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HomeMy WebLinkAbout030-2008-95-200 4' ° 3 o I O ua c 0 0. 0 N ~ a a E Q, o a c N O N 1 CO .D O F- .O Q d C O E ~ •U 0 N O N a~ 7) O C C CL O i C C 0 0 3 a = z o-a) 10 a)ci LL c 'T Fv W III, ~ a E 0 o c m I 0 O Q - -a cca a0) ~ I z y rn LU E a: 00 v p 0 z d m co FM- p 0 N O C (D O U_ O z d Q w O to F- ~ N a~ z m E ~ O (D M E 7 ~5 CD • I N N _ O N N O Q Q o 0 z z 0 N E z Cl) O 0 = C L; N 00 --1 _ ~ IL a ~o Y c 4) E B o M ai O D o IL 3 U cn 0) 0 :3 Z FL U) 31 0 z_ w a.. a. IL 10 'p y c w 0) ~ 0) 0) 0 z N 7 7- '0 04 0) C,4 Z O O-- O .x E i C ~ LL m 0 = (6 N Q) 3) N 0 d Q } iI? Q O o 0 ~S c N N w C U 0 W O O O O N O C E ~^o 91 M l a} Q) CO a N Q1 co V) V) N E N a) N V O _ O Vj Q) 0 N L~r ON O 0 1 ~ N Z FL- ~I M '7 o ~ O' E U M a >t ti~ - y?n' O M U) > N O N Cn E m m 0) a at ° a • cis c d d m c rr`i~v E i c c ~1 A 0 CLm '0 mc°) s STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER //rte~, ~,/,r/• ~i ADDRESS7~~` SUBDIVISION / CSM# d y C .~%~l LOT # SECTION 2-1_T-!;~' ) N-R 1'r W, Town offj~,?~_s ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Sy~f'7 oar wG R~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK. C2 S e-1 5- ALTERNATE BM: SEPTIC TANK PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: ~f«•lA~T N Liquid Capacity: Zc~~ Setback from: Well Z"- ,`lebuse S Other Pump: Manufacturer f,1 Model# Size Float seperation Gallons/cycle: ZS-.X Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches / Distance & Direction to nearest prop. line: Setback from: well:~`HIluse/D 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: J~ PLUMBER ON JOB: LICENSE NUMBER: -~Z INSPECTOR:- 3/9 3 j t : Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labdeand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Town o : State Plan o.: P FINK,de DONNA: & RABFDY WITTHUS City [I Village R CST BM Elev.: Insp. BM Elev.: BM Description: St Joseph Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSION DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing !n 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 ❑ No ❑ Yes ❑ No I COMMENTS: (Include code discrepancies, persons present, etc.) 3._- j3, LOCATION: St. Joseph. 34 . 29.19W, SW, SW, Lot 4, County Road~~ x1x Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 3 e SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code o STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 Z4 Q) 81A X 11 inches In SIZ@. Check if revision to revious application -See reverse side for instructions for completing this application. STATE PLAyN I.RX i UMBF„8 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. J~''~(f1(~ U ?~1C~ PROPERTY OWNER PROPERTY LOCATION GJ Y.Sk,1 Y., S,-? T a N, R E (or) OPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 444/,4, 4/ c 5'M CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: Check One CITY NEAREST ROAD ( ) ❑ State Owned 0 VILLAGE' 0 TOWN , _j el,~9 ❑ Public Ud1 or 2 Fam. Dwelling-#of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Q 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 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Oround 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 19~s"6- / - lle 1l' SYJFeet l~ -d Feet CAPACITY VII. TANK Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncrete glass App. Tanks Tanks structed Septic Tank or Holdin Tank 60 r- A7 Gt'ale F-1 I R n F-1 F LiftPump Tank/Siphon Chamber ~®d L VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (N Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): G c ~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A mps) , charge Fee) Approved ED Owner Given Initial (ya Adverse Determination Ca X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber a INSTRUCTIONS - 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. 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 collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 25, 1994 ZUl East Washington venue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S94-03393 FEE RECEIVED: 180.00 FINK, DONNA SW,SW,34,29,19W TOWN OF ST JOSEPH 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. 1 Sinc y, e r Page Plan Reviewer Section of Private Sewage (608) 266-2889 SBD-8423 (R. 81/81) ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, W1,54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants ~,27 cam/ c~~ PROJECT INDEX DILHR Plan I.D. # S94-03393 Date 8-25-94 Owner Donna Fink/ Randy Witthus Phone 612-653-7597 Address 4691 Allandale Dr. White Bear Lake, Minn. 55127 Legal Description Lot 4, CSM Pending. 13.51 acres. SW 1/4, SW 1/4, Sec. 34, T30 N, R19W. Town of County St - jos.epj~- St. Croix C.S.T. Robert Ulbricht CSTM2482 Installer Local Authority/ Supervision St. Croix County Zoning Dept. 'I PROJECT DESCRIPTION New construction, for a 4 bedroom sized home. Estimated daily wasteflow: 600 gals. Soils are permiable (.4 GPD/ft2 but very restricted below 25" because of very firm, almost massive soil consistency. Soils are seasonally saturated in this region. A very long narrow mound system, curved to match the convex slopes is proposed. The mound will require 12" of sand fill. Y AUG. 2 5 1994 Pg .1 . PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SE ONS & SYSTEM PLAN VIEWS Pg.3 PIPE LATERAL LAYOUT PgA DOSING CHAMBER CROSS SECTION I n"M Pg .5 PUMP PERFORMANCE lp~iON.0 SPECS ~y9a~,,~'S I G~~ ntnntnnnunno~~ S94-03393 0 v t g3 W ;o CALE: i = f'o 0 ~ovvp sukvEya,PS ~ /`~G~~S~E" ~ - /3.v1 SET Top sp err T PREC~rs T SE-pTi c TANK T Yom} el IDS o 4 60 New 0 to PREe t5 T , 00 Tors[. OF L ECEIVED a AUG 2 5 19% 72, -AU OF BUILDING SURE WATER sysTEUS i' 9 i o r zs - ~5 DO III a 11111111 11jaii 0 1 of b b"' I Ion lid nok N eat WATioN5 - M DU-c~0 Sf/ STf y ~'yA r d N~ -906-6&-S7-&,P Q 3 N~ ~'/E v~tT~oti ~u i ~'!i•- " S,g,v0 ~i// C3 4 B,5 fe'•F6~ 594- 033 93 f of 5 ROSS. SECTIOQ OF MoUAJD wi Ttj aeD U Dy e F % ro j I y A55Eg-5ATE' 1~t ST Ri(3uT~oa G, TNicksFSS pip sysr~M Of T°PSOiL elcvArio,J V)Ji FO`2M Toe- ,1, 11 H k, 102.5u % ROO MED. 1B • 9 SAwD , plowEl~ To p Soy i uN FORM 8 % SIOPE FoRcE EIEVA Boa U)jDER MAW 101.50' 1.0 FT, - F-LEVATloa S F 1.5 FT. • lmvF-R'r OF 1 1/4" )AT£RA (S 103.0 F _ Rn FT- • Top of Rock lo~.~oG 1 . o FT• H 1.5 FT• • TOP OF- 1 1/4" IATERAIS 1 a• !e A1t,. OF MOUJJD wir" 13ED :k ytiy FvRcs: MAW 6.0 FT• I k 'f I 4 85 Fr .kn T 17 Fr 0o c 30 fT- H C3e~ of ~i PVC CAPpEp A I ~-u 53 PEI ATE' 0BSERVArtOki AUG 2 5 1994 Pipes BUREAU WATER SYSTE S PERNMAas WT M A2 KERS RECO RED BASAL Ageh = 'PAI'~y whSrFF'low - hnn 15 0 SolL. o#xfilnQA- of • C ApAci ry SQ. Fr; PROPOSED BASA4 AReA = X (A t 1) S94• O33 9a \ 195 5 8 5 X ~6 • t 17 1 CP-uTRAL, MANi FO p DiSTRt'BU TIOAJ pipe uerwoP. k P 1 1 PVG CENTRAL Di5'tR►13UT1013 LATERAIS i MAN%Fot0 ENS CAP S I Ir-+ X x 1( x i (pUG FORGE i LAST "O1E S HA ll C3E NAT TO END CAP FT. 09 01 D Vo j UM E FOR 25 dF 2" FORCE MAiI3 4.1 gAl< XavERT' E IEVgno&) A1~~ 2 51994 PERFORarrED PIPE DErAi L Holes 10CATFD Dx3 G .G,-r ram S H A 1 t BE' `I VARiAQL.E `.y V hlly SPACeD. I Y z.. P 41 Fr DI Ahe Te R 1/4 ~N . L ATERA L 1 1/4 ~N R 36" ' MANI Fo~D 2 IN 60 ~NchES Foecr MAik) Y 42 II~1 cl~E S OF IWE5/ P i p ff 9 DISTRi (3UTIoN DNSCHAR&e RATE PER LATERAL 10.53 GAf TOTAL TISGtiAR C,E RATE / NczrwOR k 42.12 GrAL, / wo , S94- 033 93 ope~ . 3 04 5 i i i PLIMP CHAMBER CROSS SECTION _AR1D SPECIFICATIONS PA E of S VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 7 JUIJCTIOW BOX MANHOLE COVER 25' FROM DOOR. 12"MIN. w/ 4iAgN1~(! IW I WINDOW OR FRESH d AIR INTAKE S~AD~ ~~EU~►T/On/ ' GRADE I y°MIiJ. zls IB"MIN. 104.0' CONDUIT 5.0' 99.01 INLET PROVIDE I I -7 APPROVED JOINTS APPROVED JOINT A ~N ( W/C.I. PIPE W/C.T.. PIPE 0 'f( J I A RM EXTENDING 3' EXT_NDI',G 3' ~0 ONTO SOLID SOIL 01JT0 LuLID SOIL B 95.7 3.3' ~ON C ELEV. FT OFF BLOCK H t,6-VA fio 95..45' RISER EXIT PERMITTED OIJL4 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E 5PECIFICAT IOKJS 005E TANKS MAWUFACTURER: Midwestern Precast IJUMBER OF DOSES: 4 PER DA-4 TAWK SIZE: 1000 GALLOMS DOSE VOLUME INCLUDING BACKFLOW: 154 GALLONS ALARM MANUFACTURER: S -1 E1 rt n MODEL IJUMBER: 101 HW 120V CAPACITIES: A=16 INCHES OR 400 GALLONS SWITCH TYPE' M r'n rg Float B= 2 INCHES OR 9_ GALLONS PUMP MANUFACTURER: _Rol 1 Pr ('n _ r-= 6.2* INCHES OR 154 _ GALLONS MODEL NUMBER: CIR 1,l2KP 119V D=15-8 INCHES OR 'AQ GALLONS SWITCH TYPE: Pigayhack Mexcur+ shat NOTE: PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE 45 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPER 0 FEET -rAok TPECS . + MIAIIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET 6AG(A, 1 0~' + 25 FEET OF FORCE MAIN aZ_FyoFtFRICTIOU FACTOR.. 22 FEET - - 25 ~A>'s• TOTAL 09MA.MIC. HEAD = q- 32 FEET INTERNAL DIMEMSIONS OF TAWK: LENGTH 8'7° ;WIDTH h' 1 " ;LIQUID DEPTH hz%ovmlVE i A 21 St ~ 594-0339_2 BUREAU 01F I IL.00 4 rri ' .ld HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "98" 30 t 4 5/8 25 f3 I t Q 3 5/8 'I l~7 6 20 m O + + 15 4 3/16 4 i. 0 10 1 1/2-11 2 1/2 NPT :I 5 - OwAft 4 E 1) 0 6CLLOFW14 U.S. GALLONS 10 20 30 40 50 60 70 BO f>t C LITERS AUG L Q4 80 160 240 FLOW PER MI14UTE OF V ; eqnpmG I TOTAL DYNAMIC HEAMFLOW PER Y'r,UTE : , EFFLUENT AND DEWATERING i _ 7 .I CAPACI'i Y 12 ~ HEAD UNITS/MIN ~i ' FEET METERS GALS LrRS 1 5 7.52 72 231 10 3.05 fit 73t - 15 4.57 45 it0 20 6.10 25 05 - 3 5/16 dr Lock Valve t CONSULT FACTORY FOR SPECIAL APPLICATIONS 4 Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. Mecthanical alternators, for duplex systems, are available with or . Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. rf p, F+! SELECTION GUIDE Standard all models -Weight 39 lbs. - I/~ H.P. 1. Integral float operated 2 pola mechanical switch, no ex1omal control required. - 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Hefei to FM0477. Model Volts-Ph Mode Am s Sim lex Duplex 3. Mechanical allernalur 10-0072 or 10.0075. M98 115 1 Auto 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". 715 1 Non 9.0 2 or 2 & 6 3 or 4 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify 098 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- "E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plux or duplex operation, 100002. 7. Two (2) hole "J-Pak", for watertight connection or splice. I CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical Alternator, fied licensed electrician. All electrical and coley codes should be followed incfud- FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO4e7; and Simplex Control Box, ing the most recent National Electric Code NFC) W y . FM0732. t+ ( and the Occu lionil Safer and aahh Act (OSHA). RESERVE POWERED DESIGN For'unusual conditions a reserve safety factor is ernglneered into the design of every Zoeller pump. MAIL T0: P.U. BOX 16347 t' Louisvd; , KY4 0256-034 7 Manufacturers of... Q SHIP TO. 3280 Ot' P.4ii;rrs Lane t~ n Louisville, KY 4,,::16 QG.4I/7Y LIMPS s INCE (502) 718-2.731 « FAX (*502)114 3624 7Tryr-9Yt-....,, _ S94= 033 93 Wisconsin Department of Industry, SOIL AND SITE 'L U Labor and Human Relations E Page ! of Division of Safety & Buildings in aCCOfd with I L iR'03 0;,,.W,ts Adm Code COUNTY V4g61 Attach complete site plan on paper not less than 8 1/2 x 11 inched h size. Plara mast include, butt not limited to vertical and horizontal reference point (BM), direction%aatf ,Yo o slope,rscale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road' APPLICANT INFORMATION-PLEASE PRINT ALL INFO RMA~FQa REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION paw.v,+ i GOVT. LOT SA-, 1/4 Sw 1/4,S 3 / T 3o N,R ! 9 E (or OW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # j CITY, STATE ZIP CODE PHONE NUMBER /.vti.f~ $Etl~ LQ /yN $5/27 (G/t) 6,-6-3 - -75,F7 []CITY T ~E~~ OWNw y R 1 15 jk j eew Construction Use [ Y'Residential / Number of bedrooms ~ (]Addition to existing building ~ j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate y bed, gpd/ft2 trench, gpd1ft2 Absorption area required bed, ft2 52~O trench, ft2 Maximum design loading rate bed, 9 pd/ft2 ~Jr trench, gpti1ft2 Recommended infiltration surface elevation(s) see P5 - 3 ft (as referred to site plan benchmark) Additional design / site considerations 411 7E67- S/7,525 5017-,W1,5- OWZ / /:~e 141,94wO S!/S 726.44 - Parent material Sc5 yt. - s,~T. sEpr:,~,..TS oat fiy/. Flood plain elevation, if applicable ft S = Suitable for system CONVENTIOw~ MOUN IN GROUND PRE RE AT GRADE SYSTEM IN R HOLDING T ANK U= Unsuitable for system ❑ S Lj7'17 D U p S pvu p S p p S [j DS SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxd3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rt- si/ / f'sl>,~ ~Psy c5 '13 / o- /t %P 31-3 z~ , v s z ' 3.2 /D a 314 s// ~ 40 sti,~ ~ >c,~ w , s . ~ Ground 3 "40 A0 Yx0 sw / ~'~Sd.~ d s - / S elev/ ft Depth to limiting i factor31,~ SSS Remarks: Boring # Ye 313 511 h~ f,~ Y s Z l~- 2-5 /a Yie 3/(~ Ae ~i as a f $ L3~3 3 LS- y /0Ve -7.,S Vn S/ 7/ S6~ dO~ i Al Ground `v elev. -ft !d' ~ 7S ye y~(p Nn 2 S/ ~,tssiU N N Depth to limiting factor Remarks: T Name: Please Print ~D 6 gfW T e,4 7- Phone: 71S 3 8G dress: csT~y .2 y~z Signature: ~ Date: CST Number: U 7 S PROPERTYOWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxfary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends 0-8 to 313 sdk' ~►+7-'. CS 3'r _ Ell 26 /0 Yle 31,:~o 5// C' Gc~ _ ~jl 5 p s s/ YV f 5 j& dt VA Ground 3 2LIa - 3 /oyiP 311, elev. ft 7's y,P Z DePth lo limiting factor 2-6_ Remarks: Boring # / p -y /D y,P ,3/Z si~ f 5,6,E 414'7~e Ccv - Y S 2 - 27 /o Y/e E3/ 3 27- , -/,s y,e,31~ S/ 2 •f 56,E -f - - - Ground elev. /oYle 3 1 5i •t7 5 lp v 9~ ft S Depth to limiting factor , 17 5 SS € Remarks: _ U~i~y wE , ,q/~yoS T .S 7-0,,PAT6 y /?'r G&) Boring # 0-y /0M 313 S.'/ / f s6,~ ~.E e~ zf . y . S 2- z1o 6 Xle J13 51-1 -2 4, <11 T ,1-i S 4r/0-,-, d-- wE!/ S Ground elev. 3 p- ? S M/ 5 ~Z. 5-61 / f ~m vii' a h ft Depth to S Y c Z ae SZS/ limiting I?i'ZO.~I 3 -T 1;u /IiU~! ovS Aoclet-71-5 Q S factor scl /~o~°7'iov ~E ST ,}-sS~.v SG Tp ~ S ~1 y 5 Remarks: `t 0 '2-0-v 2- U-b ID 2!!F~- Boring # Ground elev. ft Depth to limiting factor Remarks: con ooonio ncmq% J 0 $3 w r zo { • =G~E'h o~ ?PITS y ~Ev.PM pr = /3,v1 SEr - Top I ~'I =p /rr T ~~EV~fr~oo h 3 I 0? .6o `00 At. i i f. 72, 0 oe1 ~M eLEvATioNs - yyQ' a~ N'~ SvGGESTED Movc>p SysTfA, el Ole a elo i 133 134 Ff-9G . B S fe, f~wy ZF STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County R/BUYER ti 6 "n~~ -f' O WNE L f~ pp MAILING ADDRESS J ..Y d -7 PROPERTY ADDRESS d~ a- (location of septic~~sys~~te ) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, J Z,) 1/4, Section 7 T <30 N-R Iq W TOWN OF 077 --7-0, 5~~1 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME ICJ , PAGE,~q,3 1, LOT NUMBER i 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. 11We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: G DATE: Al 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r S T C - 100 This application form is to be complete d 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 e'l"I' Location of property Stj-i/4 Sld 1/4, Section Ji--/ T3~_N-R W Township J7- Mailing address z16 gl p/~,~~ 'Dr-- C Go ofG[ l Address of site Y aa- k Subdivision name Lot no. Other homes on property? Yes No Previous owner of property ZZ Total size of property S/ aC_rt.5 Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? ~_Yes No Volume /0 and Page Number Y-31 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 k I (we) certify that all statements on this form are true t( the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S~~ L1, cam , 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. Sig e of Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT No. STATE BAR OF WISCONSIN FORM 1 - 1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED IIIF" 523099 VOL IJO PA9E. / - . This Deed, made between Malo Dudens- single- wo(ilan.-•-. I ST. OIX CO,, P'i for Record Grantor, NOV 2 1994 and-----Randy Witthus__ASI_.AQnna._A_Fink,-.-aa_jaint__tenant p A 3:5~ f_ I Grantee, I Witnesseth, That the said Grantor, for a valuable consideration-----_ _ conveys to Grantee the following described real estate in St-Croix----------- RETURN TO County, State of Wisconsin: Part of SW-14 of the SW4 of Sec. 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, described Tax Parcel No-------------------- as Lot 4 of a Certified Survey Map filed'in -the Office of the St. Croix County Register of Deeds in Vol. 10 of CSM'S Page 2831 Document Number 522628 , I This i s not . homestead property. (ice (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And . Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, restrictions and Highway Rights of Way of record. and will warrant and defend the same. Dated this ----------------Zko day of 6L O~LT ~UU 19_94... t (SEAL) - • • - - • - - --...--•--------•--•---....(SEAL) * alo. Duden...._.._..------------...._..--•---••--.... --.-----(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) •.._Malo__Duden STATE OF WISCONSIN ss. ~ ---------------County. authenticated this day of October 19.94_ ///,~yyP~~erson ly ame before me this .--e ....day of ^!~'fl~~---------------- 19.`.l_ the above named L Samuel R. Cari R TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) qq v-~+c-~'g to bete person who executed the ~ nst and acknowledge the same. NQTARY THIS INSTRUMENT WAS DRAFTED BY W ~ ►T ..07 ~K6.is Heywood & Cari, S,-C.., _.by..Samue.. R. Cari . • • * - P.O, Box 229 --Hudson- W--- 54016 Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Co fission i ermanent. (If not, state expir i n are not necessary.) date: 19.. ) *Names of persons signing in any capacity should be typed or printed below theli signatures. r V O 69 l FILED OCT 1 9 1994+- 522628 g JAMES O'CONNELL Register of Doeds SL Croix Co., W1 CERTIFIED SURVEY MAP Located in part of the SWq of the SWQ of Section 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. CURVE DATA 1-2 AREA OWNER Radius 1839.86' Lot 2 Malo Duden 610 County Highway "E11 Central Angle O1°45'28" 3.38 Acres Inc. R/W 147,325 Sq. Ft. Hudson Wi. 54016 Chord Bearing S88°53'091'E 3.05 Acres Exc. R/W Chord length 56.44' 132,789 Sq. Ft. Arc Length 56.44' lot 3 co o M c n1 Tangent Bearing S8800012511E 4.30 Acres y T 7.. 187,186 Sq. Ft. H r Ic Tangent Bearing S89°451 31L.-S89 r~, s 'a (v ° PA R VOL 54 r , PG. 308 1~ . 0 °55-17_id ' " 726.20' v- T d 0 32.181 347.39' 346.03' 34.03' C/) IL rt _ s I` o o -380.171- _ 760.231 -380.061- y m o o d v~i• 1'Jt 0 w C7 m o -n IF- w Cj z N x o W o I i> 0 1 U7 IF- i w °o r m o n rr -i rt LOT 2 co ~ LOT 3 rm °~T c I (~l :r rv m o `o tCl I~ 6. N i Z N 0 In - V tTj n I .i I W 'E - 1 -1 Lo 1> I ► N89°42' 3611E t I L4, 1 I a :t.: ~t• . I c,~ If 1 1°_ ...+x27: 00 378.76' I 0 o I 1-1 d58.19' 320.57' 250.00' 0 m N87045' 45"E 628.76 o Ho 0 -n APPR o o - L4 N) co CD o tcl~rJ o° I- w 0 Icr,1-► v, r 001 1 9 94 ~ ~ ~ o m o - m - 00)j c: X OU TY Cet:;:.tehetisiv Pldrx~l,s / r w ? OllttlC) ail( I n I~ w{ - P.; Ccrnmittoo Ip n co 11` v U) I N S 02 9 I t>> i o I~ _ 8 r {t -,)t rq(:oided rn o r 131. 26, t II -7t N r m I N _ .iI,`` 4 days of " i v, ~ w I I N r d!7'11•w RI dQto tCo fil - I -•JIjt ooll lon S703515011E old 9.901 all J'• S~ or n ner 2 1^ +Ar. Section 34 N90000'0011E o M - - _ co Ut LEGEND 962.541 ~l I . • 11` I Aluminum County Section Monument Found South line of the SW} 0 1" Iron Pipe Foun6 UNPLA TED LANDS 0 111 x 2411 Iron Pipe Set, weighing 1.68 •,•.1 lbs. per linear foot r,f,,ty?t-v - 1001 Roadway Setback Liner R.L.LEII C. + Existing Fence Line 1 14Y11 0r-I'l A p Septic S"1'107 I r, SCALE IN FEET N-1 I s. _~t•) 100 50 0 200 400 < 17 dF mtQ Belllt;c~ SHEET 1 of 2 SHEETS VOLUME' 1.0 PAGE 2831 Y ~ 69 Continued SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify, that by the direction of Malo Duden, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows- A parcel of land located in the SW1/4 of the SW1/4 of Section 34, T30N, R19W, 'T'own of St. Joseph, St. Croix County, Wisconsin; further described as follows: Commencing at the SW Corner of Section 34; thence N90000'00"E, along the south line of the SW1/4 of said section, 962.54 feet to the ant of begirnning; thence continuing N901100'00"E, along said south line, 356.05 feet; thence N00o18'03"W, along the east line of the SW1/4 of the.SW1/4 of said section, 1315.54 feet; thence N89057'16"W, along the north line of the SW1./4 of the SW1/4 of said section, 597.52 feet; thence S00031'28"E, along the east line of a parcel of land recorded and described in Volume 547, Page 308 at the St. Croix County Register of Deeds Office, 301.16 feet; thence S89055'17"W, along the south line of said parcel of land, 726.20 feet; thence S00031'28"E, along the west line of the SW1/4 of said section, 395.49 feet; thence N87u45'45"E, along the north line of Lot 1 of Certified Survey Map recorded in Volume 3, Page 843 at said office, 628.76 feet; thence'S02014'14"E, along the east line of said lot 1, 320.50 feet; thence S78029'11"E, along the north line of a parcel of land recorded and described in Volume 900, Page 351' at said office, 131.26 feet; thence N01001'18"W, 446.15 feet; thence N90000'00"E, 216.28 feet; thence S01001'18"E, 523.67 feet; thence S87o27'08"W, 24.24 feet, thence 501024'20"E, along the east line of said parcel of land recorded in Volume 900,'Page 351, 217.93 feet to the point of begin n:i~_ Above described parcel is subject to right-of-way for town road (60th Street), County Trunk Highway "E" and all easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that 1 have fully complied with the current provi. -:ions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. 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 advice. VOLUME 10 PACE 2831 I ~I i • 69 Continued CERTIFIED SURVEY MAP Located in part of the SW4 of the SW; of Section 34, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. OWNER UN PLAT-I E_D LANDS Malo Duden North line of the SW{ of the SW{ 610 County Highway "E" Hudson, Wi. 54016 N89°57'16"W 597.52' IUi tm w 0 F" iii rn N I C) - C° LOT 4 10 1- N89°55'17"E 10 34.03' 13.51 Acres _jNc. R/W 588,354 Sq. Ft. w o IL CAP 0 13.01 Acres Exc.. R/W o 1 rn l-3 i n N ° 566,583 Sq. Ft. t~ N Iv o 0o W °+I -I i o m c a r' a rt If~1 rt -3 I-I I V a s r un o H r io ~ N C N• In B 7 N90°00' 00"E 216.28' o w s 'v ~ APPROVED OH I~ ~ m i 7 o = IC _ rJ vi " ~o m C:1 C) k OCT 19,'94 QWo - m o n rt o rt T N ~ t✓•~r,~ni2~`1i;^•.DI;~E I(~ltlt;tt'!!t W •,t bliit1b ism ~ v r• N N t(91wC~Rddef88d S87'} 7' 08"W '4`tit~i9t,ib~thays~of 24.24' c B >~rriv uht',shaU be rt r n o..~ irj N ~ Ui C . , 0 O C-" w ~ 0 V N n r v w rt n` iD Q LO N i S8904515311E 0 o - o N90 00i00nE 357.251 N9000010011E Pl Q A - N90°00' 00"E 356.05' -v S} Corner 962.54 South line of the SW d { 1318.59 - Section 34 . . e I. I-. 11 ER ll 0 ~~S1~19060/~~~~i UNPLATTED LANDS ; CNA . N H M3 SCALE IN FEET 100 50 0 200 400 ♦j~ D S L) III ~i /IIIOt11~ S11I ET 2 of 2 S11EFTS VOLUME 10 PAGE 2831 I 69 Continued TOWN OF ST. JOSEPH CERTIFICATE I hereby certify th t this Certified Survey Map is approved by th Joseph FT Board. CIerIt Date VOLUME 10 PAGE 2831 ~ lil 3? ~2 ..~Oooov a2 J V' 3 2 '1 is 0° 1 1' 2 I 3 2 1 ,h ,