HomeMy WebLinkAbout012-2001-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety ano Building Division
INSPECTION REPORT Sanitary Permit No:
515279 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Weeks, Tim I Erin Prairie, Town of 012 - 2001 -80 -000
CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No:
/d S• Z ,
Z65 Z 4.30.17.567C
TANK INFORMATION ; ELEVATION DATA
TYPE MANUFACTURER CAPA STATION BS HI FS ELEV.
Septic h O Benchmark
i
/ ���� '460 Alt. BM Q, IFZ• /61#'6 166
lf�v s" P6 '
d k. -a
Aeration J Bldg. Sewer r
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / Dt Bottom 1
Dosing Header /Man.
Aeration Dist. Pipe 9. C ,�
Holding Bot. System F �f 5�
d. 2
PUMP /SIPHON INFORMATION Final Grade 6,7
Manufacturer Demand St Cover
GPM la 3 , a
Model Nu er
TD Li Friction Loss Syste TNT Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length No. Of Trens PIT DIMENSIONS '*I No. Of Pi=_ Inside Dia Liqu Depth
DIMENSIONS
7 /ems La I
SETBACK SYSTEM TO U P/L BLDG t WELL LAKE /STREAM LEACHING Manufacturer: /
INFORMATION ��
CHAMBER OR 4
Type ggff System: � t / • I A. UNIT
GD� JGw�tZD �� � Model Number.
/1/
DISTRIBUTION SYSTEM 7 4- 7
Header /Manifol� #J Distribution x Hole Size x Hole Spacing VentjQ Air Intake
Pipe(s) �. �\ �� __
Length_ Dia T' Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth f xx Seeded /Sodded xx Mulched
Bed/Trench Center �� Bed/Trench Edges Topsoil g No s No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: IF /
Location: 1788 176th Str! New Richmond, WI 54017 (NW 1/4 NE 1/4 4 T30N R1 7W) Jewett Mills Lot 16- 22Blk75 Parcel No: 4.30.17.567C
1.) Alt BM Description = n ii.� Lb04'- G,` ,^
2.) Bldg sewer length = 4
- amount of cover = Ex�s�,
1
Plan revision Required? Yes No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepcto Signatur Cert. No.
coil U fNWO&1IfW1.90V Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
'�� Madison, WI 53707 -7162 Sanitary Permit Number (to b filled in by Co.)
51527
Sanitary Permit Application ,/ State Tran"onxumber
In accordance with s. Comm. 8321(21 Wis. Adm. Code, submission of this form to the aWgovernmental �f'f
unit is required prior to obtaining a sanitary permit Note: Application forms for Cate- owried POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information u dart'
purposes in accordance with the Privacy Law; s. 15. 1 m , Stats. X
L Application Information - Please Print All Info n
Property Owner's Name
::n motvtj �� Paccel 6 t — c)o l —8U- a
Property t Owner's Mailing Ad Property Location
r-Q Q 1 ST. CROIX COUNTY GovL Lot L • 67&-7 G)
F
City, State Zip Code NW 'V., NE ''V., Section
c�woal J (' t `r [ S o � (0 (circle one)
T N, R W
IL Type of Building (check all that apply) Lot #
�� )
1 or 2 Family Dwelling - Number of Bedrooms 3 1 & - 3 Subdivision Name `\
ry Block # �Q v.� " WA
S
❑ PubliciCommercial- Describe Use 0 1 7�
IT` City of
❑ State Owned - Describe Use CSM Number ❑ Village of
1 1 VOMDrs C9vJ ® Town of t`: ✓� �(L'1_ t n v `� J
r
III. Type of Permit: (Check ofitfwIwi4ex on line A. Complete line B if applicable)
A. 0 New System lacement Tmatment/Holding Tank Replacement Only Other Modification to Existing System (explain)
ystern
B. n Permit Permit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued
Renewal Before Plumber New Owner qr t/
Exp iration U
TV,Type of POWTS S tem/Com onent/Device: Check all that app!
Non - Pressurize In -Grow Pressurized In- Ground At -Grade Ll Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dilipersalirrreatment Area Information:
Design Flow (gpd) Design Soil Application f) Dispersal Area R iced (sf) Dispersal Area (sf) System El
5 0 17 `doe 95. 7
VL Tank Info Capacity in Total 1 # of Manufacturer ,
Gallons Gallons Units p
New Tanks Existing Tanks / Z C
c okling Tank V 0 O jC)O D (IJ 1 W+-
Dosing
Chamber
VIL Responsibility Statement- I, the undersigned, assume reqmissibility for installation of the POWTS sliopwvos. attached plans.
Pl 'Name (Print Pium 's Si umber Business Phone Number
v : LS Vla s
Plumber's Address (Street, City, State, Zip Code)
-" h 'e. Q' o .- W S Sv c))
CountyL kagument Use Onl
Approv — Disapprov Permit Fee Date Vsued Issuing t Si
Owner n ial $ Y76
IX. Condh�Reasons for Disapproval 3� 5� - �ev4�'�oJ�- re
I . Septic tank, effluent filter and
dispersal cell must all be services / maintains `7 fi „� �p ( A n
At per management plan provided by plumber. �� J � n/ � ,'.�
as 9K Makable code / ordinances, 2. AN selback tet>Juirements must be maintained t!:�CTG✓1 Q G5 6 r ✓ n1 Jam
Attach to complete plans for the system and submit to the County only on paper not V than G 8 v2:� es in size
o��Q s d a o G 'a
SBD -6398 (R. 01/07) Valid thru 01/10
LT
N U-) �� N' I ,3o N R 17 co
Qr ��
l 000 � / � �c_ , /i,�; SaS
Q
# ). ;L C)
Aklt� / - z h 6 s�cAc
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r a
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Tt ms�6\j N R 17 W
L mj � .c. /r.� ►�s��s ��ol Sas
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: — r N , yy\n+�\Jf �-
Owner's Address: 1 S R
I v-wJ �c= llv�Or1 ��� S cG D L T
Legal Description: _ )v W IV 01, S 1 1 W
c
Township: E r; r\ P", < r
County: Ste M
Subdivision Name: w
Lot Number. Ito — 3 D
Parcel ID Number. iota -a00 — W 0
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross - Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 _ Management Plan
Page 7 St. Croix Cty Septic Tank Mainte Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attac ents: Soil Test & House Plans
Designer /Plumber: �o� License Number: �3
Date: Phone Number
Signature
Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01).
Page 1
I mom �QC�
y
EZ1203H
` • -•'•- letavaa
PaOOa
I-W da _ _ _ aaPa P9d I �y
2
FF /r
dOb
vvv oav
4" ve
.625 a ae
eov
4 0
vba 2 " 1/2 Circ. = 18.84"
vda
avv vvs
vva Pba
av0 add
add 7ba d♦ b
adedve� b- ♦Vlvrvvlvvvvvlvll evavvdd
PPa7aba aed7Pa 77y77777 a177eP 7
ea7P9'7V V aPaPP774PPV b7 dOldta a..
24"
8 Bottom
36"
Void Volume Soil interface Area in- 1Ft �q
Void Coefficient in Aggregate given at 57.4 %. Sidewall (2 Sidewalls) 2 r 1 '84in = 3.14
O.D. of 4" pipe = 4.625 inches 2i
23t25in - Ift
Void volume per linear ft. = 3.14 •( MUM MUM �, • tft = 0.1 t7 ff
Bottom 2.00
-
O.D. of ce»terrylinder= tZ.S inches Total Soil interface Area 5.14 SQ.
Void volume in agwtgste of center cylinder =(3.14 -( 6.2 1' _ 334•(2JI25 n ! - .57 4 =..422 1,=
O.D. of cylinders = 12 inks ` l Projected Trench Area
Void volume in outside cylinders = 2.3.1 but 574 = .901 fts Sidewall Height — 1 Z in. •2 = 2.00 Sq.Ft.
tF2iuJR, �
( ( r Bottom = 36 in. = 3.00 Sq.Ft.
Void volume at bottom between cylinders = �t lain • 6in 3.141
l
[zinJR 12inJft Projected 112inJR • � =02 t 5 ft' TrenchArea 5.00Sq.Ft.
Void volume at outside bottom corners (112 of void volume between cylinders) 0115 12 — 0.108 fe
Total void volume = 0.117 + 0. 422 + 0.901 + 0.215 ' 0. log = 1.763 cubic ft J ft
Gallons per ft = 1.763 X 7.48 = 13.2 gallons Per linear €t.
3 f1 X 0
EPA Aggregate
Trench System
EZ1203H EZ flow
kin '
g lndustrlai Group
65 }ndus#cial Park Rd. _
Oakland, TM 3,8060
SCALE FILE tM EZ12oJit -rat SET: 1 of 1 11-27-01
T l s
PL_ i25 EFFLUENT FILTER .� 4
Polylok, Inc is pleased to introduce its new commercial
filter to its existing line of quality effluent
filters. The PL -525 is rated for over 10,000
GPD (gallons per day) making it one of
the largest commercial filters in its
class. It has 525 linear feet of Alarm Accepts PVC
1/16" filtration slots. Like the accessibility extension handle
Polylok PL -122, the new Polylok
PL -525 has an automatic shut
off ball installed with every fil-
ter. When the filter is removed 525 linear feet
for cleaning, the ball will float of 1/16"
up and temporarily shut off the filtration slots Rated for over
10,000 GPO
system so the effluent won't
leave the tank. No other filter
on the market can make that Accepts & 6 -
claim. Why have a filter at all if SCHD. 40 Pip
the effluent leaves the tank during
regular cleaning?
IOWA
AIL
.f
}
See Polylok's complete
line of products by visiting Gas deflector
our Web site: Automatic shut -off
MENUEN
ball when filter
is removed
wwrwr.polylok.com
TM
I nc.
I F! pital Drive, Wallingford, CT 06492
4S 1- 877 - Polylok (765 -9565) Fax: 203 -284 -8514
E -Mail Address: salesopolylok.com A Pro raster
Made in U.S.A. Web site: www.polylok.com Working For
Precasters.
M:
POWTS OWNER'S MANUAL & M ANAGEpllEW PLAN rage
ALEg� ATiOM $YSTEpII SPGATIQNS
Owner
Q Septic Tank Capacity 13 MA
Septic Tank Manufacduar ` , (' D NA
VES PARAPAEfOn U film Ma t 13 NA
H m*w of Bednxam _ O NA_ Ettbra�t Fbber Model
UNA
Number of Fadgty ilruts nmp Tank Ca;usoity t3 NA
Estimated fbw laver a) _ pp Pip Tank Manufacuffer DNA
Oewan flow (t , l Esti<rnemed x 1.5) Punw,Manufacdaer DNA I
Sol AppBoado n Raw pmv mom
G NA
Standal+d #nftuent/r�ent Ohl.. - - awe�e" Pnat�amanedt lhcit DNA ;
Fats. Oil & Grease MOM S30 ncg/L D Sa ndKbavef Rker D - Peet filter .
Moctmn*W Oxygen Demand MOEV :SM mg/L D NA D Mechanical Aeration D Wetland
Total Suspended Sows norm 5150 - a l lsirlfticion a OtH►er:
Oxygen Oeahend I1311M :M *+ - ln- tAoccnd tP t
Total d Sops : [fSS) 530 am& .. - :D NA:. ! A t-G D Mound
Fecal CaMmm Upotnetrac mean) :..10 iu/ 00" Drone D Other•.
Niw* n= Effhrent Particle Size )fi in die- 13 NA er:
i7 NA
011ie. D NA Othm
'Yahrea tYPk far domestic wsstswmw and sapdc mNc eflivecrt: DNA.
M ISAANMSCHEMLE
- Saeeioe.Eveirt .. - . _ , S�arrloe Fi+egn� .
bnpei*conMm of tankts) At issst Onrle avenyz 3 rrnonOtsl 3 yeas) Cl NA
Pump cut cornteihts of tankts) When corMhinad .akidae and scum equals onq V" (Yj of tank vakffne D NA
61apeat d =MS) At once every: _ - ) S yout) D NA'
trhaertttts) .:
Clean etfbmnt low 7 At .least atlas every- �: thonth D NA
kimpect - 9 urhonthts)
. Panp. punW c:orubnls & alarm At least once every: _ Q � - DNA
11vsh Warms and preestua test At lei shoe every::. - D lCsl O NA
Otlieh:
-
month(s)
.. -.. • - 'Q NA
Oder:-
D NA
filAlfilTfglIANCE '
6apectiorns of tanks and dhWamal ceps d" be made by an kWkriduull ca Vft am bf the *ftw m Iki -is tin i7f bill'.
Macs. Pkxnber; Master -Pltanbec.Restricted'Sewer fsupsua: POWTS- Mdntainar Septags Serving Operator. T"
khaF aMians must km:ki e a vkud bumeodon of ttns! ankle) to iderft any n wing a' bn*m hwdwwo Ider"y any aacfes orleaks,
measure the voltaa of ean*kwd stodge and - scan and to check tar -ant/ back-up or pondke.oat etfluent,.an.the gromW surfae.
c
The dispersal asks) stag be vkuuaily :1�. cbaak the eflkma levels in- the observation pipes' M chack lor any p *ufi.M
of etffi�rit an the - eurfaal." The piorM�:af"e#Rtreirtan the graartd surface cash indi�sataiing.coaditlaw - aiwi fegldr+efEtite
I xNats !noun of the boat .may auth ky.
VAm the combined aoewnniaatiott of sird);e =W sotfm in any tm* equals ohs -d*d Wj or ..are of the nk ta vakmv& Sus entb
cantarnbs of the tank ahai be =Z by a Ong Farrel - of in ascar#ancne with cinapDar NR i 13,
Wisoondn 40ve Code.:.
: Ap other services, kmkjcft but not pnnitad tD the swviokq of ef&Nm filters, mechanbel or pressurized components, prehsatrnsm
u n c l e , and =w mnft n g at ihtervats of 512 rriorhd - hit" - be p m l b n v u s d by a ceerWled POV"Mariner.
A service mport uihsup, tie - to iooattsgtdaborysuathorit.Y t+vhiuirt 70 dayrsof pampietiort of arty soervioe.enceni .... ::.
START !!P AM OPBiATIOMI
paps 2�1_of
For new lion. prior to use otibe F*WT8 d um m vt tmdctaf for toe presence of -ping produa wer+eilaet°.alteaaioat
flat met/ impede the l ibldni0l , t 1 1 a 1 and/or darrraall the dispersal COW. N t(qh ooracerwo ellorns are detected have the oorate ntr
of the tw*W nmun ed by a septage servkft opoc t r -prior m use.
System start up anal not occur who - *A condiborm are frlomm at tie infitradtre saafaos.
adne Power ousmes pang to ft Maya o raainiel taiptrMia'tu levels. When Power is r+sssored the ataxaar *01 be
irged ti the dispersal oeltld in ale W". dow overbedlIft*0 cdW 'aad - � ;spilt in tlis bacw� oa awcfeiae.di ier00 a�
dflnod. To avoid this aiosssion have the nil 02100 if Ift amaj ti** rmnnvrad - by a Septage Servjc g Opal Prl�i to nmMkil
Power to the efflum t pump or eontact.a flanbw or POWTS intainer to assist in menuaiy oparatiug the - pump ooni mb.iu
tsetors normal levels widdn the pump Lnk.
Do not drive or park vetaits over tapirs and dual -onds. Do tiot.d*m or park over, or odmwbw dissurb or compact, the am
whliin 15 feet dawn slops of any mound a at-gradsssi mi 1 m plip area.
Reduction or I of the loiowig *610 1I10e a0" A .1 a mW inpmm the peribnsun m asd. j nil q tai
POWTS: midbictlim baby wipes; aigstrrtim aorndsosual eoseon dsgrsassm dense, Some; dleperm qg fat
foundation drain !sump pump} water, fn* and Meds6eibie pmel's 9 9 ;treat "acrapay oit
'I l' g produeft; pesticides; sancta y mapldM sm iN m and water saftener brine.
When the Pf1WTS leis endlor is pernmen/rlt A i cut of service On steps abets be -telI a to beam tt"t - tie system b
. P�h► and sedaly abesndoiaad in oornpi•nos d 83.38.' 1MMa.r mini�tsRlua C�odac
• All Piping m tanks and piss alai be disooaas l m and - tie abandoned pips openings ssels&.
• The consents of of t wft and pits dud be'.m. d and pneperly dimposed of by a Septege Swviciad Op ra w.
• 'After gal pb Mid !asks and pits alwB - bs eoroava ted - land removed or their ow*ws removed and the void opus low witi
sok grem el or anorther inert solid rrresafiei.
PLAN
R fie PCIWTS faits - and omm of be repaired the lalln 1 1 baW tomm. o r m llerb4 talcom w prvrids a sum taamppFAa
A suitable has bow evaluated and may be udl=d for the location of a anent. m*
syaesuirL Tlis taplaeerru t, �s skoui''be prodfirlrr dliWrbenee and aarurpacdc and show ;gad tipon M
dbaoks.irart lift aid pr'oPo$j sglu0tgrs..bi: iraels and r�teNe, m pr�oseeft '
Sa*dMd.s tlne'i
+eplaostrrsrnt,arsa wl
rem* inane rased_: for anew sound alts evalradon tps!tsiiRefts.aaita6le replacernerrt ores. Repl�ar nt sys�o�ns
- con * with the ndss In -allied at that brae.
Ci A sine. - replacenwa aria is not mvrlifsinm _due to as and/or; soil liudeatiorrs. 0*** advariaes- in POINT,
t�euabnology �.boldit�g tank easy be taied as a met roeat t4 r ags;hs fuel! Powm
11 The site has not been,anreiueted to identfh/ a sultdWe reploommer vm& - Upon fafte of the fOtl W a soil and aft
evaiu dm must be pwfowmd 2m'kx p a adtobb r+spleserneil arse: `if no mat area is ova a_ 1 Whig turns
may be installed as a Ina r+ion to rapieae tab toll POWTS.
D ilcrttad and af:grads
_
iafNlir a ti sssurface. Reoo�F�ifier -
6e necorrstracioed is -_
place- foioowlttg tarrrovsi of the bi4>�t as �
_: -KW #= O`D= Tti ;gff9lT TAW MAY CONf`ANI'LiTHAC G $=MR / CR1A1i' O)CWGM DO I'
R A SEPM. P~ OR O' IM IVIEfCf m TANK INDt?!t ANY c m6la rlAm & OEATff MAY R66t![.T. -m - i
1 0111_IM M U MWiM=DF ATANIC_YAY.M q .TOR tMOSSNRE.-
aof�lTloNac ool�lerns
rrsr caws IIAAWIT - -
ANarae
- o -
» �s a s�
SiN'TAfN: SlilV1IW1� OPfiRA p'U�Sii LOC`.AL AA1THOEM
7, R i
Phone
1Ws doc mm at was *atosd in compis m vA& tenapioar Osman 83.22= if 1s M mid 83XMII. W 6 M. VWsmwb Adnai *Wmtbm Cads.
START UP ANi ORRAT101il Pap Zof
For now cons n, Prbr ID Use GfVW POWTO dW* blea ne nt tae far the presence of PrpdcNBS t9r other°.ehernir
OW may impede the ubati
prochesa a Uor darrnage then ceNW. ff Ngh oanc errtryetions are detected have the
Of the tarsi W removed by a she servicing -app prgor to use. _
I" up shad not occur w tan -po31 bra are *Oman at t#0 bdliWadve ateface.
DWkng power ouawas pump tenica enw-ft aH6ine► rnoiNINaf lwainvater i wdo6 When_ power b restored the yam be
dbdmged to the dbpwad c aNd in one a ce�[s) cad n ey rssidt in ttie ba�darp or avr6BOS of
affluent. To avoid Wn Aftuadon have Vw ocinto ls - Of-A :pump tame ranoved a Septaas Servicing Opaatim, pith". to nwborba
power to the afflut Ct purrs, or cantwt,a Pinnnber or PDWTS Hefner to as min t in rrramrft open the -pip '.tb
rOMM 60nn l levels widnin tha pump mrd . -
Do not drive or pwk vehicles over 'tanks add disband_ Do.'tct :drive or Park ova', or odierwiss'dletteb or OWN Pam 4 tlte..ama
w a 15 feet down slope of any mocrnd arm sod abswpdpg ate&.
Asdnctior► or•� of the *amt fnQ * om *o waeiesrvsw,stnvspn MW bwrwre the pWffiWU rroe end. p�ixrg 4,1001ie of the
POWM* a d bfo baby wfpea; cigarette elsetxan de8reasar dental floes toaper dir�its fat;
foundation drain trump pump) water, fruit and P t V g habicidm mess ntedbift M oW
Pdntliig Pr 1 end - Wate r sotLerier brine.
ABANDONNOff
When the PCAM fait and/or Tie pwnunNgn* t+do I oHt of service tho l o n oiritrg soaps sbM be ftb o Lo. -n"Wo thn floe system Is
�.
_Vw Y 8rrd se!fadlc abandoned inpie,,, traltra C
• Ail -piping to tarriae :and pits sireN be pant sd and-dw sb+andaned pips openings seated.
• The centents of at tanks and tits Shall be'mv and property di posed of by a Septagei Servi*V Operator.
s - After � ae tanks and
pitis atiall be eot+seve�oad'and regnoved ortheir covers removed and ttw void apsC.e fmsd with
aog, gravel or arm inert sobd rnroM.
OONtp�lAEi11CY PL Ml
If the POWYS fafls - and cannot be repaired the folowind mo awee have been; or want taken, w pnoWide a ccida
h
qlacwnent system:
A suimble nv4scunent area has been avakmoed and may be udlioed for the location of a nrpia nn tt.soil_ : a ion
s "'fie iee�s any :be
1xvitemod fr+attr di bernce'aratf aawnpscdar so slea�Wtl tat'bs irdrirged tcpor, by
x j+ red. frforrr. sa p. wind: inoPase4 . ..tOt Knee and ,. FOLOO tau prate ft'the eq�t :area WIN
roprk in the-need-for a new stir srid site avaNraOiog to asst ,wain we r"*WW= t area. Repiaaen! nit
. syst�ns pwaE
- comply wiHn tits rialea fn elf`sot at linen tine. - - � . .
0 A suitable- -�i area is not
eivsilable to sekbadc attiii/nr'.sop bona. fNatring_adi►ainsas b 'POWYS
pelf a. raMirng 'tank A/ ba lratalled as a leaf rpsM'ja tide the'failsrf F'OWTS.
Cl The Site has not been :avtinteted to identity a tuftwe replsosiait)waa: - tfpcw-f66" of to fOWT8 a sog and sits
evaluation must be_perfoaned -2o'boom a suitable wit areas `i€ no noplacunent area le avalidge, a -hok%V tank
msy be irvggiiisw as a last 0sart to riepics the f0ed POPW7 .
D -Mound and at wade safE abab on s"amm +mall be -nom in plate - falbiving ameoval of the I i;t at #W
Reoo'+ �1 - - r tr>as•in.±esEsat - _
•PUMP Am OTHM TIMMO r TAW8 MAY cW AfNi UntAL 6A=n ANDtoit Yt�tiFAgi6lT OXYGM 00 fIOT
=MUR A SOM, PUMP OR OTHER'111 axne i1T TANK u*DER ANY INSM& DEATH MAY R6SULL -OF A
: PamOlii.iu TfM. tDF A TANK.W"
. 811 gli tN.T on MOSSMW
ADDT110NN1. UOIS
Name ..
Ph�'e
SMTA6il: SERVKMQ OPtsRATQR ► UXAL t QUlAT10Rlf AUT11101 'Y .
- •Trans ,._ _ _
Nairiet. S ' ' x) ZO rO
Phone Phoins S
TliTe docuiiierN was drafted in aaiarams wbh dtapmer Comm 83.Z2iZl(bNilWl�tl acid 83- 54171. (?J 131. IAli�ormin Adx*6tnAFve Code.
SEPTIC TANK MAINTENANCE A
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
� S
Mailing Address ~ (S�
CO cd
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City /State _ _
Parcel Identification Number, _ a, co I
GAL DESCRIP _
LE
Property Location N W 1 j
AL
,Sec. T 3 D NR_)_� W, Town of �r;r 40, 1 v% I
Subdivision �
�
Certified Survey Map #
Volume ,Page # ,Lot # (_0
Warranty Deed #
Volume Page #
Spec house yes no Lot lines identifiable & no
SYSTEM MAINTENANCE
AND OWNER CERTIFICATION
IrnProper use and maintenance of your septic system could result in its prematur e failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed the system can affect the function of the septic tank as a t 3.52(1) and
in Chapter 12 - St. Croix County Sanitary stage in the waste disposal system Owner maintenance
responsibilities are specified in §Co mm. 8 ra ordinance.
Pier What you put into
tary dinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification fo
owner and by a master Plumber, journeyman: plumber, restricted plumber or a licensed, signed by the
wastewater disposal system is in Proper operating condition and/or (2) after inspection andu mf recess I) the se ite ti the on
less than 113 full of sludge. p mp g (if p c tank is
I/we, the undersigned have read the above requirements and agree to maintain the rivate se
standards set forth, herein, as set b the P wa a di
y Department of Commerce and the D _ g spo
system with the
Certification stating that your septic system has been maintained must be completed and returned o th St C Croix o nt ty s Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. I/we amlare the owner(s) of the
Property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANT(S)
DATE
` * Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
nclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
eference is made in the warranty deed.
REV, 08105)
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man
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low
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, 1 �,—, ��••• KJ 6 •J ll
paronwrttofindusby, SOIL AND SITE EVA1_; ON REPORT_ -. �.3�3 ",: -.t pop
h _
of
-,a, R.rauorr3
'y a Buiidnea ,alCt ord wlth iLHR rr: ,.dm. Code OWNTY
Attach complete site plan on paper = riot ttlan'81/2 x_11_ir�tes in size. Plat rwst induce, but
not limited to vertical an , d •horizontal Point (811�.diraction and % of s1c ;pe scale V ) AACEL :D:
dimensioned, north arrow; �locati r r rtd a d'startce to nearest ` md. 12 - 2001
APPLICANT INFORMATION- PLE�ABE POINT ALL, INFORMATION I�1� REM! �"
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT NW 1/4 NE 1141S4 T 30 17 ids W
PROPERTY OWNER'S MAILING ADDRESS LOT BLOCK a SUED. NAkE OR C s
1113 Hy #64 16 - 30 75 Jewett Mi11 s
CITY, STATE ZIP CODE PHONE NUMBER []CITY [VILLAGE JaOWN NEAREST ROAD
k J New Consfttxliort Use ( flesideaf41- Number #betfrrooms [ j AddifW b existing brid tg
-Public or oomnteraat dfest�e
Code derived daily flaw 450 gpd Re=mvnded res ign loading rate Z —mod. gpdfii __.ft_ trenck
WW
AWarptiat area rehired 643 bed, 11 563 frmtswt, ft Maxnnum design oading :ate _ _'7 iced. gp *_.& - trench, gPd/i�
Recoa coded Mellon surface elevatiorgs) 97.20 alt a rea-- 95.87 ft (as referred b site plait berchmark)
Additional design I site corsiderafts
Parent material stream -terrace— Flood plain elevation, g appGcabie ft
S = S:tiwe fior S�ISlefrl CONVE MOW mOUND N.GRO PRESSURE SYSTEM IN FILL HOLIVIG TAN(
U- tlnsrdfablefor as o u ®S [ u Gas 0 1.1 i3 s[ UND u Gds o u o s 7u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boutdagl Roots GPD/ft
In. Munseli Qu. Sz. Corti Color Gr. Sz. Sh. Sec rertd�
1 10 1 3/3 none 3. 2msbk mfr gy 2m .5 :6
_ 1,
-. 2 0-29 10yr4 /4 none sic3. 2msbk mfr gw !f ' .4 .5
Gmund 3 9-48 7.5yr4/6 nacre ifs 089 mvfr gw na .5 .6
efev. '
Ql.. tL 4 7�yr4y6 none tYrs Oi3g - -- r na na . 7 € . 8
Depth to Z
limiting -
fac�r 4
+88
Remarks:
Boring # ;
1 10 10yr3 /3 none 1 2msbk mfr gw 2m .5 's .6
2' 2 0-37 10yr4/4 none sici 2msbk mfr 9w lm .4 .5/
3 7-48 7.5yr4/4 none sl 2msbk mfr gw na 1 .5 .6
Ground
elev. 4 8 -90 7.5yr4/6 name e0 s Osg ml na na .7 1 .8
Depth to
X 1,2 ft.
Imi6ng
factor
+ 9 11 1
f
Remarks:
f A ST Name:- -Pleaw Print L. Steel Phone: 715- 246 -6200
da ress: 1554 ve. New W154017 te' Date: 12 -11 -96 CST Number: m02M
MPERTYOWki .. alle Bldrs.".y _.. SOIL DESCRIPTION F +- Pape -\2-'
PARCELt.D, x_ X001 -
Depth Dominant Color Mottles S c ucture GPD /ft .
Boring # Hodzt .- ; in. Mur�se{I Qu. �, Cont C, Texture G r .Wiz. ConsisWM Boirday Roots
Bed amch
1 p -10 10yr3/3 none 1 Ugbk r rte. r •
3 —
2 0 -31 10yr4 /4 none sici 2msbk mfr gw im .4 .5
Ground 3 1 -50 7.5yr4/4 none is Osg mvfr gw na .7 .8
elev.
)02ft 4 0 -90 7.5yr4/6 none co s Osg ml na na .7 ':. .8
Depth to
seating 1
Remarks:
Boring #
1 10 10yr3 /3 none 1 2msbk mfr GW 2m .5 .6
4 2 0 -31 10yr4/4 none scil 2msbk mfr gw 1m .4 .5
3 1 -39 7.5yr4/4 none sl 2msbk mvfr gw. na .5 .6
Ground
dev. 4 9-84 7.5yr4/6 none cos Osg ml na na .7 .8
►9 tL
Depth to
talor
artp6 '
+84 1
Remarks:
' Boring #
1 9 10yr3 /3 n one i 2msbk atfr 2f _._ .5 .6
5 2 -27 10yr4/4 none sicl 2msbk mfr gw if .4 s.5
3 7-40 7.5yr4/4 none F, 12msbk mvfr gw na .5 .6
Ground
dev. 4 0 -80 .5yr4/6 none co s Osg ml na
9 ft.
ID
+80 .�
Remarks:
Boring #
E.3
Ground - --
ft. – — - -- - - - -- -
DeDM to
Lt
Nm�ting - --
fa�
STEEL'S SOIL SETS,..-..._.
Gary j.:_Steel
1554 200th Ave.
_ _-
CSTM2298 Halle Bldrs. New Frmhmond, WI 54017
MPRSW 3254 NWitNE% S4- 73ON -Rl7W (715) 246 -6200
town of Erin Prarie
lots #16-30 -block 75- Jewett Mills Plot
N
1 "=40
Eft.= top of 3/4° pvc pipe @ el. 100'
Alt- . - -BM.= nail in Oak tree -o ol. 104.00
7 Garry L. Steel
12 -11 -96
r -
r �4�: o�.
VOL 1218 PACE069 ,
.s
DOCUMENT NO. State Bar of Wisconsin Form 2 -1982 — -
A I C 11—
WARRANTY DEED 5T. CR01): CJ. Wi
ttilCd lair Raoaa
JAN 13: 1997
Halle Builders, Inc., a Wisconsin corporation conveys and warrants to t Ut 8:40 Agr4
Timothy A. Weeks and Kelli J. Weeks, husband and wi& as '-- " IdA
survivorship marital property, the following described real estate in � Aaqww of Doe"
St. Croix County, Wisconsin:
VAMP, AND RWrURN ADDRESS
REMIN43TON LA W OFFICES
P.O. Box 177
New Richmond, WI 54017
012- 2001 -80
(Parcel Identification Number)
Lots 16, 17 21, and ..•22, EXCEPT the East 6.0 feet thereof, and Lots 25, 26, 27, 28, 29, 30
and 31, All ",being in Block "7S" of the Plat of Jewett' Mills.
$ T-�n'`a FER
This is not homestead property.
Exception to warranties: : and zoning,ordinanees, easements and restrictions of record.
Dated this 7 �' day of January, 1997.
HALLE BUIL ERS., INC
By: West W. Halle, President
and B : Linda R. Halle Secret
rY
AUTHENTICATION
ACKNOWLEDGMENT
Sihnaturc(s)
STATE OF WISCONSIN)
autheldicated this _ dap nC_ "__ ) ss.
1997. ST. CROIX COUNTY )
Personally cane before me this _z —/ day of
January. 1997, the atbove named Wesley W. Halle and
Linda R. Halic as officers of Halle Builders, Inc. to me kno%vii
to be the persons who executed the foregoing inslnintent and
TITLE: MEMBER STATE BAR OF WISCONSIN acknowledge the same.
(nutharmcd by Sec. 706.06, Wis. Slates.)
THIS DOCUMENT DRAFTED BY: ImvPYOtrO� 1Mx —,
Remington Law.Offices Notary Public St. Croix County. Wis,
P. O. Box t 77
Ncn• Richmond, WI 54017 My commission is permanent. irnot. state expiration
date: 5-1// fig7
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
?,.,J .
SUBDIVISION / CSM# LOT 2
SECTION 3a N -R W, Town of S� M`•
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
.� Y7
7 �--
1
INDICATE NORTH ARROW
d. L
/ 90
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 3 / / l/C/ � �0
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: 40LA � Liquid Capacity: /D6V
Setback from: Well House C 2,ff Other
Pump: Manufacturer Modell Size �--
Float seperation Gallons /cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
i
Width: / Length Number of trenches /
Distance & Direction to nearest prop. line: So,
Setback from: well Hous Other
ELEVATIONS �/
Building Sewer ST Inlet. 9' 9, gT ST outlet
PC inlet ,y A PC bottom Pump Off
Header /Manifold 98.3 Bottom of system
Existing Grade ,/(Td_ Final grade /40.
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: 16�
INSPECTOR•
3/93:jt
Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION a8 a
Permit Holder's Name: _ ❑ City ❑ Village WTown of: State Plan ID No.:
t l ev CST BM E Insp. BM Elev.: BM Description: Parcel Tax No.:
106o mQ. c 01'L - 2 60 - 20 - 0
TANK INFORMATION ELEVATION DATA AR '+ 0 A A
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 4 Benchmark /DUB o
Dosing
Aeration Bldg. Sewer
Holding I St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet ��g� qq, pg 1
TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet
Air I
Septic > a g ' _ NA Dt Bottom
Dosing NA Header/ Man. B, 0 /9. 0 /
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand J
Model Number GPM
TDH Lift Friction System TDH Ft
Forcemain Length Dia. I f Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /a .5h / DIMENSION
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
r L- ra'�2: l -C 1 ell
4,
Plan revision required? ❑ Yes [dNo
Use other side for additional information. r� 0 + 6 1 , F 01
SBD -6710 (R 05/91) Date nsp ctOf's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
4 JA
a
-
e
a
E
- E
f
e
i
i
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Buildin water Systerr
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size. -S - t C C
• See reverse side for instructions for completing this application state Sanitary Permit N mber
The information you provide may be used by other government agency programs ❑ Check if revision ` tt to oprevious application
IPrivacy Law, s. 15.04 (1) (ril State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property 0),vne Name Property Location
4.11 A - Cc S n X1/4 E 1/4, S T, N, R 7 ,$for) W
Propert 1 I i n�er's M� Add Lot N mbe Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
I. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Road y.
c h S 1
❑ Public 1 or 2 Family Dwelling - No. of bedroom ❑ Village s _ Town of n` ppcl
III BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s)
az- �
t
1 ❑ Apartment/ Condo
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
5 ❑ 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_ � New 2 E] Replacement 3_ [] Replacement of 4 E] Reconnection of 5 E] 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
11X'Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
lU 97. Feet 14 Z Feet
Capacity VII. TANK in allo s Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank ppp a ,� El 1 ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ 1 ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for i sta tion of the onsite sewage system shown on the attached plans.
Plumber's Nam (Print) PI tier's Si atur (No St ps) MPRSW No.: Business Phone Number:
it e . �,... jr 151173 G Is a (v 5 l S
Plumber's Address (Street, City, State, Zip Code)
IX. COLIN TY /DEPARTMENT USE ONLY
❑ Disapproved SanOrY Permit Fee (Includes Groundwater D ate Issued Issuing Ag Tit Signa ur No mps
Surcharge Fee)
pproved ❑Owner Given Initial %� i.�
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Diw_-ion, Owner, Plumber
f
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 -3815_
To be complete and accurate this sanitary permit application must include:
I. 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/ Department Use Only.
Complete plans 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) cross section
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.
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PAGE O F
1
CroSS S ecjlon 0 Sys�en -�
Fresh Air Inlels And Observation Pipe
1 Approved Vonl Cap
Mintmwn 12 Above
Final Grade
20- 42 Above Pipe _ 4° Cool Iron
To Final Grade Von1 Plpe
Maroh Hoy Or Sy E gg oming
MiQregale
O
Olilriballon — Tee t
PIP :1104 """• 0 0
6at e Perforated Plpe 6e1or
Blpe
o _ Coupling Terminating Al
110110m of Srtlem
in h c'< v
.. SOIL FILL
D1STK18UTION PIPE
APPROVED S�WTUETIC COVE
O R 9" OF S'TRAM,
e OF AGGRE Ott MARSH HAy'
lo.0r P —/r op �.
e 7' z AGGREGATE
!� \
L V. o \
� E EE
F
J 7
DIS rRI9iJTI01J PIPE TO BE AT LEAST WtNES BELOW ORIGINAL GRADE
AQU AT LEASTZO INCHES BUT,KIO MORE TE A.Q 42 IMCNES t5ELOW FINAL GRADE
1`U IMUM DSPrH OF F-XCAVAT100 ROM 0WIV ,1 (9 AvR wll_I_ BE INCHES
MINIMUM 9Ep7'ti OF EXCAv/iTImN .ROM. c 1 (-ItJAL OR49E WILL. 6E �_ INCHES
SIGWEO: ) c�
LICENSE IJUMBE R: ✓ .
DATE : � —<
Wisconsin. Department of Industry, SOIL AND SITE EVALUATION REPORT Page -/_ of —3-
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 012- 2001 -80
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Halle Bldrs. GOVT. LOT NW 1/4 NE 1/4,54 T 30 ,N,R 17 ,(or) W
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
1113 HY, #64 16 -30 751 Jewett Mills
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE JaOWN NEAREST ROAD
New Richmond WI. 5401 ) - 176 th. St.
: k ] New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate _.7 ed, gpd /ft trench, gpd /ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate 1 L bed, gpd /ft - 8 - trench, gpd /ft
Recommended infiltration surface elevation(s) 97.20 alt. area= 95.87 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material stream terrace Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ®S ❑ U ®S ❑ U 76d S El j7 S El U [R S ❑ U EIS i] U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
.................
..................
.................
..................
1 -10 10yr3 /3 none 1 2msbk mfr qw 2m .5 .6
2 10 -29 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
Ground 3 9 -48 7.5yr4/6 none lfs Osg mvfr gw na .5 .6
elev.
10 4 8 -88 7.5yr4/6 none ms Osg mvfr na na .7 .8
Depth to
limiting
factor
+88
Remarks:
Boring #
1 -10 10yr3 /3 none 1 2msbk mfr gw 2m .5 .6
2 2 0 -37 10yr4 /4 none sicl 2msbk mfr gw lm .4 .54
3 7 -48 7.5yr4/4 none sl 2msbk mfr gw na .5 .6
Ground
elev. 4 8 -90 7.5yr4/6 n.one "' Q,e> Osg ml na na .7 .8
101 ft.
614
Depth to
limiting
factor
+90
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200 ve. New Rich and WI 54017
Signature: Date: 12 -11 -96 CST Number: m02298
PROPERTY OWNER Halle Bldrs. SOIL DESCRIPTION REPORT Page _2
PARCEL I.D. # 012- 2001 -80
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD Z11
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed
1 -10 10yr3 /3 none 1 2msbk mfr gw 2M .
3
2 10 -31 10yr4 /4 none sici 2msbk mfr gw 1m .4 .5
Ground 3 1 -50 7.5yr4/4 none is Osg mvfr gw na .7 .8
elev.
100 ft. 4 0 -90 7.5yr4/6 none co s Osg m1 na na .7 .8
Depth to
limiting
factor
+90
Remarks:
Boring #
1 -10 10yr3 /3 none 1 2msbk mfr GK 2m .5 .6
4 2 0 -31 10yr4 /4 none scil 2msbk mfr gw lm .4 .5
3 1 -39 7.5yr4/4 none sl 2msbk mvfr 9w na .5 .6
Ground
elev. 4 9 -84 7.5yr4/6 none cos Osg ml na na .7 .8
99 ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
1 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6
5 2 -27 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 7 -40 7.5yr4/4 none sl 2msbk mvfr gw na .5 .E
Ground
elev. 4 0 -80 7.5yr4/6 none co s Osg ml na na .7 .8
99 ft.
Depth to
limiting
factor
+80
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Halle Bldrs. New Richmond, WI 54017
MPRSW 3254 NW4NE4 S4- T30N -R17W (715) 246 -6200
town of Erin Prarie
lots #16 -30 -block 75- Jewett Mills Plot
N
1 11 =40 1
BM.= top of 3/4" pvc pipe C el. 100'
Alt. BM.= nail in Oak tree @ el. 104.00'
,j
Ob
2Q
Q
Gary L. Steel
12 -11 -96
N 1/4 COR. SE COR.
SEC. 4 SEC. 34 -31 -17
181.17'
HIGHWA - t" 566B
282.55 565A
TEO; s 567B
to
p
282.64' ; N 566A ; �\
567D 9 �8 0 �'' 565B �4
856/559
y i N 749/432 N
Q�ti 566C c4 ' 837/273 ►�
Lo
I 0 282.73' i I o 731/30 ^' v Wd 1
/4 I °° 567C s °° dt��s s o v 5E
n ^, �t15 P \ >p N , m 0o U 683
�MY0282.82 269.63' 565C m
566D _
4 - & , 4 \ 568 A ,, � in
569A 0 0 570A L
o \\ 724/25 0 0 668/539 717/55
\,739/110 N 1 N 877/542 9.84'
821 /16 , 269.57' 571
I @ 282.86' I r o 683/,l
5686 '�� ° Y
745/506 6 5698 ° 0 570
y830/594 �� J
U y M 329.80' 571 B
J 282.86' I 0 263.19'
1 in m Up low/0 i J _ AVE. 596/
— -+ 5 569C 570C
r 745/522 rn 704/577
282.86' 571 C
8D I i
L -- - -- 262.83' - - J
5E3�
723/596 178TH , -' 5 -
7,73/596
a
I 578 697/498 4 B�
723/596 � ov, 704/5577
579B Z
oG ,E 697/498 � �9a 5�
,
14 � ',�91 0 \-O
G�
a '
5
I . - 27C
9
723 6 \�-� Gam . ' S roe 27(
114T
579D o
�, 590
Lo
5�
S T C - loo
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 & Rj "Ake w
Location of property,4W , Section _ , T 3 Z 1 -R 0 W
Township a I rw ww ; Mailing address LZ /;0,6 ` *
Address of site
Subdivision name Ups 9. 1 &C Lot no.
Other homes on property? Yes ___,?!;� No
Previous owner of property `�� a MM C'C��,� �
Total size of property
Total size of parcel
Date
parcel was created ;� / P1, j
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for ('spec house) ? Yes No
Volume M and Page Number _ �.5-1 as recorded with the Register
of Deeds.
--------------------------------•-----------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY.: which includes -a DOCUMENT NUMBER, VOLUME AND - PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified
Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all 'statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No - ; , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
f
nature o f Applicant Co - p
Date of Signature Date of Signature
N
i
STC- 105"" b
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERBUYER f1h1/
MAILING ADDRESS Z �, �. w y u // i ���s. �•� L✓� S f��/ 'y
PROPERTY ADDRESS I - i U 1 7
(location of septic system) Please obtain from the Planning Dept.
CITY /STATE _ ) K14vm�9d rl�� ESiO / 7
PROPERTY LOCATION N W 1/4, N �_ 1/4, Section T R W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER /t, -- 37>
CERTIFIED SURVEY MAP 9 VOLUME , PAGE , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 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 system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on -site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance._ with the standards set forth, herein, as set by the Wisconsin DNR.__
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year a iration date.
SIGNED:
DATE: 6? ' 7
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
I .
• I
MEND' N o. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
f�
✓
STAY BAR OF WISCONSIN FORM 2-1982
`726 �` -_�
49 VOL 1 001 3 75
-' PAGE -•-
E
i's OFFICE
Sharon L. Cunningham
--
- -. -- -- _ - - -- ----- --•------- •-- - - -• -.
_.
•; i ,r r'8
C4 I
- - - -- - -- ---- - - - - -- - -_- - - - -- - - - - -- - - - -- - - -- -- - I APR 9 1993
- - - - - -- . -- - •------- - - ---- -- - - - - -- 0 .-15 A. m
conveys and warrants to _._ - _. Ha11 e--- BuildeZs,. ..Inc - -• - -- ------ ---- -- 01
,
Rgelr'ler o+ Deed9
------------------------- --._..... - ----• ------
.............. -•---------------- ------------------------ - - - - -- - - •---•- - - -- -----
........---•-------•-• . .................. ............. ............. ..............--- -- .._......._.
'. ..........-------- ............................ .......... .-_--_____.-._-____--.___ ... .......... _...___...___...__ � TO
f________ __ -------------------------------- ...... _.. ___.. _._- _- ..._.. _ -_- - ______.._.. _..._..._. _..
------------- -------- --------- ---- --- -- --- --
the following described real estate in ........ St_.... CXQ j_x ...................county, - —
State Wisconsin:
Tag Parcel, No- - ---- --- ---- --- -- -- -- --- -- -- -- i
Lots 9, 10, 11, 12 13, 14, and 15, EXCEPT the East 5.0
' t thereof; and Lots 32, 33, 34, 35, 36 and 33, All
i lk. in,S10ek - - t M ?54410 t-he Jewett X4 l�s - AN
a5 �,
Lots 16, 17, 18, 19, 20, 21, and 22, EXCEPT the East 6.0 << -.
feet thereof; and Lots 25, 26, 27, 28, 29, 30 and 31, All I
being in Block 11 of the Plat of Jewett Mills.
i�
St. ,Croix County, Wisconsin.
I
.' a:
i
A
This ----- i- S__nolr--------- homestead property.
(is) (is not)
Exception to warranties:
�.. easements, restrictions and rights.-of-way
of record, if any.
Dated this - � day of A p ri l - - - - - - -- - -- -- - - -- --- - - - - -- I9. 9 . 3 .
� 11.1• 1r� _0�. -- -- L) --- - - - - -- -- - - - - -- - -- - _ -- - -- - -- ------------ - - ---- (SEAL)
Sharon - L - . - - Cunningham -- - - - -- - - - - -- -- -- - - - - -- -- - - - - --
-- -- - - -- a ................ (SEAL) -- - - - - - - - - - - - - - - - - - • - - - - - - - - - - - - - - - - - - - - - - - (SEAL)
r . ....... * 1�
• ...... - - ----- ... _ ....--
= AUTHENTICATION ACKNOWLEDGMENT I �
Vin � + Signaturg(s) Sizar -on --- L� - - -- •-------------------- - - - - -- STATE OF WISCONSIN
Cujnningham ss.
............. ----------------------- - - - - -- � --------------------- - - -- --
-- - - -- -- ------ • -- - -- ................ Country.
authenticated this __
day of --- App.�_ ........ ._, 19 - -93 Personally came before m6 this ................day of
I/ � ' 1 _. the above named
* Kristina Ogland �i
------------------------------
rPTmr T. . %ffv )rDvO c T A MMI O A n nul TTY T01 . T CVr1T