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HomeMy WebLinkAbout008-1028-50-000 1 N 00 O~ v ~ y 0. w Ct O N 'V I V i C \y 7 N Z c C E LL O O N Q -CO O Cl) V N Z CS > E i2 L O Z y o co Z IL M c o O Z N Z d' I ~ O N F- o Z E a M I 4J C o 0 Q Q O m w 2 Z Z N z N C N N C ~ E 7 ~ i C d N y« L Q C O 06 O- d L W O ,n C C d n L r, N l (D (n E E II: 3 3 3 n u) Z o l O O O o ?0 0 0 7 o U) > O fA J U m rn rn Z ~`l m 0 p _ 0 ~ r r . ~ 00 00 _ E w O O C co N CL O O Q C~00 O o v N c L O 3 Y C C O O LO It I, Q O. O. C N r 'L 17 - ~ 2 ! V- to ` O O C (U V 0. N C 0 00 L L 7 y n o F- F- c N o H E E_ • o N _ o Cl) 00 ° w O 2 in w ~ va d ~ a i • d 2 d CL C `Fw E E c ~ R t A Q a ~ o fn U bEPAR_tM'ENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATIONS SECTION: TOWNS P/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: E1/ca ~o /T28N/R /4661(or r aw l'alk 111A X151V COUNTY: OWNER'S/BUYER'S NAME: MAILIN ADDRESS: .~f• t~r i 1 ~i ~ 7\ /d 7~ S ~_S~ /~K~p GC/ ; S7' X20 USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ERCOLATION, STS: LA Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: IMOUND: cIN-GROUND-PRESSURE: IS YSTEcM-IN-FILLHOLDIING TANK: RECOMMENDED SY TEM:(optional) ZS ~U J [:]U . *NU S Ou ~J ~J Y•1U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the /may under s.H63.09(5)(b), indicate: N~ Floodplain, indicate Floodplain elevation: /~~['/~L// PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH fFl ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 261 13 Bnsd: A 1,33-Ras 1,,.Z, ?J B- 9817-4 ~ o ~ > 7-/d ~58 Bls,~• 2.o ans,'~• i•5 ans/~P r • ,o ' 0 BJ G-74~ 4700' S~ 100 >G-74~ 58 13Is~ "6, •./,7586 •3 B- .a 98•I6 on •2~d" • • Mt• B-~ , 9, /W,3 171r >~,7- l' lSil'7 ' a; /i~G., q I'i•.Z'.S!)' F tyedhPs B- C% f f~ .PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER 4NGHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- /23' Alon P, d/., /g P_ 2.1.7• S S 7 A,~ne_ SO P- Z 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 9s",-5'7~ . I II t- t r j I I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): / ZZo 7 46. sf Y/3 71S -011 -26"oK CST SIGNATURE: k2ae, 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 - SBD 6395 To be a complete and accurate: soil test, your report must include: 1 . Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs - Coarse Sand Pere - Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI - Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow sel - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff few, fine, faint *c Clay cc - common, coarse pt - Peat mm - Many, medium m - Muck d - distinct p prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a perrnit. The sanitary permit must be obtained and posted prior to the start of any construction. • 4 3 AN ti g V L a zT M ~ ~ V ~tn cL o f- I T M O O .Q ( Q Op ~ It H as °d d o r. 0 vq ,O c n a O ~ f~• e0~`e M -C t5 'Q~ Ito i ~V L ~ e~• AO 'Op Ol h 1 Ln ~ O o ~1 v e A v v cs Q 4r1 \ Oo N Oho M ~v O `11 I 0 a q 00 T P4 IJ ~ v V Ot Y, E13 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS' VENT CAP 4"C.2. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 23' FROM DOOR, I2"MIU. WINDOW OR FRESH I AIR INTAKE I GRADE `i"MIAs. - IB' MIIJ. CONDUIT \ 11~ IAILCT PROVIDE I AIRTIGHT SEAL I I i I APPROVED JOINT A I I i I APPROVED JOIN1 W/Ca. PIPE I I I W/C.I..PIPE EXTENDING 3' I (I ALARM EXTENDING 3' ONTO 50L10 SOIL e I 1I ONTO SOLID 6011 I I I C ON 'I I CLEK.__ FT. PUMP-1 OFF D CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEDDIRO Ep0Nc SEPTIC E SPEGIFICATIOAJS D059 TANK MALIUFACTURCR: Z<~)ee, k-, NUMBER OF DOSES: pER DAU TAWK 51ZE: 800 GALLONS DOSE VOLUME ALARM MANUFACTURER: -SIT ~~~!Gfro INCLUDING OACKFLOW: Z~Z'0 GALLONS MODEL NUMBCR: CAPACITIES: A= /9'-3S INCHES OR12913YGALLONS SWITCH TZJPL: ~✓CG~,r/1/ ga Z INCHESOR3_Oy G(►LLONS PUMP MANUFACTURER: ~ou~LT 38~J~ 13'45 IULHES OR'~j?''3L GALLONS MODEL NUMBER: lc~~0 3~l L D+~ 1Z INCHES OR 20yZ~ GALLONS SWITCH TYPE: MOTE: ~Jei''eu~S~ MOTE: PUMP AND ALARM ARE TO 6E MIWIMUM DISCHARGE RATE ZO~_ t±pM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE CETWEEN PUMP OFF AU0,01STRIBUTIOW PIPE.. /D_ FEET + MINIMUM 'NETWORK SUPPLY PRESSURE . . . 2.5 FEET + - ' FEET OF FORCE MAIN X a' F% goo piFRICT1o1J FACTOR_ 27 FEET TOTAL DyNAMIG HEAD = 927 FEET INTERIUAL DIMENSIOW~ OF TANK: LEM&TH - 7 ;WIDTH ~-i LIQUID DEPTH SIGNED: • ~L-~~' d'+~ LICEWSE NUMBER: r C~C~~/ • 44 G~- 0 DATE: ar Performanc ubme ible E le uent Curves Pumps z METERS FEET 90 25 MODEL 3885 SIZE 3/4" Solids WE15H 70 _ 20 - WE1H 0 60 F WE07H 15 50 40 WEOSH 10 30 WE03M WE03L 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 0 10 20 30 m'/h CAPACITY [qGOULDS PUMPS, INC. METERS FEET 58•E{A FAUS MW roar 13149 ' 120 MODEL 3885 35 110 WE15HH SIZE 3/4"Solids - - - - - - - - - - - - - - 30 100 90 - - - - - - - - - - - - - - - 25• 60 - - - - - - - - - - - - 70 - - - - - - - - - --4 X 20 60 O WE05HH 15 40 10 30-- 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 • 1985 Goulds Pumps, Inc. CAPACITY 20 30 m3/h ENaed" Julyr,1985 OD DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: N 2 , NE 4 , SW 4 , Sec. 10, T28-Rlt] CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Eau Galle ❑ Holding Tank ❑ In-Ground Pressure Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: S 99 INS EC I A (X/ Rick Westforth , i7 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. P .ELEV.: CST R . PT. ELE .7 0 10 4 Name of Plumber: 4 MP/MPRSW No.: County: Sanitary Permit Number: Dennis Satter 6387 St. pro'x 128735 SEPTIC TANK/HOLDING TANK 3 11, c,3z u'l" = z"_t 606(- 4 t-nK MANUFACTURER: LIQUID CAPACITY: TANK INLET EEEV- f'C •E+Jn: WARNING LABEL LOCKING COVER2 -1 I . ~ PROVIDED: PROVIDED: F:JJ f~• 7•ry $7, Y YES F-1 NO ❑ YES Nb BEDDING: DIA.: ATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT T FRESH G < C.~, AL~ARM~:~ FEET FROM LINE:{ AIR INLET: EST-► I ❑ YES NO Li?YE5 ❑ NO NEAR DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SpHoll MANUFACTURER: WARNING LABEL LOCKING COVER ".ll// PROVIDED: PROVIDED: % ~5 ?r ❑ YES NO Cc~/ 65 IJ3 3 ur0 YY) / YES ❑ NO YES E:1 NO I VENT TO GALLONS PER CYCLE: , r N PUMP AND CONTROLS OPERATIONAL NUMBER OF L NEPERTY 1 WELL,: ! BUILDING: AIR NLET:RESH BETWEEN yq / PUMP ON AND OFF )a / EYES ❑ NO ENGTH: DIAMETER: MATERIAL AND MARKING: SOIL ABSORPTION SYSTEM. Check the soil oisture at the depth of plowing FORC., C_- Q r~~ or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN 9 ~C.IC K P,) C- the soil is dry enough to continue.) CONVENTIONAL SYSTEM: 6 WID GTH: NO. OF DISTR. PIPE SPA 0V-SA:,~„y. INSIDE DIA.: # PITS: LIQUID DEPTH: BED/TRENC TRENCHES: MATERIAL: ^ - R1T . DIMEN ONS GRAVEL DEPTH FILL DEPTH DISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF RTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mounds stems to make certain that it ON REVERSE SIDE. SHOW rcl YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. ~ CetnS~~•~E SOIL COVER TEXTURE: C PERMANENT MARKERS: OBSERVATION WELLS; JDKO v C ? ( ~1 OF J it 1 YES ❑ NO YES ❑ Noje C3, DEPTH OVER TRENCH/BED DEPTH OVER TR NCH/BED A DEPTHS OF TOPS IL: SODDED: SEEDED: MULCHED: CENTER: It EDGES: tI J,-, t 1P ZJ*ES ❑ NO E9-YES ❑ NO ❑ YES E9<6 PRESSURIZED DISTRIBUTION SYSTEM: /.,'R a '~✓sl. L~ C' ` -k,2 WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH / 6.3 TRENC S: 36 'r o, DIMENSIONS MANIFOLD PUMP + MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTIQN PIPE MATERIAL & ARKIN. : ELEV.: ELEV.: DIA.: i ELEV.: PIPES: ~7 DIA.: (f ELEVATION AND f~ DISTRIBUTION Q/ &6 ~ ~S by _If5rm - J - S HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO, INFORMATION 'k N s/ APPROV[[EQ NS 7 d~i/. - 7 t ry' d V YES ❑NO T _ lr ~lr YES UeNOjE~in3 ~lL PERMANENT MARKERS: OBSERVATION WELL 5. NUMBER OF RtOPERT, WELL: BUILDING: COMMENTS: FEET FRO L M YES ❑ NO W YES O NEAREST--11i >50 qq P / Q1'l 2r/. Re In in ounty file for audit. Sketch System on Reverse Side. SIGNAT E: TITLE: SBD-6710 (R. 06/88) SANITARY PERMIT APPLICATION Cou 17-D-ILHR' In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMITI# -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 / a 8% x 11 inches in size. Cher r isi n previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 4V0 el,5~z 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. _ PROPERTY OWNER PROPERTY LOCATION z Sw '/a, S Q Ta , N, R (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # AX7*-yrjq A) A Aid CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms A L MB R( 111. 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 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/CF-Wosh 5 ❑ Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 9 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 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 3 g o s /o% Feet O Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New P-xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or S K/~- S Lift Pum Tank/ ' VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumbe 's Signature: (No Stamps) MP/MPf OW"o.: Business Phone Number:/dry r V D 1A 1 Plumber's Address (Street, City, State, Zip Code): /Pr O Ex A( o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e issued issuing ent Sig re (No S ) Approved ❑ Owner Given Initial Surcharge Fee $ J~~ /Qo Adverse D rmin ti X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed. pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your focal 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. If. 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 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 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) 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) APPLICATION, FOR SANITARY PZRMIT 8TC-100 This application form Is to be completed 1n full and signed by the ownez(a) of the property being developed. Any Inadequacies will only result In delays of the permit Issuance. -Should this development be intended tot resale by ovnec/conttactot,(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 at property , "Ri cky 4 awd KO~r l es-~S~1. Location of property N, ~NEl/4 . -W Section , I O ♦ 2~ M•M~•Y Township 9_4_W_ address e4v 23 R 10 00014; /I,P_ . 1 y0 2 5e . Address of alto k-1 V< Subdivision name, • Lot number , Previous owner of property „0_ ri-s o.~ 1 AY ne. 11 rk v► Total size of parcel 20 a'eres Date parcel was created 9-IS-199 Ace all corners and lot liner identifiable? ✓_Yas o Is this property being developed for resale tepee house)? as 0 ~50 and Page Number 14'1 as recorded with the Register of Deeds. V019100 INCLUDE WITH THIS APPLICATION THS FOLLOWINGS A WARRANTY DEED which Includes a DOCUMENT NUMBER, VOLUM& AND pAox NUNeiR0 and the BRAL OF. THR REMOTER OF DEEDS. In addition, a cartifled survey, It valiable, would be helpful so as to avoid delays of the seviewln9 PPsoeess. It the deed descclptlon tolerances to a CeztIlled survey Map, the Cogtltled Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certlty that all statements on this form ate true to the best of my (out) knowledgel that I (we) am (ate) the owner(s) of the ptopetty described In this IntotmatIon totm, by virtue of a warranty d ed recorded In the Office of the County Register of Deeds an Document No. g.5513 V, I and 'that I (We) presently own the proposed site got the sewage disposal system. (or I (we) have obtained an easement, to tun with the above described ptopetty, tog the cons ction of sold ate m, and the same has been my recorded in the office et X!~ County e'giste se as Document No. ~ a gnatuce t Own s Sl~~' n- , ~ gnatus of Co-Owner it Applicable) Gets of Signature D~-t Signature -DOCUMENT NO. JlAi'L 13AE. OF WISCONSIN FORM 1-1982' THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 451387 III r r - REGISTER S OFFICE, , This Deed, made between --_Chris-.:D._Waugeyx __and_Arlene ST. CROIXCO."WI Wangen, also known--as--Arlene.J.--Wan$-er><------------ Recd for RecoM SAN 5199 Grantor, at 12:05 P.s.IU1 and Ricky..Westforth-.and._Kari-_Westforth_,--husband--and.-wife and-_ as-.joint.. t.eu.ants-. wi.t.h..r-ights---o-f .survivo_r-shi ..----and--as-.mari-tal-prop-er.ty---- P--------- Register of Deeds Grantee, - Witnesseth, That the said Grantor, for a valuable consideration...... he- r.ece-ip-t--o-f.-wh-ich---i-s--hereby -a, cknowlnd ed--- `TURN------ conveys to Grantee the following described real estate in St. roiX RETURN TO County, State of Wisconsin: The North one half of the Northeast one quarter (N2! of L-11) 7i: _ of the Southwest one quarter (SWO. of Section 10,' ^ Township 28 N, Range 16 W, and, Tax Parcel No: Southerly 60' of the Southwest one quarter(SW4) of the Northwest one quarter(NW4) of Section 10, Township 28 N, Range 16 W, and, a parcel of land described as follows: Commencing at the Southwest corner of the Southeast one quarter of the Northwest one quarter of Section 10, Township 28 N, Range 16 W, thence Northerly 60', thence Easterly 901; thence Southerly 60', thence Westerly to the point of beginning. GRANTOR, BOTH JOINTLY AND AS INDIVIDUALS, RESERVE UNTO THEMSELVES, FOR A PERIOD OF 4 YEARS SUBSEQUENT TO SEPTEMBER 5, 1989 THE RIGHT TO REMOVE ANY AND ALL TIMBER AND/OR TIMBER PRODUCTS FROM THOSE PROPERTIES AS HEREINBEFORE DESCRIBED FOR THEIR OWN USE AND/OR BENEFIT. This is not EXE PT` homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And...gzantors _..---••-•--•-----t--•-•.--•r•-- - - warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. day of -p - - - Dated this 5th Se tember_....---•-----......-•-•-••. 19._ 89... 17 - • - - .----(SEAL) (SEAL) (SEAL) (SEAL) Arlene Wangen, a/k/a Arlene J. Wangen AUTHENTICATION ACKNOWLEDGMENT Signaturg(s) Chris D". Wangen and STATE OF WISCONSIN tr Vangen-~ a/k/a Arlen J. Wangen SS. q • - ----------••--County. ail e o - ' e---, 19 L ~ Personally came before me this ________________day of a1ft~ f f --------"-1 19.__._... the above named h . jf/M h~ 1~'t o~'AT B R OF ISCONSIN tk~ uth ized - - ---0--6-.-0--6-, Wis. StatsJ to me known to be the person . who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY GAVIC LAW OFFICE, Jorv R. Gavic S ri P n ValleY'Wisconsin 54767 ------767--------------- Notary Public (Signatures may be authenticated or acknowledged. Both My Commission is permanent s --County, Wis. are not necessary.) b . (If not, state expiration date: -Names of persons signing in any capacity should be typed or printed below their signatures. ~HCfTlMlcr --STATE BAR OF WISCONSIN FORM No. 1 - 1982 Stock No. 6001 J SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County 'J r w OWNER/ BUYER' tom'' 0 ROUTE/BOX NUMBER . Fire Number 5 a tv CITY/STATE C~/C9©v ~`)/t 1 -ZIP l02 r PROPERTY LOCATION:Atj&Ek,w(-k, Section, T N, R_ Town o f St. Croix County Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licens'ed''sept'ic tank pumper. What you put into the system can a ect t e function-of the septic tank as a treat- ment-stage in the waste disposal system. St. Croix Count residents may be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, whit 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 County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or.a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and .(2).after inspection and pumping (if nec- essary), the septic-.tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year-expiration. H I/WE, the undersigned have read the above requirements and agree 0 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 .d and returned to the St. Croix County ing Of ce within 30 days of the three year expiration date. SIGNED' DATE` St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. NG~ strNTOF REPORT ON SOIL BORINGS AND SAFETY&BUILDING DIVISION N LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LO ATIO -s- SECTION: TOWNS P/MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: N~ E~/a ,~/a /O /T28 N/R /411 (or s ~'a 1k, ~c/~ ~i9 COUNTY: OWNER'S BU ER'S NAME: MAILING ADDRESS: 7ZO USE DATES OBSERVATIONS MADE J NO. BEDRMS : COMMERCIAL DESCRIPTION: PROFILE DE PTIONS:' N TESTS: Residence 3 New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SY TEM:(optional) ~s IU s au os ❑u os u as Ou - w s , 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: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH tits OBSERVED E61.1-11 GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) i B- / e 9 •5 ; ' 14 /1 d' f.25 l3 4,9 r, . , „ ,,x,08 f B- Z 9d' Z4 / o > 7••58131s,'/•2•0 l3ntd. 1.5- QnSlf __Jr; •o ' 8r 7 •~8 B I S l• JO 8,5;/~ •,//75Bn 1, , • /•3 r $ V '0 6 B- 6,Q 79•I /rO.OZ , IS/I • AOO' s/ '2,0, Rr, v, • ~ ' Mt' A/ p+ f: B-~ 6'Z9 ' 100,3 / ne- >e,Z9' Isi~' S' /,/Z, n !,•2•SO, n eel h -Ps B- PERCOLATION TESTS TEST DEPTH. WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER -4P►Gi}E$ AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER1003 PER INCH P- 1.2-3, Alan L 30 ell y /11191" 27 P_ 2'G7• 30 g 8 7 P- •Z / 2Y Z z 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 9.~ -~~7 1 4 r - _ E - - f--~-- TN i : I I I I i .i i I, the undersigned, hereby certify that the soil tests reported cn this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print TESTS WERE COMPLETED 9O/N:~ ADDRESS: / CERTIFICATION NUMBER: PHONE NUMBER (optional): / ZZo sf ir~~ral S" d 7~ 13 716' -62011 029 CST SIGNATURE: .t~~.. 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 - SBD 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A . separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if ppropriate; 10. If the i1iformation (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone *s - Sand HGW - High Groundwater cs Coarse Sand Perc; Percolation Rate med s - Medium Sand W - Well fs - Fine Sand Bldg Building Is - Loamy Sand , Greater Than *sl - Sandy Loam < - Less Than *1 - Loam Bn - Brown *sil - Silt Loam BI Black si - Silt Gy - Gray *cl - Clay Loam Y - Yellow scl - Sandy C!ay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint xc - Clay cc - common, coarse pt - Peat mm - Many, medium m - Muck d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE OWNER: This soil test report: is the first step it') SeCUrinq a sanitary t)ermit. The county or the Department may request vel-ification of this soil test in the field prim to perinit issuance, A complete set of plans for the private sewage system and a permit application mtv;l be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must fie ohlained and posted pilot to the start of any construction. h Q _ INC X, z N N ~ o cJ Z O~ i T r 1 C-l ~ o m oo C L K ea m f ~ c a . • { CZ t!s 1 61 ~•L'o, ' ° Z ~ R) T 'fie M °•b • ~ i q 'it c ~ C q b f~7 q Q~ 3 a- ti ,x a ~O M 7 t ~ C3 4 z o b L. ~ qq 1n N v o '0 Rj ~Op v y~o v ♦ Q V ~ fl V ~ ` \ ~ z N H r cs J O 00 J ! ~ ~ `•~i 7 V Y o O O Car- Ll Z: Czl C 1 : n O w c O U ~ v c+ c' H \ in y O O r 0 0 ;2, CZ7 r' t w ` - Y V ! 7 tey ~ 1 ?AS) I s~ S~ O FP4 an `d 4-' 4-1 N a I I W O 41 o w to to A b. •a pq z a 0 I o a J `N $~4 a 1 •a Io ri y o ~C 1. w H I I~ - JO H M M ~ ' z N H U (W . U C 4 N H H U U a E-4 W W W W W 0 0 a ch+ ~ ►b o 0 I I H 0 0 C+ C+- C+ C++ ~n H H z o a 0 H ~ a o ~ o ~ z N » CD z d K w ai (D y a H C) N (7) \O tzj En (D En En C+ f1 4 • o z dry C~a~ • O 0-0 td rx7 I ® f4 U 00 ~i . a 4-31 c~i> cc: N ~ . ~ p a w v v k a z H V Cd, L V ~ ~I~ a ~ Ul W 4-3 v H H H H ~o t A 4 H a a Mme. H O z _ s z o Z a w M». H.... U U a H H~ a O ; P4 P4 fem. • z w H cv M ~ 04 1:4 W4 0 P4 P4 c~aW ~e>4 SEPTIC TANK&'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHER PROOF ?•25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE CUV W/ PADLOCK FINISHED GRADE 4 CI RISER ~-WARNING LAL y' &2 ' 4 " MIN. 18" IN. 6" IsVS lolls GA S- ~ WATER TI~H S£A' ~S ~C'cLA , TIGHT s'y EYE •J;i it~V A SEAL APPROVED Kl. C PE JOINTS W/ C PIPE 3' ON`I 3 ' ON T~P~ ' ;o11S~G`;J ti;yCE B ON M SOLID SOIL SOLID CC C SOIL AMP OFF ELEV. 7/,o FT. I OFF RISER EX D - PERMITTED G IF TANK MANUFACTURL HAS APPROVA 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: eA !5 NUMBER DOSES PER DAY : y .TANK SIZES: SEPTIC /aoo GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: GAL. ALARM MANUFACTURER: s r6r..o CAPACITIES: A = _'O INCHES = .DLO GA MODEL NUMBER: ion SWITCH TYPE: ~JE~G4~yf~,.r B = 2 INCHES = EGA PUMP MANUFACTURER: G'tf/,✓ C = INCHES = Z& GA. MODEL NUMBER: psO J.3 SWITCH TYPE: L`fieca,~-,oQo 6I. D = (o INCHES = 7,y GA REQUIRED DISCHARGE RATE ,?as- GPM PUMP 6 ALARM WIRING AS PER ILHR 16.19 F: VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2.5 FEET FEET FORCEMAIN X /,9 FT/100 FT. FRICTION FACTOR FEET T.OTAL DYNAMIC HEAD FEET G~ //S x S~ aIJA ~ INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAME`'E LIQUID E `Vl1 SIGNED: _ LICENSE NUMBER: GJ87 DATE: 60-J-90 Peatures andl2erformance <<s OSP33 1/3 HP - MAX. SOLIDS 5/8" SPHERE -1750 RPM • Available in automatic or '4 manual. • Completely submersible. 20 Non-clog bronze impeller. • No suction screens to clean. t~ 18 yq Oil-filled, double ball bearing motor with built-in overload protection. " Reliable diaphragm switch with o piggyback plug-in. e Rugged cast iron construction. FULL LOAD • Completely field serviceable. AMPSAT I-15V. • 1 1/2" Nr discharge. 65. AT 230V. 36 0 0 10 20 00 40 50 60 U.S. GALLONS PER MINUTE SPD50H/SPD 1 OOH 1/2 and i HP - MAX. SOLIDS 3/4" SPHERE-3450 RPM • Available in manual or automatic. a.DIDDAM Dual seals standard. Seal FULL LOAD AMPS LAT 1. OAD failure sensor capability xW FULL available (to be wired to an r FHA ATAM. 40 AM _ xxOV.S.00. ~.xw alarm device) on manual pumps. „ Open two-vane sewage type impeller. FULDLLOAD Pump shaft and all fasteners are xn, AT xWxw 11,am 20 ;MPS AT . stainless steel. • 1 /2 HP (SPD50H) and 1 HP 'D (SPD 100H) motors. Ball bearing construction and oil-filled. 01 1 D 2D b W so ,DD 120 ,.o 2" NPT discharge (3" flange U.S. GALLONS PER MINUTE optional). 'SKHD 150 !a 1V2HP-MAX. SOLIDS 3/4" SPHERE - 3450 RPM t6o Semi-open thermoplastic impeller. 120 1 1/2 HP, oil-filled motor. x. I T' • Pump shaft and all fasteners are w KIP stainless steel. x = FULL LOAD • 1 1/2" NPT discharge.. ` F AMPS AT I.. - Spring loaded mechanical seal F , la AMLPb;TA~ .ew. x.aT I"' with carbon and ceramic faces. - - Pump-out vanes on rear shroud w °o to zo so eo 50 60 70 of Impeller. Dual seals. Seal failure sensor U.S, GALLONS PER MINUTE capability available (to be wired to an alarm device). 5 ST. CROIX COUNTY k , WISCONSIN J ZONING OFFICE' ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 (715) 386-4680 Aug. 6, 1990 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Rick Westforth property, located at the NE 1/4 of the SW 1/4 of Sec. 10, T28N-R16W, Town of Eau Galle, St. Croix County, revealed suitable soils at a depth of 36 inches below which seasonable high ground water was noted. This site should be suitable for a mound. ' Should you have any questions, please feel free to contact this office. Sincerely, C-)al2x. James K. Thompson Assistant Zoning Administrator cj