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HomeMy WebLinkAbout016-1081-20-000 0 0 0 t� ao (D a) N a o o N C C O N a m O y� y o w x Y o ti D a o c Q CL N L E y CL " 2o ID 2 o U co CLA c I �aU N O C O N 0- p Z to _T 0 2 2- Z .02 1 c z � ° I 7 (0 tUi7 N N O C U. C° =O O. LL C° _ U N - + L N N _ N _ T O L N •d m f6 a a I I 3 N 3 M N N 3 Z y Z N W E E Lo O = 0 Z a m a m 0 ' M H I o I `oza 3 r' N o I I Z to H �- E E ° � N M C Q) I U I N C poll z _ '0 N O z z ¢ z z �I I ° I z y c c c d m M C m C }� N h N d N N d N S O v D a G a a) 0 y , G a o y � v�wv� alai �rn mtn as ,�NI Z p • ►��l R a0 a s - a a a v, a o o Q p — .- p O o fA N N 7 O N O W N O O N m M N Z y ° _ O O _ O 'D O O '5 O •O °� �' a C v m y rn v Co m rn N O 9 d ¢> In O a GI Q n U) @ *� w C ° U y 0 S N H C N N C cl b+ O m O O y = Cl) O N O C a' O C a 0 1 O N N O O N ` m N N . C U N W O •O Z M F� O M C C O yi p C M r 4) v> C L h (O CO N ', U N o M f0 O U O W O N U • O M Z y 2 F - M O Z `!' Z `e T L In O � I • • I � � # € U d••R a a d IL • cl a *Ali E Wiscor»�in Department of Commerce � Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coun fit. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanit� tNo.: Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ yy. lage ❑ ` " n of: State Plan ID No.: .clntyre, Ray 81 11 ownship o S S / CST BM Elev O Insp. BM Elev BM Description: 1 Parceli l�agl -20 -000 r 1 U1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic — /pm Benchmark 3. 5 - 0 1 Dosing Alt. BM 1. 137- Aeration Bldg. Sewer �� 3 �� Ib• It$ Holding St /Ht Inlet D • 1 �f�� .lQO TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet Septic `f0 fop �O r NA Dt Bottom Dosing 4 > too � " 8 2 r NA Header / Man. Aeration NA Dist. Pipe S '�� 02•�� Holding Bot. System 0 .6D PUMP/ SIPHON INFORMATION Final Grade c ee— Manufacturer Demand over et Model Number c.7 3 3 3� PM ST 1 TDH Lift �j.°I� Lriction System TDH (,J!SFt I oss Forcemain Length p t Dia. F " Dist. To Well > /� r SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt No. f enches PIT No. Of s Inside Dia. Liquid De DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING nu INFORMATION Type Of , 1 CHAMB Model Num System: - >10 'go >10D OR UQIT DISTRIBUTION SYSTEM 5; 4- l� �Jt 3 `` Header/Ma *�Dia. Distribution Pipe(s) r x Hole Siz� x Hole Spacing Vent To Air Intake 4 Length ` Length VO-S 'Ma. 2 Spacing —' I N 34 � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of x Seeded /Sodded xx M I ed Bed/ Trench Center Bed / Trench ges To s it s F] No COMMENTS: (Include code discrepancies, p Ens pr se t, etc.) Inspecti #1: o 7 /oS /ab Inspectio #2: Location: 1208 County oad W, t-y, WI 54013 (SW 1/4 SE 1/4 36 T30N R15W) - 36.30.1�552B 1.) Alt BM Description = � / J (, 5-D 2.) Bldg sewer length= 80 �1a, �j �cQc, . �c{,ve,,r G✓ - amount of cover = w t � `Ioa 45` - C�°"e� tnje r'o tr�i�on ulred? ❑ Yes 5L No Use other side for additional information. p 2 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E . �m t � # ®m e 9 a _ z . F t 33 9 �f z a s j t p T E 3 g � ( x g use j( � 7 P � t ,. a t # t w f g f i t . ®m... 9 f � e I S f� ♦ [ ae N z t f . w m � a 1 s t d t P f € i 1 f208' CTH- - Safety and Buildings Division Vi sconsin SANITARY PERMIT APP P 201 W. O Box W Avenue In accord with ILHR 83.05, wjs. _ dm. Zode Department of Commerce Madison, WI 53707 -7302 A • Attach complete plans (to the county copy only) for the system, on paper riot leas couri'ty than 81 12 x 11 inches in size. r o • See reverse side for instructions for completing this applic tion State sanitary Permit Number - '3S3 S13 Personal information you provide may be used for secondary purposes - ❑ Chec, if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. l ` r' State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL I ` MAC fc 4jQ 4-✓s i 0 = Property Ow r Name Propgrt 1/.a j [;,1`i T' d, N, R E (orW Property Owner's Mailing Address Lot Num Block Number Z S7 c -) (si, — City, State Zip Code Phone Number Subdivision Name or CSM Number r-cav �& •, Y7 6 j I O I )9 31- 0 S — II. TYPE B ILDI : (check one) ❑ State Owned 0 C it Nearest Road <, ❑ Village Public E3 1 or 2 Family Dwelling - No. of bedrooms W Town OF G ti w o 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �/� _ log — .2e) - O"n 1 E] Apartment/ Condo 0� — [ Z' 0� PG. 3O. 15.5 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 S ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. MI New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing 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 11 ❑ Seepage Bed 21 ❑ Mound 30 ® Specify Type _ 41 ❑ Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit / Al 6 9,0A L 43 ❑ Vault Privy 14 ❑ System -In -Fill [o2, C7 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate t!�. ystem Elev. 7. FI Grade Required (sq. ft.) Proposed (s i ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation b 0 5 5 , �0`1 Y et 0 2.93 Feet Ca a It VII. INFORMATION Manufacturer's i n gallo Total # of Mf Name Prefab. Con- Steel Fiber- Exper. Gallons Tanks Concrete glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank 0 o D ' — (l f! ✓ / y l „ j , �(. � u � 1:1 El ❑ . 1:1 Lift Pump Tank /Siphon Chamber 6 0 0 UL , � n I K 1 ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for' stallation of the onsite sewage system shown on the attached plans. Plumber' N e: (Print) Plum ig r XNo ;k ps) I MP/ RSW No.: Business Phone Number: Plumb is Address (Street, Ci St te, Zip Code). N( Lti N,A- Z 0 , 3- IX. COUNTY / DEPARTMENT USq ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issu ng Agent Signature (No Stamps) P kApproved E] Owner Given Initial 5� Surcharge Fee) Adverse Determination 2to E SBD I I /97) DISTRIBUTION: Original to County, One cop Yo: Safety ildings Dirsion, 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 a 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 and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: L. 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /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/ bepa`rtrrent Use Only. Complete plar-6 and specifications not smaller than 8 1/2 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) crosssection of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. t ,. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary March 24, 2000 CUST ID No.3412 ATTN: POWTS INSPECTOR ZONING OFFICE HERB J PELKE ST CROIX COUNTY SPIA N6298 STATE HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/24/2002 Transaction D N .3 Id ID N rs 0274 Site ID No. 188424 SITE: Please refer to both identification numbers, Site ID: 188424 above, in all correspondence with the agency. St. Croix County, Town of Glenwood SWI/4, SETA, S36, T30N, R15W Facility: Ray Mc Intyre Proposed Residence FOR: Description: Two Bedroom At -grade System Object Type: POWT System Regulated Object ID No.: 653141 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the Wisconsin At -Grade Soil Absorption System Manual (Pub. 15.21). re In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard b discharge of partially treated or untreated liquid wastes to ground surface or into surface waters or Y g p Y q �' groundwaters of the state, the owner will employ a properly licensed plumber to repair, modify or replace this system (including the possibility of installation of a holding tank with proper disposal) with such action approved by the Division and appropriate local officials. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. HERB J PELKE Page 2 3/24/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 03/15/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 � Oerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 i I I i i i I Page—L of 7 PRIVATE SE'WAG'E SYSTEM INDEX AND TITLE SHEET Property Owner( _ �AY �� �•� rrx �" Project Name: ,� nee PrajectLocation: �o. � L✓ Stmt Ad&#cv O A osccp o .✓ a o0 Contents: Page 1: Page 2: _ �o �.�•✓ Page I ad' Al '� G.tofl ��6 Tie•✓ o /YT- �•�/of V`�• t '0�. Lori�,l CQi ���t V Psge 4: v s Page g- J fi��7L L A.✓.r�Qr�i� e/;wei l , d,ts �e'G N9S o A ©�NGE Page 6: G'ui+�.� �iJf o./�.i.✓G! Gc..e SE� GO Page 7. Y1 TEiY Zf e .O r...✓ Name: /�'�.�� �ae� 5igoed: _ Creden(U Nmaber: Date: Address: ' L.? Rep Phone Nmabec: ;;%s' LLD G 8 DIV. v Z.+► �- ? I V. s i' s�1 v e b o b k \ ��♦ � � ate, 1 y, h � i�• e • PLAN VIEW page of , ZPages L �.5 •. B zz r E — I r r r'r r r w A I� P o._ J L . 2 , 51 D • 65 PI /6 B 1/2 B A E . ft. Y . ft. .'1/28 •• _ y.? ft. g ft. F : �� ft. L . �'� f t. . ft. W • �?/ _ ft. . ft. D . B f C . H ' Fabric Di stribution , Lateral . Soil 'Cover Observation: 12 7" ', ,� s/ 3 r 2 rr H Well � ;��� F - C; 1 �r .::•• rr I offf Note: H is ` • measured fro m directly below p A Z I > 5 the lateral to 5 finished 'grade. D A C E• 5' • • rt rr R 0 P21 w C\ C �. It n H old t mn h ` 0 rl n cn td ' r rr M o w w N � • Ma t*i h rr • o a p• w ^� r� N (Q fD Page .S • Of 7 SEPTIC TANK E•PUMP CHAMBER CROSS SECTION SPECIFICATIONS 4" CI VENT PIPE 12" MIN ABOVE GRADE 8 WEATHERPROOF ?' /p' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE �--- WARNING LABEL 4" CI RISER y �_� 4 " MIN. 18" IN. 6" MAX. i �► INL13' �► Fq WATER TIGHT SEALS GAS- TIGHTI ► '► T VAPPROVED A SEAL I JOINTS WITH rr- APPR —f= , " ALM APPROVED PIPE PIPE ON 3' ONTO OtiTO SOLID SOIL SOIL' PUMP OFF ELEV . &G FT. --- ' OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL • 3" APPROVED BEDDING UNDER TANK N CONCRETE PAD SPECIFICATIONS SEPTIC/ DOSE TANK MANUFACTURER: ufFGurr .✓c, NUMBER DOSES PER DAY: TANK SIZES: SEPTIC /000 GAL. DOSE VOLUME INCLUDING DOSE too GAL. FLOWBACK: lyy GAL. ALARM MANUFACTURER: CAPACITIES: A = INCHES = GAL. MODEL NUMBER: Joi SWITCH TYPE; /yd r /� j, B = 2 INCHES = j f AL . PUMP MANUFACTURER: ��,O� /^��K C = /,�q INCHES = ly GAL. MODEL NUMBER: • rAl 33 SWITCH TYPE: D = _�_ INCHES = //R Z GAL. REQUIRED •DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 9,o FEET ♦ MINIMUM NETWORK SUPPLY PRESSURE . . ... . . . -7 FEET + as FEET FORCEMAIN X /,8 FT /100 FT. FRICTION FACTOR . . �j FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S/ ; WIDTH 70 ~ ; DIAMETER LIQUID TEA- y? •• i Typical Application* Sum /Effluent pum Typical Application' Sump /Effluent pump _ Capacities SW /SD/VS25 - to 44 GPM (2.8 Vs) Capacities SW /SD/VS33 - to 48 GPM (3.0 Vs) Heads SW/SD/VS25 - to 24 h (1.3 m) Heads SW /SD/n33 - to 26 H (1.9 m) Elecirical SW /SD/VS25. 11SV,19, B.OFLA, 60Hz Electrical SW /SD/VS33. 115V,1e, I0.OFIA, 60Hz Motor SW /SD/VS25. 1/4 HP shaded pole w /thermal overload Motor SW /SD/VS33 - 1/3 HP shaded pole w /thermal 1550 RPM overload 1550 RPM Minimum Recommended SO/VS25 = 12' (304.8mm) Minimum Recommended SD/VS33 =12" (304.8mm) Sump Diameter SW25 =18" (457 mm) Sump Diameter SW33 =18 "(457 mm) Automatic Operation SW = Wide angle float Automatic Operation SW = Wide angle floal switch (manual available) SO = Diaphragm pressure switches (manual available) SO = Diaphragm pressure switch \ VS = Vertical float switch __ __ ___ VS = Vertical float switch YS =Sin le cord Mat Construction Cost iron an engineered thermo plastic Materials of Construction Cast iron and engineered thermoplastic mpeller Ther moplastic vortex I Discharge Size 1.1/2" NPT(38.lmm) Impeller Thermoplastic vortex Discharge Size 1.1/2" NPT(38.1mm) _ Solids handling 1/2' (12.8 20' 1/2" (128 man) Power cord 10', S1TW, (20' optional) Solids handling Power cord 10' , S 02. (20' o ptional) Superior Features • Carbon /Ceramic mechanical seal • Oil filled motor w /automatic reset Superior features • Carbon/Ceramic mechanical seal • Oil filled motor w /automatic reset thermal overload thermal overload • Uses single row ball bearing construction Uses single row ball bearing construction • Piggy -back plug available for easy maintenance and •Piggy -back plug available for easy maintenance and replacement replacement 91 30 i I i S SW33 VS33 b qi 20 � z 4 3 5 1 t y Ol 0 Capacity-U.S. G.P.M.1 10 Liters/Second 0 10 frA yf. _ _ M" 1M ai uau�tt 1 11 � �... • 1 Uh �1�111N ""` twos p(P r.r ye � 1 v: '6tr, TION W0� Page �Of _Page: AT -GRADE SYSTEM CAI,Ct3LA At - Grade Structure 1. Inches Limiting Factor Depth Percent Land Slope 3. .add Gal /Day Daily Design Flaw Rate (DDFR) 4. . G Gal /Ft2 /Day Design Loading Rate (DLR) D DF R =AXB 50 dv Feet2 Effective Absorption Area (EAA) = DLR Effective Absorption Width (EAW) - A 6,_ Feet EAA EffectivQ Absorption Length (EAL) a U& B = E 7. R-3/ Feet 8. 3 / Design Linear Loading Rate (DEER) DEAL �- 9. 8 gate Width = A = C Feet Total Aggre Feet Finished Width (W) = A + C* = D + E ** Feet Finished Length (L) = 2(I) + B Fe Finished Height (H) = F + G ` 13. - - Feet 1/6 B ) ) Observe W Locations Feet 1/2 B ) Texture Of Soil Cap Material 15, Ne twork Design Pre ssurized Distributaon 16. Distribution.Lateral Sizing Inch Hole Size 2 Feet Hale Spacing v. S Feet Lateral Length Inch(es) Lateral Diameter Feet Lateral Spacing p� Feet Lateral Invert Elevation 17. Distribution Pipe Discharge Rate Number Of Holes Per Lateral GEM Total Rate Per Lateral Total Number Of Laterals �� 7G GPM Total System Flow Rate 18. Manifold Sizing E N r R Manifold Type (center Or End) Feet Manifold Length * *If only A Tee Fitting Is USE As The Manifold, The Manifo] Inch(es) F.e a Manifold Diameter * Leng & Diameter May Be Re- ported As Not Applicable (N 19. Fbrcemain o? Inch(es) Forcenain Diameter _- Feet Fbrcemai.n Length -W 7 GPM Minimum Dosing Rate (System Flaw Rate). S Gallons Fbrcemain Liquid Capacity hew Wisconsin Department of Commerce ((ff SOIL AND EVALUATION Division of Safety and Buildings - Page of Bureau of Integrated Services in accordant A �dmn'i 83..09; Wis. Adm. Code / County Attach complete site plan on paper not less than 8 1/2 x 11 inc '', ,,size. P"sl .. include, but not limited to: vertical and horizontal reference po t (BM), direc4ion and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # E APPLICANT INFORMATION - Please print all information.: f viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law 14 {t) Property Owner Property Logat'r� �G AY N Y /tom Gov). I 1/4 1/4,S� T NR S (o Property Owner's Mailing Address Co Block# Salo Nam or CSM# City State Zip Code Phone Number �] Town Nearest Road ;�-6ity �- �/tlle9e tr .. .oa ZC,o /ter e a I I SY70 / ( 7 &s - ) 839- aGS' ,e/ o o , a moo. ��. �✓ ® New Construction Use: ® Residential / Number of bedrooms �_ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily ` J// � ����' y flow .�00 gpd Recommended design loading rate . / bed, gpd/ft . -f trench, gpd/ft Absorption area required .Soo bed, ft Soo r rig rate Jr bed, gpd /ft _G trench, gpd /ft Recommended infiltration surface elevatio " `to site plan benchmark) Additional design /site considerations -S'o're W'ae"r* C'o 'ad' /tdivoudD Parent material 'Arrr -cw Flood plain elevation, if applicable /J/w ft S = Suitable for system Conventional Mounds /." o In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ® U El s 0 U ❑ S ®U ®S ❑ U ❑ S ®U ❑ s ® U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots x¢ - - -•• in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground r elev. , 3 - o rR 5' C s/ s Y / y �- 6 arm s6 - s/ -2 Depth to y` 6f EOQ6L/� limiting factor �L in. Remarks: Boring # C i` G r lgf-14 S Ground — 5� 7•s e .e S C s r elev. Depth to limiting factor / / sr in. Remarks: CST Name (Please Print) i t e Telephone No. 11 Na / /G f re, r r /.S Address Date CST Number So3 A A /-f AIW Y PROPERTY OWNER IiC�Y S.✓ rrc� SOIL DESCRIPTION REPORT Page .? of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 4 zoxf ' V AV r- n. S Ground - elev. .t- ot'•c S L — S G 1 !O6 9 ft. s G r �O,roc�c Depth to limiting factor m in. Remarks: ors! Boring # Ground elev. ' ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to , limiting factor ' Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 R.9/98 Iv �v x � o 0 • C n H K Z ;a tTj Cl) o > a Z O N C A � V n � 1 � a 0 N � h y w � ©' .•3 R .d ou a ? A 4 6-- q \ r o - O � i 0 9'' { lr T 1 Q C7 W O o � o r e W Q ® k � n a 'R of h t o v y L g- y State of ft conSln ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION APPLICATION FOR THE USE OF AN AT -GRADE SYSTEM 201 E. Washington Avenue - P.O. Box 7969 Madison, Wisconsin 53707 Location: Township /Municipality: _' 1/4 V4 Section)Lt RISE_(or W C It ) — Street Address: SUDdivisi n: County: r& Landowners Name: Mailing Address: I (We), the undersigned, make application for an at -grade system on the above N �� described premises. If approval is granted, I Agree to have the system constructed in conformance with the plans and specifications approved by the Department of Industry, Labor and Human Relations (DILHR). I further understand that an at -grade system is somewhat different that a conventional onsite sewage system and as such will require detailed inspection during construction and monitoring after the system is P ut into use. I agree to permit both county officials charged with administering county sanitary ordinances and DILHR employes or other authorized persons such as the system designer, to have access to the above described premises at any reasonable time for the purpose of inspecting the construction, or of monitoring the system. I agree to either personally or by my agent contact DILHR or county officials to arrange the time and date to begin construction of the system, after obtaining a sanitary pe rmit. I agree to pay the cost of any monitoring required by DILHR for the purpose of measuring the wastewater treatment performance Of this at -grade system. I understand that this application does not ermit m P e (the applicant) or my agent (the contractor) to begin construction.. (If the system is approved, DILHR will send the applicant a letter of approval which authorizes construction of the system after all necessary permits have been obtained.) I agree to give notice to any subsequent buyer that an application for an at -grade system has been made and if installed, that the premises are served by an at -grade system, and further agree to give the buyer a copy of this application. S�gnat a of Applicant Date (validLonly if notarized) STATE OF WISCONSIN •• .••��PR� A bed and sworn to before me this COUNTY OF ®T A( aX. 3 P = 'o oUry�p uD t too W1 scons i n ��y . 1, v,.. •••• ° �� rF OF • W ' IS�"7 v a ® nmission Expires: DILHR•SBD•5524 P °f ®esaaoasn ®q9• i i / � � � .s � ,,,� . = /- / � i � � �� s• /� / � / , _- - , .� i� t ��t -- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT A OWNERSHIP CERTIFICATION FORM I � Owner/Buyer Gt U = °� �l r Mailing Address Property Address 1 o C (Verification required from Planning Department for new construction) City /State Parcel Identification Number 01 b - 6E / - z1V' CKD 34p. 30. IS 55Z9 LEGAL DESCRIPTION Pr operty Location �J0 ' /4 Sec, , T 3 L• N -R l own of 0- IfA - % �4 Subdivision '—" , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume (o Page # �3s Spec house ❑ yes tK no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 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. Uwe, 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 Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be cornplcted and ret!u -ed to the St. Croix County Zoning Office within 30 of the three year a piration date -� ��o SIGN OF APPLICANT DATE OWNER CERTIFICATION 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 ro erty described above, by virtue a nanty deed recorded in Register of Deeds Office. S A OF APPLIC NT DATE * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I „ S tock H.Y Mil,»rCompyy%" J R No. 13001 DOCUMENT NO. ll STATE BAR OF WISCONSIN —FORM 1 VOL 649 FA"" 3 W ARRANTY DEED THIS SPACE RESERVED FOR RECORDING DA 378 Q V THIS DEED, made between Leo N Kadin er an H I,. REGISTERS OFFICE Kadinger, husband and wife as joint t n t s o ST. CROIX CO., W& Rec'd. for Record this 2 1st Grantor -- and Raymond McIntyre an Mary E. McIntyre, husband and day of Jul A.D. 191 2 wife, as joint tenants, at 8 :30 A M. Grantee, W i t n e s s e t h, That the said Grantor, for a valuable consideration hokfw of Doode -- -- RETUR TO conveys to Grantee the following described real estate in St. CrOlX Hawa d F. Thedinl a g Atty. County, State of Wisconsin. P.O. Box 69, Menoinonie, WI 547 South Half (SZ) of Southwest Quarter of Southeast Quarter (SA4 SF.'-,) of Section Thirty -Six (36), Township Thirty (30) North, `-- -- - - - -- Range Fifteen (15) West Tax Key No. This deed is given in satisfaction of a land contract between the above parties dated May 18, 1974, and recorded in the Office of the St. Croix County Register of Deeds on July 8, 1974, in Vol. 513, page 273, as No. 322856. O�0 ITA This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Leo N a in r and T.. Kadinger - , husband an wife, warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements restrictions, and roadways of record, and will warrant and defend the same. Dated this 15th day of Ju 19 82 0 (SEAL) -(SEAL) * * T�e9 - �Q xaainger (SEAL) / (SEAL) ► Ha * z el L. K er ir�� -- Ha — AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this 15th day o f STATE OF WISCONSIN l Jul l 82 ss 19 . y - County. f Personally came before me, this day of ' Howard AeA g a * the above named _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - -- I� authorized by § 706.06, Wis. Stats.) HUI III It All 111 ICI ICI 1110ICI' ICI II I�l ICI Cil Ifif ICI 11111;x! Ilil llil!!;�I III I�I�I�hCil'I�I �I�I ICI !11;�fil,�(�I sus .w e e ss R sw w onww T S 04 let pop go C l A 0 C O l 02 1 S M L .I■sse ws •esa�w «swwae�e>•� � � ���� S R Y i r 26' -0- 26' -O "(LOT TO SCALE) 13'-0" 1 2' -3" 1 ?' -3" y .s jr m o ., �z.... . ' islssltil% toO•• .•'�w, • V p P- ' • ■ .............. ...$• •.r.. iii .w w � 1 lELIE3 •., � t �: � • ..,SCAB' r • it ... H 1 CA7160" crisdis w ........ .... 1 O •lui � � � a 11=11 Q a6' -0" 13' -0" 26' -0" N. T.S. -7- r --------------- ------------ ---------------------- 1 - r - - - - -� - - - -- - -� R N d igs m I I 1 38 -1 R ' I 1 * I 1 I I I I a pg I 1 r� i• F` , 1 1 MPH I � aQ Q I 1 •� , I Mall SAFETY AND BUILDINGS DIVISION 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 isconsin Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary At -Grade System Onsite Verification Re - port Are the soil and landscape features accurately reported on the Soil and Site Evaluation Form --&_ye s no If no, provide a further description by including an onsite report, which may consist of a soil profile report, or provide a brief explanation below. If yes, what other type of Private Owned Waste Treatment System (POWTS) could be used? MskAAPA County Official Signature Date Sw 1 / SE . - 3o 15 Uri Property ovation P '--'j' GTE Landow ers Name SBD- 10513(N.11/96) I PELKE PLUMBING, HEATING, & WELL DRILLING INC. N 6298 STATE HWY 25 D URAND, W154736 715- 672 -5266 FAX 715- 672 -5267 MEMO Date TO: Su 'ect: - t .. f k 7 "ING Opp = V ` s IL 4-- /D , Wt P.�L' 1`�. Wiscoh %in Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of J bureau of Integrated Services in accordance with Comm 83.09, W Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and �. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print information Reviewed by Date Personal Information you provide may be used for secondary Nrposas (Privaclaw, s. 15.04 (1) (m)). Property Owner Property Location N ?' W Govt. Lot 1/4 1/4,S T ,N,R S & (o�. Property Owner's Mailing Address ' r r r "` 4 Xot # Block# Sii Nam or CSM# City State Zip Code a NumbeiF G-,Gly [;-3fillsge 2 Town Nearest Road A LL Gl .� SY7ol a6sf oo Lo. /i9.0. L✓ ® New Construction Use: ® Residential / Number o# Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Cli r .fr•t�rs o! . y bed . s trench, Code derived daily flow - ?4 5 0 god Recommended design loading rate , gpd/ft gpd41 Absorption area required Soo bed, ft Soo D rench, ft Maximum design loading rate . S bed, gpd/ft _. trench, gpd/ft Recommended Infiltration surface elevation(s) /a� o �� LA�oar (fort o� Lour rag41t (as referred to site plan benchmark) Additional design/site considerations X - Ye .44&x* t ar lefiyoaro Parent material ny'e -eN Flood plain elevation, if applicable — ft S = Suitable for system . Conventional Moun /.t VS In-Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ®U ❑ s ®U ❑ S ®U ® S ❑ U ❑ S ® U ❑ S © U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 13 1 D - !rt .t - v 8 �F Z x, 3 - I r Ground Y 3 ' /0 /A `/L X/ ` 41 � elev. r / _X ft. ,*t s L s .2 Depth to f Xcpw0ex limiting factor in. Remarks: Boring # / 0 -12 oY - s ' v o� /T •.� a .T /' O yd-iv Y •� « �n . a Y.f s Ground 1• ,t elev. X 60, L ft. S.i' itee.t Depth to limiting factor,/ sr In. Remarks: CST Name (Please Print) if knat Telephone No. 1 //C .sES rErr /.S 8 Leo Address Date CST Number So3 ,o.,c r ,S. E � !✓ s i o• .GC.�Y /� r.✓ rne� SOIL DESCRIPTION REPORT PROPERTY OWNER , Page .? + of - � PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench E - 3 a - s s, /ydF4a r Ground _ Q�Nici pr i- elev. a- oY•e S C � S L I 00 — .7 f t. s G+` lD�roc a Depth to limiting factor ste in. Remarks: Z,0,Y ZC ,a�0-10r i.✓ if/-3 Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure p Texture Consistence ,Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # . Ground elev. ft. Depth to - — limiting factor In. Remarks: Boring # 13 Ground elev. It. Depth to limiting factor in. Retrarks: , SBD -8330 (R.9/98) M � V ~ ` 104 LA y � � J O v O h a� D r -,! @ ; V v k ti v v 3 v 0 • ZL 2 ~ �� v t _ a O y " W o W W d ' W a a Cl) H C W a V y m om "mo moofflk r FOR DATE TIME M OF �G PHONE AREA CODE NUMBER EXTENSION D ❑ FAX v El MOBILE AREA CODE NUMBER 71ME TO CALL C-5 MESSAGE Fix d� s fl SIGNED FORM 3002P LITHO IN U.S.A.