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HomeMy WebLinkAbout008-1028-80-100 St. Croix County Planning and Zoning Wednesday, Alarch 28, 2007 at 4:11:12 PM Detail Sanitary Information Page 1 of 1 Computer #: 008 - 1028 -80 -100 Sub /Plat: NA Section: 10 Parcel #: 10.28.16.147A10 Lot: 3 TN /RNG: T28N R16W Municipality: Eau Galle, Town of CSM: Vol. 14 Pg. 3903 1/4 1/4: NW 1/4 SW 1/4 Owner: Olson, Molly 411 County Road BB Woodville, WI 54028 State Permit: 370269 Issued: 06/14/2000 POWTS Dispersal: Non - Pressurized In- ground Permit: New County Permit: 0 Installed: 11/27/2000 POWTS Detail: Bio Diffuser (16 ") (PSA) Bedrooms: 4 WI Fund: No POWTS Pretreatment: NA Notes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined >4/1/00 - Not Required Fogerty, Dave $0.00 Jon Sonnentag Sigined Oft: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 11/27/2003 11/15/2004 04/01/2005 11/15/2007 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — � �I ,Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3 i �r s d Human Relations Divwl:n1 of Erty & Buildings in accord with ILHR 83.05, Wis. Adm. Code C Attach complete site plan on paper not less th has in size. Plan must include, but C not limited to vertical and horizontal refer e Pilo d# 1, bon and % of slope, scale or /Q -�.'t �/— dimensioned, north arrow, and location Ma ce t road. /D 27 C) (gyp APPLICANT INFO RMATION PLEAS PRII4t. - 4 ?t%FORMA -"ON REykWEtM5Y DATE PROPERTY OWNER: PROPERTY LOCATION MOO D� t GOVT. LOT 1/4 Gd 1 /4,S T� AR E (qdV PROPERTY OWNER':S MAILING ADDRESS S ' X LOT # I BLOCK # SUBD. NAME OR CSM # .uL3ONTY s w. 9 1 I� f CITY, STATE ZIP Y DE R <' e []CITY []VILLAGE OWN NEAREST ROA w d`a ,8 [/]' New Construction? f/] Residential / Num&ofedrooms [ ] Addition to existing building ] Replacement [ ] Public or commercial describe u/ / -1i' Co a ve daily flow � gpd Recommended design loading rate �� bed, gpd/ft trench, gpd/ft Absorption area required efSe bed, ft 75 trench, ft Maximum design loading rate _ _ bed, gpd /ft _ trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations .i [Ate cT J /r 6r,4RV S TN/=' 1, r"wA> - Parent material G ztf 7 Flood plain elevation, if applicable 4ZT ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING T K U= Unsuitable for system IZl S U OS O U 0 S ❑ LI S❑ U ❑ S U ❑ S 4U SOIL DESCRIPTION REPOR ACG- Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouiclay Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench /..S S G t:4 Ground elev. ft. Depth to limiting factor Remarks: Boring # / •\ y`� 4 1i}v \ \ vi: ?:' z 7 Ground yy elev. ` ft. Depth to limiting factor 7rf' Remarks: ST Name: — Please Print r Phone: C REV A ddress: 2 3 Signature: Date: CST Number: 6 d �2 iii PROPERTY OWNER 7PJ#f SOIL DESCRIPTION REPORT Page *or*IL - PARCEL I.D. # w a Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed jTrench <, 17 'IV Ground elev. Depth to limiting factor ? !� / Remarks: I 3or° Boring # Ground elev. —0 — -- 8 y,L ft. Depth to o— — mS C- limiting factor _ 7 lGr�' Remarks: f COQ. Boring # s Ground elev. ft. Depth to limiting fact Remarks: Boring # I Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) • Sr FOGERTY PLUMBING & PERK TESTING, INC. P.O. Box 130 ROBE06, WI 5402 Cyr'$ a - Fret D d x�/ �� d✓n , rop if l� �r'rc /'tyc' a '' ;/,sue, r+s� eF T p �R 7, lop p 1� JS IItT' 1 Et .4CT r ' r �Y �I NotT/* AX;Et I g k-,* fS FDA To 0144A" vey S°t.�Tf �EY� �1eE'� acs FoR NrS' ss�o >f/ER 407E AcccgWtej) FOX �Ao jmuT �/P °,oaRr 1 St. Croix County Planning and Zoning Wednesday, March 28, 2007 at 4:26:25 PM Detail Sanitary Information Page 1 of I Computer #: 008 - 1028 -70 -200 Sub /Plat: NA Section: 10 Parcel #: 10.28.16.146B Lot: 2 TN /RNG: T28N R16W Municipality: Eau Galle, Town of CSM: Vol. 09 Pg. 2426 1/4 1/4: NW 1/4 SW 1/4 Owner: Bourn, Richard 419 Cty. Rd. BB Woodville, WI 54028 State Permit: 224691 Issued: 09/16/1994 POWTS Dispersal: Non - Pressurized In- ground Permit: New County Permit: 0 Installed: 11/07/1994 POWTS Detail: Bed- Seepage Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Aloes Issuer /Inspector As Built Plumber Other Requirements Additional Notes Money Owed Tom Nelson Yes Lickness, Chris Wieser 1250 septic to 750 pump tank to 12'x 72' $0.00 Mary Jenkins Signed Off: Yes bed. notecard filed w /permit Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/16/2005 04/20/2006 11/7/1997 04/20/2006 I I s , K uc - 9 2000 T. CROIX COUN Ott J RVEYOR'S RECORD V �ReO�s e � � Wt ►y 014 ,� s4ao co•, 6 1 1�a G. CERTIF SURVEY MAP MOLLY OLSON Located in part of the Southwest %4 of the Southwest % 4 of Section 10, T 28 N,, R 16 W, Town of Eau Galle, St. Croix County, Wisconsin LEGEND �( OWNER'S ADDRESS J � COUNTY SECTION CORNER (AS NOTED) BEARINGS ARE REFERENCED TO 474 G T. H. "BB " MONUMENT WOODVI L L E, W154028 THE WEST LINE OF THE SW 114 O SET 1•x24• IRON PIPE (MIN. OF SECTION 10, T 28 N. R 16 W, • FOUND W ND L 1' IRON ON PIPE LINEAR FOOT) ASSUMED AS N 00' W 00' E. 0 SOIL BORINGS WEST 114 CORNER SECT /0N /O, T 2B N, R !6 W /FOUND BERNTSEN ALUMINUM MON.I SCALE IN FEET. I inch a 1501116M -I al I 0 so 100 160 300 I m+ I I NW 114 SW !/4 N. L INC SW SW 1/— q X33 331 $a vl `° o W ii ✓i�L14L>_ _y, .,�_�GE � � 06 3 • Iti R �/ Ai 7i w rT � I I 1 N. LIN E PR /VATS ROAO EA_S �Ji I \ I � 66`PRlV.4TE' RpgOWAYEASEM_E%VTY E g24 P. 4 - ---. —. I S, L /NE PRIVATES 86 ° �B 4 4 "E r v ��' ' 20) b EAST L I NE Pq 637.7 r— 0570.83 ROADWAY FASEAIENT ROADWAY EASEMENT ; T' O SE CORNER EASEMENT a I RS `'I O b tv LOT 3 O I O W a p �S 6 5 ° 07'44 "E �. O o I $ . CONTAINS 231,458 SO. FT. OR 5.314 AC. '105.7o ��I 2 I 2 12 5, (221,558 SO. FT. OR 5.086 AC. EXCLUDING RIGHT OF WAY) � 129•g6 " 0 3 Cj Fu► j33 �`I I cal " � � -�► -JI I `•� 8T2.02' r FENCELINE r�ij O 1r r a N 87 ° 2 '48 W 905.0 6 00-X- - 66 905. r. H. 88 t e 3 I L 4 ,2S tu, $ c Jl n b; J colba�� i •ra. 3 APPROVED � t.�►uRE ,�,� S - olx couNrr OUTNW W, Parks Committee (FOUND / 4 REVISED THIS !!fh DAY secrioN 991f OF JU Y f FOUND 314 IRON BAR! r 2000 JUL 2 5 2000 �� N It not retarded within 30 days of LAI ' approval date approval shall be null and void THIS INSTRUMENT DRAFTED 8Y JERALD L. LARSON SHEET / OF Z Ir Vol. 14 Page 3903 4761'98 ® CERTIFIED SURVEY M MOLLY OLSON -' 1 i °art of the Northwest 1/4 of the Southwest 1/4 and thm South'.Nest 1 /1 of the South�Nest 114 of Section 10, Township ?8 North, Range 16 West, wn of Eau Galle, St. Croix County, Wisconsin. C Indicates 1" x ?4" iron pipe weighing 1.13 l.bs. /1 in Ft. set. '''Indicates Fence. UN PL A T T ED L A N D S Owner's Address: 474 C.T.H. ''BB" _._.._ dv i .l 1 e , WI 54028 O^ S 00. 04' 03 "W 636.33 E f N E W l/2 SW 114 "hone_ ) 3714 01 0� A FILED g DEC 0 61991 �- b O O R Q o JAMES O'CONNELL 3 1,. Q W Register of Doods W a y a v SL CrWx CO., WI y U 0 b ty . j W y - V ti o O q 0 b ^ h n 0 N O H � A'�— b „ It N 00. 34 ' 01 "E 9 J SS Qt 3 0 UNPL A TIED L ANDS O o� n may. 8 C C ;1 4LL BEAR /NOS Re r. r0 THE WEST LINE OF rH£ W 'A Q = tq SOUrNWESr 114 or SEC, /0, r28N, R/6W, a a 3 �I m j O ASSUMED N00.00'00 W o m ro ll . W 4 Q U e h . o p W O 3 .� Mi ' n 3 n M h /027.T9' 1618. 31 961. 68' 6 W LINE SW 114 N00. 00'00 "£ 2646.10' M -- ,��1IIIIIII /�I� N N %�� \ S G 0 t y., 66 / C . T , H. B B 0 � Dated: July 29, 1991 Revised: September 1?, 1991 LAU • NCE � This instrument drafted rrr PH by Laurence W. Murphy .. • 713 y . .. RI VER FALLS,..* ••. RI • � � , .. ., ,t , 9' Wisc. . vo 1, 9 °age 242 L A N O CertiFied Survey Mips St. Croix County, Wisconsin Laurence W. Murphy Registered Land Surveyor S` f/ E'E' r OF 2 �wisconsih Department of Commerce PRIVATE SEWAGE SYSTEM y: ` Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. 370269 Permit Holder's Name: ❑ City ❑ Village ❑2Town of: State Plan ID No.: O lson, Molly Eau Galle Township CST BM Elev., Insp. BM Elev.: B Description: I Parcel Tax No oq_ (0 z - # -(00 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W-e S Z G r Benchmark y O / ,® o Dosing s �G d Alt. BM era I Bldg. Sewer A q Holding St/ Ht Inlet TANK SETBACK INFORMATION St /Ht Outlet TANKTO P/L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic S�y� 3Z � Z�� NA Dt Bottom X33 - o- 18. /U Dosing 4P ¢ Y3 i / 3 ' NA Header / Man. r.)f rev S G (S Ae NA Dist. Pipe Holding Bot. System CM�i i - T a PUMP/ SIPHON INFORMATION Final Grade Manufacturer Ga W5 Demand St cover (Z . Model Number F o -/ 7 ,0 GPM V I I o 9d.Z� TDH Lift 2 Lriction Sao System TDH Ft oss Forcemain Length ? Dia. 2 Dist. To Well SOIL, B ORPTION SYSTEM P BED DIMENSIONS Width / Length f No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 7 3 O DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM E G manufacturer: INFORMATION Type O y CHA ER Model Number: System: DISTRIBUTION SYSTEM Header/Manifold N Distribution Pip Lc x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length �d Dia. ,6/& Spacing M SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes , & Q No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1 / Z 7/ao Ins ection #2: Location: 411 County Road BB, Woodville, WI 54028 (NW 4 SW 1/4 10 T28N R16W) - (c f 1 `( 3 �0 3 1. Alt BM Description = 1161 bf e ov cb, 3 2 - 3 6e f iven. ) 2.) Bldg sewer length = ?-,P' a y� Q (6{ (d a V„ (_4 a� ow'� Q c C c< r c/ df ,e;cc m unt of cover = td %(/ (q ��' P /o �` s� per Kei O, �,Ku f5 (a1` l"•� {s, tau s -e an f e d a r- �U,1 t3 Plan revision required? ❑ Yes Q] No Use other side for additional information. Z -s (, SBD -6710 (R.3/97) Dat Inspecto ignature Cert No Fogerty Plumbing #221180 �',Gll/T� � Fxssrrx�G ; 28288 McKenzie Rd. Spooner, WI 54801 -- (715) 635 -9609 lvnr 6/ 9 fK,�Es '•�- SclfLE' mF / "� asA� # ' • ABov moo. eN Q ill = om Tv? of 'T' sf, S l�l3 x 4 -14 ,9cT = cv�tc � > Sa / off _ FxE�4�•T• I ��= lor Lrv� O - p ast. L• s It swv: 041 APEAZYes /)r ( j r,fr,OF vwx S ystcµ - �/ � D,�w► j -- ; X ��, 7 R�rcc NES �7v' ems. -�- ►t ---- ►t_a --o ��� ✓ Safety and Buildings Division Vi sconsin R A 4 201 B Washington Avenue Department of Commerce In accord with Comm 83.05 �i . Code .! Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the Sys on paA6 won, than 8 1/2 x 11 inches in size. r • See reverse side for instructions for completing this applic r State S nitary Permit ffumber sr 3702,( Personal information you provide may be used for secondary purposes i k ❑ Ch k it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. '' y Stat Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRI T LL I TION Property Owner Name It, � I^ e 4, S T , N, R E (orYV P operty Owner's Mailing Addre l� Lot Number Block Number .,►— City, tstd Zip Code I Phone Number Subdivision Name or CSM Number © ....---------1* 1. TYPE OF B I ING: (check one) ❑ State Owned ity Nearest Road Vi LJ Public 1 or 2 Family Dwelling - No. of bedrooms O Town OF ± 111 BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Numl er(s) 1 [] Apartment / Condo U Y 9 end i 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 _ p( New 2. E] Replacement 3. ❑ Replacement of 4; E] Reconnection of 5 ❑ Repair of an /— S stem __ System -- -- -- - -- - - -- Tank Only Existing System _ __ __ _Existing System ----------- - - - - -- ------- - -a- -- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 121 ❑ Mound 30 Lj Specify Type 41 ❑ Holding Tank 12 pfSeepage Trenc 3 T 3. 22 ❑ In- Ground Pressure , 42 [] Pit Privy 13U Seepage Pit ❑ Vault Privy 14 ❑ System -In -Fill 0 0 T ft 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 5' . S Feet Feet Ca acit VII. TANK in gallo Total # of Prefab. Site Fiber- Ex per. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic A p p structed Tanks Tanks Septic Tank or *k ❑ ❑ ❑ ❑ ❑ Lift Pump Tank r 1049 ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of t nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: Sta p W No.: Business Phone Number: Afr/T' "' er's Address (S eet, Ci y, State, Zip C e): v ,L' Iol d Z3 IX. COUNTY / DEPARTMENT USE ONLY C] Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued 1, 44 , "63- Agent Signature (No Stamps) GrApproved ❑ Owner Given Initial 2 Surcharge Fee) �l Jl Adverse Determination 2 - J �IO(� ! 14 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: r vw `r"G:s eaYc, , SBD -6398 (R. 4199) 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Rdnewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage system's rrfust be properly maintained. - 14i * e sepfi ' tank(s) must pumped by alicensed pum`perwhenever . necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contac" your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. — �-- 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 ` II. Type of building being served. Check only one and complete # of bedrooms 0 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconpe;ction, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check,experi mental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropciateprefix (e.g. MP, etc.), address and phone_number. Plumber must sign application form. fX .c6untyJ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than &1/3 z 11 inches must be submitted to the county. The plans must include the following:' A) plot plan, drawn" {"o `s`cafe'"Sr Witlh 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 caun"ty,'E) soil test data on a.1 15 form; artd,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. A ` The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. q •� V I l y jL 1 9 � 0 J p � L s ,- � � ti t v �. ZZ o � N Go ca it N lk f , m*nn3r,DepartmentofIndustry SOIL AND SITE EVALUATION REPORT Page 'r of 3 tbor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than i *bes in size. Plan must include, but not limited to vertical and horizontal referen t, (BM} direcpp land % of slope, scale or PARCEL I.D. #6V — le �— o dimensioned, north arrow, and location a dFsI�ance to near�sE r6ad: pp .4—A0 /� APPLICANT INFORMATION- PLE #k�ORINr ORMATION RE WED BY _DATE PROPERTY OWNER: PROPERTY LOCATION Jlir G( 3 ' ¢� - { y GOVT. LOT GV 1 /4 1/4,S/0 T Z p N,R / E (qjS) PROPERTY OWNER':S MAILING ADDRESS ST GF10)( ;' LOT # BLOCK# SUBD. NAME OR CSM # CITY, STATE ZIP CQDE` ❑CITY ❑VILLAGE VOWN NEAREST ROAD New Construction Use Residential / Nu m Brooms y (j Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow _.jrM gpd Recommended design loading rate 7 _ bed, gpd /ft .8 trench, gpd/ft Absorption area required W bed, ft trench, ft Maximum design loading rate _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) OK57 g4 t'z V - l9,Z 8 ft (as referred to site plan benchmark) Additional design / site considerations Parent material &Zff,�/� H -- t/EL rOr r 7 Flood plain elevation, if applicable ---- -- ft S = Suitable for system CONVENTIONAL I M UND IN- GROUND PRESSURE I AT -GRADE I SYSTEM I FILL I HOLDING TANK U= Unsuitable I P S❑ U S❑ U VS ❑ U qns ❑ U 1 ❑ S U ❑ S Pn U 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. Tir nch -7 — G G AV IF 7 2 74V fT.S Ground el ev. ft. Depth to Q y 3 3 limiting fact Remarks: Boring # 7 Ground elev. f� ft. Depth to limiting �' « factor Remarks: CST Name:— Please Print Phone: 36 A ddress: /?� � • mss ., ery Signature: Date: y , CST Num S� 21 PROPERTYOWNER Tdsk A& Ak ) SOIL DESCRIPTION REPORT Page PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .. o y 4 ...: - Ground elev. ft. Depth to � y 3 3 limiting factor Remarks: Boring # S Ground elev. , 9 ft. Depth to limiting factor Remarks: Boring # #e ®s G .a Ground elev. we ft. Depth to a�- ? 3 3 3 a " , P limiting factor Remarks: Boring # .... .... :.: . Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) FOGERTY PLUMBING & PERK TESTING, INC. P.O. Box 130 ROBERTS, WI 5402 f{.�E E'yxx -d Fr�'t D Q W/ ° AM , !`o if l� •a rc /'t��' a �Y ' ' air //r �►' AV l o x. " �4 Notrlf FtE�D ,�,CFr!- rS FOX So�TH 1gc,ELl� 1fR�i4 ss AVA krS' ^07A W1 Ole - ,�r�w /�o E sfip�tc� to�c) ACCCgWleD /70' t /'/�vp�xr`1 LANE F,evcF 1 ti � PAr f CF # PUt-%P CHAMBER CROSS SECTIOIJ AU SPECIFICATIOuS i VEUT CAP 4 "C.I. kjENT PIPE WEATHERPROOF APPROVED LOCKIAIG JUIJCTIOAI BOX MANHOLE COVER Z5' = RO.^1 DOOR. !� WIWDOW OR FRESH IZ "MIU. AIR INTAKE GRADE-- I COUDUIT IB "MIN. \�� ----- - - - - -- PROVIDE I -- —�- IAILET AIRTIGHT SEAL A I III ALARM B I II I I *APPROVED I JOINTS WITH ELEV FT. APPROVED PIPE _� I 3' ONTO Pump—, OFF D SOLID SOIL COLICKETE BLOCK RISER EXIT PERMITTED OWLy IF TAMK MAWUFACTURE:R HAS SUCH APPROVAL SEPTIC f SPECIFI'CATIOI DOSE TAWKS MAWUFACTURER: G �f IULIMBER OF DOSES: 3 PER DAS TAWK SIZE: GALLOWS DOSE VOLUME F 3 ?�� ALARM MAWUFACTUKER: IAICLUDIMG 6ACKFLOW: �l� GALLONS MODEL WUMBEK: tot G./ CAPACITIES: A= 20 IMCAESOR .;eL_ GALLO U S SWITCH TYPE: __ 46f61 4(17 Z I N CHES OR J a GALLOWS PUMP MAMUFACTUREit: AW 4P4C10 C= Z I - IAICHES OR Z4 GALLONS MODEL WUMBER: y D- INCHES OR __Z2_ GALLOWS SWITCH TYPE: � G_1�� MOTE: PUMP AMD ALARM ARE TO BE MIAI IMUM DISCHARGE RATE XD_. GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEKEUCE BETWEEU PUMP OFF ARID DISTRIBUTIOW PIPE.. — L? FE ET + MIUIMUM METWORK SUPPLY PRESSU . . . . .. . - 2"'g — FEET ♦ � FEET OF FORCE MAIM X .' F / 100 FLFRICTIOA! FACTOR.. FEE TOTAL OyWAMIC HEAD = FEET IUTERWAL D1MEMSIOWC OF TAUK: LEWGTH ;WIDTH ;LIQUID DEPTH S_I C_A 1C f1 i -- ��5 � .. �.t %� ire► \tr uu acn. � 7 � � �•��• M DVP03 M • i j V er ti ca l s ump Pump '14 '1 1 S u b mers i b l e Effl P ump I I GO ADS n ump $pecrficatons METERS FEET ti o 0 PM 10 Discharge, size 1 %.' NPT 9 30 MODEL: 3871 -.Solids 3" azlm`um ; ' Motor ' >a 25 Single phase :115V r ti ��� o ' Materials of C astructlon 6 20 Brass/thermopstic 5 Features and Benefits > 4 15 ' EP05 •Top suction eliminates 3 ,G impeller clogging. s 2 •Corrosion resistant , FT 5 EPO4 construction. • Float actuated switch. ° 10 20 30 50 (FM 0 2 4 6 8 1 12 m°Av METERS FEET CAPACITY 25 MODEL DVP03 Pump Specifications Features and Rene 6 20 4 /,6 and /2 HP • EPO4 impeller- semi -open design LU 5 15 Up to 60 GPM with pump out vanes to protect si 4 Maximum head to 32' mechanical seal. 0 3 10 Discharge size 1 NPT • EP05 impeller - enclosed design 2 Solids: 3 /4" maximum for improved performance. s , 5 Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides 0 0 ° 5 10 15 20 25 30 35 40 U.S.GPM bearing construction. superior strength and corrosion Single phase: 115V resistance. 0 2 4 CAPACITY 6 8 100/hr Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • GSA listed models available. i All Models are designed for continuous operation and feature stainless steel hardware. i s ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ` AND a OWNERSHIP CERTIFICATION FORM Owner/Ba3�r /�Yol/v oGS��t/ Mailing Address 1 -17V X B ,�� 1� w ��O.t F --� Property Address $ $ (Verification required from Planning Department for new construction) City /State mitt l yxLGE _ Agr S'� �� a rcel Identification Number n ek— /0.1 —fie — IeV LEGAL DESCRIPTION Property Location &1� ' /a, - C &/ YA, Sec. /o , T N -R W, Town of .6" has . Subdivision ,Lot # Certified Survey Map # - - ---- -- , Volume , Page # Warranty Deed # �a 40 7 , Volume, d&t , Page # X Spec house ❑ yes 0 no Lot lines identifiable 11 yes ❑ no SYSTEM MAINTENANCE / Improper use.and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SI NA E OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. l 5 /Z a oo SIG A OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i I, DOCUMENT NO. 1 WARRANTY DEED STATE OF WISCONSIN -FORM 9 THIS SPACE RFSDNVED FOR RECORDING DATA 3 Tills INDENTURE, Made by Ole SOlStad Ll/k/a Ole E. Solstad and Leda Solstad, husband and wire, I� i� grantor S . of S t . Cr01X County, Wisconsin, hereby conveys and warrants i to dolly Bourn r grantee RETURN TO j Of St . Croix County, Wisconsin, for the cwn of One and No/100 ($1.00) 1)011 Ir r11 other v,11t,,�i_,.Lc� consideration the following tract of land in S t C ro-t ('I,uluy, State of R'isc un >in; The Southoest r tion Nine u1 the Southwest �'�tart��r (;' V1.''.;SL'I' - t -hl� Nor +.h�.���. (�u� I�tr.r oC t.hc Southwest Quarter (n;jJ „Sl'r'' - , �'.IlC3 tli�' P'�C;rt,'! II�I.1_; U t)it' �("lll. Quarter OS the South�;�,�;t (lit lr_tcr (r)' „ =6ti';SIV',) of all in Towm:;hij) T..cnt�7 i_Ifhi r _I ct: or - COr(jed J11 tt:t 20, . )u�J(:�, 7_II . - 21)9855 . SIGN'I;ll AND tin::ALGI) IN 111t1`,F t;1? U]' - - -- (SEAL) STATE OF WISCONSIN, St. Croix I'Iaena!ly c.Lluc Ilcfl�rc nc, this 1 �i L:. ' .Iv e` `i' A. U 19 70 . theaLov(, narned Ole Solst�ld :i/k/,1 ole 1';. Ol:;l:1C1 �incl I. tii ,>CJl`�t,icl i to me YtTlq��ul6alfi per,on S -_ u"hu c•xciutl -I file for(•goint; instrum'.nt and I - knowledgell the same. NOTARY IaI'taL(1 1). (11 p Z H SEAL f ThSe ihetrument drafts / Notary _County, Wis. D � '. *i R4I�IE `�� �fORM�1N ���..__ — ! Notes Public St . Croix , t,� My Commission (Stlpires) (Is) pv mail n t (' - I the Wisconsin Statutes prodder that almeab , rded ahall have plainly printed or typewritten thereon the name@ of II r grantees, witnesses and notary) � e, � ` 1 (} h A WARRANTY DEED -STATE OF. WISCONSIN, FORM N �tS� M. C. MILLER CO.. MIL@'AYL[r 200 0 100 200 400 y �. W 1/4 COR. SEC. 10 I 146 354.40 �6a• i`/S 14 °' 637.00 3 614.79 � 850, 1161, �-� LOT 1 W G C.S.M. 9/2425 t ct 146A �j(l o ioo- NE 114 _ 1 W 114 p C U 1 � t 639.39 1T 14 y 146B �5 LOT 2 b LX I •1 � 147C f� h 0, 603.0 5 9 alf oi-s" 71.61 0 6472.72 9 � tMa 670.83 co / C 147A $� I � s E 1/4 SW 1 14 -SW 114 zu I 147B ` V fe z `— V b a CERTIFI D SURVEY MAP MOLLY OLSON c ed in part of the Southwest' /4 of the ,Southwest fi+ of Section 10, T 8 N, R 16 W, Town of Eau Galle, St. Croix County, Wisconsin. LEGEND OWNER'S ADDRESS SECTION CORNER 474 C.T.H. "BB" ONU (AS NOTED) BEARINGS ARE REFERENCED TO WOODWLL E W1 54028 THE WEST LINE OF THE SW 114 SET 1 x • IRON PIPE (MIN. O WT. 1.18 LINEAR FO OF SECTION 10. T 28 N. R 18 W, a F01 01.1 ASSUMED AS N 00' MY 00• E 6 SOIL BORINGS WEST I14 CORNER u �► `� SECTION /0, r28 N, R IS W I IFOUND BERNTS£N ALUMINUM NON. I DY i SCALE IN FEET:1 hich ++ 150 faW ' 0 50 100 150 300 I I L NW114 N. L INC — SW 114 I33 133Im C CVr, ! 41r� Ii h �6 - c,l 3 c�1 I �" � -•- -- -- NE PR /VATE ROAOWAY 1 I I b ?_R JVAT€ !Q_OADWAY EASEME T _ l PR /VATE S ° ' �� r ' 9 '? 4 ' P igg 1 �'-_ B6 38 44 E 670. 8-y' RDADwar £ASENf r EAST L /NE A VATE ROADWAY EASEMENT I 637.77 p I SE CORNER b I /00 ? EASEMENT V I I v l �t O W I 4 LO ~ L1 6` -- w S850 " CONTAINS -31,456 SO. FT. OR 5.316 A.C. 5.70' , . y I (221 558 S0. Fr. OR 5.086 AC. EXCLUDING RIGHT OF WAY 129.6 _ 0 3 DUI i I ,I /00' co 0 � I cJl I i . 7 + B72.Q2 FENCELINE zt M . 7�L 66 I _ . H. " 88 �/ N B7 ° 2 '48 W 905.06 /3 p a L!','VOS fA — �I W �.I c\ 8 1i �gs Q .4 $ 3 ,� LAU SOUTHWEST CORNER W . Y SECTION /O, T 28 N, R I6 W 1 FOUND 314 IRON BAR) RIVO , i IAIS THIS 1NSTRumENT DRAFTED BY ✓ERALD L. LARSON SHEET / OF 2 CERTIFIED SURVEY MAP Molly Olson Located in part of the Southwest Y4 of the Southwest' /, of Section 10, T 28 N, R 16 W, Town of Eau Galle, St. Croix County, Wisconsin DESCRIPTION: That certain parcel of land located in part of the Southwest' /4 of the Southwest' /4 of Section 10, Township 28 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Southwest comer of said Section 10; thence along the West line of the Southwest 1 /4 of said Section, N 00° 00' 00" E, (assumed bearing on the West line of the Southwest 1 /4 of said Section 10), a distance of 661.53' to the POINT OF BEGINNING of the parcel to be herein described; thence continuing along said West line of the Southwest 1 /4, N 00 00' 00" E, 300.15' to the South line of that 66' private roadway easement described in Volume 924, Page 420 of St. Croix County records; thence along said South line, S 86° 38' 44" E, 670.83' to the Southeast corner of said easement; thence S 00 00' 00" W, 149.75; thence S 85 07' 44" E, 235.16'; thence S 00° 00' 00" W, 135.19'; thence N 87° 12' 48" W, 905.06' to the POINT OF BEGINNING, containing 231,458 square feet or 5.316 acres, subject to easements and restrictions of record. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Molly Olson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. Dated: May 8, 2000 This instrument drafted by Jerald L. Larson NOTE: Each parcel shown on this map is subject to State, County, and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and appropriate Town Board for advise. W. s pus, �n SHEET 2 OF 2