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HomeMy WebLinkAbout022-1048-50-400 -0 0 o p N Oi C N w ~ I n O O N i i N h 0.p Q' I I Er I 'o z o a 3 Cl) ~ ro Z N E z = o z d 00 w a m z I' o N C C7 U O Z d Z d c O N F- (n E 72 a7 O 2 E D O tU N C • _0 O c co m 01 ^\O Z Z N E z N O R a°' a 'ea Y ro N L ro O o D O G E WSJ Z n > LL 3 d cn aB O O O z g o co c) m }~y N 0 (n 0 m rn aNi N ro` } N N 2 N N 4 _ 0) O 0 o 0 m a n m a > ro 7 O o 3 a~ N c O O C 0 F- Z5 O w e? O O O O O O N C O O O O L N L E Y 'B N N N N 00 C ro E C N d' O fzz 7- r- l=yam) , '+~.i CD ~ Y - O N IO Q) CY) 0) U) N C N O O cO f~ r.1 r + w ~ ` a • a @ y E i E c `~1 A 0 a O in 00 .rte AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION N-R g~ W ADDRESS ty Iral r ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT a- LOT SIZE ~PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM U~ Cs h N 4 INDICATE NORTH ARROW BENCHMARK: Elevation and description: r 5~ Alternate benchmark SEPTIC TANK: Manufacturer: Liquid Cap, iajq Rings used:-/-Manhole cover elev: Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front , Side, Rear Ft. From nearest prop. line: Front , Side, Rear Ft.~~2 Ge ` No. of feet from: Well l, Building: /.2 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I PUMP CHAFER Manufacturer: Kos-~- 77 Liquid Capacity: 7.5 C O&Z Pump Model: c- ri Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: X Trench: Seepage Pit: Width: Length Number of Lines: 2 Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: 20" No. feet from nearest prop. line:Front , Side,, Rear Ft.lrS_, No. feet from well: /I/C~ No. feet from building l%~ HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building nearest road Alarm Manufacturer: INSPECTOR: DATE : 7 PLUMBER ON JOB : LICENSE NUMBER: 6/90:cj LQQ&Tl0"art,> UA*IWn NNIC 17.2 j , TOWN HAL Laborand Human Relations RWATN9AGt ~ s 1 CM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-- 193435 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: NICKINNIC CYT ev.: Insp. BM Elev.: BM Description Parcel Tax No.: r 6/,o ' 022-1048-50-400 TANK INFORMATION ELEVATION DATA A9300095 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' 6 Benchmark 1p7, D f o U Dosing 7 ~io Aeration Bldg. Sewer Holding St/ Ht Inlet 6,S y /00,71- TANK SETBACK INFORMATION St/Ht Outlet 6.6 7 to! TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet /UU,6y Air Intake Septic a0U t N i} fa " > /a- NA Dt Bottom y 9 7, 0 g Dosing ao0 < dS- >~i 5 NA Header/ Man. 3,o 3 y d 5 Aeration NA Dist. Pipe -3, 6 ! 0U a G Holding I Bot. System b 3, PUMP/ SIPHON INFORMATION Final Grade ~.aL /off, OL Manufacturer s Demand 5 C6-Z y,~ a /ua . g Model Number 3 r~ ~OGPM TDH Lift Friction System~5 TDH Ii,(A Ft Loss He Forcemain Length Dia. Dist.Towell X-,;14 SOIL ABSORPTION SYSTEM BED / TRENCH width Lenjth No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK INFORMATION Type O lkw y CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Heavier/ M' /anifold Distribution Pipe(s) x Hpl /Size x Hole Spacing Vent To Air Intake Len th Dia..' Len g Dia. S acin 9 9 I P g I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 44 / Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center J 0 ' Bed /Trench Edges /d_ Topsoil La"Yes ❑ No [-Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ICKINNIC 17.28.18, NE,NW, LOT 5, TOWN HALL RD. INN . , l i Plan revision required? ❑ Yes E~ No Use other side for additional information. 7 :.j ( a SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION =1L In accord with ILHR 83.05, Wis. Adm. Code couNJY !5 STATES;?, ITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1 8tf x 11 inches in size. ❑ chef revlslon co previous application -See reverse side for instructions for completing this application. ST TE PLAN I.D NUMBED 1. APPLICANT-INFORMATION - PLEASE PRINT ALL INFORMATION. 15,q3 - ii o PROPERTY OWNER PROPERTY LOCATION v %l« &A6 Tc~l~1'f I f L- I14EY, A144, S T 22, N, R E (or) W PROPERT)LOWNER' MAILING ADDRESS LOT # BLOCK # r AtC S 4N 715'" CITY, STATE ZIP CODE PHO NUMBER SUBDIVISION NAME OR CSM NUMBER Z4 W10S©,✓ Gv < arCo 3X1 06 2-9 C-5 l l P II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLL.AGE : NEAREST ROAD ❑ Public 1 9 or 2 Fam. Dwelling-# of bedrooms 2- PA E T NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) ©ZZ a~g - S~ ^ y~ 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. TYP 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. 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 3 ELEVATION S 7 l Z_ Feet / 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 structed Tanks Tanks 44,p - Co\ P, Se tic Tank or Holdin Tank AVO O V _J~_ I I U '75 F1 Ej 01 El I LJ Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Na a (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Ulm . S' m AWA, w~ Mpoo t~3~Z 7~S a6 - 3~Z Plump~r's Address (Street, City, State, Zip Code): 7070 .540 IX. CO NTY/DEPARTMENT USE ONLY ❑ Disapproved Sa I ry Permit Fee (includes Groundwater a e ssue issuing em Signatur (No S rn urcharge Fee) ,k'Approved ❑ Owner Given InitialE'`' D%~ 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 I 1. A sanitarypermit 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 $anitary Permit Transfer/Renewal Form (SBD 6399) to be submitted. t'o 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 aid/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 .f 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'f2 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) soiLtest 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) oR~ ~e o w~ t (s~ /r ie~ OF 14ee ry -LDo M Li E r (lE rZ ,e4 /P I.L.H.R. 83.08(2) PROJECT INDEX SHEET . Owner: / I~'~E GUMS Tom" ? D ~ L 7/57-- 3 F6 O Z ~ Address: ~f3 Tie-0,65 L,), 11VAreti SVO/to Site Location: LOf CSM 2-y'2 ea5 AVE i NO ~ Spy ./7 TL ~,v TO& v sT ~~o,X Cov.~ry Project Description: i /v>: w 3 13t, P4Af _ hob At Gv,4STE COnv 0 S-4:5 A0 soy %s ~ t4A ~3vr 5E,Js4..)4111 6v t r 4T' 2-7 14 ",ov,UP s y 5'7F ars1,v 6, $1 Page 1. PLOT PLAN VIEWS Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAYOU-I Page 4. DOSING CHAMBER CROSS SECTION r A0, t L" Page 5. PUMP PERFROMANCE SPECS 4Y 17 1993 EAU OF sull,r~' PLUMBER: 6u 44, .544, M Ar eE 111/9 ooa 3~.z S93_'010 06 DATE: SITE EVALUATER/ DESIGMER ONSITE SEWAGE SYSTEM SIGNATURE ,t. V ~d//✓r/iJ'V"O Va/rr~Y~ F r may- ~i`-'1 F r7 01 RTWIENT OF I_ADr AN U 6A TIONS DEPA _ DIVI'AFE D ING a SEE CORRESPO ENCE ~ o~ m e o i~ ~ G o , 70 N moo' v~`~_ 1 ~ ~ 1, 11 0 1 1 1 - 1 03 1 ~ n! o ' o N ~b D N 3 o O - rn w r fp f~/ So . L o T L. ~ S~ ~ ! C ~ O L ~ O tul G I G r 0 a w ONSITE SEWAGE SYSTEM -v rte, ~ ~rt 4~ MAi RELATIONS R~ DEPARTMENT OF U~ RY, I ALA A F SkF A ' UI► i DI I I S93-01006 z o I D NCE j SE COR ES D • i~ tj\ of 17 V1 ~ C ELF 04 7-/V,0, IAI)II&/' T oC Get 7-&IP l /j -'O y /0 Tod G-f- T/S / 0 `1, 20 x ' E UfJ-TiU~ ?o~ o f If fi(E Get TE- 3 7 Page 2- Of S Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand SYSTEM Topsoil /D .3, 6.3 - 3 J ~ E D D . -UNOe: r-, % Slope A-G-G9(=G,^-rt Bed Of 2 Sv~9ESTED Movup ?~v,;: o,FM 2 z (Force Main Plowed Layer /o Z • ~O3 Aggregate Toy ~.;vE F i~ vt r~o.v 0 0 Ft. /0/10 E 3 Ft. Cross Section Of A Mound System Using F 7S Ft. A Bed For The Absorption Area G /.O Ft. A Ft. H 5 Ft. Signed: B 117 Ft. License Number: K /0 Ft. L 67 Ft. Date: ,J e Ft. Alternate Position 1 12- Ft. of W zg Ft. Force Main Observation Pipe A la ° t1F__-_-orce Main Distribution Bed Of 2 - 2 i Pipe Aggregate I Observation Pipe Permanent Markers S93-01006 Plan View Of Mound Using A Bed For The Absorption Area - ONSITE SEWAGE SYSTEM ^,?AY 7 1$9 0OF8111- "J, A, Pa DEPARTMENT OF IN ST AF LABOR AN. N. NGN TIONS DIVi Q r SEE CORRESP ENCE Page 3 Of S FF pF U c ~oR c~- • V O/ L2 U 01VA4 E Fo,e Z_6" _ i f1Acr /A S r Axle- Perforated Pipe Detoll zv Ri Gti r Foy' U~ l v~tE End Via- PVC End Cap) PVC Pipe 1. 'o s c Holes Located On Bottom, Are Equally Spaced R w PVC Manifold Pipe Alternate Positlon Of Distribution Force Main Pipe Lost Hole Should Be Next To End Cap End Cop--) Distribution Pipe Layout P ~Z Ft. R y0 - X yg Inches y ~"8 Inches Signed: Hole Diameter Inch Lateral Inch(es) License Number: Manifold Z Inches Date: Force Main Z Inches # o•f holes/pipe G y /O Invert Elevation of Laterals /D Ft. • R15717iBU?"10A) P,15'eX4,,eCC t474- FOR E~~lt 1476 RA 70 ~aQ/~►+~ wv 'P-~. OT i S 2-7, • ~o7rtl l7~ST/ri/3l>T/O.J L7/,SG6i A~'GE ~fITE~-o~ ~f/.C~IvDiP/~' Z~, D ~-/.w~tv~, ONSITE SEWAGE SYSTEM 6 a S S93 0 00 Eo Arx'x%? a DEPARTNIENT OF R bT LABOR AND J~ N R LATIONS ~~~J DIVI N AFE ND I NG i-AU OF -tffE- OR OsSPO E E PUMP CHAMBER CROSS SECTIOU AND SPECIFICATIOUS PAGE OF ,C - VENT CAP 4'.C.I. VENT PIPE APPROVED LOCKING WEATHER PROOF JUNCTION BOX MAWHOLE COVER 25' FROM DOOR, w/ 4 A,&OW6- 1AfE~ WINDOW OR FRESH 12"MIU. AIR INTAKE yRA~~ Irf *rlo v GRADE CONDUIT -zz 7:---- f /Ev,4n Oil/ 98'0 PROVIDE I - INLET AIRTIGHT SEAL I I i I I i I v APPROVED JOINT A `N5 K I I i I WPC IVP PEOIWTS W/C.I. PIPE I l~ I I I ZXTENDING 3' I I ALARM EXTEIJDING 3' OIJTO SOLID SOIL I II ONTO SOUR Svl: s y yea , I 1/0 (3.3) I ow l~-~ c •I I ELEV. FT. j I PUMP- __J ~ ! OFF D 1~3 6 K ~g~ BLOCK 4~ IE u!~ f ' y5J RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E 5PEGIFICATIOPIS DOSE PiP,~7e_i9 ' TANKS MANUFACTURER: I.IUMBER OF DOSES: it/ -PER DAS Ay TAWK SIZE : 7.50 GALLONS DOSE VOLUME ALARM MANUFACTURER: 5. 3. cLEC1'R(} INCLUDING BACKFLOW: GALLONS i MODEL NUMBER: /6 0 / CAPACITIES: A= ft~ INCHES OF, 300 GALLOWS SWITCH TYPE: MERCV,p✓ / ~/O h T B=. Z IWCHES OR a GALLONS PUMP MANUFACTUREM (2 oL12S //-2 yo//S ~3ItP C = yc' Z IWCHES OR GALLONS MODEL NUMBER: 3 94?5 56,Pit S # IfEO 3 p. /.S INCHES OR 2* GALLONS SWITCH TYPE: 9I66yQAtrK MtRCJRyJ /oAr MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 30 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEAI PUMP OFF AND DISTRIBUTION PIPE.. Z FEET -rAok S'hfGS . + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EAC(A- Of '3)} PIf- ' 2S FEET OF FORCE MAIN X /:Le ~ F ooFtFRICTIOU FACTOR.. FEET tAoAk IF 7S TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH LIQUID DEPTH ONSIT Co4d dvoxal~ E SEWAGE SYSTEM S93-01006 Y• .I rt A P f+{i G,V fi'r AY 17 111d~ DEPARTMENT OF I U ~ Y, LABOR A H AN LATIONS DIV SAF AN DIN r " " r~ gar SEE CORF;ESP DENCE h 3885 TA'G' _.,w.., AVAILABLE CERTIFICATIONS ETL LISTED SUBMERSIBLE PUMP CLASS 1 AND 11 DIV. 2 AND E CLASS III DIV. 1 AND 2 ETL TESTING LABORATORIES, INC. CORTLAND• NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION sf I - PERFORMANCE RATINGS (gallons per minute) MODELS WE0511H WE0511HN Series HP Vohs Phase Max. Amp Series WE0512H WE0712H WE1012H WE1512H WE0512HH WE1512HH WE0311L 115 9,4 NO. WE0311L WE0311M WE0532H WE0732H WE1032H WE1532H WED532HR WE1532NN WE0312L 230 4.7 WE0312L WE0312M WED534H WE0734H WE1034H WE1534H WED534HH WE1534NH HP Y3 A /2 3/4 1 1 i6 %2 1'/2 VVE0311 M 1/3 115 9.4 RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0312M 230 1 4.7 5 100 70 80 90 106 - 60 - WE0511 H 115 13.0 10 80 65 76 87 102 112 56 84 WE0512H 230 6.5 15 60 57 72 84 100 108 53 82 WE0532H 208230 3.4 20 36 45 65 79 95 105 48 77 WE0534H ' 460 3 1.7 25 25 59 74 91 100 45 75 WE0511HH /2 115 1 13.0 30 50 67 85 96 40 72 WE053 WE052HH 2HH 2/2 6.5 35 40 61 79 92 35 70 ~ 3.3 S 40 26 52 72 86 30 67 WE0534HH 460 3 1.65 45 10 43 64 80 25 64 WE0712H 230 1 10.0 50 30 54 73 18 60 WE0732H 3: 208230 5.4 55 17 42 65 12 58 WE0734H 460 3 2.7 _60 6 30 54 3 54 WE1012H 230 1 12.5 65 16 40 51 WE1032H 1 208230 7.0 70 5 26 47 WE1034H 460 3 3.5 75 14 43 WE1512H 230 1 15.0 80 4 40 WE1532H 208230 9.2 90 33 WE1534H 1 460 3 4.6 100 24 WE1512HH 1 230 1 15.0 110 15 WE1532HH 208230 9.2 120 5 WE1534HH 460 3 4.6 metal parts, BUNA-N elastomers. METERS FEET = 010 0 6 • Temperature: 1600 F (710 C) 90 ! ....Z_,3__.._ maximum. I • Fasteners: 300 series 25 80 stainless steel. wE15t0 - • Capable of running dry 70 without damage to 20 WE1 d1i i components. W _ sGPnn WEOf1 5FT Motor: W x 50 _ , • Single phase:'/3 HP, 115 or a 15 I _ 230 V, 60 Hz, 1750 RPM; o 40W E05 1/2HP,115V,60Hz, ; i.. 3500 RPM;'/2 HP through 10 30 WE03a0 1'/2 HP,230 V, 60 Hz, ' 3500 RPM. WE031IBuilt-in overload with M 5 automatic reset, class B 10 insulation. i I • Three phase:''/2 HP through 0 0 1'/2 HP 208/230 V, 460 V, 0 10 20 30 40 50 60 70 80 90 100 60 Hz, 3500 RPM. 0 10 zo Class B insulation, overload CAPACITY protection must be provided in starter unit. 8 7 7 1 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOJR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 • (H63.090) & Chapter 145.045) LOCATION: SECTIO • WNSH UNICIPALITY: OT NO.: BLK. NO.: SUBDIVISION NAME: E/arVv~/ /Ta8 H/R 18, (or, W IQ W rv r+- I rv COUNTY: (Qy~ ER'S ByY~ER'S NAM MAILING ADDRESS: ST CY V L W RMR~~ 311 10, r~ (K~VGr Fa 5401-1. USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: X New DESC IPTIONS: ER ATION TESTS: Residence x XNew ❑ Replace I_ G_ g 3 1 1_ Q 3 0 I o s4..hy ~G ° SL.V% RATING: S= Site suitable for system U= Site unsuitable for system h ;"1 p 1 YA 7~ I • - 9 r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMME ED SYSTEM: (optional) ❑S U 19N ❑U ❑S U ❑S U ❑S U MOurVD If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5) (b), indicate: N II. rV I Floodplain, indicate Floodplain elevation: N PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 0-9" [Tan S:) 9-19" A S;) 19- So Rd B+ SL 3a-36 " RASn B- 1 3(0 16110 No,, E- 32 mW%e/ CIL w/e.rq/0-S a737." 3l" L:~wssYar~ C' y8+S;~ 1) 1' 6.5:) 1)--a (3.,S1 04-28 * S., SCm B- 2 0 106.1 >N o w e 2 7 e') n.~,tt*~ a-' e?0 " :)8- 3 p'1"rwss-fora „ o-8~GyCi, S=1 $-1~''R+S: 1~-32''6ZLB,SL 13- N 0 N E .31p la tltl R~sn-t<6., SCLL W',tk Vneff)is -_T 34" C' -12 C* 8h 5;) 12.21" G, S; 1 24-40" X6, SL -Q, " B- rJr!v 10 3, Z No W F- q 0 SCLL v:rt '61s 1,,L -to , ra, on 71/.s ~7 s" B- ~O D 9~ Cry 6. 5:) q 25" S3„ 5: 25- 37 & 6. ve.ry~r;.~ 5! ~0 S W eN ~ ~0 ~•'7+ n.~fr, a'f 30 7.44 Dcr, (46 SL 40 Qjj.A CtL o-1''C,.if3.5;1 7-27 G.5:1 21-36 L+ti-, SL Se'ru.:i~ r►wA B- 95 102'& hjoNE 27 40 -41 LG.' n.rfle 41-4 ftlb+ CLJ_ _j PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ 1 20 rJ o N e 3 t+ . 314 -5' _'g 4 rp,: ~ / I/i P- 2 20 VV 3 0 3 P- 3 1 f'o Norvft Sd -CY, h Y/6 44 P 20 waNa 0 rw;w 4 ~3//' Y% 4 P- 5 ,J F) _-C 30 0%i'- I// 4& t 4 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Tv aF- Wre d w) sys6,r i's ~l es:s".o FT 1T_ uG _ I 11 _..._.......T r i I C I 1 -7-1 "o f sr ~ ov ~»0w++ 30 1 ! ~ I E ~ Dr ' 1 °_W ~r 4~~ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proce r d methodic" IppH,r e.W nsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge an ef'f NAME (print): TESTS WERE COMPL €D J C A, Y- P N -C L I- I I- ADDRESS: CERTIFICATION NU BER: PHONE NUMBER (optional): 1042- f e t v,*, F-tli W e 40 1 S3 if I I I I S_ A1;5_ -19 ' CST SIGNATURE: omd~ le DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - S$D - 6395 To be accurate soil test, your report must include: 1. Co I description; 2. The i i n must clearly i 'i -ate whethe is is a resi ` or commercial project; 3. MAXI._ fiber of bed r commE use planned; 4. Is this _ solacement 5, Compl )ility i t' s. A SIT IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHE' "S ARE Rt_' OUT BASED ON SOI ONDITIONS; 6. P' rbbr here for vvi-iting ~scriptians =nd corrsl )g the plot plan; , tely locatir7g yc[.: ~ rations. C~ to ,le is preferred. A ,'ire_'; ? vertical elevatioi-i it ~)oint are r y shover), and are permanent; ~ces as to dates, names, _ ~s, floor' . -i lata, percolation test exemp- c.)riate, `ion 4-1--,.3 elevation) do--, not apply, ° Vin the appropriate box; 11. _ir ..:iress and yo,jr ion n = , , 12. 17 co.~ re(luired. ALL _ TESTS MUST BE FILED WITH THE .UTHORITY ~..IITHIN \YS OF COMPLETION. f.-, w VIATIONS FOR CERTIFIED SOIL TESTERS J! Textures ~mbols BR - 01 10") SS le 1("13") L N" 'Id is d s1 _n - l E3 r.~ C3( si Gy Y art) R - sl'. _o n mot - 3 H VV L S:_ . zXttl res Ii'>posal BM . VRP - F ~ rence Point TO THE OWNER: tl Y y. retjuest _ -Jvate a 1 - or ier to lie sago y J S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER T Ml e Le~m,_~ ~c-~;w /4 {f L V ~ -Q6.2_- ; ADDRESS FIRE NUMBER CITY/STATE ZIP N-R e? w ' PROPERTY LOCATION : '1/4, 1/4, SECTION , T 2-P TOWN OF St. Croix County, SUBDIVISION_C5M 10- 9 : r261p , LOT NUMBER ✓ . 17 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 for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and SCUM. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : S' - 93 St. Croix co. Zoning office 911 4th St. Hudson, WI 54016 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), thenla 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 M/e Location of,property ~1/4 1/4, section T ~LN-R `d W Township itCtit" Mailing address t e 77jA-e-o f3s 1,%v. 4L p56,) 4_)i'S S O,- Aft* 48 Of site 16Y0 -T w A kI Nz1, br► v< Subdivision name ~j 9Q~_ o7G/G Lot no. other homes on property? yes No Previous owner of property 3)d / 1_)eF7167X0, Total size of parcel Date parcel -was created t C~7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes &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 NUMBER, 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 my (our) knowledge that I am t (we) (are) he owner(s) of the property described in this information form, by virtue of a warranty deed recorded in eQoffice 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 County Register of deeds as Document No. • Sign atur of applicant Co-appl,'cant 5'x`)`73 Date of Signature Date of Signature } a t,{ THIS SPACE RESERVED FOR RECORDII r OA i A R~ DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 WARRANTY DEED 498880 VOL 1000PAGE 286 REGISTER'S OFFICE cAleL To N W S TE RQ •4 HL Anne cox co., wt AA1I TA .1 y ~iESTERAA iYL N vS 8A N D A AID Reed for Record MAY 111993 1:10 P 111:11111 jjt~ RDA s • M conveys and warrants to i? LIS RA ND ~ ~~fwtnL~Jll:+ Of Deeds ?y RETURN TO the following described real estate in STS L /Q O l V County, ► State of Wisconsin: Tax Parcel No: rPT, of NC iy off' 7JY~ NIY~y 171' S,ECT%oN /7, i` rowNYhfjP ;Ie /PANG,' AF W, eZ1,i-16: 0ESCA"iBA--4 Y AS L07- S. CSRTi~'iE',D S'&XkE' k vol 9 M1 PG. 016 /G J F,XEMPT t This IS N07- homestead property. (Is) (is not) Exception to Warranties: Dated this fl day of .zrn.~!% 19 (SEAL) C Le ~0e," (SEAL) .CA,TLToN E GYESTE~/J~DAI~/L 'SEAL) (SEAL) --AwiTA M tvESTEROA%/L AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. Stm Croix County. Personally came before me this 11th u.3 "Ps 19 authenticated thin " May , i919 3-the above named Carlton EA Westerdahl and Anita M. Westerdahl TITLE: MEMBER STATE BAR OF WISCONSIN • (if not, to p9t known to be the perso ' vjhf~esecuttid 'be- authorized by § 706.06, Wis. Stats.) f instrument 4 oNledg !an7e: r THIS INSTRUMENT WAS DRAFTED BY eAA1LPQN Af/FS%,5221-AHl Ill Ja s O'Connell y. St Croix' ~Co4nty, Notary Public Wis. Z (Signatures may be authenticated or acknowledged, Both My Commission, is permanent. (if riot; Wetfy'sxpiration are not necessary.) data: April 20, t92Z_.1 F S82 NTC ooQ1 'Names of persons signing in any Capacity Should Ila typed or printed below their signatures. i WARRANTY DEED STATE BAR OF WISCOtISS+N Nalco Tax Forms, P.O. Box 10208, Green Say, WI 54307-0208 Form No 2 - 1982 t; FILED MAY 0 519930 _ JAMES O'CONNELL ftisles CI Deeds 498579 SL Cronc Co., WI C EP T I F I ED S UP V E Y MAP Located in the NE 1 /4 of the NW 1/4 of. Section 17, T28N, R ~,8W , Town of Kinnickinnic, St. Croix County, Wisconsin. Owned by: Carl Westerdahl 621 7th St. North C. S. M. I Hudson, Wi. 54016 V.3 , PG. 653 I UNPLATTED LANDS_ NORTH-SOUTH 14 SECTION LINE S 01'18'13"W 421.92' _ 191.63' 230.29' 4? 8.07 NI/4 COR. SEC. 17 S1/4 Cor. T28N, RI8 W Sec. 17 N LOT 5 0 LOT 4 Q► 135,953 Sq. Ft. a 138,076 Sq. Ft. (3.12 Ac.) w (3.17 Ac.) lD W,CP Including ROW Including ROW CO ~I a~ 127, 306 Sq. Ft. iv 129,013 Sq. Ft. 4 NI (2.92 Ac.) (2.96 Ac.) 4 W,0. 14 Excluding ROW M Excluding ROW CO 3 ►-1 0 ~ l 3 ~~uu h 2 , rn i W (D 0 y ~ HARVEY G. • Vol 0 JO N z CO Z n S H 899N 0 W rn HUDSON I N t.~ WiS ,re "iQft / CU U R' to - CID aI z ro Illtes oN o w 5 ~bac~ 0 0 W N v N ~11a ri4~ s CURVE INFORMATION APPRO~ z M . 'c9 ~~~,p, a 42' 53" X00 `fl I A~5 ~~2~6 59 /CH=15 30 0' 'S2W 05' P~~'' CURVE TANGENTS Y ®s193 N36°54'19"WOy~'~2'~ SgQ~~~~ N23°32'52"W Z~g.~ aY1 L- - 73.67' N 5 0°15'45"W ST. CiROIX COUNTY 2.52 ~ ;:~prokensive P A6' N 29 3/ ' ZanWo wW , X6 2 NP ft" 06"Wrat" ~`v~ ' SuRJ~ Za~~' Bearings referenced to the North- 91ne recorded 0 South 1 /4 section line, recorded as wi111Ah 1646VC-of' / % i co:' 9' - So 1~' 13 "W . aplprotralad~tiP/ ~ ' 1 i 10 r,WWvoid No NO 55'28" 89.92' LEGEND NW Corner Section corner monument SCALE IN FEET 1' = 100, T (Berntsen cap) • 1" iron pipe found 0' 25' 50' 100' 200' 300' 0 I "x 24" iron pipe weighing 1,68 lbs. / lin, ft, set. Drafted by: J W G Fence. 493-3156 VOLUME 9 PAGE 2616 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE „I, r 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 April 29, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Carl Westerdahl property, located in the NE'-,NE;, S.17, T.28N., R.18W., Town of Kinnickinnic, St. Croix County, WI., has been conducted with the assistance of Bob Ulbricht, CSTM# 2482. This onsite revealed suitable soil for onsite sewage disposal over fractured lime stone bedrock to a depth of 24" while meeting the requirements of the A + 4" rule. This site should be suitable for new construction utilizing a mound septic system having 12" of sand fill. Should you have any questions, please feel free to contact me at this office. Since ely, mes K. Thompson Assistant Zoning Administrator cc: file