8'9 i CERTIFIED SURVEY MAl' VOLUME PAGE ,I,OTNUM3ER Improper use and maintenance of your septic system could result in its premature failure to Ila idle ' wastes- Proper maintenance consists of pumping out the septic tank every three years or sooner, if ne ded by licensed septic tank pumper. What you put into the system can affect (lie function of the septic ank i 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 Co inty accepted this program in August of 1980, with the requirement that owners of all new systems agr a to keep their system properly maintained. llie property owner agrees to submit to St. Croix Zoning a certification form, signed by the o vner and by a mater plumber, journeyman plumbcr, restricted plumber or a licensed pumper verifying tl► t (1) tite 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. UWe, the undersigned have read the above irements and agree to maintain the private se vage disposal system in accordance with the standar set' forth, herein, as set by the Wisconsin NR. c m Icted and re urned to the St. roix Certification stating that your septic has been maim fined mu t 19- County Zoning Officer within 30 days of the three cpr a pi ration dZIC SIGN L onrl.. ~ l ~ • 1 St. Croix County Zoning Off= Government tenter 1101 Cannichael Road ' Hudson, \~'I S4016 t r r.•w~ STEINER PLUMB & ELEC INC 7154258818 P.02 • 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should thi development be intended for resale by owner/contractor, (spe house), then a second form should be retained and completed whe the property is sold and submitted to this office with th ~ appropriate deed recording. - - owner of property Litton E. S. Field Location of property 1/4 1/4, Section 13 T 28 N-R 20 11 P.0. Box 64016 Township Troy Mailing address St. Paul, MN 55164-001 Address of site 290 St. Croix Cove Road subdivision name St. Croix Cove Lot no. ; Other homes on property? Yes xx No Previous owner of property Total size of property Total size of parcel Date parcel was created ; Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes x N volume and Page Number _ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAG NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, certified survey, if available, would be helpful so as to avoi delays of the reviewing process. If the deed descriptio references to a Certified Survey Map, the Certified survey Ma shall also be required. PROPERTY OWNER CERTIFICATION i I (we) certify that all statements on this forth are true to th best of my (our) knowledge that I (we) am (are) the owner(s) of th property described in this information form, by virtue of warranty deed recorded in the office of the County Register o Deeds as Document No. and that I (we) presentl ow . n the proposed site for the sewage disposal system or I (we . obtained an easementr to run the above described property, for th i i , struction of said system, and the same has been duly recorded is he of e o he County Register of Deeds as Document No f Signature of Applicant Co-Applicant Date of ignature Date of Signature ` i WISCONSIX DanCUMENT NO. I i TATS BAR T CLAIM DEED Rai 3- 19821 TM1• uact ecscavta roe eccoeolno DarA `i _ 'VOL f' 1.~ 1O81FAGE 346 I r1t -Ice fi • ~i Litton E.S. Field and Nancy T. Field, husband and wife. ii 'I~'dte.Req ;ce JUN 6 1994 V% 30 + tclaims to • Litton E_ S. Field and Nancy T, Field_,__as_______._• i .0 t othe Litton E S F iel d Re v __ocable Trust quirustees dated ;i a +~A +,itOwdr+' ` :::~ecem6er-:27, 1984 as restated on__October__17 1991,t t ~I their successQr..truSte~s.--••-• t~ - ~ the following described real estate in $.t_.... cro.ix County. I~ State of Wisconsin: etTURN To 1 ~ I i I ~ ~ Tax Parcel No: t it Lots Seven (7), Eight (8), and Nine (9), St. Croix Cuve Subdivision to Township of Troy, according to the recorded plat thereof on file and of ~I record in the office of the Register of Deeds in and for St. Croix County, Wisconsin. I I' This i s..not.........••-•--•- homestead property. (is) (is not) i •-•-----...r...., 1x..... Dated this day of ne 94 (SEAL) h SEAL) ii - i ton E,.S,.-- ' 1 I~ l .......(S.EAL) 11! .------.--(SEAL) II . - NancX..T. eld - . I II AUTHENTICATION ACKNOWLEDGMENT NNESTA Signature(s) STATE of *19WXX1QX MI Ramsey county. ll authenticated this day of 19...... Perso y came before me this ...l...... day of . • •19..981.. the above named -Litton.-E_S_--Field.-and--Nancy-T a--Field-,----- .husband..and..wafe---------------- i TITLE: MEMBER STATE BAR OF WISCONSIN (If not, . authorized by § 706.06. Wis. Stats.) to me known to be the person 5----•-•-- who executed th foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Leo H. Oehler, #21866 r...4 . ME-IER---- KENNEDY--&-QUN N CHARTERUY------• N T r 44~ Minnes_ ta.-St-.-,-.St.,••Paul Notary blic..-f~(1fh1!{it ------.County, Iw/~/~i4N1 - - #ZQQ ~4 c' "Q erman nt.l If not, state expirati n i (Signatures may be authenticated or acknowledged. Both xy Co issio s p are not necessary.) date: a - - 9 MAFOA TOWBER" i ANY Pu"' - IIN ESOTA " _ t *Names of persons sicning in any capacity should be typed or printed below their signatures. W ASHMOTON COl 306 Well Ap. "M I STATE. BAR OF WISCON,1-N3 ,~,',yepr FORK Na. 3 - 1982