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HomeMy WebLinkAbout020-1100-70-100 c o O r. p u9 m C N tom. U ` N O 1' 'O C ~ C C M i E E ` awo - a ~ 0 2 C ov 00 'D y O O c d L r r O C C C U Lll _T U L a) y O ` = U z O 2 N C Q m Co ~ m U. CO C C v CL n 0 c j Q d ° EL M v ~ z z m a co 04 M F- z 0 O Z a III' c d Z d' C O to F- r p N Z ' -O v M ~ i _~V I~ N O C • N CL O O m z° z z z N co C c I O N N R m rT y - d CL CL t0 ) c c 41 m c c L j Y U ~Nv z v> o U) Iy- U) c ►~r `r' a= z O O O •wa ~IL aa a 7 O V1 N O co 00 O O trV = ~ N n E O 0 O a`) n m y a-' t z c m I U) U) p O ~'V O O p y C E (0 C) O p U 3 o co a) p U C ~ o N oo a F- U` N E E C C ay+ C 7 'a -0 N -I O N 7 C y O O U • 1~1 o Cl) 2 t~ o z z z u) ~ w d 7 L: CL w 0 (m CL 4) r- Ej i C C 3 rww G~ O m t 3 w O _1 A c) a O m c~ STC 104 AS BUILT SANITARY SYSTEM REPORT OWNER /~1 ADDRESS SUBDIVISION / CSM# S~ 3Z~7 LOT # SECTION 3K T 2- N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: ALTERNATE BM: /30 7/V.,4 .Sip~'y~ Oti t ~y~ SEPTIC TANK / PUMP CHAMBER / HE)LBING /BOO re-X Manufacturer: 40 • Liquid Capacity: P. G, 00o " 'YG IVe// Setback from: Well Ye-7- House Other J Pump: Manufacturer Z'01611 Model#~ Size yjj- f Float seperation _/S Gallons/cycle: Alarm Location ltiSiPE_ SOIL ABSORPTION SYSTEM Width: Length N Distance & Direction to nearest prop. line: 33~ Setback from: well: N if ' House 36 Other ELEVATIONS Building Sewer ST Inlet. 7ST outlet PC inlet PC bottom Pump off Header/Manifold V/6 , Bottom of system /0//0-, Existing Grade 100,10 Final grade Ala, ENV DATE OF INSTALLATION: PLUMBER ON JOB: ~'OIW LICENSE NUMBER: AIJ ~ 33 7 INSPECTOR: 0-i'M So~✓ 3/93:jt ` . r v • I `-f7 QI y o~ o Q kA o ~ Q o %Q N, cl, N 14- I n l ~ ~ n I M o yx Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Bu►ldings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Plan No.: REEDY, TIM & DONNA 9 CST BM Elev.: Insp. BM Elev.: BM Description: n Parcel Tax No-: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 60e0~144~_ Benchmark Dosing Aeratiori- Bldg. Sewer ' H StIV Inlet sp 9,f liq TANK SETBACK INFORMATION St/ IIiIft outlet ((,7' ' ey, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet s~ Air Intake Septic NA Dt Bottom /p 95, d/ Dosing > Sp' NA Man. Aeratio Dist. Pipe 3,s 3.ss, r 3 a• . a /o/. 8'0 H Bot. System PUMP / INFORMATION Final Grade Q Ln C r Manufacturer De and Model Number ~8' 3a`iPM TDH Lift Loss mead , Forcemain Length 3a' I Dia. Dist. To W~6 SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of Trenches PIT _ No. Of Pits Inside Dia. th DIMENSIONS DIMENSIONS--- SYSTEM TO P / L BLDG WELL LAKE / STREAM :LEACHI anufacturer: SETBACK INFORMATION Type O C ER Mo el Number: System: 146ru,,7cl "35 r% 36 R UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) y x Hole Size? x Holle- Spacing Vent To Air Intake Length 70' Dia. a Length ~a Dia. lya, Spacing V~ 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 S, Bed /reenter Bed44rg%*h Edges Topsoil ❑ Yes ❑ No E] Yes ❑ No y, COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.34.29/.,19W, NW, N, E, Lot 5, Baker Road Plan revision required? ❑ Yes No / Use other side for additional information. 9 SBD-6710 (R 05/91) Date Inspector's Sign ure Cert. No. C-Da 1 ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: - " I SANITARY PERMIT APPLICATION veILI~7IIR In accord with ILHR 83.05, Wis. Adm. Code COUNTY .~T, STATE SA IT RY PERMI- fi -Attach complete plans (to the county copy only) for the system, on paper not less than RA q ~ 55 8% x 11 inches in size. ❑ Check if revision to prebious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION. S Jr - D 3 L & PROPERTY OWNER PROPERTY LOCATION TI~I 3 !✓ya Nom'/a, s 3~ T 2- , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER h~urxoA.) 406~ 9*7y2 cs y so 32-77 UZI 2 E3 CITY II. TYPE OF BUILDING:: (Check One) El State Owned C] VI LAGE : /y~vOs~ NEAREST ROAD ❑ Public I or 2 Fam. Dwellin g,## of bedrooms PARCEL TAX NUMBER( S) III. BUILDING USE: (If building type is public, check all that apply) 0 2-0 116 6 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPPE~ OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ 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 Pressuriz Distribution Experimental Other 11 ❑ Seepage Bed 21 E 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 da REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION $QV j_12_ /,2- • -4~4 Op l6 . /'O Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExistin Gallons Tanks Concret structed glass App. Tanks Tanks Septic Tank or Holding Tank 12-W 2Q ~6_4.xa 4e Lift Pump Tank/Si hon Chamber 40 I , 1 FT7. El Fj LJ I El VIII. RESPONSIBILITY STATEMENT Af4/0~,e-s 33-0 7 I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signatu e: (No Stamps) MD/MPRSW No.: Business Phone Number: ,3 Po-" Ad' Plumber's Address (Street, City, State, Zip Code): 374- 6 R19 IX. C LINTY/DEPARTMENT USE ONLY `r ❑ Disapproved Sani ry Permit Fee (Includes Groundwater Date issued Issuing A ent Si na ure ( tam ) Approved ❑ Owner Given Initial ~ /urcharge Fee) Adverse Determination 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete dine 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 fakes; 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 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) SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Industry, Labor and Human Relations August 11, 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 S94-03266 FEE RECEIVED: 180.00 REEDY, TIM / DONNA NW,NE,34,29,19W TOWN OF HUDSON 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. Si erely, James Quinlan Plan Reviewer Section of Private Sewage (608) 266-3937 SRD-6423 1N.01191) - - - - ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # s9/ 03-z& C, Date & Owner Tiy ? D,t~i/J,¢- ~~El7Y Phone 7/~' 3~'(0 .S'7 % 2 Address 4.2iS . ,r yDiG Legal Description 1_,o7--5_ Cs~y S'p 3 L7 ~2.5 ~JG.es .vw, *46E SEC . 3 y , 7'2. y,v, ! f Town of 14 uOSo.-j County 577- C -S-T. RoaevzT- q4L-(32i G(.jT- CST-,1 2ypZ Installer Local Authority/ Supervision Sr- GR o i' X Co u,~3 1`y Z.r, o ,',v pT-. PROJECT DESCRIPTION ,q/E IV COt! 57,f 0C T"/'o.J ~5 Tih.a T'E=o 0,4~ y ~v~l 5 r~~lo c~ ® o GPs . /30T SE,¢SoNr4'!ly S.4Tv/+'~O /1-7T 2.7 ff /L1ovvj> SyS RECEIVED AUG 1 1 1994 Pg.l PLOT PLAN VIEWS . P9.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS SAFETY & BLDGS. DIV Pg.3 PIPE LATERAL LAYOUT ' P9.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS HUDSON. WIS. IFS` 1 GNtiaV~1► . its _ r /3M SET' ' ro T•eN of s• ~ E l~v.4-T'iov 30' • _ ~•4GlCl~v E' ~r 7S C fro aZ rn the urea 25 tt, below the boslope edge of tho ° Snil ~SOrptioo System must remaio 101isturbed. ' i d3 1 It I o i C Rje&c.45 T 5,& -,or,; c o ~ r°r~4L of l.~ Puc- FoRce- A-f . g. - ~Ropos~~ /G~" 136-l~iPri wC I ~ a /fO.tiE•siT-mac F 4 .n c2 or 3" Z. b-,4 &e s so•AorG. 594 _0 3266 o 2-72- Y7,1 b 13 /00- o 1 z /067.10 Sv~G~-sr~-o .~-foU,~,p s frsr~ 'leril*riov 4.,11A, /oL OoO PG i 64 r-- P5 2 of S CROSS SECT IOAJ OF moUAJ D w ~ r ti SeD (3E0 of ro ~ISTRi(3uT~o~ ~•y ay5eCjrATE (s, TtiickaFSS piP oF T°PsoiL SYsrEM e l evA rio,v uui FORM ToE 161.10 ~ a RYA o Mao. • ' ~ . • . • . 9 . e' SAmi;> . . PIow6D To P SO u>J FORK O % SlopE roRcE ~ Nh;~ E~~vnroa ~,~0€.R D FT. ELEvAT*I0 s I• g Fr. INvF-Rr o F -L2 IAT£RA(S l0/• !00 F • ~?O FT. • Top of Rock y7 G l . ~ FT. I !,M H ( ,S FT. ' Top °F 2 IATERAIS /0/. PO PLAN VIEW OF MouJJD Wi r ff BED FoRcE MAbJ A ~ F T• I I 4 y Fr Fr f 1 t' • t f T 'g w Fr W 33 _y ° Fr Pvc cAppEp To I -L A. dT3SERVhTtOa 99RE56i P~peS PEaMAAjeNT M AR eERS f 3 ; REcquiReo 13ASAL AReA ; ~At'~Y whSrE F'!ow 1200 SOIL l AYf i t rlQATto E , 5- C Af'ACI"fy 54. Fr. x tz pRoposEp 4ASA4 AReA - P~ 3o-f Cj - ~►STR113uTIOA.1 PIPE )JET-WORK LAyo o MAO% 'oesT T ~n\ 6 A Me w Fob / Fr. ~,vDcd~l/~ t9 Z. F T \ Z S,oE-c~~l/s R yd Fr 00 FoRcE Mi4iN X C--- _ ImcHEs Fr. of Pvc Y 2- IwcNFs VRRi*itf3LE ° TOTAL VojC> VOIu}th GAIS , P sTowcft H Ole DiAMETER YfiN~H~s l /%-t e pA. L• It t I J INc I~~S MANIFOLD FoRcE. MAitj F i o~ ~0l£5 PE /y LNVERT E LEVATIO.) OF L ATE RA l S is/. Co O PE RFORATEr' IDETAi L sup cAp P~ PE • RemouEE All 7)R►ll (3uRR5 \ Y HoIES 10CATEC o,J Bc)TT'oM EqL)-AIIY SPACED , V1 STRi BUT-10,,j D►5C-hAi2 &E RATE FOR etch LArERA L PAR 0V_5 16.3g GAS / MiX1 TOTAL Dcs-rRiB0Tior.3 Di5cH~R&E7 RATE FOR NET WORK 3 Z, -7 (e G~.L/1~11•,V. ~ a•rj r MiNi MUM ~th~ . PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 J~ OF S VENT CAP i"c.2. VcNT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FROM DOOR, 4VAiCNloI-~~tU "klr)OW OR FRESH 12"MIU. AIR INTAKE `91QA9~ E/EV~tTiON GRADE I 'i° MIN. /oi - - COIJDUIT _ ~(y.0 PROVIDE I AIRTIGHT SEAL I I I ili v VED JOINTS APPRO APPROVED JOtA W/GI. PIPE INLEfLIB W/C.Z. PIPE ~EXTENDING 3' EXTENDIIJG 3'DOI ALARM ONTO SOLID SOIL ONTO SOLID S1 y'Z ~3 Y'~ i I I I I 3.I I oN q3. C ELEV. FL fA. P OFF D • S BLOCK N K `~a"'A '~~7 t"A rio,J Sz•58 RISER EXIT PERMI7fED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E nS P E C I F I*CAT I OKJ S DOSE ,e e - TANKS MANUFACTURER: 4l7EF)~S `avert- WMBER OF DOSES: PER DAM TAWK SIZE: d jo /SO O GALLONS DOSE VOLUME ~~ff ALARM MANUFACTURER: de - INCLUDING SAGKFLOW: /S GALLONS MODEL DUMBER: V L CAPACITIES: A=/ 9 5 INCHES OR Yak GALLONS SWITCH TYPE: t+.ERe-uAg F/OAT 8= 2. INCHES OR / GALLOWS PUMP MANUFACTURER: ~~jODE~ILc/p L C= -7 5y INCHES OR I`S GALLOWS MODEL NUMBER: D= /y INCHES OR 0 GALLONS SWITCH TJPE: IOi9Jy13Ac* L4E'RcvRy f~O'47-MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE ~GPM pINSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. d ' FEET -AA )k GS^~ + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EAC(4- 0' - D Pl~t• + :5 FEET OF FORCE MAIN X 1 (NSF o FRICTION FACTOR.. --f/ FEET "UrIS ~.D. TOTAL DYNAMIC. HEAD = FEET kovvD 37 INTERNAL DIMENSIONS of TANK: LENGTH ;WIDTH -.~---;LIQUID DEPTH 00 N HEAD CAPACITY CURVE 3 7/e 6 1/4 0E MODEL "98" 30 4 5/B J 25 e I 3 5/8 = 6 20 m + 7• O 15 ® 4 3/16 10 - ? ` 1 1 /2-11 1 /2 NPT 2 •1 5 0 I U.S. GALLONS 10 70 30 40 50 60 70 80 LITERS 80 160 240 „ 0 FLOW PER MINUTE ' ' - TOTAL DYNAMIC HEAD/FLOW PER WnUTE EFFLUENT AND DEWATERING 'j CAPACITY 12 HEAD UNITS/MIN 'i FEET METERS GALS LIRS ' S 1.52 72 21,13 1 70 3.05 61 ?.J i 15 4.57 45 l/U L-J A 20 6.10 25 95 3 16 ( r• I S Lock Valve 23' I ;41"" r f; ' CONSULT FACTORY FOR SPECI ~l APPLICATIONS p Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are avajlable'jr without alarm switches. variable level long cycle controls. IA ,I n SELECTION GUIDE !i 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - s/2 H.P. 2. Single piggyback mercury float switch or double Pr99Y1tack mercuN, float i ~•i 98 Serlev Control Selection switch. Hofer to FM0477. Model Volts-Ph Mode Amps Simplex Du hex 3. Mechanical alternator 10-0072 or 10-0075. ' M98 115 1 auto 9.0 , 1 or 1 &7 - 4. Sec FM0712, for correct model of Electrical Alternator, "E-Pak". 5. Mercury sensor float switch 10-0225 used as a control activator. specify N98 115 1 Non 9.0 2or2&6 3or4&5 ry D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired•in sim "E98 230 1 Non 4.5 2 or 2 &6 3 or 4 &5 plex or duplex operation, 10-0002. t 7. Two (2) hole "J-Pak for watertight connection or splice. CAUTION -Oct information on additional Zoeller products refer to catalog on Combination Stanef, FMO514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, PM0477; Electrical Alternator, FMO466; M,:chanical Alternator, tied licensed electrician. All electrical and safety codes should be fultowed incidd. FMO495; Alarm Package, FM0513; Sump/Sewage Basins, FMO467: and f;implex Control Box, ing the most recent National Electric Code (NEC) and the Occupational SAlety and 4 FM0732. Health Act (OSHA). •'1 .a RESERVE POWERED DESIGN For'unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. t MALI T0: P.U. BOX 16347 Louisvilis, KY 40256.0347 Manufacturers of... /LA O. SHIP T0: 3240 0 Pdi!'ers Lane tt S Loci;viiki,KY4','216 QU.fI/Tr LIMPS /NCE (502) 778-2731 0 fA,Y 1502) 774-3624 i j 4 6 $9-0326 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT P Labor and Human Relations age 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 81/2'x me4~i Plan must include, but not limited to vertical and horizont . ' PARCEL I.D. # al reference poi 8M) directu5n ancfi~i6 pe, scale or dimensioned, north arrow, and location and dist b,Whearest,road. APPLICANT INFO RMATI - ALL,INFfl:A't~gTION REVIEWED BY DATE ON PLEASE P PROPERTY OWNER: j PACP~RTY LOCATION T/° DO.fJ,//~- ~EE' : y LOT VW 1/4 Al_-E1/4,S 3 YT 2• ~N,R E (or I I- r, POP PROPERTY OWNER':S MAILING ADDRESS ; _ r OT BLOC K# SUED. NAME OR CSM # 9/ S.03 L? ;7 CITY, STATE ZIP CODE MBER" CITY ❑VILLAGE grOWN NEAREST ROAD Rt,6 l'S Gv/. ,S'yoz 3 ( X 37 1 v nso,J [ New Construction Use [ Residential / Number of bedrooms y [ ] Addition to existing building (J Replacement Public or commercial describe _ Code derived daily flow ° d gpd Recommended design loading rate 5 bed, gpd/ft2 • trench, = 91`i Absorption area required soo bed, ft2 500 trench, ft2 Ma)dmum design loading rate • S bed, gpd/ft2 ' 'trench. gpolft2 Recommended infiltration surface elevation(s) /0 ft (as referred to site plan benchmark) Additional design / site considerations 5-176 S v~T~idl~- Foe 1Yoc-*p w V 'X Cs y ' /gam Parent material Sc S 6P RocArro,~ Flood plain elevation, if applicable &,f: It S = Suitable for system CONVENTIOw& M~OUyD IN-GROUND Pg~uRE AT-GRADE SYSTEM IINN FU HOLDING TANK U =Unsuitable fors stem ❑ S L~(J Ly'S ❑ U ❑ S C~CJ ❑ S ❑ S C~'0 11 S Cam' SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ftBoring # Horizon Texture Consistence Boundary Roots Bed MrK:h in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. t o-!G /OYR 2- S/ fSk W7a/Q CS 1 3f . G Z G-3 0 31511. .2- 4m fie Cw zf . s . ~ Ground 3 2_S /D 7.sve rz, '511 /7° 4irvfl, w elev. /O 0. /V ft O /O Y4 J// !547V X4rie-V S/ / 7' f e w 75e Iv P Depth to limiting factor , _32-- y55 Remarks: Boring # ~ • ; , . ~ t) O 3//2-- sC✓i~ .wr 7CIl~ C5 z n.. 2. 2 617 lo YW 3/3 5/ Z ,6k n►.r fi " es ~f s 3 7-lam 75 y,/c' '01 D, s ce.e cc 4v Ground ' elev. y /3 f I f /O !o ft. 7 5 s SI / 7C i't U CG cv N' A/Depth to limiting fact .r J- Ll Remarks: ~foAfi Zo,~ 3 T Name:-Please Print ~~t3 E~ r L 18 R II, CA T--. Phone: 71s- _ 3 F6 A'lF 5- Address: (,s S O • VPSp.J SyOl~v C'S ',Y.2 Signature: Date: CST Number: ORIGINAL PROPERTYOWNER REEPX SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed reach 5 I.KVY k-7 3f S , to 3~ L /o ,e 3~,/3 f s~,e fie c s Z_y . y . s Ground Q /D O / S~ ~ ~ M+ Xie /swlc 154,7 ~ S G elev. -f It. y y /O !k Y -7. sZ s 511 2 *1 ,d,~ ,,,,►-f t a ~v s ~ Depth to S l -~0 75y,O 313 f ,p d vA limiting factor ASS Remarks: ff0/I?~ZO,v S' - CE•yF--JT~D S ~iP~4G~~~.v . Boring # 13- Ground elev. ft. Depth to ` limiting factor Remarks: Boring # 13 Ground elev. ft. - Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: con wvmiD ncwm JAWRAO r L l3NJ SET: ~o . s• f? ~ l~tJ.tTiov C;~~ 5C,4/E . / 30" of 0 . az rn py , 33L33 i • 7/ ~o E L, Q /fo~ES~rE 'Lo r 5" 2.5 ~9Gc s so L . 272. Y7 m~ b u /o O. /0 B). loo.-lo S~6G~sr~o .~oU,~p s frsT~ /~'v.~Tr~v rv~/~ ,~d " $,,~j 3 9G • 000 /p' P~ . 3 al 3 - O S e LE® 2 AUG 02 1993m- JAMES O'CONNELL 3 5032Register of Deeds '`7 St. Croix Co" wl N 1/4 COR. NORTH LINE OF THE NE 1/4 NE COR. p1 SECTION, 34 S8fS52'46"E 2634.71' SECTION, 3 r O S'p 2606.45' 0 28.26 Oo (L m t rJ) S~, y~, fD Cn -a O Z ID ~6'' x rn 0 F~• y m I I ro N oE G o I I- N 49°2320"E M a ° 1-1 O 94.76' rt %S rt -n n) -3 0 0, rt, aaCO \ \ <<` \2 i N rt, a 2D' cn r- La O C W. N / O" B O lM1 N N A) Yr 2 D. 7 cl. -h N / 0 LO O 1* w v s -n O0 N - f h m m m a eb ' iv ~ z (0 (r C!1 m U l 00 cn rmir n O D / n OD cp C7 rnd (.n rt Om ~ 0 -n pIC' i n rt -n o u, 0, r+ s I> c T 0 I W m I OD ,A rn w a n n N I C= Am m H c/) O 33' 33' Z < 00 m N N8c-P46'38"W cm o I OD 272.47 (n 3 C) c. I> :J O E I~) cn I -I O OD CID ° I C_O ID Is £ .-4 fs G o I~ I CE) Im IF- 0 FIT O) O OD ' v p W (D I I~ I-I x IC 3C m p 10 - m two x c a o ID I> m S ro ° ti] 1O I~) 0 _ Z I -I G I~ = C°i -n in r rt g ^ a ° d Xs co o w `-r rn o c c HOUSE co I Cn m w m = m = QWFy~ ft ° rn rr v ~c C4 c K v r. N W -i d O' N C/Y n O N N n ~i O N = = 7r C fn rf Cfl -7 lG F.,. f... eD Co N 0 w o _ SEPTIC 66 n O G ~ G °o w ---I rt, m d ~ o w ~ ao ~ ~c I - r• m _ 2o N89°46'38'W 272.47 o C. T H. N~~ - - o - - - - - 0 Q p ^ n UIV~OLA I I Lr `r\N J' VoLUNE 9 PAGE 2663 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 90~J.r/+ Fa MAILING ADDRESS 6 j;0e'1A IW ' ` D/j~ CUBS ~S Ke 2- PROPERTY ADDRESS & 8 13Ae45;e . f7j~so.J 1 S yp~~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~U h-SO~✓ l PROPERTY LOCATION NW 1/4, /Vhp~_ 1/4, Section ~ T Z` N-R I ~ 'rJ TOWN OF V P. r6N ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEYMAP VOLUME PAGE Z( LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year a iration date. SIGNED: DATE: St. Croix County Zoning Office Government.. Center._ 1101 Carmichael Road Hudson, WI 54016 11/93 S T C 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies .will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenla second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. Owner of property 71*M 3 _-bd NN l- 'PeZV Y Location of, property /UWl/4 A~~_114, Section T N-R ~f W Township UPSaA.~ Mailing address Address of site ~~K V fJ.lo^~ w~S Subdivision name Lot no. Other homes on property? yes y No Previous owner of property Total size of parcel 2. 14 etC S Date parcel -was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No 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 PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid. delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register o. Deeds as Document No. , and that I (we)'presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has, been duly recorded in the office of County Register of deeds as Document No. _ Signature of a licant C a licant Date of Signature Dat f S at e + RECORDING DATA . ` DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR WARRANTY DEED 520517 z., u r Lip ~ , Imo:. G. Ray an wife Steffen.and ST. CROIXCO., WI This Deed, made between _____an_____d ____.d Ree'd1brRcs,;ord atricia K. Steffen, husb - - AUG 2 3 1994 Grantor, A and Tim.-E-=---Reedy__ and__Dgnna---1?e_edy,--.hush ns~ __saad__ at 10:00 . ~~VI wife-, as survivorship -marital--prQ-p2 Tty,______________•__ of D990 , Grantee, Witnesseth, That the said Grantor, for a valuable consideration------ of one dollar and other valuable consideration conveys to Grantee the following described real estate in St. Croix RETURN To County, State of Wisconsin: Tax Parcel No: Part of the NW; NE 4j Section 34-T29N-Rl9W described as follows: Lot 5 of Certified Survey Map recorded in Vol. 9 of Certified Survey Maps, page 2663 as Doc. No. 503277, St. Croix County, Wisconsin. This is not homestead property. (JS (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And--------G. Ray Steffen and Patricia K. Steffen warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and restrictions of record, if any, and will warrant and defend the same. Dated this 22nd.. day of -August - . 19 - --------------------------------------------------------------------(SEAL) - --•------(SEAL) * G. y S te (SEAL) e - ------------(SEAL) * * Patricia K. Steffen AUTHENTICATION ACKNOWLEDGMENT Signature s STATE OF WISCONSIN ST. CROIX tJ d C0414613. D authenticated this day of 19 - Personally came before ajay:•of ------------August }9.9 arced G Ra S_teffen-an~ a . * St effenu.sia c~"r"icl w_ - rrvl:+v • TITLE: MEMBER STATE BAR OF WISCONSIN - (If not- - - - v.:; , V ` authorized by § 706.06, Wis. Stats.) I~ e persons 3 t~(ilo U&II the O*Davi • - e t and acknowledge bhe'Vg&. THIS INSTRUMENT WAS DRAFTED BY Ro ert F 7 1 W~ - WA & M~LL -••s--------C-------------------------------- 522 Second Street Estreen _.___.4_Q1_ Notary Public ----St. Croix County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date- 19------•-•) •Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR`OF WISCONSIN Wisconsin Legal Blank Co. Inc. l ~ • I t Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT' CA'9 ( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. / d-7-10- APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION R4 ,r /Jf -T S Te FF GOVT. LOT IV60 1/4 NE 1/4,S VT 19 W PROPERTY OWNE '•S MAILING ADDRESS LOT # BLOCK # cSUBD. NAME OR CSN1p~~ Ice 41 CITY, STATE 4J~5 ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST R 1f0 pSo~ s~/o/ ~ ( 7/s) 3 P4, - 'May 14 L) PSc .v 13~4!<t~ New Construction Use j7cj Residential /Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Y5o - Code derived daily flow rooa gpd Recommended design loading rate - s bed, gpd/ft2 ' trench, gpdtft2 Absorption area required ' bed, ft2 trench, ft2 Maximum design loading rate S bed, gpd/ft2 trench, gpolft2 Recommended infiltration surface elevation(s) s-~ P 5 3 ft (as referred to site plan benchmark) Additional design I site considerations so 1L S Sv~Tml3/E ° ~'LS~ AP4 A0041D 7YAE SyS Tf ' Parent material SG 5 44 -0Cer0v - Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S [0 U ®S ❑ U ❑ S CR U ❑ S 91 U ❑ S ®U ❑ S [MU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxl3y Roots GPD/ft in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tench 0 /0ye2/Z s Z, 34 v?P-k s 7 4? l 69-15 /!9 rle 313 /~s z A", 5-6C ir►r uFoe $ Z..., , 7 , aQ Ground 13, 5-33 /oYX d,f, „+t~ CS . 7 ~ elev. DE LlJrypo o .c~ . S : , G ft. /3 3-ys Y 4lee s/ Depth to C yS~ld YR 4/~ G,P. rev L ~1ESr5 /j/.!`~ limiting factor „ Remarks:--$ SE*FreA4 //Y S47yoeof-77"--O f T 3 3 - Boring # d_ 7 /p Tie IY2-~ 1AS1 , 5 ' . L-/z /o ye. 3/3 Sf' Z, , Sb~C ,f,r,-F~ 5 2-•~ S : G ".1' SAX- /3, ~2 /o y~ y~y s/ ale s _ . S Ground elev.yle ft. ' si/ 1, -F She f f' .C' , G .o C I 31-yi .S Depth to yX 414 7.5Y s/ , limiting f]~ ~`t~oSD Gi ~l~ 7~o.v factor /`1 ES 7b•~ 32- Remarks: SO ilS S ~SD,r~ f// S+}Tr1 4- r .3 2 S CST Name:-Please Print 1j Phone: ;71f--3'p6- 00/00 Tess: HOMESITE SEPTIC PLUMiiiniU 655 O'NEIL RD. HUDSON. WIS. Num: Signature: ROBERTULBRIGNT Lq -W 'P? /~,F, y' ZD _!3 CST ~ WIS. MASTER PLUMBER LIC. N0.3 P.R.S. y, Ik ' I)ItNN. tWSTALLER A DESIGNER LIC 0,~ to 1'[ o v A., Sr STtr-ci [ L ffj~L /-It .tit. O 3-2- ~ - F3 ~ , i S^,N D ~i ~l r I C~ v l ORIGINAL y PROPERTY OWNER 5'lE~Ff%ys SOIL DESCRIPTION REPORT Page Z of ~j--- PARCEL I.D. # l-Dt 4' cS~ ~6-NTJ / A3 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundery Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends 3 0-15 /O yR -2-11 S/ 2,-f, shk nM f 2 T57 s , G s-La /0 Of zrz she ew%+ cs 1,.4 - s , Ground 9, - a to y le JY s, / 2, , s r , s , elw. ft. /o ye- Y/G w dt. e-41f y e5o~ rs 004-, A g" D s Depth to /g 1 24 9 / oYX yIK 6 S.( / f y6 t rA F 2 limiting factor C y.? - 7Z /o Ye s/P S D M+, 9R / ><0C 7 34 41)--)l /o YA 316, I s , Remarks: So''L SE S~4TUiPT"O /1`T 3 (,~o Boring # SSi 13 ~~4C6C`ep ~ 'l5 . so: Lifiv~- ~ s iov s Ground elev. 0/1v,,0 0 $ i /,v Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: Boring # ti Ground elev. ~ ft. Depth to limiting factor Remarks: con ooonio ncm~y Al/1D,274.v T if/OT-6- /'D/c 7`a /'S Sv,v c~- 6- 7- A) 04;4P 7% 1'-5 7-i .off xeM 1ti,f-.,-r,o Y r f~ 6- P 40 v tJ y Z40 (h G k M G G C s Z -gym AR, W w LA IaFR oN O C U1 -i © O O O fi 21 ~ om -6 LA -G to Z p O Z. Z5? rn W 3 H (~+l z c ~ R ~ ►i G.~ (A -4 O ~ -a ~ f1) O I ~Z 3 M w ~ ~y ~ N f ~ a ~ a 0 ' W N j ~ . w -o 0 0 a r' 0 //00 1/0 400 ZA A/) 5 FILED fella ~a/~r!'Cl 6 2 AUG 021993 r1~ g -JAMES O'CONNELL 3 Register of Deeds 503277 ~ St Croix Co., WI NORTH LINE OF THE NE 1/4 NE COR. N I/4 SECTION, COR. S8152'46"E 2634.71' SECTION, 3 34 00 2606.45' n • O cn 2826' FO° W N O • Z Iv ~6+. x o+ c) o c rn C I i ^ ° m x Z o 0o w m r0 il_ NW23'20"E O I .-7i l 94.76' SF \\9 \ d rt I 1> / 00 AN \ \ a' 0 N N CD a O 1-h y w z W \~sFT \ rt 0 (D B H s \ c_ V) O' B O N M w A~ O O N 'L,JCJ" rt O co ° rt m O - ~ w o' 00 N (D (D ro m=3 O O t 0 C'") OD m W ~c o o_ IIJ] O m o -n O -I N o 1 S 0 - n rn n F o rt I > 0o H Of m- =r O C 1140 o m i f 0 - f- N I I w a n n 0 H C/) r o m c o x N C cn r er < z _ rn w 33' 33' z 0 z m N88°46'38"W I -i 272.47 a 173 ao c T 0 O G V c -3 I / 0 Q. I~) o v+ OD- I~ iC~ H = O 00 1 j> 4 N - IM 00 0 0 co 41 01- p 3C ne. m IO IZ G 0 -n tai I> r c w" a j~p I~) 0 •4 a z w o r z I -I c In .O w •-h to = rt B d - v' = o ► -n n HOUSE LP !1) m w rt o o CO > > > OWE~L CTp :t co T m rr o- " n N W -I a O to aD N N w W y' N o 0 w 0 V1 ~ tC ~ ~ N 1'h ; w o fi SPTI~ I k A (7 ' n _ 66 0 G W rt O t" O N w ~ o w ~ I CD 7 CD N89046 38'W 272.47 0 to it 11 - - - C. T. H. _ _ N o 0 o. UNPLA I I EEIJ _AND ~ VOLUME 9 PAGE 2663