HomeMy WebLinkAbout028-1015-10-000 Wisconsin Department of Commerce SYSTEM Count
WAG S
PRIVATE SE
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 370211
Permit Holder's Name: ❑ City ❑ Village ❑ jown of: 8tate Plan ID No.:
Rush River Townshi 5 1 & 4 4
CST BM lev. :- , Insp. BM Elev.: BM Description: -'Parcel Tax No.:
l l90 - a C0.0 � l oe le - 028 -1015-10-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark J_-
Dosing WAS Alt. BM - l
Aeration Bldg. Sewer T•+
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet 00
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet s R Z • (p0�
Air I
Septic C7D -/ r NA Dt Bottom �Z �O l ( O
Dosing > ( fS 50 NA Header/ Man. �; QS
Aeration NA Dist. Pipe Z �, -, o4 IF
Holding Bot. System
9`t. go
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer ,� Demand St cover
Model Number 1 GPM
gD TH Lift �,�� F .ZZ Sysaem2,s TDH q.18 Ft
Le ngth �� Dia. F Z Dist. To Well -+
SOIL ABSORPTION SYSTEM
DBE BENCH Width 6 - t Leng�h r z No Q renches PIT No. Of Pits Inside Dia. Li uid Depth
"T l DIMENSIONS
SETBACK
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING anufacturer:
INFORMATION Type Of n CHAMR Mode mber:
►N1
System: o"'k >In y �� S'fo OR UNIT
DISTRIBUTION SYSTEM
Header / M nifold � Distribution Pipe(s) lir x Hole Size x Hole Spacing Vent To Air Intake
Length Dia _� Length. Spacing cr 30
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
COMM (Include code discrepancies, persons present, etc.) blspection #l: 6& /07 /OD Inspection #2: —
Location: 412 200th Street, Baldwin, WI 54002 (SE 1/4 SE 1/4 11 T28N R17W) - 11.28.17.80A a2
1.) Alt BM Description = obes v .aa �• `j °1
2.) Bldg sewer length= 13
- amount of cover = p ? � Z �I �� t, ` (�J / . n
3.) contour = 3- ' g� e� a,'� g , 9 a '�`� = 1 b 2 , 3 6 } O.Np,►l d4
� ev ,,.IQ 9 `� � - �`0` I�.�- � V^.°.u-i^r� eq ir d 7 t Plan r lion requl I Q Yes No r
Use other side for additional information- Z p
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: ,
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Safety and Buildings Division
14 sconsin SANITARY PERMIT APP ON 201 Box Washington Avenue
Department of Commerce In accord with Comm 83 05, s�itd ._
! Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syI on o tor less S my
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this appl Cv lion ([} State i Sanitary Permit N
� •- r F.'q j CS7 i
Personal information you provide may be used for secondary purposes S ( C ►X ck it revision to previous application
[Privacy Law, s. 15.04(1) (m)]. }N"(`/ Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL "INFORMJCMeN ALL I = 3
Pro erty Owner Name Propert �
eW*t�Y t L_ - _, f� T 7 r N, 11 17 E (or
Property Owner's ailing ddress Lo N Block N umbe r
is ca
i y, Stptg Zip o de `hone Number Subdivision Nam or CSM Numb
� 7v It /v Nearest Ro
❑ Vil d
tl. TYP IL ING: (check one) S tate Owned � yy
lage
Public 1 or 2 Family Dwelling - No. of bedrooms 3 ia Town OF R �l Sh �� ✓ter U p S�
III, BUILDING E: bu ilding Parcel Tax Number(s) {
U GUS I (f bu d ng type is public, check all that apply) � � oZ�
1 ❑ Apartment/ Condo A ? - a � � ` /V _ .
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Fac 't /
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. (21 New 2. ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of S. ❑ Repair of an
______System ______ __System____________ ^ TankOnl�r_ __ Existing System ________ ExlstingSystem
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21'f(Mound ❑ Specify Type 41 C] Holding Tank
12 E] Seepage Trench 22 In- Ground P essure �) u� 42 E] Pit Privy
13 E] Seepage Pit 43 ❑ Vault Privy
14 ❑ System- In -Fil �-
VI. ABSORPTIO YSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Re wired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. Inch) Elevation
400 S1 s 3 1 5 1. (�(A Q Q� 5 Feetj Qo Feet
Ca acit
VII. TANK in gallon Total # of Prefab. Site Fiber- plastic Exper.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass App.
Tanks Tanks
Septic Tank or Holding Tank G /plc' �@ r7 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 1 260 1 /Y?/ ' e,5, An ❑ I ❑ 1 ❑ 1 ❑ 1 ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installati n of the onsite sewage system shown on the attached plans.
PI tuber's Name: (Print) Plumb 's Signature: Stamps) MP /MPRSW No.: Business Phone Number:
:6e- S404 ► O 1, 9 9 3U7 ( y to 4 -
Plumber's Address Stre , City, tate, Zip Co e):
5v 1.041io De. t,c)�_ sU�a�r
IX. COUNTY / DEPARTMENT USE ONLY
E] Disapproved S itary Permit Fee (includes Groundwater ate ssue ='Agent Sign ture (No Stamps)
Surcharge Fee)
[ Approved C] Owner Given Initial
Adverse Determination - s _UD 5_30
X. CONDIT NS F APPRO L / REASO S FO ISAPPROVAL,;
oat S� � - Q S clo�
SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
l
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 pr 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 vG}ienever
necessary, usually every 210 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151. -
To be complete and accurate this sanitary permit application must include:
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.
Safety and Buildings
PO BOX 7162
MADISON WI 53707 -7162
TDD #: (608) 264 -8777
hsconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
May 20, 2000
CUST ID No.691727 ATTN.• POWTS INSPECTOR
ARTHUR L. WEGERER ZONING OFFICE
421 N MAIN ST ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROVAL Identifica rs
PLAN APPROVAL EXPIRES: 05/20/2002
Transaction ID N 3174
SITE: Site ID No. 192477
DUANE NEWTON - RESIDENCE Please refer to both identification numbers,
ST CROIX County, Town of RUSH RIVER; 412 200TH ST above, in all correspondence with the agent
SE1A, SE 1/4, S11, T28N, RI 7W
FOR:
Description: MOUND SYSTEM
Object Type: POWT System Regulated Object ID No.: 664354
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
+ On page 2, all of the lot lines were not shown and the parcel size was not provided. Therefore, this
approval assumes that the entire onsite sewage system is contained on the same parcel as the residence it
serves and that no portion of the system is closer than five feet to any lot line. Refer to s. Comm
83.07(2)(a)., 83.10(10., and 83.15(4)(a)1., Wis. Adm. Code.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation /operation.
CAUTION: Wis. Stats. 145.135(2)(b)., indicates that the approval of a sanitary permit is based on regulations
in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus, depending on the type of system and your design, this plan approval may not be eligible for sanitary
permit approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a otp ential for a lawsuit that may delay the effective date of the code so this status may or may
not change.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
ARTHUR L. WEGERER Page 2 5/20/00
SiniRE DATE RECEIVE D 05/17/2000
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
AGEL OWTS PLAN REVIEWER II BALANCE DUE $ 0.00
Integrated Servic
(608)266-2889, M - F, 0745 - 1630 HRS
PEPAGEL @COMMERCE.STATE.WI.US WiSMAA ti. -7633'
cc: DUANE NEWTON
Page of 6
100 MOUND SYSTEM
MP S. FOR
01:1 -1I �SL�G A 3 BEDROOM RESIDENCE
LOCATED IN THE f- 1/4 OF THE SE 1/4 OF SECTION 1 1 ,T N, R 17 W,
TOWN OF RVs�k- S7 e-VL(�lX COUNTY, WISCONSIN.
INDEX
PAGE of 6 TITLE SHEET
CORRECTION NEEDED PA of 6 PLOT PLAN
PAGE of 6 PLAN VIEW -CROSS SECTION
SEE CORRESPONDENCE PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
POW.
PREPARED FOR °j ?�Iltr
App
f DJVIS opAR T �®
1.2z.o 10 '� l�vE. f FE ND ME
W sgwom 8 NGS
SEE
-� j OR RESPo NOE
Y� �
PREPARED BY
14 EGEE;tEF2 1SC3 11._. TEST = hiG
AMID .
DES I G>n! S1= I C:E —= S�itN
F.O. BOX 74 421 N. RAIN ST_ �`SC o S/y
RIVED, FALLS. NI 5442 2 • �r ~•
1I5-4� ,-4165 ' AR
_ w -
s 69t5P
- R EA,L� iN,
* SIGN
y
JOB NO. 1 LAS
PLOT PLAN Page 'Z-
Scale 1 "= q '
0
L-Lqyi � 1
(�� x —WE'LL
I ZS g,Z
I, 9� qS'
3a! o n
ZrarOF 7,4PUC
t
i is • l .
�� NOT ao►�G�T �DUF�I'PUC�
MOBILE t+ONe
ins CORRECTION NEEDED
SEE CORRESPONDENCE
4 1 X01 ST- £
� v
NOTES
1.-Elevations shown are existing ground elevations unless otherwise noted..
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( -- f — required)
4. Septic tank to be 1000 gallon capacity manufactured by
P1 tpw�5 tJ i�C 3t' • 7)0-lp T�Xk -% 3E -- S o Gam -
5 . Bench Mark ESL U. 100' W N" t - I N POLE,
6. Divert surface water around mound to ponding at the uphill side.,.
Page 3 Of b
Approved Synthetic Covering
c �3 Distribution Pipe
Medium Sand
Topsoil --H �o
F Elev.
3 E
D
e
3 % Slope
(Force Main Plowed
Trench of Z" - 2"
From Pump Layer
Aggregate
Undisturbed D l.0 Ft.
Soil E � Ft.
Cross Section Of A Mound System Using F 0,S Ft.
I Trench For The Absorption Area G N•� Ft.
A 5 Ft. H I• S Ft.
B 1S Ft.
I \Z Ft.
Linear Loading Rate= b .0 GPD /LN FT J g Ft.
Design Loading Rate= o /SQ FT
K `b Ft.
L 0 � S Ft.
A4401M&te� Position of Force Main W ZS Ft.
"7 L
_ B K A�4eit►
w •
Distribution Trench Of
Pipe Aggregate
' 1
Observation Permanent-/
Pipes Markers
• (Anchor securely)
Mound Using 1 Trench For Absorption Area
Page L ) Of b
Perforoted Pipe Detail
0
End View
End Cop Pertoroled
j �\`. PVC Pipe
Install permanent-marker
at end of each lateral
Hales Located on Bottom.
Are Equally Spaced
Q End Cap
PVC Force Main
Distnoution
Pipe
Lost Hole Should Be
Next To End Cap
Distribution Pipe Layout P 3b .2 S Ft.
X 3Z Inches
Y 3o Inches
Hole Diameter 1 `y Inch
Lateral Inches)
Force Main Inches
# of holes /pipe \S
Invert - Elevation of Laterals 'IS- Ft.
Place lst hole from tee with succeeding holes at Sail intervals.
Last hole to be next to the end cap.
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE S OF 6
VE1JT CAP
4 C.I. VENT PIPE frT WEATHER PROOF APPROVED LOCKING MANHOLE
10' FROM DOOR, JUAICTIOAI 90X COVER WITH WARNING LABEL
WINDOW OR FRESH 12 "MW.
AIR IN TAKE y
GRADE I
COIJDUIT
\ N
PROVIDE l -- --
IAlLET 7 AIRTIGHT SEAL
APPROVED JOIAI A Tank constructio shall comply i iii APPROVED JOINTS
with COMM 83.15 and COMM 83.20
ALARM
b ( Il
� 1
I ON
C
-- S
LLLV. FT. PUMP --, "�
� OFF
L D
Ub � COOCRETE BLOCK
3" ApPftoveb
RISER EXIT PERMI3fED OIJLy IF TANK MAAIUFACTURCR HAS SUCH APPROVAL ggpp
SPECIFICATIOKIS
Do 5 _ M t w
TANK MA>`IUFACTURER: ��� p� IJUMBER OF DOSES: 3 'z 4 PER OAy
TAWK SIZE: 1SC1 GALLOWS DOSE VOLUME
ALARM _IK/WUFACTURER: S'S.NZ��I) SYS��?s INCLUDING RACK /LOW: GALLONS
MODEL 1JUM8CR: to t K CAPACITIES A- 18 04HE5 OR 3 5 } ` ( GALLONS
SWITCH TYPE: B a 2. IIJCHES OR 3>9 " G�LLOfJ5
PUMP MANUFACTURER: z'Uell-tnZ G: IUCHES OR t26 GALLOWS
MODEL NUMBER: 01,$ 0= 12 - IMCHES OR Zay "0 GALLONS
SWITCH TYPE:
I'I� � NOTE: PUMP AMD ALAR A C TO 6E 8
MINIMUM DISCHARGE RATE 3 S l GPM INSTALLEO ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEELI PUMP OFF AIJ0..DI3TRIEUTI6M PIPE.. 8'110 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE .. . . . .... .. 2 FEET
+ ZCJ FEET OF FORCE MAIN X i-4— FYo FT FRICTIOU FACTOR. O ' 4� FEET
-- TOTAL MJIJAMIC HEAD = �SJ'°I°/ FEET
DIAMETER v
INTERAIAL DIMEWS%OWJ Of TAWK: LEAI67Ii ;WIDTH - ;LIQUID DEPTH
BOTTOM AREA -- 231= GAL /INCH
AS PER MANUFACTURER A:a-S GAL /INCH
HEAD CAPACITY CURVE 3 7/8 — 6 1/a —�
W MODEL "98"
30 4 5/8 -►{
f3
25
3 5/8
S2 6 0 ® 1
+ +
15 0 I
4 3/16
6 1 1/2 -11 1/2 NPT
` .S. GALLONS 10 20 30 40 50 60 70 80
LITERS
80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE
EFFLUENT AND DEWATERING
CAPACITY 1
HEAD UNITS /MIN --------- --rrr-
FEET METERS GALS LT ■
5 1.52 72 273 3 i
10 3.05 61 231
15 4.57 45 170 4 3/16
20 6.10 25 95
Lock Valve
SKI 102 /
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available
or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
Standard all models - Weight 39 lbs. - % H.P. 1. Integral float operated 2 pole mechanical switch, no external control required.
2. Single piggyback variable level float switch or double piggyback variable level,
98 Series Control Selection float switch. Refer to FM0477.
Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075.
M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak.
N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4)
D98 230 1 Auto 4.7 1 or 1 & 7 — float system.
6. Four (4) hole J -Pak, junction box, for watertight connection or wired4n
E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10-0002.
7. Two (2) hole J -Pak, for watertight connection or splice.
CAUTION
Forinformationon additional Zoellerpmducts refer to catalogon Combination Starter, FM0514;Piggyback All installation of controls, protection devices and wiring should be done
by a qualified
Variable Level Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/ licensed electrician. All electrical and safety codes should be followed
including the most
Sewage Basins, FM0487; and Single Phase Simplex Pump Control /Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
r Louisville, KY 40256 -0347
Manufacturers of. .
1 ' SHIP T0: 3649 Cane Run Road
Louisville, KY 40211 -1961 Qaaurr 9uuvs F 11VC6 /939"
/ l0. (502) 778- 2731.1(800) 928 -PUMP
FAX(502)774.3624
Wrz;nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Nof
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COMM Y'^
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ;I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFO PLEASE PRINT ALL INFORMATION Rq\REWEl) BY DATE
1
PROPE TY OWNER: PROPERTY LOCATION
GOVT. LOT 114f 1/4,s//
' N
PROPERTY ��R:S 41LING ADDRESS LOT # BLOC # I SUBD. NAME OR CSM i
C C
I
M
I T E ZIP CODE PHONE NUMBER [:]CITY VILLAGE OWN NEAREST RO
_.4 �dy;J
r [A New Construction Use Residential I Number of bedrooms Addition to existing building
I
Replacement Public or commercial describe
Code derived daily flow S Q gpd Recommended design loading rate _Z bed, gpd /ft trench,gpd/ft
Absorption area required bed, ft2,:?,-/6-' trench,ft Maximum design loading rate bed, ,
gpd/ft -2 - 2 trench, gpd/ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material ::2!�ZL /"'�Z � ? "�'e ) Flood plain elevation, if applicable Allt — ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDINGJANK
U Unsuitable El S 14 U [OS E] U ❑ S MU 0S MU ❑ S Ug U I 0S XJU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouncbty Roots G P D/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw&
Soy O
Ground A11 AQ`
elev.
2Z
Depth to
limiting
factor
Remarks:
Boring #
..............
................... . . . . . . . .
Ground
elev.
9�1 ft.
Depth to
limiting
factor
Remarks:
CST Name:—Please Print Phone:
Address:
Signature: ?zy Date: CST Number:
PROPERTYOWNER SOIL DESCRIPTION REPORT Page -2 20L 5
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench
LAO
v
Ground
elev. S- L
=ft. -
1
Depth to
limiting
factor ,
Remarks:
Boring #
Ground
elev.
h.
Depth to
limiting
factor FT
I
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
p:u
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
LS13D-8330(R.05/92)
XY S l.' l�
cz/ X8
a I
i
� � g
-I
ST CROIX COUNW
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer DU CLD e- - e t.Ar
Mailing Address la a() 1 ye - G�
property o e Address - K L A — 4 12- Z±
(Verification required from Pl eat for new construction)
City /State
Parcel Identification Number u Y ' / U t - G G
LEGAL DESCRIPTION
S ^ - S E `l <, Sec. 1 1 , T $ N -R "1 W, Town of U � Y�er
Property Location 1✓ / <,
Subdivision Lot #
Certified Survey Map # _. Volume . Page # -
Warranty
Deed # 61 U ? g'�q , Volwne ? , Page # 1 G
Spec house O yes 0 no Lot lines identifiable H yes O no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature ;aihue to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. Wbat you put into the system
can affect &e function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
mastorplumber, jorrneymanplu nher, restiictedplumber or a licensed pumper verifying that (1) the on-site wasteWaterdisposal system
is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than''l/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system withZhe standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State Of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the tluree year expiration date. A951 CO
SIGNATURE OF APPLICANT DATE
OWNER CLRnOgATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge,. I (we) am (are) the owners) of
th perty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
�` DATE
SIGNATURE OF APPLICANT
« * «« «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
*« Include with this application: a stamped warranty deed from the Regi of is made in the warranty deed
a copy of the certified survey map
t'- STATE: BAK OF °tISCONSIN FORM 5 --1900 i rM s s�.e� ssauvso foa RseonoIao DATA
D OCUMENT N o. pSx REpREAENTATIVE'$ DEED
�_` � '( U►A�t ?, _ REGI STER 'S OFFICE
W . F ern ST. CROIX CO., W!
Dal,° ..............•--...... ...._...._......._._- ..... - - -.. - ...........- _ ..... Recd for Record
-..
.................. .... t JUL 2 61990 +
• „•,•.-- ,_.- •.-- -.... . as Personal Representative of he estate of
....._.._.. ...... vlayA d A New on ...................... ........................... ... .. 8:30 A M
.- ..._....
1
.
................ .._ .-._._.._......._....... ..........._........_.......__. Decedt en ). oiQsrdt
a valuable consideration - onveys, without warrarty, to ............. ....... .......... 1
Duane K. Newton
............................. .................... ...
............ ................. ...... .- ................ ............................. I......_
.... . ........ . .. .. Grantee Rt, RN ro
St. CrO1X ._ - _._ -- •Count
! the following described real estate in ......... ................... Y
State of Wiscoi, sin (hereinafter called the "Property ") :
Tax Parcel No :..... . .......................
Northeast Quarter of Northwest Quarter (NE; of NW;); Northeast
Quarter of Northeast Quarter (NEh of NE;); and West Half of Northeast
Quarter (W� of NE's) of Section Fourteen (14), Township Twenty -eight
(28) North. Range Seventeen (17) West.
j East Half of Southeast Quarter (E� of SE'k) of Section Eleven (11)1
Township Twenty -eight (28) North, Range Seventeen (17) West.
This deed is given in satisfaction of that land contract between
Gladys A. Newton, a widow, and Duane K. Newton dated July 9, 1986 '
and recorded in the St. Croix Couitty Register of Deeds office on
July 10, 86 in Volume 746 of Records on page 439 as Document
No. 414
This conveyance is also made in final distribution of the above
described real estate in the estate of Gladys A. Newton. Gladys A.
Newton died testate on December 2, 1989 and the grantee in this
deed is the person entitled to this real e.wtate pursuant to the
Last Will of Gladys A. Newton. TIRANSZB
SAY A
FEE
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which
the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the
Personal Representative has $�7\ce acquired.
Dated this -- -- - -- -- - - - -- /-- lL- -- -- ----- -- --- ....... day of - - -_- Jtl l-Y_- ----- - - - ---- -- - -- - -- -
--- ------- ..(SEAL) - ---- -- -- --- ... - -• -- -- (SEAL)
- - - - -- ' - - - -- Dale.. ..... rD. - _---- - - - - --
Perxonsl Reyresnntsti :e Persona! Rep rr_•ser.'..tiv�
AUTHENTICATION ACKNOWLEDGMENT
rr
Signature (s) - _---- __.__.____; STATE OF RISC�NSIN
- ---- - - ---- ..
� ss ,
ST. CROIX
!. --- - ----- - i -- . --- -------------- County.
authenticated this -------- day of --------- ----------- -_.., 19__. -.. Personally came before me this --- �.�------- .day of
O J111�7 ---- --- - -- --- -- 19. _ the above named
- - -------- -- ----------
-- D .W" ...F�4_[1
•
TITLE: MFNIBER STATE BAR OF WISCONSIN
:\
(If not. ,... - -------- -
at ;,!- .prize § 706.0; VVIs. Stats.) 4 J' to me known to be the Person ----- _- who executed the
fore , i.� -true t and acknowledge the same.
THIS iN4TR'JMeNT WAS DRAFTED BY q �
• _ . ..�.,
Thomas R. Schumacher j: - --
l3At{iCE, NOR_`1AN. SCHUMACHF.F�:�P�iR Ct154' ' -- - .. .. - - - --
WA[,TF,st, .$.. lc. --- - .. !t � -a q , "�.Ih1 .._ f - . Cr'c� --- County, Wis.
1b,s3 JAsdnr.iy autd or Cni..mi.,sion is per.i :anon.. \r iot, state exn'ratinn
77
ar not r ces ;arv.) a•, ..........
-late; _. - ----
• \sr. ^..s r,! per �r,e signir�4 in n :. ;ty y -:jA h, 1rp or b..{ ! "4, th-u-
S ? : \'t t: R 1H n }' ' '. �)1rI?. w" •in I, -vaI n'Hr k .n..
PEFE.i:. ' .lF6Sc : + "i .i.'tYE S DF,ED FORM Yn. -_ 1 M Ir s W:;
T