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040-1163-30-000
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CROIX COUNTY ZONING OFFICE COUNTY St. Croix County Courthouse O 30NINGOFFIC 911 4th Street a Hudson, WI 54016 v Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. completion of this form is essential so that the orooerty can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria)FEE: $175.00 WATER TESTING (For VOC'S) ---FEE: $25.00 SEPTIC SYSTEM INSPECTION-------------- (Determines if system is properly functioning at time of inspection) Property owner's name DJ 1 1..1 K JOE Property owner's address Qr-Q QLQ\CK RSS Legal Description SE 1/4 of the 5 �,! 1/4 of Section 96-3 _, T 2 2LN-R_.LQ Town of -t-en Lot Number Subdivision Name FIRE NUMBER LOCK BOX NUMBER Color of house W4 1T�- Realty sign by house? Q0 If so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: hk Telephone Number - Z Z O REPORT TO BE SENT TO: L U Z Z",zC) Closing date Signature 1 COMMEACIALTESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 - 3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NOA 35556/01 PAGE 1 5T. CROIX COUNTY REPORT RTES 10/31/89 COURTHOUSE DATE RECEIVED* 10/30/89 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS Zedjilik 6 Speer LOCATIONS 105 Black Bass Rd., River Falls COLLECTORS St. Croix Zoning SOURCE OF SAMPLESPorch Faucet COLIFORMS 0 /100 st INTERPRETATION** BacteriotogicaLLy SAFE NITRATE-NS 5 pps Under 10 ppe is safe for human consumption. COLIFORM + NITRATE LAB TECHNICIANS Pas Gane WI Approved Lab Not 19 OFA,AVEP 4bAN V { Means "LESS TRAP' Detectable Level Approved byi A ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 WPART EST - ROY T• 28 N- R.20-19 W 13 A ,w SEE PAGE 2S L ce �7.r f�i7p//'ew F Mayer .P¢/ph / eta/se a/a/ e. prod LAKE y y.c.q. nse 96 NeGscv7 rOWER• /eo ST CRO I X TB//Z Zeta 2 Enloe, • ".4 7 5 e 67 B7 n' RK FFF qX � ,/,'/>C FI LTQlncs C ��a N •� Mcv9a et h FF T4Y Wood ff � i �u Sh.�lee F ° A/or/7A217 R.0 Tr IUCIC/��°ll O v t /94 Wuy Rue 2 /9 3 •E/s f-on 24 Geyer .9itfiui <d s 79e5 L 899 eie Gscn O �A�//4s �a°n •ief S G22 fo• �� t Tack O1' • z C C.-R.11'. t ho y 144 s s �/77e.5 ff Necb . —ALL ^/C�C a/'B/' I>aJc 338 0 • TRRCT.S V3HA�1 ': 000//V /53.2 W :i TStAGTS: H� �. RD. TT/39 Q 29.25 V�meS fj T�,SQ.F .. • 4-0 .f=FB flocs to GRO�o�E Ca//et7'e 6choe/// W 51 ,at 191 LL Off /i/ein 770/77QsT 2 !John J /60 17on W. grown L 7r IT Ba 260 �olC/u ,j C • ROL L G �� R I✓�ma/ie 2/6.7 1744 P�� •W 0 f�' .w 7a Ed tfi M v e1'a/ Tris... .r,i�vc ... Pea/son •. ✓9B 5u0.. • fR3 .BW 6C 6L r • • /Y /BO � nar wan uU 7' kr/f*; Lo/irtZ"/a. ' c cS/oc.E,cla/ s�'41 '.° •:,.� Q,#. EV/s y • 787-3 fa b3 YJa Ma/v/n d i a Ce/nohauS J 0 ... D. SY,ck,.4 y EDi uc e/ L rtris sanc`s c.79 t u aG`iS wC 0 0 J%1 Leo. Fr X -h hLI cw • . .. ��'' tl �''fJmb�usf= Cerno ss�RO, ss v/d h • .• e _. � •ze�o/.kt emo/ M � a�a S /s6.67 /60 V .F t e!' 40 use • W./bete s' 9 MM t~if 4/BS /B7 F�ff¢/fa o per` UEOC9.a C¢u 1 Knobuc Ba f 34 f/obC 9p Bo f' sman ee�� Enfe Prises,Ltd. z,, "�, n i� c5'tan.H. srh l l� .6io`s9 Clause tas �v � � C 0 Look /-(� co .• ad u Lw/f •• g.39883 Ose/TlarJl. •ILWACO � Ruse .� o n� •�.a,Qo//an¢' 3\lC/ tTo 7 f $F /ss °/ Tar a,J c chwe��i��er- �tlC Ge a .r 7s c 7 .70 IF /_9AF oc,Ffor- MaP Pub/s PIERCE.COUNTY R.20 W- I-F-R./9 W. st c :x ounty,w,s NOTICE �;'�. All maps and other copy in This plat book are protected by the copyright. No item \ `� in whole or in part in this plat book may be copied, traced, reprinted nor any •� O F photographic reproduction be made. Any such violation will be prosecuted to the limit of the copyright laws. +� This applies to ALL users of this book, as well as any printer, photocopier or any fv• other person making such copies or reproductions. ROCKFORD MAP PUBLISHERS, Inc \� ©Copyright 1985-Rockford Map Publishers, Inc. Joy P. Dummer, President 7 ' FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER BOB RACICH TOWNSHIP TROY SECTION 25 T 28 N-R 20 W ADDRESS 105 Black Bass Road, ST. CROIX COUNTY, WISCONSIN River Falls, WI 54022 SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SEE ATTACHED SHEET I INDICATE NORTH ARROW DENCILMARK:Elevation and description: BM-EL. 100.00' on spike 1" above ground in Alternate benchmark BM-E1. 90.64' on 1" X 2" Wood Stake with lath. fence post SEPTIC TANK:ldanufacturer:_ Weir..ef Liquid cap. /000 Rings used: 0 Manhole cover elev:_____Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front >100 I Side Rea / r? Fr _ 7 too From nearest prop. line: Front~ )"oo Side , Rear~'oo Ft 11 1 1 No. of feet from: Well Building: ~ (Include this information in the above plot plan) Or g 1010 (2 reference dimensions to septic tank) SEE REVERSE SIDE CAUP.TY' ~Oeti'rNG. =c ~ ~ ` `a PUMP CliAMBER Manufacturer: Wets -er Liquid Capacity: 7J Pump Model:5S)% Pump/Siphon Manufact.: err Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: 1 6to Alarm: Man.: L eve. _A)arm Switch Type: flI2f -Location Distance from nearest prop. line: Front_, Side_,, Rear-Ft. Distance from: Well DD Building SOIL ABSORPTION SYSTEM Bed: X Trench: Seepage Pit: Width: J;L-__Length 373 Number of Lines: 2,__Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from well: No. feet from building I NO NG TANK Manufact er: Capacity: No. of rings u Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. 1 -Front , Side , Rear Ft. No. feet from: Well, building- nearest road Alarm Manufacturer: INSPECTOR: DATE: II ~I PLUMBER ON JOB:-Zk&jjh~K~ LICENSE NUMBER: 1 gd 6/90:cj • DEPARYMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & H~,1MAN RELATIONS DIVISION P,p. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION SE MADISON, SW34f Sec. 25, T28-R20 ~AO~Q Sfa signed D. Number Town of Troy CONVENTIONAL ❑ ALTERATIVE Black Bass Rd. ❑ Holding Tank ❑ In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bob Racich 1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: ~ REF. PT. EL CST REF. PT. 90, I /mil'. d Name of Plumber: MP/MPRSW No.: County: Sanitary P mit Number: Paul C. J. Steiner SEPTIC TANK/HO6&1NG9AW' Z fo CGS ! MANUFACTURER: LIQUID CAPACITY: TANK INL NK OU ARNING LABEL LOCKING CO R~ f PROVIDED: PROVIDED: 00 #J1 I u, 9~. /a YES ❑ NO ❑ YES NO BEDDING: ~E DIA.: NEAlFMATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT -110 FRESH C o. C,a, ALARM: FEET FROM AIR L T: ❑ YES NO ❑ YES NO NEAREST ur(~~ >/~Dr/",, DOSING AMBE 3 d, X3, ' C~ MANUFACTURER: BEDDI G: LIQUID CAPACITY: PUMP MODEL: PUMP/WHI MdvfANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ~Q ❑ YES NO C~v cSS / • 1 e ~(S YES ❑ NO YES ❑ NO GALLONS PER CYCLE: IM AND CONTROL OPERATIONAL: UMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL ND MARKIN or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN/ the soil is dry enough to continue.) CONVENTIONAL SYSTEMOA eS = Q• 23 WIDTH: LE N OF DISTR. PIPE SPAC NG: ~C~OVEJR INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: RIAL: PIT DEPTH: DIMENSIONS a- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR IPE DISTR. IPEt~AT R~L: N ISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END:' f~/-jC,s'o PIPES: FEET FROM LINE: i i AIR INLET: ~~-d~ ii J C~ /K• - NEAREST ~IGZ~ G~ UD 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: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES El NO ❑ YES ❑ NO DEPTH OVER TRENC D DEPTH OVER TRENCH/BED D=PTHS TOPSOIL: DED: SEEDED: MULCHED: CENTER: EDGES: ❑ YE O ❑ YES ❑ NO ❑ YES ❑ NO PRE RIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRNO.OF ENCHES: LATERALS PACING: GRAVEL DEPTH BELOW PIPE: VER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: [BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST 10 710 et in in county file for audit. Sketch System on Reverse Side. SIG TORE: TITLE: / SBD-6710 (R. 06/88) DI~HR SANITARY PERMIT APPLICATION couNTY 'ell In accord with ILHR 83.05, Wis. Adm. Code ~a STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ f J 8% x 11 inches in size. C ec if revisio o evrous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER <zo 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ` 1/456(/1/4,S Tag, N,R A0 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER w1 Yo y r II. TYPE OF BUILDING: (Check one) NEAREST ROAD ❑ State Owned & TQWN 0 8 on R Z Public ®1 or 2 Fam. Dwelling- # of bedrooms L PARCEL AX 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 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ® OfficeXaeteiT 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2.E] Replacement 3. ❑ Replacement of 4.E1 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE (7 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 17101A1 (72, ELEVATION 4 z o L~ C~ Ll oZ </0 Feet 7 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank Lift Pump Tan VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P111 ber''s Name (Print): Plum Signature: No S mps) MP/MPR8W Pie.: Business Phone Number: Ce 7 7f~ yWV1W c j Ste, Ic~et~ C d, 41,1- . 1 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE LY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issue Issui Agent Signature (No Stamps) Surcharge Fee) N Approved ❑ Owner Given Initial 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 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 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 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) sdil test data on a 115,form; and F) all sizing informatiorr. ' 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) cl- 10E • ~ ~cISTviG C1,~1.~ovTS \1~- ~Ot II ~RRN li rail Bob RPcC1CH xl FI r~Awrto►~ too' ~ ~ -7w~3u ct~rNu n~ rJ Co ti 9h - c-. toy • zo w s u~ ON CO►JCSt1f1t_~ G~'h,~o~+T R-es tDeY1CE all, o~ tl~ ,f a IL tN i Cttw Y° W YF #r o co wuSZr.~~ 10D~ wtIS\az aw cvtfm.. SLibnc ' tW . Ste, y`pvc ort - ~z. go,bY' R . x eu_ 90 ~ C E -Y-% ST)uG> STP%\'LG w/LI)T)i K . '9 Low SAoT ~ N9o' of 2." Pv C Forta~ ~l [x., . C S W1~L 1-otZ L~1~./i1N~11Cy~, f \l0"(E : ItiJ 't`k \ S IAC~'TL''''O X00 110\ZT~} Ip d g N Qla =cewksTwG) C`~`G~ ~'~tNT> WEGERER SOIL TESTING et. q 4.co' AND DESIGN SERVICE r^-- \ \ S ' o F LI Pv "tka P.O. BOX 74-421 N, MAIN ST, ti 2" o~ cov r~ RIVER FALLS,. WI 54022 715-425-0165 AM r C1.. Loo.oO ~ Ota splk.,~ ' E~96U~ 66iqur.~ 1~ CJ~ 'POJT;-. 1 3~I~ 1NVL`~-T of 1'7PwlFo~-p L31 . R1.ZD' ►`oL`t'~R~ PftttA yti ~ O F C~(~,ipo s\,TO 98U . s , / ~sf y 82P; / ' S o-T''tp tv~ o F laeo SOTt DESCRIPTION FORM Location Map-On 0 u e Shoe $o j3 R CIC PO_ tjtym Soil t- Pump oo S kl sTw'1 t 10 3 /o SLOPE: PURPOSE" S e ~'M Lam!*sTI.Y A R.T?-BUR. ASPECTI: oc.t-. Zo m90 Y ST C~v~k r°UUU`T~f w~ GsT?~Pt-'S s° LOT S . pr :off sEJ' -s o sec_!, RZOW DRAINA6E .~~►J 01=. TtLv GALLONS-PER $0. F T9 PER DAYI T Cam" «k DNYCTfi r_ _ PARENT RIA~(s)/DEPTH SOIL SERIESt - 4 HORIZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE`''CCAYSKOSS/ PORES ROOTS PI,I.. :MY REMARKS O Ss. Shp 1 0 _ s ~.o~ttz. ~ 13 - ~-g ~ 1 ~ h m v ~N z s- z3 Zo~tz Sly - Fs l 1 `F~bk )A Vi l cS. 3 Z3.s$ to1-c~_' 316 - vsl l`F~bk mom.. Sg _ tts vo"tt. `1 [z _ - S o s m 1. O•- S ~~oycz 31 - Y 3 z3.s8 1b`t2 316 s l Z.►ns l6k m~_l 1• ` 4 - _ ` . W°, Ai%.w%r. s Z 'S - ys: tioyc~ 1 1` t 3bk rn~~ 0_6'L )K as 3 U?rlu 'I~~tQ 1Z S U S ~►e.j 1. _ v,......~_.D ;:a:.' x `"lt ~s~s S~► J' 61 P, v 00 SCS OTHER `SITE FEATURESAOTES: /LL 90 FAF CST UNITO TORS/DEPTH; Signature Date 1r II ' State of Wisconsin ` Department of Industry, Labor and Human Relations a SAFETY & BUILDINGS DIVISION PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WEGERER SOIL TESTING & DESIGN Owner: BOB RACICH P.O. BOX 74 105 BLACK BASS ROAD RIVER FALLS, WI 54022 RIVER FALLS, WI 54022 RE: Plan Number: S90-40654 Date Approved: November 1, 1990 Gallons Per Day: 128 Date Received: October 30, 1990 Project Name: RACICH, BOB Location: SE,SW,25,28,20W GUEST HOUSE and OFFICE County: ST CROIX Town of Troy The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of th Wisconsin Administrative code. 6 This approval is for the following components only: - NEW CONVENTIONAL c•~ 0,6 ~ Inquiries concerning this approval may be made by calling (608) 785 8. 0 Sincerely, cs/nN~N O FCC G RD M. SWIM Section of Private Sewage Division of Safety and Buildings 4PP039/0009n/14 cc: BOB RACICH X Private Sewage Consultant SBD-6423 (R. 08/88) Page 1 of 6 CONVENTIONAL SOIL ABSORPTION SYSTEM FOR ~ Rooty I1.1 -w'w Fc~R =~QC~u~v '~tlrJklu/ S~s12u1cC Atip ly 1 RAUf1 C'vkST -"Use. LOCATED IN THE S C f ly OF THE Sw' ~y OF SECTION Zs , T Z16 Ns R ' W, TOWN OF TRo`-( ST, ct~o~x COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PROJECT DATA PAGE 3•of 6 PLOT PLAN PAGE 4 of 6 PLAN__VIEW-CROSS SECTION PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR Taos RA C1_CH_ J o s p L-A Ctc I3Nss IZSJA b ~~UElZ F7~LC.S, WI SyoZ ro C 0pi~~ l~j. ' •S V~ ~Ti. PREPARED BY ARTHUR L. • 40 WECERER EiLSWGHTH, COY ° W ip. _ S WF_EC3EFrEFc SC) I t- TEST I 1%4 (a S AND 11119 ~9 4, DES I iC; SEFcV I GE ~SIG14 P.O. BOX 74 421 N. MAIN ST. /0 - --4 - 90 RIVER FALLS, VI 54021 715-425-0165 Job # q0-ZO8 PROJECT DATA Page Z of 6 This proposed system will serve a 1 room guest house (part time use) and a bathroom in the barn. The owner provides an equine veterinary service and on rare occasions, a customer might use the bathroom. WASTEWATER USEAGE Guest house-Rooming house 1 room X 100 GPD = ----------100 GPD Bathroom in barn - office = 141X 16' Use retail store sizing 14X 16 = 224 sq.ft.X.70 = 156.8 divided by 30 =5.2X1.5= 8 GPD Owner- use employee sizing. 1 X 20 GPD= 20 GPD Total anticipated wastewater 128 GPD • SEPTIC TANK CAPACITY 128 plus 750= 878 GAL.(minimum required) A 1000 gallon precast concrete septic tank will be installed. ABSORPTION AREA Class 1 percolation rate. Rooming house 0.9 X 1 X 140 =------------------126 sq.ft. Office-retail store 0.03 X 5.2 X 140 22 sq.ft. Office-employee 0.4 X 1 X 140 --------------.56. s.q.ft. Minimum absorption area req'd. 204 sq.ft. A 12' X 52' dosed conventional bed will be installed to provide 624 sq. ft. of absorption area. ~ ARN II ~i = I GR nv E~ ~r2~A 7I ~ ~ UUU ~Rxl~uf-~ too' F ml: N mCtw%ft, e~ wogs Co iv CAE~r~ ~ ~!r1-~..1.05•TA ~ t,t.ia~c.~. 1 f'sp: ~ousE 0►,1 cA►JCQlTes ~ a~,uou T a a1~,tG~J - p sh vGVlew t~# _)7'~+ a i?.4F:~1 ' ~ t a ...A°dCrin. and LL o ~I. co f.~ >-,ussr.-\.- 10,ob Ci111. wt~sL~z C KJCLrL%TIA SeP71e 7'f1*J'M . S ' \ 0 OT•t • qO, by R X ~L, 90 - C K\ ST)iu G> ONS1 i SCbiT.4 \ti z, o e9°- F'~ow sport f ( 'y~f ;,ainvClyV ~~O' of Z-" PvC Foric~ n 19-r~.+ ~oL✓,►~~iur,~ 5Z~ 31 3, ~-qS, b' ~ 95.2• -~y'~ PERFOR S~1 vl~ 6' l2~ p ~iS~~DdL1~~C1 a PE ~r It 1'2 y Pu , SouDWh~-~- ; P1P~ • QS. b G CtavvQ t s, {{r V- u ~~ts tt~ . u o o p O d v p o m -C y a o. b o a 6Od 3 op ~ Q G O GO G~ QL.. ~~Sa 6 CO'1~1t~I~4C OR 4~ p d b o ~ VO 0 _4~1►1'~CT- S1RR v c, oG G eZ.r=11.O . -10 ~ u~-C--11itSTR)811 lS - ' if 'Met% /t~y~-`~1 PUMP CHAMBER CROSS SECTION AIJD ; SPECIFICATIOKISa ~E S OF 6 VENT CAP '1"C. Z. VENT PIPE WEATHER PROOF APPROVED LOCKING JUIJCTIOU BOX MANHOLE COVER WITH 25' FROM DOOR, w1~R1~lIN 6 Lt\SEL- wuJOOW OR FRESH It~MW. AIR IIJTAKE 1 GRADE slL LsL Cj0a- 4 MIN. 10' MIN. 7 COIJDUIT . L'"- IM. INLET WRr~~~!I-kWDE AIRTIGHTkA APPROVED JOINT A APPROVED JOIWTS W/C.I. PIPE II ( W/C.I. PIPEORpVC ALARM EXTEMOIIJG 3' ONTO SOLID WIL d I i ON C CLLV. g- F1 PUMP- OFF 0 3.b p COIJCRETE 9LOCKA 3" ARPRw9( 0OINQ RISER EXIT PERMI-UED OWL'J IF TANK MAIJUFACTUR£R HAS SuCH APPROVAL I 86 SPEC-IFICATIOKIS DOSE . w~~~ QOU Ls7 uDUc NIIMpER OF DOSES: TA K MAWUFACTU0.CR. 3 y PER OAy . , TANK SIZE' SQ GALLOWS DOSE VOLUME S.S. ~~TRO S'-L3TtB"9 INCLUDING GACKPLOW% lb0'~ GALLONS ALAR MMJUFAC.TURER: MODEL AIUM66R: Lo 1 Nw CAPACITIES: A= is INCHES OR 300' B WALLOWS SWITCH TyPt: ei;-- aoit'Ly 5= Z INCHES OR "41 G( LLOUS PUMP MANUFACTURER: ~ 5- - - , -y C. a INCHES OR W3-4 GALLOuS MODEL NUMOER: 61m D- X? INCHES OR yb' GALLONS SWITCH TYPE: 1'1 CuQ'~f MOTE: PUMP AND ALARM ARE TO OE MINIMUM DISCKAR" RATE 31• S GPM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AUO_OISTRIbUTIOU PIPE.. 10•20 FEET + MINIMUM NETWORK SUPPLY PRESSUR~E/.. . M FEET + x'10 FEET OF FORCE MAIN X z'za FJooFxFRICT1ot,1 FACTOII. 3.88 FEET i TOTAL DtI JAMIC. HEAD = X3.68 FEET J of AMI=IIER 9ok lv P INTERNAL DIMEWSIOWt OF TANK: LELIGTH ;WIDTH -Is 11114r ;LIQUID OEPTH 3..~. ~o"Rvh ~421sA = Z.31 = Gh1- / tluCH lAS PE'!2 MR1JU Fp•C~l)[L~1~ = ZA•0 5 GPrL-/ IAJC-1'I 500/4 Features Pump Impeller is recessed Powerful 4/10 HP Motor is Rotary Shaft Seal has carbon Micro Switch (SS4 A) has per- 'Tornado" type - operates oil filled for ood insulation and and ceramic faces for positive manent magnet on switch arm for completely out of volute passage lubrication J1 bearings and seal. seal. Body is stationary, prevents activating switch. Diving full opening for flow of Overload protection built-in, has string or trash from winding ABS Plastic Operating Switch Ilquidds and solids. no starting switch or relay on seal. (SS4 A) has steel follower molded t Motor Housing is heavy cast mechanism. Switch Housing (SS4 A) is into top for activating switch magnet. iron, epoxy coated. Stator is Thrust Washers and Sleeve completely sealed from sump pressed in for perfect alignment, Bearings are oil lubricated for liquid, easily removed for best heat transfer. smooth operation, long pump life. replacement if needed. Dimensions SS4A SUM :r lrrr[. tr 285.8 mm • I 304 mm i i Ar,Y f t y arh': `re a { (-241.3rom---24t3rrrtt^-+~ i Performance Curve C"=Ty UTPAS PEB MINirrE'.. -i 0 20 40 60 80 too 120 14o 180 1180,200 220 240 4- r a _ 122 - H._~~.~ 20 + fq+ z 18 ~Cgpq ° 18 CITY _ 14 - , _ 12 ~ ~ 18 tel. I ~ r ' 2 0 -b " 10 4"15? 20 '25`30"'35'• 40'T 45750 re :.CAP=TY GALLONS PEA MINUTE Y, Accessories Performance Table Myers offers a wide selection of accessory stems 6`iise with the SS4 pumps: adjustable level controls, wet sump controls; alarm feet 2 4 6 8 10 J366 14 16 18 10 11 controls, electrical control boxes and switches, heavy.du' check Total valves, polyethelene and fiberglass basins.- etc. ' . Read Meters 61 1.22 1.83 2.44 3 05 4.27 4 88 5.49 610 6 71 Gallons Per Hour 3,600 3,600 3,450 3.300 3.150 1,550 2,?50 1,800 1tilers Per Hour 13,625 13,625 90 11.923 9.652 8.516 6.813 4,921 2,a98 ©0 o Performance Capabilities 13 D 0 0 Capacities to 60 GPM 227 LPM Q Heads to 24 feet 7.32 meters Pump Down Range * 4 to 41V2 inches 101.6 to 114.3 mm Automatic: control6 control boxes . Solid Handling Capability 1/, inch dia. solids 19.1 mm dia. solids Liquids Handled Fresh, drainage effluent waste water 1 Intermittent Liquid Temp. 150°F 66°C 1 J I °:a; Motor Vic HP Electrical 115/230 V., 12.0 Amps, 1 d), 60 Hertz r Discharge M inch 38.1 mm 'Automatic model, (manual pump variable wph swnch). C•h9dC` 1reNe8 myars F.E. Myers Co., Division of McNeil Corporation Ashland, OH 44805 (419) 289-1144 Telex 98-7443 State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION GENERAL PLUMBING PLAN APPROVAL 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 WEGERER SOIL TESTING & DESIGN Owner: BOB RACICH P.O. BOX 74 105 BLACK BASS ROAD RIVER FALLS, WI 54022 RIVER FALLS, WI 54022 RE: Plan Number G90-40695 Date Approved: November 6, 1990 Date Received: November 2, 1990 Project Name: RACICH, BOB - INTERCEPTOR Location: 105 BLACK BASS ROAD Town of TROY County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All items required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved. If construction has not commenced before the expiration date, new plan approval must be obtained. The Bureau of Plumbing has reviewed these plans for plumbing code requirements only. This approval is for the following elements only: - PRIVATE INTERCEPTOR MAIN SEWER - SANITARY Inquiries concerning this approval may be made by calling (608) 266-8075. Sincerely, 6L ITA M. DOCKEN Bureau of Plumbing Safety and Buildings Division PGP001/0011w/26 cc: BOB RACICH X Plumbing Consultant SBD-6423 (R. 08/88) Page 1 of, 6 CONVENTIONAL SOIL ABSORPTION SYSTEM FOR B!~`Im2uor~ 11J wlo1-IJ Fc~R - uE= V 'T 2~ Nh IW Smut ~C A►~~ ~ Ruor1 c~vLST LOCATED IN THE SCI<y OF THE Sw ~y OF SECTION ZS , T zg N , R zO W, TOWN OF TRo'f , ST• CRo~x COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PROJECT DATA PAGE 3-of 6 PLOT PLAN PAGE 4 of 6 PLAN_YIEW=CROSS SECTION PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ~3oB RA C1 CH J o s Z L<K etc v~-,s-' Roan ~1V~1Z Ft11..1,5, WI S~lOZ2 cap' PREPARED BY ARTHi iR L- w WE _RcR = a ELLSP:GHTH, t UJEGEFcEFc Z-3 C) I I- TEST I 1,4 Q •s W,; AND DES I GIV SERVICES 1~u IGl; c c+. y F.O. BOX 74 421 N. MAIN ST. /O 24_ 90 RIVER FALLS, MI 54022 715-425-0165 09040 Job # q0-• ZOa PROJECT DATA Page Z of 6 This proposed system will serve a 1 room guest house (part time use) and a bathroom in the barn. The owner provides an equine veterinary service and on rare occasions, a customer might use the bathroom. WASTEWATER USEAGE Guest house-Rooming house 1 room X 100 GPD = ----------100 GPD Bathroom in barn - office = 141X 16' Use retail store sizing 14X 16 = 224 sq.ft.X.70 = 156.8 divided by 30 =5.2X1.5= 8 GPD Owner- use employee sizing. 1 X 20 GPD= 20 GPD Total anticipated wastewater 128 GPD SEPTIC TANK CAPACITY 128 plus 750= 878 GAL.(minimum required) A 1000 gallon precast concrete septic tank will be installed. ABSORPTION AREA Class 1 percolation rate. Rooming house 0.9 X 1 X 140 =------------------126 sq.ft. Office-retail store 0.03 X 5.2 X 140 22 sq.ft. office-employee 0.4 X 1 X 140 56.sq.ft. Minimum absorption area req'd. 204 sq.ft. A 12' X 52' dosed conventional bed will be installed to provide 624 sq. ft. of absorption area. I r' • ~ ~XIS~~ C1.~1.iUVTS \1\ _ ~Q\ •••r_ r d RRN ~i J~I ~I GR Av E~ ~rR~A 7) ~ FI, r~Rxi~U►•1 goo' p1I N 9E~~~ ct_~YW n~ rs Co N CA~-(r y. n Ia 91'"1 - r*l.. 1.05•?A l~v S~c,l. b~EST oN ~4WCQQ[t'~ f C viousE ~'"hru ov T ' t0f lti tg CL ypp cr s Fa aIaG~J gdN3~~ ~ h ,.iw G R.NS 5 L t-r co CaucjcZ s~p7la 7Y1uk r PvC \ 0 off ~'~.go,bY ® R x Ems- 90 - CE x\Sl7+aG> opu I I.,-L "Vat, jl CA STt1tr s w/ Lg174 \b S \a w cli 0 Kd~ VAgP„rs _ l2oA b fvi i Wit.. 89°- ~~ow spoT> f ` dam/ D a 17p'oF Z"PUC Fo~ZC~ rr~lt+.-OehTlurJ S'ctCTC-Ii 1No~; l.U~tL \S Wcq ~ S WPB N~CResT Pru> ~ t~u~ ~s ~PLUMBINQ PC'R. e~ Cox►'~pau g 13'1 1~ oT~t'S. ' (.iCR~~~!CIrt2~G~~ ~ , RMW S s~ L RELATtOkS Iti~: mot. ~ty.oo' S'EE CORR, ')i 3i~i~" E \1S~OF c.~''~C Al AM - t't., 100.00 ~ 0/.~ ap~~ ~ No '1HSOh~ 65tgW.A~ F~~ POST; 1 3.1u 1'JV T of IFo-a k--1 woop Lq,~ sRT ?.rr C %AJQ~k S 1v1TP~l Pt1ZC{~ 'i• 4 5 \'R4v o s'wp Taft, Ao'~h of 9~ y ~ ~ ^ q a 3 i y 06 8 °T~~ F 8 ~o 6. s I ~3s$ 2~t-cN nw N 5Z '26 L=L.qS. 6 qs. z• 3. _~y'~ t'ERFoR A~1'~ Pv C v ~~z -1► ~ , 12 , D\S`t'R19uTo~ Pr PE Q L4 PNM SO<.IDWh~-~- 3, tiZ q5. b• G 2oVrvQ 4 "_NIRiT -fS1.PE -yam/ - Fttvts !F~ ~ GR SAE 141 "Aot-IMI-IM u U D p V Q O Q> C d O O 1sQ b° a a O6 3 0 0 D b p t'i1~1•T'E'~If4Z DR q~ p O d ~ ~ G o a.~ 0 Q_ 1►) OJr'1 i1~T 4-S1Rh V c, oG G G' c a~ L o a o ELEV. 0. 0 ~ LwPU-C:-.'QISTRl8U1~~fP -6p - - - - • PUMP CHAMBER CROSS SECTION AND SPECIFICATIOMS ' ~ E S OF VENT CAP 4'C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING , JUNCTION BOX MANHOLE COVER WITH ?-5' FROM DOOR, It~MIV. wARNIN 6 LIBEL wtNOOW OR FRESH AIR INTAKE GRADE aL °10 - I '1 MIN. r CONDUIT WAIN. . - Sr2~ IIIIPAIN. \ PROVIDE I . INLET T AI1tTI4HT SEAL I I I ~ ~ I} I I i v APPROVED JOINT A ) I APPROVED JOINTS W/C.I. PIPE I I) I W/C.I. PIPEORPVC EXTENDIAI6. 3' I I ALARM ONTO `01.10 SOIL Is f I I ON c CLEK FT. I PUMP OFF 0 3.b p CONCRETE 9LOCK 3" APPRQvEt RISER EXIT PERMITTED OfJLy IF TAIJK MAIJUFACTURf.R HAS SUCH APPROVAL BE,OOING SPEC.IFICATIOAIS DOSE . wl ~s l=R CXXiCIg TDDUCZ S 3 y ! c TANK MAUUFACTURER. WW ER OF DOSES: , PER D" TANK 51ZE : -I SCE GALLOWS DOSE VOLUME tb0•`I ALARM MAUUFACTURI`R: 2•ME1-ECTILCI S'-LSTV "13 INCLUDING OACKFI.OW: GALLONS MODEL NUMBER: Lot Hw CAPACITIES: A= is INCHES OR 300.6 GALLONS SWITCH TYPE: Y'l 2CUR-~l 15 n Z INCHES OR LtD' I LLOU5 PUMP MANUFACTURCR: °~-~-~Z COI L HMV ~f C INCHES OR 16b GALLONS MODEL NUMBER: Oil D INCHES OR GALLONS SWITCH TYPE: M~a-Y NOTE: PUMP AND ALARM ARE TO BE MINIMUM (DISCHARGE RATE GPM, INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEIJ PUMP OFF AUD-013TRIfbUT" PIPE.. Zo'°o FEET + MINIMUM NETWORK SUPPLY PKESSUILE FEET + FEET OF FORCE MAIN X z'z g FF/ToofILFRICTIOU FACTOR.__-3*u FEET TOTAL OtIWAMIC HEAD = X3'88 FEET nt P%tl El'ER -%0 " Zro P IIJTERWAL DIMEIJSIOWf OF TANK: LEMCvTH ~IIDTH =~~r...;LIQUID DEPTH 3 Z AS PER MRuU FAC~w-t=% zo.0 5 GRL-/ IJJ C- 14 U W CPC G 4, O F_ HEAD/CAPACITY CURVE 47/6 6/A MODEL 97 30' - a 8 4% - 1'1e - 111h NPT Q 6 20• a - a3it6 W U_ Z 15• ) ~ 88 0 4 J Q 0 to' 3,.5 2 ° us 10 20 30 40 5o 6o i0 GALLONS LITERS 0 B0 160 240 101,6 FLOW PER MINUTE m' L OYWMIC NEADRLOW PER MINUTE K0.UMT AND DE9MTE1ONO CAPACITY 35/,6 r103 UNFIS01101 GAL LTRS 56 212 46 174 35 133 15 57 Lock Valve 23.75' CONSULT FACTORY FOR SPECIAL APPLICATIONS 9 0 4 0 6 9 e Electrical alternators, for duplex systems, are available a Mercury float switches are available for controlling and supplied with an alarm. single and three phase systems. a Mechanical` alternators, for duplex systems, are avail- a Double piggyback mercury float switches are available able with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch. no external control required. Standard All Models - Weight 331bs. -1A HP 2 Single piggyback wide angle mercury float switch or double piggyback mercury float switch. Refer to FM0477. 97 Sarbs Control Selection 3 Mechanical alternator 10-0072 or 10-0075. 11110" VOR"111 11 1 Aaaps Shoplex Duplex 4. See FMOT12 for correct model of Electrical Alternator. "E-Pak". M97 115 1 Auto 12.0 1 or 1 6 7 - 5- Mercury sensor float switch 10-0225 used as a corrol activator, specify duplex (3) N97 115 1 Non 12.0 2 or 2 6 6 3 or 4 & 5 or (4) float system. 097 230 1 Auto 6.6 1or167 - 6- Four (4)hole"J-Pak". junction box. for watertight connectionorwired-m simplex or py 290 1 Non 60 2 or 2 f16 3 or 4 6 5 2 pump operation, 10-0002- 7. Two (2) hob "J-Pak". for watertight connection or splice. 10-0003. CAUTION For MlorataNon on addhional Zoeller products refer to catalog on Combination All MMIda9en of earttr eta p - I devices and v*V4 shouts be-done by a StarW FMOSK Piggyback MWOOY Float Switches. FM0477: Electrical Alternator praMaA f inead atechicI L AN eleckkel and selefy cedes a1 -1 be IDNowed FM-048t Mechanical Albmator. FMNft Alarm Package. FM0513: and Sump/- b ckallag Ow and rac Na9enal Electric Code VWC) and the Ooarpatlond Sewage flle - FM0167. so* and health Ad (OSHA} RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. . ~ 3280 Old WNW Lane Manufacturers of... Zff ~~~ff O. P. 0. Box 16347 a Lo iW* Kentucky 40216 N N (502) 778-2731 FAX (502) 774,M4 u~urr PUMPS S,vcE /P3P Q LDINGS DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY PERCOLATION TESTS (115) P.O. BOX 7969 LABOR AND HUMAN RELATIONS MADISON, WI 53707 (H63.090) & Chapter 145.045) LOCATIO : SECTION: UNICIPALITY: LOT NO.: BLK. NO,: SUBDIVISION NAME: Se 1/42W'/4 zs Tzes N/R z E (o T~~ - - COUNTY: NER'S YER'S NAME: M L ADD SS: ps $C~ 81tSS F-A~A ST-cam lX ~o$ C c RovS W► S o Z2 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: ROFILEDESURIPTIQNS: STS: ®Residence 1 N Iz\. QRNew ❑Replace I O_ 9 q0 t to Qi►ReIV RATING: S= Site suitable for system U- Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S(STE -IN-FILL HOLDING (TANK: RECOMMENDED SYSTEM: (optional) ( ICS s a u ®S U Y~I S EA" ICJ S a u El SEA u K S L ►b~ IWA L 8n w*01P If Percolation Tests are NOT required DESIGN RATE: ( If any portion of the tested area is in the w ` under s.H63.09(5)(b), indicate: 'N3' N, Il Floodplain, indicate Floodplain elevation: 'v PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGH ES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- \ 115 ~16.Z iUpn)~ > Z\ S sel~ Ph GE: 3 01= B Z 1~0 °IS.S B- 3 1o g, 9. S,1 > lug Z , ~ B- 1 \ Z qU.S 7 1 t B- S toe °tS-Z > 108, B- PERCOLATION TESTS TEST DEPTH-. WATER IN HOLE TEST TIME DROP WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P. \ 66 N , . S it_ 3.oq < 3 P_ 2 5 IJ,1~, buOP w s w G irJUuvrtS 3 P_ 3 58 1v•~, 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. P, L. s I SYSTEM ELEVATION ~ 1 ~ f. ~O • i - - i - I _ 1 _s C~m H see- ~ S 1, 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 Administrativa Code-a tb daLaxe rdedrpdheIn tityf the tests are correct to the best of my knowledge and belief. wwtt(U~ CC T~~~~jj(( NAME print TESTS WERE COMPLETED ON: DESIGN SERVICE ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): P.O. BOX 74 421 N. MAIN 8T. C-ST UL) 0 S- x. "11 S_ LIZ S 616 S FOVER l W1 541M CST SIGNATURE: 715425.0165 °4O 11 Z. DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - AGE l 0 F 3 l3RRN Bo'8: Ri►cCtCE} I Co N CP.CT~ cwt _ tos.ZO I 1 ~1,W1 owl oOwCQt1'~_~ i R~2T1Ut1iJCE~ j 3 y i i Olt .v' OJL1 I ~ ~r.'Z,"I~ipyp STMLO W) LPtTA , I tNK lip d • S H N WECERER SOIL TESTING -AND DESIGN SERVICE P.O. BOX 74,421 N. MAIN ST. RIVER FAILS, Wt 54022 715-~25-0168. ~ouE 662n~,a,p d~ wooD L1,-~{ S@T FYT CORNS 1 ~ t'>:•~ Pt ~ P~'IL~ y~. O F fZUPo sip B ~ , aO'RUh of 9~ i / / By w `Q/ ~6~N \ ~k AL~pt~~ $oT''~Olv~ o F ~ @'O oo,S' "PAGE 7-oF-3 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER T r~ C Il l ROUTE/BOX NUMBER FIRE NO. DS CITY/STATE ~7~"Z 5 ~v i ZIP 2 Z PROPERTY LOCATION: 1/9 1/9, Section ;-J , TN, R 710 W, Town of St. Croix County, Subdivision , 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 for a MAXIMUM of $3000 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 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 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED i DATE St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 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 ~t~'~~lf~T r4f ~I~CICl~ Location of property %Y 1/9 ` 1/9, Section T N-R W Township V Mailing address Address of site Subdivision name _ Lot number Previous owner of property Zed ~t Total size of parcel -7, 7 ~r{ S Date parcel was created Are all corners and lot lines identifiable? ~s No Is this property being developed for resale (spec house)? Yes No Volume r ) 7 and Page Number Z//~7 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 survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warrant deed recorded in the Office of the County Register of Deeds as Document No. ~ '3755 ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded] n the Office of the County Refistet of Deeds, as Document No. '7 a 'a 1Z 1, . -W- 4.,4 Signature of Owner 3 nature f Co-Owner (If Applicable) c ` G 713, /9d Date of Signature Date of Signature I DOCUMENT NQ. wARRAM THIS sFACC "CSCXVSD FOR "scaw•"D DATA STATE BAR OF WISCONSIN FORA I -1 M 1 453755 wct 857PIM 417 Richard F. Zejdlik and Kenneth D. Speer REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record cis NOV 2 a 1989 conrr>d and tlarrulta to Robert A. Racich•.and .Robert......,... Racich, as tenants in commo.n_... . _ C. A 5•.4 M 4 ^ i f? r IQr Al ry "Clu.. 10 14~~Frc ~q.,r. ,.J 4-yc) 1 the following described :cal carafe in St..... Croix ...Cou ntY. State of Wisconsin: Tax Parcel No: THE SOUTHEAST QUARTER (SE 1/4) OF THE SOUTHWEST QUARTER (SW 1/4); THE SOUTHWEST QUARTER (SW 1/4) OF THE SOUTHEAST QUARTER (SE 1/4), SECTION TWENTY-FIVE (25), TOWNSHIP TWENTY-EIGHT (28) NORTH, RANGE TWENTY (20) WEST; and GOVERNMENTP LOT "1" OF SECTION TWENTY-FIVE (25) AND GOVERNMENT LOT 101" OF SECTION THIRTY-SIX (36), TOWNSHIP TWENTY-EIGHT (28) NORTH, RANGE TWENTY (20) WEST; Except parts of Government Lot "1" of Sec. 25 and Government Lot "1" of Sec. 36, described as follows: Commencing at NE Corner of Gov't Lot "1" of said Section 25; thence S 50 feet; thence W 400 feet; thence S 24o30'W 325 feet; thence S 10°45'E 890 feet; thence S 31o15'E 786 feet; thence S 876 feet to the S line of Gov't Lot "1" of said Sec. 36; thence W on said S line to Lake St. Croix; thence Nly and Nally on Lake St. Croix to the N line of Gov't Lot "1" of said Sec. 25; thence E on said N line to PLACE OF BEGINNING. TRAN 'i t.J:?oo This ...i.s not . _ homestead property. OW (is not) Exception to warranties: easements, restrictio: • and rights of way of record, if any. Dated this day of ~~C?tJc's~J OrIQ. , 19 8 9 aA-,►zf_ (SEAL) )SEAL) Richard F. (Zej . (SEAL) t<.L (SEAL) Kenneth D, eer AUTHENTICATION ACHNOW LSDOMSNT Signature(s) STATE OF WISCONSIN as. p)c- Ac C Cour,ty authenticated this day of _ 19 Personally came before me this • -7"-day of piQ KFixI/.Le':K... 19.. A the above named . Richard...F..... Zej.d.j.i.k _ . TITLE . : MEMBER STATE BAR OF WISCONSIN Kenneth.•_D...... Speer.._ (if not, authorised by 1 706.06. Wis. Stats.) to me known to be the person ..5....... who executed the foregoing instrument ankaelbowlapdse• acme. TNIS INSTRUMENT WAS DRAFTED By Jeseph D. Boles Attorney at Law 1 f( y i County, River Frills, WI 54022 1 Notary Public Wis. (Sittnatures may be authenticated or acknowledged. Both My Commission is ebt.1L* 4 ijate expiration are not I,ecessary.) date: 19 YZ•) •yam.a of 0eraona •ianinQ r, u•.y ra,scity .i,. -i be isped or panted brluw tn. v ullnu„nv. ••••,,r~U .,•"Nla''+l a. STATx BAR OF WISCONSIN Stock No. 1300'l VoRtd No a - Nitlr , QMCrtrt