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HomeMy WebLinkAbout040-1059-80-000 0 _ a % o 7 0 \ )) m LL 2E2 ' / =0 t =n � . , . m552 # )2h § < 5550 G co k �D W }p)\ § £° ° co , m - o a § «=fE \ k \ LL � m CL ) ! o $ ) / \ / cc E < _\ 2 .. o § / $ § $ a m § B z 2 \ \ k § {k - z . . . . c §° 2 E e C0 � \ / ° (q \ \ L) � e � - .. } � ) { \ C14 ) 2 : § b k © I An 2 7 q } k 2 2 � \ E _ \ \ k 2 k ® z LL 2 a 2 U) \ § � k \ ° ' � ` z \§ § § \ § CL � \ o / 3 fD Eg § / & / ° \ & \ \ a $ _ @ 2 a k / f 4 : \ / § § ) f \ ? . ` ~ t G 2 e 7 o z f z / ■ n O ® � � � 2 « EL P.M a \ E ' k a § c 0 a 2 0 2 � Parcel #: 040-1059-80-000 03/21/2006 09:23 AM PAGE 1 OF 1 Alt. Parcel#: 15.28.19.227G 040-TOWN OF TROY Current [X_' ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O- KUNZWEILER,WALTER&SHARON WALTER&SHARON KUNZWEILER 698 GLOVER RD RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *698 GLOVER RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.690 Plat: N/A-NOT AVAILABLE SEC 15 T28N R19W 1.69 AC IN SE NE COM Block/Condo Bldg: E1/4 COR SEC 15 N 443.51 FT TH W 164.5 FT,TH S 443.5 FT TO CEN LN TN RD E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 167.5 FT TO POB 15-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 516/406 2005 SUMMARY Bill M Fair Market Value: Assessed with: 102492 220,100 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.690 43,500 168,300 211,800 NO Totals for 2005: General Property 1.690 43,500 168,300 211,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.690 43,500 168,300 211,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 221 Specials: User Special Code Category Amount I i Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER K LA-^a w TOWNSHIP SEC. /S" T 2 p!_N-R Z I W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION /�/� LOT LOT SIZE PLAN VIEW I Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i /zoo ,s r. T goo 3 ffen� et 5x (off / 5;?.Yo �L jr2 5yS�•r'a --- 0 f 7- 61'1 E 0 CJ r ILY ------- -- - - �ZL jae, INDICATE NORTH ARROW � �i.C� C6/✓LL-✓ r� BENCHMARK: Describe the vertical reference point used A6 Ec. Elevation of vertical reference point: /l,1J Proposed slope at site: SEPTIC TANK: Manufacturer: Gt),045 Liquid Capacity: 0 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road.: Front,O Side,O Rear, Q /cam feet - From nearest- property line . ' Front 10 Side 10 Rear,0 feet Number of feet from: well (0 5 � , building: 3o' (Include this information of the above plot plan)( 2 reference dimensions to septic tank) L SEE REVERSE SIDE PUMP CHAMBER Manufacturer: G(/ e Liquid Capacity: Pump Model: ri -7 Pump/Siphon Manufacturer: Z Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: app Alarm Manufacturer: L Pve Alarm Switch Type: -2 ✓3���t. Number of feet from nearest . property line: Front, O Side, O Rear,0 Ft. d 3 Number of feet from well: J/ Number of feet from building: 3 g (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: k Width: -57 Length: l(o Number of Lines: -% Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, 9 Side, O Rear,0 Pt . �S Number of feet from well: 9� Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: f Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box CY or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: /Z//7" Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: i Dated: Plumber on job: ` ---- License Number: 3/84:mj DEPARtMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS BO 7969&HUMAN RELATIONS P.O. PRIVATE SEWAGE SYSTEMS DIVISION P.O.BO BUREAU OF PLUMBING MADISON,WI 53707 f-1� SF4-,SF4-,S15,T28N-R19W UCONVENTIONAL ❑ALTERNATIVE StatePlanlD.Number. IH asst9ned) Town o6 Tt1.oLf ❑Holding Tank ❑ In-Ground Pressure ❑Mound Gtoven Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER- INSPECTION DATE. Watt KunzweUen. Route 5, Rivets. Fad, WT 54022 --a(o ;3d BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN. EF.PT.ELEV.: CST REF.PT.ELEV. Name of Plumher. JMPIMPRSW Np. Coomy Sanitary Permit Number: Ro en Timm 3224 St. Ctcoix 112834 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.: TANK OUTLET ELEV. WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ❑YES ❑NO ❑YES ❑NO BEDDING VENT DIA.. VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. VENT TO FRESH ALARM FEET FROM uNE AIR INLET ❑YES ❑NO ❑YES NE ❑NO AREST l DOSING CHAMBER: MANUFACTURER BEDDING LIOUIO CAPACITY PUMP MODEL. PUMP/SIPHON MANUF ACTUHER WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOP ERTY 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 LENGTH DIAME Tf H JMAIIHIAI AND nnARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dr Y enou h to continue MAIN 9 .) CONVENTIONALSYSTEM: BED/TRENCH WIDTH JLFNGTH NO OF OI STR PIPE SPACING COVER JIN1101 DIA &PIT$ LIQUID TRFNCHFS MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR PIPE DISTR.PIPE MATERIAL: NO DISTH NUMBER OF PROPERTY WELL. BUILDING VENT TO FRESH BF LOW PIPES ABOVE COVER E1.EV INI.F T ELEV END PIPES FEET FR M LINE AIR INLET. NEAREST-► MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE FERMANF.NT MARKERS OBSERVATION WELLS _ ❑YES ❑NO ❑YES ❑NO DEPTH OVER THENCH HED DEPTH OVFR TRENCH BED DEPTH OF TOPSOIL SODDEU SEEDED JMULCHED C ENTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS M_EV PUM11P MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO DISTR JOISTH PIPE DISTRIBUTION PIPE MATERIAL&MARKING ELEV ELEV DIA ELEV. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SITE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS NUMBER OF PROPERTY WELL BUILDING )1 FEET FROM LI"E: `j ❑YES ❑NO ❑YES ❑ NEAREST 3 qsI o _ C lo 70 a3 )V Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710(R.01/82) Zoning Adm,inizttc;OA �ILHR SANITARY PERMIT APPLICATION � �' �� In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# pia gj —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES ® NO PROPERTY OWNER t/ PROPERTY LOCATION L �- Z u-)lZ t/ i '/4 4, S 1'5 T Z8, N, R 1 (or PROPERTY OWNER'S MAILING ADDRESS LOT N M ER BLOCK NUMBER SUBDIVISION NAME CITY,STATES ZIP CODE PHONE NUMBER CITY /nl// NEAREST ROAD,LAKE OR LANDMARK 11/I�Y a Z 7145 S�ZS, d[{i ❑ VILLAGE : ✓L 271JG0� �eL 11. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family__ OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b. Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. N Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. XSeepage Trench c. ❑ Seepage Pit .. 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): T Ib al;y j �Z L' feet �Private ❑Joint ❑ Public VI. TANK CAPACITY Site in allons Total #of Prefab_ Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank /71✓� `C ')p 1:1 Lift Pump Tank/Siphon Chamber $at> ! ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No St mps) MP/MPRSW No.: Business Phone Number: -2ZZ/ y 7 7Z 2l Plumbers Address(Stre/et,C�ity,JState,Zip Cod I Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester(CST)N m CST##� 16&1 l CST's ADDRESS treet, ty, Slap,Zip Co e) Phone Numb r. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Siqgitary Permit Fee Groundwater ate Is mg Agent Signature(No Stamps)i6-26,9d RApproved ❑ Owner Given Initial QvZj� t rchharge Fee Adverse Determination I2U`� 9S44 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber e INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT- APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or,resaon given when application is disapproved. Complete plans and specifications not smaller than 811/2 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; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ------------------------------------------------------------------------------------------------------------------------------------------------------------ GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground ratt's r-- included the creation of surcharges (fees) for a number of regulated practices which Wisco EI3'S e can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r8ttrQ! is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 his application form is to be completed in full and signdd by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuence. 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - burner of Property , If X ti' 2- uie� Location of Property 9k /V jE 1%, Section /,S , T _N-R W 'Township zL e / Mailing Address Zo 92 ( /a ✓ r- cu 'Address of Site Ui 7 ? Subdivision pane Lot Number Previous Amer of Property �c� F e r e- I S -C'_ /\J Total Size of Parcel &_9 ,4C/r S Date Parcel was Created __V Y�i p r -4-0 9 `� Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes - .� No Volume v_ P and Page Number 20 (" as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWINC: 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION T POP-) crWk that a.Ct itatementrs on thus 60AM ahe thug to .the best o6 my (ouA) hnc.utedge; tJiat J (we) am (aAe) .tile owneAk) 06 the phopehty deaciabed in tit a inAalma.Li.on 6ohm, by v•ch-tue o6 a waAAan.t de d k itded in the 066.tce o6 the Ceitn.tyy RegiAteA o6 Deeds ah Document No. v - ; and that I (cue) phedentGty c.un .tl�e phoposed bite bon .tile aewage di-5p0a a ya em (OIL I (we) have obtained an eauement, to hun with the above deAc/Libed phopeAty, 6oh the conathucli.on 06 aai,d aya.tm,' and the name has been duty keeokded .tn the 066.tce o6 the County Re9iAteA o6 Veedd, ae Docwnent No. ) . r . IGNATURE Oh E SIGNATURE OF CO-0 ER (IF APPLICABLE DATE SIGNED DATE SIGNED i t it f. ', A , f ± �• }� �. �`(j'j Mme. h .19'��1115 �AxVi• 17\a � � �y]�••�.//Ia)j./Yy/ii���II��//jyI��//,,/L,�■,■y�) . 6dti�'t������A¢G'�� , � q .�Hlf dp>*t� ��lt;�tf6lSP 4ff Vl�1..'wV V F✓ ,' t , f .. Al. , if V"}�� T1L0 VG V; ni da betty on '-' Johl1 Wi.:�'e F. aye�teden 'husband end'wifO. f, l�bc'dyi#or 0, ' tltlittt'!! '•' ;:Id by Qfrw.�d. YY.t. �b.15'. and ait;et Kunztaaile>" end baron i - r �Kunfwailar, .huebatid d' 8t wiia.A•t ,':r, „- ... d� 1`. r ,t r; ',Fart• W i th a 1i a'!i 0, Thol the staid arahtbr 16f 0 valuable Cohaideratltln R �r of Deeds T6UORtld Ai1d.No/1O0 bollaV$ w, .,r w w r +-(9�i30OOOrO . • r•' �. i; ednveya 10.0#4 6 the fallowing described real istate id'-• ,gt`�Ar ig.�'.:.Cdunfy, �hE7Up TO r 1 State of WiNconsin't 1' A pose% o€ land located in the 8tk-of 1Vg y'�ed� ors .� , ��.., :r• 15w2g-19,' Town,of Troy, more -ftxily deerritil'tt ea r, fax kiy a c followrs:' ' 'COtnillettcng at 'the' Ek,tbt'ifir o 113d•.$ idn;35 i, . his i�rt` �tttrtrlid�prie 'which point 'ie on the cet�itei'line of the 'fo�otl;Road.ails ;` '' r t ter` .J the point of beginning, thihee distance of 443.51 feet; thence. 380,Piliv R dietidt 6o r5f.164 50 fef3!';�L�{ ti°61! :`:f, S00431E 4 distance of 443,50 feet to';,t:he Celtte>*,iitie',o>� e�iid 'owt 'rltdi�d;, �liette , 4{. t N89C)17 It along the eentetr ,line of e�'Aid;.TOrbn,i�on�:+� ietAticp.of.'161iSNIAt ..fib z l; }, the point of boginning. 'Said, parcel'odntairiitl '.'�,� `eot'ea,iriclti�ing o Rb t� w i right of vAy. IC Together with all and singular the heteditemente Grid upputtehancee dletbdhlo belbnglhg o?_in any wlde dlfpart0'1 i� 4(1 I. add x41at Fey .i� warrants that the title it good, Indefeasible in fee olmple.and free i cledi of ptlbtimbrandes bitcedt and will warrant and defend the same. Executed at River Falls, Wisc0119in this day of- t.. SIt:M AND S1 ALED IN PRPMENCE OF Johtl W. Weyer ise4t ,r } • y Carol Ann VeyetefM r Signatures of F •r, authenticated this day of Titles ;Mbmbar State liar of WiOConbie or Oot A'utltof1ie4'6ndNr Sec, 706.06 vir, 9TATI; OP MCf7IQ9tN 'Piet 6 -County, Personally came before me, this 4th djy of.� d0k the-above named. _ 4bhn W.. eyereit�en A d Catoi An 'p tlttlieen •'" to me known to be the person—S! who eilacuted the fbregoing inalrumbnf illd 0ekdotµlodged the a'ame This instrument oil 16i Ativerttei►4 �r 'River Palls, .'Wigeonsina t�► ry 7 iii The asp of*itit�A os 1' aplional, ey'•i;; y •f. ''J , f' n t. ' ti 91' , I Names of esteem slgniAg in any capacity should be lyped,or printpa " (ta47,ttle ,bi�lltltUtlts J ' �' ' ry; , '" e'A�ttANlit.11f3LdW9TATB gAk Ot ;Wfetrt)NbtN��rrbkt�'tlff� i'�,t4`dlt.*:',•+ �.'' 1 r{•f �� ° + r..,Mn. H z N H a STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z 1 tj OWNER/BUYER {� r- Shit r-o/i Gv e-i � Ct�L� H ROUTE/BOX NUMBER J�rL�a C16 vL' !^ �Oa� Fire Number / > 7.IP CITY/STATE /UeY l`'GZ l.[,_S `e 'f. PROPERTY LOCATION : SE 14, HE Section , TN , R _W, Town of Tr 0 Y St . Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes . Proper maintenance con- sists of pumping out the septic tank every three years or sooner , if needed , by a licensed septic tank pumper . What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St . Croix . County residents may be eligible to receive a grant for a maximum of 60% 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping ( if nec- essary) , the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth , herein, as set by the Wisconsin Depart- ro ment 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 2L DATE St . Croix County Zoning Office P. O. Box 98- Hammond , WI 54015 715-796-2239 or 715-425-8363 Sign , date and return to above address . ANTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS_ ,USTF�Y, C DIVISION BOX 1!yOR RELATIONS PERCOLATION TESTS (115) MADISON WI 53767 (N63.090)&Chapter 145.045) CAfiTO 'HIP UNICtPALITY OT NO.�BLK.Np,: SUBDIVISION NAME: i/4 C/ TZBN/RI4or �UN1 Y: W NAME: MA 1Z`i --/��- rCfeo►x QLT" '�C eUNj:ZWU1LE/it 69B 6covts�' aAj KIVt:4? FQUS V1 r _ DATES OBSERVATIONS MADE b ETON DESCR4 o STS: ,Residence �NK L�Now RePtaco I I`Gt / 9�� Atin, 2 / 115— i r)(.s opt 8 2 Sa►t.s >Pl q 131 LLA T_ rING:S-Site sultaWis for system U-Site unsuitable for system _r"S)NV fT6 M IN- ' yI1-Fi1L OIOINGp�ANK:Rj�1COMMENDED SYSTEM:Ioppttiionnal) w l�J J ❑u S ❑U S ❑U ❑U ❑,+� UJU nNy�T16kiA L 1 FE+��u E S ' 9tXL, Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the-1 1 der s.H63.0915){b),indicate: ok4ss IT- Floodplain,Indicate FloodPlain elevation: /ef A PROFILE DESCRIPTIONS DE Q/MBER pEPTHT>Sii ELEVATION ATE -INCH CHARACTER O SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED EE ABBRV.ON BACK.) 97.06 > g 91 bc �6, T PERCOLATION TESTS i DEPTH WATER IN H?L TEST TIME V RATE MINUTES �nhlftR AFTERSWELIN INTERVAL-MIN. PERIOD PER INCH _ ► _LL&E I 97.So >z >z > Z < 3 V. N ft<t w^N: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate state or distances. Describe what are the huri- ,wd vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent ,t slope. uAPLR -TP,.1£NC-N - 93 410 &NCAI`•taR►c- SW CaitNCR of Coal` rEM ELEVATION Lojr;R Z Titcr,e.i(i&S 91 lb PAIS 1N 1;ca,M of 6A&AGki FLEV- 106.00- c Al •S uA ER -rQ actl tN Ike IC 0 i pevu+ / A 6- 69, iE4s'LE loP ;6L*C.KT6P, - 4LaJtR CA 1, ., undersigned,hereby certify that the soil tests reported on this form were made by me in accord with the procedures and roathods specified ur the Wisconsin ninistrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, IE(print Y: TESTS WERE COMPLETED ON: . .,pQV6t )o+a S 1 ', /NC -- A&USr- 2 19� _ If : , I CERTIFICATION NUMBER: PHONE N}}J�MBER(opliunal): S(C'L'c ST Nu�s�. , . Soo�6 _ 34$4 _I 7 SI(' TUfiE: } i HIBUTION:Original and one copy to local Authority,Pinpnr1y Owner mid Soil Tnsttn. H-SS"395(R.02/821 - - - - -- MPRS 3224 WI MPCA 696 MN JOB m SHEET NO. OF Ti 11' CALCULATED BY DATE Excavating Co. CHECKED BY DATE_ R 1, Box 192, Wilson, WI 54027 SCALE 71&386.W3 ROGER TIMM 715-772-3214 � . .. .. ....�:...... j ....... ._ "93 - T I. .i--- r r �P lam► 4v b� ,!'r,�lam` n _..._ fieo"I - - : e ..,...._...,. ....... ..... .�....... ., .�.,,.... ,.,,. ,.............. .._ .. .........._. .-- -. L. 3Z 7 .... OR Ale ..- ... ,. .. s .....:: PROM 2WI C&P"T 1-Om-Mm 01111. MFRS 3224 WI ` MPCA 696 MN JOB Timm SHEET NO. OF Z CALCULATED BY— e r DATE -/7 ?8 Excavating Co. CHECKED BY DATE_ R I, Box 192, Wilson, WI W27 SCALE 715-386.5443 ROGER TIMM 718.772-3214 , ..... .......i. .. .f _ ;.... i �.. ..... .:. ! ..:. ;.. ;. ......i..... �. .:......� ...; ..1.. ..,....... ' e � ........ .. ...... :... 4........a ...... ..... ...... a .. ....... .....:.... .. ..n... ♦.......... .............:........ ........... .... i.... f . �t r �1 0 b - Zd _ p ..... _ ....... _ .........,, .... i... : ..........i... i i,...... , i.. ..:...........d. 3. .. ...... .... ... ....i.,..... .... ... : ..o........ ....... ..............:.. .. .. .. , .. ..,., .... ...... .. ...... ,.. ... ...... .. ...... ... ... ...... ... ... ....i.. ...i. ........... I ............. MM,2041®la..Gmbe Mao 01471. J(,�.i r, , tA f •, Z.W t Fil e i� PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP `"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUWCTIOAI BOX MANHOLE COVER � WINDOW OR FRESH 12"MILT. AIR INTAKE I GRADE I I 4' MIN. 18"MIQ. COIJDUIT--" 10°MIAI. \ � ---------- ICJ I_E:l PROVIDE I ---- --(- AIRTIGHT SEAL I III J/ I APPROVED JOIN? A I III APPROVED JOINTS W1C.i. PIPF. I III W/GI. PIPE EXTENDIKJC. 3' I II ALARM EXTEIDDING 3' 0QT0 $OLID SC1l_ B I I ONTO SOLID SOIL I I I I oN C i I Ell- a� PUMP-•_� OFF 111 � D CONCRETE BLOCK RISER EXIT PERMITTED ONLJ IF TANK MANUFACTUR61R, HAS SUCH APPROVAL SPECIFICATIONS SEPTIC AND DOSE TANKS MANUFACTURER(Q O : gs'-KL, (DUMBER OF DOSES: -PER. y DA TAMK SIZE : _.S"r oo ✓-1 GALLO►JS DOSE VOLUME ALARM MANUFACTURER: �y� Iu rr� INCLUDING BACKFLOW: °�� GALLONS MODEL WLIMBER:�r( L CAPACITIES: A= L3_ INCHES OR 2 GALLONS SWITCH TYPE: � r �I��J`t B= - INCHES OR �S" GALLOAIS PUMP MANUFACTURER: -----ZDe f 1zY C= /1 INCHES OR -16a GALLONS MODEL MUMBE.R: 11) y 1 D-_L?-INCHES OR 12 GALLONS SWITCH TYPE: �✓ >DI 4�u_,k NOTE: PUMP AND ALARM ARE TO ESE PUMP DISCHA.Rf.E KATC GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE Bi5ewcEAI PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMHM NETWORK SUPPLY PRESSURE//. . . . . . . . , . . 2.5 FEET + FEET OF FORCE MAIN X F/ooFT.FRICTION FACTOR.. FEET I — TOTAL OtJQAMIL HEAD = FEET INTERNAL DIMEN5IGNC OF TAIJK: LENGTH / W DTH ;LIQUID DEPTH SIGUED: LICENSE IJUMBER: DATE:�_ t y r, + HEAD/ A W♦ � • . � W r' 115 at 110 „ .LL PA C CA _ 95 R"VE 30 , CU zs .p. 26 Y 24 MODEL EFFLUENT �° 4 D 7$ MODEL 189 DEWATERING _ ,65 } 18"4 60 55 Q 16 MODEL 163 MODEL F 14 18 ` 12 40. 35 10 MODEL a' 30 MODEL 137,139 185 SEWAGE and „ 6 DEWATERING 6 20- MODEL "1 15 MODEL 161 2 ODEL W W $ 53,55, y~j S7,59 Q ALLONS 10 30 40 $0 `60 70 .80 90 100 110 24 LITERS 0 80 160;- 0 210 320. .. 400 75 70 i FLOWIkR MINUTE 4 18 60- MODEL D 295 W S5 = 16 I V 50 Q14 MODEL 2 294 � �. 12--40- a P293 35 10 MODEL F 284 i 8 25 MODEL 6 20 282 r I 4 .,, 10 MODEL OE 2 5 267,268 _ 0 3280 Old MAIM Lane F GALLONS 10 20 30 10 50 60 '70 60 90 100 1,0 120 130 140 150 160 170 160 190 P.O.Box 16347 LoUltvift Kenfacky 40216 LITERS 0 so ;160 240. 320 400 480 560 610 720 (602)778-2731 -SLOW PER MINUTE