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HomeMy WebLinkAbout040-1082-90-225St. Croix County Planning and Zonin Friday, December 02, 2005 at 11:15:23 A.V Detail Sanitary Information Page I of I Computer tl: 040-1082-90-225 Sub/Plat: NA Section: 21 Parcel4: 21.28.19.326C10 Lot: 7 TWRNO: T28NR19W Munklpality: Troy, Town of CSM: Vol. 19 Pg. 4857 1141/4: SW 114 NW 114 Owner. Sylla, Brian 502 Rolling Meadow Drive River Fab, WI 54022 State Permit: 218957 Issued: 09/29/1994 POWTS Dispersal: Mound Permit: New County Permit: 0 Installed: 09/29/1994 POWTS Detail: NA Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Notes Inspecto As Built Plumber Jim Thompson Yes Wang, Tom Signed Oft: No Maintenance Scheduled Pump Date Pumped 1 st Notification 1/1/1985 11/1/1999 04/01/2005 11/1/2002 04/01/2005 WM1997 Other Requirements Additional Notes Money Owed permit notecard filed with archives - formerly lot 2 $0.00 of CSM 10/2819, then lot 5 of CSM 14/3893 2nd Notification 3rd Notification SYLLA, Brian SW4t NF.tt, Sec. 21 628� Glen Park Road T28N-R19W, Town of (River Falls, WI 54022 Troy, Lot 2 Address Site: 502 Rolling liead'ows Drive River Falls, WI 54022 Permit No.: 218957 New System - Mound 9/29/94 Thomas A. Wang u Parcel #: 040-1082-90-225 12/02/2005 11:06 AM PAGE 1 OF 1 Alt Parcel M 21.28.19.326C-10 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/13/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - TEPPEN, RICK L & RUTH ANN RICK L & RUTH ANN TEPPEN 192 HWY U RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description • 502 ROLLING MEADOW DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.192 Plat: 4857-CSM 19-4857 040-04 SEC 21 T28N R19W PT SW NW FKA LOT 2 OF Block/Condo Bldg: LOT 07 CSM 10/2819 2.195 AC) & PT LOT 5 14-3893 BEING CSM 19-4857 LOT 7 (3.192 Trect(s): (Sec-Twn-Rng 40 1/4 160 1/4) AC) 21-28N-19W SW NW Notes: Parcel History: YIQ/rl % Date Doc # /� Vol/Page Type 10/19/2005 809727 2911/285 WD 10/13/2004 776972 19/4857 CSM 07/23/1997 1101/266 WD 07/23/1997 1096/184 .19 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class RESIDENTIAL G1 Totals for 2005: General Property Woodland Last Changed: 09/06/2005 Acres Land Improve Total State Reason 3.192 50.800 ( 206,900 257,700 NO 3.192 50,800 206,900 257,700 0.000 0 0 Lottery Credit: Claim Count: 0 Certlfication Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Chargaass Total 0.00 0.00 U Parcel #: 040-1082-90-200 12/02/2005 11:06 AM PAGE 1 OF 1 Alt. Parcel M 21.28.19.326C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/13/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RETIRED SYLLA O - SYLLA, RETIRED Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 12.208 Plat: 3893-CSM 14/3893 SEC 21 T28N R19W SW NW FORMERLY PT OF Block/Condo Bldg: LOT 5 LOT 1 CSM 4/1157 NKA LOT 5 CSM 1413893 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) (12.208AC) NKA CSM 19-4857 21-28N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/27/2000 627129 1529/537 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Totals for 2005: General Property 0.000 Woodland 0.000 Land Improve 0 0 0 Last Changed: 04/27/2005 Total State Reason Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category H Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040-1082-90-100 12/02/2005 11:05 AM PAGE 1 OF 1 Alt. Parcel #: 21.28.19.326B 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/13/2004 00 4 Tax Address: Owner(s): O = Current Owner. C = Current Co -Owner RETIRED SYLLA O - SYLLA, RETIRED Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.195 Plat: 2819-CSM 10/2819 SEC 21 T28N R19W PT SW NW BEING LOT 2 OF Block/Condo Bldg: LOT 02 CSM 10/2819 2.195 ACRES NKA CSM 19-4857 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-19W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1101/266 WD 07/23/1997 1096/184 WD 07/23/1997 1087/131 WO 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land Totals for 2005: General Property 0.000 0 Woodland 0.000 0 Last Changed: 04/27/2005 Improve Total State Reason 0 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Chargges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 n O AS BUILT SANITARY SYSTEM RE RT OWNER��N�'� ADDRESS_ V! Q r LI( (Y 'rF V- FG /i L,% ! sVw) F� 1 z SUBDIVISION / CSMI LOT ' SECTION d T VO N-R_Zg_W, Town of Ta ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1 �r=W INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: P N, l), F, �, 06 r SEPTIC T PUMP CHAMB HOLDING TANK INFORMATION Manufacturer:/!(,kesf r!ce� Liquid Capacity: - b0 Q r Setback from: Well (� House 30Other Pump: Manufacturer G6lA s Model# )[0 3 1 Size /3 Float seperation rr Alarm Location Gallons/cycle: / v SOIL ABSORPTION SYSTEM Width: (� � Lengthy Number of trenches d Z rr1PS Distance & Direction to nearest prop. line: r PSy r Setback from: well: ��o0 House 710 Other Building Sewer PC inlet )leader/Manifold Existing Grade ELEVATIONS ST Inlet. ST outlet PC bottom Pump Off Bottom of system Final grade DATE OF INSTALLAT PLUMBER ON JOB: V4,e, I LV LICENSE NUMBER: 3 ) S INSPECTOR: 3 / 9 3 : j t Parcel #: 040-1082-90-100 04/15/2005 05:11 PM PAGE 1 OF 1 J Alt. Parcel #: 21.28.19.326B 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner ' SYLLA, BRIAN P & ANGELA M BRIAN P & ANGELA M SYLLA 502 ROLLING MEADOWS DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 502 ROLLING MEADOW DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.195 Plat: 0428-CSM 10/2819 SEC 21 T28N R19W PT SW NW BEING LOT 2 OF Block/Condo Bldg: LOT 02 CSM 10/2819 2.195 ACRES Tract(s): (Sec-Twn-Rng 401/4 1601/4) a 21-28N-19W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1101/266 WD 07/23/1997 1096/184 WD 07/23/1997 1087/131 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 26782 257,200 Valuations: Last changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.195 50,800 206,900 257,700 NO Totals for 2004: General Property 2.195 50,800 206.900 257.700 Woodland 0.000 0 0 Totals for 2003: General Property 2.195 48,400 191,100 239,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 110 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 as ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI54016-7710 (715) 386-4680 January 17, 1995 Tom Wang W 9672 770th Ave. River Falls, WI 54022 Dear Tom: I am trying to complete paperwork on system installations, and find that I need AS BUILTS on the following: Brian Sylla Pat Delander Kathy La Mothe Please forward these to the Zoning Office as soon as possible. Thanks for your cooperation. Sincerely, Thomas C. Nelson Zoning Administrator cc: file STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER j'\ 5' 11 lei ADDRESS 6 a %_ 1 y % �d Deli l`y ` S ��t , S✓i�l�oi SUBDIVISION / CSMI_ �d �LOT / SECTION__; TN-R)� W, Town of Q ST. CROIX COUNTY, WISCONSIN EW OW EVERY EVERYTHING WITHIN AN I IN100 FEET OF SYSTEM 100 v p y�;a'l�o,�e 6t 354 l poo q 150 Comb. Iqmk tt Pel del') 0IP IND]CATF•. NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tanF; manhole cover. 4 Department of Industry, Human Relations Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) PerSmYL Holder's �RAN City Village Town of: CST BM Elev.: Insp. BM Elev.:, BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /%%�>''=. ern Dosing Aera to Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Airto irintake ROAD Septic W74- NA Dosing NA Aeration— NA Holding PUMPII'IPHON INFORMATION Manufacturer Demand Model Number GPM DH Lift I Loss Friction S stemal4 TDH Ft [Forcemain Length Dia. ' Dist. To Well -r',SOILABSORPTION SYSTEM i . IDIMENSIONS I County: ST. CROIX Sanitary Permit No.: State Pan o.: d - Parcel Tax No.: l� ELEVATION DATA �,�y '� W STATION BSPY HI FS ELEV. Benchmark �/G sl, /� J, w Bldg. Sewer St IX Inlet 5t% $( Outlet Dt Inlet Dt Bottom )yp' �v/'2 Header / Man. Dist. Pipe Bot. System 0s.0 Final Grade - ` i BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Insi id Depth SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM L Manu acturer: INFORMATION MBER ype now 44- Model Number: System: /I' a, c1 OR UNIT DISTRIBUTION SYSTEM bildrift I Manifold Distribution Pipe s� „ x HoeSize x Ho a Spacing Vent To Air Intake Length IL Dia a Length BOO Dia Spacing 3� Y 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 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Tro .21.28.19W, SW, NE, Lot 2, Rolling Meadow Drive Plan revision required ❑ Yes []No Use other side for additional information. SBO-6710(R 05191) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: CAkI1TARV DF92UIT APPI IfC_ATIAN .�... ■.ems a��Itn In accord with ILHR 83.05, Wis. Adm. Code Coto".. STATE SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than ❑ al 8'%x 11 inches in size. �5j CheckIfrevla toprev iousapplkason -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 0 o!n PROPEEOWNER `Q PROPERTY LOCATION 711 /a,S Ta E[orjtO Y. o?f .N,R19 PROPE TV O 141�^ MAI ONPnAn DF 4 r /mod o/r% rl rf led LOT # BLOCK!! + CI STAATE r ZIP ^ NUMBER SUBDIVISION NAME OR CSM NUMBER, 1-� �COM J CITY n` I NWST �iOA/D /,, n If. TYPE OF BUILDING: (Check one) ❑ State Owned ILLAGE F�o fr_ /�(t4 ❑ Public [N1 or 2 Fam. Dwelling —#of bedrooms � (S)) /�O `!l! ev III. BUILDING USE: (If building type is public, check all that apply) (1/010 !! vv 1 ❑ ApVCondo 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 Bit applicable) A) 1. KNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 ElSpecify Type 41 ElHolding Tank 12 ❑ Seepage Trench 22 LJ 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 t� � REQUIRED sq. it.) PROPOSED (sq. ft.) (Gals/�ylsq. lt.) (Min./inch) / � ELEVATION V! 6 QI >, , ► eet eet VII. TANK INFORMATION CAPACITY in allons Total Gallons #of Tanks Manufacturer's Name Prefab. ncret Site Con- Steel Fiber- glass Plastic Exper. App. New istl Tanks Tanks strutted Septic Tank or Holdino Tank iudho t I-AlAp Tor Litt Pump Tank/Siphon Chamber y 1 f f VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum is Name (Print): Plu Signature: ( mps) P Business Phone Number: o H Plumber's Addre (Street, City, Stilits, Zip l/ I` IX. COUNTY/DEPARTMENT USE ONLY Approved ❑ Disapproved El owner Given Initial Sa . ry Permit Fee (Includes Groundwater /�Q'/� CMSurcharge Fee) AD Date Issued �. 2 y Issuing Agent Si mpe) " 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 QD 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. 11 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: I. 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. Ill. 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'h 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. SBO-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations July 26, 1994 WANG EXCAVATING THOMAS WANG W9672 770 AVE RIVER FALLS WI 64022 RE: PLAN 894-40722 SYLLA, BRIAN SW,NE921928119W TOWN OF TROY MOUND SYSTEM 2226 Rose Street La Crosse WI 54603 IJA n1xH:141"ffl COUNTY OF ST CROIX The Department has reviewed the above -referenced submittal. 180.00 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. to the plan number shown above. Sincerely, 4 rard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 5079R/ 1 8HD4w dL *imo Please refer r•• 1 �a14 S iy NFey Sep.ar ? jf3lay TdtN C19 3y31 4 0 407x2 Tro Town ship S ►x G)el1 io be )' Arom Slsfe� AN Zig EOM GCMgI*4A-n0P3 ?ANIt . 13cCEIVEZ) JUI 2 5 I994 Top.N.U.P,�..Siake SAFM a BLDGS. DIv, e pt�'� pGE S�st� .io ally dit n 0 % 00 Ov VZr x Pr Poe 3 s E coaR 12�S. N x 4ea+�x (4111►, meadow O r. . ;. . :,,; ,, t, .s;- �, , ':n4 + �' r .N� ,. 9� �.... N f-�. i'1'. .)`ram �..`� Page _ Of _ Straw, Marsh Hay. Or Synthetic Covering ASTM (-• 33 Medium Sand 6" Topsoil J F — 3 S94m40772 iDistribution Pipe JCI 3 9r. Slope Bed Of — 2 %Z LForce Main Aggregate (6" Delow Pipe) Cross Section Of A Mound System Using A Bed For The Absorption Area Lu A (� Ft. Signed: �—' " g tj Ft. ^` I License Number:` K )0 Ft. L Ft. Date: j �_ Ft. A ternateofPosi—tion���G�s�S�t:W` I l_ Ft. " �oree�r► �'v _ �li� w Ft - Force n _ Force Main Plan View Of Mound Using A Bed For The Absorption Area G Plowed Layer D I.0 Ft. E Ft. F SO Ft. G D Ft. H 1•5 Ft. 594- 4071.2 rV rnoL,; Fold Pipe, i �, n�V co -� Las holc s6ovli be hcxV 6 Endl Cap 2 )d U9(15 QS 3.o F� X �nchc3 i ncti %,I cl (o) I/��o�� a10.•� 1nC6 (es torcC inain dui►. —�-- nc�is 0 Dolt per pi pc�L-- lt ULA 414LO. x ImAer..1 /05-75'F+ Iv pR;VATE SEWAGE SYSTEM Conditionally pROVED AP�� L es �ws�ml Of �► M" SEE ENCE SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS S94-40722 4" Cl VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHER PROOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 FINISHED GRADE 4" CI RISER WARNING LABEL r 6" MIN. ABOVE GRADE 4" MIN. --� 18" IN. 6" MAX. - ** NLID / WATER TIGHT SEALS GAS- TIGHTi_A SEAL APPROVED BAFFLE j ALM JOINTS W/ CI I PIPE B PIPE 3' ONTO -v— r ON SOLID SOIL OL OIPUMP OFF ELEV . l /.XFT. OFF ** RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER ;EPTIC / DOSE "ANK MANUFACTURER: 'ANK SIZES: SEPTIC -- DOSE ALARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: "UMP MANUFACTURER: MODEL NUMBER: SWITCH TYPE: CONCRETE PAD 15. B 5/i IJ Y: 114 LUDING 1(0,10 GAL. INCHES = 301 GAL. 2 INCHES = 1 70 GAL. Q INCHES = /2(a. 9 GAL. INCHES = 190. Z GAL. tEQUIRED DISCHARGE RATE �_ GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC IERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . 9 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . 2.5 FEET FEET FORCEMAIN X ��q_FT/100�FT. FRICTION FACTOR . ,y[p FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH �oWIDTH �� ; DIAMETER LIQUID DEPTH SIGNED: t/?✓ �G✓ LICENSE NUMBER: DATE: DEPAdRENT OF INDUE'TF?Y, LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS PERCOLATION TESTS 5 DIVISION P.O. BOX 7969 6 w 407 2 �DISON, WI 53707 (11H�83.09(l) & Chapter 145) LOCATION: • 4 ,/ SE TION:T T NICIPALITY: — r X-1 N/ E OT 0.: NO.] NO. SUBDIVISION NAME: SUBDIVISION t f or •---_ COUNTY amp ( IaN !'a R S e A-1-ki 0 7� oflter USE ®Residence ]NJO.BTED�RC(1_) MFRDESCRIPTION: New ❑Replace RATING: S- Site suitable for system U- Site unsuitable for system ss• s -a a •- tr'.':���•7l .�I ONVENTI NAL: OS ©u MOUND: ®s ❑u IN- ROUN os ©u EM•IN-FILL os ®u OLDING TANK:RECO Is ®u MENDE EM:Ippt�4 n'I` , ��U„ J -' If Percolation Tests are NOT required DESIGN RATE: G If any portion of the tested area is ' the , .H`,• under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate FloodPlain elevation:. - PROFILE DESCRIPTIONS BORING NUMBER TOTAL pEPTH IN. ELEVATION P H T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR; 7 TUBE, AND DEPTH BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) OBSERVED EST. HIGHESTTO B I sYr' ro�r�� NONE 3f1'' I� err i i B• ,5y it t Sao j P l V B. B- 1 4, fione PERCOLATION TESTS TEST NUMBER DEPTH INCHES WATER IN HOLE AFTERSWELLING TEST TIME INTERVAL -MIN. DROP IN WATER LEVEL -INCHES RATE MINUTES PER INCH p RI Qn I PrO 2 PERIOD, 3 1P 30 f P- 73 D /6 /'/& 3 P- 3 q 790b s P. P- P. PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan, Show the surface elevation at all borings and the direction and percent of land slope. SY,$TEM ELEVATION snake �3 o P3 3% °tie x g pt 16!;, C loo,o /ae .p A bh_. Top I' I Idbh q = koce holes p o' bC1rc Holes S' ktre Poace.l On fro � = 1 a�`-CJ14ovti\Q N.w.f'�.. tN (Zolli►u� ''Y1eeLc�OLt� prr I, the undersigned, hereby cart, y that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. DISTRIBUTION: Original and one copy to Local Authority, Property Owner ana Sod Tester, DILHR-SBD-6395 (R. 10/83) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND INDUSTRY, LABOR AND PERCOLATION TESTS (115) HUMAN RELATIONS ' QLUB�83.09111 & Chapter 145) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 UOt-AMM:SECTION: '/ t/ /TsN/ E (or T NICIPALITY: OT O.:BLK. NO.: -- SUBDIVISION NAME: COUNTY- ILIN ' oil 5YcCd USE NO. BE : CO M R TION: ®Residence ` XNew ❑Replace RATING: S- Site suitable for systom U- Site unsuitable for OEIST©V M® S O� [:]S ©U O S I®uL O sG®NK: RE CO MENDE EM:Ipptjgnell)0 Ji If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is i the o(jh^y under s. ILHR 83.0915)(b), indicate: FloodPlain, indicate Floodplain elevation:. )7q'_ PROFILE DESCRIPTIONS 7 ' BORING NUMBER TOTAL DEPTH IN. ELEVATION P H R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLO ; I E;"AND DEPTH TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) OBSERV D B- I 5tj" ID55(S NONE 30'f tr6l 91 si I'a-5v ns B- -51Y g'�oIt d nn B- o/ rrj j1 �t 30 .y �/�AA1 B- S i 5110 "8y, S r'fi>�ro1 -� ll B- t Ag"�one PERCOLATION TESTS TEST NUMBER DEPTH INCHES WATER IN HOLE AFTERSWELLING TEST TIME INTERVAL -MIN. DROP IN WATER LEVEL-INCHESRATE MINUTES INCH PERIOD I PERIODPER P 30 1 2 9y o 37 p- ! S P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan, Show the surface elevation at all borings and the direction and percent of land slope. SWEM ELFFVATION Via. �' Ts� c g3 p P3 36'° �oaa xg PI R U St 165, o JO�.D /`de .0 �.+'►�.. To 4 � A01re Ro(e5 o= PC ire h{o%5. AC ife Poaree Pro�s�°c� . hPC4�'ioh . On fo/14,41 TN Rent►►,e73q a iew Or, I, the undersigned, hereby certi y that the soi tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-63951R• 10/83) -OVER - `i INSTRUCTIONS FOR COMPLETING FORM ?IS - SBO - 639S To be a complete and accurate soil test. your report must include: 1. Complete legal description; 2. The use soction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS: 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your lost locations. Drawing scale is prefered. A separate shoot may be used if desired. 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; g. Complete all apropriate boxes as to dates. names, addresses, flood plain data, percolation test exemption, if appropriate: 10 If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11, Sign the form and place your current address and yur certification number: 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols at — Stone (over la') BR — Bedrock cob — Cobble (3 - 10") SS — Standstone gr — Gravel (under 3") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate mods — Medium Sand W — Well is — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand — Less Than 'I — Loam Bn — Brown 'sit — Silt Loam BI — Black si — Silt Gy — Gray CI — Clay Loam Y - Yellow act — Sandy Clay Loam R — Red siN — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fit — few. fine, feint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct - p — prominent HWL — High water level, surface water Six general sod textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This sod test report is the first step in securing a sanitary permit The county or the Department may request verification of this soil test in the field prior to permit issuance A complete Set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit The sanitary permit must be obtained and posted prior to the start of any construction ORDINANCE AMENDING CHAPTER 17 ST. CROIX COUNTY LAND USE ORDINANCE REZONING LAND FROM AGRICULTURAL TO AG. -RESIDENTIAL ORDINANCE NO. 3 Sa WHEREAS,the Statutes of the State of Wisconsin provide for a Planning and Development Committee to act in all matters pertaining to county planning and zoning; and WHEREAS, the St. Croix County Board has established the St. Croix County Planning and Development Committee; and WHEREAS, at the request of the County Board this Committee is to review petitions, hold public hearings, and present its recommendations for rezoning requests to the County Board for action; and WHEREAS, the St. Croix County Planning and Development Committee has fulfilled its duties regarding the petition of PAUL SYLLA/BRIAN & ANGIE SYLLA, with the following legal description: A parcel of land located in the SWh of the NWT; of Section 21, T28N-R19W, Township of Troy, St. Croix County, Wisconsin, described as follows: Beginning at the West ; corner of said Section 21; thence N00'00'00"E 425.00"; thence N 88'44122"E 225.00; thence S00'0010011W 425.001; thence S88'4412211W 225.00; to the point of beginning. This parcel contains 2.195 acres subject to all easements, right- of-ways or conveyances of record. THEREFORE, BE IT NOW ORDAINED by the St. Croix County Board of Supervisors, meeting in regular session, that the parcel is now rezoned from Agricultural to Ag.-Residential. Dated this c-9 day of g } , 1994 ST. CROIX COUNTY PLANNING AND DEVELOPMENT COMMITTEE Negative s Dorsey Linda Luckey William Oemichen orge Menter Ronald Raymond Affirmative �Q9y Thomas Dorse Linda Luckey Ronald Raymond STATE OF WISCONSIN . COUNTY OF ST. CROD( L Sw.E Nabors, SL emk County peak DO HEREBY CERTFY I* t1a lmepdrp b a bw and ao ld a)py of 0 35a(-Ci,4) a tpmd oy to Canty Bad of S*wAsm al ttalr naeUrg nela 3h, c Q o Sw E. NOW. SL-CmtK County Ckrtk STC-105 OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS CITY/STATE SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County Tia al SG 114 %Ph ra y /C ted CS a ro //,' It % m d'iW S 1 ) _r' (location of septic system) Plea4 obtain from the Planning Dept. PROPERTY LOCATION J w 1/4, Al E 1/4, Section T O`k N-R_jW TOWN OF (�& A ST. CROIX COUNTY, WI SUBDIVISION _11L� LOT NUMBER p CERTIFIEDSURVEY MAPTO 1 59VOLUME AMPAGE as , 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 dat- n.. 7 SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 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 b �'t 4- Location of property J& 1/ Township 7-)D 1d Address of site Subdivision name Other homes on property? Previous owner of property Total size of property Total size of parcel ~1/4, Section ,TN-R /YW ilina address Yes X No Lot no. Date parcel was created '� k l J, 9y Are all corners and lot lines identifiable? _Yes No Is this property being developed for (spec house)? Yes No Volume ivv r and Page Number as recorded with the Register of Deeds./A0 / 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. glge N , 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. 50611 -tea Y/ �/3/9� Signature bf Applicant C Applicant Date of Signature Date of Signature