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HomeMy WebLinkAbout012-1071-30-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ` Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1 'ermit Holder's Name: ^ City ^ Village ^ T n of: Samuel, Dave Erin Prairie Townshi .ST BM Elev.:- Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ ~ Aera olding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ( > -/ ~ ~ NA Dosing 7 r~~ ~ 5 / >~~.~'~ NA Aet' ~ NA Holding PUMP /SIPHON INFORMATION ~ ~~ ~ Manufacturer ~ ~ ~,.,~ Demand Model Number 2 ~ GPM TDH Liftb,s~ Lriction .3 ~ System._~ TDH ~, , ~ Ft Forcemain Length ~ ~ Dia. FZ r~ Dist. To Well ELEVATION DATA County: St. Croix Sanitary Permit No.: 370279 State Plan ID No.: Parcel Tax No.: 012-1071-30-000 STATION BS HI FS ELEV. Benchmark 2 - ~ ~ ~ Alt. BM Bldg. Sewer St Ht Inlet i5~/ Ht Outlet Dt Inlet ~ ~ 3- y Dt Bottom Z ~~. Header /Man. SS~ Dist. Pipe Se .3 _ /~~. Bot. System ec ~ _ 9~ Final Grade c aGK St cover ao_. ~VII.AD~VR1'IIVrV~T~ICM /7 ~~ il.,..~..~~ iie,./ BED / N Width ~ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN `3 ~ DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK r INFORMATION Type O ~ / 5 7'~ ~ / ~ '~~ H B R OR NIT Mo a Num er System: f^ , ~ / DISTRIBUTION SYSTEM Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~ i /~ Length ~d Dia. ~ ~ f i Length ~ Dia. /1/~" Spacing ~ ,/(/ 7 / 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.) Inspection #1: ~ / Z /G~ Inspection #2: / / Location: 1871 130th Avenue, Baldwin, WI 54002 (NW 1/4 NE 1/4 34 T30N R17W) - 34.30.17.513B 1.) Alt BM Description = (S l 2.) Bldg sewer length =±L d ~~~~ -amount of cover = 3,) ~x % s+~:"~ d, ~ i,~.c l~ Gt ~ 5 ~a <<.H.~ c ~ lvr~/ ~rl~y~ s Plan revision required? ^ Yes ~ No Use other side for additional inform tion. ~~~ ~~ ~, G SBD-6710 (R.3/97) Date Inspector's Si ature Cert. No.• ~` ~~ i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: `~sconsin sANI ARY PERMIT ~ M Department of Commerce In accord with Comm .~ dm~Code ' r: Safety and Buildings Division 201 W. Washington Avenue P O Box 7162 Madison, WI 53707-7162 • Attach complete plans (to the county copy only) forth ~ m, a~t less-' "`~`=~ unty ~~ ~ , than 8 v2 x 11 inches in size. . )~c , , ~ ~ ~ ~ ~a ; • See reverse side for instructions for completing this ap tion~~ y; I u ~ t to Sanitary Permit Number - ~ `~xp ~ ~ 37 O Z ` 1 J Personal information you provide may be used for secondary purposes us appKcacion pre Check if revision to [Privacy Law, s. 15.04 (1) (m)]. ~ ~~ ~ e Plan Review Transaction Number I. APPLI ATI N INFORMATION -PLEA E PRINT ALL ., MATT Property Owner Name ~ •'i) ~ o ~ L loci Property Owner's Mailing Address Lot Number ^ B~Qck Number Ci ,State Zip d~ Phone Number Subdivision Name or CSM Number OD L F B I IN (check one) ^ State Owned ~ ~ !ty ^ Vll age ~ Nearest-Road, Public or 2 Famil Dwellin - No. of bedrooms own ~ m ber(s) 3`f- ~j0, l7. C)'13 g III. BUILDI G USE: (If building type is public, check all thatapply)P-t''S~i°P~ Parcel TaxNu y ^~ 2 /v ~ O~ O O L U~ p 1 ^ Apartment/Condo 2 ^ Assembly Hall 6 ^ .Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1, ^ New 2_ replacement 3. ^ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an -_____System ________System _____________ TankOnly______________ Existing System ________ Exlstin~System B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other ~f 8 r31. e= SZ` yf 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 11 ^ Seepage Bed ~ 12~eepage Trench 22 ^ In-Ground Pressure l 42 ^ Pit Privy i ~ 4 ~ ~ 7S 43 ^ Vault Pr vy J 3 ^ Seepage Pit f ~ ~ ' ~ ` '' 14 ^ System-In-Fill - 3 X ? f ~ G ~ /t VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate .System Elev. 7. Final Grade 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/y/sq. ft.) (Min./inch) 45.E ®9s:6 Elevation ® 9sY Feet . 7 Feet C/ /sue .~ -- qSS VII. TANK INFORMATION Ca cit in hallo 5 g Total # Of Manufacturer s Name Prefab.' Site con- steel Fiber- Plastic Exper. i Gallons Tanks Concrete glaze App New Exist n strutted Tanks Tank Septic Tank r Held+ng-~artk- Q Q ^ ^ ^ ^ ^ i Pump Tank er ~ ~ 4~ ^ ^ ^ ^ ^ II. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's ame: (Print) Plumber's S' : ( o Stamps) MP/MPRSW No.: Business Phone Number: ~~-~ ~~ v~~9 O s`~~ ~ Y~r~->~ Plumber's Address (Street, City, State, Zip Code 6~S z - IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue. Is In gent Signature (No Stamps) ~A rOVed pp ^ Owner Given Initial Surcharge Fee) rO ~~~ D~ /~ - l/.~~• Adverse Determination v / REASONS FOR DISAPPROVAL: L X. CONDITIONS OF APPROVA f , SBD-6398 (R.12I99) DISTRIBUTION; Original to County. One copy To: Safety & Buildings Division, Owner, Dlumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sal ~itary permit maybe renewed before the expiration date, and at;~ time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revis ons to this permit must be approved by the permit issuing author ty. 4. Change.. in ownership or plumber requires a Sanitary Permi f Transfer / Rei ~ewal Form (SBD-6399) to be submitted to the county prior to installation S. On~ite s swage systems must be properly maintained. The septic tank(s) rr ust be pumped. by a licensed pumper whenever necessa~ y, usually every 2 to 3 years. .. 6. If you h. ve questions concerning your onsite sewage system, contact your local code administrator or the State~of Wiscons n, Safety and Buildings Division, 608-266-3151. To be comb Mete and accurate this sanitary permit application must include: I. Props rty owner's name and mailing address. Provide the legal descript on and parcel tax number(s) of where the syster n is to be i nstalled. II. Type ~f building being served. Check only one and complete # of bedr Moms if 1 or 2 Family Dwelling. III. Build ng use. If building type is public, check alt appropriate boxes that apply. IV. Type ~f permit. Check only one on line A. Complete line B if permit is f ~r tank replacement, reconnection, or repair. V. Type if system. Check appropriate box depending on system type. VI. Abso ption system information. Provide all information requested for lumbers 1 through 7. VII. Tank nformation. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and mangy facturer's name, indicate prefab or site constructed and tank mat arial. Complete for all septic, pump/siphon and holdi ig tanks for this system. Check experimental approval only if tanl s received experimental product approval from DILHI;. VIII. Respc nsibility statement. Installing plumber is to fill in name, license n ember with appropriate prefix (e.g. MP, etc.), addrf ss and phone number. Plumber must sign application form. IX. Coun y/Department Use Only. _ -~ , X. Coun _y /Department Use Only. Cor~F lete plans and specifications not smaller than 8 1/2 x 1 1 inches mcst be submitted to the county. The plans:rnust incl'uc'e the following: A) plot plan, drawn to scale or with completed rriensions; location of holding tank(s), septic . tank(.) or other treatment tanks; building sewers; wells; water mains/ pater service; streams and lakes; pump or siphon tanks distribution boxes; soil absorption systems; replacement system areas; and the location of the;building.served; B) he ~izontal and vertical elevation reference points; C) complete spec ifications for pumps and controls; dose volume; eleva :ion differences; friction-loss; pump performance curve;.pump m~idel and pump manufacturer; D) cross section of the soil absorption system if'required by-the county; E) soil teat data on a 1,15 form; and F) all sizing information. GitOUNDWATER SURCHARGE 1983 Wi~cc nsin Act 410 included the creation.of surcharges (fees) fora numt~er of regulated practices which can effect grog ndwater. - The movie c collected through these surcharges are used for monitoring grog ndwater contamination investigations . and establishment of standards. PLOT PLAN PROJECT Dave Samuel ADDRESS 1871 130th Ave Baldwin Wi 54002 NW i / 4 NE i /4 S 34 /T 3 /R 17 W TOWN Erin Prairie COUNTY ST. CROIX MPRS Shaun Bird 22690 DATE6/14/00 BEDROOM 3 CONVENTIONAL IN ND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE 800 GalbnS DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 1526 # of chambers 48 ,BENCHMARK V.R.P. Top of Culvert ASSUME ELEVATION 100' ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.7/95.6/95.5/95.4 130th Ave 120' _ B.M. Trench one lies furthest to the west, and each trench shall be 45' -( 1" lower as they heard to the east. 10 120' Lt 60 3' 4-3' X 77' Trenches with B-5 6' Spacing ~n+ - - - - 30' 25' S 45' 3y~ B-4 !s~rs~ ~ro.S~~ jr Vent ~,~ s 1~,,. ~(cv~« 60' 100' Sidewinder High > 12" Capacity Leaching of Cover Chamber with 31.8 ft^2 per chamber Existing 3 6' Long 16" Bedroom 34„ Grade at System Elevation House Well `i ~,i, l'~"vT PI,PC ' ~.5 =~c~~ ~ocF. •~+n;row ox F-ResH ,41R IA1"-AKE r---VE i~7T CAP ._~_ WFATNERPRGOF +UAJC?"IOt,~ BpX 12"M!u. li ( ~C~` COIJDUlT-~ I ti-":= GRADE 18"' "', I fS.I . PU^~~P CHAr'fif;tP C.R0~5 SEC"1GIv ANG °ECIFICA'i IC~JS ?~ iIJLET I t;LEV. ~~ FT 1 I I I o~ r~ P --.~ ~~~ fl,•. 1. v ~~ `w~ 1 PRCViCE ( AIRTIGHT 55=AL *APPROVED JOINTS WITi~ APPROVED PIPE 3' ONTO SOLID SOIL. COAlCRETE BIOCK sEPrlc F 005E TAUKS AL11RM PUMP A 8 c D I.lUMBER C1F DOSES: \,/ RISER EXIT PEftM1~1°CD C)h.lt_~ IF TAAlK MAIJUFA.CTLJRE.R HAS SUGF{ APPROVAL _ SPEGIFIGAT1oA.i TA1JK 5lZE ; _~ GALLO/JS MAAlt1FACTUttGii: , MODEL -J1SM6ER: sWfTCfi TyPf: 1"'1AAfiJFACTURI<R: '"`7"'~'~.~ /~~~C~ ,wOaEL ?JUMDE:R:-r~ SWITCH TYPE : ~ _ bl~-~ ~?'~t.z„ M11J1ML1A'~ O15CHARGE RATE(~.~ ~ GPM A~FROVEa LgCK1~1G MAIJHOtE= CaVEr y'~ M,IIJ. ~~-'- - 19~iM1~:. ~I~ ~+~ III I' I ALARM II. ;I-~ I T, Ohl of~ L~ PER DAy DOSE VOLUME tNICLUDIIJG bACKFtOW: ~~~ GALL N5 CAPAC!TIES~ /l = ~ ~ IE!CNCS OR ~~UGALLOHS 8 =___~__IIJCHES OR _~~~~ GALGO-JS C=~i-SCMES ~~ ALLOAIS D=~I1~:CtiESOR ~Zb GALLONS iJ0'1'E: PLIh1P A-JO ALARM ARE TO DE INSTAi.LED 0!J SEPARA,TE CIiLCLiITS VERTICAL b1FFEREIJC6 DETM/GIVr;! PUMP GFF AA,iD DISTRI~UT;O-J PIPE.. ~ FEET t~Mi~A1r1MUM AIETWORK Si1PPL`~ P~~RE~~SSUR~~,~E~, _~ FE,ET ~°5~^.. r EET OF i'ORCE h1AI1J X ."'_L._F/oa f~FRtCT10A1 FACTGR..~,., FEET - TOTAL. D~IJAMIC HEAD = ~.+_. FE>;T liJTFR1~2A~. AM ICaNC QF TAA1K: LEtJCaTM~_,;WIDT?-i ~;L14VID 3(a c~p~ ~pp~.er ~y , - v l.~o-ct_ Lv.i~c~ `~v ~y kp. k..~iv ~iw»g. ~ (.1 r~ DEPTH 91Gf`lEC' LICENSE -JUMBEFt:~~ 6~ ._EL~_1~L_ /'"`~ DATE. ``r ~,rr ~, Pump Characteristics Pum t/Motor Unit Submersible Manual Models SW25M1 SW33M1 Automatic Models SW25A1 SW33A1 Horsepower 1 /4 1 /3 Full load Amps 8.0 10.0 Motor Type Shaded Pole (4 pole) R.P.M. 1550 Phase 0 1 Voltage 115 Hertz 60 Operation Intermittent Temperature 120°F Ambient NEMA Design A Insulation Class A Discharge Size 1-1/2" NPT Solids Handling 1/2" Unit Weight 30 lbs. Power Cord 18/3, S1TW, 10' std. (20' optional) Materials of Construction Handle Steel lubricating Oil Dielectric Oil Motor Housin Cast Iron Pum Cnsitl Cast Iron Shaft Steel Mechanical Shaft Seal Seal Faces: Carbon/Ceramic Seal Body: Anodized Steel Spring: Stainless Steel Bellows: Buna-N Im eller Thermo lastic U er Bearin Bronze Sleeve Bearin lower Bearin Sin le Row Ball Bearin Strainer/Base Plastic fasteners Stainless Steel Performance Data 32 w 24 Q 1/ 3 HP W x U ~ 16 Q t/4 HP z 0 a I- o s 0 0 10 20 30 40 CAPACITY-U.S. G.P.M. ~ f l~ 50 VVl 60 Total Head (feet) 1/4 HP GPM 1/3 HP 4 6 44 41 47 45 8 10 12 14 36 33 29 26 43 40 37 34 16 23 30 18 20 18 12 26 22 23 24 6 0 16 10 Dimensional Data r- 3-1/2 5-7/8 --~ 1. All dimensions in inches 4-1/2 2. Component dimensions may vary ± 1/B inch 1-1/2 NPT 3. Not for [onstru[tion purpose 3-1/2 DISCHARGE unless certified 4. Dimensions and weights are approximate 5. On/Ofi level adjustable 3-1/2 6. We reserve the right to make revisions to our products and their specifimtions without notice v>. - PUMP 111/8 ON 10-1/8 9-1/2 DISCHARGE HEIGHT 3 3-1/2 PUMP OFF AURORA/NYDROMATIC Pumps, Ins. 1840 Baney Road, Ashland, Ohio 44805 (419).289=3042. a rn z 0 w H z a U U Y in ,Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor end Human Relations Divisipn of Safety ~ Buildings in accord with ILHR 83.05, Wis. Adm. Code '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 ~o of slope, scale or dimensioned, north arrow, and location and distance $st road. APPLICANT INFORMATION-PLEASE P N~~:LL INFORMATION S~ . PARCEL I.D. # ~~~ PROPERTY OWNER: ~;.i' ~r~,; ,,~.~ ~\ PROPERTY LOCATION ~~ :.:_' ~ ~ a- GOVT. LOT Nh/ 1/4 1/4,S T 3 PROPERTY OWNER':S MAIyyL~~ING ADDRESS ~ : ~+ ,,, ,,,~~~q - '. LOT # BLOCK# SUED. NAME OR CSM # L 1 ~ _ ~;.. i~~ V- Page L of D/X /-3D -moo D TE 6 ,N,R I 't 1~) W CITY, STATE ZIP C Dl±' /PHON~;1VlitAJl A ^CITY ^VILLAGE ,®fOWN NEAREST ROAD D ( ~ "~- 'R ~ o~ [ ]New Construction Use (Xj Residenh /Number of bedrooms.. '•% 3 [ ]Addition to existing building G~ Replacement [ ] Public or comrTtefcfa~desor~~ ' l~ Code derived daily flow ~) 50 gpd Recommended design loading rate . z bed, gpd/ft2.3 trench, gpolft2 Absorption area required ~Sn bed, ft2~trench, ft2 Maximum design loading rate ..Z bed, gpd/ft2.,-.trench, gpd/ft2 ` Recommended infiltration surface elevation(s) /D~. ~ ft (as referred to site plan benchmark) Additional design /site Considerations~f~ r ~ 6cc,Esid~ of ~.ound _TU~T ~esi~rae. ~,r,o~ ~~ rc~.r~ace dr4i~ ~ a Parent material ~ 1 ct c. t ~,Q -i;.~`I l Flood plain elevation, if applicable n/ ~I ft . S =Suitable for system ONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U=Unsuitable fors stem ' ^S ®U ®S ^U ^S ®U ®S ^U ^S ®U ^S ®U `-~'~~.°:°`,~,~.,.~.d~501L DESCRIPTION REPORT - Boring # ?~'i~i~iw~i\}l.;i \rr ,~..~~.~~:s Ground elev. /~ ft. Depth to limiting factor Gz ", Boring # r z '~'...v.~v.; p~ f1`. iriiiti~: ti4:~:ij:::: Ground elev. /oo. z ft. Depth to . limiting fact ~ , Depth Dominant Color Motlfes T Structure istence Con , Roots GPD/ft Horizon in. Munsell Du. Sz. Cunt Color exture Gr. Sz. Sh. s Bed rer>ch / o- // /D .Z/.Z `1 S/ s6k MF 6S 3-~ S .Z 3 ~ C 3 C s6k /rl F' s 2-F z. 3 3 3/- ~2 E s c / ~ SL c S k ~ -' y ~ . s i C ~o~s t) lest G/3 ~ 7. S R 6/8 e/z/ ,. Ramarkc• J v-/2 Io 2/L ,l Z S6k S 3f s ~o Z iZ - 30 /d ,c y~~,/ ~ ~ r-'1 s b k h'1 F i ~' S Z ~ 3 3 30- y~ s,~ y/y f ~ s~. ~ . sdk ~f~ ~-s v~ ~ s ~1? - s 7~/ ?. a ~~ 1 ~"~ S~~ ~' /yl G ~ ~ `- P ~ N P ~ rh o~ st) 1 Remarks: CST Name:-Please Print ~ ~ ~ ` ` eY t \e\$~2, _ Phone: ..T 1 S - a,3S- g'3~9 ddress: ~ ,~ -~ ~ 4 '~P3d~ 5-1-. ~1~v~c~rv~.ant~ ~tSC S~N7S/ PROPERTY OWNER ~AVE SG w~.vr' L SOIL DESCRIPTION REPORT PARCEL LD. #f DI'oZ - /O ? / ' 30 - C~© Boring # 4:; xt :titi~. ~ ::ti ~{ ...,.....:a,::a. Ground elev. oosft Depth to limiting factor N/g ' Boring # ~ .ra _ ~f 'y ~:v ~.~:;~ Ground elev. 99 ` ~• • Depth ro limiting Boring # ...a...a.;r ~:. ,..: L 4: 2 J c~2 ~w~~~is Ground ele `I7. ~ Depth ro limiing facrorN ~. Boring # :~,a:~•: :~ ~ ~h ~r~ ~m~. Ground elev g1 ~ ft. Depth ro limiting fac~- Page '6. of ~ ` . . Horizon Depth Dominant Color Mottles -texture Structure Consistence Bourx~ Roots ~ GPD/ft in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. ry Bed reach o-/ /o z/z - / S F 3 .S ~ Z 1/ -3,Z l0 'c/ r / 'r C S.6 k m F; GS .Zf' ,Z . 3 '• 3 3Z-y8 7. s ~ y/ -J SL ,~' s6k h1/,F,e - ~ of . s ~' i ' i ! - _ . __ ~ Remarks: I v - /,3 . -/o ~c .Z /z s r Z rn Sbk -'~ F C S . ,3 C i , S .. ~ 3 .? /3 - 3 © y/6 C' .~ r+~ sb k -')1 F; 6 S z c . ,2 - 3 3 -$o ~~Q 3~ -- s~ z ~S6k m ~, as i ~ :y-,s ~ So-s4 S~ .5//~ ~ zo°/'- p ~ s• -'~ L G.~ 1 r--t . ,7 .~ 8 5 ~-~o ?s,e s/G . .. -5 _ v s w-k. s 1~ . 7 ~_ 8 7• y s~ G a Remarks:-~(ZO, rrr/ ~D~ ~ro-.~P~_ ~~I3 / ~nr~ ~a,.~.s ~>..aer~e very ~~~5~ . Z ' " o? ~ 3~ S~ ~ Z r+~ Sb k ~ Fi ~S 1 ~'-'- ~ . ~s a ,3 _ 7 S~ S/8 0 S s Y~1 ~. Y~ S I ~ . ? . ~ 8 _/oG 7 fR 7~3 ~.sy~ a is 7.5 ,~ ® S o 1'x'1,1. - - y ` . S ~ ~. $ ai~~ ~ z /d ~a~ ~ ~;. ,~~ Remarks: f a~p~ 15'/, n ro.v~l ~~ Very vw5i s-4- csrnd ~~~uxs• t-, ~^-r; t-ilo-1 I o- /o /D R Z/z 5 ~ r+,: Sbk I'1'L FR S I ~ S ~ z o-3 ~ o ,e y/y ~ c z -~ s k m F' I -~ . z . 3 ~ 3y -) / /D ,¢ 3/ 6 trot s t S 1.. I •~ ~,k ri'1 F 1~ I V~ _--~__,- .'S/ , S 7/-80 to -G/~ In~Q ~si/ ~ .S o - .~/ ~ S' c/z/d Remarks: (17 ~'lc r~ ~ rn L9-i.c YtitnlS'tr ~~ VPv~,\ C~°Ln1S't' Pc/1n~-.C4i.IM.C 1V~~~~1'ri '~:CSV1:--- SBO-9330(R.05/92) Dave Samuel 1871 130 th Ave. Baldwin, Wisc. 54002 Soil Evaluation Additional Notes Soil borings #4,Sand 6 were the first series of borings evaluated. There were a number of soil conditions in the series of soil borings #4,S,and 6 that suggested we move to the East side of the driveway. The conditions identified in these series of borings were; 1) Mottled conditions identified at a minimum depth of 70" 2) The limiting conditions at 70" would create a conventional system trench with extremely poor side wall penetration. 3) Extremely moist conditions existed at 70". The very dry seasons we have had raises questions on the amount of moisture that was found in the borings. 4) We did not have enough room to lay out a contour line for a mound system on the West side of the road. RECOMMEND Recommend that soil borings #1,2 and 3 be used as the proposed system. ~ __S ._13..._ S o~ 1 ~of\nctS - - --~-_ a ~\ ._. ~Cih ~S UU. ~. _ _....._ ~'~-- 100 - I 130`' Wye. I is~ i i I .9 S.s.~ h h`~ ~' i ~_ /0(.33` S~ptlc TgN1C cevr'R ^~i O w,~u.. ~"_! _ e ~0O o ii ---~---1L23~ .' .. /o` n - --~ ~._ ~~~ 1~. _M .y ~ e 1 . 100. ° --~'cx ---c-~ ?~ ° Sri/SwaJ Cu//o _~s~~_S1dE__Q{_dcr~ wad/. --/~~_~sM.1Z C/. /O/.7~ 1-2a-rz~~_co_rn.rc- >j~ 6r~ ~5, P c~ecf. -WCS~` en c~ wiS~K o~Ec,E iriPCfS ~~•n~z_~:LL ~cb~rve met4/fabfe /97~). D~ ID 1" 5~/ ~ _~an~u~r ~\N~ ._ ~- __. ro. t~S.eC3 _ ~- ~_ ~°~ d ~ , ~S~~Yh ,. s ~~~' - S ~- L ~~_ ~ ~ .~ ~U L 1, inch _~ _~U_~-_~_ D.av~ Saw\vel -1 ___._..18?L_ _ 13Q t` I~lve 3o N - R /7 ~./ ,ER/N Pk~/ R/t' _ tG/N. S~ . CRO/X C'auru'~! ,_L_cJisc,______ __ J 17ATF: 523 ~GC_ AWN: 1~._~ ...,.,. ST. CROTX C(?UNTY ZONING QFFICE CER:IFZCATION STAT~28NT FpR 'JT:LIZATION OF AN EXIaTING SEPTIC TANK This to certify that I have inspect®d the septic tank pr+~aantly serving the residence located Dt; ~I/yl 3(, /j~~. 3CC ..~, T~0 :~ , R j W, Town of -~ ~'~ ~._~.TCvtit,~%~_ , ~St . CrC3x County, Wl,sconsix~. than inspactian, I certify that I have found the tasak. and baffles do be in good aoridi.ticn, and 3.t appears to be fuactior~ing properly. Last ti.mo serviced ~/~r~ 60 ~ - bid flew back oveur front absorption system? Yes_~ N ~ (if ri4, skip newt 1 i,ne . R,pproximate volume or 3emgth of time. gallons minutia Capacity: ~,_,_ Cori3truatio~i: Pre a Concrete 7~ Steel Other tKaaufactuxer (if known) . l ~~.ara ~ ~..~ Age of Tsnk if known} . ~ 2oNO~eun ~ ~~~~~~~ 5 Lure ;Name] Please Px nt T1Cle _ License Nu er. ~~~U ~ ~ Dats~ Foam, to be completed by licensed plumber (s. 145.06, w~,sopn8in stritutesi or licer~ae9 diRpcser (NR 113 Y~iscorisin Administrative Coda? Plumber (applying fQr sanitary pex~~nit,} Certification; ~n accepting the above etazement regarding ®xiating s®ptic tank aoridition, I certify that the tank, to the best of my knowl ge, l conform to tlrie rCgairementi: of ZLHR 63, '+~iS- A3tr. Code {excep r inspe tion opening Over outlet baffle). NarAe dGl // ~ Signature MP/MPRS _ Owner/Buyer Mailing Addrt Property Address ._5~=-~-~~ _ (Verification requited from Flanniag Department for new construction) ~ ~~ City/State Parcel Identification Number / ~' l O 7~ - 3U ~ ~ 0 U EEGAL DES~,R~IPTION ~l Property_Locatxon ,~~'/., ~.~ '/~, Sec.3 / . T~~N- W Town of /~ ~~rul~-~ r--- Subdivision Lot # ~ ./ ~- f Certified Survey Map # Volume // .Page # Warranty Deed # ~~y~~~ Volume ~p~6~ Pa e # . ,, II Spec house ^ yes Lot lines identifiab~ ^ ao SYSTEM M Tly~r~'.tvs Improper use sad maiatea:nxaf yoar septic system could result in its premature failure to handle wastes. Proper maiatcnance consists of pumping out the septic tank every $uoe years or sooner, if needed by a licanscd pumper. What you put into the system can atl~et the function of the septic teak as a tttatmcat stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cert~ication form, signed by the owner and by a masterplumber, jotcraeysaanpIumber, restrictedplumberora licensedpumper verifying that(1) the on-site wastewatcrdisposal system is is proper operating condition and/or (2) altar inspection and pumping (if necessary), the septic tack is less than 1/3 full of sludge. Uwe, the undersigned have rand the above requirements sad agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce sad the Department of Natural Resources, State of Wisconsin. CertificaCion stating that your septic system bas bees maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o throe year expiration date. dI / cri GNATURE OF APPLICANT DATE OWNER CERTfFIC, ATION ' Y (wc) certify that all statcraeats on this farm are true to the best of my (out) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~ UG SIGNATURE OF APPLICANT DATE `*«"`" Any information that is mis-reprrseated may resu;t is the sanitary permit being revoked by the Zoning Department. •st•«• ** Include with this application: s stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST CROIX COUNTY 'SEPTIC TANK MATIVT~NANCB AGRELYviENT' . ~ . AI>iD OWNE$SHIP CERTIFICATION FORM `~„ r . 546 ~~z ~ ~F ~ r~~ F22~ ~i STATE DAR Of WISCONSIN FORM 2 - 1982 ~, WARRANTY DL•ED DOCUMENT NO. _ _ _ -- - -- ii - -- - - ~ __ _ _ _- f _Keith E. I,Eary, Jr. , and Judi I,earY,_hus~nd and wife, conveys and warrants to _Dayid .T_ 4amuel~A $,ia~)~pp~snn tlx following descnhed real estate in St. LtO1X County, Stitt of Wisconsin: The North 416 feet of the East 562 feet of the NorthwPSt 1/4 of ;hc *lortheast 1/4 of Section 34, 't'ownship 3C North, Range 17 West. i~°~~' REGISTER'S OFFICE ST. CRflIX CO., yyl Raa't1 kr Rt-t:v-r SEP 0 2 1997 9:45 A M Raybfp d D..d~ TNIS SPACE RESEP~ED FOR RECOROtNCi OATH NAME ANO RETURN AOORESS ~~ ~T tS~R This i s homestead pmpeny. (is) Exception to «•arranties: Easements. res:.~-ictions and rights-of-t,ay of record, if any. Dated this __ day of AUQt15t , A.D., 19 97 . (SEAL) ~ (SEAL) • Keith E. Leary, Jr. - (SEAL) (S~.AL) _ Judy J. ary AUTHENTICATION ACKNOWLEDGMENT Signature(s) Sate of Wisconsin, ~ ss. authenticated this day of Co nt , 19_ Personally ca~g before me this day of '~ ?b ~, , 19 ,the abrne named Keith Leary:and J ud~r Lealiy+, h au hanr3 -_ end w~ift^ Tf~LC: MEMDER STATE l1AR OP WISCONSIN _ Q (If nr•t, L authorized by §706.0(,, Wis. Stars.) to me known to he the person ~ wI~Q c ~ egoing i ment and ac wledge th ' . SAC THIS INSTRUMENT WAS DRAFTED BV ~t~.Qtr.~y Kricti rla Qq] and __ Hudson, WI 54016 (Signatures may be authenticated or acknowledged Nota Public, IY . Ih~th are not A1y commission is permanent. County, Wis. (11 not, slate expiration dart necessary) - ~ ~ _. 19) 'Names of txrNnc siRninR in anl~ aparitt should by Ipped .x prin ted Fxlo.c iherr siRnmu Cc, ~ -~ -~-- l\':1RR,1NT1' Dt:FD fir,\rt fl.AR Or- \t'I$CONGIN I nr.n \'u 1 - I~H2 V145torrntggal g~,yr~ ~ . 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