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STC - 104
AS BUILT SANITARY SYSTEM REPOP?T
Gia VIC,
OWNER
r a 4XI
ADDRESS
F~ Z
SUBDIVISION / CSM# LOT #
SECTION _T__2:yN-R_L2W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
S OW EVERYTHING WITHIN 100 FEET OF SYSTEM
a
k k
W r.r L
\A a--
r
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: t~ C7 r
ALTERNATE BM'
EPTIC CHAMBER /_fiOLDING TANK INFORMATION
Manufacturer: `0.0ts'o t- Liquid Capacity: ~OOO ~p 0
t ~
Setback from: Well House 30 Other
Pump: Manufacturer Model# 1 Size
t
Float seperation t Gallons/cycle:
Alarm Location WIA S f
SOIL ABSORPTION SYSTEM
Width: j Length D Number of trenches
Distance & Direction to nearest prop. line: q'' --I
~ r '
Setback from: well: House f~ Other
ELEVATIONS
v''19d,
Building Sewer ST Inlet: 1',;4W outlet
PC inlet PC bottom Pump Off
Header/Manifold 6, c Bottom of system y
Existing Gradej y Finalt grade 1] p~ 4
• ~ a --v -e ti-- `.T, e\ i ~y.y1.--•4 S Y ~ l
DATE OF INSTALLATION: ff fY
PLUMBER ON JOB: Ak;
LICENSE NUMBER: { ' f
INSPECTOR: i,.
3/93:jt
~Gbss~ 's ,2 , rt , ~Il4~typr.26.28. J&1VATE S:WAggS ElVrad Y County:
Labor and Hu„an Relations INSPECTION REPORT
Safety and Bui@dings Division '
o.:
(ATTACH TO PERMIT) sanitary itiRROIX
GENER! _ INFORMATION
Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan D o.:
OT.A iRusb River
CST BM iev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9400077
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
/pp -
Septic 17k i 6,Z0 qvo Benchmark di-
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet q, a 9a
Verit
TANK TO P/ L WELL BLDG. Aiinta to ke ROAD Dt Inlet V 99-1 7
Ar I
Septic >J C) 7C € _~o ' 1-30 NA Dt Bottom 13,59 ~7, 33
Dosing y eD p 7i 3o" U ' NA Header / -
Aeration NA Dist. Pipe ,3 c/
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade wa 9S. a'
Manufacturer
Afll~ , Demand S-~
Model Number a j~UGPM Id .2' y'?'
TDH Lift, j,,~°J I Triction.R$ System TDH PA Ft
oss Head
Forcemain Length Dia. w Dist. To Well )-too
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS _ S0 DIMENSIONS
LEACHING Manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM
INFORMATION Type O ;;7, r CHAMBER T Model Number:
System: 8c) !'17~:/-nom ~S 1/00,
DISTRIBUTION SYSTEM
Header / mvrnf*ld Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. ~ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of I xx Seeded/ ded xx Mulched
Bed /Trench Center 16 Bed /Trench Edges Topsoil 0"Yes ❑ No 04-Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION:; Rush River.26.28.17, SE, NW, County Road Y
/ / .t~ = 3 0 `,l Gl~ze.e,~-~-0 'G"`-~- ~,~*~.r,. ,may. , e _
V'.... { i. P S t l S
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. a 9U 1 4
SBD-6710(R 05/91) Date Ins'ector'sSignature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i y
Urt ~6~0 31y r!
C ~
.a~~.4~-~.. `)s../ {gyp A.~~ } 1 r. i~i®.-.,"
R
14
Cam' ~
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t
~ILl~IR' SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code CO
CKvI
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than CZOgOK;
'8% x 11 inches in size. ❑ Check if revision to pre sous 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
L c (-,c} a / u ~ 6 % WtAl,a, S T 27, N, R ~ E (or)
PROPERTY OWNER'S MAILIN ADDRESS LOT # BLOCK #
CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
l-tLd .ten ` C. C.~ .S-Lred3
II. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILLAGE : NEF~T ROAD tt- f j
❑ Public M1 or 2 Fam. Dwelling-#of bedrooms PARC E L TAX NU RO duo' w3~ 1S0
III. BUILDING USE: (If building type is public, check all that apply) 7 _ /
1 ❑ Apt/Condo r=
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. TYPPE1 OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 'CT I 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 Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 E3 Mound 300 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) ELEVATION
3 D i a1 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App_
Tanks Tanks structed
Se tic Tank or Holdin Tank e e e "C
Lift Pump Tank/Si hon Chamber c9~ w e, ~'T oa F-1 F-1 El I Lj
VIII. RESPONSIBILITY STATEMENT <Z om 6
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 S amps) MP/MPRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip ode):
IX. COUNTY/DEPARTMENT USE ONLY
p Disapproved Sa ary Permit Fee (Includes Groundwater Date Issued Issuing Agent S' ps)
harge Fee)
u Surc
Approved El Owner Given Initial Vm.
dve a Determination X. CONDITIONS OF ATROV L/REASONS FORDIPAPPRO
Stir o ~ ~c~ r,,, t dt~ ~oo~ tor► l~~~c
SBD-6398 (formerly Plb-67) (R. 11/88) 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/Renr:=via! Flinn "S8D 6399) to be
submitted to the "ounty prior to installation.
5. Onsite :,ewagcs s to rs must be properly maintained. The septic tank(s) m. ,t be l:un!ped licensed
pumper whenevo,, necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewagg system, contact your !ocal code adm nistrator or the .
State of Wisconsin, Safety & Buildings Division, 608-266-3815. '
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and,complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, -econnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorntia , system information. Provide all information requested in ##1-7.
VII. Tank !,-Joi -:atiorr. Fill in the capacity of every new and/or existing tank; list tl-. total ga.i!cins n.Jmber of
tarks an manufacturer's name. Indicate prefab or site constructed and, tank n&terial. (')rnr`'cr'~. for all
septic, pu't)p/siphon and holding tank,. for this system. Check experime rtn, _ pprova c r, -r ink: received
experir-ne .tal product approval from Dil..H 1.
VIII. Responsit!lity statement. Installin: fi!!.irrr!?µr into fill in name, licenst, n'±rn`rer with a;7pror4,.e prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application worm.
IX. CountylDopartment Use Only.
X. County/Department Use Only.
Corrip:!ete plans and specifications not smaller than 8% x 11 inches must be ,ubmitted' to the .county. The
plans m,, ,.t include the fol!owing::r) plot plan, drawn to scale or with co.mpl - sirne )3io•is.. : etion of
holding t.nK(sr; septic tank(s) or other treatment tanks; building sf w~~s. A ;iii;, water r ~a iis, vgte,- service;
stre?.ms 3 6 iakf-s; pump Or siphon tanks; distribution boxes; soil ales:,-r; rot ~iystern reola, i,rr!efrt system
arras; wliI n 'n -ation of the t,ur• ;i^g served; 8) horizontal and vertical refert-ice 0oic)'s;
C) complE E; 3pecifications for purops and controls; dose volume; elevation differences: tr icti,_ n loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil ab:,orpdon system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsi;i Act 410 included the creation of surcharges (fees) for a rlUrrber of
regulate;-,' pra :;es which r,a-• elect ground 3fer-
The ,r;OnleS Cr~'!ic GtEs"o throUghtr:sr:! Cfrrcal<3rqt ,tre ".lie<' f;',r
watet t:tlolarni-la,ion ;rive-sis(T•~t -ns and f
anotl ,woos s~ S ~sfss ~d o she
SBD-6398 (R.11/88)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
November 11, 1993, 2226 Rose Street
La Crosse WI 54603
t~
WEGERER SOIL TESTING '
PO BOX 74
RIVER FALLS WI 54022` "
RE: PLAN S93-41255 FEE RECEIVED: 180.00
GIOVE, LOLA
SE,NW,26,28,17W
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 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,
'ot
Gerard Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
2802R/ 1
SBD-64231 K. 011911
i
S 9 3 4 x 2 6. Page of 6
MOUND SYSTEM
: FOR
A Z BEDROOM RESIDENCE
LOCATED IN THE SE 1/4 OF THE MW 1/4 OF SECTION Z6 T Zb N, R 17 W,
TOWN OF i~vsl~ [~lU , g'C • c2otK 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
1~-?6.89 t l~'C_ .65 _
g D v«L~ , i ~1_l shoo 3 . ~ •.a MLI D
spy d 2 1~~3
n r"'
P'FWPARED BY
®~~~M',gas®Q®~a1
WEGERER SOIL TESTING •~Q P-60
AND. e
DES I CGN SEf-zV ICE t ®rg®,
t ° ARTHUR L. ° o
® ° WEU5?ER : ~
P.O. BOX 74 421 K. SAIK ST. ® i C-075 P
RIM. FAlls. MI 54022 E1WW s. _
= p
115-42.,-01d5 •
do-z~-43
JOB NO. ~ 3 - X6 3
Page 3 Of to
S3 SS
Approved Synthetic Covering
Distribution Pipe
Medium Sand _
N_ ~G
Topsoil F Elev'_ q 6. 0
J E D
3
b
% Slope
7v-o-vClk fteig Of iy- 2 %Z Force Main Plowed
Aggregate From Pump Layer
Undisturbed D 1 _O Ft.
Soil E 1- Ft.
Cross Section Of A Mound System Using F Oa Ft.
I Trench For The Absorption Area G ~•a Ft.
A S Ft. H )-S Ft.
B So Ft.
I IS Ft.
Linear Loading Rate= 6•b GPD/LN FT J -7 Ft.
Design Loading Rate= O. 3 GPD/SQ FT
K 5 Ft.
L I Ft. of ,Pa
A#wmimte Position of Force Main W 11 Ft.
L
g K
A ~,°G- - - - - - -
W
Distribution Trench Of 2 2
Pipe Aggregate r
Observation Permanent J
Markers
Pipes
(Anchor securely)
F d~t$3~~i~~~
RoYs" . ( Tr h For Absorption Area
9 ~.a
LAW i HUMAN s~'
~Fp(. "MUSTAY
OF ls,AF n ILA
p1VIS1 N
E
SEE GO R
co W S J 3 412 5')pay E 6 o~ ~
0- M W W HEAD CAPACITY CURVE s/4
"53-55" SERIES 4%
• 25 •
TOTAL DYNAMIC HEAD/ I 47A
FLOW PER MINUTE
EFFLUENT AND DEWATERING o
CAPACITY
f7 HEAD UNITS/MIN -1'~ -
a 6 20 FEET METER GAL LTRS 43/16 111/2 NPT
= 5 1.52 43 163
V 10 3.05 34 129
_ 15 4.57 19 72
15 19.25 5.87 0 0
a
Z 4 r
Q
J 10.-13
a 10 I
H
O
2-
5
23 `l 9s/,6
0 7
1
US 10 20 30 40 50 33/32
GALLONS
LITERS 0 80 160
FLOW PER MINUTE
i"
el CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Piggyback Mercury Float Switches • Available with special cord lengths o
available. 25', 35' and 50'.
• Variable level long cycle systems • Alarm systems available. < f i~
available. • Duplex systems available. f/
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 Volts-Ph Mode Am Simplex Duplex 2. Single piggyback wide angle mercury float switch ordouble piggyback mercury float
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 altemator 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 g, 6 3 or 4 & 5 5. Sensor mercury float switch 10-0225 used as a control activator, with E-Pak (3) or (4)
float system.
53 Series - Wt. 23 lbs. -.3 H.P. 55 Series - Wt. 25 lbs. -.3 H.P. s. Four (4) hole -J-Pak". )unction box, for watertight connection or wired-in simplex or
duplex operation. P/N 10-0002.
7. Two (2) hole'J-Pak", junction box, for watertight connection or splice. P/N 10.0003.
For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; CAUTION
Piggyback Mercury Float Switches. FM0477; Electrical Alternator, FM0486; Mechanical Alterna- All installation of controls, protection devices and wiring should be done by a qualified
nator, FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control licensed electrician. All electrical and safety codes should be followed in addition to the
Box, FM0732. most recent 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. r
Q 3280 Old Millers Lane Manufacturers of...
Z EZZE/T TZ7. 1P. O. Box 16341 • Louisville, Kentucky 40216 „
`p O
-2731 FAX 502 774-3624
(502) 778 ( ) Quacirr PUMPS ShNCE My
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT OC T - 4 1993 Page of 3
Labor and Human Relations
DivisiLr.of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
• COUNTY
S~'. C-1?-C1 bX
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
L tj L A G L t,'i Vlz-- GOVT. LOT S S 1/4 Q k) 1/4,S U T Z 8 N,R 1-1 E (orfiD
PROPERTY OWNER':S MAILING ADDRESS LOT #
w 6S 9 BLOCK # SUBD. NAME OR CSM #
6 S - -
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MrOWN NEAREST ROAD
VIu-v- W 1 51100 3 (mil s) Z73 - S61 ~ v S!{ Rtv eov►v`T'~
[4 New Construction Use Residential ! Number of bedrooms Z [ ] Addition to existing building
j J Replacement [ ] Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate - bed, gpd/ft2 a• 3 trench, gpolft2
Absorption area required 5 bed, ft2 3, 5 trench, 112 WAmum design loading rate c~ - S bed, gpd/ft2 6 trench, gpdAt2
Recommended infiltration surface elevation(s) C" 6, C) ft (as referred to site plan benchmark)
Additional design / site considerations y'"tiuuKrj w 1`M S' x< S% ~S Ctt xv , l f o f S ihib Fr L 1l - Z = x s
Parent material S 1_ T0- Flood plain elevation, if applicable N A - ft
S = Suitable for system CONVENTIONAL MOUND 7 IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U =Unsuitable for s stem ❑ S I$U 53S ❑ U ❑ S 1V ❑ S If'U ❑ S U ❑ S OU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisbence Boundary Roots GPD/ftin. Munsell Qu. Sz. Cont. Color Gr. Si. Sh. Bed
wich
1 o-to 10`t~ 313 - S 11 Z~ sbh m ~h 4-s )uj a- s o,16
1
xti Z t~ Z~ ti~ `i fZ 3/b S l l Z~ S l~>R m `F 1- cs o - S o, b
Ground 3 20-313 ~-S`tQ Y~6 - 6~ s 1 \cS~k m F')^ S °'S
elev.
C1 "S` ft. 1- 3$ -EL I ~ • S `12 VI/ Flo EL 61 Z Gv,% ~ e- s b k ~ c s - - -
Depth to S 45-y -)-S7t2 3/y c 1 oYn m`~j S -
limiting
fang
Remarks:
Boring # a S 1 v d• S c~ -
CJ 0 -9 313 S z Z 9-Zy \';w-t lz alb - s l 1 Z~ s bk W, ~'S P. L
, 11
3 z ~F-3 y 7• S `i R Y/b - G s wL S ~1~ vn x it - o y o S
Ground -S `412 11/6 V c 1
elev. 4 3`1-6y ~,SyR31 w`1R
°1 Z ft.
S b4 - - - LS 61Z
Depth to
limiting c Sr,
factor
It -as-. 'sf f!~~ _
Remarks: r .
T Name: Please Print Phone:
Arthur L. We erer 715 6'5J
Address: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
q3 - Z0$ s~-Zy, 1R93 M00576
PROPERTY OWNER G LO V SOIL DESCRIPTION REPORT Page?- of 3
PARCEL I.D. # r
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer
1 0- ~o~Q 313 - s i z~sbk es 1~~ o•S o
w
9
_ o • S o. b
?tiw«>` ` Z q -ZS LO IZ 3J~ - S 1 Z`E S~k v►1'f1~ C- -2
Ground cS - o•Y o.S
elev. s7 Q sty
cl t~ ft. 3\43% 31y
Depth to LS eR - - - -
limiting
factor
Remarks:
Boring #
Y
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
w
Ground
elev.
ft.
Depth to -
limiting
factor
'Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of
SCALE 1"= 30 '
ad
LT[C v . 94 6 q c~
` -4 B. a ~uL ogk (C ~c
N
a o P
A) Z-) ` o ~ S J
I
IT LOT Cla
D v I 6 0A, o
~t. a6 ? 'NAT Zo v' o wooD
hi i I I FusT•. Top ow p03T
~ I LSL. ~03.S•
I ~ I
2 I
J
L--
-
L1. 0.3 y
Oo t~iOT e.ohpR ~T
Wl- D 1 s rI kj \t 3
TT} LS MZIsA
WkEt- L h w S~' .
- 7.o S
q3
SEP. Zvi (1171 (715 ) 425-o169 M00576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Lz Pr and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
c COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Ste' C1~-0 ~X
Rot 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.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
L O L A G L Z, V GOVT. LOT S E 1/4 Q k) 1/4,S U T Z 8 N,R 1-1 E (or)(9)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
w 6 S 9
CITY, STATE ZIP CODE PHONE NUMBER (]CITY []VILLAGE (MOWN NEAREST ROAD
I3 -D~iVty W1 SSfO0 3 (~lS)Z73_ 5~1(, R-vsli P_EVNR eov►vy-y "
New Construction Use [Jq Residential / Number of bedrooms Z [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate - bed, gpd/ft2 3 trench, gpd/ft?
Absorption area required 3Z 5 bed, ft2 3, S trench, ft2 Mabmum design bading rate S bed, gpd/ft2 6 trench, gpolft2
Recommended infiltration surface elevation(s) °l r) ft (as referred to site plan benchmark)
Additional design/ site considerations't1our\ifl w I'M S' x So' I~ Cltf -1Ntrrv ,1 r of sf1Nb F-1 IL - Z VS
Parent material Flood plain elevation, if applicable A - ft .
S = Suitable for System CONVEN110NAL MOUND "ROUND PRESSURE AT GRADE SYSTEM, IN FILL HOLDING TANK
U =Unstidable for stem ❑ S OU MS ❑ U [I S 13 ❑ S caU [IS ®U ❑ S MU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mofl)ees Texture Structure 'Onsistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Cobs' Gr. Sz. Sh. Bed Trench
h~ 1 0-10 vz 4313 - S t Z`~ Sbh ~h o. S o. 6
'Em
Ground 3 2o_3t3 -)-S`tQ VA, '1 ~CS~k
elev.
~•s 11,rL !/6 Rio Q6/Z Gks1 ~~sbtic rr,~t. cs - -
- -
Depth to S y3-y _)•SYR 3/y C1 orn Y)l a's
limiting
~o rv 4N s ~~1 G rM cb `'~iv -
Remarks:
Boring #
1 0-9 3I3 - S1 Z a-S lvi o•S:C3
Z z q-Zy 3/~ - s i 1 Z~Fs bk wt`~►~ c-s _ o.S o- L
3 Z~{-3y ~•SyRY/b - Ghsl ~w1S1~~ wt'~I~ cs - ° 4:o S
Ground -S `1 R V/6 §1 c 1
elev. 3y-6y ~,Sy231 wytR e/Z s~-c.t
fl M•FV_w ~S -
S b4 - - - LS RR
Depth to
smiting
Remarks:
TName:-Please Print Arthur L. We erer Phone: 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
Signature: Date: CST Number:
°l 3 - ZOE Ste- Zy, 1993 M00576
PROPERTY OWNER G lZs V)= SOIL DESCRIPTION REPORT Page?- of 3
PARCEL I.D. #
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
yt.~~ 0_9 1~`1Q 313 - -.is1k 'M 'F - c.S
`t2 316 - S 1 Zi S'mk v►n'F1~ cs - o • S o_ b
Ground 3 ZS-3y >-S`9R y/6 S) sblt v►ti~~ c3 - o,Y o•S
elev. S7 tL S~6
q4.6 ft. 3y 3'3 -).s 'I e Sty' to e ~/z oVVN
Depth to 03 a - - -
limiting
factor
314
Remarks:
Boring #
YSY~In{
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor '
i
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of
• SCALE 1"= 30
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911
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!V I Po sr. ToP Or- POST -
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Do t~ioT eo►~tvR~T
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lCtovst: 7o Rt RT' l..L~ST 2S Y?-0t1 ►ti uUwb.
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sip. zY, (`tq 3 ( 715 ) 25-0169 M00576
CST Signature Date Signed Telephone No. CST #
S T C 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER C,
ADDRESS. FIRE NUMBER
CITY/STATE ZIP-
PROPERTY LOCATION: 1/4, Wl/4, SECTION N~R W
TOWN OF l a's'k St. Croix County,
SUBDIVISION , LOT NUMBER _
Improper use and maintenance of your septic systeia 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 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 /tqe, 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 w.i.sco, ifiin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning officer within
30 days of the three year expiration date.
SIGNED: l_.Cd 1~~c4t~-r
- / Ff
DATE:
St. Croix cc. Zoning office
911 4th St.
Hudson, 141 54016
STC -loo .
This application form is to be completed in full and si ned bs
'
tile owner(s) of the property being developed. Any inadequacie
will only result in delays of the permit issuance. should this
development be intended for resale by owner/contractor,(spa'a
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. 4.
rr r. rrr..r-rrrrrrrrrrrr rrrrr r--rrrr-rrrrrrrrr r rrr r rrr--rr~rrrrrrrrrrrrr.~..•
11 I
Owner of property
Location of property. .6t 1/4 f LLl/4, section' _N-R W
.Township
Hailing address -~f`u, I
~~P n c r 1 /
Address of site e-la /mod
Subdivision nameLot no.
Other homes on property? _ ves____ X_No
f :
Previous owner of property _ E((en W,
Total size of parcel ~r (C 0 rare 5
Date
parcel was created
4;..
Are all corners and lot lines identifiable? _Yes
Is thia property being developed for (spec house)? Yed •„.Ho y `
Volumeand Page Number ,4zY0 as recorded. with the Register
of Deeds.
•
rr~rrirK rrrrrrrrr~rrrrr r~rrr-rrrrrrrr-rrrrrrrrrr----r~rrrrr rrr.Yr Yr rr...Y~l.li.1iM
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
.A WAItttA ITY DEED which includes a DOCUMENT NUtiDERI._, VOLUME AND PACT:
<,-.;IUtttiCstt:. & THE SEAL "OF THE REGISTGI2 OF DEEDS. In addition, a x
certified survey, if available; ;would be helpful so as to avoid
delayo of the reviewing process. If the deed description
reforencon to a cortified survey Map, the certified' survey 'Map
shall also be required. PROPERTY OWNER CERTIFICATION
I(wo) certify that all statements on this form are true to 'the best of riy (our) knowledge that I (we) am, (are) the owners ^
og
the property described in this information form, by virtue Of a '
warrnnL•y•,deed recorded in the office of the county Register 'of
Deeds hs'Document No. ~t u
~`ihwza• *~QG .47q~ , and that I (we) presently,.' own the proposed situ for the sewage disposal system or' I .,,(we)
obtained an_easement,._ to run the ,above, described..>,pr pert
the :consytruction ~i,of said aye tam , Yir•~* fly
laeen dul
"Register ""the,," same=u..h
recgr
Y t,
f ~
Yin
e office`' of County' of deeds as Document
No. 5
Signature, of,'ap~l cant 'Co-applicant
I •
Date of Signature'
Date of Signature
DOCUMENT NO.. ( WARRANT . DEED TNIS S►ACL RESERVED FOR RCCORDING DATA t`I
i
'STATE BAR OF WISCONSIN FORM 2 -1982 ,
. 508280
- c7 1Q ,5 Ge Q-
Ellen M- Davey.! a widow and not remarried REGISTERS OFFICE
:T. CRAIX CO., WI
Reed for Record
tr0'J 0 21993
conveys and warrants to Lola Glo•ve, a single Berson ai 2./00 p, M I
V;
- $0, ~Ih
- fOfONdt
n RETURN TO
_
the rv,..,wing described real estate in St .-:Croix. County,
State of Wisconsin:
Tax Parcel No:
Part of East Half of Northwest Quarter (E of NWh) of Section Twenty-
six (26), Township Twenty-eight (28) North, Range Seventeen (17) West
described as follows: Beginning at the Northwest corner of SE4 of
the NWk of Section 26; thence South along the West line of said SEh
of the NWh with the centerline of CTH "Y" a. distance of 765.45 feet i
to a point 528 feet North of the South line of said SE4 of the NWh;
thence East parallel with the South line a distance of 412.5 feet;
thence North parallel with said West line of said SEh of the NW'k a
distance of 859.2 feetto the center of CTH "Y"; thence Southwesterly
along the centerline rof~ said highway `extended a distance of 423.0
feet to Point of Beginning
FEE
i 9 not . homestead property.
This - -
fi~9 (is not)
Exception to warranties: Easements-and restrictions of record.
Hated this 27th - day of October 19.93...
N-
. .
------.(SEAL) , 4 X.GW --------(SEAL) I~
Ellen M vey !
i •
(SEAL) (SEAL)
•
AUTHENTICATION ACKNOWLEDGMENT
Signature (a) STATE OF VMjt5tMW ILLIN IS
sa.
County.
.
authenticated this day of 19 Personally came before me this _..00 day of
------------Qctobe............... 19.93_. the above named
Ellen,_M. Davey------....---•--•-•---•--•-----•----
' . - - -
TITLE: MEMBER STATE BAR OF WISCONSIN
„
(If not- .
authorized by § 706.06, Wis. Stats.) to me known to be the persons..__..__. who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Thomas A. McCormack -
• - -
b FFtEt a.....
Baldwin, WI 54002 ' . L -SEAS»_
Notary Public C' Wis.
(Signatures may be authenticated or acknowledged. Both my Commission is pe*i ar T$.4 *U i ation "0
are not necessary.) date: MMfRE518/?~s- ) II
II - -
fl •Names of persons signing in auy capacity shoaid be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
FORM No. 2- 1932 Milwaukee, Wisconsin
VIC
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