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HomeMy WebLinkAbout034-1033-70-000 -0 C) 5 0 a O ~ Mi C ~ N O O ~y C O a O (D 'gyp o ro a i CL C e > v On O N m . O O (0 L) N y y E E► m c N ~ x > N w 3 'n 76 o ° O Z U w Y L (6 d LL cc V U -O C (6 co E N p E Q ~ ~ 0 N U M z O v 'E z N N u, a co N O z :!t O fn F- r N N ~ E N O C _ O ~ N Z 1 o e p~ U N c O N o Q Q o z z Z o N 0 a0 a L a A c o6 0 aNi D O a H H H E O O O O • rrv o a a a a c,4 c) N W J U U` rn rn h 04 o 3 0 0 ~ cp w 2 N Q } a M d m C~ O O 7 w O O O O N C O M O C O n o F 'o y c (n rn oo _ r N 'O O O. 'D e- O M w m CP am O O) tryj' _ r ~V O oC N Z~ a N E E v d N c) =5 Cn z O N H (n • a a> .V N y c E c c 3 `~1 A cia2 0 inv FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP ►'c / SECTION ( T N-R4'5- W q~ 3 gvv~ &tQ,okj.' " ADDRESS j_T✓c ST. CROIX COUNTY, WISCONSIN A0 - 2, -b SUBDIVISION- I LOT LOT SIZE SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM INDICATE NORTH ARROW BENCHMARK: Elevation and description: A540. oc? A)U} cotes ee Alternate benchmark c SEPTIC TANK: Manufacturer: r~.~QcSi~S Liquid Cap. 1E~J6 Rings used:-1-Manhole cover elev: -'-3 Final grade elev: Tank inlet elev.: O Tank outlet elev.: !9'3, 7 No. of feet from nearest road:Front , Side ~-;~Rear Ft. - From nearest prop. line:Front , Side--!-! Rear Ft. /(7 ✓ No. of feet from: Well , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 0)e((5ti~ Liquid Capacity: goo Pump Model:0je63L_Pump/Siphon Manufact.: Pump Size Elevation of inlet:_q5,;7 5 Bottom of tank elevation Pump on elev.: (,l Pump off elev.:Gallo cycle: /did 8y c~~ Alarm: Man.:-5,1 &AL !91 Switch Type: Location ter"` r (3-7 Distance from nearest prop. line: Front_, SideCRear_Ft. l Distance from: Well Building_~ZCoo SOIL ABSORPTION SYSTEM ow& Bed: L/ Trench: Seepage Pit: /p Width: ~_Length 1 Number of Lines: Area Built Exist. Grade Elev. Proposed Final Grade Elev. fb it Fill depth to top of pipe: t No. feet from nearest prop. line:Front , Side Rear Ft. 7.;? No. feet from well:[50 No. feet from building_ 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: 174--j am PLUMBER ON JOB: LICENSE NUMBER:- 6/90:cj I Li r l~.J~IQ V ~y ( O Nel Al d op t I po a/ 6Oa Co wa,L a CI& kl~~ I ~ J~ SWNW HWY. `QiConslnl5 partmePn olfriduF yELD 15.2`3 PRIVATE StWA`GE tYSTEM 128 County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 171479 Permit Holder's Name: ❑ City ❑ Village EXTown of: State Plan ID No.: ESTINGEN JOHN G -ATTORNEY SPRINGFIELD CST BM Elev.: Insp. BM Elev.:, BM Description: Parcel Tax No.: G C?~ /G,Ccu1<-~ crc~ r 034-1033-70-000 TANK INFORMATION ELEVATION DATA A9200245 - TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Inlet Dt./ TANK SETBACK INFORMATION St/ IBC Outlet Vent irIto ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Ar I Septic NA Dt Bottom s/ Dosing >25 r NA Header/ Man. Aeratfun- NA Dist. Pipe 0 7~ Holding Bot. System PUMP / SiP'ft9li INFORMATION Final Grade i r Manufacturer ~a Demand 3 Model Number ~CU3 GPM( TDH Lift J,~,17' Friction ,Zpr Systern 5 TDH 11,07,14 oss mead Forcemain Length Dia. a~ a Dist. To Well SOIL ABSORPTION SYSTEM l' BED/TRENCH width Length r No. Of Trenches PI Inside Dia. Liquid Depth DIMENSIONS 1MEN I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Man urer: SETBACK INFORMATION Type O f i CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM HaaiLer / Ma fold ri Distribution Pipe(s) H Ix Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Z ` Dia. Y Spacing r r p 1 / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Q r/ Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched sets/Tfie.cki Center ~D Bed/Trench Edges )eq - /r Topsoil es C] No es E] No COMMENTS: (Include code discrepancies, persons present, etc. 0 rcF. c~ Plan revision required? ❑ Yes 2.9 Use other side for additional information. l 9SBD-6710 (R 05/91) Date Inspector's Signatur Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: } i DILH 2 SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY - ST. CROIX STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El I 8% x 11 inches in size. check re isi n to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S92-40480 PROPERTY OWNER PROPERTY LOCATION JOHN NESTINGEN SW '/a NW S 15 T 29, N, R 15 E (4~0 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # N/A 800 MAIN STREET N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER BALDWIN WI 54002 715 684-2424 CITY NEAREST ROAD 0 'F II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE : SPRINGFIELD STATE HWY 128 ❑ Public X❑ 1 or 2 Fam. Dwelling-## of bedrooms 3 A EL AX NU BER III. BUILDING USE: (If building type is public, check all that apply) 034-1033-70 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 El Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.E1 New 2. X❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 ❑X Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 450 375 375 1.2 N/A 101.9 Feet 104.17 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank 1000 1000 1 WIESER CON C. Lift Pump Tank/Si hon Chamber 600 600 1 WIESER C N . 171 1 El El I F] I F1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No S pal MP/MPRSW No.: Business Phone Number: BENNIE HELGESON 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W 1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui Agent Signature (No stamps) Approved ❑ Owner Given Initial ~~•0oSurcharge Fee) 2,1-9,2 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary p rrrdt is valid for two (2) years. 2. 1"our• san4ilry` permit may be renewed before the expiration data, and at the time of r.er,evv ti any new criteria in the Wisco~,sin 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 (SE D 63991 to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacernent, 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 ga'Ions, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the! county. The plans must include the following: A) plot plan, drawn to scale or with complete dimuns6 ins, I )cation of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells, water rn3i-is!later 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 10,3s; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorpJon 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 P,- o:.; h the(- e surcharges are used for monitoring groundwater„ gro+.wd-• water contamination, ;nvesfiaations and establishment of standards. S8D-6398 (R 11/II8) 4 'Dq to I sloe ` I u 'Ifi~ y Ar« SEWAGE SYSTEM itiona ROV N R1.A~1 ~,yp P6 F 1P-~~~~RY' LAW 0 Wj ~JO BU~~ ~ ~ tj OF v ~o«~ 10P'VkNto 001 CORaIE SEE k Ff'n cJt 1~1~0~ o e~-~ ~n ~3 .M ~ R P. I Co. (I G /OGCf~cG Gwl ~o.n6o -td, k, It u I, C- ABAti 000 'Ctt~ C-XtSrlrsv SEPTIC; SYS'rFa,A As Fey, lLNR 83. ~Z Sc OL ( U ' t ~e v1Ft~'~~U~vN _eS 1u~a errs Page Of Cross Section Of A Mound Using A Trench For The Absorption Area ~~u ~•r.ler~ -r f'Apw. 16 2.5' Medium Sand Fill F - 6 o soil E e .1011 -.ll• f 3 E D pNSiT qG Plowed Layer reEnW h Of 12"~ 2," Aggregate, " B pGf lgir' overed With D Cd Ft. Mars thetic Fabric r ~E Ft. G Ft. r @(~f~ R ©H ~~A±±i~Q+l F 7 Ft. H Ft. tl':~;17'.i~Jt~fifi•~.. 4.J'w" til7uw. SEE Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe Permanent Markers Observation Pipe rA. 0 W _L I-- N"'Trench Of 2Z` Aggregate \ Trench Of" - 2Z" Aggregate I r L A 5 -t. 1 1 a.5l4 Ft. K 11 Ft. W Ft. B `7b Ft. J Lp.aS Ft. L I Ft. License Signed Plumber: Date: e5 1~►.Gc P=R.'-pRj -r' `p .'PIPE Z)=- -A) L F?VC h1?E ?N'.. Cji0 / I AT BUD OF eA CH LhTr:MAL -FUD tAF. Q 1 Fo ~-ES LU: K O1J -B, T,r D y Or ~ _.~'I.~H AIJD r:Rc t'mt~PLIY SP0.C.d~ . t P C ' Fuot1 tau ti p Pt_hCE lhS`~ ltOLt~ UEx-r -M FuJ CAP, ~J~S~R\ $uT7 0lJ . Pt P E 134 0 ~_T_- SEWAGE SYS-T FT. UNS (fog Y c.14 w . APPRO RELASIONSt_e OIL y~VD 1•a.~lV 1 N. . AC.6d nF 1"~!O` ~~RY , LAS A $UI L)Y`~~ L.= L - DCPAR~ >=ottC~ Yl A ltj c~ SEE ?r- OF Ii of-es/PJ ps coaa~ 1)JV, el-f--N.bF L.ITG?-AL-S pL r~ C E, ! sT NU ~-E g F Ror1 T W 17H S U cc-EENUJ G HOLES i4'T.- - l l•1TEKUit-(_ 5 . - LAcST HOLE ~D RE NEXT' 7D -T}tE D CJ~P- SEPTIC TANK & PUMP CHA BE ,R CROSS SECTION AND SPECIFICATIONS c 4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVF..1 W/ PADLOCK & FINISHED GRADE 4" CI RISER WARNING LABEL 6" MIN. ABOVE G ADE _ 4" MIN. 18 IN. AGE SYS EM 19 ,.,INLET ~ _ 0 GASS - nowD ELM L R ` TIGHT i , JOFF 4►1 MG 'j CRY' IABOAN A SEAL PPROVED CI PIPEa iOINTS W/ CI ' ONTO B IPE 3' ONTO v4- ON SEE C SOLID OLID SOIL SOIL PUMP OFF ELEV . SFT. RISER EXIT D ERMITTED ONI F TANK ANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD coo SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: 14-7e,SfrS NUMBER DOSES PER DAY: TANK SIZES: SEPTIC ,00 GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: ly1 8`I GAL. ALARM MANUFACTURER: S e, CAPACITIES: A = INCHES = _30 :Z . MODEL NUMBER: SWITCH TYPE: jN-ercL'ft-L Ply.-. B = 2 INCHES = )3.69 GAL. PUMP MANUFACTURER: C = INCHES = GAL.. MODEL NUMBER: SWITCH +cPb D = INCHES = l34 Q GAL. REQUIRED DISCHARGE RATE `a `GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 13 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2.5 FEET + 19.0 FEET FORCEMAIN X (.?V FT/100 FT. FRICTION FACTOR -3,j3 FEET TOTAL DYNAMIC HEAD = lg.¢3 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER S e c LIQUID DEPTH SIGNED: y1.~ LICENSE NUMBER: l'-%L1 DATE: 1/88 Po Z Qa 01 Fl e.. t .r. Q ~ PT (pG AI of I W ~ ' Dphv i f"o ~ITE S 1kGE SYSTEM D ifo~ _ RELATIONS iSION OF S' _w... A SEE CORRES N N 7~ z, -H In H r H x f1 bd ZS ~ H O O ~ 1A-1 t 00 C to k, c A 1 o 0 cy*, ~ . lid a x x O v, ~ y 0 9 o 64 O O N ~ ro to r.b N ►ai t" mo - 04 to CD 130 z ~ H (r a C7 M M ]C r H z O r A i 0 . H C7 70 O S x yO ~ 'd x H ~ v vs . r. ]C ~ H O z iml N o ya v w ` O p~ O y_ r, r 0 Performance - ubmersible Effluent Curves Pumps METERS FEET 90 25 80 MODEL 3885 SIZE /a Solids WE15H 70 Z 20 WE10H J' -Z I j WE07H- 15- 50 1 WE05H 40 10 WE03M 30 IN, 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 i 1 1 0 10 20 30 m3/h 1 CAPACITY gGOULDS PUMPS, INC. SDECA FALLS PEW 'rM 13148 METERS FEET t 120 MODEL 3885 35 110 WE15HH 30 SIZE 3/a" Solids i 100 90 25 80 0 70 X 20 J 60 1 H 50 WE05HH 15 40 10 30 20 5 10 .#1 - 0 0 J 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I 1 1 1 0 10 20 30 m3/h # CAPACITY I 3 01985 Goulds Pumps, Inc. Effective July, 1985 II , SOIL AND r ATJON REPORT in ac CCFIF~"~~:~~ ' Adm. Code DIL.HR COUNTY Attach complete site plan on paper not less than ST ea` o ~ x di x 11 I I 'Siie. Plan' u includo, but PARCELI.D. rr not limited to vertical and horizontal reference n M), direction and % of slo ' ale or dimensioned, north arrow, and location and dist nce ton rest r T`i/ -1 i REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRI L INFO5B.";T1QN PROPERTYONNER 1 PFP TYLOCATION NGUlC 06 A e t v~ c ` L . LOT 114 Ujl/4,S 16 T c N,R I E (all J PROPERTY ONlNER'S MAILING AD MESS 9 T K BLOCK M SUED. NAME OR CSM Ir CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILIAGE OWN NEAREST ROAD GlevtiwO C( L~^ 64613 (71) 72-) - „ A el $ (J New Construction Use ( vj"Residential /Number of bedrooms 3 14 -Replacement ( J Public or commercial describe Code derived daily flow z/~SO gpd Recommended design loading rate ° _~Lbed, gpd/f12 . S trench, gpd/f? Absorption area required, bed, 112 trench, ft2 Maximum design loading rate ~ bed, gpd/it2_.,a~11trench, gpdA? Recommended infiltration surface elevation(s) /O/.1 It (as referred to site plan benchmark) Additional design I site considerations 0 S " S d.. u A,, R Q d. Parent material h- ov e T l 1 Flood plain elevation, if applicable Alfa ft S = Suitable for system CONVENTIONAL MOUND I T INGROUNDPRESSURE AT-GRADE SYSTEM IN FILL HOLDING TAN U= Unsuitable fors stem ❑ S I n 131 ❑ U ❑ S C ❑ S ❑ S e v L ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boutlary Roots G'PD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Gr. Sz. Sh. Bed Tre t. k I 01 a S" 6 I~ c~ f Ground 3 -~d o Cf. -Z S 6K W l o y S ele v>. 3 t' eft. y u ~ s 5-4 a.S-0 L w. sb~ vn a~ I P _ CAP Depth to 33- . S 6yRv S . a 2- vy~ limiting l, factor Remark's: Boring # ( 1 3~~ S;•M,xs:~:..., l r ~ l C~ ~ ~ l aJ b Fn ~ r Ci I w. o I Ilk s Yrz 5 a s~ t S Ground dL elev.0 s Y(Z i~ f b e w. S 6~ ,nn 1 C+ lo t Depth to S - S C c sk vv~~ • 3 lirniling (actor Remarks: aT er 'I CST Name:-Please Print So „ Phone. '/LS `7 3D Address: O`< 0 e j s Signature: Date: CST Number. SOIL DESCRIPTION REPORT Boring # Horizo Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bafxiary Roots a, Bed Trer 1`3 / v^ s z; n" W ' a r- c~ t c d Ground 3 11-26 v s Yg elev., Depth to limiting factor I1 11 Remarks: Boring # ,~::~.~s I ~ AYR t s I 5 e L Ground 3 -17 O E~ b _ elev. p„~3 p r i S zi L ~vC S bn~r u.~ , a; y Vti 3 P' Depth to y S L 1 L s k limiting factor Remarks: wa+~r ct' Boring # 2 4 1 P .S k/ y I / w'c:r !v YR i 56 cJ ~i )o C d c~ Ground 3 C~-d S v S r( s6 elev. vri 31~ 22 3) 10 k- Depth to S 3L ) o -3~, ~ roe 6 S C_ J C- P 5 J, limiting faeror t, Remarks: l ester a Boring # S: Ground elev. h. Depth to limiting factor r Remarks: . i I I I j I II 9 Ij ~I It T I NQ ~ I j ~ ~ it II I j I I ~ ~I 'I III i - - r i I I j II ' I I III I I I nl I (a ~I I ~ I I ~ . 6,3 i 1 j II • 1.~ I ~ I ~ i I III i ! I ~ I I I T I I i \ ~1 I I I I i 4--Til~pcnc-c-'' 7,71 _ ' r IIP b0. b~_o!__ I I Ili I I I ~ j I~ , j If 1, - ~I I I 3,51c~ I-J i I I ~ ~ ! I I I I ~ I i I I , I _ i I ~ II Ili ~ I II I I ~ I I I I ~ I I i ~I I I i j III I I tie I i I I ~ I I j _ I i- - { - - - I - { - -t - i - C - 1 - - - T-~- i I - I i I I I I I I i ~ ~ ~ I I I~~~-~ I I I ~ I I f t I I I t - I ~ a I I I I I ~ I , I _ II I , -i - t y i - - - I ~ I a I I I I ~ ~ I 1-- 1 I I I I i ~ L I i I I I t ' ~ I I I f- I 1 -j 1 -t - - - ; I-- - + - - - I I l ~ j 1 1 1 ~ I I i I 1 e ~K , ; - ~ - 4i ~ i . ,e. • f ~ ~ ~ ~ j . Y.k.:... ~ ~ , s i #~y I f' ~ Y ~°~~•sa~r ~ T'. r ~ .N° t - r ~ ~ t~.~~~:. s,~ , State of Wisconsin County of St. Croix i hweby certify that dds inIb M I I N a full; flue and coned oopyeMad NWANM Rk MW of ns,a d in my Wft wA Mrs Men cowed by WAL AWK June 19 L2_ James O'Connell James O'Connell Register of DeecN frl Deputy ST. CROIX COUNTY a i~~;rxJ~ WISCONSIN ZONING OFFICE 4 ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 May 28, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the John Nestigen property, located in the SW 1/4 of the NW 1/4 of Sec. 15, T29N-R15W, Town of Springfield, St. Croix County has been conducted. This onsite revealed suitable soils at a depth of 11" below which seasonally saturated soil conditions were observed. This site does meet the requirements of the A+4 rule and is therefore suitable fore a replacement mound requiring 25" of sand fill. Should you have any questions, please feel free to contact this office. in erely, r P ames K. Thompson Zoning Administrator cj ST C- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER JOHN NESTIN FN ROUTE/BOX NUMBER 963 HWY 128 Fire Number 963 ' I CITY/STATE GLENWOOD CITY WI Z E P 54013 PROPERTY LOCATION: SW NW t4, Section 15 T-29 N, R15 Town of SPRINGFIELD St. Croix County, Subdivision N/A Lot number N/A Improper use and maintenance.of your septic system could result in its premature failure to handle wastes. Proper maintenance con- gists 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 treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a .certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper vert- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning ff.i,ce within 30 days of the three year expiration date. SIGNED 1) ATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be'retained and completed when the property is :-sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property JOHN NESTINGEN . `Location. of Property SW 14 NW 14, Section 15 , T 29 N-R 15_- W Township SPRINGFIELD Mailing Address 963 HWY 128 GLENWOOD CITY WI 54013 Address of Site SAME Subdivision Name Lot.Number Previous' Owner'.of Property Mark A & Kathleen P Mustful Total Size of'' Parcel 20 acres .'-':Date Parcel was Created 1976 Are all corn ers and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes X No Volume* 557 and Page Number 82 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume.and page number, and the Seal of the Register of Deeds. In addition, a certified surveyavailable, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTV OWNER CERTIFICATION I (we) eeAti jy that aU 6tatement.6 on thi.6 6osm aAe tAue to the but o6 my (ouA) (inowtedg e; that I (we) am ( aloe) the owner (.a) o6 the pnopen ty du cA i.b ed in th i,b .i,nbohmati,on JoAm, by viAtue ob a waAAanty deed tecosded in the 044iee ob the County Regi6teA ob Deed6a6 Document No. 341406 and that I (we) pseaentty own the proposed site goA the sewage dizpos s ys em (os I (we) have obtained an easement, to stun-with the above desni.bed psopetcty, 6os the eonsttcuction o6 said 1 system, and the same has been duty seconded in the 046iee o6 the County Registeh o6 ':Deed6, as Docume NO EASEMENT. SIGNATURE OF OWN~U SIGNATURE OF CO-OWNER (IF APPLICABLE) .t June 24, .1992 June 24, 1992 ;r;.DATE SIGNED DATE SIGNED