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HomeMy WebLinkAbout040-1147-20-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER L44A, ADDRESS 3oG cL)E, x B a~ 6L ds4r, 1101 j-y")/4 SUBDIVISION CSM# C SM I1~1 9 °n"~ y/S LOT # SECTION 1,Y Tc93_N-R_L~_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM e rfl~ Lbe'l9er S@P~,cTan~ ~copoj a(, Wetsrr paw`P Ta"~ 7cvp a •f C©r c re •e for- wed Stove clew /00.00 JVar1'~ Sca(c 1'r= 30' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f } BENCHMARK: &Po C 6,mcsefe ~►Lt6dS/Ode ALTERNATE BM: SEPTIC TANK/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: U)Qs ej' Liquid Capacity: 1 2 Q Setback from: Well House_ _Other Pump: Manufacturer__ M~ip~ 5 Model#..Shi y Size • ~j/~~~P r Float seperation Gallons/cycle: ki'b %a Alarm Location SOIL ABSORPTION SYSTEM Width: Length 75 Number of trenches OZ Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: / o PLUMBER ON JOB: C LICENSE NUMBER: # R~ INSPECTOR: 3/93:jt •Wisconsin Department ofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and-Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Pla CRIST, ROY/JUDY q3-1 'i CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /oJ . (,U /,-9 , C ~ as ? 0~ ter, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j Benchmark Dosing . ion Bldg. Sewer A at Holding St/ I Inlet 3SL 9 /d ' TANK SETBACK INFORMATION St! Outlet ' ?e y' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic /Gb NA Dt Bottom 12,73 Dosing }r ~~//Js C2 ~~7s NA Header- S!d Aeration Dist. Pipe Holrg"` Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand a We Model Number <dM GPM TDH Lift4,:~13 Frictions System TDH Ft Loss Head Forcemain I Length Z.5 Dia. Dist. To Well SOIL ABSORPTION SYSTEM TRENCH Width Length,, ' No.Of Trenches PIT No. Of Pits In Dia. Liquid D pth DIMENSION o~ DIMEN I N SYSTEM TO D P/ L BLDG WELL LAKE / STREAM LEAC Manufacturer: SETBACK ns CHA BER Mode Number. INFORMATION Type O OR UNIT System: 6-et61Fe5~/,jo DISTRIBUTIO SYSTEM Header Distribution Pipe(s) ev r- x Hole Size x Hole Spaci en Intake Length Dia. Length 7L Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sy I Depth Over Depth Over xx Depth Of Seeded/Sodded xx u pod-nrench Center B~J~rench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 5 r- LOCATION: Troy.13.28.19W, NW, W, Lot 1, East ove Road Plan revision required? 0) es ❑ No p~ Use other side for additional information. Q SBD-6710 (R 05/91) ; t Date Inspector's Signature Cert. No. pA, ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: 14 I I SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code St Croix STATE SANITARY PERMIT # =Attach complete plans (to the county copy only) for the system, on paper -not less than 224687 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. PROPERTY OWNER PROPERTY LOCATION NEgNE4 , Sec. 13, r 28, N, R20W and Roy Judy '/a '/4,S T ,N,R AWW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 300 East Cove Road 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson WI 54016 1015 )386-1625, CSM VOL. 9 PAGE 2415 II. TYPE OF BUILDING: (Check one) ❑ State Owned NEAREST ROAD Tro East Cove Road ❑ Public ®1 or 2 Fam. Dwelling-## of bedrooms 4 PARCELTAx NUMB (s) III. BUILDING USE: (If building type is public, check all that apply) 040-1147-20-100 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.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 30 ❑ 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 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 600 750 750 .7 95.2 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App [Tanks Tanks structed Septic Tank Lift Pump Tan Xximew 1000 1000 1 Weiser VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu r/ ature: (o mps) MPI No.: Business one Number: Paul C.J. Steiner 6780 715 _ Plumber's Address (Street, City, State, Zip Code . _.M2_10 q45t--h Riye-r Ealls. WT ~4022 IX. C TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater) ate Issued Issuing Ag t Si nature (No mps) Sur ee 4~ pproved ❑ Owner Given Initial Adverse Determination li 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 r 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 r 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) PUMA CIIAV111YR CROSS `SECTION AND SPECIFICATIONS Vent Cop - Approved Locking Neathar Proof Manhole Cover . Junction Aox' , 1211 Min Vent Pips ?tin Final • C r a d c 18'' H i n Co nduiC 18" Min " A ov c d PPr Joints W/ Inlet • , C.I. Pipe Cxtcndinl: Approved lag 1' Onto Joint w/ Solid Cro C.I. Ai c Extending a' Onto i AlAro► So lid o Ground On C .Pump Of f • Concrete Block' A M SPECIFICATIONS T A N 1: p--^-•^ i ilanufacturcr: -Weiser Manufaccurer; s Tank MatcriulCon-Crete Modal NumbaC: Tank Siza1,000 Callonc Switch' Typa Float Total Dyttiamic Ilead: F CAPACITIES Yutn~~ pi:,charl;c R.ttc: CI 'Total Daily k,fflucnt:Callor - Per Di A » or 480 Callone Numher of Doues 4 Calloc It Gallons Dose Volume; 150 » ~ 2-- or --Gallons Notes: 1. Scc pump' curve for or 190 .------Cnllona additional performance or a36 Total 1'ank information. Capacity acquired » 1,014Cnllona 2., Pump and alarm aCe to be inatrilled on ucpacaV: circuit au per 1wia 16.19 HAG ALARM It n n u f n c t u :r a r I T Peel a No.ic l Itumta<<: D ;t w i t c 1j Type. Float ' G ~ Pa9e~ of 500/4 ' Features Pump impeller is recessed Powerful 4110 HP Motor is Rotary Shaft Seal has carbon Micro Switch (SS4 A) has per- 'Tornado" type - operates oil filled for good insulation and and ceramic faces for positive mannnt magnet on switch arm for completely out of volute passage lubrication of bearings and seal. seal. Body is stationary, prevents activating switch. giving full opening for flow of Overload protection built-in, has string or trash from winding ASS Plastic Operating Switch liquids and solids, no starting switch or relay on seal. (SS4 A) has steel follower molded Motor Housing is heavy cast mechanism. Switch Housing (SS4 A) is into top for activating switch magnet. iron, epoxy coated. Stator is Thrust Washers and Sleeve completely sealed from sump . pressed to for perfect alignment, Bearings are oil lubricated for liquid, easily removed for best heat transfer. smooth operation, long pump life. replacement if needed. Dimensions U ~ r I Performance Curve ~r I hFA~ CAPgC~rY ' , ~Y Accessories Performance Table Total Feat 2 4 6 8 10 12 14 J6 18 20 22 Head Meters .61 1.22 1.83 2.44 3.05 3.66 4.17 4.88 5.49 6.10 6.71 r Gallons Per Hour 3,600 3,600 3,450 3,300 3,150 2,900 2,550 2,250 1,800 1,300 660 x 4,911 2,498 6,613 11 C] Liters Per Hour 13,625 13,625 13,058 12,490 11,923 10,976 9,652 8,516 1 :j Performance Capabilities ° e o®o Q ❑ ❑ ❑ Capacities to 60 GPM 227 LPM ® Heads to 24 feet 7.32 meters Pum Down Range * 4 to 4Vz inches 101.6 to 114.3 mm Solid Handling Capability % inch dia. solids 19.1 mm dia. solids Liquids Handled Fresh, drainage effluent waste water Intermittent Liquid Temp. 150°F 66°C Motor Vio HP Electrical 115/230 V., 12.0 Amps, 14). 60 Hertz Discharge 1V2 inch 38.1 mm x rr 'Automatic Model. (manual pump variable with swilcn)• - J. Myers F.E. Myers Co., Division of McNeil Corporation Ashland, OH 44605 (419) 269.1144 Telex 96-7443 SANITARY PERMIT APPLICATION COUNTY • V'~L■'■■'l In accord with ILHR 83.05, Wis. Adm. Code St Croix STATE SANITARY PERMIT # --Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Chi if revision to prey us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION NE4NE4SeC. 13, T, 28N, R20W and Roy & Judy NW '/4 NW '/4, S 18 T 28, N, R 19 &MOW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 300 East Cove Road 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Hudson, WI 54016 1(715 386-1625 CSM VOL 9, Pq 2415 II. TYPE OF BUILDING: (Check one) ❑ State Owned NEAREST ROAD RI TOWN OF: I East Cove Road ❑ PUbIIC 121 or 2 Fam. Dwelling-# of bedrooms A_ PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 040-1147-20-100 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 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 30 ❑ 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./inch) ELEVATION 600 750 750 .7 95.2 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank wN1*Wk9s3fift _12~ . 1 wp-i ger F-2 F-1 I Ll I Ll F-1 r_1 F1 Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu er's ignature: (No tamps) MP/192F.SW No.: Business Phone Number: Paul C.J. Steiner f;v , 1 C 780 715 ) 425-5544 Plumber's Address (Street, City, State, Zip Code): N8230 945th Street: River Falls. WI 22 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signat a (No Stamps) Approved ❑ Owner Given Initial 7 Surcharge Fee) y Adverse Determination [e4~/~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber s 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. Vlll. 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) ol I PL41 r'l Scale l k= 3®~ N lk ~ k ►xco ~f Se~`~ic Tan l .2 OX Y 1311 Flev. /00,0'0n 7trnc~iS 5 wreps~' 7b bows{ C oncrel a Bis e o f U N Wood S fov-t S a i L QS l coo e ~~Q/ o b ~y1 rye t0 ~ ~y ~C' MP 6 790 Wisco nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page N of 3 L2br-r and Human Relations. Division of Safety & Buildings in accord with Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x in ize. Plan mush in` de, but PARCEL I.D. # not limited to vertical and horizontal reference point (B 2}icerction a / slope, scale`' r l '47 - z0 - 0 O 11 a q 0 - dimensioned, north arrow, and location and distance t ne est a'° REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT Ct..INFORMATJOtj 1;' PROPERTY OWNER: ;31!A0PER TION k3E-W ti °F 19-L kt U, 2Z1ty 8 v~ t~~~ ~.,1 Tr a 1/4 n1 W 114,S t S T Z 8 N,R 19 E(a)Q) PROPERTY OWNER':S MAILING ADDRESS OT K# SUBD. NAME OR CSM # 3vo e- aaue R-0" CSth vu~, q ~L►s CITY, STATE ZIP CODE PHONE NUMB []VILLAGE ®rOWN NEAREST ROAD Hti~SOl.~ w L 5 ii n !S) 3$ _ l6 iZ,b1-f • cr~uE l~~lt~ [ J New Construction Use (J(J Residential / Number of bedrooms [ ] Addition to existing building 1>4 Replacement [ ] Public or commercial describe Code derived daily flow bon gpd Recommended design loading rate o - bed, gpolft2 9•% trench, gpd1ft2 Absorption area required 8 SB -bed, ft2 -1 So trench, ft2 Maximum design loading rate 13-1 bed, gpolft2 0- trench, gpd/ft2 Recommended infiltration surface elevation(s) 01,S • Z ft (as referred to site plan benchmark) Additional design/ site considerationsDIEV'WDW6 W eLW- of-- $_b G . S Bali R PyM P F'1 Pt-l dg R gra ut R m,. Parent material Lo ~Cs s o v eat- S PctuD w nu `rl j R s N Flood plain elevation, if applicable N- A- ft S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDMG TANK U = Unsuitable for system - ca S ❑ U ®S ❑ U ®S ❑ U 9S_ ❑ U ®S ❑ U ❑ S OU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisterce Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch - Sit z`FSb~ M'F►~ cw - o-s u•6 1 _ Z 1$-Z6 ►O~tZ 3!I 5)') Zw, Sbk w~'Fl- Cw ~ u.S o. L Ground 3 16-3-7 to 11fL ~/3 - s \ 1 c sb~ wt v'F1, cs - 0-q 0-s elev. S~ ( l CS bk vn C S ~9.2ft. y 3 -fib lo`IlZ 3!L - 0-2 Depth to 5 4-$$ -).SyL al S f~6tr O Saj wt ] _ 0.7 o. 8 limiting factaB a Remarks: Boring # bVz m'f t^ cw - o, S 6 b_ll, l0`1~ 31Z x vM^~ Sir,: 2 Ib Z3 lo`LR 313 - St I Z~1 sbh vn f~. Cw - o S o, b Iv~`t"'I2a: ~i 111 3 Z3 3S to ~tlz 3 I L Z 3bh w► `Fw cs - o, s o. L Ground _ elev. y S-uy ~•S`72 3l~ - SKG~. D Sg wt~ CS ' o~.~`$ S tf~!$b' ►O `1 R ~f/6 - S $G~. O S9 1'►1 Depth to limiting factor >S$" Remarks: CST Name.---Please Print Arthur L. We erer Phone. 715-425-0165 Address: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: 111q- 1$) 8-8--`l M00576 PROPERTY OWNER L-Q-LST SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# ~~t0- ~t~l`l_ ZO-l0o Depth Dominant Color Mottles 'Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boutx>ary Roots Bed Trench t.,.; 3 I a-~s toys ~l2 s~ Z~Fs6k yv% 0- k, o.s u, IL < 11111 •.:<'<-:' Z %S-ZS IotiR 3/3 S I Z.wr 5b4 vh `f I- C It's 0-4 Ground 3 Zs-~o U~41? 31t: std Z`F36vt o•s o• C elev. X19 5 ft. y0 -012 1O 011z (1/6 - S tf61- o 5.5 wM _ p . 7 •8 Depth to limiting factor ~~Zr Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ^'n Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05192) PLOT PLAN Page 3 of 3 r Roy, 8 Z \-b4 0-lz! S-r SCALE 1"= 30 ' P, Z ~o ayo- ~1~'7- Zo- ~o u t~cv~ : ~i ~~s1- ~'l~ P `M LUvE ! S l o C~ SOI.)1 t+ C,F SLe~ NU,% w~.~ ~S > 100' ~1ocz'n~w~sT Or T a tti CL s. 't' S, a g_1 L'rL 4S•1' S' S.3 ~t 9 9 Z' ~ qq s ~3! t - Lc~.o ON } COUCRL'~'1'~c %Ovslt a . . ~Y) OF WObD s1b~F. ~ to - DLO---- 1 *--L L Z `C1? !CIS SK 1.S' Lcx►G , w-,~,.~lw,ul! b• PCpA'rt.7T, -M, Pa ep, f( ~'~,F,c-otJ~ Ro►~fl gy-1al . -(715 ) 47.q-0165 M00576 CST Signature Date Signed Telephone No.. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page d 3 Labor and Human Relations . Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT• cAIIZ~x 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 EL 0 . L ~L-) - ZO -10 O dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION UST-U~oF s~ 19,T~►.t,22OOv Ll`-t ~ S~ CCZ ST" GeVT. lz T M I&) 1/4 N w 114,S IS T Z 8 N,R 19 E(or)Q) PROPERTY OWNER -S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 300 la-- C-ev ( rz_okta t - 0.9 r1 QoL., q, pq 7-q is CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EFOWN NEAREST ROAD hd> Nv~SO►~ t,~ l SLtul(. (-))S) 38(o- 11.Zc E• coUE RX, [ J New Construction Use [JQ Residential / Number of bedrooms (J Addin to existing building j>Q Replacement [ J Public or commercial describe Code derived daily flow 1.010 gpd Recommended design loading rate c bed, gpdtl 2 L- ! trench, 9pd19 Absorption area required % S8 -bed, ft2 Z So trench, 112 Maximums design loading rate o- bed, gpolft2 0• trench, gpo1ft2 Recommended infiffration surface elevation(s) °L S • Z ' It (as referred to site plan benchmark) ' Additional design / stle considerationst)eille~JbIIU6 W eu'u- of BLDG: S ewes, R PyM P "tPtl-t al RLQ ut pt. M. Parent material L- i l s S o v tm- S Pnvo w ou tw ft 3 N Flood plain elevation, l applicable N- A- It S = Stbtable for systf#rt CONVEMONAL MOUND IN- 0 PRESSURE AT-GRADE SYSTEM IN FILL HOLDM TANK U = unsuitable Or ter - Us ❑ U. ®S ❑ U ®S ❑ U $ ❑ U 4M$ ❑ U 11 $ ou SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Moines Texture Structure Cor>siStence B0.nd3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed iench I` O-l8 to~~ z (z Sil -L1- b' c vn'F1~ Gw - p-S o•b F 11s; Y' Z 1$-Z6 lO`tR 3!I S1 l Z►~ sbk v►n`F1- Cw u.S o L Ground 3 2%_3_ to `'1fZ 3/3 - s \ 1 ~sbk tin Uhf, C.S 0-q 0-S elev. , l SO I C.3 bk m 'Ft- C S g9.2fL ~ 3 -fib O`t2 3!` 0.2x'3 Deoto S 4.6-88 w - S gs~ o sg limiting factor S a Remarks: cw p.S 'so-6 Boring # ~ b_ t ` l0 `1 S2. 31 Z - S l l Z ~ b>z tih`f H 3 2 ) b Z3 10 `t R 313 - s i f 2w, s bh w1 Ctti - o - 5 o. ~ 3 23 3S t~J~ 'IR 31 ` - S t ( Z i Sblz '14- 0--s - o. s o. I, Ground o- . $ elev. %4- S-uy 7,S1 Q ~ 31Y - S> Gtr D o, Depth sq v~ cS ' - S t1~1-88 10 `i R y//. _ - S $Ga S9 hl 0.8 to - fimiting a Remarks: CST Name:--Please Print Arthur L. We erer Phone. 715-425-0165 g rer Soil Testing & Design Service-P.O. Box 74 River Falls,Wl 54022 Signature: Date: CST Number: g~- I~1 8-8--c1 M00576 PROPERTY OWNER C-Q l5T SOIL DESCRIPTION REPORT Page of PARCELI.D.# o~l~- 1111`1, ZO-loo Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourrUy Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench S voyu 3I z - s' Z`P5L6r wt i Cw o.s u• 1 1~3 Z \S-ZS Ir.~ -tit 313 T1 J Z*1 5b4 Wt `i. 0-LU c,S a-b Ground 3 ZS-1l0 It,1-12 311: Std Z.`Fsbk ~n~'~. CS - o•S 0.6 elev. °t9•S ft. yo-qZ lo~R ~/6 S gGM O 5 9 1~ 1 p, o, B Depth to limiting factor i ; Remarks: Boring # D,wl Ground elev. ft. Depth to limiting I factor Remarks: Boring # I Ground _ elev. ft. Depth to _ limiting factor Remarks: Boring # ED! I Ground elev. ft.,\ Depth to limiting factor Remarks: SBD-8330(8.05/92) i I I I PLOT P LM Page 3 of 3 Roy, 8 ZuWy cRtsT- SCALE 130 ' P. z, t~. Wo . a40- t~V7- Zo- io u mac, : ~iEMC~~T metr o ptR`CY Lwe US tz v $ So3T, 01: SLb"i'@A t't1ZSJA . wt~~~ ~S > quo' wo~z'rHW T or- cIt- ° X seUlvic ~t a89 g_~ ~t aS•z' s- S_3 6±-► - ~L. L11o.0 oN o~ wooD slu~F. ~ to = J 1~O C SThC.L Low C. 1I ~1 0, g rh To c`c~i F y Le w 8- ~8- ( 715 ) 425_n1 E M00576 CSTSignature Date Signed Telephone No, CST # 0~~ Ll 7 q L17 CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4-NW 1/4 AND THE SW 1/4-NW 1/4 OF SECTION 18, T28N, R19W, AND IN GOVERNMENT LOTS I AND 2, SECTION 13, T28N,R20W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: STANLEY POND Ath..*--COUNTY MONUMENT FOUND R T. 3 C. T. H. F (CALLED N.W. CORNER OF SEC. HUDSON , W I 54016 18,T28N, R19W BY ST. CROIX NOTE: BEARINGS ARE REFERENCED TO THE COUNTY) MONUMENTED W. LINE OF THE NW 1/4 b"°`MONUMENTED WEST LINE OF THE OF SEC. 18, (SHOWN AS TRUE BEARING M NW 114 OF SECTION 18. IN COUNTY RECORDS). UNPLATTED;. LANDS N GOV'T. LOT 1 NW - NW 0 N S 86° 15'02 "E 7 47.8 3 4.39..27' 308.56' L 0 T O' CD 10. 00 ACRES Q~ N ( 435,599 SO:FT.) Q. J. 9.95 AC. EXC. RbADR.O.W. J• 1 433,414 SO. FT.I O; N a _ O , a W• W. , EXISTING I--: HOUSE a, DRIVE ~ CL Z z. Z• oo SI LO •1~ ' GRAIN BINS Mf Oi - N86015 02 W 397.09 - N86015'02"W 246.87'- w APPROX. N. LINE GOV'T. LOT 2 N APPROX. N. LINE SW - NW i. h• b. UNPLATTED LANDS • • , , Z' UNPLATTED, LANDS GOVT. LOT 2 M M SW - NW N W Oat N_ N 0 c SET I"x 24" IRON PIPE WEIGHING W 3 1.13 LOS. PER LINERAR FOOT. C 0 2 N I" IRON PIPE FOUND ON S. LINE E 114 CORNER SEC. I8 OF GOVT. LOT 2, SECTION 13. • ro S. LINE GOVT. LOT 2 (COUNTY MONUMENT FOUND) ~9387.03'41"E 1551.33' N86037'14"W -5168.59' ,~~~NINgpN " N8 700341"W 44.55' N86037'14"W 21.47' ~vO' • ,,~~I Fr. ~OVE RD•J/ a E- W I/4 LINE SEG. IB COUNTY MONUMENT FOUND • (CALLED W i14 CORNER OF SEC. JAMES M. 18, T28N, R 19 W BY ST. CROIX WEBER dW s.~ w~•w-o COUNTY) S- 1804 JAMES M. WEBER S-1804 i SPRING VALLEY 1 WIS. 1 DATED- 5-30-2S\ SCALE C-150' $ U R0' 75' 150' 300' fell i 81-131 THIS INSTRUMENT GRAFTED BY M.SUTLIFF SHEET I OF 2 DESCRIPTION A parcel of land located in the NW4 of the NW a and in the SW4 of the NWk of Section 18, T28N, R19W, and in Government Lots 1 and 2 of Section 13, T28N, R20W, all in the Township of Troy, St.Croix County, Wisconsin, more fully described as follows: Beginning at a St.Croix County Survey Monument purported to be the W4 corner of said Section 18: Thence N8700314111W along the South line of Government Lot 2, Section 13, a distance of 44.551; Thence N1041111"E 1328.561; Thence N8601510211W 397.09' Thence N0046152"W 478.851; Thence S8601510211E 747.831; Thence S304415811W 477.351; Thence N8601510211W 246.871; Thence S1041'll"W 1327.80' to a point on the East-West Quarter Section Line as monumented by St.Croix County; Thence N8603711411W along said line a distance of 21.47' to the point of beginning. Contains 10.00 acres (435,599 square feet) subject to East Cove Road right-of-way az shown. Also subject to any and all easements, right-of-ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St-Croix County Subdivision Ordinance and under the direction of Stanley Pond, I have surveyed and mapped the above described parcel of land and that this map is a correct representation of the boundary thereof. Dated this 30~ day of sezr~-. , 1991. `~~tNiNtA1~~ James M.~ weber 51804 %Nf1~~00~5~~A,j_~~,• Y • WEBER LAND SURVEYING (715) 425-0164 it 1~I JAMES M. ~ • WEBER ' 1 • S 804 SPRING VALLEY Wis. iv P-* 0 00 #tests SHEET 2 OF 2 91-131 This instrument drafted by Jim Weber. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER t - S MAILING ADDRESS ~e_o5'7- 6Uc- oecl PROPERTY ADDRESS SoS e 1 a 131, I G'^ (location of septic system) Pleas e obtain from the Planning Dept. CITY/STATE ya dse)--r 1 W f ` PROPERTY LOCATION r 1/4,4J~ 1/4, Section, T_~" N-R__L2_W TOWN OF y ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE IS , 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 find 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 mu completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ation tI SIGNED: DATE: U 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. - ------""--d------------------------------------ Owner of property o v Z Q ~F ~ y S Location of proof erty 1/4 1/4 , Section , T N-R W Township ~4,V Mailing address ,100 6 ~,-S7- doe ge- u aN wi s f~o~G Address of site ~ja d a~T Co~r~' Subdivision name Lot no. Other homes on property? Yes No Previous owner of property ,STS,// Total size of property /64 at'v.,-3 Total size of parcel d6 aG4-~ Date parcel was created v. 4, 11 Are all corners and lot lines identifiable? v"*Yes No Is this property being developed for (spec house) ? Yes ✓ No y 7.6 Volume 9;,r 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. Signa ure of Applicant jG6-Appli Date of Signature Date of Signatu e ~ _ 8-'@Yt. -~..r. _ ..t~':~~~ . '.~`~:er.r`~ _ _ . ~ r .w~ ~ . ..c. - k_,.., . _,:,.3 _~+•~-.wu~ ~ _....'PP -h3t•.:~aa"s f - THIS SPA '.E RESERVED FOR RECORUiNG DATA r, EDOGUMF"NT NC, Wlt ll lfAN"i"Y DEED STATE BAR OF WISCONSIN FORM 2-1982 4`~'~ VOL 921 pA,t 476 REGISTER'S OFFICE Stanley E. Pond, Jr., a single personST. CROIX CO., WI Recd for Record . ,Y 1991 at '11:40 A. M conveys and warrants to Boy..E. Crist and Judy. L._.Crist., , husband and wife as survivovship_marital property....- Register of Deeds RETURN TO St. CroX. COllnt the folloxing described real estate in St . . yr State of Wisconsin: Tax Parcel No- A part of the IM 4 of NA and SG14 of NA of Section 18-28-19 and GL "1" 13-28-20 being described as Lot 1 CSM, Vol. "9", Page 2415, Doctunent No. 474847. Thi; is homestead propert}. (is) (is not) Exception to warranties: easements, restrictions and rights-of-'clay of record, if any. Dated.thi day of October 1991 ~lL~l~i/ GAG/ (SEAL) (SEAL) Stanley E. Pond, Jr. (SEAL.) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 1 Ss. I-- t. Croix County. authenticated this day of.__.__.._ 19 Personally came before me this % - _dac of r1 ObeZ _ 19 91-. the above named - - ~taniey E. 7'onl, Jr. _ TITLE: )1F,`IP,F,R STATE: BAP. OF NCISCONSIN (If not.. authorized h; $ 7o(I.06 Wis. Stats.) to me kno-.%n to he the p ccc,itud the fp riy~r~m~* .nOrunw it, ~i „%vltdQR ee `eP . (J i IN 3TRU +1 1. WAS OA aFTED nY Krist ina G- 1 gin! L-deer At tor? j at T ~~,J ~ Al i E •7oy C~~ru . ~G ~ (Signa>>.r. r.ay h< a,t},enh,:atcd or acknnwL-1,nd. ftnth p,n.anint (If tit: r 0%i r;&on are- not ~.err~,_„ir}') Jul; 1~ I~,9~ 1 I dntu : i •A .i p-:•,r., -,z^ T'C W,..c ih. 'ARP:IVTY DFF.D STATE "AR (;F 1S( 11; 1J t - µ.ynk C t. POHNI So 2 - i' -2 M :,va k V' ;in s FILED O CT 101991 nIr Rug o1 U: " , 4'484`7 $L Croix CO" WI ~ CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4-NW 1/4 AND THE SW 1/4-NW 1/4 OF SECTION 18, T28N, R19W, AND IN GOVERNMENT LOTS I AND 2, SECTION 13, T28N,R2OW, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: STANLEY POND IS.--COUNTY MONUMENT FOUND S00•.E.'.COVE.R'pI (CALLED N.W. CORNER OF SEC. HUDSON, WI 54016 Is,T2811 ,R19W BY ST, CROIX COUNTYI NOTE: BEARINGS ARE REFERENCED TO THE `r MONUMENTED W. LINE OF THE NW 1/4 **'-MONUMENTEO WEST LINE OF THE OF SEC, 18, (SHOWN AS TRUE BEARING NW 114 OF SECTION 18. IN COUNTY RECORDS). y A ,f'~;„ ~YV G, UNPLATTED,' (LANDS, OCT 18 1991 GOVT. LOT 1 NW - NW ST. CROIX COUNTY COMPIfHENSIV'E PARKS PLANNING AND ZONING C0Mv1IT1F.G N S86015'02" E 7.41..$ 3 308.56 419.,-:2 7 ' U,: in L 0 T ~•o0 10.00 ACRES 14 Z• ti ' l 435,599 SOrFT.I s a Q• J, v 9.95 AC. EXC. RbA0 R.O.W • ( 433,414 80. T. I J• W. EXISTING 1- HOUSE ~ y 6jr W E'LL r0 +1aj: J' C Lll...~~~~1 DRIVE vl d. Z. - CL • z Z. 0 .J 81L0 ~ /ASEPTIC GRAIN BINS . N86°15 02 W 397.09 - N86015'02 W 246.87 -APPROX. N. LINE GOVT. LOT 2 APPROX. N. LINE SW - NW J UNPLATTEO LANDS UNPL.ATTEO LANDS GOVT. LOT 2 M M SSW - NW NOTE. DRIVE LOCATED IN DRIVE a APPROXIMATE CENTER O s SET I";r 2411 IRON PIPE WEIGHING W 3 OF 66' WIDE STRIP 1.13 LBS. PER LINERAR FOOT, z O Z . N DING SETBACK 37'14"W B L I UI N L E. „ 'o I IRON PIPE FOUND ON 8. LINE N66• E 114 CORNER SEC. IS Mi , OF QOV T. LOT >tSECTION 13. • M (COUNTY MONUMENT FOUND) ~ ~~(,5. LINE QOV'T. LOT Y 66.03 6 i~03'41"E 1551.33; ~ N8637114"W 5168.58' M - - sul #%,U70 341"W 44.55 N86037-14"W 21.47 M E.COVE RD.~ E- W 1/4 LINE SEC. 18 ♦ _ ar COUNTY MONUMENT FOUND V' l,, 6 6 WIDE ROAD R.O. W. ' (CALLED W114 CORNER OF SEC. • 18, T28 N, R IB W BY ST. CROIX JAMES COUNTY) • S.-1804 . JAMES M. WEBER 6-1804 SPRING VALLEY WIS. DATED f ~►,`9 i REVISED I0-14.9I SCALE 1u:150, ` 094060,00 A fts~,~~~ 0 75' 150' 300' V 41 91-131 THIS INSTRUMCNT DRAFTED BY M. SUTLIFF SHEET I OF 2 VOLUME 9 PAGE 2415