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HomeMy WebLinkAbout040-1129-90-000 0 � y I N t Q I ti � a I .o � � I v � I m A � I ao °'a I m 3 I z° c w m LL c � .. — O U 3 - E Q Oc m_ M c) LLJ d i+ 00 co A H f4 a m o O z v 0 Z a c � I V1 N co N 2' • O Q Q O C Q Z z N z ' d N Its =3 a — m E co y N G G ra` .0 c, °1 (D CD E 3 a o , • _Y 3: a a a CL z a L fA J V O O O O O z C) - 0 rn rn O E m y a Li N 7 a� CD 10 f- CD H C C4 O .� �'�, j In Q O ! c v d p O O c O (V O N O O 0 y 0 O U try)' •�1 ri H~ !! Y C O z co co N 0-4 N T O E aC d.. L CD 4O rn o Z FO � � 1n I I • a # v m a m c � a> c t A 0IL2 10NCi t Parcel #: 040-1129-90-000 12/16/2005 01:07 PM PAGE 1 OF 1 Alt. Parcel#: 34.28.19.543D 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-FREDRICK, DENNIS&SILVIA L HERNANDEZ DENNIS&SILVIA L HERNANDEZ FREDRICK 672 CTY RD M RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): "=Primary Type Dist# Description *672 CTY RD M SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.370 Plat: N/A-NOT AVAILABLE SEC 34 T28N R19W PRT SE SE.37A BEGIN Block/Condo Bldg: 292'E OF SW COR SE SE; N 165', E 105'; S 165 FT;W 105'TO POB S 33'FOR HWY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 34-28N-19W Notes: Parcel History: SHOULD BE SEC 34 NOT 24 AS RECORDED ON Date Doc# Vol/Page Type 2587-387. VALLEY VIEW MANAGEMENT 06/03/2004 764667 2587/387 WD DOESN'T OWN ANYTHING IN 24- 01/12/2004 751351 2490/183 WD 08/10/1998 584738 1347/180 WD 07/23/1997 808/162 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 103068 158,500 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.300 30,000 122,600 152,600 NO Totals for 2005: General Property 0.300 30,000 122,600 152,600 Woodland 0.000 0 0 Totals for 2004: General Property 0.300 30,000 122,600 152,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 158 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDINGS LABOR&HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O.BOX 7969 BUREAU OF PLUMBING MADISON YVI 53707 SE4, S$4, S34,T28N—R19W ❑CONVENTIONAL ALTERNATIVE State Planedl�.,D.Number: Town of Troy ❑Holding Tank El In-Ground Pressure �Mound (If Vn.*5554 CTY M NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: c) Robert & Carol King Route 5, River Falls, WI 54022 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.. Name of Plumber: MP/MPRSW No.. County: Sanitary Permit Number: Thomas A. Wang 3231 St. Croix 99078 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: U"U 0 I I NYES. LINO DYES NO BEDDING: VENT DIA.: VENT MATL. HIGH WATER EARES'rR MBER ROAD: PROPERTY WELL: BUILDING: VE TO FRESH ALARM. LIME:_ �� t AIR INLET. ET FRO ``JJ DYES NO C DYES ❑NO DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY. PUMP MODEL. P . WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: W �9J1�'1 DYES ❑NO S J YES ❑NO ❑YES NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF 'PROPERTY WELL. IBUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES 9NO NEAREST SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE the soil is dry enough to continue.) L MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH. NO.OF 171PE SPACING. COVER JINSIDE DIA.-. #PITS. LIQUID 13EDITRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH JDISTFLPIPE DISTR.PIPE DISTR.PIPE MATERIAL. NO.DISTR NUMBER,OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV.INLET.ELEV.END. PIPES FEET FROM 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- meets the criteria for medium sand. TIONS MEASURED. YES NO SOIL COVER ITEXTURE PERMANENT MARKERS: OBSERVATION WELLS r. YES ❑NO YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED [""U"D. MULCHED. CENTER. EDGES. r� �. S III t 0 I S DYES C2'NO YES ONO tYES NO PRESSURIZED DISTRIBUTION SYSTEM: t WIDTH. LENGTH. NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: BEDITRENCH TRENCHES: DIMENSIONS ` -L of - (p 1 a 11 S MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL. NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING. ELEV.. ELEV.. DIA.. ELEV.: 4O PIPES. DIA,ELE1/ATION AND : I C) ; DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED INFORMATION PLANS: YES El NO YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: [NUMBER Of= P PERTY WELL:EET FROM LINE: YES ❑NO YES NO EAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: Zoning Administrator DILHR SBD6710 (R.01/82) INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION f t 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 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, contactlour 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 systeri is to be installed; Il. 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 8'/z 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 treat(nent 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 Ater included the creation of surcharges (fees) for a number of regulated practices which Wisconsin's ran effect groundwater. The surcharge took effect on July 1, 1984. All of the water that ouried treasure 1 u::ed in your building is returned to the groundwater through your soil absorption o /f system or the disposal site used by your holding tank pumper. � o "ne °; on es i thr:,ugi these surcharges are credited to the groundwater fund adnw:is is re:i by he lepl- rtme nt of Natural R-)sources. These funds are used for monitoring grow d- t ,-,atct, g _ji�dwater conto—nir.aticn in,,estigatio�ns and establishmF nt of standards. ;round,,vaiF s ,-vcrt'. grotect;ng. � A SANITARY PERMIT APPLICATION cou�TYe�� � � In accord with ILHR 83.05,Wis.Adm.Code STAT SANITARY PER MIT# y� —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. 7_ 21 —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES NO Pf P TY OWNER PROPERTY LOCATION 01 tre '/4, S Tp?�, N, R E(or OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME C Y,STAT , ZIP ODE PHONE NUMBER CITY ..� NE A FAST ROAD LAKE OR LANDMARK "ya S a rf El VILLAGE:: rO �T 77t&TOWN 11. TYPE OF BUILDING OR USE SERVED: t 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.k'OSS'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. Conventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e.,R Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ®seepage Bed b. ❑Seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): 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 he OG '000 - /r rl^t°C4, Lift Pump Tank/Siphon Chamber SD ,)Z ? e !I 1 52 1 ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): Plumb ' ignature:(No St am s) MP/MPRSW No.: Business Phone Number: Plumbers Address(Street,City State Zip Code): Name of esigner: AU d S LAJ �Y4t l2° /C i✓G�' 1�a`�? �✓i 5�� ?0'1 Jh.t , n VIII. SOIL TEST INFORMATIOIN Certified Soil Tester(CST)Name CST# CST's ADDRESS(Street,Oily,state,Zi Code) c /� // Phone Number: l�OK �V `l�C d 7-ree� /� l jfev- AG65' IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) NJurcharge Fee Approved ❑ Owner Given Initial � ��� � � Adverse Determination Q5,CC) X. 7 MMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property `/ Location of Property ., , Section , TN-R W Township Mailing Address Address of Site Subdivision Name . Lot Number Previous Owner of Property 4� Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? C__ Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (toe) centl6y that a.P.,C Atatement6 on thin ahe tAue to the bt o6 my (ouh) hnowt.edge; that I (we) am (aAe) -the ownen(.5fookm 6 es.the pnopenty de�scAi.bed in th,i,e Cn6ovnati.on 6onm, by vi tue 06 a waAAanty deed neconded in the O66.tce o6 the Count Reg.i�s.teh o6 Veed�s ass Vocument No. • and that I W at ( e) pned ente yy y awn the pnopoded site bon the sewage di�spoA5 dyAs em (on I (we) have obtained an eaeement, to nun with the above deacAi.bed•pnopenty, bon the conatAucti.on o6 eaid e ya.tem, and the dame hae been duty neconded in the 066ice 06 the County Reg•idten o6 Veede, ab Vocumen.t No. ) A� SIGNATURE Oh OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DOCUMENT NO. SrA'FE UAN Ur wtbL;ur4bi14—rUNm i 1 WARRANTY DEED 336060 VOL 544 PACE12 i THIS SPACE RESERVED FOR RECORDING DATA ' THIS DEED, made between Edward C Mealy and Julie M. REGISTERS OFFICE Me-a_1y, husband and wife , and each in his and ST. CROIX CO., WIS. her own riRbt Rec'd. for Record this_18th and Robert T King , a single man Grantor day Of••-5? ho—r-A.D. 1916 t 0 A M. Grantee, Witneaaeth, That the said Grantor for a valuable consideration Thirty- Register of Deedi Nine Thousand Five Hundred Dollars - - ($39 ,500 . 00 conveys to Grantee the following describedreal estate in St . Croix County, RE RN TO State of Wisconsin: East 105 feet of West 397 feet of Tax Key # South 165 feet of SE; of SE% of This is homestead property. Section 34 , Township 28 , Range 19 . TRANSFER FEE Together with all and sin lar the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And Edward t . Mealy and Julie M. Mealy warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights of way of rec cIrd, if any- and will warrant and defend the same. Executed at River Falls , Wisconsin this day of October ' 19 76. SIGNED AND SEALED IN PRESENCE OF (SEAL) Edward C. Meal ` SEAL) Julie M. Meal (SEAL) (SEAL) Signatures of authenticated this day of 19 . t' Title: Member State Bar of Wisconsin or Other Party Authorized under Sec. 706.06 viz. t STATE OF WISCON$IN St . CrO1X Ss.County. } October 76 Personally came before me, this / day of_ 19 , the above named Edward C . Mea y and Julie M. Mealy I to me known to be the person S who executed the foregoing instrument and acknowle d the same. This instrument was drafted by Gaylord, Attorney V+ C. L. Ga N TORY . y , y # r Public County, Wis. The use of witnesses is optional. V L .,•'mY Commission(Expires)(Is)� '� Names of persons signing in any capacity should be typed or printed below their signatures. M.Y MiI1erCanpanr� WARRANTY DEED—STATE BAR OF WISCONSIN, FORM NO. 1 — 1971 �i _ x . cn H a r STC - 105 a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County x tv H OWNER/BUYER to ROUTE/BOX NUMBER �v �` ��� Fire Number 7 .CITY/STATEGLT' �' s ZIP PROPERTY LOCATION:'2E 3&, 5� , Section , T_E2f N . R_Zy W. Town of , 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 pdt 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. Ho E I/WE, the undersigned , have read the above requirements and agree to maintain the private sewage disposal system in accordance with M the standards set forth, herein, as set by the Wisconsin Depart- b 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 . SIGNEDv�^ CJ l E DATE I-S. St . Croix County Zoning Office P.O. Box 98, r ' Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. t INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 , To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; 9. Complete all appropriate boxes as to dates, names,addresses, flood plain data, percolation test exemp- tion,if appropriate; 10. If the information (such as flood plain,elevation)does riot apply, place N.A.in the appropriate box; 1 1. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (oven 10") BR - Bedrock cc[) - Cobble (3- 10") SS - Sandstone gr - Gravel (under 3") LS - Limestone s - Sand HGW - Nigh Groundwater cs - Coarse Sand Peic Percolation Rate need s - Medium Sand W - Well fs Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than sl - Sandy Loam < - Less Than 'I Loam Bn -- Brown sil - Silt Loam BI Blank si Silt. Gy - Gray el - Clay Loam Y - Yellow scl - Sandy Clay Loarn R - Red sicl -- Silty Clay Loam mot - Mottles sr, -_ Sandy Clay Ltd/" frith sic - Silty Clay fff - few, fine,faint c - Clay cc cornrnon, coarse or - Peat rnm -- Many, mediurri rrr - Muuk d - distinct p - prominent HWL - High water level, Six general soil textures surface water for liquid Waste disposal BM - Bench Mark VRP - Vertical Reference Point T O THE OWNER: This soil test report is the first step in securing a sanitary permit.The county or the Department may request Vol ification of this soil teat ill the fi+ad prior to permit issuance. A complete set of plans for the private esvaws system and a permit applical iorr roust he sulxrlitted to the appropriate local authority ill order to obtain a permit. The sanitary permit must be obtamed and posted prior to tfw start of any e:aPsVuctioM. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDJJSTRY, GG DIVISION HUMAN RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1) &Chapter 145.045) LOCATION" SECTION: OWNSHIP UNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: Est'/ �/ 3 T- s-WR 'i 9E (or `,\ - _ COUNTY: OWNER'S UYER'S NAME: MAILING ADDRESS: ST, \Y- 'T Cnsz�_ t-,)NjG 2T S 'R_t P::A L-l_S,w I 4`' zZ USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: ®.Residence ❑New Replace I a Z�_ RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM: osZu 11:1 s ®u as ®u os u sou -�o� Nk� If Percolation Tests are NOT required DESIGN RATE: 9 If any portion of the tested area is in the t� ` under s.H63.09(5)(b),indicate: t,,� • Floodplain,indicate Floodplain elevation: ' �1 •� PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-ING4E6 CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH I4 ELEVATION OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 1 5.3I o' 3.s ' 3' , S Y I TOO @ o.`� ' b�zGySi Id's; �.� YznGws�,1 �1L-L_ w/ B- 2 - ) 9 g .S y 3zvo � -o V-,t\p `Z W,6-T • 1.8' S f I z-3 S n is B- �,Q)fh`cZCvsri7s3 ' `D1i6ys1'I ; 1.3 2811 B- 3 .a 6.O ►vo>v oT @ Z '� S e_` w G�- C 1-!Izm t✓b a-r--m B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERIOD PER INCH P- P- P- P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _ _ _ /�f]�y _7 4..__. .. _.,_ 1 ._ -......1 _ { GNccQ ? I r,,,,,,,,,,,,, I — E J }� _ tN a cal - -- _ _. - � r � r . . T 17 Se�L� �v1 = SO � S�-C. 3SL I,the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code,and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ZTUR L . V3 EGG Z )- Z.7)-S/., ADDRESS: - y f ox --Z CERTIFICATION NUMBER: PHONE NUMBER(optional): L_Lsw© I Su6i z �, �)s_yZs-�16� CST SI NAT RE: �• DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER— Fa ge 1 of E MOUND SYSTEM FOP, A 3 BEDROOM RESIDENCE pen LOCATED IN THE OF THE SEV/y_OF S E C T I ON T N W, TOWN OF COUNTY, WISCONSIN . INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PA GE 3 of 6 PLAN VIEW-CROSS SECTION PA GE 4 of 6 DISTRIBUTION PIPE LAYOUT PA GE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR IZ1U1� .�F1�4S, W1 Syo-2.Z. PREPARED BY ARTHUR L WEGERER, WEBER AND ASSOCIATES WEGERER ? •f • o-e1e a = BOX 74 421 N. MAIN STREET S ELLSTH RIVER FALLS, WISCONSIN 54022 X004 '6 ZS I Gl; Ct LLB Sf� �r � Job O PLOT P L.A N Scale tfuic. W ELI C>1�1Zj'[GE SlA$ N 1 p09 C1'NG U C ;N Nov S`E DNS Y IV , a S' MIN. 3Z OF 51u " i CL Vp'1P OF SN1 P��-�- P � S �y / U. �JL o OF Pl pE- \� •- - - -- - -- i bo ►ZCUT REhwE 96 PIPE I LL '-"ATt!lu K_ i r i� � 1• r � O r o e)4. N1z I ST. TAS-- "CA}'►1?t�C-S� BSL� P2 v, ` \ E►'IOV� C.AVSkS 2� R�pI r�cE w I'M �;L y .P .95 Avr�t� �-ANks , BR,C-Atc soTTans, �XV6 �ubS of 2 2 SOS LoT tlalE- - - - - -- — 93 D\TC.fi d 'N! CDPJJ?_ UF SE I/y- SE//y SEC, 3y, P_19 N OTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2 . Install cast iron pipe 3' onto undisturbed soil both sides of each tank. 3. Install permanent markers at end of each lateral. (_�4 required) ego 4. Install 4" observation pipe with approved cap. required) 5 . Septic tank to be lyoo gallon capacity as manufactured by _w�S� c.�1J c� � �Qgn • 6. Bench Mark- Elevation loo,v' paJ go--TU" OF: 5Ib1NG FyT Sou`rHehST GoR�1 of 7, Q1 V�TZT SuRFa cE_WJ\7E ARtNt Wb MDu)jb Tb -Por.� uG_AT_:uP1 ILti.S1 Dom: r L r'TD S��oF urn CC CIR Sirow,Morsh Hoy, Or A�PROV Synthetic Covering Distribution Pipe Medium Sond Is PIC" H � Topsoil = _- F 99.so I fE D IA \jk?tIES% Slope Plowed 6% Z°% Bed Of 2 Force Loin 2 2 Agor a oot e From Fump L o y e r D N,O E -2—LI P7- Cross Section Of A Mound System Using F 157. A Bed For The Absorption Areo G �>rtii $1? G D��Q H 1• S FT, fit, t.F 1 rV 23 .IV 7 �� oas�v�,�u►� PIPS �ZS /ryi BAD OF J/z-m 2'/z"HGGRE6ATE j�1 4 O o BSCRWR-r10tJ JI S Pt�tS ty' 1y' Ll1T 1,15 AL1�1J V �Ew SAGE y OF PER wtzATeD P►P� �ETn,E E A\11E'w PE52FD�got"t:'S 0►J PV 0- P►Ptr O F L Ii�Tj m N Os i G7 ► Pv c �tsTftt B ubo►.t P�vE '/c b I A NvLe s ZOO 6 � w 1'•7A t2�'F.Z d 2� T RST HvLE It 8E 1.3 t;-xT To E:vt CA'P PV G FpjZOE 'LS "P,I pJ FlZ or i L 8 Is 'b1S-M)BusTI J pInE LM!ovT 16-S FT P 11.9 ',FT. LL L>tTL�ALS S r r �p�;(�.� rtFt"~�`It�''',tI y �`` � � I ti. LD►1tA,tL ' 1 N ,,•-.-"" _ � t-CPC►Iv i# OF twLES 6 PNTt_ P,PE ,w�T Et-FV . Vi:s 1-T F LA'rGA LS I WEATHER PROOF ..,..►. JUKICTIOK] BOX MANHOLE COVER ?-5' FROM DOOR, 1 WINDOW OR FRESH f,tr, INTAKE GRADE -T 41 ELEFv. 96.5 t I MKI. COAIDUIT `-- ---------- \a� ----- ----- IB"mild. \\�\ PROVIDE I ----- IMLET IRTIGHT SEAL I III V $ $` � f,(� ��' {'�',,� I III APPROVED J0111T5 APPROVED JOINT A `�l0{t1,lAi`' ► I II W/C,I, PIPE W/C.T. PIPE CL EXTENDIUG 3 E E XTPIDING 3' r�',CNS I III ALARM ONTO SOLID SOIL ONTO SOLID SOIL ri ON t! 1' ELEV FT D�pPFrfA� 1 n 6� < ,..� ��,t --� �// ; PUMP OFF D � Opl CONCRETE BLOCK lie RISER EXIT PERMITTED OULy IF TA1JK MANUFACTURE=R HAS SUCH APPROVAL SPEC.IFI'GATIQUS DOSE TAIJKS MANUFACTURER:k)1Si' CWM PP- C-15 NUMBER OF DOSES: 3-� PER DA5 TAWK SIZE : S� GALLOIJS DOSE VOLUME ALARM MANUFACTURER: SySTEF'JS IMCLUD1NG BACKFLOW: `3� GALLONS MODEL AIUMBER: O Nw CAPACITIES: A= \S INCHES OR 30D" 6 CALLOUS SWITCH TSPE: ��L cjjQ'`f g= Z INCHES OR Ub'1 GALLONS PUMP MANUFACTURER: FE QL S C D C= lD /! IMLHES OR 1Zt3*1 GALLONS MODEL NUMBER: SS Y D= 84 INCHES OR ZBu'' GALLONS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE MIAIMUM DISCHARGE RATE Z8 J� GPM INSTALLED ON SEPARATE CIRCUITS _ VERTICAL DIFFEREAICE BETWEEKI PUMP OFF AND D15TRIBUTIOU PIPE._ FEET + MINIMUM METWORK SUPPLY PRESSURE . . . . . . 2.50 FEET 1.O\ F.T. Cl LI� �- LAD FEET OF FORCE MAIM X �p�FRICTION FACTOR._ FEET TOTAL Dy3UAMIC HEAD — 1S'� 0 FEET — go'' Totem MTERRIAL DIMENSIOMG OF TAA]K: LEKIGTH — ;WIDTH _ LIQUID DEPTH 5Z BoTTnt-I A2Efl = 3. 1� X Z_ — th3= z3� _ �O OS GRL./Ih• SH313W N! OV3H -IVJL01 PA6 & of � ' O o0 ti CO U) d' co N r O O N O 0 co N N O LO o N O ui Lu O D [- Lf) z . z O LLI LLJ Cl) cy) Cf) Cc CC ° O J Uj W N �� � -J �= g Co o ® C) Or N ,- tl) U o o U a N cc U U Lj (.D O o O LO NAe O O CO �- N O 00 (D oO Cfl � N N N N N r T- T r T -�-i 4 WEGERER, WEBER & ASSOCIATF,S 421 N. MAIN STREET Land Surveying • Civil En in�°`� -��1 f° RIVER FALLS, WI 54022 PHONE (715)425-0164 Percolation Tests ATTN: ��n') ; ATE g – zq CC: SUBJECT: LSU";C-,- \T—CtiJG WE ARE ENCLOSING THE FOLLOWING ITEMS: NO. OF COPIES DESCRIPTION SENT TO YOU FOR THE FOLLOWING REASONS: ❑ FOR APPROVAL [] APPROVED AS SUBMITTED [] INFORMATION DESIRED ' FOR YOUR USE ❑ APPROVED AS NOTED ❑ RETURN COPIES ❑ NOT APPROVED ❑ FOR REVIEW AND COMMENT L] A )LIf 6HT �_ ::J� SSf81 L/Y-f 'T1 `r' ©1Z i� L-i'�S�l'l�9T 1�--(GK TS i�UIZ ft S LIS;'7L�t WEGERER, WEBER & ASSOCIATES by Wisconsin Department of Industry,/ '\' �ILHR Labor and Human Relations t•���� 3' INSPECTION Leroy Jansky P.S.C. 1 Safety&Buildings Division ,;,gib �� REPORT 13 E. spruce Street Bureau of Plumbing ipplNG Chippewa Falls, WI 54729 Inspection Date pFE10E (715) 723-8786 Name of Premises A#jr shy} gal Description GW#*Township County AJ Master Plumber Name and Address Master Plumber Firm Name and Address Plan I.D.No. Sanitary Permit No. J r/Soil Tester -1"C-Pt .01FA Licensed Person's Name(s)and License Number(s) 1\ 'A-Nf=.E,r--,_F7 Owner's Name and Address � ����� F'{ S t _ t ✓. -i ✓ A �^ E 9 zo if 71 l 5 �,t -4,4" '1'- 11 9 �- + A4, u? �RI l/t� s r ✓ i .{ J i--- 1 • 1 . _._ ---f . - I j s 3 } Page of Signature of Responsible Licensed Person(only one needed) Signature of Plumbinq)Consultant/Private S age Consultant Check Copies Original: that apply to: - rM ssD-6192(R.ilias) District QILHR O Plumber 0 Ovum,- DCCou6t'ViLocgl_I sp. er in I � __ .state of Wisconsin ` Department of Industry, Labor and Human Relations i C)l ' 9I t SAFETY&BUILDINGS DIVISION Of0ce of Pivlsion C,0-60s 2711 East Avenue i,';r�ri t'IF1�1�CCn��t i)ii P.O. Cxr,;,x 1:31 ` 7 C7 i t V 2 F'r.t:it:7Ctt fC. [,,ear ' �l Pi 3) 5 t.C:" 311C c.'bu r.ity Ji;A''j-c: i' ?-w,on ot Trey,y, S$. Croix Co ir'+j :r, r.i f r d V,.ri irice )"F_Ciues c -c,c` sx-ct.iC.I, xi_i AV� { 3i LI {a}, , .�� {� tt: ) I , IL1.flk. 'b ... '2 c 9 ro } { 3 , c . . �.�; IL e: : (!,) {1 } C:i tits: Vifx"ftb in 1;''.+e:iniStratitr`e i,uttf-- C.Ci zJ(!E:k'e(^ GF ut ly _'�:, !<i"'7. The )c,ti't7':+II j; 'aka ! E i@ CC'YIC�l z rjfta �y cle}�1F"UG'�:t.,. 1 iic, C`uw `�Ti6n -: Z nc '1,-h al< Slil�f :KatE-.,,r .JE: pert.:aafiE nt ly ct vertc. Z-.noun t;'ic z.,C'vne s stt'r.. j'e )"ides 1equiriF 'i.i?at a Ixii tit-S( ratio, sy:iCi: I t � )Cr rit?,( ftCi LIosf.' " t ?�;e« t(.et to c ti: xc v;f r'aC3P_ iLf !?GiA1iIPY? i3' .. 1k;O-i 'a.c}ble kui1i�'Mq; zi rEt}tari€:': sys'terl .at')r7ii l ?')C));, be Inf-Aalle(l, ovCir t i l l ; ti sy StE'rs! sha;,l l t,' #: ,::+:, i l-l:iti3l l tc? it) a core uG l,,.e r reii; a t ouivi Sy stew sf°bl 1 vyct I-,e installed over it i c:i ed 1 (:(°++►.VF.trt.7t,r';ti >y,rc.f_. y '�t .. c.'aX.'�i�:t.ai _.)�}C)..ia,• i Slope icy t3 C,;i�3u s. .t h' if the4 it��!' 'a (3 34i x e., s -'�n�.',.t Ci '�� w - ti:� C(.1` ')"t )"i:a�.t- is �.: LL: iE.aa ti`z�!rE ,,f, !�; �S j?t_fi 1.«Gk i'iii^ S�r: 7V' p ervie I.A'L' soil s % c et'fl u. 'rft sj`ti-�i i he c'i stri'-?ut;co n v.e tic k;'. ` b r trench vstcn,; a..rid VNC, dyiF � .A T-hi r) ' ., fe , Qt ii. toe 5S s<71 remain urdi�t,ii.rs �v ,r` ."', "f C.*s�f r> c ,c; r s c c ,i ti'; 'tkt« ups1Gpc' toe � tv i i, 1 C-t ,.:I «. '� > i t4�t:�.�� t3 yet: �' i(:4:'�"if;R'� !„te..., . .., veiw, iti+ .c trorl an kX'isting F�CUIVIIS absorption syster will h.r, Cs,a'.r f! i 1 ; .i ;Cif tion of "ti%e +C1 ±r'3SIi:i'it:' 1 I i 4Al i M-., over aill ,.: r9rii;C)nee., C'rive5'ay; ii por'ti civ.. <i"i �y a dz !.C'tyr:c 's E-n(''s I op e- will !>f' (:v or v >�:i l i nq conventional sysst'.em. ; i a*urw, a' �.1 i Lc'' i nstd'1 4k 1.. ii; an art---a u1 t•: slop(., v3.y'v"j i.'i'; Y` `._.;_f> to V'. f-` - rrin a P�'ICC`trtltt:i Y'c�tE tai i. � rsli.6i iTi �iiE' i�iiC'C: utii� � }, � ti)t1;ri3�i . sai l ; v( i;;Ui+1, -, -iJ 3 i susE i, i s toot. taut� L)O �; ,�7��1 c�G 'e { i tcii S f:+Ltxa tt!t`i. T1Gi:i 1. �c" s:G4}t'sG'1S tiiGt>is �i(3;ii Gt;€ . �1 Rr[ 1' ✓'' s7 VLO ' Alic -12 DILHASBD-6423(N.04/81) .State Of Wisconsin ` Department of Industry, Labor and Human Relations er SAFETY&BUILDINGS DIVISION r �)ul u J, ! l l Of t:1'10 C-At.C4 c lIC Stdtel!:IentS' S:ii nit;ted o)) [)eiia7 f of tiIt pe itiovrx '.'e re C oils i tjer d. T A s variance is specific to vie Srr >l eCt f;f't i i-il o l and Citr)rict be vse(:'. for all-*, ad 1 t1 Ci?ia� r?;t?e"i f 7 Ci>.t1 itil`)S l('IC P r(,1), , cc: . rGy j«i Sliy, Private SF_ rae !or.sifl dl# -1 iStriCt Clhippo,'a Falls _I op 110 son, Zor ,i rir, rT,lni ni stxator - '>t. Croix 9"ounty j�) ��!.�fr L.• �,�i�:�)�°r�f4 r', )%'dal i'<r!:'.r DILHR-SBD-6423(N.04/81) State of Wisconsin ` Qe�artment of Industry, Labor and Human Relations a u r:,�,• ..,,..;,, ,. .A�; •, .>...:..�F �F�t� :,:�G.ir :,441111 f#liFjROVAI.. SAFETY&BUILDINGS.DIVISION M kw of Divis, ri, C °i �3��i�t.:t Rdu ,t, •At)C) i ca{"-ion rYl WF U l+'ir Q, Wf F3>,1 Gl ,,dt:>;,;'l.r�i t:;, ( t,i'lE>; iti0P,I 1<1 1,1 NG 1'.0. 1>1)X tit 1,1oU l 1 '; ;Zal.'i lt•_l-f'i} I-K ti',I:1: 44022 R"d.Vl.R,d:Al,t_A.: WF 54022 ' .. w. R!' ; .`.liln v uilil'3F;k; Date -uqus t" 4 , 0907 r Bx`. • }.as,,] I«}<tt, t?cA r Da'4 : . !,( Dato loceived .t;t..t1:y 16, IQA7 1?rojact Name: i: :NG, l-tJr;lTti.l R1 >:.}l. !{t' i 6r"tjo}i, 0 ,01 34,78, 19W 1`t tuki, of ;1-ROY C:a,°aooty : ST (;l O I X The pll,'rLlll'ing plans and apeci t it;:af> on 3 for this l,"si njo Gt havc boon Y,o}(7ot.+!ed for c all,l.a tk'i(:Y, la, '-h a:p i c ab l o coci� . !his i approval s based � }:: ;hapt or t { T45, 1a1'f;.":<:: 'nsin St;v4+qt; q "1'd 1h , INt`,t':*.'ym i" Administrative rode. I ho );tans aro stay{ii!)k.k:a cE.nd lz:(onal l'/ ,d{:il:)i•(.tlC'd 1hi • Ala'>!;if'.wal i:'i nantin,Ii i}l. c;owp Banc w) any Kip"fations sli%:t+n on the }._ r,}") 1, All itG,l7s;; Thai .',ark not;E:+<a .must; tines correct:od . A l l s- X1411'mi `.i: i--C<d:"i.rod i: y k J,.s a it V '•iii inqo i•tawa"i`Si9i.I;}. or i:e)Liay ';i!"}all bu i}1;3'!.aii1P.i'l - installation . �rY J ft0' t'fa GCF'ir('k'id;';t:i.rt}::� l l'iE? { i r:s_�i:} ,,:.aj �>i,,iii)l",t:•.t i 6+iiiy;ll"k';:L 1i{(' for '1,1'):1.°� , .. "„>1'��..ta �hF?E,.�s �s:.'d13� set A:YI- )+l.d.l"i_> b1.L t.fl il;., -'d;l �,, :.i't:,ll�`.k'7 l ^lf��7t�r„t,�.k•-: `_.Y C'.d i7'tp a.���j':. l'!!tu construction ion sit;-? 3yi4,+ iClstitt. l.t.,,t lnl j notify Me a il"''!'it':il,)riat'.e', inaVoCt.or when li't is t_d!'at?i't;;,tla l wi ,1 l c;ht'i4 rp K" years I r , t::ho datp .JtT; tr,..iJ or if a ;t;i})"{'t ar y j:)ok tiii;t'; in obtainod,, i L will yxpiro t'-ho day Kho t,iM �. `ha ldt,iv'eau of Plt,itib:inq !-an rHui::wod tlrr •� �e- 1:}.L„iii5 for pI .>/:i•lp r,:e7cle {°'etlt.jti^crittc?1'i1'':i u •l.y Slit :o plans 1avo not 7Gt." i':.`l.tc+wod for l;tie a:t,daA irt?gl.If.•-9"t?tiU?i'tt 'i ,,E't forth i i#9 Section 11M BY for pyriccot plumbinq 50 64 of the +�, �• C7J1t.•i){"i}t.�i 9'�t,�iril&)ltit,i`i:ll;AaJ'' C:(,?t'�e�!.+1t,;- 'tr ,., Ttiiz ,u}IiLM"ov ,tl 16 for Iho fo1l:owi.nq ( �wpo"PnEq ;ntf':; l?i,JIL l a l. i•a. ION t:-C`tt:I4lFriv , a::(?1'il.efia'iinq thi.b aplfE^^r1wnij kHov bo liiaads by nallinq {60R) 1 66,?BRO ly �t PFM PAGE', <;ti?a ic:3n ca, Division t'f S h c to w and i !'•I,E i l d i nq'i M013/000YO/ J, cc : l'Ml'i KING G t-ai...i vot o s t,tzire<•11e:, 1.:C}i')gi,il tMi'i1 :4a i',t:,f ('s aeF"t!' l'l t,alitbing (,',C)Ylnu l t;an i DILHR-SBD-6423 (N.04/81)