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HomeMy WebLinkAbout008-1049-70-200 g CL, : o Z ii, 3 ^ O ke) 0 0. 0 N ~ o i o a I O T 0 co y a- 15 y -0 O Oy N o. C 0 0. 'p U N v T Er oO p 'a U Co z C N 7 m E (3 .2 LL r- 2 - ° a 8 a 2 E ° Q -a c °c 3 M z Li (D ;j z 0 O co w I! a m n H CD N ° _o c (9 (D o z a V +N O m Z 3 c V' N z 2 E v ° N co E ° O N • N N 0 'a c Al c N 4 O Q Q w z z o m I _ N z 00 w C141 04 E y N 04 m d d O C. w c O d v U N 00 O D a EI c N 75 U) U) F- H d= vU_ p z> H ~y C 0 0 3 O O O Z N i ° a a a N 4 m *ai m y M Cl) N 7 O m J V Q rn rn } Cl) O O '`J O CO N M n _ E O O _ L3 :3 GR C~ r M 'C N (D O a N H ~1 O O O Q O O` N O C C E N (D (D O C) 0) O f..' N N O O rVV\ n N 0 N N L a) C c E E N .a p (n C m U O C6 04 L L 'OI n W C M (U F- N~ n Co r- M cn E E U) ~~il O •n- W -°i O z Cl) O ~ ~ I « E d v r/1 m A a. 3 it _a ` a C. Z .V N y C " E c c rz 0.4 ttww STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER h $Ov- ADDRESS SUBDIVISION / CSM# LOT # SECTION. f -7 T~N-R I (o W Town of jF-CAti a5A ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J~ + V A p (00- 00 16e 0~2. P(-f 44.7 4 ~ r Co ovt 4 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. L BENCHMARK: ALTERNATE BM. c~S c. T 7.- l SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION Manufacturer: Liquid Capacity: epEpQ y°~,~.~ (f ak,(~~ Setback from: Well House 3 3 Other Pump: Manufacturer Model# WA031't Size ~r Float seperation Gallons/cycle: r3S-. l3 Alarm Location ~e ~v 5-~ ~O~c -hS.civce SOIL ABSORPTION SYSTEM Width: 3t' -Length 7 Number of trenches N - Distance & Direction to nearest prop. line: ar- Setback from: well: House `7,L_ Other ELEVATIONS Building Sewer 45-1 ST Inlet; ) -3 ST outlet. fQ (96 PC inlet v d PC bottom 35- Pump Off W7, 31 Header/Manifold Bottom of system /00,0 y Existing Grade 00 Final grade S DATE OF INSTALLATION: PLUMBER ON JOB:` LICENSE NUMBER: n INSPECTOR: 3/93 : jt ~ z c LQQA'A;QVpert9eNVof s4 ► 17.28. %IIVATHEdRMY~TEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary ermit o. GENERALINFORMATION : Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID o.: S E ev.. Insp. BM Elev.: BM Description: nC Parcel Tax No.: ~S /~o le 4K_Is~ 06 TANK INFORMATION ELEVATION DATA A93 0030 (v/, 95 93 - TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ac2~`5 Benchmark 3/(,d Dosing 7. ► ' 1~ 35 . O~ Aeratioer- Bldg. Sewer Holding St/ V Inlet TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto ROAD ---W InIpt Air Intake t Septic y~ 30 ► NA Dt Bottom OLD Dosing .7 31 30~ 3$ NA -Waidw / Man. Aerati n NA Dist. Pipe mss" vv. ~3 ' Holding Bot. System 3 C40 CTO PUMP/ SIPHON INFORMATION Final Grade ~ S. T• 7 Manufacturer Oux .1- Demand 94087 Model Number GPM p'l Systema~rV DHfl. Ft TDH Lift L .1 oss 38' Forcemain Length ' Dia. o? " Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width i Length V71 No. Of Trenches PIT N . Of Pits Inside Dia. Liquid Depth DIMENSION F DIMENSIONS LEACHING Manu rer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O r) CHAMBER Model Number: System: yicowj -104. OR UNIT DISTRIBUTION SYSTEM ++ewdw4 Manifold Distribution Pipe(s) " x Hole Size x Hole Spacing Vent To Air Intake 3(p Length 57 ' Dia Length a - ~ Dia. Spacing 45 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over y A xx Depth Of xx Seeded/ 5sdeted• xx Mulched Bed/Tt==:ICenter Bed/Treat Edges/Z Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE, 17.28.16, E N , 0TH ST.~ CO&r7_0_4 L JaQZe .0~e1 3, z lop, 0 Plan revision required? ❑ Yes P_W0 - Use other side for additional information. iwl SBD-6710 (R 05/91 ~4 y~ Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: r L DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ erns ~ ~ue.~wn+Y+.awar STAT SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ,L 8'/z 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. PROPE OWNER ` - PROPERTY LOCATION ® '/a '/4, S ( T 2$ N, R Cc~ E (o W PROPE OW ER'S MAILING ADDRESS LOT # BLOCK # l U.Eji CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER t , ~A7 t ODv2 1(-7/5' $ II. TYPE OF BUILD71-101r, : heck one) ❑ State Owned ❑ CITY GE : NEAREST ROAD M U. G v o t~ t-- ❑ Public 2 Fam. Dwelling-# of bedrooms 3 PAR EL L.. N MB ( ) III. BUILDING USE: (If building type is public, check all that apply) 008-1049-70 100 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. I ~ New 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 Pres_s_,urriiz'ed Distribution Experimental Other Mound 30 ❑ Specify Type 41 ❑ Holding Tank 11 ❑ Seepage Bed 21 OR 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./cinch) ELEVATION ,4 /6-0- 00 Feet M.:25Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank < uoQg;~r, . F1 F1 I El r] Lift Pump Tank/Si hon Chamber 1 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam s) MP/MPRSW No.: Business Phone Number: M~ l 7.9 Plumber's Address ( t, City, State, Zip Code): W ~a2 "7 a IX. C TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent a No Sta Approved El Owner Given Initial Surcharge Fee) A,~K ~ - Adverse Determination X. CONDITIONS OF APPROVAL/REASONS 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. 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. It. 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 .31/2 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, !ocation 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 uses' for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) II vpl" QAre - - 7 - q 'QL y~.11 U R F loo. oo S Y- f GOn2I7U Ta.iK ~N N ~ yob` 1~ ~ ~ Y X7.7 ~ln- e ~3c~t~ \ lt.~c1:6 f V rP cL ROO r ) p; f k ~.e~oSe`1 -TttE USED W6µ- 5HAU_ BE A o 1 Mim. 2 S F-+, FROM ANY TAW K/ AND A M04. 5b Ft. eUNA 'rt1~ MAJt~1a AizEA . . f e k c G I ' SY~~EM ~~W AGE f cojitiortaff, ~~~gTr~`~ ~A~aA p o i~1SJu ~ t~ ~ SpFr OLPAR~@~►~4JZ ;VtStQSJ U ~ SEE ~Utt~E II Page f - o _ Straw, Marsh Hay, Or Synthetic Covering Distribution). Pipe Medium Sand pwe t H Q ~CJ l00 - (P b Topsoil =L,7s IF 00•Go 3 ONSITE SEWA E S e'dluo % Slope Force Main Plowed Bed Of 2 1-0 - 0 regate From Pump Layer jljAtd riE AT tb,14, ? fltlvl D Ft. E_ Ft. Cross -Secfiion Of A Mound System Using A Bed For The Absorption Area F ,7~ Ft. G Ft. A J' Ft. H /.S Ft. Signed: B 4_ Ft. License Number: -~_O/ K 10.3 Ft. Date: 7 -7 Icy L Ft. 2.D Ft. Alternate Position I 1 L.--fFt. of Force Main W Q(~.37 Ft: L 1 Observation Pipe 01 r - A W I° ---~i u u • Distribution Bed Of 2 - 2 i Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Perforated Pipe Detoli End View )Pa.rforoled End Cop \E 4A PVC Pipe a° Permanent End Markers J& s Holes Located on Bottom are Equally Spaced Q PVC Force Main From Pump SYSYGM Nsj iE SAGE J11jotattl END ? PVC Monifold Pipe CaN Pvc ROV oictribulion... A Hr111T~GNS Pipe LREOR AND HU Lost Hole Should Be t►y1}S~~Y, ~j~( ~L GS 1 Next To End Cap OpAR mL7w14I ,,~~td`y pF S U SEE C()Rf~~ E Distribution Pipe Layout_ P R S X Y_ Signed: Hole Diameter Inch License Number: Lateral " Inch (es) Date: 1] - `f - 9 _~R Manifold " 2 Inches Force Main Inches lAole3 ft, LoJ era.t SEPT C TANK 8 PUMP CHA BEK CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 8 WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVE] W/ PADLOCK & FINISHED GRADE 4" CI RISER f WARNING LABEL 6" MIN. ABOVE GRADE _ 4" MIN. 18" IN. 6" MAX..E SYSTEM I NL'ET' L. F& 1 ~WA GAS- .w~ TIGHT ~l Al RCLAI 4 A SEAL 1 ~ APPROVED JOINTS 4J / C I ED C I PIPE C h N2 OF It 1011SAM gOA g D B , A LM 3 ON'A 1VlS;flN OF O ON PIPE 3 ONTO SOLID , SOLID SOIL SOIL po EV. FT. -C OFF ~Q RISER EXIT D PERMITTED ONI IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD /cvo SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: Wet'serS NUMBER DOSES PER DAY: TANK SIZES: SEPTIC /Oap GAL. DOSE VOLUME INCLUDING DOSE ~Op GAL. FLOWBACK: GAL. ALARM MANUFACTURER: ~~ec n 5,_,4,,.,,CAPACITIES: A = INCHES = 30I •~~k GAL. MODEL NUMBER: SWITCH TYPE: cli-- B = 2 INCHES = 3eGAL. PUMP MANUFACTURER: C`p~LI C = INCHES =,7 GAL. MODEL NUMBER: E03, $5 SWITCH TYPE: D = /~l INCHES = fy~ gy GAL. REQUIRED DISCHARGE RATEv GPM PUMP 8 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 1,5- FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . 2.5 FEET + _L~L(2_ FEET FORCEMAIN X 2.6a FT/100 FT. FRICTION FACTOR ? 668 FEET T.OTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER pleas e See ToKk LIQUID DEPTH Sf cc SIGNED: `r ~I,ICENSE NUMBER: DATE: 7 1/£38 ro, N . gr o 717 p ! M~ o I ~o r-- M --4 71 W o 70 00 -----T; - 'cn I 'n W I NSITSEWAGE SYSTEM L 62~!l / l INDUSTli iD HU RELATIONS ~N 'VISION OF HFE At BUILD GS . r~ H bd COR H z 0 A i n z C W O M o C, H P O 7C tC*f n [,j ' t ` d r w x Sb y ;tf t*f y . lid Lam' - ! o p H y H j O x9 f7 y H x H H w of ~D x y ~-f{t O W x to ►d loo to b y r~ to H d a H b .~n ' 9 tl 70 ~ 0 b td I t' r.........' WO OO'! ~ay m n o H 9 d C+f hrJ t d x O A i O H • N b O x HH~1 b Z H s v ~ tf 5z r" z O p x -1 H x i y N O H 9 a N v, %0 v x L-J C ~zz w 0 H ~ v D z ~ ~ o O~ M L=9 ~N ~ d v O' . ors n V v APPLICATION FOR SANITARY PERMIT STC - 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 C ` C '1 74 :.Location. of Property! U c 3L, Section i , T `N-R I_~ W Township4 Mailing Address Address of Site 7 L jq"L J) 01) f Subdivision Name. 1. Lot. Number /V -T ~d/ Previous' Owner.of Property 4F Total: Size-- of` Parcel .Date. Parcel was'Created !ire all corners and lot lines identifiable? Yes - No Is this property being developed for resale (spec house) ? Yes No Volumes and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A.Wairanty 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 refer- ences.to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) eeAti.by that a,P,r? statements on tiiz botm cute tAue to the but ob my (ouA) k.nowtedge; that I (we) am (aAe) tithe- owner(s) ob the pnopehty deacxibed in this .i.nbo. oration bojun, by vi tue ob a waAnanty deed tecoxded in the Obbtice ob the County Reg.i4ten ob Deed6 as Document No. (off ; and that I (we) ptuentZy own the phopos ed .6 to bon the d ewag e d is pos s y.a em (on I (we) - have obtained an easement, to Au.n•with the above deschibed pnopeAty, bon the constnucti.on ob said system, and the same has been duty kecokded i n- th.e~N ice o b the County RegizteA o6 peeda/61J cument No. yu~ ,6 ) . C 11 4 '17 SIGNATURE 0. OWNER SIGNATURE OF C -0 R (IF APPLIC LE) ,•.DATE'SIGNED D TE SIGNED DOCUMENT No WARRANTY DEED _ STATE•', BAR OF WIS(ON.~-._ F',".`,1 - 45646" SroL _61 ll REGISTER'S OFFICE Harvey R. Serier and Marvell A. Serier, ST.CROIXCO..W1 husband and wife, holding a- survivors.lip Reed so(Reco(d II marital. property JUL 291992 and warn-ruts to Raymond E. Johnson and at 10:40 A. M Pamel.a_J. Johnson, husband and wife, ^olding as_s.urvivorship marital property a a , all, ~11 of Deeds _ I the fgll,) in;% descr hed real estate in St- C r o i x X ...County, State of Wisconsin: pdrt of Tax Pircel No:.------- - - South Half of Northeast Quarter (SI of NEI) of Section Seventeen (17), Township Twenty.-Eight North (T28N), Range Sixteen West (R16',J) , described as follows: Commencing at the Northeast (NE) corner of Section Seventeen (17), Township Twenoty-Eight North (T'8N), Range Sixteen West (R16W); thence on an assume) bearing of SOO 27'18"E, along the east line of the Northeast Quarter (NE1) of said Section Seventeen (17), a distance of 1315.75 feet to the Northeast (NE) corner of the South Half of the Northeast Quarter (S1; of NEI) of said Section Seventeen (17) for the point of beginning of the parcel herein descrbhed; thence continuing SOO027'18"E, along said east line, 832.64 feet; thence N88 12'14'W, 1814.02 feet to an iron rod- thence NOO0?7'18"W, 881.51 feet to an iron rod on the north line of the South half of said Northeast Quarter (Si of NEI); thence S86 39'18"E, along said north line, 1816.60 feet to the point of beginning. _ I HE j I This ) S not. homestead prcl,erty. XNJ4 (is not) j Exception to airanties: Easements and exceptions of record. I I r4- I Dated this 7 _ day of T(Ib~ 19 92 . Harvey R. Se77rier (SEAL)CF-~ t(, (SEAL) Marvell A. Serier AUTHENTICATION ACKNOWLEDGMENT Signature(s) - STATE OF WISCONSIN S3. S t. C r o i x County. authenticated this day of 19... Personally- came before me this _~?....-__day of I 92 the above named j - Harvey R. Serierand - _ . - - - ' - - carve-ll A Serier - - - - - TITLE: NTEMBER STATE BAR OF WISCONSIN (If not, . - . authorized by § 706.06, Wis. Stats.) known to be e rson tiho e. cued the _o ng instr ~ acknowledge he re. i~ _ T'rli5 INSTRUMENT WAS DRAFTED BY Thomas A-. McCormack Baldwin, WI 54002 - \ :t,:r-: Public $ t . - r 0 1 X Count,, Wis. I: (Signatures may be authenticated or acknowledged. Both (7•mmission is permane :t. (Tf not, state exn;ration - - ` are not necessary.) 4--e: 19 ) "y -Names of Dersens ?igning in any rapacity sh_uid br ts-d ; t d 1,,!, WARRANTY DEED STATE BAR OF :TI~CONSIN !J•s^Dns,n Legal B'iark , Ir,r FORM ti 2 - : _ %!.a'hee. YYisconsm ST C- 105 i SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER af~~~~x J . (-T" ROUTE/BOX NUMBER Q eecj Fire Number ~e CITY/STATE S ZIP PROPERTY LOCATION:SP Z, A)E_it, Section TS N, R * T St. Croix County, own o f Subdivision Lot number Improper use and maintenance.of your septic system could result in its premature failure to handle wastes. Proper maintenajxpe con- sists of pumping out the septic tank every three years or sooner, if needed, by a 11censed septic tank pumper. What you put into, the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on- site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three-year expiration. 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 Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkpe within 30 days of the three year expiration date. SIGNED 1) AT E LD-) St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. i' SOIL AND SITE EVALUATION REPORT D ^LHR in accord with ILHR 83.05, Wis. Adm. Code COUNTY l11 ..\MP~,IM.NRIARM Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL S I.D. C Rd not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or N dimensioned, north arrow, and location and distance to nearest road. _ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY tai: 12-ye-r! PROPERTY LOCATION a a-, --Tv ~ S e, GOVT. LOT 5 E 1/4 NC 114,S / ? T N.R E (O PROPERTY (~IVN R:'S MAILING ADDRESS LOT # 113LOCKN SUED. NAME OR CSM N CITY STATE ZIP CODE PHONE NUMBER []CITY VILLAGE OWN NEAREST ROAD St LA)' Soo (7 /s) 6 g yy6 r -)30 rA [New Construction Use ( ]'Residential / Number of bedrooms 3 j ] Replacement (J Public or commercial describe Code derived daily flow -VTO gpd Recommended design loading rate bed, gpd/fl2. err trench, gpd/ft2 Absorption area required .37S bed, ft2 37r french, ft2 Maximum design loading rate _ ~L bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) /oo. e, 9 - - 61 It (as referred to site plan benchmark) Additional design / site considerations Parent material G I a c r'a_ ] T111 Flood plain elevation, if applicable ,OA- ft S = Suitable for system CONVENTIONA MOUND INGROUNDPRfSSURE AT-GRADE DSYSTEM IN RLL HOLDING TAN U = Unsuitable tors stem ❑ S C~ O [at ❑ U O S B-0 AT [~'U L~'CJ El S R< SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence , Bed Tre 3c r:<~;.:~t•>:> 3 w. s e- ~ Ground ~y' ]o y o~~~ s f cr t F• , (o elev. zy ft. 3 - 1 `7. s s c c s b vvy - , S- Depth to limiting factor Remark's:- Boring # a& . s 1. s?h: 'r j -7 1 c u~ I 3(0 Li vy\ c3P 3 - °P,-- - s 5 1 l f I 3 Ground - elev, 6 1n Depth to - - - - c limiting u~ fact„ A 2C c2 Vii' s Remarks: CST Name:-Please Print Address: R6ti4 ( n r r r 4 L CX_ LU i 5 y Signature: Date: CST Number. SOIL DESCRIPTION REPORT Boring # Horizo Depth Dominant Color Mottles Structure PD /It., N in. Munsell pu Cont. Color Texture Gr. Sz. Sh. Consistence Bourses' Roots - fled Tru - toy sal mow. sbk AA - Ground nd 3 S- f YR s 6 k-\.f CA- elev. t b '71,22-ft. y~ s ,s Sc '71,22-ft. r o- v y p, 3 Depth to limiting YR factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # M. t Ground elev. ft. Depth to limiting factor i Remarks: i i i I I _ I - -t-- r - I i N C~ S~ ~('O r ~.I W 2 j ~ i ° I• ©!rg , l S~o-~C~ I i I C I it ! I I ! ~ I ~ I ' ! ,o ~3 I i ~ i i i I sti u,tabl~ Re V6 I R OVA ' I I II j EJA I'' I I ' I I I I ! I I r I i i ~ ii I r I I I I ~ ~I I ! i } , I I I I ~I. ' I I I ' I I I 1 { I I i I ~ I I I I i I~ I i I i I i ! i I I I I I t I I - i i i I I i j I I ~ T L. ' I I I i I l ~ I , - I I I i~ I ~ L f T { I _ - I 4L - I C i I I C I i ~ I ± i I ~ I I ii I i , I I I, I I I I I ` I I I { ~ I ' i_ ~ I I I ! I ' I -I i I i I I I I I i . i I ~ 1_. I C I I ~ r I i ' f r I ' 1 1 , I ~ ~ t , ~ ! I I 1 I I I ~ I { I f { ( I I I I I I I ' I i ~ ~ I - 1 I I A- -A + i i i I ~ ~ 1 ' I I ~ ~ s I ' ~ I T I ; I I i ' i { I I, i _I I I j~-- I I ST. CROIX COUNTY WISCONSIN , ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 22, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Ray Johnson/Harvey Serier property, located in the SE 1/4 of the NE 1/4 of Sec. 17, T28N-R16W, Town of Eau Galle, St. Croix County has been conducted. This onsite revealed suitable soils at a depth of 24" below which seasonally saturated soil conditions were observed. Should you have any questions, please feel free to contact this office. i erely, a mes K. Thompson Zoning Administrator cj