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HomeMy WebLinkAbout040-1089-70-000 a o °C; o c 0 o a~ O N N N v > taco 3 N co 0~v ..r o EN j O N (6 to 0 O N > .q VJ O L L Ol U) 0 C m J, cn .c2o N -D 0 7 U .B O cn N ° 3= c Q) 0 Q) Q L) CO cn N 0 a ya m En M u co Q V z co Q) c + 0- -5 U. C a w `D• cn O Y C O L C c C Q 000OCD I 3 cn E z 0) z M co Lu a m O 0 z L)i o a~i Z c z to H- ~ (D ~ ~ M I O c • = O :3 1 0 z z o N zl ~ E N I _a c ~i 06 U) y m a~ o_ 0 N O G G E 0 m m N a E w O Z d N -co N J U y rn Z _ > v a~ N ~I (D ~ Q E .c o ~ m e a I o v v o v v Q Z in m O ° o i 00 N O C E p M O j Q) y O C y 7 p, O c CO a c o€ -r- cq ' U C O co 0 0 j H 00 O 2 o 0 V) E O R U • O Cl) H a N 0 Z `n ~ z Cn 0 ~ II v ~ L m a ~ L L: CL `~1 A oIL ov~ic°~ Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: • Labor and Human Relations 8T. CROIX S.tfety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENER~I~dAL INFORMATION Permit - log Na hUL & ELIZABETH ❑ City C] Village Town of: State Plan No.: CST BM Elev.: Insp. BM Elev.: Description: Parcel Tax No.: BM 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 TANKTO P/L WELL BLDG. ventto 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 Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER 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 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: Troy.23.28.19W, SE, SW, Radio Road Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ r a , SANITARY PERMIT APPLICATION ILHR In accord with ILHR 83.05, Wis. Adm. Code coa Y STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ai ~ q a -;I' 8% X 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN ) ~ . NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 15 y S LOCATION PROP OWNER PROPERTY EY, 50.) S 7-3 T 18N, R ey I (or )(2 PROPERTY OWNER'S AILI G ADDR LOT # BLOCK # _ _j I c2©2 /Y C STATE ZIP CODE PHONE NUMBER SUBOI'1v1E OR CSM NUMBER pjaer ~-l Ls Wr 6 2 ! yaS~ r/o / ro II. TYPE OF BUILDING: (Check one) 11 State Owned VILLAGE NEIkREFr ROAD ❑ Public ❑ l or 2 Fam. Dwelling-# of bedrooms S PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 040 - log -go 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. ❑ Reconnection of 5.0 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 N Mound 30 El Specify Type 41 El Holding Tank 12 El Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. 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 0_61 3 S ZI; o~ 102. S Feet "W7 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New kz~istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank / t-e ur Lift Pump Tank/Si hon Chamber G st b lP.T¢I^ IQ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name (Print): Plumber's 'gnature: (No Stamp MP/MPRSW No.: Business Phone Number: Plumber' Address (Street, Ci State,'Zij Code): , o'er A d`f~C lS $Vo 2-IX. LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sad, LrY Permit Fee (Includes Groundwater Date Issued Issuing Ag t Si ur (No S ps) 5 Approved E] Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS , 1. -A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. Ali 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. Onsife 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 131/2 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; close 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. S8 D-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations November 15, 1993 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S93-41285 FEE RECEIVED: 190.00 POULIOS, PAUL & ELIZABETH SE,SW,23,28,19W TOWN OF TROY COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, 2 .1 O ~ C*4 _j Gerard Swim Plan Reviewer. Section of Private Sewage - (608) 785-9348 2844R/ 1 ~~SBD.64231 R. 01 /91) Page of 6 MOUND SYSTEM FOR A S BEDROOM RESIDENCE S9347285 LOCATED IN THE SC 1/4 OF THE Sw 1/4 OF SECTION Z3 T Z$ N, R 19 W, TOWN OF -1ZU~( r ST CA-LJjX COUNTY, WISCONSIN. INDEX 3 PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PA GE 3 of 6 PLAN VIEW-CROSS SECTION : PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE coo PREPARED FOR ~t'CUL. \~►v~ ~L\ZF\~3E"Rl ~OULI,QS '~1_lJ _Y~ l,l_ S t LlJ ~ S~ Q Z. Z FREPA= BY WEGEE~ER SOIL . TESTING v~ ~SCoey AND. * DES I CN SERV I CE o~;.r'' ARTHUR L. P-0. BOX 74 421 N. MIN ST. r ® ~ WEGERER Ts 0-875 P + w RrN. RIVER FALLS. VI 54422 r 715-425-4165 'e I G 14 11-2_R3 JOB NO. a 3- Z b q PLOT PLAN Page 7 -of b scale 1"= 'to' 5 S9341 29 iQ.65 ~~s M Wg J J 2oct ~~~0 lip J ?~U-Ae J 6p ` 15 I~Y N Lp~FprV . SYL t'N X W ~1L 'N. 8~ VP T UE" Su F w►ov ~vp ~No t LFlts'T Z S NOV 12 ~3 ZS- i SAFE II r- , ~1.L08 a If i a a~-70/ I P~~ os~ o ~ - S j a P 81~-1'L•l00•p ON 8~. A 1iL6H- Aj"DI A. PU I' I P~ P~ w / L.t}'R1 CLIt6- I , - „Qv A E`ISSVST 200' OF 3'~ pvCO~lA~ltlOil~' FcR.CC ►'~1~1N o~ PPROVEI ~ r DES; OF tNOUSTRr, T LIBOR & NUAIAN DIVISION OF 3IOP1S ET1r AHD o y~J NOTES: g 1. Elevations shown are existing ground eldr~ ep 93SoOrati~ oted. 2. Install permanent markers at end of each lateral. (Y required) 3. Install 4" observation pipes with approved caps. ( Z required) 4.-Septic tank to be 16~-AS gallon capacity manufactured by 1,31ZSILSZ Ccwc R.g 1571 T% C~ -►n M~Q To " wtknint WeAD Gt, •L- ' 5. Bench Mark spvCT 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of 6 5 9 3 4 1 Approved Synthetic Covering Distribution Pipe Medium Sand Topsoil F Elev _ 01. 5 E " b ; `A % Slope Bed Of 2N- 2 %2 (Force Main Plowed }~~j~b*~s~ .rp Aggregate From Pump Layer D t•0 Ft. Of WOUSISY ►J►B~ HUM Cross Section Of A Mound System Using E 1 Ft. DEPT. 6Ui1.~`'w~ tNVt 0* OF ed For The Absorption Area F z, 8 Ft. G 1.O Ft. c, E SEE C SPOND ~a A 6 Ft. H VS Ft.' GPD/LN FT B 105 Ft. Linear Lo ding Rate= Design Loading Rate=o•,sY GPD/SQ FT j l5 Ft. J -7 Ft. NOV 1 2 1 *no C3 K kkz). 5 Ft. SAFETY & MCI " e ate °~-,i v„ L lZ,b Ft. Z`b Ft. F„ n Ma; Z L Observation ' Pipe A W - - ---------------------I17F orce Main Ek.31ulm PVT ° N N oPPUS l C ~F1 Distribution Bed Of 2 - 2 2 Pipe Aggregate I Observation Pipe Permanent Markers (Anchbr securely) I Plan View Of Mound Using A Bed For The Absorption Area Page y Of Perforoted Pipe De loll End View Perforated End Cop.) PVC Pipe 0>e Install permanent-marker s`a, _ at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main Q PVC Manifold Pipe ution * * NOV 1 2 ~v3 Distrib " Pi e Last Hole Should Be ( SAFETY at EL!'". Next To End Cap End Cap I P ~°L6Ft. Distribution Pipe Layout $ 3 Ft. X b Inches aM Y Inches Hole Diameter Inch 40 ditlott Lateral Inch(es) Manifold 3 Inches ® ~'I1Q u HDMpDs Force Main 3 Inches ~st4Y• D # of holes/pipe DEVI- ~ 10h ~ Invert Elevation of Lateralstn0.0 Ft. SSE G Place 1st hole 35 a from center of manifold with succeeding holes at 0" intervals.. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTIOW ARID SPECIFICATIOUS PAGE S OF 6 VEiJT GA► SO 341 H"C.Z. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE JuWCTION BOX COVER WITH WARNING LABEL 10' FROM DOOR, IYMILI. WINDOW OR FRESH ) AIR INTAKE I GRADE I 'ir M1A1. I0' MIN. COWDUIT-" 18"NIiAI.~ lh _ PwKOVIDE I INLET 5-jSA1AGHT SEAL I II) f 44 AGS I I V e I APPROVED JOIAIT A 11 Onstr u hall -Omply I I I ( APPROVED JOINTS I I. HR 83.20 Ill ALARM with approved wit Vls'- pipe extending -1 I 3 feet onto solid soil. ENO I ( ON Both sides of c a0I -.~c~t 0 0 I I " nk. t a L L E V.3 F T Dom' Wv10~`- -;SUMP-~ OFF N D g,rE GpK'~ SXFEV & IE'~. X6.0 CONCRETE BLOCK APPRW9c, RISER EXIT PERMITTED ONLY IF TAWK MAIJUFACTURCR HAS SUCH APPROVAL gEppllyG SPECIFICATIOKIS ~ii...• TAWK MAIJUFACTURCR: W~ CI JC TB _ PROI~%JLTS IJUMBER OF DOSES: 3~ S PER DAy TAWK 51ZE : ti~VG GALLOWS DOSE VOLUME t -1 ALARM A"FACTURLR: S`~1 ST IIJCLUDIAIG OAGKF4OW: GALLONS SS.LTL~'~p L~ 1S MODEL AIUMBER: LuI Mw CAPACITIES: A= "~~Z-ihICHESOIL SOZ'y "LLONS SWITCH TZIPF.: Evlk wya-Y 8= z INCHES OR S-2"2 OfLLOU5 PUMP MAIJUFACTURCR: ZA - Cc~Y"IPh~`1 Cs oil/z- IUCHES OR 272''7 GALLOWS MODEL NUMBER: 63 lP D:_71ZINCHES OR GALLOWS ti"► ~`~-Y MOTE: PUMP AMD ALARM ARE To D ~ Of SWITCH TYPE: MINIMUM DISCHARGE RATE Ll Z- 17L INSTALLED 0 7 CIRCUITS/„/ Z 1. 1-7 VERTICAL DIFFERENCE DETWEEM PUMP OFF AMO-DISTRIBUTIQW PIPE.. FEET MINIMUM NETWORK SUPPLY PFLE55URLE.... 2.50 FEET + Z- SS FEET OF FORCE MAIN X 2'~3f//00rtFKICTIOU FACTOR. 6 FEET TOTAL 09IJAMIC HEAD = -2-4 FEET DIAMETER % INTERNAL. DIME.IJSIONt OF TANK: LENGTH - ;WIDTH -.;LIQUID DEPTH BOTTOM AREA r- 231'= GAL INCH AS PER MANUFACTURER = ZS-7) GAL/INCH _ W HEAD/CAPACITY CURVE 161, 163 AND 165 SERIES TOTAL DYNAMIC HEAD/FLOW PER MINUTE W w EFFLUENT AND DEWATERING f LL 28SERIES 161 163 165 so FT. M. Gal. Ltrs. Gal. Ltrs. Gal. Ltrs. za 80 5 1.52 106 401 61 231 61 231 ` kmo EL 10 3.05 100 378 61 231 61 231 _ 70 - --MOM 15 4.57 91 344 60 227 60 227 °a 20 163 20 6.10 82 310 59 223 60 227 = 60 25 7.62 74 280 57 216 59 223 v 16 30 9.14 65 246 55 206 58 220 Q 50- 40 12.19 46 174 46 172 55 206 12 a 50 15.24 21 80 1 191 a OD L 60 18. 15 43 161 t- 30 70 21. 30 114 6 zy -53 A 80 24.38 14 53 20 90 27.43 4 10 44 .%.7 100 30.48 Lock Valve, 56' 66' 87' 0 GALLONS 10 30 40 50 60 70 80 90 100 1110 LITERS 0 so 160 240 320 400 r FLOW PER MINUTE Standard all models - Weight 77 lbs. - 20 fL cord - % H.P. - - 1%- 11%NPT 161 MODELS Control Selection ' ~3-6 (OR) _ Model Volts-Ph Mode Am Sim x Duplex - M161 115 1 Auto 14.0 1 or 1 &9 N161 115 1 Non 14.0 2or2&8 3or5&6 IR - A _ - l D161 230 1 Auto 7.0 1 or l &9 E161 230 1 Non 7.0 2or2&8 3or5&6 7- F161 230 3 Non 3.0 2&4 3&4or5&6 I 2 n' 'H161 200208 1 Auto 8.2 1&9 - In `1161 200-208 1 Non 8.2 2&8 3 or 5& 6 $ 'J161 200-208 3 Non 2.2 2&4 3 & 4 or 5 & 6 ,sx QLQ~~~ ~y,l~• 'G161 460 3 Non 1.5 2&4 3&4or5&6 I 1 ` Standard all models - Weight 77 lbs. - 20 ft. cord -'h H.P. i 163 MODELS Control Selection s Model Volts-Ph Mode Am Simplex Duplex - M163 115 1 Auto 14.0 1 or l &9 N163 115 1 Non 14.0 2or2&8 3or5&6 - D163 230 1 Auto 7.0 1 or l &9 E163 230 1 Non 7.0 2or2&8 3or5&6 F163 230 3 Non 3.0 2&4 3 & 4 or 5 & 6 SELECTION GUIDE `H163 200-208 1 Auto 8.2 1&9 - 1. Integral float operated mechanical switch, no external control required. ''1163 200-208 1 Non 8.2 2&8 3 or 5 & 6 2. Single piggyback mercury float switch or double piggyback mercury float `J163 200-208 3 Non 2.2 2&4 3 & 4 or 5 & 6 switch. Refer to FM0477. 'G163 460 3 Non 1.5 2&4 3 & 4 or 5 & 6 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. 4. Combination starter. Refer to FMO514. Standard all models - Weight 92 tbs. - 20 fL cord -1 H.P. 5. See FM0712; for correct model of Electrical Alternator, "E-Pak". 165 MODELS Control Selection 6. Mercury sensor float switch 10-0225 used as a control activator, with "E-Pak" V Volts-Ph Mode Am Sim x Du x alternator, 3 or 4 float system. 7. SIMPLEX CONTROL BOX 10-0050, 115/230V, 1 Ph. max. 2HP use one (1) 230 1 Auto 9A 1 or 1 & 9 - single piggyback wide angle mercury float switch OR two (2)10-0225 mercury 230 1 Non 9.0 2 or 2 & 8 3 or 5 & 6 sensor floats for level control 230 3 Non 6.6 2 & 4 3 & 4 or 5 & 6 8. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in 200-208 1 Auto 10.7 1 or 1 & 9 - simplex or duplex operation. 200-208 1 Non 10.7 2&8 3 or 5 & 6 9. Two (2) hole "J-Pak", junction box, for watertight connection or splice. 'J165 200-208 3 Non 7.0 2&4 3 & 4 or 5 & 6 'No Molded Plug '13165 460 3 Non 3.3 2&4 3&4or5&6 For information on additional Zoeller products refer to catalog on Combination Starter, CAUTION FM0514; Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0486; Mectumical AN Installation of co al proseclon devices and wh" should be done by a Mewed gtraitied Alternator, FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex electrician. AN electrical and sandy codes should be toMOwed lnekoft ft mod ratios National Control Box, FM0732. Ebctrlc Code (Ep and on 0coilpolkinal Sandy and Hanish Ad (OWl RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 3280 Old Millers Lane Manufacturers of . ZAIZZLff O_ P. Box 16347 O Louisville, Kentucky 40216 © (502) 778-2731 ,QL(UrY )9LWA9 SNCT lyyg Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor arjj Human Relations Divf&Rin f Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code _ COUNTY A `M ST♦ CW(/E Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION Pf-CUL 1vK~ L LIZPrBim:j V>,pv LLOS GOVT. LOT S E 1/4 SLj 1/4,S Z3 T 7.f3 N,R Icl E (o M1l PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1.Q~cl w. \-VA r-1LL`TO`tj t_~ Z. - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®fOWN NEAREST ROAD ~lUl~2 l.lS DUI S~UZZ- ()tS) 4ZS, ~7SZ --r9_011 `tZ 'ZIZ \~R\~ New Construction Use [5~J Residential / Number of bedrooms S [ ] AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ~1 S O gpd Recommended design loading rate o 3 bed, gpd/ft2 - trench, gpd/ft2 Absorption area required ~ZS bed, ft2 6L5 trench, ft2 Maximum design loading rate o- S bed, gpd/ft2 0 - to trench, gpd/ft2 Recommended infiltration surface elevation(s) 1 ~1 5 ft (as referred to site plan benchmark) - I =~5 Additional design / site considerations H uvA)b w t 7-M 6, x 1(3 S , a eo - wn t A j. 1' ov ' A x.'~h r-ILL Parent material S PN►j\-a `1 Lu >h Tt LL Flood plain elevation, if applicable N A . ft LU =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRAD SYSTEM IN FILL HOLDING TANK =Unsuitable for s stem El S ®U OS ❑ U ❑ S IOU ❑ S U ❑ S 1 U ❑ S 1J U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch ti~.xati<.:r,:.tiS; VYl \ t^ 0.'S _ ..7 • ~ U ~ V 2 g-74 t `Z l2 31 L S t Z r<S (3,S 3 S `1 R- y16 - S Z C. \'r m v f 1, e o S o. 6 Ground elev. I~~ 8 ft. 3~-~16 '1•SyR y/(, S-1 R y/y SC.1 Depth to CdAv 7 v S tb _t a S /3 Sn►W Cam'! rS limiting , . factor Remarks: J Boring # S1 S s 0-9 ~o~Q 3/~ _ Zf sb~ 2 q-t6 to`ffR3/` S1, 2-~s1~k Yn~l, CS o.Sv.L Z 3 16-33 LlR'!!b S"i Z.c~bVL .1•nv'~4 cS Ground _ r. elev. ~ 33 -Yti -)-s Y2 VA l s 1-1 tz y/ m 4 V->ti 1o1.? It 3 S ~'1 R S v uv Depth to limiting factor , Remarks- CST Name:-please Print Arthur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: Date: -7-3 CST Number: M00576 C'l3- zLR PROPERTY OWNER lr vL-IOS SOIL DESCRIPTION REPORT Page 2-of 12, PARCEL I.D. # t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 11))bz v~~F~ a.s ~ o.s o.6 z g-~1 lu 4 Q Z~SPh m'~~ cs - o,S U. 6 Ground 3 \7 3 °I S `1 Q y/(, S Z C c0.* Yn V iF , C S - v• S u. elev. loS.o ft. 4 31-U9 ~•S y2 y/` Sya y/ Sc1 ow ~Y-►rt~i - - - Depth to 3 S ft~ t, NJ 6m Q limiting factor 39" Remarks: Boring # Ground elev. 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) Y PLOT PLAN Page 3 of 3 SCALE 1"= qb ' ~tq7 ,92 I X9.65 ~e~t~,s a 03 I ~ a ~ 10 X ~ e ~J T ~ ~ 2 ~ o e- Pr`fiory SYZ~,TC N 0 2 i I z8' ~.~u4a i T3•~- 2g I II i a I rj I ~ I I t'~,L06 ~ I ~ v1 ( -70fo I j p~-~o~ os I I r- ~ I S Bo ~ I ~ 2 At l~r w / L1~TH ~ZIUS° I 6.3 ~ e -Z V O~ 93_z69 C~3 (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 labor and Human Relations ] i Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST, CtOIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Pf'~UL t l.t?.Pt'$~TI ~v LL OS GOVT. LOT S E; 1/4 SL--j 1/4,S Z3 T Z$ N,R l4 E (00 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # -UT-Y, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD l~t0Ev- F-4MLL_ s "11 Syoz-z- (ors) 4LS, g~sL _M01-f R~ot Z pQ New Construction Use Residential / Number of bedrooms S [ j AddiWn to exisfing building j ] Replacement [ j Public or commercial describe Code derived daily flow '1 SO gpd Recommended design loading rate o 3 bed, gpdd/ft2 - trench, gpd/fl2 Absorption area required bZS bed, ft2 6L 5 trench, ft2 Ma)dmum design loading rate o- S bed, gpd/ft2 0 , 6 trench, gpd/112 Recommended Infiltration surface elevation(s) l O-t • 5 ft (as referred m site plan benchmark) Additional design/ site considerations ,..M Oua p w L Trf 6'x f 0 S ' S eD - rn t N . 1' Or s)h &.'t Fr LL - Z 5 Parent material s AKx-zt, 4 ba k m Tr LL Flood plain elevation, if applicable N A • R S = St~tatAe for system cow noNAL 20 S IN-GR"D PRESSURE AT-GRAD SYSTEM IN FILL HOLDING TANK U= Unsuitable for ❑ S ®U MOUND S O U ❑ S IOU ❑ SU ❑ S I~ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence ft xtary Roots GPD/ft in. ' Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mrch O-8 10`ttZ 31y Sl1 Z ~Sbk v~f h C'-S - b•S d~6 Z g_zy ~r3Ia 31L - Std Z FSbk m ~1- cs OS o•b _ rimlwalill v eS - v 5 a Ground 3 24-3' • S `f ~!/6 s I 2 c ~.bk 'M - elev. - ~O`1.8 ft 3p -Y6 '1•s `1R y/6 S`IIL y/y Sc~ ovh vn~4->K~i _ - Depth to O C N S ITS-t2 S /3 Stpv> CapI-S limiting factor 3~y Remarks: Boring # I 0-9 ti0`1.Q 31`f - St ~ ZfSbk ~ f 0..s o•S b 2 Z 9-16 IQ' -1tZ WL s t, Z sbk wt ~t, cs r c, S o. L 3 16-33 --),S Ll IL yit, S z C~ek . v cS - o• s o. b Ground p elev. 33-Y6 -).S Y2 VA t S L1 R V/ Cn Mi T'-1ti 108 ft. 3 Srcwt INS U oQ Z , Depth to limiting factor y T Remarks: TNarne:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: QA41L C/ Date: CST Number: q3_ z69 1b-Z9-~3 M00576 3 Of PROPERTY OWNER loS SOIL DESCRIPTION REPORT Page r PARCEL I.D. #E x Depth Dominant Color. Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench n- S 3< 1 V 1 S 1 Z'F S bh m S v. 6 A. Ground 3 ~~-39 S yQ YA s ZC C-%r* Yn vf~- c s - u• S d. b elev. IQ&.) ft. U 39-y9 ~~s y2 SyR y/ scl o`^^ ,M~y-m~i - - - Depth to 3 S n~0`i~ Q limiting factor w 39 Remarks: Boring # 13 Ground elev. ft. Depth to limiting - factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # E {xY• AY 4~.YVY'iry•~:i•A~ Ground elev. ft. Depth to limiting factor Remarks: y PLOT PLAN Page 3 of 3 - SCALE 1"= `{O ' o 00 toot ~ F~C1-D 1 Q ~ L.u e r~~~ry SYt'vTCN G 1- 0 i J 8•~- 1 2g . I I I ~ I ~ ° CL I I j e>r~oe e ~ a ~ I ~ I '1°fo cg i P\ZO\~ os ~ I ~ j i S 80'x'1 2 i _ I I D ! 7 A p i k5-L- too - `c1lGl-H- 3/y"DID. PUj i ? Pt tit w / Lfl~ et.toS I e.3 t e ~ ~ , - - - - - -i j ICI i O Apo or U n~ 93_z69 C~3 (715 ) 4 .5-01 65 M00576 CST Signature Date Signed Telephone No. CST # 1 ' mm I poll" p"11 . _ -rift... - - - - „rw•..r.,..,,.pc., .•.....,.3.~:~° - - , tr.,r . ° JOB NO.- 74 -014 j ry I /0~ % .I AD 1 ouj c r r FOR '%et of s,E %F . a' Jfw %f q reelign ,Zh T~ryissbirn..: 28 ;Keith Rags .11V . ett, 0 . M.. of ...Tray, T _._,.~"f•~ jyl~rc .St. Grotx:_ ~os.~nt1/~: r t. _ S 89006sVi Ig777,4'. t , Y • S 84.OI' HQ's' 0 INDICATES IRON PIPE STAKE BASED ON A SURVEY MADE 411117¢ E 4 oAT9 4-30-7 CCAL9 r so0' n CHMED Z3 28 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County WNE DYER MAILING ADDRESS 10°1 w N. M t L -roo Pe- Ri v&c fA u4 W1, PROPERTY ADDRESS C;24 ;t- ]Cc N p~~ D (location of septic system) Please obtain from the Planning Dept. CITY/STATE Ti2b. c In CROjX CO ~'S`' ^s ^ PROPERTY LOCATION 5 E 1/4, 5 W 1/4, Section z 3 T Z$ N-R_j~ W TOWN OF Tay ST. CROIX COUNTY, WI SUBDIVISION ° rv E LOT NUMBER N~ CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER N/ 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: X GOB DATE: " 9V 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 Pc.~.~ ~U za t3G-~H Pdu-L Z S Location of property__~ E, 1/4 I~ 1/4, Section 23 T 2$ N-R I a W Township -Fe -ay Mailing address tool 4Ayh1L~(aLD Da-. (Z%vc255~, S WF Address of site d & Z P, a-" U Subdivision name N ON S Lot no. N° Other homes on property? Yes ✓ No Previous owner of property 12%c,4Aa-Z7 L, ~ST'~ gE:iR Ct Total size of property t 9• CAS cu,^cs Total size of parcel SA. e-nL Date parcel was created 4 - 3 o - -)`t Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? Yes ✓ No volume 90 9 and Page Number IG-41 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. I i I 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. 1 -2/ 5 3:7 , 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 C6--A licant 6 9~z Date of Signature Date of Signature S TAT fFAC[ RCSERV [D FUR RLCORDINU OATH - DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-198x f - WARRANTY DEED V1J37 W fl PAGE 164 REGISTER'S OFFICE This Deed, made between _Richard--L.,- Sternberg dad ST. CROIX CO., WI Beverly A.. Sternberg, .husband, and wife--as joint. Recd for Record tenants - Grantor, .111E 1 0 ~g~~ and Paul Poul.ios and Elizabeth Pou1igs,_husband---- pt 10:45 A. M n and wife as marital survivorship property. ~~irn'►,RJCJC ~~Wftq of Deeds Grantee, Witnesseth, That the said Grantor, for a valuable consideration. - - - - RETURN TO conveys to Grantee the following described real estate in County, State of Wisconsin: KfU~'i R_,il FJ~af~- c~~o- I Tax Parcel No:.-..-•-----• PART OF THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER (SEZ of SWZ) OF SECTION TWENTY-THREE (23), TOWNSHIP TWENTY-EIGHT (28) NORTH, RANGE NINETEEN (19) WEST DESCRIBED AS FOLLOWS: Commencing at the S3% corner of said Section 23; thence NO028'48"E 659.83 feet; thence N89°06'33"W 1297.92 feet; thence SO°11'49"W 660.9 feet; thence S89°09'19"E 1295.03 feet to place of beginning. SFAS k This - is_not.---- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; and Beverl A. Sternberg _ Richard L. Sternberg- that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record and will warrant and defend the same. Dated this /o?, _ day of July. 19.91 (SEAL) (SEAL) Richard L. Sternberg .(SEAL) "Bvriy (SEAL) A. Sternberg AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF WISCONSIN ss. - S.t-r.-.Croix---------- ------County. authenticated this day of--- . - , 19-.--.- Personally came before me this . 1A..._..day of .-.--Jiuly...... 19.91-- the above ramed Richard L. Sternbergand BeverlyA - - Sternberg TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - - - . - authorized by § 706.06, Wis. Stats.) to me known to he the person ..S.._ _ - who executed the foregoing instrument and acknowledge the same. THIS IN TRUMENT WAS DRAFTED By Steven B Goff, Attorneyy at.Lav. ~A f~QV R. 110 North Main Street, Box 167 River. Falls,..Wl...54022_ Notarv Public St. Croix .e unt%, Wis. I~ilnature= may he authenticated or acknowledged. Bath MY Commission is permanent. (lf not, state expirratwn are not necessary.) date: > •?ism~ of pervo- signing m eny cep ari•y sh„ ad he tyre-i inted b--I,,w their eignatu-- STATF. BAR OF WISCONSIN ~►LCfTM[,[r FORM No. 1-1982 Stock No. 13001 u D ST. CROIX COUNTY F I ( E Q , SURVEYOR'S RECORD FEB 2 ~a►+ES o 4 1978 3 4 6 8 22 CERTIFIED SURVEY MAP ` w, ,Z CHARLES WALKER Part of the Southeast 1/4 of the Southwest 1/4 of Section 23, Township 28 North, Range 19 West, Town ofTroy, St. Croix County, Wisconsin. N 89 ° 03 48" W 13 00.80 I I ~ .2 ~ vi "33 aj ~ L OT I / %r I N d. lop ~ M ` _9, 8•d. ~c . 2, `~(l ~I ITV ~1 00 N 89°0s` 16"W 1 299.17 Lo -r Z. EX I ST 1'd G. IQ 9.84 AG. R.¢sID¢NCC NI ~ 0 m 1.1.40° 26'48"~ o Indicates 1" x 24" round iron pipe set 65,9.63' weighing 1.13 lbs/ft. S ►/4d Gorr . Sme_ 2.3y o Indicates ill diam. iron pipe found. T2B M ,R.19 w . (MON. Foowb) Descriptions That certain parcel of land located in the SE 1/4 of the SW 1/4 of Section 23, T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin, described as follows; Commencing at the South 1/4 corner of said Section 23; thence go N 000 28' 48" E a distance of 659.83 feet to the Point of Beginning of the parcel to be herein described; thence N 000 28' 48" E 659.84-feet; thence N 890m03' 48" W 1300.80 feet; thence S 000 11l 49" W 660.90 feet; thence S 890 061 33" E a distance of 1297.92 feet to the Point of Beginning, the above described parcel containing 19.68 acres and being subject to easement for Town Road purposes over the Easterly 33 feet thereof. State of Wisconsin ) County of St. Croix) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Charles Walker, I have surveyed and divided the lands shown hereon according to official records and in accordance with provisions of Chapter 236 of Wisconsin Statutes and the St. Croix County Ordinances; and that the map and description shown hereon are a true and correct representation thereof. Datedi 20 January 1978 James L. S 10 2 , 01 4;Mu A-; JAM~8 L. _ Reg. No: g; M Vol. 2 Page557 MURPHY Certified Survey Maps S~ 1 0 4 2 i~ St. Croix County RecordsRIVER FALLS/ St. Croix County, Wisconsin APPROVE-0 wISC, k, 00 APPROVAL OF THIS MINCIR SUBDIVISION FEB 15 1978 DOES NOT M_M;d APP.,GVAL FOR BUILDING SiTc OR SEr)'IC SY-TEM. ST. CKOiX Lev iY REFER TO H62.20. COMPREHENSIVE PARKS PLANNING AND ZONING COMMITTEE