HomeMy WebLinkAbout024-1036-60-000St. Croix County Planning and Zoning
Detail Sanitary Information
Computer #:
024-1036-60-000
Sub/Plat: 40 acres
Parcel is
30.28.17.234
Lot:
Municipslit r.
Pleasant Valley, Town of
CSM:
Ownw:
Clark, Chad 143 150th Street River Falls, WI 54022
State Permit
208994 Issued:
0511111994 POWTS Dispersal: Mound
County Permit:
0 Installed:
05111/1994 POWTS Detail: NA
POWTS Pretreatment: NA
Section: 30
TNIRNG: T28N R17W
114114: NW 1/4 SW 114
Permit: New
Bedrooms: 3 WI Fund:
Notes
Issuer/Inspector As Built Plumber Other Reouirements
Not determined Yes Lickness, Chris
Jim Thompson Signed Off: No
Maintenance
Scheduled Pumo Date Pumped 1st Notification 2nd Notification 3rd Notification
5/11/2005
CLARK, Chad NW, SW, Sec. 30,
1498 Evergreen T28N-R17W, Town of
River Falls, WI 54022 Pleasant Valley
Address Site: 143 150th Street
Baldwin, WI 54002
Additional Notes
data from notecard
Permit No.: 208994 5/11/94 Chris Lickness
New System - Mound
Thursday, April 06, 2006 at 8:43:23 AAf
Page I of I
Money Owed
$0.00
• Parcel #: 024-1036-60-000 04/06/2006 08:38 AM
PAGE 1 OF 1
Alt. Parcel #: 30.28.17.234 024 - TOWN OF PLEASANT VALLEY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address:
Owner(s): O = Current Owner, C = Current Co -Owner
CHAD D & DIANE CLARK
O - CLARK, CHAD D & DIANE
143 150TH ST
RIVER FALLS WI 54022
Districts: SC = School SP = Special
Property Address(es): • = Primary
Type Dist # Description
' 143 150TH ST
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 41.080
Plat: N/A -NOT AVAILABLE
SEC 30 T28N R17W NW SW TOWN- SHIP
Block/Condo Bldg:
PLEASANT VALLEY.
Tract(s): (Sec-Twn-Rng 40114 1601/4)
30-28N-17W
Notes:
Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1005/554 WD
07/23/1997 1005/552 WD
07/23/1997 849/342
07/23/1997 775/55
2006 SUMMARY
Bill #:
Fair Market Value: Assessed with:
Use Value Assessment
Valuations:
Last Changed: 06/03/2005
Description
Class
Acres
Land
Improve
Total State Reason
RESIDENTIAL
G1
1.000
15,000
138,800
153,800 NO
AGRICULTURAL
G4
39.080
4,700
0
4,700 NO
UNDEVELOPED
G5
1.000
200
0
200 NO
Totals for 2006:
General Property
41.080
19,900
138,800 158,700
Woodland
0.000
0
0
Totals for 2005:
General Property
41.080
19,900
138.800 158,700
Woodland
0.000
0
0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 139
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 900 0.00
St. Croix County Planning and Zoning
Detail Sanitary Information
Tuesday..Novenrher06,?007at11:34:17AM
Page i of
Computer 0: 024-1036-60-M Sub/Plat: 40 acres Section:
30
Parcel p• 30.28.17.234 Lot: TN/RNG:
T28N R17W
Municipality: Pleasant Valley. Town of CSM: 114 114:
NW 114 SW 114
Owner: Clark, Chad D. 143 1501h Street River Falls, WI 54022
State Permit: 208994 Issued: 05/11/1994 POWTS Dispersal: Mound 24" or more suitable soi Permit: New
County Permit: 0 Installed: 07/1311994 POWTS Detail: NA
Bedrooms: 3
WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/lnsoec[or As Built Plumber Other Requirements
Additional Notes Money Owed
Mary Jenkins Yes Udmess. Chris
found a 1992 permit issued by DNR for using this $0.00
40 acres as septage fields. Previous owner
Jim Thompson off: Yes
James Freemman. File with sanitary permit
Maintenance Notification
Scheduled Pump Date Pumped Notification
5/11/2005 5/3/2006 04/20/2006
5/3/2009
7/1311997
rt OVE
0 CT 3 1 1994
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER (`,"( I ��A r �Z-
ADDRESS ^)Ld - 150/
/A , ✓ lc� f=¢
SUBDIVISION / CSM#LOT #
SECTION4 p�Q_T � �1 N-RW, Town of f Lmg --`t 041k'1
ST. CROIX COUNTY, WISCONSIN
PLAN VIER
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
�3
r �,
s
1qil
i INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
vl-v,,jLL J4-
BENCHMARK • 1 o U a 5 ,lit
ALTERNATE BM: I (, q ,
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:
Setback from:
S,P y- Liquid Capacity: W00 'p
r i
Well_ House _ Other
Pump: Manufacturer / n f ` l P✓ Model# `7 '] 55 Size
I'
Float seperation_ Gallons/cycle: ol(%i
Alarm Location L. irvtt-k _
SOIL ABSORPTION SYSTEM
Width: 5� Length r Number of trenches
Distance & Direction to nearest prop. line: Jq 5'
1 1
Setback from: well:�C) House 13 Q Other
ELEVATIONS
Building Sewer C(I"( ,CA ST Inlet I O�i �`i ST outlet
PC inlet I(u �{ PC bottom IL5a5/4 pump of
Header/Manifold' Bottom of system_
Existing Grade ? Final grade
DATE OF INSTALLATION: -j / 00/0 "( m
PLUMBER ON JOB:
LICENSE NUMBER: J P
INSPECTOR:}
3/93:jt
VAAW 11FICt1DUATInN
TYPE
MANUFACTURER
CAPACITY
Septic,
5Q/ may,
Dosing
_4�0
Aeration
Holding
TANIC S�INFORMATION
TANKTO
P/L
WELL
FOLDG.
ventntato ke
Airl
ROAD
tic
NA
ing
[AerationE
36
NA
--
-_
Holding
Pt IMP / SIPHON INFORMATION
Manufacturer I ��PSLI�Q
Model Number
TDH I Liftj 9,Lf I Friction y�\ S stem r� TDH D ,h Ft
I netForcemain I Length Dia.'9-// Dist. To well
rr rkiAT1A41 r
STATION
BS
HI
FS
ELEV.
Benchmark
Bldg. Sewer
i
St/A Inlet
f
144
3 771
St / jl( outletMIT
a
3. fll�
Dt InletQI{
.�
Dt Bottom
� 7
-Header / Man.
�.
Dist. Pipe
0•33
Bot. System
r
, 50
Final Grade
SOIL ABSORPTION SYSTEM
BED / TRENCH width Length U rTBLDG
ches PIT
No 01 Pits
Inside Dia. Liquid De,
SETBACK SYSTEM TO P / L WELL LAKE/STREAMSEA Man er�,/ C MINFORMATION YPe `� OR UNIT
System: YLl Gt)
DISTRIBUTION SYSTEM
Header/ Mani of I Distri ution Pipe s I x Ho a /Size ,� I x Ho a Spacing I Vent 7` tr Inu
Length Length Dia Spacing / � I > >U
9
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
B�11TrmwehCenter Bed /iyaehEdges Topsoil ❑ Yes No ❑ Yes CO] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Pleasant Valley.30.28.17W, NW, SW, 150th Street gilt
O'd
l�J 1.1 U•P � L,,p
/- J %%%is t .Cfisc
Plan revision required? ❑ Yes', 0'0-0 q
Use other side for additional information.
,S4D-ee71,p Date Inspe rsSignatuye Cert No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
3 'Z
4v
1%
1 eAfIUIYAov DCDAAIT ADDI Ilf_ATIAN
va' 5a76a. . �.......
t i�iri i In accord with ILHR 83.05, Wis. Adm. Code
C97. I
STATE SA f'T1A PERnMI
-Attach complete plans (to the county copy only) for the system, on paper not less than
v 9 i
❑ We application
8'h x 11 inches in size.
Checksrevisiontopr
STATE PLAN I.D. NUMBER
-See reverse side for instructions for completing this application.
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PR PERTYOWNER
C L 6wle /1
LOCATION
(,J k, S 3cl T N, R/ or W
0, 4Cr
PROPERTY OWNER'S MAILMKiADDRESS
LOT #
BLOCK #
iL
CIT7ATE G
ZIP CODE
PHONE NUMBER
SUBDIVISION NAME OR CSM NUMBER
If. TYPE OF BUILDING: (Chack orm) Lj State Owned VILLAGE : REST ROAD
ElY Public 7'1 or 2 Fam. Dwelling-# of bedrooms �
'/
,2 O-�f7 DO
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ ApVCondo
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)
S 2. ❑ Replacement 3. El Replacement of 4. ❑ Reconnection of 5. El Repair of an
A) 1. New
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 La Mound 30 ❑ Specify Type 41 ❑ Holding Tank
42 ❑ Pit Privy
12 ❑ Seepage Trench 22 ❑ In -Ground
43 ❑ Vault Privy
13 ❑ Seepage Pit Pressure
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 13. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 16. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
G
30 0 -' 5 en ? - C> / i n/.F- / 8�eet ldfe _� Feet
VII. TANK
CAPACITY
ns
in gallons
Total
# of
Manufacturer's Name
Prelab.
oncret
Site
Con-
Steel
Fiber-
glace
Plastic
Exper.
App.
New
INFORMATION
Gallons
Tanks
structed
Tanks Tanks
Septic Tank or Holdino Tank
1 Li�Z
Lift Pump Tank/Siphon Chamber
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print):
Plumber's Sig tore: (No tamps)
MnPn/MPRS:7;
Business Phone Number.
Plumber's Address (street, City, We Zip Code)"
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (includes Groundwater e e u I ing Agent Signatu a INo S
,,,���---,,,///Surcharge Fee) tamps)-
Approved ❑Owner Given Initial
�
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
we..& : U/b9 0 4/ 14, h/0
S1313•63MR.08M) DISTRIBUTION' Original to County. one uopyio:ziereryaouuomya ..— W
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. Onsite7sewage 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:
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 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.
Vill. 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
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)
A4
SANITARY PERMIT APPLICATION
COUNTY
,TDILHR In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. ❑ Chsok if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER
PRPPEIRTYLOCATION
AL 0([
W Y. Su!%,S 3 T ,N,R / or W
PROPERTY OWNER'S MAILING ADDIRFM
LOT #
BLOCK #
CI , ST,ATE ZWCOM
PHONE NUMBER
SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE P� t/�513/Iry TY " !AD 7.4 7`—
❑ Public E91 or 2 Fam. Dwelling-# of bedrooms
III. BUILDING USE: (If building is public, check all that apply)
1 ❑ 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 Bit applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit ## Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 9 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER F1 2. ABSORP. AREA 3. ABSORP. AREA 14.LOADINGRATE 5. PERC. RATE 6, SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
1
3 DU DSO %ti 5'0 /, :Z_ �VA 9_ F et OD. Feet
VII. TANK
INFORMATION
CAPACITY
In gallons
Total
Gallons
# of
Tanks
Manufacturer's Name
Prefab.
oncret
Site
Con-
Steel
Fiber-
glace
Plastic
Exper.
App.
New
istin
Tanks
Tanks
structed
Septic Tank or Holding Tank
Lift Pump Tank/Siphon Chamber
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print):
Plumber's Signature: (No Stamps)
MP/MPRSW No.:
Business Phone Number:
Plumber's Address (Stre4K, C State. Zip Cods):
oT�4 �.n wles
IX. C UNTY/QEDARTMENT USE ONLY
Disapproved
Sanitary Permit Fee (Includes Groarge unndwater
Dole IssuedIssuing
Agent Signature (No Stamps)
❑ Appro
wrier Given Initial
Adv rse Determin ti n
X. =NDSOFAPPR VAL/REASONS FOR DISAPPROVAL:moo C1
SBD-6398 (formerly Plb-67) (R. 11188) DISTRIBUTION: Original to County, One Copy To: Safety d 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 qnd 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.
It. 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 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'h 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 takes, 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.
ti `
SBD4M (R.11f88)
'A/nconsinDepartment olIndustry, SOIL AND SITE EVALUATION REPORT
Laoor and Human Relations
Page � of 3
Im
couNry
ter. IX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
PARCEL I.D. I
not limited to vertical and horizontal reference point (BM), direction and %of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION
PROPERTY OWNER:
C tii' �� C. L_ N (Q 1'C
PROPERTY LOCATION �
GOVT. LOT Ia W 1/4 S W 1/4,S 30 T Z8 ,N,R t 7 E (or"J
PROPERTY OWNER'S MAILING ADDRESS
LOT I BLOCK I SUED. NAME OR CSM I —
Yq°tC
CITY, STATE ZIP CODE PHONE NUMBER
❑CITY ❑VILLAGE TOWN NEAREST ROAD
DSO TiF S7.
�Ll S2 FPiLLS Wl 5Yo ZZ f71�4ZS- SS�f3
l�L�PcSPs+.�T Vht l�Y
K New Construction Use PCj Residential / Number of bedrooms Z ( J AdMQn to existing building
J J Replaoemenl J Public or commercial describe
Code derived daily flow 3D0 gpd Reconvwnded design lowing rate bed, 9Wd 0. I trench, gpd4t2
Absorption area required Z So bed, ft2 ZSO Irench, ft2 Ma)dmum design loading rate a - S bed, gpd/ft2 0 , b trmch, gpd/ t2
Recommended infiltration surface ekva vro s) q - S It (as referred to site plan benchmark)
Additional design / site considerations H C&HOt "LTA S x n ' IlitevCY - r" Aj 11,22" 1 of S?VuD FILL -
Parent material S �S" D% .j L Flood plain elevation, it applicable 1.1. P� • It
S = Sw We for System
I DONV ONN
El ® U
MOUND
®S ❑ U
DWROM PRESSURE
❑ S IOU
AT WDE
❑ S ®U
SYSTEM N FILL
❑ S (�ZU
HOLDW TAW
❑ S K U
U = UrGtatable for system
Boring #
)N
Ground
elev.
018_S fL
Depth to
limiting
factor
Ground
elev.
9 j_S fL
Depth to
Wiling
factor y
30
Sn1I ❑FSCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Mom
QU. Sz. Cont. Color
Texture
Sere
Gr. Sz. Sh.
Consistence
Bandy
Roots
GPD/ft
Bed
rercfl
2
ty-313
\oo-t2 Gty
S
o S
c5
-
o• S
o•L
3
3o_Sz
>o�t2 61V
y>z s78
z
�` `
c ,��•o
—
3
coti
ru S -).S
3/ c
►" ck
ar'o s
Rumndec,
1
0-13
�o�t2 jt3
—
s�
3
ZD-3a
0 S.03
wt u `r
C S
C_ F,.sylzsie
!
IN10 '-r R b z
�3
0
j�y
y 4(
�- o Cs 61-L
�1
O'er
rnv
ST Name: --Please Print Arthur L. WeRerer Phone. 715 -4 2 5 -016 5
egerer Soil Testing 5 Design Service-P.O. Box 74 River Falls,WI 54022
SignaWre: �Y � ���� q 3- l S 3 Dale �- 3 O —4 3 CST Number.0 0 5 7 6
PROPERtY OWNER CLk SOIL DESCRIPTION REPORT Page
PARCEL I.D. #
Ground
elev.
o)V.-) ft.
Depth to
limiting
factor
Ground
elev.
It.
Depth to
limiting
factor
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Boring #
Ground
elev.
n.
Depth to
knifing
factor
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz Coal Color
Texture
Structure
Gr. Sz. Sh.
Cor>sisterm
Bardary
Roots
GP
Bed u
0-\2
lo�Jtt- 313-
2
\Z-3
to-IiZ
3
31-3b
lo`a2 8 !I
7 $ YR 5/ib
s
—
SS BR
two
u >v
ZU G !.v
``
So t
6
Remarks:
Remarks:
Remarks:
Remarks:
SBD4330(R.OSM)
SAFETY& BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 22, 1993
WEGERER SOIL TESTING & DESIGN
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S93-40831
CLARK, CHAD
NW,SW,30,28,17W
TOWN OF PLEASANT VALLEY
MOUND SYSTEM
2226 Rose Street
La Crosse WI 54603
FEE RECEIVED
COUNTY OF ST CROIX
The Department has reviewed the above -referenced submittal.
180.00
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely,
Dennis Sorenson
Plan Reviewer
Section of Private Sewage
(608) 785-9336
ssn.sw dL unu
,.
Page 1 of &
MOUND SYSTEM
FOR
A Z BEDROOM RESIDENCE
S V 3 i 0 V
LOCATED IN THE ► k) 1/4 OF THE SW 1/4 OF SECTION 30 ,T Z.8 N, R 0W,
TOWN OF P�-EhSftkjr UkLQ!Y , Sr. CAZLuIX COUNTY, WISCONSIN.
INDEI
PAGE
1 "of
6
TITLE SHEET
PAGE
2
of
6
PLOT PLAN
PAGE
3
of
6
PLAN VIEW -CROSS SECTION
PAGE
4
of
6
DISTRIBUTION PIPE LAYOUT
PAGE
5
of
6
PUMPING CHAMBER
PAGE
6
of
6
PUMP PERFORMANCE CURVE
PREPARED FOR
1496 Lv2RGR-Es-
V;W- lk FkLLS,L-1L SV4-LI
WECiEREF:Z SOIL . TEST I NO
AND .
DES I 431V SIERV = CE
P.O. IM 74 421 L MIK ST.
RIVER FXU. II 54W
11"M-0I65
AE�`-lyED
AUG • a
' FE i BI.WS. DIV.
B-q-aid
JOB NO.
PLOT PLAN
Scale 1"=40 '
Page Z of (o
w�
W
I2
_ YS�[tJ1
v�uue E `SE�YN o GE S f
GNSi�
4
�'`6�jt4L'1W�s
J
OePAR ISIOJA
of
SEE GORK�, NQ G
glz�-193 N �'
31q" PUQ PIPe w/LATT1
1-Xl"i Ik S` OMrr
20 OF Z�pu trL 5
WRt� YIMW M.
91' �
'r; _;j,lC%s
y" PVC
w eL.I_ 'ho W PrT L!S7 S
o * + ovtiU Ptwo ?�r LL'R S1
ZV �-1Zon 1",ks
4o`or- V `Pu C
r'tp,JJVTkilu "W. `{Z eOUNR oU�R PIPE 1F SwOw
w�1 L Ivor BF RtTr1Ot MPr1"-1*JAJ 1"IN. 60'r
C.oUWTk oR F?S Pet CAOE I" R+v.{
PItZCR L^Jh lE L�At-L BE V-e"Queb .
FAQ M 10� ►q!p
1 \ I
I N CAI
nll
t�L 44
-gyp rJoT US" p1tcT oil
Q1STulk% T*13 no*'%
<�. V. 1—�
I Ig.2
NOTES: LTL 013 s
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be lboV� gallon capacity manufactured by
W� S�2 C=0►.� Gft-t'iS �2��ycT S - Pu1'� P d liiP� L�IQ 1� 9E w► SO Gk�. �St
5. Bench Mark S� ft%Ci c u!N
6. Divert surface water around mound to prevent ponding at the uphill side.
Approved Synthetic Covering
Medium Sand
Topsoil
3 It
7 % Slope
Of 2
Aggregate -
(undisturbed
Soil
Page 3of
istribution Pipe
� Elev _ c113• S) -
Force Main
From Pump
Cross Section Of A Mound System Using
I Trench For The Absorption Area
A S Ft.
g So Ft.
I 1 S Ft.
Linear Loading Rate= 6.0 GPD/LN FT J -7 Ft.
Design Loading Rate= O.3 GPD/SQ FT
. K 10• S Ft.
L Ft.
p4ttgawt-e-Position of Force Main — I W "L-► Ft.
Plowed
Layer
D ).O Ft.
E 1.3S Ft.
F o•b Ft.
G . o Ft.
H 1- S Ft.
L
ILg K
�Wn Trench OfAggregate
PermanentJ Markers
ely)
pl � y A Ifw
lift%� :PE•
0
Is
116 Trench For Absorption Area
Bli�
n
lDl;vu
tip "W
DCPFri D,VyS10
yEE CpfinE51'DNDEKGE
r,
Perforated Pipe Detoll
Page Y Of b
893-40831
End
J.'� 0End Vier
'erforoted
OVC Pipe
I L_Distnoution c
Pipe
Lost Mole should Be
Next To End,�pe_', 1
f
_. tnlflli`•
ai
PVC Force Mon
Install permanent -marker
at end of each lateral
Holes Located On Bottom,
Are Eptwny Spaced
- P ZY Ft.
X 1Z Inches
Y 3 O Inches
Hole Diameter 11 V Inch
Lateral Z. Inches)
Manifold — Inches
Force Main Z Inches
i of holes/pipe 4�
Invert Elevation of Laterals 99.00Ft.
Place 1st hole IS from tee with succeeding holes at 3 Ottintervals.
Last hole to be next to the end cap.
PUMP CHAMBER CROSS SECTIOW AMD SPECIFICATIONS' PAGE S OF �o
r
40C.1. VEAIT PIPC
3 10 1 FROM DOOR,
WINDOW OR FRESH
Ala INTAKE
le'AIN.
i� INLET
APPROVED JOINT
I
with approved
pipe extending
3 feet onto
solid soil.
Both sides of
tank. gq-SO
EUV. FT'
VCUT CAP
WEATHER PROOF
JUUCTIOU DOX
ORAOE
3y:j-40831
APPROVED LOCKING MANHOLE
COVER WITH WARNING LABEL
v
Y
PROVIDE I
AIRTIGHT SEAL
I
Tank construction shall comply I
with ILHR 83.15 and ILHR 83.20 I
I
l
J
_.�1.
C
* RISER EXIT PERMITTED OWLy IF TANK
SPECIFICATIOAIS
4• MIN.
�� j Ie•nlu.
I11
ICI
I ( APPROVED J011JT5
I
I�M
Oki
> OFF: '
awc",F�
3" APPRW9 V
:FI APPROVAL 18¢0011*6
DOSEK MANUFACTURCR: W'LQS� C��Re� DER Of OOSES:��PER D"
TANK SIZE' --)S(7 GALLOWS DOSE VOLUME d
ALARM MANUFACTURER: 5'S- M-MM SI-IST&I S
INCLUOIAI6 OAGKFLOW: �Z'�'3 4AlLONS
MODEL 1JUMpCR: 1S�1 tiw CAPACITIES: A= �,' WCHES OR 3� GALLOWS
5w1TCH TyFc: Y-VtMCUR-Y 5 = Z IMCHEt OR qt. 1 GpLLOu5
PUMP MANUFACTURER: ZO�TLL�2Cp►1PAAjy C. 6 WCHESOR20'� CALLOUS
MODEL NUMOCR: r'3 - 5 S Dn �S INCHES OR 300' 4' GALLONG
SWITCH Twpc: Y DOTE: PUMP AND ALARM ARE TO eE
MIAIIMUM DISCHARGE RATE Z �' GPM INSTALLED OU SEPARATE CIRCUITS
VERTICAL DIFFERENCE CETWEEU PUMP OFF AUO_015TRIBUTIOU PIPE.. 4' SO FEET
t MINIMUM NETWORK SUPPLY PRESSURE .... ..... .. 2.50 FLET
T
+ ZO FEET OF FORCE MAIN X 0.98 Fo fLFRlCTlory FACTOR. O. ZOFEET
TOTAL OtJUXMIC. HEAD — ,'�0 FEET
DIAMETER $O` iaP ,I
INTERNAL DIMLIJSIONA Of TANK: LEWGTH � ;WIDTH =;LIQUID DEPTH 39
BOTTOM AREA _ c 231= — GAL/INCH
AS PER MANUFACTURER = ZU.OS GAL/INCH
A��6oFb
W
W W
W LL
25
C
Q 6
LU
0
i
a
4
0
J
H
O
2
15
10
0
US
GALLONS
LITERS p
HEAD CAPACITY CURVE
"53-55" SERIES
TOTAL DYNAMIC HEAD/
FLOW PER MINUTE
EFFLUENT AND DEWATERING
HEAD
CAPACITY
UNITSIMIN
FEET
(sAL
LTRS
5
1.52
43
163
10
3.05
34
129
15
4.57
19
72
19.25
5.87
0
0
z.3.y
10
30
80
FLOW PER MINUTE
160 rrll�
V
11h -
111h NPT
I
S93m40831
I
�T'
�r
•ta♦a.l�.
1��
,'Y*'2'�'�l
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Piggyback Mercury Float Switches • Available with special cord lengths of 15',
available. 25, 35' and 50'.
• Variable level long cycle systems • Alarm systems available.
available. • Duplex systems available.
Standard cord length - automatic 9 ft.
Standard cord WVth - non -automatic 15 ft.
Y6ifd5 •ERIES
Control:ideallorl
Modd
Veit -Ph
Mods Ames
sinngn
Delon
M53055
115 1
Auto e.0
1 or 1 A 7
NLV55
115 1
Non eo
2or2ae
3or4A5
D53/55
230 1
Auto 4.6
1 or 1 A 7
E53/55
230 1
Non 4.0
2 or 2 A 6
3 or 4 A 5
53 Series - WL 231tis. - .3 H.P. 55 Series - Wt. 251ti3. - .3 H.P.
33/31
SELECTION GUIDE
1. Integral float otere ad ne , , —11cl noexternal control required.
2 Skeg" piggyback wideangfamarcury noerswitctler double piggyback mercury mat
aatloh. Rater to FM04T7.
a Machadcel anwrster 10- 0 or 10.WM
4. Sera FM-712 ter oonnct nteOM of Electrical Alternator, 'E-Pak-.
S Sensor nurwry AM ewleah 104Muaadraoontrol adWator.wnh E-Pak(3)or(4)
Moat system.
S Four (4) hole -J-Pat . Junction kox, for wam No conrsegon or eked-ln simplex or
duplex operation. PM I"=
7. Two (2) hole -J4%k . Juclion pox, for watertight connection or •plloa, PM 10-0003,
Fatelomeaft oneddniorWZaNarproducttfoWtoatebgonComtina mStater,FMO514: CAUTION '
Plpgypack Mercury Flat 3lrkhes. FMO477; Elamical Atienstor, FMOM LuchalWai Anerne- All Installation of wrtrote, preeeetien devices mid wkh alrould W done by a quaimed
neon. FMOM: Aimn Package. FM0513r Ildroprsawaa Basins. F1104e7: and skmplax Contra tin enhae 'electrician. AN electrical and eery codes should be f-11, hn oration to th•
Saw, FM0732. most recent National Etee I Cede (NEC) and tiw Ooclyatival $o" and HoMh Aa
(OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
`ZOfLLER O� 3280 Old Millers Lane Manufacturers o/ .. .
p � P.O. Box 16311 Louisville, Kentucky A0216 � „
(502) 77&2731 •FAX (502J TJ4 3621 QIFVM4 Amsa9 ,S;#cF /939
se rMYe SEC w
uusncw rsnum.ro
rep, 195, o - ur , , r• ,aCw nirr
A parcel of land located in the NW 1/6 of the SW I/
Section 30, T 22 N, R 17 W, Town of Pleasant Valley
Croix County, Wisconsin, wore fully described as fo
Commencing at the West 1/a corner of Section 30 tha
SOUTH along the nut line of the SW 1/4 a distance
)).00' to the point of beginning:
Thence EAST, )2).00';
Thence SOUTH, 270.00';
Thence WEST, 323.00' to a point on the west line of
Se 1/a;
Thence NORTH, along the west line of the Se 1/6 a d
of 270.00' to the point of beginning;
Contains 2.00 acres subject to ISOth Street right o
Also subject to any and all additional easements. r
ways or conveyances of record.
NOTE: THIS DESCRIPTION IS FOR MORTGAGE PURPOSES ONL'
140 SUBDIVISION OF THE ORIGINAL 60 ACRE PARCEL IS AL.
WITHOUT FIRST COMPLYING WITH THE ST. CROIX COUNTY
SUBDIVISION ORDINANCE IN THAT A CERTIFIED SURVEY MAi
APPROVED BY THE COUNTY AND TOWNSHIP, IS REQUIRED.
CONTACT THE COUNTY SONINC OFFICE FOR INFORMATION
RECARDINC SUBDIVISION ORDINANCES.
SIRVEYfR'S CERTIFICATE
I, Janes M. Weber, registered lard surveyor, hereby
That I have surveyed and napped the above described
land and that such plat is a correct representation
Dated this 14 day of a ., V.•. , I
Dares M. Weber S 1904
WEBER LAND Sl.RVFY I NC
(715) 425-0164
S. (o.xr. Srr M
i--r.psrhox rsusus¢o
1000 IW S)
A parcel of land located In the NW 1/6 of the SW 1
Section 30, T 29 N. R 17 W. Town of Pleasant Valle
Croix County, Wisconsin, wore fully described as "I
Co noing at the West 1/4 corner of Section 30 th
SOUTH along the most line of the SW 1/6 a distance
)3.00' to the point of beginning;
Thence EAST, 323.00';
Thence SOUTH, 270.00':
Thence WEST, 323.00' to a point on the must line c
SW 1/6;
Thence NORTH, along the must line of the SW 1/4 a
of 270.00' to the point of beginning:
Contains 2.00 acres subject to 130th Street right
Also subject to any and sit additional easesents,
ways or conveyances of record.
NOTE: THIS DESCRIPTION IS FOR MORTGAGE PURPOSES OF
NO SUBDIVISION OF THE ORIGINAL 40 ACRE PARCEL IS I
WITHOUT FIRST COMPLYING WITH THE ST. CROIX COUNTY
SUBDIVISION ORDINANCE IN THAT A CERTIFIED SURVEY I)
APPROVED BY THE COUNTY AND TOWNSHIP, IS REQUIRED.
CONTACT THE COUNTY ZONING OFFICE FOR INFORMATION
REGARDING SUBDIVISION ORDINANCES.
SLRVEWt'S CERTIFICATE
I, 3anes M. Weber, registered lard surveyor, herel
That I have surveyed and mapped the above describ,
lard and that such plat is a correct represmiatir
Dated this Ift� day of c< , �
Saxes M. Weber 5 IRD4 --
WEBER L*D sistviry :
(715) 425-0164
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER LNAy 1 Q/R.U� Ci�iRft
ADDRESS N&0331 920 sr.�✓;�IRE NUMBER_ 55T
CITY/STATE -A&IE.s' /-*?cLS LJ/ ZIP SyOz2 r��w�
PROPERTY LOCATION: {dl/4, S6J 1/4, SECTION JL0 , T Zy N-RL7W
TOWN OF [�ASA.Vr U/�(�Cy/ , St. Croix County,
5UBDIVISIONA10 d0ME MC su.rr�L" 2.J66el) 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 a 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 604; 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 syst.em is in
proper operating condition and (2) atter inspection and pumping (it
necessary), the septic tank is less than 1/3 iull of sludge and
SCUM.
I/lie, the undersigned have read the above reguicNr.,ents and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as set by the wiscn.rtsin DNR.
Certification stating that your septic has been maintained must bAe
completed and returned to the St_ Croix Co. zoning of4icer within
30 days of the three year expiration date.
SIGNED:,�,� C //
DATE:_y�
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
••Y;
yt;
STC -loo
9'I1is 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
spoe
'louse), tile" a second form should be retained and completedwhent':e property is sold and submitted to this office with the r,
appropriate deed recording,
r. .r r rrrr.rr rrrrr rrrrrrrrrrrrrrrrrrrrr
• Mrrrrrr-rr-r-rrrrrrrrrrrrrrrr---
Ownar of property L-�W,2,. 01141YE R.
Location of property /c JL/4 �1/41 section'•30
Township _ Az_ffs/,vr �Gcc 3i i `/ } �. <
Hailing address
c
Address of site
�A
Subdivision name_ .t/o 49Mc DEED _Z3
ok,s, e y w Lot no, i
Other homes on
property? yes•-..X._Ho � •:
;a
Previous owner of Jrs,�•,ES property
Total size of parcel f}s 'O .n
Date parcel was created l o1/44• 9 `f ,
Are all corners and lot lines identifiable? you
Is thin property being developed for (spec house)?•_yes ryi
'I
volume_/CG and pege� 'Number S`,, 3L as recorded, with the Register a
olrDeed■ • '�.
rrrr ...rrrrr rrrrrrrrrrrrr ........................
INCLUDE WITH THIS APPLICATION TITS rOLLOWIIIC:
A WARItA ITY DEED which includes a DOCUMENT NUMBER, voLUHE AND PAC1:
1JUMUl;R- &- -THE "SEAL "OF T118 ItIlGIST[slt op DEEU3. In addition, a W.
certified survey, if available; iwould be helpful so as to avoid s
doloya of the reviewing process. I! the deed �deeariptlon
reCoiences to a cortitied survey Hap, the cerdeed d s or P ion
shall also be required.
ap
' • •' fir:
PROPERTY OWNER CERTIFICATION
I(wa) certify that all statements on this form are true to the
bast .of my (our) knowledge that I (we) am (are) the owner(s)•'pr L
tho property described in this information form, by virtue ot''a
warranty deed recorded in the office of the County Register of
Deeds as Document Ilo. iZ 97 7 0
own the p , and that I (we) presently %:0-
pro proposed site !or the sewage disposal system or I .(We)
obtained nn_easemont,. to run the above described_ r ��J
;*1:he construction •ot.r:esaid system, and "the "same " p �perty,, toe
recorded in ' thr-:Office `of County ' Register of dee¢,RP
PDocument ,Y~
No.
.�
As gnatur of apol can ;...v .
`4 Co-app .cant
r ;
yam• ��y ' �} ,
Date of 8 gnature
Da a of 04.9naturs
111//1/�■
April 28, 1994
Mr. Chad Clark
1498 Evergreen Dr.
River Falls, WI 54022
Dear Mr. Clark:
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
Thank you for your telephone call of last week regarding the
property which was deeded to you by Daniel O. and Jeanne M. Clark
as recorded in Vol. 1064 pg. 432 in the Register of Deed's Office.
As we discussed, I became aware that you had separated and created
this 2 acre parcel from a larger 40+ acre tract with plans of
building a new home on it. This has unfortunately created a
violation of the St. Croix Co. Subdivision Ordinance. Specifically,
any parcel created which is less than 35 acres in size must be
surveyed. This property, being less than 35 acres, should have
been surveyed prior to being transferred into your name.
We also discussed that when a parcel is zoned exclusive
Agricultural as this is, and it is reduced below 35 acres it must
be re -zoned to Ag.-Residential.
I would like to ask for your cooperation in correcting this
violation. This can be accomplished in one of three ways:
1) Re -zone the parcel to Ag.-Residential and create and
submit a certified survey map to our office for review
and approval.
2) Deed the 2 acres back to Daniel and Jeanne so that it
becomes part of the original 40+ acre parcel.
3) Obtain the entire 40+ acre parcel.
I would appreciate any efforts you
matter as soon as possible. If you
this matter, please call me at (715)
letter and I will be happy to assist
Sincerely,
J es K. Thompson
Assistant Zoning Administrator
cc: Town Clerk
Corp. Counsel
File
could make to resolve this
have any questions regarding
386-4680 upon receipt of this
you.
94-V-16
St. Croix County Planning and Zoning
11'ednesdaY. April 18, 2007 al 2: i8: JO PM
Detail Sanitary Information Page I of
Computer 1t: 024-1036-60-OW Sub/Plat: 40 acres Section: 30
Parcel #: 30.28.17.234 Lot: TN/RNG: T28N R17W
Municipality. Pleasant Valley. Town of CSM: 1/4 1/4: NW 1/4 SW 114
Owner: Clark, Chad 143 150th Street River Falls, W 154022
State Permit: 208994 Issued: 05/11/1994 POWTS Dispersal: Mound 24" or more suitable soi Permit: New
County Permit: 0 Installed: 07/13/1994 POWTS Detail: NA bedrooms: 3 WI Fund:
POWTS Pretreatment: NA
Notes
Issuer/Inspector As Built Plumbe Additional Notes Money Owed
b Other Reouirements
Mary Jenkins Yes Lickness, Chris $0
Jim Thompson higned Oli Yes
Maintenance
Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification
5/11/2005 5/3/2006 04/20/2006
5/3/2009
7/13/1997
Wisconsin Department oflndusby, SOIL AND SITE EVALUATION REPORT
L:bpr and Human Relations
Page 1 of 3
COUNTY
5T . c>Mtx
Attach complete site plan on paper not less than'8 112 x 11 inches in size. Plan must include, but
PARCEL I.D. rE
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION
PROPERTY OWNER:
C 11 tt \'2� C. L h 2 VT
PROPERTY LOCATION
GOVT. LOT N W 1/4 SW 1I4,S 30 T z% ,N,R 1 i E (me
PROPERTY OWNER'S MAULING ADDRESS
LOT R
BLOCK a
SUBD. NAME OR CSM a1
1�TU
q9� LSUk�RGR
—
—
_
CITY, STATE ZIP CODE PHONE NUMBER
❑CITY ❑VILLAGE [TOWN
NEAREST ROAD
�2ll��L FGI�LS WI S402Z (�ISI4ZS_SS�B
PL�RSPm�.uT Uhu�t`t'1
\SOYA+ ST.
K New Construction Use Pq Residential / Number of bedrooms Z [ I AdditW to existing building
t 1 Replacement [ I Pudic or commerdai desaibe
Code derived daily lbw 3tJ0 gpd Recommended design loading vale _ bed, gpolft2 ° troxh, WW
Absorption area retored Z So bed, ft2 ZSO nn h, ft2 Ma)dmum design baring rate a , S bed, gpdAfl2 G, b nndl, WW
Recommended infiltration surface elevation(s) 9. S • S It (as referred to site plan benchmark)
Addtionaldesign /siteconsiderations '?- C M1118A Mt�`O w\TH S x 3U, 17.0 /ct{ - "&) mMt*l 1 of Stwb Ft L
Parent material 15i'%1..A L Rood plain elevation, If applicable fJ • +i • It
S = Suitable for system
CONVB4TlONAI
❑S ®U
MOUND
I ®S ❑U
NalOUND PRESSURE
❑S i
AT -GRADE
osoul
SYSTEM IN FILL
❑S WU
HOLDNG TAM(
❑S $1U
U=Unsuil"for
Boring #
0
Ground
elev.
g8•Sg.
Depth to
Willing
factor L
Boring #
Z
Depth to
limiting
factor
3 O"
SOIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Movies
Chi. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
CansisGenoe
Boundary
Roots
GPD/ft
Bed
Tmr&
o-ty
\O -tQ 3 3
—
'S 1
Z FSbk
m
a S
-
o• S
o. b
3
30_52
IOKR 6!y-,�syTt
5/8
,
cSw•
c ��w
-
—
-
3
co+Q
At/S 7.S
31 C_
I Tmck
S00-&S
Remarks:
2
1AZO
lb4e 3/6
-
51
eS
3
-30
lt:01R 61
—
`�'S
0 s9
WAuFi,-
CS
-
G.S
u.6
3o-v9
1��I R 6/y
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YK L)�l,-
e
-
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Remarks:
TName:-Reese Print Arthur L. We erer Phone. 715-0.1,65
er6rer Soil Testing & Design Service-P.O. Box 74 River Fal ;5*022
Signehre: J ,/� t� 3 - 1 S8 Data:
�-30-`?3 M00576
PROPERTY OWNER
PARCEL I.D. #r_
SOIL DESCRIPTION REPORT
Page Z of 3
Boring #
3
Ground
elev.
of4-7 ft.
Depth to
limiting
fact r,r
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
Ground
elev.
It.
Depth to
limiting
factor
!I
Ground
elev.
ft.
Depth to
limiting
factor
Horizon
Depth
in.
DOminantColor
Munsell
Motms
Qu. Sz. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/ft
Bed
Trench
o -\Z
to-1t7- .13-
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Remarks:
Remarks:
emarks:
Remarks:
M-8330(R.05/92)
PLOT PLAN
SCALE 1"= 140 '
Page 3 of 3
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730-93 (715 ) 4 5-016% m00576
Date Signed Telephone No. C5T if
WIsconsinDepartment oflydusty, SOIL AND SITE EVALUATION REPORT
Labor and Human Relations
Page N of 3
m dcw/u min iI_nn w.w, ...a. r.vn,. waw
COUNTY
Attach complete site plan on paper not less thatt 81/2 x•11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (B", direction and % of slope, scale or
PARCEL I.D. !
dimensioned, north arrow, and location and distance to nearest road.
REVIEWED BY DATE
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION
PROPERTY OWNER:
C ht Pr-p C- L h R VT
PROPERTY LOCATION ��;;�
GOVT. LOT N W 1/4 SLO 1/4,S 30 T ZS ,N,R I-? E (we
PROPERTY OWNER'S MAILING ADDRESS
LOT BLOCK i
SUBD. NAME OR CSM
CITY, STATE ZIP CODE PHONE NUMBER
❑CITY ❑VILLAGE MOWN
NEAREST ROAD
[Ztt,�'R FftILS W) SVOZL C'/Iy42S, SS'18
!'�1_�SRwT VR��I'!
1SOTtE ST.
K New Comwdon Use Residential I Number Of bedroans Z I 1 AdMT to existeg building
I I Replacement [ I Pudic or cominerdal describe
Code derived daily low 300 gpd Recamtended design beding rate _ bed gpdnfl2 0 3 trench gpolft2
Allsolption area MOW Z, So bed, ft2 Z-sa bench, ft2 MWatum design loading nda n - S bed, gpdM2 0 • b tench, gp W
Reoatmended irlftgrafon srrfaoe d aUort(s1 4. S • S It (as reletted lo sile plan bentchowiO
Addlienal design / lit Maideldons �Za w11'1 @_A p%L* 1t b W M Sic SQ ' `TF�F'Yy V Ytlwt tMly l I � OF StWU
Parent rtttlferial S h* ro is Z%W r= Flood On darafion, i applicable IJ - A - ft
S - Suitable for Sy51em
cwiw oNAL
❑ s ®u
MOUND
®s ❑ U
14GRDl1ND PRESSURE
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AT-GPADE
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❑ s $I u
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Boring i
Ground
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C�a-Stt
Depth to
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atn
Boring #
U
Ground
°I elev. . ft
Depth 1D
irtiling
Pallor
30"
SAIL DESCRIPTION REPORT
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Contsis6ertoe
Boundl3y
Roots
GPD/
Bed
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STNama.--PleuaPrint Arthur L. Wegerer P.h"' 715-425-0165
firer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
4gnWG Date. - 3 0 -9 3 CST Number:
0 0 5 7 6
�./ a 3 - 1 se
PROPERTY OWNER
PARCEL I.D. x
Clft\ZK
SOIL DESCRIPTION REPORT
Page of 3
Boring #
3
Ground
elev.
o)y•7 ft.
Depth to
limiting
factor
ii
Horizon
Depth
in.
Dominant Color
Munsell
Moores
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Bombay
Roots
GPD/ft
Bed
Trends
—
2
7.$ `rR S/b
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Remarks:
Boring #
On,
Ground
elev.
ft.
Depth to
limiting
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Remarks:
Boring #
r
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
memarKS:
SBD-8330(R.05/92)
n
PLOT PLAN
qr ATY 0 '
Page 3 of 3
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7-3�-43 (715 ) 425-Ut 6.5 t400576
Date Signed
Telephone No. CST #
• State of Wisconsin
pcpartment of Natural Resources
Oay--103&- 6o -000
SEPTAGE
REQUEST FOR FIELD APPROVAL -�O- aZ a . / 7
Form 3400-133 10-87
Completion and submission of this document with appropriate
support Information Is mandatory under s. 146.20, Wis. Slats.,
and Chapter NR 113, Wis. Adm. Code. Failure to properly
complete and submit this form while using a site for land
disposal of septage Is a violation of s. 146.20 and Chapter
NR 113 and may result In a monetary penalty.
Name and Address of DNR District Office
f Otis
�300Y/ it A7'.4aE.
�/4C� L GAi�9�ll/i s'y7oJ�l�
Name, Name of Firm and Address of Licensed Disposer
F
Johnson's Sanitation
W5990 570th Avenue
L Ellsworth, WI M011-5100
Action by WDNR (See checked and initialed box for
action taken)
❑ Denied due to Insufficient Information being submitted
(See circled areas above as indication of missing
Information)
By
❑ Approved based on submitted Information
By
❑ Denied based on submitted Information
By
to DNR /
IT�e of Field (Check [XLOne)
Low Use I I Dormant Field
ofs� y --1-3 0
ed Acreage , , ,
Submitted Information (Check [XI boxes if sent)
® 1 copy of Request for Field Approval
(Form 3400-133)
® 3 copies of a Site Location Map
3 copies of a Soil Information Map
❑ 3 copies of the Sol[ Investigation Data (only if
no Sol[ Information Map Is available)
❑ 3 copies of a completed WDNR Agricultural Field
Operations Form (Form 3400-102)
❑ 3 copies of other Information
Date Received
Field Legal Descrlptign Section Township Range
Approxim?te,FI1Id Size (Ac) DNR, Field No.
Special condition(s) of approval
❑ Approved conditionally until Inspected (by WDNR staff)
By T
❑ Denied until inspected (by WDNR staff)
By
❑ Approved based on WDNR inspection
By
❑ Denied based on WDNR inspection
By
❑ Only the area outlined by red on the Site Location
Map is approved
By
State of Wisconsin
Department of Natural Resources
Complete this form for each field and send to the
appropriate Department of Natural Resources district
office for evaluation seven days before the field Is
to be used for landspreading of septage.
Additional copies of this form are available upon
request.
Street or xoute
City, Slate, Zip Code
Telephone Numb n
0 4I )
AGRICULTURAL FIEL
1._Usme of FieldOwner
Air !-
2. Name of Field Farmer
3. Are local permits regi
If yes, by whom?_
W5990 570th Avenue
different
Yes Vg No
SEPTAGE
AGRICULTURAL FIELD OPERATIONS
Form 3400-102 Rev. 3-88
Completion and submission of this document with
appropriate support Information Is mandatory under
s. 146.20, Wls. Stats., and ch. NR 113, Wis. Adm.
Code. Failure to properly complete and submit this form
while using a site for land disposal of septage Is a
violation of s. 146.20 and ch. NR 113 and may result
In a monetary penalty.
4. How Is access to the field limited?
❑ Fences M Remote location
❑ Warning signs ❑ Other (describe)
9. Has the field been used In the past for septage or sludge
disposal?
Yes []No
A. If yes, please Identify by whom
TJog-olf
;
B. When was septage or POTW
sludge last spread on field? oath and Year)
C. How many years has the field /f
been used for disposal? 7
i. Minimum distance to a residence, business or
recreational area
Feet (If less than 112 mile)
7. Mininum distance to a community water supply well
Feet (If less than 1/2 mile)
and Township Loca on of 'beta / LL
� ai
)opti�y Sect�n Trow P Range
!d Acreage r
I. Minimum distance to a private or noncommunity well
Feet (If less than 1/2 mile)
9. Minimum distance to a surface water, sink hole or
wetland
Feet (If less than 1/2 mile)
10. Minimum distance to a dry run or ditch
Feet (If less than 1/2 mile)
11. Estimated depth to groundwater
Feet
t2. Estimated death to bedrock
/A-t#�94-�-
Feet
Maximum slope
v
What type of land use is adjacent to disposal field
(X al14 appropriate)
❑Residential ®Agricultural []Mining Operation
❑Commercial []Forest ❑ Recreational
❑ industrial ❑ Landfill ❑ Other
Land use of disposal field
® Agricultural ❑ Other
❑ Forest
If agricultural, what crop Is being grown or will be
grown within eight months?
C0 R,y
D d Gallons per acre
I
1
I
I
1
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PENCE
COUNTY
I PLEASANT VALLEY T wP. - I —R(7SN RIVER TM'P.
1500 1600 1700 1800 1900
SYMBOL OF
DEPENDABILITY
AND QUALITY IN
PLAT BOOKS
SINCE 1944
ROCKFORD MAP PUBLISHERS, Inc.
4525 Forest View Avenue, P.O. Box 6126
Rockford, Illinois 61125
N
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2000 2100
S & N LAND SURVEYING
PROPERTY SURVEYS
TOPOGRAPHY SURVEYS
SUBDIVISIONS 8
CERTIFIED SURVEY MAPS
ALLEN C. NYHAGEN, R.L.S.
PHONE: (715) 386-2007
108 WALNUT STREET - HUDSON, WISCONSIN 54016
19
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