HomeMy WebLinkAbout008-1011-20-100 Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y
l INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
P erso n a l inf you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 370267
Permit Holder's Name: ❑ City ❑ Village ❑ T n of: State Plan ID No.:
Lund Builders Inc., Eau Galle Township 5 ID = 3 (
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
R, 9� M �5-�- �� 008- 1011-20 -100
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic -� 6pD Benchmark 3. 2'� o3.6q 7j - go
Dosing Alt. BM (' Z `lZ . (. z
Aeration Bldg. Sewer S3. S
Holding , "-" St /Ht Inlet 20 ,s ` 2�S0
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Air to
I ntake ROAD Dt Inlet
Air
Septic 5 SZ ` _�(_ I r NA Dt Bottom oZ 3,65
Dosing S� r 3 j NA Header / Man. o$ cw "16
Aeration NA Dist. Pipe &0 • 9 Z
Holding Bot- System �' � ap, S
PUMP/ SIPHON INFORMATION Final Grade $ S
Manufacturer V i S Demand St cover r S?. 31 tz
Model Number M� SD 4"t> GPM 16c-
5 TDH Lift 20.02
F System TDH 32 Z7 Ft
Forcemain Length 21 Dia. Z " Dist. To well
SOIL ABSORPTION SYSTEM
(� W TffNfFI Width 7 / Length 3 r N f Tsertches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ` 4 D IMENSION S
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Ma cturer: INFORMATION Type Of CHAMBER - go - del Nu
System: 2 S 7 l� ° - ' OR UNIT
DISTRIBUTION SYSTEM k_:� 6° ► '�
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
u
Length � Dia. 2 Length A Dia. Spacing ? ��{ 3(0 0
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/Tr nch Center Bed / Trench Edges Topsoil ❑ ❑ Yes ❑ No
C R§ 1? dd ecode dis r R and a s Qr�s�pr t t nspection : o-7 as ao Inspection c
Location: 23h Avenue, �alctwin, 4UUL N \N IF4 � ) W 1/4 4��T2811N R16W) -/ 04._28.16.58A10 -Lot 1
1.) Alt BM Description =+f l SIC aif 3.80 =
2.) Bldg sewer length = 3 (.o 2�- 4`
- amount of cover= > '4Z" `v"�
3.) contour= a�f °19•z`(�5� 3.�0 ` t� = Io
Plan revision requir ? ❑ Yes No
Use other side for additional inform4tion. oq
7r SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
isconsin P 0 Box 7302
epartment of Commerce In accord with Comm 83.05,Wis. Adm.Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for thtaion `n a n less ti p
than 81/2 x 11 inches in size. �EtW t C&O ( x
• See reverse side for instructions for completing this ap Stai Sanitary Permit Number
!� 0 `3 2000, Personal information you provide may be used for secondary purposes 3T C�OIX eck if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. QTY e PNumber
I. APPLI ATION INFORMATION - PLEASE PRINT f' 74 * 3z/w ,5-
Property Owner Name Propert o
4.(�/J CC L crrr'L 1;S T �N,R`/jE(ol®
Property Own Mailing �(s Jy f Block Num -
Cit tae /,c Zip Code Pho a Number Subdivision Name or CSM Hu bet i
. TYPE BUILDING: (check one) ❑ State Owned °❑ vita �° �1 �( ��++ Nearest Road
Public or 2 Family Dwelling - No. of bedrooms Town OF(,. ,44 CSA LL
111 BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) 47. !(p. SSfE —rD
1 ❑ Apartment/ Condo Ig�� -' �/� - - / 8fl O
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. UL 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
---- ystem -------- 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 )/Mound 30 []Specify Type 41 []Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r 1 42 E] Pit Privy
13 El Seepage Pit 1 �D 3 eC 43 ❑ Vault Privy
14 ❑ System -In -Fill 0" cvt c ( C (. ZS
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallo s Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq .) Proposed q. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
7 9 7 . X4 loi Z5FFeet eet
Capacity VII. TANK in gallo Total # of site
INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
New Existing Gallons Tanks Concrete strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank �� 6�� ❑ ❑ ❑ 1:1 ❑
Lift Pump Tank /Siphon Chamber — ❑ 1 ❑ I ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum s Name: (Print) Plumb s Signatur o amps) pm"irS�'0' No.: Business Phone Number: oft
b
Plumber's AjdWss (Street, City, State, Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Agent Signature (No Stamps)
Approved []Owner Given Initial Surchargeree)
Adverse Determination � � d� -�-
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
t
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licerised'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, 606- 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
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 1/2 x 11 inches must be submitted to the county. The plans must
include'the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
CROUNDWATER 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 and Buildings
1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
N v iscons i n TDD #: (608) 264 -8777
www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
May 31, 2000
CUST ID No.267341 ATTN.• POWTS INSPECTOR
WEGERER SOIL TESTING & DESIGN ZONING OFFICE
421 N MAIN ST T CROIX COUNTY SPIA
PO BOX 74� I 110 CARMICHAEL RD
RIVER FALLS WI 54022 WI 54016
r
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/31/200 Identificaf ers
c� J6 Transaction ID N . 319716
Site D No. 193265
Please refer to both identification numbers,
SITE: f ';, 0 �, � above, in all correspondence with the agency.
Site ID: 193265, GREG CADALBERT
ST CROIX County, Town of EAU GALLS; I- iV>yNUE
NW1 /4, SWIA, S4, T28N, R16W ` L'
FOR:
Description: MOUND SYSTEM FOR GREG & CARLA CADALBERT
Object Type: POWT System Regulated Object ID No.: 666407
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
CAUTION: Wis. Stats. 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in
force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus
depending on the type of system and your design, this plan approval may not be eligible for sanitary permit
approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a potential for a lawsuit that may delay the effective date of the code so this status may or may not
change.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 05/26/2000
ik
`�E�z -v✓ FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
KEI H A WILKINSON , POWTS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM
KWILKINSON @COMMERCE.STATE.WI.US WiSMART code: 7633
cc: LUND BUILDERS INC
i
TlT s EL T -
- Page of 6
9
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
LOCATED IN THE NW 1/4 OF THE SW 1/4 OF SECTION � ' T ZFJ N, R 6 W ,
TOWN OF GiN�LE , Sr. (2_. W W COUNTY, WISCONSIN.
INDEX
PAGE l 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW +CROSS SECTION; OF Mbupib
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER K- S ECT I D N AAA, SficifICAna1
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
P.Q.W.T. S.
Conditionally G��G � � Pt�LA :CI�DfC�3E1Z.T=
r Y A K CU
% P 9-4. ov I"
-
DEPARTMENT OF COMMERCE RIU� �'L�S lJI SCUT -Z
DIVISION OF SAFETY AND BUILDINGS
SEE CORRESPONDENC
3 l ° t l PREPARED BY
WEGE[Z SOIL TESTING
AND .
DES = GN SERA I CE 'A0 s`��NS
P.O. BOX 74 421 N. 11AIM ST.
RIVS FALLS. 111 54422 +�
D915
6118YY0q'T►�
y S I-
I G14
JOB NO.
PLOT PLAN Page Z of b
Scale 1 "= y p '
S S - ni flu .
2
0
x s vGG�s��,j W� W G�'flU►v �
"' — IO ' OF L4 I( Pu ( Z
S
I
J
Z
J
i
9
Z
i
c�tirt�sZ@2, aq -Z
�Tl. 1UU • ZS � •
s �
\
\\ \
►vOT eoM.Pfter o2
I eL g8
NOTES
1. Elevations shown;.are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( 2 required)
4. Septic tank to beI /b0O gallon capacity manufactured by
5. Bench Marks 3rd# (- LL• 1(30,0' ory u /LA"
13► l 2 - 9z. 99.16' oti 6 ,1 061j, ..:Vy'( n 1>\1C \?I P( l J /Ljq'Tx
6. Divert surface water around mound to prevent ponding at the uphill side.
- Page 3 Of
Approved Synthetic Covering
Frs C- 33 Distribution Pipe
Medium Sand
Topso _�, H _ G
il
_J I F- Elev. VDb•Z -S
3
b
4 % Slope
Bed Of 2 2 -2 Force Main Plowed
Aggregate From Pump Layer
D l.o Ft.
Cross Section Of A Mound System Using E Ft.
A Bed For The Absorption Area F o •?3 Ft.
G \.D Ft.
A Ft. H 1 -S Ft.
Linear Loading Rate= 1- I GPD /LN FT B 6 3 Ft.
Design Loading Rate= o.3 b.GPD /SQ FT I 1 `- Ft.
J `a Ft.
K 1r Ft.
r- - L 8S Ft.
Trf—
W Z Ft.
L
Observation Pipe--
,,\
$
i -- --
A I - - -
W o ------------- - - - - -- ------------------ - - --•I Force Main
Distribution Bed Of 2 "- 2 -
2
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For' The Absorption Area
Page L Of 1 e
Perforated Pipe Detail
End View
Perforated
End Cap {� PVC Pipe
�
ce
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
P
PVC
Manifold Pipe
Distri ution
Pi Qe
Last Hole Should Be
Next To End Cap
End Cap
P z8.5 Ft.
Distribution Pipe Layout
S 3 Ft.
X Inches
Y 3 Inches
Hole Diameter ' Inch
Lateral Inch(es)
Manifold Z Inches
Force Main Z Inches
# of holes /pipe 10
Invert Elevation of Laterals Ft.
L16r G
LI
Place lst hole 1g from center of manifold with succeeding holes
at ��� intervals. Last hole to be next to the end cap.
Combination Sep-t-ic; Tank and
PUMP CHAMBER CROSS SECTION AND SPE CIFICA TIO NS' PAGE S OF
-VENT CAP WEATHER PROOF
JUNCTION BOX
'1'C.I. VENT PIPE , APPROVED LOCKING
lO' FROM DOOR, MANHOLE COVER ovIV
'.WINDOW OR FRESH u- 'P+RtJltJ6 L.N%EL
ALP, INTAKE
� I
c'• SMh -x . I
I&L EL 90 -� I `(, MIN.
L - IB'MIAI.
PtP_ 11�
tAp proved wl FllC�t6ttT - er}P PROVIDE
� AIRTIGHT SEAL , A Tank construction I I Approved
I I CI joint w/
shall comply with ALARM PVC pipe
ILHP 1,3.15 and 83.20 a I I I
i ,
C I oN
I I
LLEY- FT. __J
PUMP �
OFF
0
C OIJC RETE
BLOCK
5
R15ER EXIT PERMITTED OIJLy IF TANK MAWLIFACTURCR HAS SUCH APPROVAL %E00:N
EOD t NG
SEPTIC F SPECIFICATIC11JS
DOSE
TA L) KS MAWUFACTURER: 'QtR:S�M U C TL WUMBER OF DOSES: 3 • S
1�C�0 600 PER DA4
TAWK :,IZE - GALLONS DOSE VOLUME r
ALARM MAWUFACTURER: S -S•i_ tj!t o ,S'7 S INCLUDING, 6ACKFLOW: �bs'S GALtON,�
MODEL ►DUMBER: lC) L �AW
CAPACITIES: A= Z 6 1MCHES OR 3u _2 •3 GALLO
SWITCH TAPE: f'LeiL eJ,(ZY
B = Z ►WCHES'OR Z GA LLO WS
PUMP MAUUFACTURER: Y n L jt�ZS
tAICHES OR � bs- S GALLOWS
MODEL NUMBER: S'p INCHES OR �Cj"
GALLONS
SWITCH TYPE: _'n'Kl.. = 6C) $
MOTE: PUMP AND ALARM ARE TO 5E
MINIMUM DISCHARGE RATE 4 6 -a GpM INSTALLED OU SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEW PUMP OFF AUO..DISTRIBUTIOIJ PIPE., Z3•b� FEET
+ M11 NETWORK SUPPLY PRESSURE 2.Sp FLET
+ 2 `S FEET OF FORCE MAIN Y, F oF>FRtC7tou FACTOR_. q0 FEET
TOTAL DYNAMIC, HEAD — 1 4 - q Q) FEET
As per manufacturer gal /in. Liquid depth S1,
ME Series
1/3 through 1 -1/2 HP
Effluent Pumps
Performance Curve
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350 400 450
100 1
90 28
80
2 4 Cl)
70 $0 w
M Uj
W
w F �Op 20 2
U- 60 Z
Z —
w 50 $ 16 w
2 =
J
g 40 M F$0 H
O 3� .�0 12 O
30
L4 aa
B
20 MF33
to 4
0
0 10 20 30 40 50 60 70 80 90 100 110 120 130 0
CAPACITY GALLONS PER MINUTE
M"rw • 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -6658 Telex 98 -7443
K3327 8/92 Printed in U.S.A.
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of
Labor and Human Relations 3
D'ivisidn of Safety & Buildings in accord with ILHR 83.05, Ws. Adm. Code 7y
COUNT I
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include but `.� CZG L X
not limited to vertical and horizontal reference point (BM), direction arid %o of slope, so& or PARCEL I.D. # CQb
dimensioned, north arrow, and location and distance to nearest roaq
APPLICANT INFORMATION— PLEASE PRINT ALL INFORMA IMPED BY DATE
PROPERTY OWNER: PROPERT)�GAT10 4
6£�R6C 1/4 X44,1 /4,S 4 T Z.8 ,N,R 1 6 E (or W�
PROPERTY OWNER':S MAILING ADDRESS • Ld 8 # SUBD; AME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE. JgOWN ' NEAREST ROAD
3��pwtN ,ru 1 S40ZZ ( - )IS) &8Y -Z911 1 r* ►lrul'.
[,j New Construction Use Residential / Number of bedrooms y [ ] AdditiQn to existing building
[ I Replacement [ ] Public or commercial describe
Code derived daily flow b 0Q gpd Recommended design loading rate `� bed, gpd/ft trench, gpolft
Absorption area required 5>,l bed, ft S t» trench, ft Maximum design loading rate • S bed, gpd/ft , L trench, gpd/ft
Recommended infiltration surface elevation(s) s it (as referred to site plan benchmark)
Additional design/ site considerations �yt�j w / $ ' X b3' [3t=_p , }v1 Im Iwl• U r r 1 Z " 01=- S A n tj Fr
Parent material LWM S p U tM G LPMLf-L T uL Flood plain elevation, if applicable IV A ft
S = Suitable for system cONVENnoNAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑S 2U [K S ❑U ❑S (OU El ® U ❑S OU ❑S Rill
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmiday Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tuch
Zj S b t-c. FYI,{.- Clti 2 V 'F • S
Z 8 -zy ! O `t 2 y! — si ti z`Fs b� >n'F►- � - - s . 6
Ground — I's y IZ y/ — S 1 \ cSb1z. m V ` C.S • S
elev.
q s ft y at-I? S 4 R Y/Y L o
Depth to
limiting
factor
Remarks:
Boring #
I o -9 IDti R 313 - s J z'e sbk w,�, elv Zuj - 5
El
.6
Z of z6 to L lL2 , - 1 y
al
3'Fsbk �n'fi- c
-1 Zb 32 7.S `11Z y! S _ .
- S
Ground
elev. y z -Y SLiP v 1slim S /g
qa. 4 3
Depth to Zi
limiting
factor
3Zy
Remarks:
CST Name: — Please Print Arthur L. We erer Phone: 715- 425 -0165
ress:
egerer Soil Testing & Design Service —P.O. Box 74 River.Falls,WI. 54022
Signature: Date: CST Number.
` _
e CI- 00 220254
PROPERTY OWNER \VLZ'T - 'r SOIL DESCRIPTION REPORT Page Z' of 3
PARCEL I.D. # 00'6-11311-
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft
in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots
"' Gr. Sz. Sh. Bed
•Nh+ a \. w�..L.
,S tG1 Rd t
�� -LO
cw • 5 .6
G 3 rj
3 - ),SLIP— V /
1 y z-qP. S `iR y / y — IsNR Sig, L ow,
Depth to ;
limiting t
factor
3 Z'r ;
I
Remarks:
Boring # -
!,M. "n
t
M.
t
Ground
i
elev.
ft.
Depth to -
limiting
factor
t
Remarks:
Boring #
kiiv +. .•:Sit•.:.. n. i
Ground
elev. t
ft. I
Depth to
limiting
I
factor i
Remarks:
3oring #
t
around I
?Iev.
f t.
)epth to
imiting
actor
Remarks: _
`�l oo��M f+ •'�r �•�n•
• PLOT P LAN Page 3 of 3
SCALE 1 "=
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'b'S1vRO TOO S Pr� _
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• I/
a r�tF f _ ti�o.0' 0 t 3 1�1 Pic PtVAE
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o _
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.
9Y -30,1
zzoZsy
( 715 ) 425 -n1 6S r
CST Signature Date Signed Telephone No. CST #
Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page
Labor and Human Relations g _ of 3
Division of Safety rt< Buildings 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 ST' CZQ X
not limited to vertical and horizontal reference point (Blvd, direction and % of slope, scale or PARCEL I.D. # cnb - Vpm- Zo
dimensioned, north arrow, and location and distance to nearest road. '
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION rRIEVIEWED�Y DATE
2 tOG�D
PROPERTY OWNER: PROPERTY LOCATION
80W. t rvw 114 sw 1/4 ,S 1 4 T Z8 ,N,R 16 E (aQw
PROPERTY OWNER':S MAILING ADDRESS. LOT # I BLOCK # SUBD. NAME OR CSM #
Z, Z. Of 3 55 Tlf
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN ' NEAREST ROAD
3 LOW t N t S V 0 �U G Prt -L.L? 5 S 'T'>+ m L.
[,j New Construction Use Residential / Number of bedrooms y (J AdditiQn to e xisting building
j ] Replacement [ J Public or commercial describe
Code derived daily flow b oo gpd Recommended design loading rate • `f bed, gpd$ < • trench, gpd/ft
Absorption area required SAD bed, ft S o� trench, ft - Maximum design loading rate • S bed, gpd /ft - L, trench, gpd/ft
Recommended infiltration surface elevation(s) \� tz� - S ft (as referred to site plan benchmark)
Additional design/ site considerations 'f'»ukt W / $ " b3' gt`p , M 1tv )ft U H 1 Z " 0E Sf'AAj f=t LJ
Parent material Lp g p U tM G cP7eLkL TLL ' Flood plain elevation, if applicable VQ A It
S = Suitable for system I CONVENTIONAL MOUND IN- GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system I ❑ S 2 U 0S ❑ U I [IS ®U ❑ S mu ❑ S MU [IS IR U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Bandary Roots Bed rerxtt
in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh.
F o - I 31 3 z`F n1f�. cI.„ 2u • -6
Z 8 -Z y 1 0 , 1 M yl — Si 1 Z`s b w- wfi-
Ground 3 IV -It - 1 . S yli y/
elev.
9 S ft. '-lIZ Y/Y . Sit z 5/3 L `'� Vvl'r1- ` • `►
Depth to
limiting
factor
z8�
Remarks:
Boring #
El � o -`� Icy R- 313 - si 1 2'Ps�k wt's, ew Zug • S .6
Z a= Zb
3 ib 32 �.S �ttZ y! s ]h Vj `�- c S • y ' S
Ground
e ft y Z -Y9 SLYQ- y!Y ,s�,cz s/8 L v� 1,,'Fl,• — • . 3 i -y
Depth to
fimiting
factor
Remarks:
T Name: Please Print Phone:
Arthur L. We erer 715- 425 -0165
ress:
egerer Soil Testing & Design Service - P.O. Box 74 River.Falls,WI. 54022
Signature: Date: CST Number•..
�a -3 oa -I ► -1q =0o 220254
PROPERTY OWNER SOIL DESCRIPTION REPORT Page?-of 3
PARCEL I.D. # o0 — ►OIL - ZZ
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
Ground 'ItZ V/ y pt! cS - • 1 4 •5
elev.
l •S it. q 1-q t S ti R v1 y -i s Lm S T
:y
Depth to
limiting
factor r
3 Z'r
Remarks:
Boring #
.. r , > =
:
:
Ground
elev. '
i
ft.
Depth to -
I .
limiting
factor }
:
I
Remarks:
Boring #
kk
i
Ground
elev.
f t.
i
Depth to
limiting €
factor
E
Remarks:
3oring #
�. xr:.v:: fi•
,round
;lev.
ft.
)epth to
imiting
actor
Remarks:
PLOT PLAN Pa 3 of 3
SCALE 1 "= UO '
a oo' - ru
- LbT 1 0�= PRciPoSBA c. S. wt.
�o
F V)
iJ
...1 V
.J Q
1- p �w,xr- i .a4.g'o+a 8 't�►Gri,��y`D1w. PvC Ptipe
2 � �
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\ \ �v �O tJpZ- t-0a'LPIry -e1 dR
ez�o �
2 ��
CL °t5
O •
0 4 0 59
s.
640L .s
9� -3 00,1
00 ( 715 ) 425 -n1 F,5 it
CST Signature Date Signed Telephone No. CST #
- WEGERER SOIL TESTING and DESIGN SERVICE
SOIL TESTING - SEWER SYSTEM DESIGN
ATTN: DATE ti-ZS
CC:
SUBJECT:
THE FOLLOWING ITEMS ARE ENCLOSED -
0. OF DESCRIPTION
COPIES
--
SENT TO YOU FOR THE FOLLOWING REASONS:
✓FOR YOUR USE FOR REVIEW AND COMMENT INFORMATION DESIRED
�ya 'm Lc�z Li �j � LW411I J �l`1�U�1 L IUD U 6s
0&-) LOT BEnQ MO O S-')
WEGERER SOIL TESTING
<7
AND
DESIGN SERVICE
��- ��� I NTY
� ZGf�INGOrFICt
P.O.BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715- 425 - 0165
Wisconsin Department of Industry, a� 6� ll 1
La
HumanRelabo SOIL AND SITE EVALUATION- REPORT e l ol
Divi�sic{)o Safety 8 Buil�r gs in accord with ILHR 83.05 i . Adm. Code'
�
�. r Y
Attach complete site plan on paper not less than 81/2 x 11 inches in si ;nn mu t?'t. Ste` CU LyC.
not limited to vertical and horizontal reference point (BM), direction a trot slope, r EL I.D. #
dimensioned, north arrow, and location and distance to nearest road. I
f
j €.
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMA I REVI WED BY DATE
.t 5T C
PROPERTY OWNER: 'P OP
G BTU \Z -6IE t1L1zL 1-7" TJW 1/4. 51i: /4,S T Z 8 NR ! 6 E ( W
PROPERTY OWNER':S MAILING ADDRESS • K �S, NAME OR CSM #
Z.2.R3 SS `R+ A = c,pas� cs",
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN INEARESTROAD
`i pWI , wt SyLUOZ his) L8tl- z.9II Gti°�L SS `rYt RV� .
[,>4 New Construction Use [xJ Residential ! Number of bedrooms y [ J AdditiQn to existing building
j ] Replacement [ ] Public or commercial describe
Code derived dairy flow b o0 gpd Recommended design loading rate • `f bed, gpd/ft •6 trench, gpd1ft
Absorption area required 500 bed, ft2 S oo trench, ft Maximum design loading rate • S bed, gpd /ft -6 trench, gpd/ft
Recommended infiltration surface elevation(s) C ° • S ft (as referred to site plan benchmark)
Additional design /site considerations W 10Uh/� wlSx 63 t3t� . w1 Jrvt wtuwt �Z, Or= S;YT" Fr L.L .
Parent material L�, Q`4S a Q�i'Z 6L4Mi t't-_ 1't Lj_ Flood plain elevation, if applicable ry tQl It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U 0 S E] U El S �U ❑ S IOU ❑ S 2 U ❑ S f,$U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barclay Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. B ITmr&
-3 ct zvf • s -�
Ground 3 » -3ti $ K R yl L C Sb\ 1til ' C 0,
elev. IV
tt 4 3o -30 S Lr ( V/ �- •S `� 2 s Ja L c� w► _ - 3 ; y
Depth to
limiting
factor
30'
Remarks:
Boring #
0 -9 1 312,
L 9 Z.o 1 Z , 1 1 y l y s z+5 b�. h f cw - .s b
Ground 3 �-�' z9 1-S'�tZ Y L � L t e w,�� c - • y - s
elev. y
ft ZQ - l S Fi tt Li � �-► 2 s L ok j - , .� '• y
q °l•9
Depth to
limiting
factor
Z9 y
Remarks:
CST Name: - Please Print Phone:
Arthur L. We erer 715- 425 -0165
dress:
egerer Soil Testing & Design Service -P.O. Box 74 River .Falls,WI. 54022
Signature
aoilw //s ^y g9 - 3 o f l.► Date: Z - 2_ �c� CST Numbe 220254
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z! of
PARCEL I.D. # 00'Z-
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary oots R GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench
10`1 311 _ Sly Z'� yn7 cry Zvi - JD
Ground 3 11 -z.4 Li V- yI - L, l t• Sbk
elev. m
9 9.(3 ft. 42- yl F;. Sys, L o K, M `F�' • 3 -y
Depth to
limiting '
factor
Z
i
Remarks:
Boring #
g.
i
,y I
. i
Ground i
elev.
ft.
Depth to j
limiting I
factor
Remarks:
Boring #
I
7
Ground
elev.
ft. �
Depth to
limiting i
factor,
Remarks:
3oring #
i
1
around
?lev.
ft.
)epth to
imiting
actor
Remarks: _
PLOT PLA Page 3 of 3
SCALE 1 "= 1 4�j l '
s s 11 FTU 1. _ /!
Lp cq�pt� s1R -
3 2 1 °'
ro
I�
Ir
sMT
x
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3 11,1 " I)tA PVC. PIPE W /l_!�}¢
B:3
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BIttFI t1100.0' 10 Vfjgtj
31,1 Dtic) PvC PtPE W /t.."
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\Z,o w _ Fe e.e
49 -3u8 -)
zzoz�y
( 715 ) 425 -01 h5
CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEI"FIC "TANK MAINTENANCE AGREEMENT
AND
OWNERS1111' CERTIFICATION FORM
Owner /Buyer ION L3�;1n�R —�►
Mailing Address _ 101 O
Property Address Z 5 5 - rh A- VC -a4 lM
(Verification required from Planning Department for new construction) o2G0 I1"�° -- °!r
1
City /Stale tl`i t Wi _ Parcel Identification Number g t' Z-0 /O IL
LEGAL DESCRIP'T'ION
Property Location W '/1, ,5th ' /j, Scc: —!I_, T -Q� N -Rj(p W, Town of EAg Q 116
Subdivision , Lot #
Certified Survey Mali , Volume , Page #
Warranty Deed # , Volume , Page #
Spec House O yes CTiio Lot lines identifiable N'yes Cl no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out (lie septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the sejrtic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plrnnl_ier, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain (lie private sewage disposal system with the standards
set forth, herein, as set by the Depattnrent of Connneree and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days,of the three year expiration date.
GNATURE OF APPLICANT DATE
OWNER CC' RT1FICATION
I (we) certify that all statements on this forru are true to the best of my (our) knowledge. I (we) am (are) the owner(s) c(f
the property described above, by virtue of a warranty (Iced recorded in Register of Deeds Office.
/ /
z N)XV, E Or AI) LICANT DATE
* * * * ** Any information that is mis- represented may resnit io the sanitary permit being revoked by the Zoning Department. * * * * **
** Inct+rde with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is trade in the warranty deed
Lo?"
v u AJ La Ir' pia. v el.,L1 L L�
P -- ---
176 _ - 5 ".� 44 `` ra vim„
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624596
H WALSH
STATE BAR OF WISCONSIN FORM 1 - 1998 REGISTER REGISTER R O F DEEDS
OF
WARRANTY DEED ST. CROIX CO., WI
Document Number 1 51 S PAGE 137 PAGE RECEIVED FOR RECORD
06 -09 -2000 12:30 PM
This Deed, made between George L. Birkett and WARRANTY DEED
Doris Birkett, husband and wife as joint tenants EXEMPT if
CERT COPY FEE:
Grantor, COPY FEE:
and Lund Builders, Inc. TRANSFER FEE: 10 .50
RECDRDING FEE: 10.00
PAGES: i
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of
Wisconsin (the 'Property"):
Lot 1 of Certified Survey Maps as recorded in Volume Recording Area
14 of Certified Survey Maps, Page 3814, as document Name and Return Address
No. 618781, located in the NW 1/4 of the SW 1/4 of 'Ir L U. N D Gul d e Y s
Section 4, Township 28 North, Range 16 West, in the /D 1 O iV� m P I/ 5 7
Town of Eau Galle.
1� 1 v e x F SVO d.1
008 - 1011 -20 -100
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, roadways and restrictions of record.
Dated this ! �/�{ day of 7a ,fle , Zoe o .
*
George Birkett
c e
* * Doris Birkett
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) I ) ss.
St. Croix County.
Personally came before me this 7ilr` day of
authenticated this day of �u�E , Zm o v the above named
..,,,,
* Vii• •
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person: ted-
(If not, the forego' g instrument and
authorized by § 706.06, Wis. Stats.)
J n
THIS INSTRUMENT WAS DRAFTED BY
* /�l L �ly`r9t•�G � �O i�sa�G�/
Michael Forecki Attorney Notary Public, State of Wisconsin
Eau Claire, Wisconsin _ My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are - )
not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 1 -1998
Produced with ZipFormw by Vertisoft Inc. 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -9805
Attorney Michad H Forecki 1930 Brackett Ave, Eau Claire wI 54701 -4627 Phone: (715) 835 -3029 Fu: (715) 8354112
Jun 07 UO 03:13p Reuben lloor°nink 715 -684 -4875 P.1
DFt`.- 21 —Sa! 04140 PM 19i1F•F'la`r L,a11L tSU k'✓a_'Y11•, Ir ?ir9$ri'3i11 P.Ia4
Certilled Survey .Map
George atld Doris 01slictt
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