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HomeMy WebLinkAbout032-1005-90-000 Q o w oo v o o o ° o M d o 00 4 0 C 3 I C~ N C 6 c6 N O ' I 40 Y r.+ N c w :0 C Q V N N 0 N O. 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CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ` I 8s a.' INDICATE N TH ARROW Provide setb c-ei~d levation information on reverse of this form. Provide 2 dimensions to center of septic tank tnanhole cover. I BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION /GAO Manufacturer: Liquid Capacity:~/~ 3B.e- ~Zo 3 ,ee-_,2/' Setback from: Wel l ;~/d//` House Other Pump: Manufacturer Model#ldz6-yml size Float seperation 'M Gallons/cycle: /7Z Alarm Location SOIL ABSORPTION SYSTEM Width: Length s?S Number of trenches Distance & Direction to nearest prop. line: Setback from: well:.- Housq,,22,e_~,S• Other ELEVATIONS d9e- 9/ i9 o7e~- 90.89 Building Sewer ST Inlet : S&~ q?. ST outlet 3~,P ~3. 73 PC inlet 129q PC bottom iq Pump Off sa Header/Manifold 7G Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L sl+ par r~J rs ry, 2. 31.19. 2AUVATE SEWAGE SYSTEM County: L?bor and Human Relations INSPECTION REPORT Safety and Buildings Division ST_ r-ROTX GEIRAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 199904 Permit Holder's Name: ❑ City E] Village Town of: State Plan ID No.: r"W@ L ev.: Insp. B Elev.: BM Description: Parcel Tax No.: OZ91 032-1005, TANK INFORMATION ELEVATION DATA A9300304 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a} loo~0' Benchmark ab,0 Dosing a/~vv a Aeration Bldg. Sewer fo,o QI.~ Holding St/ Ht Inlet ? z 3,G TANK SETBACK INFORMATION St/ Ht Outlet 10"3(- QO.&7 TANK TO P/ L WELL BLDG. Air Int tontake ROAD Dt Inlet r q qq I I. a a Septic )do, NA Dt Bottom I ~ ,06 ~ b ~ y Dosing NA Header/ Man. ~rn~r,o5 Sd9 g9.76 Aeration NA Dist. Pipe / gS,s;l Holding Bot. System (o.d9 r1 y,-7 4 PUMP/ SIPHON INFORMATION Final Grade L1,0 ct7 Manufacturer 5 Demand s,73-' 9s-g3 6.1~yI ~.~°ur.~ .q a~, 3 S Model Number b 3 L i-T) j,, GPM 011 Ster~~•~ f 101.73 8~ •S a- TDH Lift Friction System TDH Ft oss mead Forcemain Length 15' Dia. a Dist. ToWell 'w0 SOIL ABSORPTION SYSTEM BED /TRENCH Width/9 Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth g 5- DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type o e G /;1 3 CHAMBER f Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe( i~ tl x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Lengthy 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 : SOMERSET 2.31.19.28{" ~.ab s 36 - ^ 9 rn1 S Plan revision required? ❑ Yes ❑ No . Use other side for additional information. 151` Z-4; 4 x, ,~c y, F& I SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ' Y ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s LQCMUX;art XWy,2.31.19. 2PtIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST_ CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 199904 Permit Holder's Name: ❑ City ❑ Village 7C Town of: State Plan ID No.: 'L 71 Ir C2 ViD 0TJAVT_T?Q V Z MARV AMM Ri RnMERSRT ev.: nsp. B10 Elev.: lz~cription: / Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300304 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S a~ /000 ' Benchmark o o b U Dosing V 400 a Aeration Bldg. Sewer Holding St/ Ht Inlet ' q3 G . TANK SETBACK INFORMATION St/ Ht Outlet lu`?~ qo"t`r 7.S%- 43.-73 TANK TO P/ L WELL BLDG. AirI to ROAD Dt Inlet r q 9q Ar Intake I I • Septic ado o' NA Dt Bottom I S ,O 6 ~f b ! y Dosing NA Header/Man. r3Mo,ios Sad gS.76 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade (q,0 qi7. 35 s Manufacturer Demand ' gs.33 S q-7, 3 5 Model Number Aj4-531/ L j~ GPM Str7t(~Iti~ f'T) 19.73 8ro•Sa TDH Lift (p/ Loss System TDH I) Ft Forcemain Length 75' Dia. d v Dist. To Well X160 SOIL ABSORPTION SYSTEM BED/TRENCH Width/9 Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS S 11 7 SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution P4' e(sl~ II x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length a 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: (Includ ode screpancies, persons present, etc.) LOC rATIOIJ : RSET 2.31.19.28 Plan revision required? ❑ Yes ❑ No I Ll Use other side for additional information. /I /J SBD-6710 (R 05/91) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH - SANITARY PERMIT NUMBER: l j , I SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN DILHR STATE SAN Y PE MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ /I,/ 8% x 11 inches in size. Ch k f rev fo U411cation -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 of %a %4, S T , N, R Jcl E (or PROPERTY OWNER'S M IN AD ESS LOT # BLOCK # CITY, STA E ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CS NUMBER If '.,ZZ II. TYPE OF BUILDING: (Check one) CITY NEAREST ROA ❑ State Owned ❑ VILLAGE ❑ Public 01 or 2 Fam. Dwelling4 of bedrooms AR A • M R( ) III. BUILDING USE: (If building type is public, check all that apply) 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 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) 1.0 New 2. 11ni Replacement 3. ❑ Replacement of 4.0 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 Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 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. rich) ELEVATION 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. Tanks Tanks strutted Se tic Tank or Holdin Tank '-dnnn Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio of the onsite sewage system shown on the attached plans. Plumber' Si ture N m MP/MPRSW No.: Business Phone Number: Plumber' ame(P int)• g s P ber' ddress ree ,City, State, Zip Cod IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Is ue Issuing A e o Stamps) ❑ Approved F-1 Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 wherever 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 E1% 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 manufac-;urer; 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) I Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page--/ of Labor and %man Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but riot 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 PROPER OWNER: PROPERTY LOCATION GOVT. LOT 1/4,S T - N,R ore PROPE OWNER':S MAIL NG A DRESS LOT BLOC # SUED. NAM OR CSM # CITY, STATE ZIP CODE PHONE NUMBER I' QVILLAGE MTOWN NEAREST RO D [ ] New Construction Use d(J Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow _ gpd Recommended design loading rate , j- bed, gpd/ft2 ,_~Ltrench, gpd/ft2 Absorption area required /4,a,% bed, ft2,&s trench, ft2 Maximum design loading rate . <S' bed, gpd/ft2_trench, gpd/ft2 Recommended infiltration surface elevation(s) 9-5/71 It (as referred to site plan benchmark) Additional design / site co siderations Parent material JS.r. Flood plain elevation, if applicable vll ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U ®S ❑ U OS ❑ U RIS ❑ U ❑ S [M U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench \4ti}:•ii•:ti '{tiL.a i4: Ground 1114 elev. &ft. Depth to - - 'Aljo )VP limiting factor Remarks: Boring # Ground elev. JIL 7 Depth to - limiting factor Al Remarks: CST Name:-Please Print j Phone: Address: Signature: API Date: CST Numb r PROPERTYOWNER SOIL DESCRIPTION REPORT Page~=-2 of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistience Bol rb3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& Ground _ ~elevv / Sew, Depth to limiting 3 factor Remarks: Boring # . . U1. Ground elev. ft. Depth to limiting factor Remarks: Boring # \~vyYh.4h:..h\!C an +~:x Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: i j I ! I F-z I ~ I i I I 1 ~ i I j ! ~ I ! r I ' i i ' I j I I I I I I. I I ! I I I f ~ jI I ! x/' j I I ! I I I I ~ I I j i I /a, i o j I j I I P _ 01 C, ~ I I ~ ! I i~lE S ! ! i I I I ! 6;A 1 I I, I j II + i I ' r y I I ~.-L_ I ~L. i i ~ I i I I I I LL ! I I I I i I ! I ' I I 1~ I ! I~ I 1 i I -!--L _ _i _ ! - L - - I I L I L - - 1 ! i I ~ I ~ ! i i I I j I I 1-1- ' 1 I j j i I I I i ~ I ' I I I j I j I I I I 1 I ; I i I ; : I I~ I I I 1 I _ 1 1 ' _ ' i --i-~ - i I I _ .__L L--- L _ _ i I + I ' ' I I i ~ I L l I i I ~ I I j 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 ' 1 I 1 I I j 1 I ~ I I I I .l- I I I i i I I j i I I I I ~ I j I , LL - I ' 1 j j j ~ I I ~ I ~ I I I i i 1 I ' I I i I I 1 _t I I t F ' I -I I I l- y 1 I t 1 I I~ I , I I I i i ~ I I I ' ' - - - ---L - j ' _ . - - - - - I I I l j i~~ l l i l ~ I ~ i I I I j ~ I I ~ i I : I 1 i I I f : I , I I I SpX.~.d',~sz 6V 6 ~ 6 ~ C O a b 6 / ~.JE 7A~ ~,S 6 S' Q 6 0 6 ~ a 0 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 40 C.I. VENT P I P C WEATHE R PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 25' FR¢M DOOR, WIWDOW OR FRESH 12"MIU. AIR INTAKE I GRADE M(N. IB` MIN. CONDUIT PROVIDE ( INLET AIRTIGHT SEAL I I I J/ I APPROVED JOINT A ( I I ( APPROVED J0I10TS W1C.T.. PIPE I III W/C.I. PIPE EXTENDIN(S 3' I II ALARM EXTENDIUG 3' OWTO SOLID SOIL ONTO SOLID SOIL B I I GN G I. 1 PUMP :__J' ' OFF r D CONCRETE BLOCK RISER EXIT PERMITTED OWL4 IF TANK MANUfACTURC.R HAS SUCH APPROVAL SPEC.IFI.CATIOAIS EPTIC AND - OSE TANKS MAIJUF'ACTUREK: ~Q, t r~S IJUMBER OF DOSES: PER DA14 TAIJK' GIZE: GAL OIJS DOSE VOLUME: ~78 GALLOMS •cl ? A ALARM MAIJUFACTURER: 15e, - G PAC1T1E5. A= 22 I►JCHES OR CsALLOWS c MODEL 1JUM5ER: 6=_...~,2.IIJC14E5 OR IScla_ GALLOUS SWITCH TYPE: ' Ca l~ INCHES OR ~LZc~ GALLOUS PUMP MANUFACTURCR: oz :z INCHES OR GALLOUS M011EL NUMBER: ) NOTE: PUMP AND ALARM ARE TO BE IMSTALLED ON SEPARATE CIRCUITS bW11CH TYPE: PUMP DISCHARGE. RATE GPM(N VERTICAL,DI1YERENU DETWEEM PUMP OFF AiJD DISTRIBUTION PIPE.. 10 FEET J + MIKAMUM NETWORK SUPPLY PRESSURE ~ FEET ♦ ~ FEET OF FORCE MAIN X F/oOFxFRICTION FACTOR..-Z -I- FEET i TOTAL DyIJAMIC. HEAD = FEET RITERNAL DIMENSI N5 OF TAIJK: LEIJCvTH ;WIDTH -,,LIQUID DEPTH 31GIJED: LICENSE NUMBCR'. 3r.~ DATE: z"I'D U, b m e ib ~ f f I u, - cis x; Performance Curves Pumps METERS FEET 90 MODEL 3885 25 80 SIZE 3/4~ Solids WE15H 70 I 20 WEI H 60 -WE07H 50 15 WEOSH 40 10 30 WE03 WE03L 5 - 20 lit 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i i , , 0 10 20 30 m'/h CAPACITY [gGOULDS PUMPS, INC. SBECA FALLS PEW Ym 13148 METERS FEET 120 MODEL 3885 35- 110 WE15HH SIZE 3/4" Solids 30 100 90 25 80 70 20 60 O 50 WE05HH 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i i , i 0 10 20 30 m3/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 C3885 PAGC of C~ Az C17 '-'.3 stae n FtNM• Ak Weh AM 0►~~/~~IINI PIP• . ~.~••~+409440A Y••1 Cy I. ^i0• 48 ° A6;•N 111 ..,,1' C••1 up ~:I~. 1<~ /1•N'0t•ll• YwN IV• • ~ M INS O/ ir•~Mik C•r•rN• ~ . , 2; p•ua.lly~ . ' h1• Y•H i••••1~ II~• • ralw•1•d ►1lo• YN•• • C•.•11•s T••wM•11• AI • ••11•w 01 i 11• i P% ®03TKIBUT10/.1 I ° IAPPR0`10 S•jurICTIC COVC 2" OF AcGREC~►1E `"'MATZMA OR V OF STRA1• OR MARsI• NAy PO, AGGKCGATr. ELEV. F~cMr FEET •••ti~ .r`~. OISTRI15UT101J Fire `70 br. AT 4ChiT _ IAICHC3 DCLOW ORiC11J~1, •.aAOt AWV AT. t.CAiTtO IA9CHtL OUT 1.10 MORC THAW 4% IuCltti ULLOW /IIJAL r.ItAOC I MWUA DEPrviOF EXCAVATIOP FXoM OWWAa 6R v WIL BE IQC.HCS M ©EPn1 OF EACAVATiom FOP% 0' 141Ng1- rjRAPJ. Wlt.%. ec .j;; INCHcs 81GIJ LIGCU3C UUMDCIi: w' ww~w ; • DATT l` 3 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _ d ADDRESS: 1~Q )d/ FIRE NO:__ ~ /S LOCATION: _ 1/4► _ Sr 1/4 SEC.- _TTN-R ~C~ W►~_ TOWN OF: _ST. • CROIX COUNTY SUBDIVISION: At LOT NO. / 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. SIGNED: ' DATE : - St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 STC -loo . This application form is to be completed in full and signed by the ot,'iler(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 Location of property_Stij 1/4 S'Z- 1/4, section- T_--F 'LN-R~W .Township ;P~6T Hailing address Address of site Subdivision name_ Lot no. Other homes on property? Yes No Previous owner of property Total size of parcel Date parcel was created ' Are all cornars and lot lines identifiable? --,eyes No Is thin property being developed for (spec house)?_-Yes Y No volume~~-J.hnd page Number as recorded. with the Register of Deeds. 114CLUDE WITH THIS APPLICATION THE FOLLOWING: A WARIUJITY DLED which includes a DOCUMENT MURDER, VOLUME AND PAGE. NUMBER & THE SEAL Or THE REGISTGIt 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(wc) certify that all statements on this form are true to the best . of ny (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 'n the office of the county Register of Deeds as Document No. , and that I (we) oo:n the proposed site for the sewage. disposal system orreI (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'. I '7 Signature of ap~l cant Co-applicant O-- , l y Date of Signature Date of Signature *DOCUMENT No. STATE BAR OF WISCONSIN FORM .x-'192 T- SPACE RESERVED FOR RECORDING DATA 6UIT CLAIM DEED VOA 942 ~~-F 35 481.0` _ - REGISTER'S OFFICE Charles H. Traiser and Therese M. Benck, and $T. CROIX CO., WI - - _ i each in his and her own right _ Rec'd for Record quit- cl aims to Charles F Traiser and Ma r y Ann E . ~11AR 2 7 1992 - Traiser Family Trust, Cha rles H. Traise - r and C 8:30 A. The - rese M. Benck Co-T- ru-stees, having full pow.e-z to_.ae:] 1- and encumber Register cf Deeds the followin.iz described real estate in St_•.-CroiX.._-_------___- County, State of Wisconsin: The Southeast Quarter of the Southwest RETIRV To - Quarter (SEtSWJ) and the South Half of the Southeast Quarter \ a (S}SEA) of Section Two (2), Township Thirty-One (31) North, Range Nineteen (19) West, except Lot One (1) of the Certified Survey Map in Volume 5 of Certified Survey Maps, Page 1411, as Document No. 392424,and EXCEPT highway conveyances. Tax Parcel No: The Northeast Quarter of the Northeast Quarter (NE}NEJ) and which lies East of t4at part of the Northwest Quarter of the Northeast Quarter (NW}NEB) Highway "35" and South of Highway Letter "H", all in Section Eleven (11), Township Thirty- One (31) North, Range Nineteen (19) West, except Lot One (1) of Certified Survey Map in Vol.7 of Certified Survey Maps, Page 1961. An undivided one-half interest in the following: That part of the Northwest Quarter ' oI the Northeast Quarter (NWtNE 0 of Section Eleven (11), Township Thirty-One (31) North, Range Nineteen (19) West, lying Westerly of State Trunk Highway "35", except the South one (1) rod thereof. The North Half of the Northwest Quarter (N}NWJ) of Section Eleven (11), Township Thirty-One (31) North, Range Nineteen (19) West except the following described parcels: (1) Beginning at a point 375 feet East of the Northwest corner 360 feet; Quarter of the Northwest Quarter of said Section Eleven (11) ; zhence South 550 feet; thence North 360 feet; thence West 550 feet to the point of beginning. (2) Commencing on the Northwest corner of the Northwest Quarter of Northwest Quarter of said Section Eleven (11), thence Easterly along the North line of said Northwest Quarter of Northwest Quarter a distance of 990 feet; thence South at right angles a distance of 660 feet; thence West at right angles a distance of 990 feet to the West line of said North- west Quarter of Northwest Quarter; thence North along the said West line a distance of 660 feet to the point of beginning. Y rr ' This is _ not homestead property. (is) (is nut) Dated this 1st day of January, 19 92 (SEAL) ~V J~-a2.1~~ (SERI.) Charles H.T~ra(i~ser (SEAL) (SEAL) Therese M. Benck AUTHENTICATION ACKNOWLEDGMENT of Charles H. Traiser and STATE uF WISCONSIN Si;;nature(s) Th ese M. Benck County. January 92 LSt~ „i 12 F rl:;ully came hefore me this day of ttc above nat d 1a _ Leo A. Beskar ,I Leo A. Beskar, Attorney RODLI, BESKAR & BOLES, S.C. 219 Norty Main, Str~c~t .t. ro,nt,«;,. River Fa 1S, 6+]I 4022 ; ' I „r If !t. t. -t:,tl• exnvrntinm -I tut: c't..N:11 Ill, D - 1 ill: I ♦ '.i . W.- ~ s~ /yJ sic ~ T.3/r✓, .~~9/~1 9= x a ' G o 4 6 / ~aE ~`~'.rES L'' G 0 .0 (J" G' O ~SoT c~ fv.Cc.E Q s~ r G ias' Bii~ 91< / Zi O 6 6 E m v uVV~ 1GVVi,uG V1Y1V0 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _'Z_ of Labor and, %man Relations Diviion 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 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 PROPER OWNER: PROPERTY LOCATION GOVT. LOT 1/4 - 1/4,S T N,R /orC PROPE OWNER':S MAILING A DRESS LOT BLOC # SUBD. NAM OR CSM # CITY, STATE ZIP CODE PHONE NUMBER El ❑VILLAGE OTOWN NEAREST RO D [ ] New Construction Use dQ Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2--trench, gpd/ft2 Absorption area required bed, ft2j' trench, ft2 Maximum design loading rate _,_<.S' bed, gpd/ft2_trench, gpd/ft2 Recommended infiltration surface elevation(s) p S~yl ft (as referred to site plan benchmark) Additional design / site co siderations Parent material Flood plain elevation, if applicable It 7=Uunisutabloerfor ble fsystem CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK is stem ®S ❑ U ®S ❑ U 0S ❑ U RIS❑ U ❑ S MU ❑ S Wu SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 'le A114 'Z d - ! i - Ground 114 elev. ft. 11 2; Depth to 3 - - limiting -N g "I factor d7 s a Remarks: Boring # X r Ground elev. 7 9~ft. Depth to limiting } rye ~7~ / - _ factor L Remarks: CST Name:-Please Print Phone: Address: r> i Signature: Date: CST Numb r 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page_-~2-of PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground _ -y 7, 7-qe elev. ift. a , Depth to q S9~ s" - ivo limiting factor 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) ~ t i i I t i ' j ~U Ali _ ' ~ -~k.. ~ _J?-~-ff~~'~_ ~ _ _ 1__ I I i I i i 1 J G I I_. I t- - - b - 1 - 1 - - Q +"4;,- + r rj I t r- r - I I~ f I i i ~ ' I I~ ~ ~ I i T - . I I ( - ~ I I ; a , r 4 I ~ ! F I I ~ j I L L - i- - - I ' I I I ~ I L ---t-- i- I - - - - - - - - - I 1- I I : ( ~ I I~ I I I i I r , : - j I i : I 1 i i I I I i . j i I ! : : I j i 1 i i i : 1 I Form - S T C - 104 w , AS BUILT SANITARY SYSTEM REPORT r OWNER TOWNSHIP S " SEC . T LN-RL~_W ADDRESS , l ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT / LOT SIZE t. PLAN VIEW Distances and dimensions to meet requirements of H 63 l SHOW.EVERYTHING WITHIN 100 FEET OF SYSTEM 7fi~us F f a~ 10 i INDICATE NORTH ARROW I ~ o BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC T4NK: Manufacturer: ~gJ~~iquid Capacity: /OOHS Number of rings used: Tank manhole cover elevation: S Tank 'Inlet Ilevation:.. Tank Outlet Elevation: L9, L ? Numbe';.c of fEet from nearest Road: Front,O Side,O Rear, feet From nearest property line Front,O Side,O Rear, _ feet Numbe- of feet from: well building: (Include this information of Zhe above plot plan)( 2 reference dimensions to septic tank) SEE:REVERSE SIDE y ..r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORBTION SYSTEM Bed. Trench:- _ Width: Length: Number of Lines: Area Built: Fill depth to top of pipe:~ Number of feet from nearest property line: FI'oAt, O Side, O Rear, Ft.~ Number of feet from well: L Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj ,TMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS OR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION .O. BOX 7969 BUREAU OF PLUMBING ~MADISOTV, WI 53707 CONVENTIONAL ❑ALTERNATIVE State PIan I.D. Number: r S ( El Holding Tank El In-Ground Pressure ❑ Mound If assigned ) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTI N DATE: ChaAte,s TnaiseA R. R. 1, Sammset, W1 54025 .t ~S-g J- BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SE SW Section 2 T31N-R 19W, Lot #1, Town ab Same~us e t Name of Plumber: RSW No. County: Sanitary Permit Number: Cat Pawms 71563 St. Ct oix 49454 SEPTIC TANK/HOLDING TANK: MANUFACTURER: I LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKIN R / C, q G~ n PR VI ED: PROV / / / /•~C~ YES ONO S ONO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER UMBER OF ROAD: PROPE RT WELL: BUILDING: VENT TO FRESH ALARM. FEET FROM 2q LINE: a, AIR INLET: DYES NO DY 0 NEAREST IJ S bZ l DOSING CH MBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL PUM SIPHON MANUFA J )ER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: DYES ONO DYES ONO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIO NUMB 'OF PROPERTY WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN FEET LINE AIR INLET: PUMP ON AND OFF) DYES NO ST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plo n E LrNI, T if DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease it ( IN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH NO.OF DISTR. PE SPACING COVER INSIDE DIA #PITS LIOUID TRENCHES: r N]pRIA PIT DIMENSIONS I Z 6 GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. D R. NU BER OF PROPERTY WELL BUILDING: VENT TO FRESH BELOW P PES/ ABOVE COVER. ELEV. INLET ELEV. END: PIP LINE: AIR INLET: /1 n FEET FROM f -s ~ Z'(✓ I (r .O~ 4 Z l ~ NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for P OVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it O REVERSE SIDE. SHOW ELEVA- D YES NO meets the criteria for medium sand. IONS MEASURED. O SOIL COVER TEXTURE PJOBSERVATION WELLS. ❑Y ONO OYES ONO DEPTH OVER TRENCHiBED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL: SO DED. SE DED_ / MULCHED: CENTER. EDGES. DYES NO DYES ONO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH -NO LATERAL Pq ING IG7 VEL DEPTH BE PIPE FILL DEPTH ABOVE COVER. TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DIST .PIP MANI OLD MATE AL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.. DIA.. EL PIPES. DI A.: ELEVATION AND . DISTR IBUT ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORREC LYI OVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS1-f I : DYES ONO DYES ONO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING FEET FROM LINE: DYES ❑N DYES ONO NEAREST Sketch System on Retain i ounty file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) unsconsin APPLICATION FOR SANITARY PERMIT a OUNTY DILHR r (PLB 67) UNIFORM SANITARY PERMIT # ~ ~ OEPRRTTEI"IT OF JlDuStRV. LRBOR 6 HUMRn RELRTIOns y 9 ys tic i -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROP.ER~Y OWNER MAygIF1G ADDRE _y k-1 I PROP RTY LOCATION CITY: ,jj 1/4, S , N, R ;J•(or OWN OF: LOT NUMBER IBLOCK-PqUMBER SUBDIVISI N NAME NEAREST F OAD LAKE OR LANDMARK STATE PLAN I.D. NUMBER i r 3 TYPE OF BUILDING OR USE SERVED, 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair r Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench U Seepage Pit ❑ Holding Tank F System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of CoPrefab. Site Steel Fiberglass Plastic Gallons Tanks ncrete Constructed Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 9 -~Q.,Z/ p Private ❑ Joint El Public 10-3 I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. N"of Plumber (Print : Sig re: MP/MPRSW No.: Phone Number: Plum r'S Address: Name~f Designer: LL 4 J:0) 7le-1,I)AId, COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved ❑ Owner Given Initial p X Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBO-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber r r INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398- To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec House"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property Section T p j-_ N - R W Township Mailing Address ~ 11 T r i Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel P Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number LI- as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTy OWNER CERTIFICATION I (We) eeAtijy that aU statements on this 4o&m ane tAue to the best of my (ouh.) knowxedge; that I (we) am (are) the owner (s) ob the pnopenty de.6c4i.bed in -thus in6on.mation Soh.m, by viitue o6 a wa4Aanty deed Teco4ded in the 066ice o6 the County Regizt4h o6 Dgoax ah Dof ilmoof Mn 3 a, y a~ ; and that I (we) pnuentty own the pu pos ed site ion the sewage un OAn v system (oa 1 (we) have obtained an ea,6ement, to n.un with the above desclribed pnopen-ty, bon the eonst uc ion o6 said system, and the same has been duty 4eco4ded in the O~6ice a6 the County Regi6teh o6 Deeds, a6 Document No. r SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED VOL. 5 Page 1411 Doc. # 392425 Eli t. - LI. I , is 7 • r Gy N ru I Co I 'M ~I O I' o ~0 BEART1tiGS i2E.r'i..:lNC;..Tj TO THE SGU'111 co 7~ ~ I LINE Or THE SC? 1/4 ASISUMED TO BE EAST. I C7 w I > I r unnlattec:_lands _owned_by_o_:hers rn [';EST LINE-Sr1/4-SW 1/4 r S00027-261-1-4 522.72' IG 0 4"9.72' 33.001 r;• N I N lD N N I a' .P N w w Ire Iv N tai o ; I ri, IfD i 001P 0 'J O^ n I r I~ m-3 tr 0 1.0 '-1 (n U) v o O >J o M j r~r IF-•' r. o rl M .1 O (t ~s O r I U7 O Irf O i0 O h1 16, r;1 I$ 1¢ © r; r I G7 :3' IM O M 0 I m 1^I Ih' O • I : Cn I 1«3 33.100' 49.72' I in ro 1 r f 1 ~o T :00 27126"E 522.72' ,a o. ' C7I G] I c• G Icr W O IM . t•3 un►.)la.ctea_lands_owne<<_by_ )ja_ter ti 1-r y C•) C IC 10 u-, APPROVED X I.. r1 f1 ~ ion o I n n, N J 1.11 I` ~~;n CIOUNITY CC, ttitl~c f4F1Cj Pi?!!D;!TtG G7 UI O 'L4.: }.C 1v t4taX:!77EE N r;. I-~ to w C) 0 {D r. t7 1-'6 tv APPROVED Io a 17, ^h y 0 ~ w N 11V8I I C I I I APR 0 " I i J 1 .l V _X 4~ Y C A ~ :[TJT1wti~a trJhiSIT,r}:.. !y CJ t Z, 0 :0 J 'D l:l _ tq ~3\ cr ' x P. 0 i. r LQ N . .P h 7 I, J f O FS " _ N o n Ci a7 1- O t cn h7 O F• o a 1< F fi ` J Sl!`"VF_Y(',:;"S C` RT I F I CATE I, Al.lon C. I,Nhagen, a registered L=-n(i Su::-vcvor. hereby ce?-;-ii" _ha:. i-_ile direction of Charles 1P. T.rai.ser•. T have surveyed.. des e L.he lan parcel which is represented by -his Cert_if_i.ed Sur.ve-': that t:.^ exte-r.ior boundary of ::he land oarcel su:r.veved and r-ia-)-,ec. is Cesc.--i.bed as follows: ` cccl of land locacad in part of. the SE 1/4 of the S:? 1/4 of Sect.;.on 2: T 31 N,. R 19 Town of Somerset: St. Croix County. Wisconsin.. fu .-_her described as follows: Coirt,-iencing a z the SW corner of Section 2, thence East 1337:16 feet along he Sout'n line of the S17 1/4 to the point of beginning of this description thence continuing East; 250.00 feet; thence N 000-271-26" E.; .522.72 feet; thence ;hest.; 250.00 feet thence S 000-271-26" V;1 along the west line oj-` c-he SE 1/4 of -the ST4 1/4 of said Section 2. 522.72 feet tc the point of beginning. Above cescribed parcel contains 3.00 acres and is subject :.c a Town Roec easement and all other easements of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and descr.ibed7 that I have fully complied with the current provisions of Che.-)tzr 236.34 Wisconsin Revised Statutes, and the Lane: SuLdivisions Ord .nance of the County of St. Croix in surveying and mapping same. This Map is hereby approveC, by the Town Board of Somerset Bate Town Clerk t e ` INu1i W' I i l = H N H y ' r STC - 105 H SEPTIC TANK MAINTENANCE ACRi::h:MENT Ho St. Croix County d v OWNER /IiUYF:I:--~ - - - - Fire Number ~ ROUTE/BOX NUMBER Fire Number CITY/STAT1= LP - 5-45-- - - - - PROPERTY 1.UCAT ION: .1 Secti.orn l_ -_N. R J9 W, -r _ St. Croix CouJnt.y, Town ol AL Subdivision Lot n u m b e r Improper use and maintenance of your septic system could result in its premature Iailure to handle wastes. Proper Ili aiii tenait ce con- sisLs ul' punlp:ing out the septic tank every Lllree years or sooner, if needed, by a licensed sejgic tank huwl,c•r. What you'put into the sysLeul can affect the function ol` tlla !;Cl)Lic tank as a Lreat- ulent stake In the waste disposal systew. St. Croix County residents iii-4y be, cl- tiblc• to ruceivo a grant Cur a maximum of 60% of the cost of replaCc'ulerlL of a 1 a i ling, system, which was in operation prior to July 1, 11/8. St. Croix County accepted this program in Aug;usL of L980, with the reyUirenlerlt that owners of a 1 1 new sYstems agree to keep their systems properly nla inLa ilied . The property owner agrees to submit to SL. Croix County Zoning; a certiIIca Lion lorill , signed by the owner and by a plaster 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 ess<,Lry), tide septic tank is less than L/3 lull of sludge and scum. Certification Form will be sent approxi.mat_,~!y 30 days prior to titres year expirat ion. o I/WE, the uudersigaed, have rc,ad the rihovt' requireillellLa and aL;ree cn to malntaiu tho private suwagu disposal :;ysteul in accordance With the st.arndr_Irds r;ut forth, he reirl, a5 set by the Wisconsill Depart- 'b ❑letlt 01 Natural Resources CUrtil:i_caLL01,1 furnl must be completed and returned to the St. Croix County X.olliug Office within 30 days of L h e three year uxpira L I date SICNPIl Cry~~ U AT 1. 1 St. Croix County Zoning Oft~Lee P.U. Box 98 It annnoit d, W1 54015 715-``796-221'39 or 715-425-8363 Sign, date and return to above address. DEPARTMENT OF REPORT ON SOIL BORINGS AND `r1 BUILDINGS DIVISION INDUSTF!Y, LABG,R An PERCOLATION TESTS (115) SO53707 HUM&N RELATIONS (H63.0911) & Chapter 145.045) • p LOCATION: SECTION: TOWNSHIP/.Y: L.NO. IVIS I M s L ~/4~ 2- /T3/N/Ri71(.')W1 A/. So,n NS A joNi ~y 5 t. COUNTY: ^ OW ER'S BiUYER'S NAME: MAILING ADDRESS: f~CF USE DATES OBSERVAT NO. BEDRMS.: COV RCIAL DESCRIPTION: PROFILE DESCR P 1 R ON TESTS: Residence -3 /V RjNew ❑Replace 2_ , RATING: S= Site suitable for system U= Site unsuitable for system egge, o 1 o CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-11LLHOLDIN TTAANK: RECOMMENDED SYSTEM:(o tional) ®S ❑U ®S ❑U ® S ❑U ❑ S U ❑ SU CO r) 1&0- 1 o If Percolation Tests are NOT require DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 1A PROFILE DESCRIPTIONS BORING TOTAL91 DEPTH TO GROUNDWA ER- S CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHW ELEVATION OBSERVED ES HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-2 7 loo/ NONQ, > 0 8 -6/s/0' .8 -2, flnll~ I - 15 , 3,2- 7' I B3 7 n to Q ~ `r o-.1cisil; .9 2,8-wen l - ' r B-~ /01,/ IV otye, o- 9 -2.01s ' 2.- I - / / B_ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 4NCHES' AFTERSWELLING INTERVAL-MIN.', PERIOD 1 PERIOD2 PER D PER INCH P 0 E s P- o S- 1 y4t -3 P- 'T' qd IV A] F 0 O JAI 131-3 P-- P- P- 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 ?7, CA u _ I T I E 1 L f ( _ i rt~ I 3 3` t p ( / I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord vafTRthe praeedRres and met14~SrpecifTQJTrC sconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. T /l1 ff~~ ~o NAME (print : TESTS WERE COMPLETED ON: C Ck 0W O -Ij P 3-, 3 -gy AD MESS: 7 CERTIFICATION NU PHONE NUMBER (optional): t.v m C, ri C(JY U), ► L 5 o f '7 SS- S 3 6 913 5`' CST NA URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - gei TR CT'7 NS F)fR CORIPLETING FORM 115 BD - 6395 To ~d ecurt so il tes port must include 1Col 2. The use se- Indicate : rh, ti s is a or commercial project; 1 MAXIMUP," Jrobms or ( 'gr6at use lanned; 4. Is this a ~I r systet t WN'Kr I'll s ,.ting bo e e I IS SUI BILE FOR A HOLDI G NK ON F ~L BULE 0 T BAkSE1D,ONs(~ L CONDITIO ss shhem for v1r~ iting pr )file scripti ns - d mpletin e ~t t plan; 7. { locatir5f,l YOUr to nns. a~to scale is pre rred. A sep4rat sF 8, MaI. ~ , (Are and v ;a elevation referen „-c early 4iown ~ ra re perma t; est. exec 1, r n;alete xe • to c rtes, names, addresse ood p in da a, Pe'-' C' r 10, s d p n, elevation} dogs r , place (~(.A. i'a the -xi 11" ;e yo urrent address and yore" h0rl numhe 1 s and disc'i' ite as retluir( ^INL L TESTS MUST E FIL iTH THE =1ITY WI r AYS OF COIttPL ABRRI IQ~NS FOR C- - SOIL TESTES d Tex Other Symbols wor 10" Bedrock f c<>1~ - C 1- 10") _ andstonr> 31 1 Limestone High C,roru On eR. Grew sI i i Less Thi Bf ovvn sli - r lack I _ k ty Clay fit h ' - - E I711n . r;.lneIC H~ ter level, Vl ;'ter" Byj _ k ` vl3P v "t R - IS OI D , ~artrner Y r-.tuest r r'nm; (tl, !','ate 1 to PAGE OF w • : CroSS SZP,EIUtI o~ 13r►~ S•~s~en Fresh Air Inletc And Observation Pipe c f Approved vent Cop Minimum 12" Above Final Grade I I 20- 42" Above Pipe _ 4" Cod Iron To Final Grade Vent Pipe Marsh Hoy or synthetic Covering win. 2" Aggregate Over Pipe OIalr1bu110n Pipe 0 0 0 0 -Tee a Aggregate aeneolh Pips ° Perto(oled Pipe Below o -CovOing Terminating At Bottom 01 Syclem i D ~I~kl `gnc~l< ~L~eJh r 117 r1 SOIL FILL )ISTRIBl.1Tl0►,l PIPE APPROVED $4ttPF-TIC COVER o o ~'"'-NIATERI^I- OR 9" OF STRAW rOFhGGREGAIE--''~ OR MARSH HkJ ~•7 (oOF %2 -2~~2 AGGREGATE ''B ~ 1EL E V. OF Q, t-Y- FEET ~r 3r DIS7`RIP31JTI0AI PIPE TO BE AT LEAST il"I'luclHES BELOW ORIGINAL &KADE AIJU AT .LEAST20 WCHES BUT AIO MORE THAI) H2 IAICHES BELOW FINAL GkADE • r - MAXIMUM DEPTH OF EXCAVATiaij FKom oKi&vvAL 6RA1DF- WILL BE 70~ INCHES MNIMUM Wrh of FACAVATIOW IFFKoM, 0411 ,11JAL (59W' WILL HE _-3 INCHES i SIGLIED: I LIGEUSC. QUMBE13: DATE' 110 K• X ~ - I 1f I ~ i I f i it I I i I I . `i i a f t i 112 1 7T .a Q~ M J