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HomeMy WebLinkAbout028-1009-10-000 Q o : a 4 0 ~ I ~ I o I 0 I N ~ I ~ I ~ I , 121, I O C Z N L. t9 d LL O N a N E Q r U O N Q ~ ~ a I cwn w v o ~ a m M C/) 0 O Z d U r cn w d Z C O fn H Z a N M ~wvJ a i s s o I C O O Q Q w ~ Z Z ~ Z ~I N N c I a N C o N 0 L co O O O N w 0) 0 N O N N C. _O O O O a E 0 0 N N `n Imo- FN- a w o 0 ~i 0 0 0 Z o o • c a a a FL o in m y w to U in rn rn > O LO '0 c c) I. > p) d O N N I r- C) Q O N -p E LC) M t N O m N ~8 'a Q cn m o W C C P- co cx) c? 0 :3 o m m W u) c U d M °o cD r \ N O- C "6 N N V 0 C:) C C N_ u c,) 7 C 00 L O LO y N F- C N oo N O 7 L N M O O N O N E f9 m • N 0 0 0 N Z N ~L (n L mL M a m a a w • c d v N y C rr`1w~i +r E ` C c' 10 l STC - 104 r 1 , A* 0 ` AS BUILT SANITARY SYSTEM REP OWNER r V4 &jW F d, ADDRESS SUBDIVISION / CSM# LOT # SECTION T N-R W, Town of i. P j.= ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM tpODG~, 65 y S yid y 6c 3 a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r r. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~~(~,csY`ey~,~/ Liquid Capacity: ZZi Setback from: Well /00 = - House Other Pump: Manufacturer ~l Z~DeIIe~ Model# f7 Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: DO House , Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: G✓i~.L(,c LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin epartmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Sa`~ety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.: DEYOUNG, CHARLES/JANET QX CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic "-0 Benchmark Dosing fj}r (~5 03,0`1 Aeration Bldg. Sewer Holding St/ Ht Inlet 9("// TANK SETBACK INFORMATION St / Ht Outlet Verit TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet Septic 400/ >/00 ' go, >qp NA Dt Bottom clr ~J~ q d ,k Dosing 4 s O~ QSl ~1 NA Hz-d"r/Man. Aeration NA Dist. Pipe ~,oq g8,6 Holding Bot. System 5.9 q q7,757 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ; . ~ 8• Q3.~ y GPM Model Number u 48,5 TDH Lift Friction C~ $ysten~l TDH Ft Forcemai n Length (p' Dia. N Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ' Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~I DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO Model Numer: System: YYI b1c D c~s ~,O f o o OR UNIT DISTRIBUTION SYSTEM Header/ fdFaaifoid Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length_ Dia. 1 I11-1 Spacing Ij i'1 3 d ~SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over l) xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil J~f Yes ❑ No WYes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Rush River.3.28.17W, SW, SE, 50th Avenue g q orb -7 Plan revision required? ❑ Yes [/No Use other side for additional information. I 6~ o 1 ~ a^:~ E off- SBD-6710 (R 05/91) Date Insiictor's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH, SANITARY PERMIT NUMBER: I LHR SANITARY PERMIT APPLICATION Co In accord with ILHR 83.05, Wis. Adm. Code STATE S~AN1ITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than o~ ~~(O 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION „t ¢ w '/4 '/4, S T,; , N, R E (or) _T zr PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 7A J F "j,-,e CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER !JE' 642 -SS ,Ua- 11. TYPE OF BUILDING: (Check one) ❑ State Owned O VILLAGE 41Cr NEAREST ROAD ❑ Public 911 or 2 Fam. Dwelling-# of bedrooms 2 PARCEL TAX N'U R ) III. BUILDING USE: (If building type is public, check all that apply) 0 , l609 Q 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 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. ® Replacement 3. ❑ Replacement of 4.E1 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 M Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) qf~' ELEVATION 36V ;7,5-d ,5-D 0_5 'd Feet - $ Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App T [anks Tanks strutted W I I F K+_ od i d6✓Q.S~ Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 4:~sr) e b D Vlll. RESPONSIBILITY STATEMENT 1, 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) P PRSW No.: Business Phone Number: Ile ,e art S c kraY S LE Plumber's Address (Street, City, State, Zip Code): IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Stary Permit Fee (Includes Groundwater Date Issued Issuing Ag t Si a (No mps) Approved ❑ Owner Given initial .61--surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. . 2. Your sa ,itary permit may be renewed before the expiration date, and at the time of renewal any new criteria r1 the Wisconsin Administrative Code will be applicable. 3. All revs: ions to this permit must be approved by the permit issuing authority. 4. Change; in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBC, 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.,: , z- 11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies co'lected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 'r SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 17, 1994 2226 Rose Street La Crosse WI 54603 ,gyp 11 WEGERER SOIL TESTING 421 N MAIN STREET PO 74 RIVER FALLS WI 54022 z 4-40974 FEE RECEIVED. 180.00 RE: PLAN S9 . k w • DEYOUNG, CHARLES & JA 9 SW,SE,3,28,17W TOWN OF RUSH RIVER - 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 145r 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. Sincerel , ~M G and Swi an Review Section of Private Sewage (608) 785-9348 4433R/ 1 SRO-6423 (R. 0"1) Page of 6 MOUND SYSTEM S94-40-974 FOR A Z BEDROOM RESIDENCE LOCATED IN THE SW 1/4 OF THE S E 1/4 OF SECTION 3 , T "?18 N, R 17 W, TOWN OF lR,V S~A U , sT• C1Lo Lx COUNTY, WISCONSIN. INDEX PAGE l '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 I PREPARED BY WECGEFtEFR SO I L TEST 2 NG /;xscolv'qAND . .~..«».....y DES I GR! S1ERV I CE : P.O. BOX 74 421 W. KAIN ST. _ "D-G .R RIVER FB. Ml 54422 ~ T"' 115-4r.~-0165 ~NNN~ Q, ;SIG14 RECEIVED {~v G, 10,14 4 y AUG 1 2 1994 SAFETY & BLDG& DIV. JOB NO. g y - Z PLOT PLAN S94- 4-097 4Page z- of .~o Scale SCE -NUT ARppERti-/ l.i/~~, PvC 41P@ w/ LATH . 1*~ST~c~1. CV:PpUtX,T 6u' of 4" PvC -S P JCL%j W/FROST SLg'JG ti-~tr.~ , yZ" col,~Z S Q, a a ~ 98 ~ b n 3 a'/i • is 3 O So of Z''PVC f M%W `s o / 0 e• Z o O Q / 0 0.0- CTL ON / A'~ FC►vQOVV QTR l ST1 N G 0 *J svo CO ;AF"iA X33':g`..: li ~O~'' wC2.L IrDC~'1~Tp ? !0(~' ~Y Lv o1= ►-i W k b pft? DIV CC ° So T* N-y E . J N NOTES: 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 ZoAO ASO gallon capacity manufactured by 5. Bench Mark S e` ~rao U e. b. Divert surface water around mound to.prevent.ponding at the uphill side.: Page 3 of S~)4-40974 Approved Synthetic Covering , -AST" Distribution Pipe Medium Sand H G. t Topsail F Elev. X18.0 3 , b % Slope (Force Main Plowed Trench of V'-2k " From Pump Layer Aggregate Undisturbed D Z_o Ft. Soil E Z- a Ft. Cross Section Of A Mound System Using F o-Ib Ft. I Trench For The Absorption Area. G Z.a Ft. A 5 Ft. H I- S Ft. B SO Ft. I 1q Ft. Linear Loading Rate= 6-0 GPD/LN FT J X0 Ft. Design Loading Rate= o•ZSGPD/SQ FT K l y Ft. L Position of Force Main W 3"4 Ft L t fie, 1 , B K Wit A. 4- - - W Distribution Trench Of 2 - 2 2 Pipe Aggregate I Observation Permanent 1 ,.ie 40 Marker, ~es Ufa g, es Mound Using I Trench For Ab~o of>St eyGE AR ~ 00 Page -Of I Perforated Pipe Detail S94-40974 0 End View )Perforated - End Cap_ PVC Pipe Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cap * PVC Force Main Distribution Pipe Last Hole Should Be Next To End Cap ~E Distribution Pipe_ Layout Z _ X 3X~l Inches r ' a Y 3° Inches 4 'rr((}yy [ yp n ; >1f1NS Hole Diameter t~Y Inch ~At=1YY Ali 1 ily r. ' Lateral " Inch(es) Manifold Inches t Force Main Z Inches # of holes/pipe 10 Invert Elevation of Laterals 98-S Ft. Place lst hole 5 from tee with succeeding holes at 304 intervals., Last hole to be next to the end cap. _ Combination Sept° c;Tank and b 4 - ` .0 9 7 ~ PUMP CHAMBER CROSS SECTIOM AMD SPECIFIC ATIONIS ' PAGE 5 _-(W 6 r WEATHER PROOF VE..kIT CAP JUWCTIOU BOX 4- 4'C.I. VENT PIPC APPROVED LOCKIIJ&. "1101 FROM DOOR..: MANHOLE COVER wt'1~ WIMDOW OR FRESH WARIa11J~. LA61EI.. It Mlu. co„DU,r AIR INTAKE GTZ. q 6011 ( 40 MIIJ. I / ~ ~ ib'MIIJ. PROVIDE ( IA1 LE T - AIRTI6H T SEAL I I I ' I III SR~~S I I I APPROVED .011J' APPROVE --A- D JOIWT I t ( W/C.I. PIPE,~KIx w/C.i. PIPE OIL Tank construction I III ALARM EXTEy01U6 3' EXTENDIM& Fshall comply with 11 ONTO sous col. OUtTO $01.10 59~4. 1 y~ 83.15 and 83.20 d I i may, Y~ I I Ou y s{ C 1 ¢,gt1A aAl s3`S L PUMP OFF ~'aZSZ©F 'SpE I\ O , D~~L- 01jISID CONCRETE R O O OLOCK SE~ " APPRc RISER EXIT PERMI'IfED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL 11400 SPECIFICATIOAIS SEPTIC f . DOSE MANUFACTURER: ~ p1 ST IJUMBER OF DOSES: 3' Z PER Why TANK WZE: LOSO 650 GALLOWS DOSE VOLUME t S•S. .~-SRO Ski M s ItJCLUDIN& BACK/ LOW: GAI.LONS ALARM MANUFACTURER: MODEL uUMBER' 1 O Hw CAPACITIES: A= LS WCHE5 OR ` Z S S WALLOWS SWITCH TYPE' CU (LY 9 = Z- INCHES'OR G( LLOWS HUMP MAWUFAGTURCR: z'OC~-I.ER ~T'LPMy~( C~ E' WCHES OR l~Z GALLOWS MODEL WUM6ER: S~ D= L S INCHES OR ZSS GALLONS _ b q b SWITCH TYPE: 0Cuiz-y MOTE: PUMP AMD ALARM ARE TO BE Z3.y0 INSTALLED OW SEPARATE CIRCUITS MIIJIMUM DISCHARGE -RATE GPM VEKTICAL DIFFERENCE DETWEEIJ PUMP OFF AUD_D15TRIBUTIOW PIPE.. b-Z$ FEET t MIMIMUM LIETWORK SUPPLY PRESSURE 2.50 FEET S~ FEET OF FORCE MAIN FYOr>:FKICTro►J FACTOR.. O. sb FEET TOTAL Dy1JAMIC HEAD = q' 33.FEET Pump chamber. DIAMETER 3£3'` M)TERWAI. DIMEIJSWW~ OF TAAIK: LEW&TH. -;WIDTH --.;LIQUID DEPTH BOTTOM AREA - 231 -GAL/INCH AS PER MANUFACTURER = 1'-1- GAL/INCH 94-40974 6 6 W W HEAD CAPACITY CURVE s1/4 I- U_ - - 53-55" SERIES 4% 25 e TOTAL DYNAMIC HEAD/ I 4% FLOW PER MINUTE EFFLUENT AND DEWATERING e CAPACITY + HEAD 20 UNIT MIN -11/2' a 6 FEET METERS GAL LTRS N 111fz N PT = 5 1.52 43 163 e 10 3.05 34 129 15 4.57 19 72 Q 15 19.25 5.87 0 0 Z 4 C J _10- . 3 3 I 0 ~ 2 zs vo 5 915/,e I 0 l 7 US 10 20 30 40 50 33/32 GALLONS LITERS 0 80 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Piggyback Mercury Float Switches a Available with special cord lengths of 15', available. 25', 35' and 50'. e Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non-automatic 15 ft. SELECTION GUIDE _ M53/55 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volta-Ph Mode Amps - Shn ex Duplex 2. Single piggyback wideanglemercuryflcatswftohordoublepiggyback mercurylloat M53/55 115 1 Auto 8.0 1 Or 1 & 7 switch. Refer to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10-0072 or 10.0075. D53/55 230 1 Auto 4.0 1 or l &7 4. See FM-712 for correct model of Electrical Alternator, "E-Pak" E53/55 230 1 Non 4.0 2 Or 2 & 6 3 or 4 & 5 5. Sensor mercuryfloat switch 10-0225 used as acontfol activator, with E-Pak (3) or (4) float system. 53 Series - Wt. 23 tbs.-.3 H.P.- 55 Series- Wt. 25 lbs. -.3 H.P. 6. Four (4) hole "J-Pak". junction box. for watertight connection or wired-in simplex or duplex operation. P/N 10-0002 • 7. Twq (2) hole "J-Pak" junction box, for watertight connectionar splice. P/N 10.0003. For information on additional Zoeller products referto catalog on Combination Starter. FM0514; CAUTION Piggyback Mercury Float Switches. FMO4771 Electrical Alternator, FM04K Mechanical Altema- All Installation of controls, protection devices and wi ft should be done by a qua0fled nator, FM0495; Alarm Package, FM0513; Sump/Sswage Basins,-FM0467; and Simplex Control licensed electrician. All electrical and safNycodes should Wollowed In addition tothe Box. FM0732 most recant National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AVA TO. Ao. BOX 18347 Loub9ft KY402564347 Manufacturers of... OELLE S/1 M: 8280 Old Millers Lane O. LoubvO, KY40216 a r~O u r9 (502) 77 -2731 *J (800) 928-PUMP QUALITY p1A/P9 fNCE ~filJ X 774-3624 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 La~!5or and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ' - S'L.. C,2U L K Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan musA 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. 0 Z 8 - t oC3 01 t APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Cb~1 2 L,~~S Plri _ ft NlEr- _'Z9E \0tJX3 G eT Sw 1/4 SQ 1/4,S 3 T Wa N,R l-Z E(o N PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # _ 16 loo So `TtiF 1)ve. - - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [@TOWN NEAREST ROAD ~3Act.b&o UV WI SgW7- (7t5) 68 t{- Z.7S-7 _2_L1S ~~VL SO `r4 n-ue. [ ] New Construction Use [dQ Residential / Number of bedrooms Z Addii# Qn to existing building DI Replacement Public or commercial describe 2 Code derived daily flow 3Ao gpd Recommended design loading rate bed, gpd/ft2 0.2-5 trench, gpolft Absorption area required bed, ft2 _LSO - trench, ft2 Maximum design loading rate 0. 5 bed, gpd/ft2 0. b trench, gpd/ft2 Recommended infiltration surface elevation(s) °L g o ft (as referred to site plan benchmark) Additional design /site considerations Mouhjb w / S 'k SO 'TZVvc-H • t' llQ• ZL1' of SR>ub r LL - 5 =1 r Parent material s ou (ffy- 0- t 11 Lt, Flood plain elevation, if applicable N- R - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL. HOLDING TANK U = Unsuitable for stem ❑ S ® U _ ®S ❑ U ❑ S [Z U ❑ S ® U O-S RU ❑ S Rill SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench - b- S a b I o_L I r342- 3 1 Z Zjsbk tvy'fy, a. S f< `"f`h Z 6-~3 t042 3Ly - sil Z`Fsbk `~L- c s - o.s o.L Ground 3 -Z lWiz 3!L - 6>^5C 1 Z'Fsbh H,-fh o.S elev. c-Z I. %,I R Sig _ cl q.8 ft. Z~ 3 L I ~ k R V /arc %41Z S/ C Depth lg limiting factor Remarks: - Boring # r' 1 0 _-'7 10`112 31 Z S t Z `F bk Yvj`F a- S - o• S u RE- 3 Ground L3-30 %4rL VIL q t0 `rQ sl2 S i C-J C5~11 ha~fh elev. q4.8 fL Depth to limiting factor a Remarks: CST Name-.--Please Print Arthur L. We erer Phone. 715-425-0165 Ves eerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: /n~ Date: CST Number: C~t-L 9v- /YZ 8-10-4 M00576 PROPERTY OWNER -'Z)~ .~f 11U1uG SOIL DESCRIPTION REPORT Page-e- of j PARCEL I.D. # 02, 1004 - LO Depth Dominant Color Mottles 'Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color : Gr.. Sz. Sh. Bed Trench `3` ) 0_'1 ►o`-►CZ ~t Z - s`1) Z ` As Z c.S - o.S o. 6 "4: Z '1-L L `12 Y l3 S j I 2 `F J ~lZ vn 'F'1~ CS . S U. Ly. Ground 3 1~-31 !O `22 X1/6 c~ s`M Y!6 S~ c) O 1M - _ d t0 elev. Lit 31Z ~h °IAa. ft. Depth to limiting factor 18M Remarks: Boring # I i Ground ' elev. ft. Depth to limiting factor Remarks: Boring # ME n Ground elev. ft. Depth to limiting factor i Remarks: Boring # I' 3!4i" Ground elev. ft~ Depth to limiting factor Remarks: SBD-8330(8.05192) PLOT PLAN Page 3 of 3 i SCALE 1"= 3Q ' 't*'► -~,~oo.o ow ~~"`~16>a1~ 3lYr~lA. UT l~\?pP~(i}y ul~~, PvC PLP@ W/LATH verse ~ Z $o" , i G 1A ! a ~ 4 Q Ni y ;'t iv /1 rvU IvCZL Loc~~p ? Ito, ~Y U w Ol- uv e.,p ire ~ . r (715 ) 42~-oi6S M00576 -GST Signature Date Signed Telephone No. CST # . Wisconsin Department of'IndusUy, SOIL AND SITE EVALUATION REPORT Page \ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' . - COUNTY sue, e-CZO I K Attach complete site plan on paper not less than 81 2 x 11 inches in size. Plan musli 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. O Z 8 - COO of - 1 O REVIEWED BY DATE APPLICANT INFORMATION=PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION cvvtm I,~ fyx~ 7'ftlVe~:r -'Z~E \-(Ovlu G G9VF."T Sw 1/4 SC 114,S, 3 T. Z% N,R 1-1 E01 1E b PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 1 bo So `C* bVe. CITY, STATE ZIP CODE PHONE NUMBER EICITY []VILLAGE ®fOWN NEAREST ROAD 13f+ck-b&ow wt S%tooz (7tS) 6,5q- z-)3_7 ~vst~ C~~v~sR s~ -r>~ f~t1ff. [ ] New Construction Use I,tQ Residential ! Number of bedrooms z (J AddtGQn to-existing btaldutg [ Replacement [ l Public or onmmerdal describe- _1 ed o.2S trench, Code derived daily flow 30o gpd Recommended design loading rate , gpolft2 9 Absorption area required bed, 11112 _LSO • trench, ft2 - Ma)dmum design bang rate e • S bed, gpdi'ft2 trench, gpcW Recommended infiltration surface elevation(s) a It (as referred to site plan benchmark) AddiftW design / site considerations Y' WP_,fl w / S 'Y- S O 'rt2~yvcg , I lv , z " of S Rw D I=t LA_ - S = t 9 Parent material ""a w L4 e-[ h Li- Flood plain elevation, if applicable N- A - ft S = Suit" Im pysIem CONVBJitONAI MOUND IN4MOUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for sys stem ❑ S 0U_ ®S ❑ U ❑ S [9U 11 S IN ❑_S [au ❑ S ®U . SOIL DESCRIPTION REPORT " Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD/tt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bound3y Bed nj0- J o_1~ to~-t~ 31Z - si( Zj3bk Vvt`Ft., ok_S b•S e.b n Z 6-L I to Lt SL 3Ly - sil Z`FSbk ~ft- C S - o•s o_l. Ground 3 t3 -2 l0 `t 31 L - 6~ 5 C_ S bh t+, elev. Z $ `1 R Sig _ aq-13 ft Z6 3L 10 I2 R. V l 6 co a si Depth to limiting factor a Remarks: Boring # J o--t Io~1tz31Z - Sil Z`~sbk yvviF, a-S - o•S o•6 Z -7-13 1r1`1i;L V/3 - S-t 1 Z'FSb\'t 'PCh cS o.S o• 6 _ _ s~.cz.v16 3 t3-30 1bl12 V/G q. Growtd to ke sl2 S t ~J Omt yt1fy, - - , elao ~1$fl Depth ID Imillng fa~ M Remarks: F,eg e-Please Print Arthur L. We erer 715-425-0165 rer Soil.Test ing..&._.Design Service-P.O. Box 74 River Falls,WI 54022 . . Date: CST Number: `3~- fYZ B-LD_4 M00576 PROPERTY, OWNER ."r:u:U)uG SOIL DESCRIPTION REPORT Page of. PARCEL I.D. # oZ b-.1004 - lD Boring # Horizon Depth Dominant Color Mottles Texture 4 Structure Consistence Bounclaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color G Gr.. Sz. Sh. Bed Trench r>:~ ~ o = 1 l0 `-1.12. ` 31 Z 5.1 1 z `~'S ~D~Z rn.`Fl~ ~1.S _ o . S 0.6 ,:4 3 } Z ~-l8 l0 `Z2 Yl3 SjI Z`F3~k vn'~ CS o.S v.L 18-31 t0 ~t2 ~/6 aZ sy2 vl6 aJ O 1+0 ~G Ground % 3 t p k s t't elev. °f ft. Depth to limiting factor LJ Remarks: Boring # _ a .13 Ground elev. ft. ; 3 Depth to limiting i factor = . Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # _ ht~ Ground ' elev. fi Depth to limiting factor Remarks: SBD-8330(8.05/92) i PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' -~.tioo.o' on► \\'``~it6~{~ 31y" ~►A. UT A\2op~R~/ LlN~*, PVC PLP@ W/LATH . lam-, 98 s Bal B.3\° ~.A C~~t6E / . I 1Z.~S~.pCuCE o I v ° LXL 014 X WW1-W~l.. ~~o~ tL - NI rvu wt2l Loci loo' N U Ic, ot= n uv a,p pvQpt J I i F= ~ ~I 10-~~ (715 ) 425-~1 ~5 M00576 CST-Signature Date Signed. Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER -V 1% ra MAILING ADDRESS ~--PROPERTY ADDRESS .Sl!n A~ Rf % e 1~ F (locatio of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section T.N-R~W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , 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 with he standards set forth herein as set by disposal system the Wisconsin DNR. P 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 expiration date. SIGNED: DATE: D `L ` 9 T St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 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), then a 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 V1,2-A P:7 Location of property 1/4 1/4 , Sectio T__L__N-R_1LW Township ask ~,~~~o j-- Mailing address zk, k y6 a2 i it U2" ~L-& D t~--- Address of site ` Q l i`h (.C 1' S~c~d Subdivision name lZD;'%~ Lot no. Other homes on property? Yes No Previous owner of property It G D 1f 4117 size of property a 0C)O 6L u~S Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes l o Is this property being developed for (spec house) ? Yes No Volume J~,5 and Page Number ,O'~ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 fice of the County Register of 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 the County Register of Deeds as Document No. Sign ture of Applica t C - q -I?g- q4 g-~4-q4 Date of Signature Date of Signature N. 8d, Warrub o.94-cam rom ~esr►zt oa wlsooasa► am 236.16, W4.8tatatS& re Nw 1 M ROW t+r M&N Mtn SM19 a BLSUDD s oo. } 298115 eou 455, PA,04 This Indenture. Made this 19th day of May . A. D., 19 69. between Clarence N. Johnson and Edna G. Johnson, husband and wife and each in their own right, part iecof the first part. end Janet Karen DeYoung, part y of the second part Mitntooet4: That the said part ies of the first part, for and in consideration of the sum of • One dollar and other valuable consideration to them in hand paid by the said part y of the second part, the receipt whereof is hereby confessed and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part y of the second part, her heirs and assigns forever, the following described real estate, situated in the county of St. Croix and State of Wisconsin, to-wit: I Starting at the southeast corner of West One-half of Southeast Quarter of SE-i,)II Section 3, Town 20 North, Range 17 West, thence north 14$ rods, thence west 1,0 I rods, thence south 48 rods, thence east 40 rods to place of beginning, containing I 12 acres more or less. I A Party of the second part covenants that she, her heirs or assigns, si.r111 not mortgage or sell said property without the written consent of the parties of t 3 i the first part as 7 ong as either or both parties of the first }kart survive if party of the second part, her heirs or assigns. I Parties of the first part reserve the right to use the well, barn ~,i.d lard subject to conveyance, except the home and that property used as a 1r,rrn in conjunction with said home, as long as either or• both of Dirties of thu first I part survive said party of the second part, her heirs or aesigns. An affidavit by either or both of parties of the.first }part that thf.;.y do not ; desire to use the afore described reserved Property shall be dec'MCCi Sufficient ~ '•-''^-e-~ei~ai.=ru~e:,vsaard, ~:i1'~::~•..,~,qS{,~,.-1~31L2S~5,,~, _ l Vog'tt4cr with all and singular the hereditaments and appurtenances thereunto belonging or in anywise ~I appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part ies II s of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. Zo I1abt anb to 1201b, the said premises as above described with the hereditaments and appurtenances, unto the said part Y of the second part, and to her heirs and assigns FOREVER. ~ k1n0 totatD Clarence N. Johnson and Edna G. Johnson for their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said part Y of the second part, her heirs and assigns, that at the time of the ensealing and delivery of these presents they are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, i h x`" and that the above bargained premises in the quiet and peaceable possession of the said part y of the 4 Mi r: sctond parr, l1,1' heirs and assigns, against all and every person or persons, lawfully claiming the whole or any part thereof, i,} cy will forever WARRANT and DEFEND. -.iii CCIUIlrutii CEII)MUt, the said part -l us of the first part lid'ehereunto set their hand3 and seal this 19L I I day of flay , A. D., 19 69. Sighed and Sealed in Presence of t 't•'. it l~ri^~r _..(S al) t,-l ill l . ~tntr of tUtQton~in, 1 ss. ........._...._..._.._._..._County.~ Personally caune before me, this lay of . A. D.. 19 o`I the above zinmed ; .t r• ,t f..... a to me knowri to be they person,' who executed the for 'going h.1 rurnrl'iit,anti acknowledged the same. Notary Public, County, Wisconsin My commission expires r by r Drafted 1 - !N 11. t'h. La Wis. titwts. provitim that all In.trutnonts W be rocordrd ah.ll ha.r plainly pr1nto t rn tvl-rittnn thrrmm the oamm `.f III.. 1,r4nlur. t.~•a~ o u,. ~ q o W i b ro :r L 1 W C P ~ry v w C III qo o V j. I i a V v~~i M t `I Boot