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HomeMy WebLinkAbout012-1022-20-000 ~ o I ~ °o, I ~ oO I M~ p~ I U~ I et ao d d 0 o L c L m N vc O O N o 4 o~ x L 00 y ~ II a~ I =O fp N -0 ca .y N Y p O o a ° c `.t N € aU'i ° v 0 o c0 o• o = a~ a~ v z I z I C .U W V°1LM c •O N co U. 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CROIX CG NTY, WIS ONS 3DIVISION , LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f ! F-1 I I l i I < < 7,17 i it i 1 Ath ~ Antcaw MFGR. Indicate N TIC TANKS COtICRETE _ STEEL ~ S cate N0. of rings on cover f Depth DRY WELL NCHES NO. of width length area 777 no. of lines` width length area: jf~_ ;depth o top of pipe .I ^.EGATE 3 - ii •:.s.: RATE AREA REQUIRED A s~ AREA AS BUILT l ,claimer: The inspection of this system by St. Croix County does not imply complete _~.pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for item operation. However, if failure is noted the County will make every effort to ermine cause of failure. ASr.S AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED PLU; iBER ON JOB LICENSE MMER S G z r REFDRT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM San.itany Penm.i-t 4 State SPpt.sc%- ,7 .t NAME Z' ;Z r rown.6h.ip S.. Cno.ix County E Locatioia ~ Gt'l Section 7> SEPTIC TANK ~ j Size gattons. Numbers ob Compantmen.tz i D.i.6.tance Fnom: Wett 12% on greaten Mope 6t Bu.itd.ing 6t. Wettand.3 ~ . H.ighwaten it. DISPOSAL SYSTEM D.iztance FAom: Wett it. .12% an greaten ztope Bu.itd.ing 61. Wettand.6 Ft. • H.ighwaten it. FIELD DIMENSIONS: W.idzh a6 .trench it. Depth ab &ock below x.ite .in. Length o6 each tine it. Depth a6 rock over. t.i.Ee in. Numbers o6 tines Depth o6 t.ite betow grade .in. it. Stope o6 trench in pen 100 fit. To tat Length o6 tines D.i.6tance between tines St. Depth to bednack it. Totat abd onbt.ion area 6t2 Depth to gnoundwaten it. Requi&ed area 6t2 Type of Covet: Paper oit St-taw PIT DIMENSIONS: Numbers a6 p.itz Gnavet around p.itzs yep no Outside d.iameten it. Depth betow .inlet it. 2 Totat abz anbt.ion area it ~z Area nequi,%ed it2 INSPECTED BY TITLE APPROVED DATE 197_- REJECTED DATE 197. <s i i I I . EH 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS ' WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: %V~%, Section ,TJQN,R/2$ (or) VV, Township or Municipality Ai dze e Lot No. ,Block No. 5'r. u sion Name County Owner's/Buyers Name: " Mailing Address: TYPE OF OCCUPANCY: Residence x No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW, ,REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 7q PERCOLATION TESTS Wn_24/-79 SOIL MAP SHEET aq NAME OF SOIL MAP UNIT PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 9 3 P- A's -30 P- je A,) i-r _10 A? 3 3 3 P- 3 !i //1 30 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- B- B- 7 B- p , T B- 9y_ -1,6 6_4 rx B-& ~(O-AIQ a7-S JQ- JZ -:[:~j _Z 16 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan t e 1%ation and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. . . u_ e soa yes r E i E 1 ~ Est 1 ruck IN. ~1 Iol. 001 f 3 jj s c'Id; /+dC' ~~FS t • I, the undersigend, hereby certify that the soil tests reported on this. form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Certification No. Address j LC .Name of installer if known 0 AS Copy A - Local Authority CST Signature l ~ 1, PLB 67 State and County State Permit # P Permit Application County Perm' for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: an 4-- B. LOCATION: '/44 1/d, Section , T, , R J t (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township JE&L C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family x Duplex No. of Bedrooms 002 --No. of Persons_ D. SEPTIC TANK CAPACITY /4M Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons refab oncrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lin aI Ft. Width Depth Tile depth (top) No. of Trenches Seepage Bed: -.?X-Length__WidthDepth 00" Tile depth (top No. of Lines a Seepage Pit: Inside diame r Liquid Depth No. of Seepage Pits Percent slope of land ~2 Distance from critical slope WATER SUPPLY: Private; Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the C rtified Soil ester, NAME - J2.0 V C.S.T. # Y ~S J and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone < Plumber's Address NZAL WIZ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i , - r~ 1©.a,0 E E WFIf, _ ..w ~ I f x E j`n E r 100~( i r E Do Not Write in Space 13elow - FOR COUNTY AND STATE DEPARTME USE ONLY L' Date of Application 12-51 741 Fees Paid: State 7W~ .Co t L ~-d Da C Permit Issued (date) ` Issuing Agent Name ` Inspection Yes No State Valid# Date Recd ' 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 Fsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 and Human Relations sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croi:n Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mus 7V~3t/ ot limited to vertical and horizontal reference point (BM), direction'and % of slo PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road Z APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION r, , RE ED DATE PROPERTY OWNER: 111OPERTY Vilton Peterson 'r. dS (/A✓ GO jj-T 1/4 S>;.] 1/4,S t T 30 N,R17 xV,(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLO BD. NAME OR CSM # 1605 1,65 the Ave. n/a n/a n/a 155 acres CITY, STATF zIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD rTew Richmond, WI. 5401/ 015)246-4271 P_rin Prarie 165th. Ave.& GAG ( New Construction Use [4 Residential / Number of bedrooms 3 [ ] Addition to existing building LWeplacement [ ] Public or commercial describe o ~ ~S aily flow 450 gpd Recommended design loading rate .6 bed, gpd/ft2 .7 trench, gpd/ft2 0o Absorption area required 750 bed, ft2 643 trench, ft2 Maximum design loading rate • 6 bed, gpd/ft2 •7 trench, gpd/ft2 (1~ Recommended infiltration surface elevation(s) 97.32 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material streari terrace Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 5S ❑ U Q~S ❑ U E~S ❑ U ❑ S Cs ❑ S CI2~ ❑ S M SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrtdary Roots GPD/ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer>d1 1 0-12 10yr2/2 none L. 2/m/gr raft g/w 7/f 5 . .6 U 6 2 12-39 10yr4/4 none sil. 2/m/sblc mfr g/w 1/f .5 .6 Ground 3 30-92 10yr/.4 none 1s. 0/sg mvf_r na/ n/a .6 .7 elev. 101.52 ft. Depth to limiting factor off Remarks: Boring # 1 0-9 10yr2/2 none L. 2/m/gr mfr g/w 2/f .5 .6 2 2 0-24 10yr4/4 none sil. 2/m/sbk mfr 1/f .5 .6 3 24-32 l0yr/L/4 none is 2/m/sbk mvfr .6 .7 Ground , elev. 4 32-96 10yr4/4 none S. 0/sg m< *,~Q,, a n7a / . f3 101 _52_ ft. Depth to limiting factor I -A ` >96"~ E a Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-24 g Address: 1 j ITI. 54017 Signature: Date: CST Number: 7-12-03 cstm 2298 PROPERTYOWNER Milton Peterson jr. SOIL DESCRIPTION REPORT Page PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-10 10yr2/2 none L. 2/m/gr mfr g/w 2/f .5 .6 2msbk mfr /w 1/f .5 .6 sil. none 2 10-2 8 1 4 4 / Ground 3 28-44 10yr4/4 none Is. 2/m/sbk mfr -,/w n/a .6 .7 elev. 100.32 ft. 4 44-84 10yr5/4 none S. 0/sg m1 na/ /a .7 .8 Depth to limiting factor >8A!-- 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) STEEL'S SOIL SERVICE 1554 2OPth. Ave. Gary L. Steel C.S.T. 2298 Milton Peterson jr. New Richmond, WI 54017 MPRSW-3254 I T!rM S8-T30N-81714 (715) 246-6200 town of Erin Prarie Oil ~'W n4)- 9t PL r t 60 1 t Gary L. Steel- 7-12-93 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ( Zut~bO ~'1 --l h• ADDRESS ry Nt 1/y a ~ ~ c.l~vri► e-~) s Y a ~ ~ SUBDIVISION / CSM# LOT # SECTION . 8 T.30 N-R Q W, Town of E iv-1) pr`al 1 r~ IIS ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t f rx~ ' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / TION Manufacturer: PCA, ~~1 PAU Liquid Capacity: Jam' Setback from: Well dV 'i-- HouseG Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width : vZ Length 1,3 Number of Distance & Direction to nearest prop. line: Setback from: well: / House 176 Other ELEVATIONS Building Sewer ST Inlet. ST outlet /aV, PC inlet PC bottom Pump Off Header/Manifold_!91. 11 Bottom of system? 7, .3 Existing Grade Final grade f dz~'~ DATE OF INSTALLATION: „'M PLUMBER ON JOB: 0_4a~ LICENSE NUMBER :pAj_5 3 INSPECTOR: 3/93:jt LW,M'slrGX;ar-XU*i IE 08.30.MV "jk'& EWY GG) County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar pmigwjLx . GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State P /rev.: nsp. M /e~v.: f~ JBM Descriptio Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300196 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer [Holding St/Ht Inlet v TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Header / Man. 9 U Aeration NA Dist. Pipe Holding Bot. System 3 PUMP/ SIPHON INFORMATION Final Grade 7D Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of W hes PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mode Number. System: / l 0770 >/v0 ~f.~4" 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: ERIN PRARIE 08.30.17.118 (165TH AND CTY GG) 11 ~ I Plan revision required? 1Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date L Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4 W DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY r ' ~ TIIs&NIrA jY ?Efnnly # -Attach complete plans (to the county copy only) for the system, on paper not less than /9_3, ~/.(j/ 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. PRO;Meu&~ NER PROPERTY LOCATION 2, ti`-S oh A V N6J t/4 5 %4, S T 30, N, R 7 r) W PROPERTY GO~WNR'S MA~ N~G~ DQFSS LOT # 91A BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER AL-A" p%gA W t 5`1017 AS- 61P A1_#-)7j /5'5 a rev s II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE hl h Y'4 r/`j /V( 5 Q*A-vt C:P G ❑ Public 0'1 or 2 Fam. Dwelling -#of bedrooms3 PARCEL A NUMBER( S) M-MY Oh C/ 74- d p o 111. BUILDING USE: (If building type is public, check all that apply) _ o7p a 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. ;9 Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5- El 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 ,1~ rU REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 7J 0 7._0 IVJq Ic~~ Feet X64 S-1 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks strutted 77 1 Septic Tank or Holdin Tank rfi~ Lift Pump Tank/Si hon Chamber f T1 1 1-1 1 LJ LJ I L1 I F] VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Pri Plumber's Sig atu : (No Stamps) MI'/MPRSW No.: Business Phone Number: 6a ) y j n Jd w-e r l I mn 156.3 7/S je16-51&S Plumber's Address (Street, Ci tate, Zip Code): d//99 owe- AAg, L r+ a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Issue Issuin i n ❑ Approved ❑ Owner Given Initial Surcharge Fee) Averse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber i , INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at tho time of renewal any new criteria in the .'✓isconsin Administrative Code will be ai'plicable. 3. All revisions to "his permit mus'; be approved by the pe,.niit issuing arutl-ruri,y. 4. Changes in ,own.- r-ship or plumber requires a Sanitary Pon,mit Transfori9en;-:wal Form GI=s;: 6399) to be subLgj ed- to the county prior to 'installation. 5. Onsite se Fringe systems must be properly °hraintair,Yc The septic tank(t,) r'n -,,t be pun. t !icensed 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-tie State of Wisconsin, Safety & Buildings Division, 608-266-3815., r. To be complete and-accurate this,sanitary permit application must include: L Property owner's name and mailing address.. Provide the legal description and parcel tax nurnber(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 appl IV. Type of permit. Check only one in line A. Complete line B if permit is for tan ( replacement, r;connection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Abs,-rpti^r° system information. Provicip all information requested in ##1-7. Vll. Tank :r;fu -;ration. Fill in the capa o .f every new and/or exist ;m_; ' st t ie total gL It nr., -~urriber of tanks any anufacturer's name rdic~rre prefab or site constructed arc! tank material. (;Ioroi- -i~ '.(,ir all septic, purnp/siphon and holding tanks for this systE:m. Check :l ;ipproval ' er received exi;e•riri;-r?.il product approval fr,-,rn DILIM. Vlli P ~pc~~~Ri ;itr statement. Installing plumber is to fill in narne, license r~! °flbce with approprili E Vf4fix (e.g. N1"r etc a r sss and phone number. Plumber must sign application rn. !X. County _ )epartrnent Use Only. X. County/DI;partrnent Use Only. Complete plans and specifications not smaller than 8'4 x 11 Inche ::!.-:t bE submit'.f-J rl-~, f(r s° rr nty. The plans i'llCiUde the following: A) plot plan, drawn to scale or - oth ?-:plE le drn,f-,- Cori of holding ±;~7kr;s) septic tank(s) or other treallment tanks, 1.,u dire;; r a - el s; w 1mi -i:.:,r service; streams a d la"is, ramp or siphon f.ar-ks, disl6bution boxes: soil ~c~ wlr iir,r systeoi, n t,rt system areas, earl,., the location of the building ser,-ed. `:1j horizontal and vert.cC' _ Ie 'Cn ref0r !r,,(* ints. C) complete specifications for pumps and controls; dose volume; F ievati ir: c rfference_~; fr ct! :r; loss; pump performance curve;,pump model and pump manufacturer; D) cross sect';on 0 the soil absorption system it required by the,CQVty; E) soir test data on a 1:15 form; and F) all sizing information: GROUNDWATER- SURCHARGE 1983 `Nisconsin Act 410 included the creation ,f surcharges ftes) for a nrum i+_r of regulated pra(.tices which can effect groundwrLter. Nthe rionies collected through tliesq,~ :rc,t a. e.€ rr e yr "l u c ri,vrj 1 i:at rkf w~,4,. c.A,.=iminatton en(a E'stab• s' :.!t _ 3 SBD-6398 (R.11/88) S T C - 100 This application form is to be completed in full and signed b the owner s Of the property being developed. Any inadequacies will only result in delays of the development be intended for resale byt owner/ontr ctor C d 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 Location of property /U1~ 1/4 $Q1/4, Section T.,3 )N-R~W Township Mailing address /(.0 S 11-S t4~- Q 0l Address of site S Subdivision name Lot no. Other homes on property? yes_ No Previous owner of property Total size of parcel S S 4G reap, s Date parcel was created Are all corners and lot lines identifiable? -4-Yes No Is this property being developed for (spec house)? Yes Y No Volume and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: - - A WARRANTY DEED which includes a DOCUMENT NUKBER, VOLUME AND PAGE NUMBER & 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 ray (our) knowledge that I (we) am the property described in this information f(are) the owner( orm, by virtue sofoa warranty deed recorded in the office of the County Register of Deeds as Document No. own the , and that I (we) presently proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described rt, for the construction of said system, and the same hasp been duly recorded in the office of County Register of deeds as Document No. Sig ature of applicant Co-applicant Ae" o• Sign at re Date of Signature w DOCUMENT r.0 ~ ST:1'Cf•: 1;.1(C ()E IV[il'UNSIN Ful:`i .5-198_ w ,..r ~,,;,v_ o,•, OUIT CLAIM DEC"] 489141 11111 J 72PA;E 5'1 REGISTER'S OFFICE Milton W. Peterson and Dorothy M. Peterson, ST CROIX "Ok. M husband and wife, Ra'd fa Rdcad - OCT 0 S 1992 quit-claims to .Milton W. Peterson, Jr. and Lynn Peters i, husband and wife as survivorship of 8:30 A. -marital__property _ _ R isler - of Dsrds< the following described real estate in St.....Cro' j State of Wisconsin: County, 4Ct, ;+ry ~p Tax Parcel No:..._._. I! j The Southwest Quarter, Section Eight, Township Thirty North, Range Seventeen West, EXCEPT a parcel described as follows: The South 269 feet of the West 321.74 feet of the Southwest Quarter of the Southwest Quarter of said Section, and EXCEPT it a parcel described as follows: Commencing at the Southwest corner of Section. Eight, Township Thirty North, Range Seventeen West; thence East 321.74 feet to the Point of Beginning; thence East 900 feet along the South Section line; thence North 269 feet; thence West 900 feet on the line parallel with the South Section line; thence South 269 I feet to the Point of Beginning. ~I c 'i EXEMPT r 'i ,I This homestead property. (is) (is not) Dated this _.__._.3.O II day of OfID f_in b`L. 19 92 it . (SEAL) EAL) " Milton W. Peterson I (SEAL) ' (SEAL) Dorothy M. Pete-son AUTHENTICATION ACKNOWLEDGMENT ;g Signature(s) • STATE OF WISCONSIN - j authenticated this day of-.--.-. 5-~•- CRQI}(_ ------County. 19.._ Personal!: came before me this ...~Q Sg~atmbu- 92 _ day of 19 ~ day of 19--- the above named Milton-_W._- Peterson and Dorothy"M,_-Peterson, husband and i TITLE: MEMBER STATE BAR OF WISCONSIN wife (If not, - - authorized b y ?OS.OS, Wis. Stats) - to I.:e known to be the person S_.. - who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY REMINGTON LAW W OF_FICES Judith A. L ton - udith A. Rem ng ton v to Y %'C' i .Richmond-.-- W~-----54017.. - ~ ~ . 't Croix (Signatures may be authenticated or acknowledged. Both Votary Public . c(iIntY„ 3I (7ommisslon is i? are not necessary.) Permanent. gptxm date: j QUIT CLAIM DEED vT\Tf: n1R oP wiscox:r\ FORM No. 3 - Iyr_ o-.n L •¢al n'•n4 Cn. lne. - Slowsu n•e, Ris. SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Q Y' $O Vl I~ - ADDRESS: _4~ 0-5 /bS ~~Q ue FIRE NO: LOCATION:-&_1/4, _5 4.)_l/4, SEC. 8 T .3 O N-R,_L,7 _W, TOWN OF:- ti~ ,n a ST. • CROIX COUNTY SUBDIVISION: LOT NO. /E-9 Acp-e4,s 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 a 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 to help with the cost of the 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 the St. Croix County zoning a certification form, signed by the owner and by a master 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. Certification from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. c SIGNED' , i. DATE: i I St. Croix County Zoning office 911 4th St. Hudson, WI 54016 ? I_ I { 1_ I j , I 1 i { r I I I i I ! I I r I , i I I I ~ I I I j I I I I ! ' j i I , i I ' I ! ~ I I ~ 1 I AD I~ I ) ~ ~I I ~ ~ I I f 41% I I I I 1 ~ I I I I ~ I I I Z , f - ~ a ! 1 i a I I I L ;I r i ; I I - r I I ! I ~ I T I I I I I- I , ~ - I- I _f - i I I - 1 i I I ~ I { i f I 1 ' ti,l 11 - I I - I ~ ~ I I { I i I I I ~ t r , I I _ I ' i a{ I r i 1 i I I I I t. I I I I I I ! ~ I I ~ I i- i I _ I I , I I I i hl i`-J I I ~ I I I 1 I ; t ~ ~ I I I ~ I I I I I I I 1 I ~ I I i r 1 ' I I i ~ I ~ I ~ I I I I I I ' it ~ I I i I I lilt I I I I i I - - - 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 L_ i ~ I ' r _ I I~ t 1 I _ 1 I I I I 1 T I I I I i i ~ I I I I I I , i- i I 1 . I I r I 1 - i ~ I I I I I I ~ j t t I I ' I - 1 } ~ 1 t I , I I I I I r I i , I ~ I I i I i I i 1 it I I I 1 , Tea / 7 cJ 6S I~-s VQ" StC11-A PAGE OF • CrvSS Sec~Iun O~ ~ en SyS~e~ Fresh Air In1e16 And Observation Pipe n . Approved Vent Cap Mlntmum 12" Above Final Grade 20- 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Marsh Iraq Or Synthetic Covering i win 2" Aggregate Over Pipe Distribution Tee Pipe - 0 0 0 0 0 6" Aggregate m a Perlaeled Pipe Below 8eath Plpe - Coupling Terminating At Bottom Of System PP~PoSe1D l lnk1 `grqr. ~ ~1< _T ton ga' 1101 M SOIL FILL DISTRIBUTIOU PIPE , APPROVED SsfN'jHETIC COVER 11 O op_ Z"OFA6GREGATE c o e OR MR'SW Oki F STRAW .3Z 4e0 F,/p-2.112 AGGREGATE 'ELEV. ofF FEET 10 DI•ST'RI15UTIOM PIPE TO BE AT LEAST O INCHES BELOW ORIGINAL GRADE AkJU AT LEAST?-0 I.MCHES BUT LIO MORE THALI H2. MCNES BELOW FILIAL GRADE MAXIMUM ®F-QTIi OF EXCAVATioij Ff OM ORI&WAL 6KA0a WILL BE 4/0 INCHES rJ?(IMUM Wr-H of EACAVATION FRO/A OIK11411bAL GRADE WILL BE so INCHES SIGHED: LIGEUSE DUMBER: - DATE: - - 9.3 a Wiscensin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations i Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix: not limited to vertical and horizontal reference point (BM), direction'and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Ifilton Peterson r. GOVT. LOT ZJfd 1/4 M•1 1/4,S P. T 30 ,N,R17 xFK(or) W PROPERTY OWNER':S MAILING ADDRESS -LOT # BLOCK # SUED. NAME OR CSM # 160 ' n/a n/a n/a 155 acres ITY, T ~~T IP CODE U15)PHONE 246NUMBER ❑CITY []VILLAGE MOWN NEAREST ROAD cf pond WZ . 5401 i! _4271 Erin 165th. Ave. & GG 2~ew Prarie [ J New Construction Use PLT Residential / Number of bedrooms 3 [ j Addition to existing building L*fleplacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .6 'bed, gpd/ft2 .7 trench, gpd/ft2 Absorption area required 750 bed, ft2 643 trench, 112 Maximum design loading rate • 6 bed, gpd/ft2 . 7 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.32 it (as referred to site plan benchmark) Additional design / site considerations n/a Parent material strean terrace Flood plain elevation, if applicable n/a it S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S O U MG O U MG O U ❑ S 04 ❑ S M ❑ S 13U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouifty Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 1 0-12 10yr2/2. none L. 2/m/gr raft g/w 2/f .5 .6 2 12-39 10yr4/4 none sil. 2/m/shk. mfr g/w 1/f .5 .6 Ground 3 39-92 10yr/.4 none Is. 0/sg mvfr na/ n/a .6 .7 elev. 101.52 it. I Depth to limiting factor Remarks: Boring # 1 0-9 10yr2/2 none L. 2/m/gr mfr g/w 2/f .5 .6 .n.2 2 0-24 10yr4/4 none sil. 2/m/sbl. nfr F/w 1/f .5 .6 3 24-32 10yrh/4 none Is. 2/m/sbk mvfr g/w 1/f .6 .7 Ground elev. 4 132-96 10yr4/4 none S., 0/sg ml n/a n/a .7 .S 101.52 it. Depth to limiting factor >96,, Remarks: CST Name:-Please Print Gar L. Steel Phone: 715-246-6200 Address: 1554 200thl. Ave.. 1.11, 54017 ? Signature: Date: CST Number: 7-12-93 cstm, 2298 Li Nv' 2tilton Peterson jr. SOIL DESCRIPTION REPORT Page2 of 3 PROP PERTYOWNER , PARCEL IM. Structure GPD/ft Boring # Horizon Depth Dominant Color Mottles Texture Gr. Consistence Bounday Roots Bed Trench in. Munsell Qu. Sz. Cont. Color . Sz. Sh. 1 R-lE1 1(Tyr2/2 none L. 2/m/gr mfr g/w 2/f .5 .6 kt<« none sil. 2/m/sbk mfr /w 1/f .5 .6 - 2 10-28 1 r4/4 Ground 3 28-44 1 4/4 none Is. 2/m/sbk mfr g,/w n/a .6 .7 elev./ /a .7 .8 100.32 -ft. 4 44-84 10yr5/4 none S. 0/sg Depth to limiting factor Remarks: Boring # L, M-1 AN:` Ground elev. ft. - Depth to limiting factor Remarks: Boring # L=3 Ground elev. ft. ` Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Seo 833Q(R 45/92) • STEEL'S SOIL SERVICE 1 SS4. ....PAth. Ave : Gary L. Steel C.S.T. 2298 Tilton Peterson jr. New Richmond, WI 54017 MPRSW-3254 pI A-Si) S8-T30N-R1714 (715) 246-6200 town of Erin Prarie l 9t oi- (0 6" ~L. i 00t , ~ c ITO v Gary L. Steel 7-12-93 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT n FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify I have inspected the septic tank presently ~~QQ..that serving the LC~i.0'r~V ,~s2`rSONN - vV . residence located at: ll)w_1/4, 5 GJ 1/4, Sec. b T30 N, R-Z7-W, Town of Ev.IY,R u, r, ,.Q. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No)( (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /4-00 V ` Construction: Prefab Concrete Steel Other Manufacurer (if known) : Age of Tank (if known): U) V'11 P6 (Signature) (Name) Please Print ►rPR s w 1363 (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code' (except for inspection opening over outlet baffle). Name 2".S0u/erS z., Signature /MPRS 46 43 5/88