HomeMy WebLinkAbout038-1079-10-100 fh0w,".~
STC - 104
AS BUILT SANITARY SYSTEM REP
OWNER
ADDRESS //s~`y~ try t
SUBDIVISION / CSM# LOT, ,
G~ +
SECTION TAN-R_2,5_W, Town of j
ST. CROIX COUNTY, WISCONSIN
PLAN VIER
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
8r
s~
6Jf11
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: f ZZ
ALTERNATE DM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
1
Manufacturer: Liquid Capacity:
Setback from: Well. House Other
Pump: Manufacturer Model#1,icQf~a//L Size
Float se eration 1~
P ~ Gallons/cycle:
Alarm Location z l~ sz~
Avec,0 SOIL ABSORPTION SYSTEM
Width: LengthNumber of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Y~ Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet. c~~ f PC bottom Pump Off ;y
Header/Manifold , W, ~s- Bottom of system Z1 ~ ,S7
Existing Grade, Final grade DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: INSPECTOR:-
3/93 : jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labo;arzf Human Relations INSPECTION REPORT ST. CROIX
.Safety,and Buildings Division
Y (ATTACH TO PERMIT) Sanitary Permit No-.*
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI ?h %ft
SOCHA VICTOR X
rairle
) Parcel Tax No.:
CST BM Elev.: Insp. BM Elev.: BM Description:
i
CA's
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 3 , 7 r 3 ~~V O~
Dosing
Aerati Bldg. Sewer
Hotdirig St/0 Inlet 9"?. (S-
TANK SETBACK INFORMATION StIA Outlet Ile), 7S y13
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet /U / 90~
Septic > !s Az ~14- NA Dt Bottom /4 661 g,SO
Dosing > NA JAsagapt i
c:12, co,
Aeration NA Dist. Pipe 7 16d,
Holding Bot. System 3,53 GD, r
PUMP/ SIPHON INFORMATION d$ Final Grade
Manufacturer Gc cl Demand s Cc 30' r~
Model Number GJ U 2~ /"L, S~GPM P Jl
TDH Lift Lriction Systems r TDH 6 S t
oss 6. Head
Forcemain 1 1 Length Dia. ~2'1
Dist. To Well F I _j
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Lengt`/h7 i No.Of T enches PIT No. Of Pits Inside Liquid Depth
DIMENSIONS DIMEN I
:
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING =umber,:
SETBACK M
INFORMATION Type Of %le~ ~cc77~~ s" r ~S~ C CRAIT model System: 6r.r..
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size- x Hole Spacing Vent To Air Intake
Length `/l1 Dia. A Length ~PP Dia. Spacing ~_/Z I >
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 2, Depth Over ~c + xx Depth Of xx Seeded / Sodded xx Mul hed
Bed/T,re hCenter (D Bed/T Edges Topsoil i~ es E] No Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Star Prairie 19.31.18W, NE, NE, Lot 2, 210th Avenugr
A A7,
Plan revision required? ❑ Yes e_1No q
Use other side for additional information. 2~~5z__
SBD-6710 (R 05/91) Date inspector's Signature Cert. No
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
SANITARY PERMIT APPLICATION
~ COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY ERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than L 4
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROP RTY OWNER PROPERTY LOCATION
t/a '/4,S T N,R E(or
PROPERTY OWNER'S MAILING RESS E 6T # BLOCK #
CI TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR S NUMBER
13 II. TYPE OF BUILDING: (Check one) rRCEI NEAREST ROD
❑ State Owned
WN OF:
❑ Public N 1 or 2 Fam. Dwelling-#~ of bedrooms -Z I R(s)
III. BUILDING U SE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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 300 Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER 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./i h) ELEVATION
Feet Feet
VII. TANK CAPACITY Site
in allons Total of Prefab. Fiber- Exper.
INFORMATION New isting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank -
Lift Pump Tank/Si hon Chamber '
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installat' of the onsite sewage system shown on the attached plans.
P/MPRSW No.: Business Phone Number:
[9,
;pIumbeNam Pri ~ Plumber's Sig to : ( to s) M
-
umber' Address (Street, City, State, Zip Code :
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Si natur (No Stamps)
Surcharge Fee) ❑ Owner Given initial
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) 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/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)
st / off- RECEivEz)
WORKSHEET - MOUND SYSTEM DESIGN
40 9 8
S 1 ~ETY BLCSS C9l/.
PROBLEM:
Design a mound system for a
The site characteristics are: ~Depth to groundwater or bedrock in.
Landslope - %
I
Percolation rate
Distance from dose chamber to distribution system
ft.
El.evation difference between oump and distribution systern f,~~ ft.
Step 1. WASTEWATER LOAD
/sdyrl gal.
Step 2. SIZE THE ABSO VTION AREA
A) Area required
.
6) Bed or trench length (B)
ft.
a:.. C) Bed or trench width (A) _ ft.
D) Trench spicing (C)
Wastewater load .24 coal/ftZ/day B = ft.
1 trek e
Step 3. MOUND HEIGHT
A) Fill depth (D) = 1LO ft.
B) Fill depth (E) = D + slope (A)+P) Z~ ft.
C) Bed or trench depth (F) _ ft.
i
D) Cap and topsoil depth (G) _ ft.
E Ca and t
Cap opsoil de th H = ,--f t.
~ipn:
I,iconse
i
Step 4. MOUND LENGTH 409 O
A) End slope (K) = D + E 1 + F + qHx 3 ft.
B) Total mound length (L) = B + 2(K) ft.
:z Zg
-7 ,A
Step 5. MOUND WIDTH
Al U
ps1ope correction factor =
A2) Upslope width (J) - (D + F +`G.)(3)(factor) = l _ ft.
(X3'9) = ys-sG
0-/ 193 j--l) (3)
Bl) Downslope correction factor ■
62) Downslope width (I) _ (E + F + 6)(3)(fac or) ■ ft.
le, 7 7-7
C1) Total mound width (W) for bed = J + A + I ft.
,7,6-
C2)
C2) Total mound width (W) for trenches =
g (no. trenches -1)(c) + A + I = ft.
Step 6. BASAL AREA
A) Infiltrative capacity of natural soil. gal./ft2/day
B) Basal area required = wastewater flow s
natural soil infil rative.capaci r sq. ft.
C1) Basal area available for bed for sloping sites = 9~~ y
B x (A + I) esq. ft.
C2) Bas are} avail le for trench for sloping si/,.,a 6 W (J + q sq. ft.
C3) Basal area available for trench or bed for levB x W - sq. ft.
Liconse l:u _
Date: 9-'l RECFIVr~ D,
AUG 2 3 1994
SAFETY & BLDGS. DIV.
Of 1W
Step 7. DISTRIBUTION SYSTEM
7A) SIZE DISTRIBUTION SYSTEM Lp 'i 0 g 1
1) Hole size = in.
2) Hole spacing = in,
3) Distribution pipe length ■ ~ ~K.
4) Distribution pipe diameter in.
5) Spacing between distribution pipes in.
6) Distance from sidewall to distribution pipe in.
7B) DISTRIBUTION PIPE DISCHARGE RATE? ft.
1) Number of holes per pipe
2) Flow per pipe GPM
7C) SIZE MANIFOLD
1) Manifold is central/ _ end
2) Manifold length ft.
3) Number of distribution lines =
4) Manifold diameter = in.
7D) SIZE FORCE MAIN
1) Minimum dosing rate = 49J4~ GPM
2) Force main diameter g~ in.
3) Friction loss ■ ~o1 ft.
J i.Lfl~
7E) TOTAL DYNAMIC HEAD
1) Vertical lift = a0y^ ft.
2) Friction loss AU62 3 ft,
3) System head 2.5 ft. WETY4I'LC-,~,3. ft.
Gi
;4) Total dynamic head = ft.
i,icer~E;~''q
i) atc
y
of
7F) PUMP SELECTION k'94 4 U 9 S 1
1) Pump selected will discharge GPM at - ft.
total dynamic head.
2) Pump model and manufacturer
7G) DOSE VOLUME
1) 10 time void volume of distribution lines = q/_ gal./cycle
2) Daily wastewater volu 4 doses/24 hrs. _ gal./cycle
3) Minimum dose volume gal./cycle
7H) DOSE CHAMBER
1) Minimum capacity required = 5"c?e2- 74~7J.~/ ~ gal .
A u 2 3 t> 4
C i= iY W C.! C23. C,V.
Si~n• ~.r
Licunso '.:u:_~J -
Date :
i
I
9 4 -40981
l~
v
1
LABOR 8 N AN pELATiQNS
'OUT. C}F lEdLusuy, A B ELDENRS /cc~ussc~ will
` QE1iE5E OF S FEa _ Eoc •i Apav.
cL C,AL P:44 P iAfjK
SEE CO ON®ENCE
mom,
AN23134
SAFETY & CL ZI C:V.
a~~ 2 31994
SAFE & 81-~~'S ~ Cld
4 ~
1
- Page-Of_Zj Z
Straw, Marsh Hay, Or 694--40981
Synthetic Covering Distribution Pipe
ASrm C--3)-4
Medium Sand
H G
Topsoil - • s-s• F
- 31 E D
8 Slope Force Main Plowed Layer
Bed of §"-211"
Aggregate
Cross Section of a Mound System Using
A Bed For The Absorption Area D~Ft.
E Ft.
F Ft.
A ~Q Ft. G Ft.
B Ft. +r H- Ft.
Signed. K i:-~- Ft.
S,Jp L Ft.
p vxvkicensg J 7,L, Ft.
1 ;2 Ft.
Cl• : 6 W .,21. R Ft.
~pt10NS
of°
GDR
S E Alternate Position of
Force Main I L I
Observation Pipe
J
B If- K
1
A I Forc Main
W 1 - -
of -2~S° -
Distribution Pipe Bed o
Aggregate
Observation
I .Pipe Permanent Marker
Plan View of Mound Using a Bed For the Absorption Area
P49e 7 Of.111
••'yr
G e L a
Perforated Pipe Detail
n
nd View
Perforated
End Cap PVC Pips
HoNe Located On Bottom,
J Are Equally Spaced
J
Q
PVC Force Main
Q PVC
Manifold Pipe ,
Alternate Position Of
Distrilrslion Force Main
pipe
Lost Hole Should So
Neat To End Cop
End Cop Distribution Pipe Layout P Ft.
R A7
S
,LJJ
X Inches
Y_ Inches
Hole Diameter Inch
Signed:
Inch(es)
Lateral u ,,I/
License Number: Manifold "'-Inches
PRIV~ ; W YSTE M Force Main Inches
"
Date:
Conditionally # of holes/pipe
® Invert Elevation of Laterals.//n4 Ft.
APPROVE
DEPT. OF INDUSTRY, LABOR i H N RELATNO
Owl OF SAFETY AN BUI INGS
SEE CO P NDENCE
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PAGE Z OF
PUMP CHAMBER CROSS SECTION AMD SPECIFICATIOIJS
A►~r+0a r VEUT CAP ti C. I. V E UV PC I.i! E
A^
WEATHER PROOF AP~'ROVE ~~K'I~IG
i
°Rr C,) JUNCT101J BOX MANHOLE COVER
~ 2StiFRAM OtYOR ,
WIQDOW OR FRESH 12"MIU.
AIR INTAKE j
GRADE
I yr MI~.....~
COQDUIT MI U.
_
Ie•/rIN.~
s
IAILET SE~p'~~ cvY PROVIDE ( I
PS 11Y AIRTIGHT SEAL I I I V
APPROVED JOIA)T on~lt~on~ I III APPROVED JOIA!
W/C.I. PIPE I I I ( W/C.I. PIPE
EXTENDIMC, 3' pE1j►~~S I II ALARM EXTEIJDIAIG 3'
OIJTO SOLID 5011. it ONTO SOLID S01
11111 ~ I I I
- 1A~ ~p pw~i I 1
uscR`I
F iRp pf I I GN
'Cp1V1 GE
to I -yo.3
EE GOEIRES PUMP -1 , OFF
D
CONCRETE BLOCK
RISER EXIT PERMITTED OWL`J IF TANK MAWLIVACTURI`R HAS SUCH APPROVAL
8PEC, IFI.CATIOIJS
EPTIC AND .
USE TANKS MAQUF~ACTURER: IJLIMBER OF DOSES: PER DAb
TANK GIZC GALLONS DOSE VOLUME: 1S GALLO►JS
ALARM MAQUFACT URER' CAPACITIES: A=._2,~_IUCHES OR i CALLOUS
MODEL NUMBER: - ✓ B= ~.-J INCHES OR - E GALLOWS
SWITCH TYPE: C= INCHES OR GALLOQ5
PUMP MANUFACTLIKE R: DIIJCHES OR ~ CALLOUS
MODEL NUMBER: NOTE. PUMP AND ALARM ARE TO BE
SW11CH TYPE: IAJSTALLED ON SEPARATE CIRCUITS
.
PUMP DISCHARGE. RATE. GPM.
VERTICAL, 01rFEREAICE bETWEEN PUMP OFF ARID D STRIBUTIOM PIPE.. /D, i' FEET
+ MINIMUM NETWORK SUPPLY PR//E~~c -;L3PTE//. 2 5 FEET
+ FEET OF FORCE MAIN X _ ~ F/oo FxFRICTIOIJ FAC OR.. FEET
TOTAL ObWAMIC HEAD = 1 FEET
,o:4x„ k,K SY
110TERNAL DIMEIJSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH ::L2~
31GIJED: LICEIJSE WUMBER: ?a~~ _ DATE:
y q,e %D a r AD
Performance YiYL YYY•r t
Curves `ii,'~ ~ 77
n1 ps
-D Pu `U
"US 2 3
METERS FEET 7v~"f
90
MODEL 3885
25 6o SIZE 3/4" Solids
WE15H
g
70
20 WE10H ~I/'~sht ~~s I
60
WE07H
15 50
WE05H
40
10 30 WE03M
WE03L
20
5-
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
0 10 ~20 30 m'/h
CAPACITY'' -c
~GOUJS PUMPS. INC.
513Et~4 FALLS WW vOAK 13148
METERS FEET
120 MODEL 3885
35 SIZE 3/4" Solids
110 WE15HH
30 100
90
25 80
70
20
60
O
~ WEOSHH
-15 50 40
10 30
20
5
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
i i i 1
0 10 20 30 m'/h
CAPACITY
01985 Goulds Pumps, Inc. Effective July, 1985
C3885
I,
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RECelveo
AUG 2 3 1,994
SAFE. & BLDGS. DIV
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AUG
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page Of
'Labor and Human Relations
Divisioq of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
C U NTY
Attach complete site planF ft than 8 1/2 x 11 inches in size. Plan must in
not limited to vertical and hors iizonttaaf ret a ce point (BM), direction a o Ie,"5~ca PARCEL I.D. #
dimensioned, north arroyf,~yui,lpc do nd distance to nearest road.
APPLICANT INFORMATION-PL PRINT ALL INFORMATION REVIEWED BY DATE
CA cams
PROPERTY Z NER: PROPERTY LOCATION
GOVT. LOT /,c 1/4 A~r 1/4,S j2 T N,R E (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # B O K # SUBD. NA E OR CSM #
,1-4115- '1/11 1 A14
CI T A ZIP CODE PHONE NUMBER ❑CIT~ VILLAGE' OWN NEAREST ROAD
New Construction Use k j Residential / Number of bedrooms [ j Addition to existing building
Replacement [ j Public or commercial describe
Cade derived daily flow ::Z~- gpd Recommended design loading rate _Z-2 bed, gpd/112'.' trench, gpd/ft2
Absorption area required bed, ft2 7s trench, ft2 Maximum design loading rate f. bed, gpd/ft2_,~~trench, gpd/ft2
Recommended infiltration surface elevation(s) Zj, S ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material z-// I L -;_j lam, Flood plain elevation, if applicable It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S [3 U ❑ S O 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. Bed Trench
Ground
elev.
`ft.
Depth to
limiting -
factor
Remarks:
Boring #
Ground
elev. 7S" 6.
ft.
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Phone:
Address: ' A
7
Signature: Date: CST Number:
i
PROPERTY OWNER SOIL DESCRIPTION REPORT Page,-~e-' of
PAROEL I.U. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
P
Ground
elev. _ - L
,2~,L ft.
Depth to
limiting -
factor
•a~
Remarks:
Boring #
Ground
elev. 4:0 9
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
AUG z 3 1334
SAFETY & BLCSS. Cll.
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83 Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 incheptj~ Plan m wt incl e,,bLX
.As not limited to vertical and horizontal reference point (BM), directs' d % of& n Erne or a PARCEL I.D. #
dimensioned, north arrow, and location and distance to neares ro Vet
APPLICANT INFORMATION-PLEASE PRINT ALL INF AT140N' REVIEWED BY DATE
PROPE TY WNER: ' PROP,5RTY LOCAT
°e tOT.1/ 1/4,S T N,R E (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # "B K`# S BD. NA E OR GSM #
CITY A ZIP CODE PHONE NUMBER ❑CITY LAGE WOWN NEAREST ROAD
J New Construction Use NJ Residential / Number of bedrooms [ J Addition to existing building
j ] Replacement [ J Public or commercial describe
Code derived daily flow r~ gpd Recommended design loading rate,/,. 2 bed, gpd/ft2_2trench, gpd/ft2
Absorption area required 3!7-S bed, ft2, ? - trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2
Recommended infiltration surface elevation(s) IA'), t ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IPRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ ®S ❑ U S ®U ❑ S ®U ❑ S I ❑ S Ell)
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiench
Ground PP _ All
elev.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. ~s 6
ft. - %
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Phone:
Address: _
Signature: Date: CST Number:
q-.1
PROPERTYOWNER SOIL DESCRIPTION REPORT Page o{
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourxUy Roots GPD/ft
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SBD-8330(8.05/92)
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469962
CERTIFIED SURVEY MAP
Located in the NE 1 /4 of the NE 1 /4 of Section 19, T3 IN, R 18W , Town of Star
Prairie, St. Croix County, Wisconsin.
Surveyed for: Craig Hanson
5923 Old Mill Road
Hudson, Wi. 54016
SCALE IN FEET I" = 150'
0' 75' 150' 300' BEARINGS REFERENCED TO THE NORTH LINE
OF THE NEI/4 OF SE~TION19,T31N,R18W,
NE CORNER ASSUMED N89032'17 W .
SECTION 19~
3 T31N,R18W
r 0
0
N
M
O
x+25.10 UNPLATTEO LANDS I" IRON PIPE FOUND
z o 7 W 392.34 N 6° 29 '05 ° W 7.54
- N 00. 46'
OF LOT CORNER.
417.44'
'
_ 7' 8,
W
2
W_
P-
I
LOT 2
0 M _ 148 , 291 SO. FT.
W 1 r- 40 ( 3.404 AC. )
z _ w; t6 INCL. R.-O. -W
_ W11 0 0 138,635 SO. FT.
1 ( 3 . 183 AC.)
QI m
EXCL. R. - O. - W
z I w 0
C, 3 O W z ~
' QI
U. - 417.46' t~ J
N A, ° K) S 00° 53' 09 °E °I
C4 , 17 I
♦ COe'$► 29.21 -
W I M 388.25' N
i, Z O NY ~
~I J I ~ O Q I
HARVEY ~ I z JI
• JOHN SON z z LOT I QD zl
W1 148, 291 SO. FT.
6>t~i0iCf1
3.404 AC.) a /'1 A pROVED
S+tg (
Hupsolt 1 1n rn 0
INCL. R. -O. - W
W{S Q` ~ 137,173 SO. FT.
y~i I ( 3.149 AC.) rn JUN 0 3 1991
qN0 S Fr ( 10 ro EXCL. R:.-0.-W. STCROD(COUNiY
'9 CCf*VAeH8WKP~%WP~"G
6 6' AM ZONW-~ CONVAM
2,'
6' ' _ .417 CD I 133.32' S 00 894.16'O E 9'
UNPLATTED LANDS
I WEST LINE OF THE
NE 1/4 OF THE NE 1/4
g M
N 1/4 CORNER LEGEND
egg o~G
S~ Cd ! SECTION 19
I Section Corner Monument
0 l "X24'' iron pipe weighing
1 .68Lbs. / lin. ft. set.
----11•E f e nc e li ne
VOLUME 8 PAGE 2362
488-1518
DRAFTED BY JWG
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER J~~~L°1Cg
MAILING ADDRESS 14)-r
PROPERTY ADDRESS Z ,7-
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCA/TIONAIZ 1/4, ~l 1/4, Section T_,Zl_N-R_.Z&_W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP X 2129 VOLUME
PAGE,, LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
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:
DATE: 9 Y
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property 0;!
Location of property ( 1/4 _114, Section /2 .,T_,T~-N-R__LS_W
Township Mailing address
Address of site
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created "
Ile 7-
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes _>~_No
Volume l and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No.~ and that. I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant *Ap &1cant
Date of Signature Date of Signature
-Opp'
4 r. DOCUMENT NO. WARRANTY DEE THIS SPACE RESERVED FOR RECORDING DATA
{ STATE BAR OF WISCONSIN r ORM 2 - 1982
b 'I
5..3
REGISTER'S OFFICE
-.,a~~
ST. CROIX CO., WI
Beyerly--Sellert--and--Debra . J.-. Hansen,-- as --tenants--in_•-__ Recd for Record
common}------•--- JAN 3 1994
at 12:35 P.
> conveys and warrants to Vktor_.G.,_..S.o-r .a._:aud..Mary-A :__.5.Q.Qha,---- IT t-"~
husband--and..wife-,------------------------------------------------------------------------ I Regiiter of r--
RETURN TO Victor & Mary Socha
- 1415 Main Street
- -
the following . described real estate in St. CrOlX Houlton, WI 54082
____County,
State of Wisconsin:
Tax Parcel No:
Part of NE1/4 of NE1/4 of Section 19-31-18 described as follows: Lot 2
of Certified Survey Map filed June 3, 1991, in Volume "8", page 2362,
as Document Number 469962.
.a
This __.....1S-nOt_........ homestead property.
(is not)
Exception to warranties: Easements, restrictions and rights-of-way of
p record, if any.
Dated this ~7. ~4~---------------•--- day of - ------December - 19-93-
(SEAL) e~~ --------(SEAL)
Sel lent
-
(SEAL) /y (SEAL)
* EDebra 2ansen
AUTHENTICATION ACKNOWLEDGMENT i.
Signature (s) _ Beyerly--Sellert........................... STATE OF WISCONSIN
Debra J. Hansen Ss.
- - -
d1? County.
authenticated this ________day of-------------------------- December _ 9_.___93 _ Personally came before me this ________________day of
19________ the above named
4 Iand..--•••
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, authorized by § 706.06, Wis. Stats.)
to me known to be the person who executed the
foregoing instrument and acknowledge the same. II
THIS INSTRUMENT WAS DRAFTED BY
Kristina 0gland
Attorneat Law
ii Notary Notary Public -------County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19________.)
nes of persons signing in any capacity should be typed or printed below their signatures. I'
I I
.dARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
FORM No. 2- 1982 Milwaukee, Wisconsin
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
I INN IN Rif
ST. CROIX COUNTY GOVERNMENT CENTER
r
I ~
1101 Carmichael Road
' - - - Hudson, WI 54016-7710
(715) 386-4680
December 1, 1994
Ms. Becky Hartman
Hartman Homes, Inc.
P.O. Box 326
Somerset, Wisconsin 54025
RE: Septic Inspection
Dear Ms. Hartman:
An inspection of the septic system serving the Victor G. Socha
property was conducted on November 8th and 9th, 1994. This
property is located in the NE,- of the NE -14 of Section 19, T31N-R18W,
Lot 2, Town of Star Prairie, St. Croix County, Wisconsin. At the
time of the inspection, this septic system was found to be code
compliant for a three (3) bedroom home. Should you have any
questions, please feel free to contact this office.
nce' ly,
J'' e Thompson
Assistant Zoning Administrator
St. Croix County, Wisconsin
mz
ST. CROIX COUNTY
WISCONSIN
- ZONING OFFICE
prxnauaur a~.■6
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
December 1, 1994
Ms. Becky Hartman
Hartman Homes, Inc.
P.O. Box 326
Somerset, Wisconsin 54025
RE: Septic Inspection
Dear Ms. Hartman:
An inspection of the septic system serving the Victor G. Socha
property was conducted on November 8th and 9th, 1994. This
property is located in the NE, of the NE; of Section 19, T31N-R18W,
Lot 2, Town of Star Prairie, St. Croix County, Wisconsin. At the
time of the inspection, this septic system was found to be code
compliant for a three (3) bedroom home. Should you have any
questions, please feel free to contact this office.
ince' ly,
e Thompson
Assistant Zoning Administrator
St. Croix County, Wisconsin
mz