HomeMy WebLinkAbout030-2066-50-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 567291 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Schulte, Daniel C. &C eryl St. Joseph, Town of 030-2066-50-100
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
/00, 2- 1 B - / CST' l 35.30.20.608G
TANK INFORMATION n e ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic //'' �.� l ^- Bench /Kvdi�Gv D� F. ILcn Z 126cl K v, ie 3 / .7 /63.- -T
ge""g • Alt.BM 2.1 /°° • �
Aeration Bldg.Sewer -3
�C�O •l
Holding St/Ht Inlet 15 ,
`T7.�
TANK SETBACK INFORMATION St/Ht Outlet V
TANK TO �q P/L WELL BLDG. ent t it Intake ROAD Dt Inlet \
/V a f 11�. /
Septic �5 Dt Bottom
Dosing Header/Man. $ �`
Aeration Dist.Pipe
7. 1 9
Holding Bot.System $•6
Final Grade 3 7
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover Z g
GPM F�( �o SOD •7
Model N er
TDH Li Friction Loss System H H Ft
T
Forcemain Length Dia. Dist.to Well t'
3 • p a/,�,.. /��Z
SOIL ABSORPTION SYSTEM
BEDITRENCH Width t Length / No.Of Trend PIT DIMENSIONS No.Of Pits Inside Dia._ Liquid Dept
DIMENSIONS 3 '76 Z. 1fl"^'jlsb8
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturc /
INFORMATION G Q_ CHAMBER OR
Type�System,
JG•nt'�.•an —7160 UNIT Model Number:
DISTRIBUTION SYSTEM N 0 r4,L,- 2Z V Z
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) �_ �__ �— �S
Length '7 Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center j Bed/Trench Edges Topsoil \ Yes [E No 0 No
COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 1242 Hwy 35 HOULTON,WI 54082(Gov't Lot 3 35 T30N R20W) NA Lot 1 Parcel No: 35.30.20.608G
RN �, c,6,)-<_. G�n,ar.�, J_ �-v 5 - a✓wp 'a'1'1 J
1.)Alt BM Description= r /
2.)Bldg sewer length= -Z4
-amount of cover= 3 i d n n •e J *gnature Plan revision Required? � Yes )<No Use other side for additional information. Date Insepctor' Cert.No.
SBD-6710(R.3197) ,
County `
fr . Industry Services Division
1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.)
P.O. Box 7162
Madison,WI 53707-7162
Ak
11• Permit Application State Transac ion Number
eIn accordance w4e'ty .21 is.Adm.Code,submission of this form to the appropriate governmental unit
is required prior inin sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Ad ress(if different thgn mailing address)
the Department and Professional Servies. Personal information you provide may be used for secondary "
purposes in accordance with the Privacy Law,s. 15.04(l)m,Stats. , Z v�—
1. Application-information-Please Print All Information "s .J
Property s Name i Parcel# J
S Ao „ 030
Property Owner's Mailing ddress ) Property Location 1 Cr
2 L'��� Govt.Lot
City,State Zip Code Phone Number,.,, OUN, y, /., Section
2- (c' e one,
_ T��N; R o w
H. ype of Building, (check all that apply) Lot#
/!,+ Family Iling-Nutttibero.Bedr o s
Subdivision Name
GJ V �w� t�✓ Block# "-
❑Public/Commercial-Describe Use 1 1 ❑City of
❑State Owned-Describe Use C,S/M Number ❑(Village of
Z 3�j ATown of DS ,
111.Type of Permit: (Check only one box on line A. Complete line B if applicab e)
A' New S stem p y ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
y ❑ Replacement System
B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV,AType of POWTS System/Component/Device: Check all that appl,
Non-Pressurized 1n-Grour I id ❑ Pressurized In-Ground '❑At-Grade ❑ o�nd>24'n f suitable soil ❑ Mound<24 in.of suitable soil Im❑ Holdi g Tank ❑Other Dispersal Component(explain LQQ��'.1 n �" �Ll Pretreatmen Device
V.Dispersal/Treatment Area Information: / I
es' Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispers Area Proposed(sf) Syste Elev ion
�j c , t/ s ✓ . 5 9d S—
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units U .�
New Tanks Existing Tanks c P
a U in . rn w C7 i%
Septic or Holding Tank
0
Dosing Chamber FF I
VII.Responsibility Statement-I, a undersigned,assu po bility for installation of the POWTS shown on the attached plans.
Plum a(Print) Plumbe' e MP/MPRS Number Business Phone N ber
c 2 7/J 0?/V/
PI umber's,Address(S~'ttr7reet,City,Sta ip Co
VIII oun /De artment Use Only
Approved ❑ Disapproved Permit Fee t) Date Iss ed lAssuing Agent Sigoure
rte-
$ -7S. `
❑Owner Given Reason for Denial 1 2 ii Zo
X Conditions of A roval/Reasons for Disapproval ''
w
1 .Co 0
PP PP �j CGu- � ! l vV Z I/UGt411/412 C,W61(
SYSTEM OWNER: �OGIJT� 'tl Jr
I.Septic tank,effluent filter and - ���,r✓ �`
dispersal cell must be serviced/maintained L-1) Gt�t �/n��i� t0
as per management plan provided Ib py py umber.
URN m and sub it tobhe County on on p r6fot/l�es�sthan 8 12 x 11 in es in size
as per applicable code/ordinances. KW 7T.
SBD-6398( 0 3 `� VI.i��r��
d a-�
B-v4. 14
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
/4W
Division of Safety and Buildings
in accordance with Comm 85,Wis. Adm. Code Coun r
t, ��
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 Parcel I.D.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 636 ZO(old- Sa -
Please print all information. Re wed by Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 3b `
Property Owner Property Location
Govt.Lot 1/4 1/4 �T,�� N do
E( W
Property Owner's Mailing Address Lot# Block# Subd. Na or CSM#
4 2
City State Zip a Phone Number ❑City ❑Village own Nearest Ro d
I ( ) c
ul- 4L
�.✓
New Construction Us Res�denYial I Number of bedrooms Code derived design flow rate GPD
❑Replacement ❑ Public o Comm rclal-Describe:
Parent material Flood Plain elevation if applicable A/
General comments -e/
and recommendations:
System Type System Elevation -/.0
Boring# ❑ Boring G
",Pit Ground surface elev.0 ft. Depth to limiting factor �aU in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
o z- f 31, C�J �-
Z
o°U
Boring# ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
Pit Grou p g
a �_
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff##1' 'Efff##2
37-� OS C
Effluent#1 =BOD >30<220 mg/L and TSS>30<150 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L
CST Norma(Please Print) - _ re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 --a --` 715-246-4516
I rty Owner_ Parcel ID# Page of
Boring#
❑ Boring
® pit Ground surface elev. ft. Depth to limiting factor �� in. SE GPDM Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
5
s c ; �� ,
f2l �l
20
T_.
❑ Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
Bod Boring
F �# Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil�Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg)_ 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SM9330(8.6100)
PLOT PLAN
PROJECT Daniel Schulte ADDRESS 512 Carriaae Lane Hudson Wi 54016
1/4 1/4S 35 /T 30 ,` /R 20 W TOWN St. Joseph COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 1/25/14 BEDROOM 4
CONVENTIONAL XXX IN-GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE L9AD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top o oundation ASSUME ELEVATION 100° Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.0/92.9 4' below qrade
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40. 36.2'
B-8
2-3' X 90' Cells with Vents
>3' spacing 30
90'
110' Private Road To highway 35
B.M.*
\3
-' 45'
0
617' Property Line 20' B-7 10' ST B-3
l0B-1 A
5' 20' B-2AL
New B.M.
1% Slope
-Pro
75' 4
Bedroom
House
3
B-4 B-3
17' 7�
Vent
>6» Quick4 Standard Scale is 1" = 40'
of Cover Leaching Chamber unless otherwise
with 20.0 ft2 of Area
with
of end caps noted
1211
4' Long
34" Grade at System Elevation
IIII
8199230
Document Number Document Title IlftIflflhi
Tx:4165290
990042
St. Croix County BETH PABST
REGISTER OF DEEDS
Occupancy Affidavit ST-CROIX CO., WI
RECEIVED FOR RECORD
/ I 12/05/2013 2:56 PM
EXEMPT #:
Name — (Owner)Typed or printed REC FEE: 30.00
being duly sworn , states, under oath, that: COPY FEE: 2.00
PAGES: 1
He/she is the owner/part-owner of the following parcel of land located in St.
Croix County, Wisconsin, recorded in Document Number 865640 St. Croix
County Register of Deeds Office being duly described as follows Recording Area
(include lot no. and subdivision/CSM or detailed legal description): 'Name and Return Address
Daniel Schulte
512 Carriage Lane
Parcel A: Lot 1 of Certified Survey Map, filed August 28, 1997 in vol. 12 of Hudson,WI 54016
Certified Survey Maps, page 3340 as Document No. 564508, located in
Government Lot 3, Section 35, Township 30 North, Range 20 West, Town • 030-2066-50-100
of St. Joseph, St. Croix County, Wisconsin. Parcel Identification Number(PIN)
As owner of the above described property, I acknowledge that the private onsite wastewater treatment system
(POWTS)serving this residence is sized for a 4 bedroom home or a design flow of 600 gal./day. Design wastewater
flow(DWF) is calculated assuming 100 gpd for 2 individuals/bedroom. A maximum of eight (8) occupants are
permitted based on the DWF; there are currently (o occupants living in this residence. Therefore the POWTS serving
this residence is code-compliant at this time. However, I understand that if the number of finished bedrooms or the
number of occupants exceeds the DWF, the POWTS may be subject to premature failure and/or will need to be
modified to accommodate the increased wastewater flows and/or contaminant loads. I also acknowledge that I will
make this information available to any future parties interested in purchasing this property.
Dated this day of IPA C , .2 O 13.
.6 4u-it
* �?lEWI.i .<<,. 2 lar uJ -
*
AUTHENTICATION M1,d,,kee,Y&ACKNOWLEDGMENT
Signature(s) STATE OF V.111,612MIN )
Mists t"-c' )ss.
6ltsfetbic(County.
authenticated this day of Personally came before me this day of
the above named
p'Wt t--t U !(. 5 cd Fw.xE
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s)who executed the foregoing
(If not, instrument and acknowledge the same.
authorized by§706.06,Wis.Stats.)
THIS INSTRUMENT WAS DRAFTED BY:
Pamela Quinn, Land Use Specialist
Community Development Department . , - _
, JACK LEWERENZ
Notary Public,State of1NiECO�YSM��r+✓� � cinnesota
S.a•.
(Signatures may be authenticated or acknowledged. Both are not My Commi sion1. ) rmanerit. If n t,•state ex i ti n d te:
necessary.) Date: -3t;
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE"
This information must be completed by submitter: document title name&return address,and P/N(if required). Other information such as the granting
1 Del uses,legal description,etc.may be placed on this first page of the document or may be placed on additional pages of the document.Note: Use of this
ver page adds one page to your document and$2.00 to the recording fee. Wisconsin Statutes,59.43.
Cover Page
1
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 11/26/13
Owner:Daniel Schulte
Location: Govt Lot 3 S35 T30 N,R20W Lot 1 St.Joseph
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Conj ngency Plan
7. Filter Specificatii S /et
8.-10. Soil Tes
Signature r
License nu r#226900- #226900
PLOT PLAN
PROJECT Daniel Schulte ADDRESS 512 Carriaae Lane Hudson Wi 54016
1/4 1/4S 35 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST.CROIX l
MPRS Shaun Bird 226900
11/25/13 (' 1
DATE
BEDROOM 4 5 J
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallonsq LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of 1"iron
ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 96.45/96.5 4.65' below grade
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40. 36.2'
A
110' Private Road To highway 35
B.M.*
2-3' X 90' Cells with
617' Property Line Vents >3' spacing
20'
•10B-1 35' B-2
1% Slope
Please note: boring
will be dug to lower 75' B-5
system elevation to be i
at a proper depth
37'
B4 B-3 Pro
7'
17 I ST , Bedroom
5 15 House
Vent w/CCU Ppv(t'k
>6 Quick4 Standard Scale is 1" = 40'
1 of Cover Leaching Chamber
with 20.0 ft2 of Area unless otherwise
5.6ft^2/pair of end caps noted
4' Long
34" Grade at System Elevation
IV
4� / / /
IN - FT
V
0 20 50 100 150 250 / 3�.
(I"=80') 33' /o i(lt
s o_ - s' /
•-F - N 1/4 CORNER SECTION 35 . � ��
T 3O N, R 2O W / 4/1/ /
/ V 4
OS€Dp �I ( ç11'
P �rrI
--"7 ,
°°1
P�=P' I -1 II
uN_-
1 w rn
2
i t
7. y
• , 3"E 61 1 rnl 1
N 52 1 I o ^ `
l 82 "------)... P�
1 \0...., I
cot_ ( �c
i ---"'�-' \-----,. 1
( \ ..
cip LOT i '11
-3.38 RES r ' o
P
340 0:4-5.
2
9�3- 1 696`■
9 40 .
is 48°3 LOT_ 6_
gvRV .; -
\FEa- P N --
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 101'
Vent I Grade Vent
3' 4" 3'
A/30/34 Septic Tank
5' Long 1" 5' S' Long w
Grade at System Elevation
3 6" Grade at System Elevation
Spacing 5'
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
22 chambers per cell
System elevations:
A 96.45'
B 96.5'
/ 55' /
/ 47' / 8' /
/77 3' 44" /6 2'
2'
-a / //
D ` Cn
N
/•X \ 1 WV 2' N
Z I \ \ \ /hI/II
\ I rD \ \
> r 4'
w r N
k 20" 11 2' Z
1,
a I <
LJ m D 0
\ I, I T,
w D 3 f\
Z t-
mx 0
r D
Drr7
Mr
(n c c m
ri N zttA
v
n m '
n n z / 6.5' m
--I v D n r 6
O D A 70= D
p I I I I I
n
(/ U Z N n m o D
D
n ri Z A
n
m m z r� n z
pwioW vv'i A Ao c rAiz
0 JNO ❑ n m A d oo„ m�
C7 A O D Z i=i
DDS m Z Vl D rZD nD
in \Dr / (/` A D p t70 z El to
M -1 <m
m
n mr
D m 17m - Dm A
A n m r r Vl-I A3
Z ❑ n r r mm mtt
a ❑ mD D m Dm
N I -1 < m w to to ty ty
ty
zm Jr, rzi m o 7 m D£ tim
/ 45' / 10' / =D A n A A , C_D_
tr
/ 42, / m� v o -< D A ''z
< m
C 6 D 7
A vi C c-, z D D
v ) vv A
D D A D v A m GI-0 r mA D
/-4-1 // DA < D n D AD
m< m v) D-
r____T Z -I m m cm ti
W / / / D* CI 0 VA
I =�, A Z r Z Cl<
\ I D m H O 7 D m
\ \ z A
Sr'�C m N P
\ Zo m r c-,O m -I D
.13
,T , N/ zZ °rm o
<Z t - z-1
V m � L1 D
D Vi
+i■ ■
❑❑ D N
r m
A Z t0 CI D A
ci m
A 0
n
VC 3>
Z m
V r D
mN r
z
Z. 0
-I-IL) D
1 3
A r- m
n Q m
A.C. m
0 e o
O
A r A
M Cl
< 77
m in
r D
m N
Z
m
A
n
m
A
D
A
PROJECT: 4154 123rd STREET �4 5% N.P.C.A. CERTIFIED PLANT
�' HUFFCUTT CHIPPEWA FALLS, WI 54729 .3 y= g�
0 1,250 GAL. LOW PROFILE #a MEMBER OF:
Rp PUMP, SEPTIC, HOLDING, C 0 A C PETE. n C if(715) 723-7446 r (800) 924-1516 Q 1 NATIONAL&WISCONSIN PRECAST CONCRETE ASSOCIATIONS
OR GREASE INTERCEPTOR FAX (715) 723-7111 www.hufFcutt,con g €
SNOIIVIOOSStl 313a0N00 1SV03Nd NISNOOSIM A 1VN011VN WOJ}}ro}fny MMM * IIIL E2L (SID MU • a01d37a31NI 3Stl3a9 a0
j0 a38w3W g I A 91ST-1726 (008) 1 944E-E2L (SID
U I 313 U 0.7 9NIO1OH '3I1d3s 'dwnd
r °0.� 62LPS IM 'Slltl! tlM3ddIH0 .L. 00 O H 31Id0Nd /101 '1v0 OS2'I b
INV1d 031311830 'y'3'd'N o 133N1S PJ£2I bSib 1�3ra�d
8�Ie
\ \
1 \
Z.0
i
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
0 A RSHIP CERTIFICATION FORM
''......--D 0 I
Owner/Buyer 1 5 .A
o
Mailing Address S f T ` _01 ,,,IAJA.cot...:5_____110,4,„_____
Property Address y.,
ar,
(Verification required from Planning&Zoning Department for new c eft s ' f A
CitylState 11001.-TO!./ . V‘i - Parcel Identification Number 0 36 1
6,- s 0
LEGAL DESCRIPTION
Gov i- L-0+- 3 j
Property Location r/4 , r , Sec. 3 J, T 3 ON R 2 W, Town of i�T. J j:). ..(2.FL_____.
Subdivision , Lot# /
Certified Survey Map #— 56 et 5 O ,Volume j Z ,Page#_3 310 -.
Warranty Deed# .j - VO _, Volume , Page# .
Spec house yes no Lot Iines ideutifia. no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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,ii needed,by a licensed pumper. What you put into .
the system can affect the function of the septic tank as a treatment stage in the was I:e disposal system. Owner maintenance
responsibilities are specified in§Comm. 8152(1)and in Chapter 12-St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zoning Department 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/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Commerce and the Departrrmant of Natural Resources,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the
property described above,by virtu of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
SI ATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.08/05)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _
FILE NFORMATION SYSTEM SPECIFICATIONS
Owner
= es., ; — _ Septic Tank Capacity s' gal D NA
------ ---_- —
Septic Tank Manufacturer � � El NA
Permit# �� 2 _----
Effluent Filter Manufacturer ❑ NA_
DESIGN PARAMETERS � � _-- - - — ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model —— -
--
Number of Public Facility Units ]NA 'Pump Tank Capacity 9a) NA 5555 NA
y r"--c2 Tank Manufacturer
Estimated flow(average) / gal/day_
Design flow(peak),(Estimated x 1.5
�j b p gal/day Pump Manufacturer NA
—
w NA
Soil Application Rate gal/daylft z Pump Moclel -- NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit
Fats,Oil&Grease (FOG) 5_530 mglL 0 Sand/Gavel Filter ❑Peat Filter
Biochemical Oxygen Demand (BODs) 5220 mg/L El NA 0 Mecharical Aeration D Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑Disinfection—�� 0 Other:
Monthly average Dispersal Oell(s) ❑ NA
Pretreated Effluent Quality y g ❑ In-Ground(pressurized)
Biochemical Oxygen Demand (BODs) 530 mg/L p'd n-Ground(gravity)
Total Suspended Solids (TSS) 5530 mg/L /' N A 0 At-Grace ❑ Mound
Fecal Coliform(geometric mean) 5104 cfu/100m1 0 Drip-Line —_— ❑Other: —__ —_
, !6 in dia. ❑ NA Other: DNA
Maximum Effluent Particle Size • -----
Other `-- —.—._. ---— NA Other. -- — - - — -—.— --- ❑ NA
Other: ❑ NA
`Values typical for domestic wastewater and septic tank effluent. ^_ ■,,,,
MAINTENANCE SCHEDULE -----
Service Event Service Frequency
❑month's) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: ear(s' _ —
Pump out contents of tank(s) When combined sludge and scum equals one-third(36)of tank volume —_- ❑ NA
___ — —___ -- E Dm onth,s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: // Aneoanrths!ears `—_mum 3 _—...--
Clean effluent filter At least once every: / l ; ___A
�.___--_--____ — D month(s} NA
Inspect pump,pump controls&alarm At least once every: _ ❑year(s', 5555 A
.-_—.----- -- ❑month's) a NA
-Flush laterals and pressure test At least once every: D year(s)
_— _ _.—
❑month's) ►� NA
Other: At least once every: El year(s)— __^
Other:-- --- —, — --- — ❑ A
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber;Master Plumber Restricted Sewer;POWTS Inspector; POWTS Maintainer; Septage Servii:ing Operator. Tank inspections must
include a visual inspection of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, measure the volume of
combined sludge and scum and to check for any back up or ponding of effluent or the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (6)or more of tl le tank volume,the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechar ical or pressurized components,pretreatment units,
and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of cctmpletian of an!,service event.
Page _.of
START UP AND OPERATION or other chemicals that
For new construction, prior to use of the POINTS check treatment tank(s) for the presence of pai nting products
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s)removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
discharged a power the pump tanks may fill e dose, overloading loading heecell()levels.
and may result in the backup p or surface discharge wastewater
of effluient.
Toavoid this to the anon have c the in one large
To avoid this s r contact ha ae lue contents onPOWTS pump to assstinymanually operating the pump controls to restoring
estore normal levels
effluent pump or contact a Plumber
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the lif foundation the POWTS:d a n
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers;
herbicides;de meatssdiap: medications;dinfect ants; fat;painting products;
(sump pump) water; fruit and vegetable peelings; gasoline;
pesticides; sanitary napkins;tampons;and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 83,33,Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
...421..auitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK TRAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS --- -- --' —POWTS INSTALLER POWTS MAINTAINER
Name c'Si Name
-- Phone -7) )-- q`)'L
Phone .� ,� C/5
SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY WHO;ITY
Name �- - - Name r,
Phone -7), -- 77 --SyV - Phone 31J--- ' 2j, ,
This document was drafted in compliance with chapter t3PS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code.
S
® T_,.1 idlllill e
l _ S
'''''' ''' ' '' ' s , l' FILTER CARTRIDGE INSTI UCTION
_,,..., ,,, „„,,,,,s„,,_,,,,_
i''' " S
TM
Installation
STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the
il
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support:
solvent weld the 3/4-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four. -
STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning -
clockwise 90°.
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced. 4 "- -- _ ,,
2. Open the outlet access opening to inspect the tank and filter. n u
3. Pump the septic tank completely, making sure to remove the sludge ' _ , w '- ,
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up on the filter handle to dislodge the I :
cartridge from the case.
oVik
5. Slide the cartridge up and out of the case for cleaning. T
6. If a VRS switch connected to an alarm is present, the switch a`
should be removed by turning counterclockwise 90° and cleaned
with water only. "'
�T t..
7. While holding the cartridge on its side (large flat surface facing k$. ' + "
down) over the access opening, rinse off the cartridge with water ''
only, making sure all septage material is rinsed back into the tank.
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 90°. _ T
9. Insert the filter cartridge back into the case, pressing down until , .,n - l ' � ' t X.
the filter locks into the bottom of the case. m ,.4
10.Replace and secure the access opening on the tank.
I
BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY
Bear Onsiite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of
consumer purchase.
BEAR ONSITET"Filter Case-Lifetime Limited Warranty
Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time
the original purchaser owns the product.
If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make
appropriate adjustment. Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper
care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will
void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear
Onsite is not responsible for labor charges,removal charges,installation,or other incidental or conseguential costs.
In no event shall the liability of Bear Onsite exceed
the purchase price of the product.
.,r
igg
I
11111111111111111111I 1111111111111111111111111111
* 8 6 6CC4 0 2 *640 1
State Bar of Wisconsin Form 1-2003 V�N H. WA
WARRANTY DEED KATHLEEN HDEEDS
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
RECEIVED FOR RECORD
12/14/2007 10:45AM
THIS DEED ,made between Elizabeth A.Anderson.a single person I WARRANTY DEED
EXEMPT 1 17
("Grantor"whether one or more), 1 REC FEE: 13.00
and Daniel C.Schulte and Cheryl D.Schulte PAGES: 2
("Grantee"whether one or more).
Grantor,for a valuable consideration,conveys to Grantee the following described Recording Area
real estate,together with the rents,profits,fixtures and other appurtenant interests __ --__- _—_— __ 13
in St.Croix County,Wisconsin("Property")(if more Name and Return Address
space is needed,please attach addendum): EXECUTIVETRLE
525 Part"Mk
Suite 240
St.Paul,MN!l6103
SEE ATTACHED EXHIBIT A
030-2066-50-100
Parcel identification Number(PIN)
This is not homestead property.
(is)(is not)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:
Restrictions,declarations,covenants,reservations and easements of record,if any
Dated Q —v. 1 Lam' 4 7
T
Z (i1 a'l (SEAL) (SEAL)
*Elizabeth Anderson
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGEMENT
Signature(s) STATE OF WISCONSIN )
)ss.
authenticated on . ST.CROIX COUNTY )
Personally came before me on QG1D.Ii y, ?De 7
* the above named Elizabeth A.Anderson,a single person ,
TITLE:MEMBER STATE BAR OF WISCONSIN
(If not, to me known to •= <•-i. -,o who executed the foregoing
authorized by Wis. Stat.§706.06) instrument a v�,/•i e same.
THIS INSTRUMENT DRAFTED BY:
Executive Title of St.Paul,LLC * ,Ol6 Ph,L,Le.S
525 Park Street#240,St Paul,MN 55103 Notary Public,State of Wisconsin d .'y,;0/i
My Commission(is permanent)(expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN Form No.1-2003
*Type name below signatures
ROBB WHITEIS
Notary Public
State of Wisconsin
1 of 2
Parcel A: Lot 1 of Certified Survey Map,filed August 28, 1997 in Vol. 12 of Certified Survey Maps, page 3340,
as Document No.564508, located in Government Lot 3, Section 35,Township 30 North, Range 20 West,Town
of St.Joseph,St.Croix County,Wisconsin.
AND
r
Parcel B: Together with an easement for ingress and egress over a p arcel of land located in Government Lot 3,
Section 35,Township 30 North, Range 20 West,Town of St.Joseph, St.Croix County,Wisconsin, described as
follows: Commencing at the North quarter corner of said Section 35;thence South 00 degrees 33 minutes 19
seconds West along the North-South Quarter line 3444.08 feet;thence North 52 degrees 27 minutes 13
seconds East 617.27 feet; thence North 65 degrees 01 minutes 58 seconds East 36.20 feet;thence
Southeasterly 185.71 feet along the arc of a 202.03 foot radius curve concave Easterly whose long chord bears
South 25 degrees 00 minutes 16 seconds East 179.24 feet;thence South 38 degrees 39 minutes 40 seconds
West 33.00 feet to the point of beginning; thence Northwesterly 216.05 feet along the arc of a 235.03 foot radius
curve concave Northeasterly whose long chord bears North 25 degrees 00 minutes 16 seconds West 208.52
feet;thence North 01 degrees 19 minutes 48 seconds East 518.65 feet;thence South 88 degrees 40 minutes 12
seconds East 66.00 feet;thence South 01 degrees 19 minutes 48 seconds West 518.65 feet;thence
Southeasterly 155.38 feet along the arc of a 169.03 foot radius curve concave Northeasterly whose long chord
bears South 25 degrees 00 minutes 16 seconds East 149.97 feet;thence South 38 degrees 39 minutes 40
seconds West 66.00 feet to the point of beginning, St. Croix County,Wisconsin.
(S0710003.PFD/S0710003/31)
2 of 2
, >
F2
Q
9
o "Li
.--4 5645'08 " ,
2
CERTIFIED SURVEY MAP
LOCATED IN GOVERNMENT LOT 3. SECTION 35, T3ON, R2OW, TOWN OF 5T. JOSEPH, ST.CROIX
COUNTY. WISCONSIN.
PREPARED FOR LAVERNE ANDERSON
STATE HIGHWAY "35"
N 1/4 CORNER OF SECT ION 66' WIDE PR I VATE -�rat pp
b P'
35. ( 1" IRON P 1 PE ROAD EA SEMEN T I O^r
r u)"I
C� FOUND). VOL. 1231 PAGE 393 y c 2
n
c'el "%oZ
1 I d Ca X C
33'I 33'I `�p n
BEARINGS ARE r
REFERENCED TO THE N-S- N 65°01'58"E �n
QUARTER L INF. (BASED ON 36.20' I -i
RECORD BEARINGS). m I $ m
i$ li 1 o
• -*_ \ o
`_ 4�' -s• \
g tiQ � 6\� 21
1,i4'..,7'.\� \ �\ yy�
O0
trl 2.2* 7yc
s'.../
N.\t
BLUFF LINE
S 38°39' 40'
• LOT I 33.00' W 10 fr 3.38 AC. +/- �� Q
3. 16 AC. TO MEANDER LINE BLUFF SETBACK(DEFINED
p , AS 100' FROM I21 --
( 137,842 SO.FT. ) xl SLOPE). a
d 3 .02 AC. TO M.L. EXC. R/W
( 131,479 SO.FT. ) fp FIELD VERIFY BEFORE d
G 'b� Co 9 CONSTRUCTION. z
LaJ O o
it * � b9a 9 �° to x o it,5 tug
S
W c .�OgPG
•
�• P SLED
co MEANDER ��Q �P�'�' AUG 2 8 1997
M°
,, Z K" sk w c
max 9
s w
\ � Deed
$ * 4,s9 y. &Calbl Co.Aw
/s. \' A./
Z w 3.9"›'"
i
is Y= x! ZSt/5 :FC
�L O ■ SET I" X 24" IRON PIPE WEIGHING 1 r,
�O I. 13LBS PER LINEAR FOOT.
F )a JAMES PA. f:4-- .
• - In IRON PIPE FOUND. Iidi7,5ER
EDGE OF WATER S F"4 -z'
AS OF NOV. 14, SPRING VALLEY I
1996. (ELEV. 675.O ASSUMED) WIS. .."/,,.,L'
I00 0 100 200 300 '!r y
rti • <a►
r O •,
11111111111 I f I
JAME `�� ° 1604+
GRAPHIC SCALE — FEET NfLSEN-WEBER LAND S RVEYING
DATED N.3v '1%.\°'\4
s+. 3' ''3-%0-c1—,
SHEET I OF 2
96-135 THIS INSTRUMENT DRAFTED BY JIM WEBER
Vo1.12 Page 3340
r
Wiscot n.:apaRtmentofIndustry, SOIL AND SITE EVALUATION REPORT 0 A/ A Page_tof 3
Labor and Human Relations
Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm.Code £1
• Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but SI"• Q.Ot X
not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.#
dimensioned,north arrow,and location and distance to nearest road. Ai/X/ nc.d 6y,11(4(J 4,_ 03o— 2o(' -0--/dJ
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION NEVI ED BY DATE
PROPERTY OWNER: 5 // e All, PROPERTY LOCATION
J. . L I. s L k GOVT.LOT • 1/4 — 1/4,S3 S T 3'6 ,N,R ZD E(o
PROPERTY NER':S MAILING ADDRESS LO j# BLOCK# SU NAME OR CSM# �\V►��fr4C.(/to
CITY, TATE ZIP CODE PHONE NUMBER ['CITY ['VILLAGE [OWN NEAREST ROAD /
\- -NnSOtv,w` s q 0L‘ (- ►s, sy9- 6Y89 s'r. SosLPN ss- ` 35"
pl New Construction Use[,>d Residential/Number of bedrooms LI [ J Addition to existing building
j ] Replacement [ I Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate -I bed,gpd/ft2 • 11 trench,gpd/ft2
Absorption area required '58 bed,ft2 1 S Ci trench,ft2 Maximum design loading rate •-I bed,gpd/ft2 ' S trench,gpd/ft2
Recommended infiltration surface elevation(s) q6-% ft (as referred to site plan benchmark)
Additional design/site considerations 'Wet-oM 4 e1/4,To Vz-')L t BLsD oft- Z T1 ��CttV3, Tl`1 S*x I S' L DJ6.
Parent material S 1 LT-I S pA 1mFt..►T twul'12 S d 6- Flood plain elevation,if applicable N-A • ft
S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable for system (2 S ❑U :4 S ❑U ®S ❑U OS ❑U ❑S NU OS [O U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxdary Roots Trench
in. Mansell Qu.Sz.Cont Color Gr. Sz.Sh. Bed ed T Trench
PUN 1 o-8 \o k t Z ' -L L s 1) 1 1~,s b k Vvi"c t- 04-S — • - • 3
ii 1 i; h ; -x, Z $-7-y Lz`1lZ 3/` - st1 ZmS \1rt In->r cS - S .b
Ground 3 2,4-VO -)•S 71231,/ - Gh s 1 1 C-s bk yn.u't- cS - • Li ■ S
elev.
' t .Zft y LIo$9 t Litz sh, Sei 61- b .s5 ml - •--) -$
Depth to
limiting
factor
Remarks:
Boring# 0,-,S • Z
': Z $-3s 1%`Ill_ 3 I — s ; 1 Zw1 S‘AT w -t.. C--S - • S -L
3 3 S-v "I-S`t tL 3Ly G% \ -S'k tin U`(-1- C.S - `[ ,S
Ground —
1Dt elev. fE y ut 90 \ '_j 5/L •9 C. %t wt \ - '� . •�Aidll
i
Depth to
limiting �4..... 't r
factor )5..,` 4)"., 2` •
? Ro" r 1e ('a::
Remarks: ;t
CST Name:—Please Print . Phone:
Arthur L. Wege `�'. 715-425-0165
i erer Soil Testing & Design z • cs- ,. . Box 74 River Falls,WI 54022
Signature: //��z • `/-1 — 96-338 Date: -L_S`9. CST Number:0 0 5 7 6
4
PROPERTY OWNER Pc j�2S0►'V SOIL DESCRIPTION REPORT Page 2-of 7.'
PARCEL I.D.#
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPO/7-in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trees
... 1 $ w--t1Z -a,LZ Si \ \ \ �c \`F. -S - • '� • •
O- l
<m" Z 8---3z. 10-1 tZ 31C S1 Zmsbh WI ‘.E . cs - • S • I.
S
Ground 3 31--38. "1•S` R_ ty C1--3\ r \QS\t,1't Y11U`FI. C. J•y j , S
elev. _\\ \. \ ft. 4 3�`t3 1.o`� 2 s/( S d.C1, b Sg w` \ - CD_ •g .
Depth to
cr311 9,1 i !r iv 36" / G2A
1
1
Remarks:
Boring# ` o_8 %`uz_ z 1 Z SL l \ Y� Sbk `M.`F4- 4k,S _ , Z • 3
It —
Z $- L lOy2 3!� si 1 Zw, Sbk 'f-- C- • S , 6
Ground . 36-4S 1.SLt t 31y -- GI-a 1 1 CS1 .t ■^n U �,. QS - • 1 •S
elev. U L1 S-q 1- I b VII-S/6 -- S(161- C %t ,'Y't ) s.. . -1 , B
1,t1..1 ft. -
Depth to -
limiting
factor •
of IP
Remarks:
Boring# I
) c -8 1 o�-i t1- Z L Z s; \ \ -L 'b >n`1�h a.S • 1-1 .
r:,..kma
`- , -
Z, 3 S 1.0 Li tz- 3/L Std Z vn S bk Yn`F1� cs s - L,
3s-LIZ 1.SLiR_ 3/y G - s1 1C5bk tinvft- cs _ ,'1 , s
Ground
elev. y y1-92 1042 S/C - S &1�1. b S5 wt 1 - `- `�
voo.b ft. - -
Depth to
limiting •
factor
Remarks:
Boring#
t
I
:
Ground
elev.
ft. .
Depth to
limiting
factor -
' Remarks:
SBA-8330(R.OS/92)
t
.
• PLOT PLAN Page 3 of 3
SCALE 1"= .1p '
I N
i r �
-"''‘a.-1)::'
b I 1
■ .� �= 1
1 �
1 \\
v
1
b viu
\ -0 \
4 \ \
�V 3ri_'e 1oe.� GO 1 vtsn] ,P% \ \ \
>J Q--)2r 114 LI‘ tip.Q N
.1-\ • r&4",/C- P 7 \ \
Wo 13.1___ el y
---s.Z WO
(2 ' ( I 1-� so l rfc 3 R'Q& Foit yN L II l rL
J
1 � 1 S Lt.S`, S . a
0
�o
ji e1.lOp I
/ I I
fri y_ _ _a.'3
el-t - I
ut L°z-lot
----??
‘;;
to
v
VLvv-7-- Lie•JE vkvuSts Tat IVr.(_.L-k5-7' ZS' FIT-GM ''t ,Tz-f ?V FEL1)S .
LA.) L k • • • S u K k
•
(44, -338
v_, L L - S—q �, { 715 ) 47. —n16s 14005.7.6_
CST Signature Date Signed Telephone No. CST#