Loading...
HomeMy WebLinkAbout038-1084-95-001 o U) O n (a O i 3 n c C 1 y O A � � c °: > � 7 (D (D 7 tD y n CD CD FF A� 0 d o v m o o m CO I n��� v, o o n o m o ° w � ; y am! • 00 O V d CD M W 3 O (A N to N m n' A '� CD Z a -- o a co N N N a; o w v, 3 N a j 7 "' 3 m w CO O N C H n C 1 N C (D f0 (O n CD W O n O A� O =r 0 3 w 3 p cn G CD D a N o l m cn Z D a ry O 0 (D (O y y G A fD (�" D y d A W o b W o w o 3 ° h' a ° rn o 3 G rn _rn o N N Q �_ C_ O .. C O CD C, O (D �. ° (D CL O O 7 iZ3 i3 K v w O A A a H 0 t °' n 3 c N N (, v 000 000 Ch Ch 3 m vvv� s� �vvg' LT O= N y O M y O 1 I (D I w D Z CD Z D Z O O a � O � � Cn � o co � N • N y m !1 CD N N I /uylr� C (D N C G ( CD I N a 3 7 3 O 7 cn c c — ;5 • CL a A I I I Z N I CD (D O CL 3 a z A 71 o O fD m A ? D a 3 Q n a j x T m c v c m Z a o a N N (D fp N O O 3 � CD o a . N 0 ti O I O > > O A (D (D DQ V EA 0 fA ti (D O CD a ° o CL o ° CL Parcel #: 038 - 1084 -95 -001 04/26/2010 08:06 AM PAGE 1 OF 1 Alt. Parcel M 20.31.18.353C 038 - TOWN OF STAR PRAIRIE Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BORGSTROM JOHN O & MARGIE A JOHN 0 & MARGIE A BORGSTROM 2040 CTY RD C SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 2040 CTY RD C SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 1.726 Plat: N/A -NOT AVAILABLE SEC 20 T31 N R1 8W 1.726 AC NE SE LOT 1 OF Block/Condo Bldg: CSM 5/1413 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 20-31N-18W Notes: Parcel History: Date Doc # Vol /Page Type 07123/1997 687/14 2010 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.726 30,100 133,200 163,300 NO Totals for 2010: General Property 1.726 30,100 133,200 163,300 Woodland 0.000 0 0 Totals for 2009: General Property 1.726 30,100 133,200 163,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wiscongin De 5artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety atd Bl ding Division ' INSPECTION REPORT Sanitary Permit No: 515081 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Bor strom, John W. I Star Prairie, Town of 038 - 1084 -95 -001 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range/Map No: / bC> �M < GS j 20.31.18.35 WC TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. 1 Septic F j} Benchmark Alt. &M 1 . 2 2 72 Aera 'on I ` Bldg. Se r /4 (oi r CQ Holding J _____ _ St/Ht Inlet ' 37 13 - V� TANK SETBACK INFORM T 9 St/Ht Outlet '11� TANK TO Pa, WEL BLDG. Vent to Air Intake ROAD Dt Inlet septic J t 3 Z -/ 2. / Dt Bottom Jt b 3 Dosing 1 _33 J Z-7 , 2 He er/ an. Aeration Dist. Pie ' Holding Bot. System i 1"_ Final Grade G PUMP /SIPHON INFORMATION e-fb ' ; n. T /0 , ,7 Manufacturer 8 Demand St Cover GPM 7 l,Z4 '2. Model Number / to s f Q 7 _ /� 3 ID�.77 6 • Z$ �� , TDH L/ , riction Lot Sy I tem H TD -37. 7 6 t T `— / t7. .4 17.Z 61/. s Forcemain ! Length / D . / N st..toWelli 3 , - 7 . � 8 $ 1O' 57 r S .(o SOIL ABSORPTION S BED /TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ?.1 Z _TTe.,A_ti ,.� '� �— �. SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION I CHAMBER OR r��. - fa �i Typ Of System: ( 1Z Sri ' ! / A J� UNIT Model Number: 0,J DISTRIBUTION SYSTEM / b + 1 b = 3Z Tw.. Header /Manifold Distribution x Hole Size x Hole Spacing ent to Aii Intakk Length 7 Dia Lengt Dia Spacing a v� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only P �,..�....�� Depth Over Depth Over xx Depth o xx Seeded /S dded xx Mulced Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2040 County Rd Somerset, WI 54025 (NW 1/4 SE 1/4 20 T31 N R1 8W) NA Lot 1 Parcel No: 20.31.18.35C 1.) Alt BM Description = 3 �A� ` CQ, 2.) Bldg sewer length = / L ED - amount of cover Plan revision Required? Yes No Z g O� Use other side for additional information. 1 -- - - - - -- Date 4 �lnsepct Cert. No. SBD -6710 (R.3/97) 111 � PA in Safen3+ and Buildings Division COY i 201 W. Wasbington Ave.. P.O. Box 7162 t • . 'L o s i N Madison, WI 53707 -7162 U Permit Nurober I (to be filka in by co.) sc Sanitary Permit: Application State N Nun In accordance with s. Comm. 83.21(2), WiL Adm. Code, suhOuion of this foorm Project Address (if diiprrmt than mailing address) t A tcaaon a � PPI unit is required prior to obtaining P� on You provide may be used for secondary / submitted to the Department of Commane. Personal infPm>att� G.� in accorda= with the Privacy Law 4 15. 1 m „ Stats. s n Informoon — please print All lnformatio Pal # ' 6 0 Property Owner's Narise pg C'i J D O r f .)� r C 3 ^ G property a Mailing Address CROIXCO Govt-1A t y City. State � Zi p Ode p tt� �✓ ` � k one S s � — T 3/ N; B. / LL Eot I I # lY. 'type of B (check all thnt apply) Lot � ) Subdivision None 2 Family Dwelling- Number of J � B ❑ Public/Commerciai - Describe Use ❑City of i ❑ Villageof CSMNumber ❑ State Owned - Deacnbe Use own of ! M. Type of permit: (Check only on box on line I Complete use B if app ca ) A ❑New System t System 10 Tteatn=VHolding Tank Replacement Only ❑ Other Momesnon to Existing System(explain) List previous Permit Number and Date Issued ❑ e of Pbmtber ❑ Penaut Transfer to New l i B. (3 P R ❑ Permit Revision Chang Owner ` �G / ��-- Before Expiration of pOWTS S Com nent/Devlce: Check all that a PW { ❑ Mound 24 in. of suitable soil 13 Mound <24 in of suitable soil At -Grade - Pressunzed In-0roun ❑ Pretsuritxd In- Crrouthd ❑ - ❑Holding Tank ❑ Other Dispersal Component (explain ❑ Pretreatment Device (explain De V. Dis tea Area Information: ! Dispersal Ana Required (sty Dispersal DpO° (�/ �' ° ° Design Flow (gpd) Design Soil AppGcatioltat C � ✓ y 7 Catty in Total # of ac VI. Tank Info (dons Gallons Units g W qCB� Dosing Cnam*r VII, Res nsibility Statement - L the auders�sed. ty for i of the POWTS shown on the attached pJam. P1 MP/MPRS Number Business Photx NumbeS P s Name (Print) 7 /,J Plumber's Address (Street, Gtity, State. Zip VIII. Coon /De eat Use Od Issuing S Permit Fee Date I g rouses $ �I75' van Reason for IX. Conditft*M#Wq awns for Diupp a�-- 1. Septic tank, efnuW-filter and J o� a.fo 0 i l cell must all be D�"` M di6J — loc.. q.� spersa servttse�;� maintained d � so per management plan provided''by pktmber. 2. An'seftcknqt*W*nts mast be rhaintaithed Q� i e syasem sad aabmN to the CoeNY orly � PaWr sot � than H 1R s 1 I faehes ht d7e SBD -6398 (R. 01/07 ) Valid duu 01/09 PLOT PLAN PROJECT Maraie Borastrom ADDRESS 2040 Ctv Rd C Somerset Wi 54025 NE 1/4 SE 1/4S 20 JTN/ 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 6/18/09 3 DATE BEDROOM CONVENTIONAL IN -GRO D PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallon LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 98.7/98.8 4' below grade @ B -1 Conventional Powts * Manual Version 2.0 B.M. 40' Property Line 5' 2 -3' X 68' cells with 2 5' Vents B -3 >3' spacing Failed drainfield 5' May install 20' valve if 70' possible B -2 2% Slope B 15' 30' �J¢. saving existing septic Not enough slope to S I tank, giving effluent establish contours � longer treatment time Scale is 1" = 40' unless otherwise noted 150' 140' Property Line 30' Huffcutt Combo tank Old tank to Existing 3 Well 25, be pumped bedroom and buried house Vent > 6» Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.8ft ^2 /pair of end caps C C O P Y 34 Grade at System Elevation Cty Rd C PLOT PLAN PROJECT Maraie Borastrom ADDRESS 2040 Ctv Rd C Somerset Wi 54025 NE 1/4 SE 1 /4S 20 /T N/ 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/18/09 BEDROOM 3 CONVENTIONAL IN -GRO D PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallon LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL *H. R. P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 98.7/98.8 4' below qrade @ B -1 Conventional Powts * Manual Version 2.0 B.M. 40' Property Line 5' 2 -3' X 68' cells with 25' Vents B -3 >3' spacing Failed drainfield 5 May install 20' valve if B -2 70' possible 2% Slope B -1 30 , 15 saving existing septic Not enough slope to S tank, giving effluent establish contours longer treatment time Scale is 1" = 40' unless otherwise noted 150' 140' Property Line 30 Huffcutt Combo tank ' Old tank to Existing 3 Well 25 be pumped bedroom and buried house Vent I >6" Quick4 Standard -W of Cover Leaching Chamber with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 4' Long 12" 34" Grade at System Elevation Cty Rd C r PAID Wisconsin Department of Commerce SOIL EVALUATION REP '` Page of Division of Safety and Buildings in accordance with Comm 85, 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 not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. J �� —/Z) - f Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6 �� Property Owner )) Property Location _ r r Govt. Lot �'` 1 /4,5,� 1 /4 2 - 0 T N 7 R I E (or W Property Owner's ailing Address RECEIVED Lot # Block # Subd. Name or CSM# City State Zip Code Phon ' r ❑ City ❑ Village ,3 Towr Nearest Road 5 ��. w i a — ( 02009 � . , 7 ,0 -; C' ❑ New Construction Useg'_ / Nupbpq(c;; y Code derived design flow rate GPD X Replacement ❑ Public orr merclal - Describe: Parent material 0 1 %r /LP L ` -� Flood Plain elevation if applicable General comments and r000mmendationns: System Type L D /IiiZ:61 ' AQ 6J G / �T System Elevation U M Boring # ❑ Boring / pit Ground surface eiev. �! 2 ft. Depth to limiting factor _ ,C� in. r*Eff#1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 l Z ; 3 Ile f ,7 ❑ Boring aBoring # pit Ground Depth to limiting factor 'Z231Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. MMunselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C ✓ 1' S �� ✓ :/ -7 7 N Effluent #1 = BOD > 30 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BCD ,: < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �� _- �� �' 715- 246 -4516 i Property Owner _ j Parcel ID # Page of [S-1 Ong # El Boring I ri.� . {� R- pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �b F-1 Bodng # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. — So — ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring ❑ Bonng # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 1150 mgA_ ' Effluent #2 = BOD 130 mg/_ and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -6330 (8.6/00) Property Owner _ Parcel ID # Page of Boring # ❑ Boring { r� �- Pit Ground surface elev. 1 V� . 1 ft. Depth to limiting factor " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 3 S � I I L I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff #2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/_ • Effluent #2 = BOD < 30 mg/_ and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. 580.8730 (8.6/00) Soil Test Plot Pla Project Name Margie Borgstrom Sh Bird Address 2040 Cty Rd C Somerset Wi 54025 l e s TM #226900 Lot 1 Subdivision ----- --- Date 6/17/09 NE 1/4 SE 1/4S 20 T 31 N /R W Township StarPrairie Fj Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 9 8.7/98.8 *HRPSame as Benchmark B.M. 40' Property Line 5 ' B -3 5' Failed drainfield 5 ' 20' 70' No B -2 2% Slope B -1 15' Not enough slope to ST establish contours Scale is 1" = 40' unless otherwise noted 150' 140' Property Line 30' 15' Existing 3 Well Sewage ejector tank bedroom house Cty Rd C ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK 'T'his is to certify that I have inspected the septic tank presently j serving the residence located at: Section �L7 T .�/ N, R�_W, Town of Upon inspection, I certify that I have fcund the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: � -17- n/7 )id flow back occur from absorption system? Yes ><'— No (If no, skip next line) Approximate volume or length of time: gallons minutes -apacity: Construction: Prefab Concrete Steel other manufacturer: (If known). Age of nk (If known).: Signature) (Name) Please print (Title) (License Number) Date Form to be completed by licensed plumber (s.145.06, Wiscorsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: Ii, accepting the above statement regarding existing septic tank condition, I certify that the tank to the be of my knowledge gill conform to the requirements of ILHR 83, Wi dm. Code (except for inspection opening over outlet baffle). Name ✓ uY� Signatur MP /MPRS II Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned nonce a y ear. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. S. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. if system fails, determine cause of failure, use alternate area and instal new s ed replacement area. Option #2. stall system at a lower elevation, by removing chambers, removing biomat, 1 new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 -386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer r � Mailing Address q 0 CA C S Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number zJ LEGAL DESCRIPTION Property Location 1 /4 , ,jk 1 /a , Sec. , T _3� RW, Town of .� ✓`e Subdivision , Lot # �. Certified Survey Map # Page # Warranty Deed # 3 / � o Volume Page # Spec house yes no , Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFI Improper use and maintenance of your septic system could result in its premat= failure to handle wastes. Proper t into maintenance consists of pumping out the septic tank every three years pumper. or sooner, if needed, by a licensed puer. What yo u Pn the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance- The property owner agrees to subm1t to St. Croix County Planning & Zoning Department a certification form, signed by the that 1 the on-site: owner and by a master plumber, journeyman Plumber, restricted plumber or a licensed pumper verifyiin8 () the s tic tank is wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), ep less than 1/3 full of sludge. have read the above requirements and agree to maintain the private sewage disposal system with the Uwc, the undersigned 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 Pb mmg & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe amtare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number bedrgpms ,( ATURE OF APPLICANT(S) DATE * *"Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) `J � UMr C��AMgER Cr�OSS SECTx{: AND SP£CLi I Cp€I ar€S S£P'TIC TANK g Goa E w£A�RpRwF AP 1 AB ,�y g jU laCT'ION B I NaLE COV E-R C1 VO44 PIPE IWINr)ow OR WITH CONi3L IT lo/ PADLOCY Ei -�` "ROM DOOR, WARN ING iABE.- FRIES . "'IAA i*i�TI�KE � �r 1 O tt E' FItI •t� � 18 . IN g . I NLE T i a INLET GAS_ SEALS TIGHT' s � � WATER TIGHT A SEA : AppRDM PIPE 3' OM SMID SOIL APpRQVED C : FF PI P£ �` ,h t31iTt� '� SOLIO. - $Cap � FT - � G�� SEAL mmp OFF EL£V - BEDDING UNDER TANKK CONCRETE PAD 3. ApPRC3V gpiCIf1CA - �' � Q� E5 ?ER DAY: NumBER DOS r - ` DOSE / NCLUDINQ / �GAL SEPTIC FACTi3RER = Os3sE v � g T ME I C1C : /��.. TANK � 't Ai.- - �� - -� 5 0 � GAL- 'pAli K ZE$ : SEPTIC GAL GAL . ir1E ; - S S — DOSE ..�- -- C3,.PACITIES= A. 7 1 a �GAL- INCHES HpFA - A RK 140DEL 004SER �O C = • -� INCHES SwITcM TYPE PUMP i�iZEJFACTUR S � f� ILHR 15• WA MODEL JJUI#BER = H WIRING AS PER SNITCH �pE: #.T3iP E AID _ FEET C° PIPE - .Q.sy FEET DISCI'ARGE "TE F3ISTRI 'IZ FEET REW;IRE� PUMP of F #BNB _ - - " , J a� ftxT C E 5rr £gICTI4N FACTS ' VERTICAL D;FFEREN PRESSURE - DNj f MINTWJK N� ORK ��AIY X , � FTI ID g + F TOTAI. �1 rjE T FOR - r '£Fi DIAMETER �-- -� -- TANK LE � � / " .� ` � rte.•-- - ""' .r F P 3iG I�I�,IIAL DIME3�SZDI�S� PUM LIQUID ��� LICENSE. NUn,BER : a r'$$ ' TOTAL DYNAMIC HEAD /CAPACITY. PER MINUTE • HEAD .CAPACITY CURVE EFFLUENT AND DEWATERING MODEL. 152/153 M152 153 W 50 Liters Gal. Liters 261 77 291 153 231 70 265 12 40 152 - 201 61 23 t w t 67 52 197 30 25 7.6 129 42 159 z 8 30 9.1 23 87 33 125 0 35 10.7 -- -- 22 E` 20 40 12.2 -- -- 11 42 0 �- 4 Lock Valve: 38.0 ft. (11.6m) 44.0 ft. (13.4m) Jt�SJa 10 0 20 40 60 80 100 GALLONS 6 1/4 LITERS 0 80 160. 240 320 3 27/32- 4 5/8 FLOW PER - MINUTE 3 27/'2 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. r ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. _ - • Double piggyback variable level float switches are available for variable level long and short cycle controls. ' • Sealed Qwik -Box available for outdoor installations. See FM 1420. • Over 130 °F.. (54T.) Special quotation required. I � � 15ZI53:SIcries 12 /a I �- 1 ' OD Con on i Model Vobs Ph lAode im lax Du iex N152 115 1 Non 8.5 1 2or3 BN152 115 .1 Auto 8.5 Included 2 or 3 t � _ sxax� I E152 230 1 Non 4.3 1 2 or 3 I BE152 230 : 4.3 1 Auto Included 2 or 3 ' N153 115 1 Non 10.5 1 2 or 3 SELECTION GUIDE ft N153 115 1 Auto 10.5 Included 2 or 3 53 1 1 Non 5.3 1 z or 3 1. Single piggyback variable level float switch or double piggyback variable level float 153 230 1 Auto 5.3 1 Included I 20f 3 switch. Refer to FM0477. o ewu,noN 2. See FMO712 for correct model of Electrical Allamator E All Installation of controls, protection devices and wiring should be done by a qualified 3. Variable level Control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. Ali electrical and safety codes should be followed including the most or (4) float system. 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. NAIL TO: P.O. BOX 16347 Louisvib, KY 40256 -0347 Manulacrurersof. . SNIP TO: 3649 Cane Run Road � p r O ® Louisville, KY 40211 -1961 QL(4L/TY/ SNCf �s7 r W (502) 778.2731.1(800) 928 -PUMP w. http; #Wwzoefer.com !D. FAX -3624 m Copyright 2000 Zoeller Co. All rights reserved. eF ICIXSLUA1fY_'P•7"7' T1Q. - WARRAMW W�.rr r.us SrAr:E A @SE'iVGQ.F aeCnROtNe o►rA STATE B3 OF WISCONSIN' F--FLM 2 - iBB� 61 T6ft,5-0 Ukbzkn Germ e ain and Pauline Germain husband af3d :5T. • - -------- _ 9"'d. f t_� e c artta ,_F_5t Qtif - �o1ra . `ena ... .. .... -.. - - _ ... May day :. rZt 8:30 A " - �6e,��s ucd crsr� nes to John O_ F3or� Strom_ and Marc,3le, aTi � _ 4 - -: �c�1�9��.,.�m. -. x- elt �7st►d3 -- - -- -- -- --- ••--- - - - - -- --- ....-..-------------------------- •----- ---------- .... ........................................ RETII.RN T3Y. - -- -- ---------------- --- - -- _._- _.._ -- ------------------------------------ .. ... _ .. . ----- --------------- - _ the ao.lowrmg described real estate in ...... S_t_-- .C3•JoIx ------- ------- - State o Wisconsin: r "fms Parcel Noc ....................... ' Part of the Northeast Quarter of the Southeast Quarter (NEa of SE o) Sect.leon Twenty (20) , Township Thirty --one -(31) North, Range Eighteen (1$) West described as follows: Lot One (1) of Certified Survey Map filed April 17, 1984, in Volume "5" of Certified Survey Maps, page 1413, as Document Moo 392579_ F EZ This 15...110t........._ homestead property. (is) (is not) Ex.ceptin- fn warranties: Dated this 27th _ .. -..- - -- - ----- -- --- day of ----.I1prz.l_.._- 19. $4 . 7 i Al -0 ....... (SEAL) °: �. '-� �z� . ` xJG'ti r _ r ✓... ..... .. ......(SEAL) Urban Germain Pa.uline Germain .....(SEAL) --- . _. ............. ............ -._ . ....... (SEA? ) ......... .. ... . .. .. ... ...... .... ......... . AUTHENTICATION ACKNOWLEDGMENT Urban Germain and Pauline STATE OF WISCONSIN -- - -- - ------------- Ger roa i n ss. ------ --- ---••- •--- ---- -- ------------ - ------------------- - - ......County. authent' ted-�this s2_l_.day of --- ./?t?- ica_._.____, 19. f Personally came before me this ..... ...........day of v_. �_ � _ _--- --- -•-••--- ---- --- -- ---- -- -------- the above nam ._Scout R. Needham --- ---- - -- -- --- - ---- - E BAR OF WISCONSIN ------- •- -------------------------- ------------------- -........ - ............. -•• (If -f:e -- - - - - -- - - -- '-- T- ----- ---•- --------•---------------------- a ed- §Y$ 7O6.96rN4s. -StaU4 to me known to be the person ------ ----- who executed the foregoing instrument and acknowledge the same. T"'S INSTRUMENT WAS DRAFTED BY ---- --- --•- --------- -- - -- -- -- ----- -••-- ---.....-- -- -- •---- ...... Reln.st Vain Dyk & Needham. S.C. ...... - - Nttx3rn - eys••a - t --- Daw- -- -- ---- -•- ---- -•-••------ ----- • - -- -- --------------- --- -- ---- -•-- -- --- -- ---- - - -- - - -- - - -• • • ----- - - - - -- New,_gichmorld�-- .Wiscon_ s_in 540.17 -0127 Notary Public ............._---- - - -._. _ _.__ - - - -- C ounty, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessney.) date - ------, 19_........) •Nalaes of persona signing in any caracity should be typed or printed below their signawres. ` © STATE BAR. OF vnSCONSry Stock No. 73002 KGhR<ele�COTroa FORM No. 2 — 12 82 2 Jo \� 2 'v oo p0 � C — o — 1 4if -3 o yr �� " APRII E� ,,,& ? ? 1984 N O o &VW. �NKE4 � ' o a �••di °pt \� X30' O 6 8s �o Q N t O O o� R • � 0 z . 4 k % _ N o �r S � SAO N � \ o � O ' H o y8 N wr n p cn � n M A ��'' — N � 'a 0 O y 0 r o il` o a APPROVED F c ti APR 11 1 " 1 /iANIE.i _ ...nEll 00 2 197J w FHB � S ., nt r ST. CROIX COUNTY COMP.IEHENSIVE PARKS PLANNING AND ZONING COMMITTEE APPROVAL OF THIS N:INOR 3L;b ,j IJ:, Ii DOES NOT MEAN AP PR O VAL BUILDING SITE OR SEPTJC'STEMP FOR REFER TO H62.20._ Volume 5 Page 1413 Form- STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER � zflv P) OgL;-S�%� (TOWNSHIP ��/}�/C C= SEC. G T . L/ N -R �r W ADDRESS ( ST. CROIX COUNTY, WISCONSIN SUBDIVISIQN LOT j LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVFRYTuTINC raTTHTM 100 FEET OF SYSTEM (3 a o y L1� LaL";C C AIA L , r /05' I � I I I I I yf > ,e A A rt K i f INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 0 7 "j'A F je",- 1 Elevation of-vertical reference oint: > P �(�� L'��� Proposed slope at site: � SEPTIC TANK.: Manufacturer: _ ('�J�E,�'S' Liquid Capacity; Number of rings used: Tank manhole cover elevation: Tank Inlet.Elevation-. Tank Outlet Elevation: Number of feet from nearest Road: Front, Rear, O � fP From nearest property line Front, Side, 0 Rear, Number of feet from: well building: 15 - c (Include this information of the above plot plan)( 2 reference dimensions to se SEE REVERSE. STDF r PUMP CHAMBER Man acturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank el n: Pump off switch elevation: ons per cycle: Alarm Manufacturer: Alarm Switch Type. Number eet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORTTION SYSTEM Bed: x' Trench: AIA Width: _M Length: 36 r Number of Lines Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear , Ft. Number of feet from well: U ( R Number of feet from building: J G 9 (Include distances on plot plan). SEE GE PIT Siz Number of pits: Diameter: Liquid pth: Bottom of seepage pit elevation: Area Built: Has either a drop box r distribution box O been used on any o he above soil absorbtion sytems? (Check one r HOLDING TANK Manufacturer: Capac Number of rings used: Elevat o ottom of tank: Elevation of inlet: Number of feet from nea t property line: Front, O e, O Rear, O Ft. umber of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector:. Dated: y Plumber on job: License Number: 3 /84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 7 CONVENTIONAL 1:1 ALTERNATIVE State Plan l.D. Number: (If assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECT O T : Jahn 0. Bang.att om R. R. 1, SvmeAzet, W1 54025 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV, . NW SE,Sec.20, T31N- R18w,Lat #1,U.GehmI .dub.,Town ab StaA Pna,iAie /U1) .'r,1) Name of Plumber: MP /MPRSW No.. Counry: Sanitary Permit Number: Don Schmitt 3205 St. C /Loix 49492 SEPTIC TANK /HOLDING TANK: L MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 9 '7 PROVIDED: PROVIDED: [:]NO f` ' YES ONO DYES NO � �� I /U•�7 U� �► BEDDING: VEF4T DIA.: , VENT MAT L.. HIGH WATER NUMBER OF ROAD: P V WELL BUILDING: VENT TO FRESH • y ° ALARM: FEET F R L•—, I AIR YES ❑NO ❑YES ❑NO NEAREST 7 n � DOSING CHAMBER: MANUFACTURER. BEDDING: LIOUID CAPACITY J PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES — ]NO OYES ONO OYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER fl :'PROPERTY WELL. BUILDING: VENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) OYES ONO 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.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH. NO. OF DISTR PIPE, SPACING: COVER J INSIDI DIA.. *PITS. LIQUID ''. /TRENCH THE ES RIAJRN' PIT DEPTH: €}IMENSIONS � :7 }� GRAVEL DEPTH FILL DEPTH DIST .PIPE DISTR. PIPE DISTR IPE MATERIAL: I SMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER ELEV. INLET ELE / V. END P P .+ LINE: r - AIR INLET:. FEET FROM I Q �. EARESfi f MOUND SYSTEM: I �) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER I TEXTURE P ERMANENT MARKERS OBSERVATION WELLS. OYES [:]NO OYES 1:1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED. CENTER. EDGES. OYES 1:1 NO F-1 YES ONO I QYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: BI"C/TRENCH `' WIDTH: LENGTH TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: Ew L.EV'ATI N AND ELEV.: ELEV.: CIA.. ELEV.: PIPES. OIA.. '.. QI'.iTRtBIiTION "HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED UFOFIM 4TIOk ,. PLANS: OYES ONO ❑YES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUItR�,': PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES E:1 NO OYES El NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SI NATU E: TITLE. / DILHR SBD 6710 (R. 01/82) ' / ✓ /L�,t WISC ° nsln APPLICATION FOR SANITARY PERMIT D ILHR (PLB r COUNTY oePRRTmenroc 67) UNIFORM SANITARY PERMIT # In°USTRN,LnelCM 6MUmgrlgELi7T1 °n5 ? z / 9 g — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size.. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION CITY: 57A-le (V 1 /4 t- 1 /4, S , T , N, R E (or LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME NEWREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED L� 1 or 2 Family Number of Bedrooms: 3 Public (Specify): IYA THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. N Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity a Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total 4kbf Prefab. Site Steel Fiberglass Plastic Gallons T ks Concrete Constructed Septic Tank Capacity Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): / Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewa a system shown on the attached plans. Name of Plumber (Print): Signat r MP PRSW No : Phone Number: 5 2 Plumber's Address: Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑Disapproved W L / ���/ ❑ Owner Given Initial (f/ iV V 7 XApproved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber r 1 { r INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 , To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.) ; 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. Form - S T C 100 Owner of Property (YOff/� H/ZG� 1% gCJM 01 - 7 Location of Property Section 7 ,0 ,T 31 N R_/,P_o Township -5 Mailing Address Subdivision Name URBA/V V Lot Number II Previous Owner of Property URBA"/N /,2e/�C2.f/ //L� Total Size of Parcel 6 21 6 Y AC267-5 Date Parcel Was Created ,FErfj / 1.9739 Are all corners identifiable? _ Yes No Include with this application one of the following . ertified Survey Map .Deed .Land Contract, or .Other >regal Document which describes the property 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. ,2 7 9 ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been du recorded i 4 UR unty Co R , f Deeds as Document No. - x ror n the Office E OF O NER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED Flo t g 9b co r \ y . a VIE S 2 3�(fl o0 Vi 1 r • ,� u • u a N �� pro s 31co 0 s N � o 0 N 2 o w e p m a n r C m No li Z N v m � 2 °D 0 C � y \ o o ? < O LA 0- A Z a � � r M 7-- w o o I, N N O 00 / — E APPROVED I y N w 0 FC:B 2 x.1979 I . ST. CROIX COUNTY COMP,(ENFiNSIVE PARKS PLANNING AND ZONING COMMITTEL APPROVAL OF THfS N,INUR SUb v,o ;Lfv DO"cS NOT MEAN APVROVAL FOI, BUILDING SITE OR SEPTIC SYSTEM. REFER TO H62.20, s; • ' DESCRIPTION A parcel of land located in the PIE, of the SE' of Section 20, T 31 N, R 18 W, Town of Star Prairie, St. Croix County Wisconsin described as follows: Commencing at the East : corrier of said Section 20, Thence S 60 42' W 750.70 feet to a point; Thence h 24 48' W 40.12 feet to a point and this being Pe point of beginning of this survey; Thence continuing N 24 48' W 376.00 feet to a point; Thence S 60 42'W 600.00 feet to a Boint; Thence S 24 48' E 376.00 feet to a point; Thence N 60 42' E 600.00 feet to the point of beginning. This parcel of land contains 5.1792 acres more or less excluding land released for highway right -of -way purposes. SURVEYOR'S CERTIFICATE I, Richard D. Booth, being a duly qualified surveyor, do hereby certify that by order of and under the direction of Urban Germain, I have surveyed and mapped the property described. The plat shown on the sheet is a true and correct representation of the exterior boundaries of the surveyed land and that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statues to the best of my knowledge and belief. Richard D. Booth Registered Land Surveyor ^ ``_ Clear Lake, Wisconsin Febr uary 3, 1979 .'e CL[Rh L,1;, P•9GE 2 of 2 � ' m � S T C - 185 r` ^ r � ~ � SEPTIC TANK MAINTENANCE AGREEMENT �^ o Sc. Croix County �c o � OWNER/BUYER p` ROUTE/BOX NUMBERFirc Number_________ �� CrrY/8TAIE % 11 PK0Y8xIY LOCATION: , , Section _�4��_, T__, , 8 Town of ^ Sc. Croix Cou"vy, � Subdiviaion Lot uumhec__�_____. � lmpruycc use mud maintenance- of your septic system could result in � its premature failure to handle wastes. Proper mu1uccuuoce cuu- alatu of pumping out the septic cuuk every three years or sootier, � if needed, by a license a LeL)tic tuou ILumLpe_r. What you put into | the system can affect the function of the septic cuok as u treat- ment stage In the waste dieyueul system. ' � St. Croix County residents Liiay be eligible to receive a grant: for a muulmum uf 60% of the cost: of replacement of a failing system, wb�--i----- in operation prior to July 1, 1978. St. Croix County accepted this program in au*uac 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 Sc, Croix County Zoning a � certification form, signed by the owner and by a master plumber, � journeyman plumber, restricted plumber or u licensed pumper veri- fying chat (l) the uu- ' ite wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the ueycic 'cauk is leas than 1/3 full of sludge and scum. � Certification form will be aeuc approximately 38 days prior to � three year expiration. ~* o ^^ I/WO, the undersigned, have ccud the above requirements and agree to maintain the private sewage disposal system in accordance With � the standards acc torch, herein, as set by the Wisconsin Depart- ~~ meat of Natural Resources. Certification form must be completed and returned to the Sc. Croix County Zoning Office within 38 days of the three year eopiruci*u dace. SIGN DATC ^ 8t. Croix County %uuiug Office P.O.. Box 98 | Hammond, WI 54O15 / 715-798-2239 or 715-425-8363 Sign, date and return to above address. DEPA OF SAFETY & BUILDINGS INDUSTRY REPORT ON SOIL BORINGS AND DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 « (H63.090) & Chapter 145.045) LOCAINON: h CTION: TOWNSHIP LOT NO.: BLK. NO.: SUBDIVISION NA / ME: �l�l '/4 L 1/4 2- i/T� NCR 1, j (or) W �' j l.' -% 7 COUNTY: BUYER'S NAME. 1 MAILING ADDRESS: L! :?1 r �; , ; /'Y - , 1l lL, 1"l� USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER CIAL DESCRIPTION: � PROFI E DESCRIPT R TS: PERCOLATION TES _ Residence vk vew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) 0 S ❑U MS ❑U [As ❑U ❑ S Zu 0 S QU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /� �) F i n d icate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKN S, COLOR, TEXTURE, AND DEPTH NUMBER DEPTI-FM. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- j D X58 (.7 17 0� ) 17 9Z 08 �3 3 83 B -2, 3 _ A) 0 I) E- r 7 V1.5' J_ — 8 n c ir , 75 oo zS B -..5 0 0 A !.5. L . I P7, 5, Z` Lq n. r. 2 ig n.C,S. // 4 Z �. iz 08 33 50 B - b' 1 0 2 N O 0L r.S.�, 2, v n. r. 2, 6, ( _z z S 8 ,3 3 B., ) ? au �I �� ►'�U � / 20 I .5. �� FB 49 t PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER tflei+ES AFTERSWELLING INTERVAL -MIN. PERIO t PERIOD PE R10 PER PER INCH P_ 1 z- A) Q z 2- 2 P_ Z 3 '— /0 D P _ 3 302 /00 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 ►� o •l� 11 , O_ IP5 N1 _ � =� � �� ��s � � 36 _ p 3 w� r T — f , , f ,SAC . `20' 1 A I 1 ,.., .. --- ... ....,.._._.. m ._ ,. , ...,.,... }...._.�....,,... -..1 _.... �..- __....< — _ ,. A ' gyp , e I 1 ,- -— 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 recortf$d and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: TD CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGN U DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. L DILHR-SBD-6395 (R. 02/82) —OVER — J INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: A& 1. Complete legal description; 2, The use section must clearly indicate whether this is a residcence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; a. 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 not apply, place N.A. in the appropriate box; 11. Sign trip, 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 Sail Separates and Textures Other Symbols st - Stone (over 10 ") BR - Bedrock coh -- Cobble (3 - 10 ") SS Sandstone gr Gravel (under 3 ") LS - Limestone * s - Sand HGW - Nigh Groundwater es Coarse Sand Pere - Percolation Rate reed s Medium Sand W - Well fs - Fine Sand Bldg -_ Building Is Loamy Sand > -- Greater Than ,l Sandy Loam < __ Less Than *l _ Loam Bn -- Brown * 0 - Silt Loarn BI - Black si Silt Gy - Gray 'cl - Clay Loam Y - Yellow scl- Sandy Clay Loam R - Red sicl Silty Clay Loam mot - Mottles sc -- Sandy Clay vv - r ^rith sic - Silty Clay fff few tire;, faint *c - Clay cc -- corrinaon, coarse pt Peat mm - Many, medium m Muck 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 TO THE OWNER: This soil test report, is the first --slop it') secrrr inq a sanitary permit. TI ct,aumy err tiie Departrru°nt may request EE �f;t.af, t of this soil test in the field pnw its r7rrr.r t .& set of plans i,lr thr', pr ivate a permit apphca ion must be sub rnitt d t t w an iocai ar.ithor ity in order to pe "m!ii The Sort ,(�"; y pea rnit muss be of t�) r an po"'ted pi lot to ?Ii_ S. 'Iirt of arty cc nsti € c I A of � F i ce_ EC• y9�9 ,16c'o G AN j i ti 0 R cry °'� i o a D /!u 121K1C �'AO Cr. I ' ;ELF 9. - C /�� ' i __. - - ,- �. , �. �.. .._ , __ �, . _ ,_ �. f _ _- . , i _ _ .. :_ i ,, - ,_ ! ,_ �� i i - ', � � i �. , - - - �; �` ': _� _ � � , � j _. , _ , . f r ; i � .. � { ;_ !- �� � � I � � x .. t - K �. � i � � � I it � � �. �' '. t .. �. tI �j � � _ 1 j t � � ,� � t �. �O�`�_ ■ • P ERF O RMANCE CU PUMP PERFORMANCE CURVE 9 R II EFFLUENT MOD 18 & 3/4' SOLID PASSING CAPACITY ' .■■■■■■■■■■■■ ■■ • . � aaeaaeaaaaea °aamaama ®® ■ ■ ■ ■ ■ ■ ■a ®eaaaaeeaeeea0me °ease ■■ �■■■ o ® ° aa a ° ae ■ ■a ° ■ ° ae ° e a a ■ ° aea ■ " ■" ■. ■ ■��e eaeaeeaeaeeaeaeaee ®eeaaaaeaa °aaaaaavaee ■■■■ 11 ■ ■ ®ea�°�o�a�a��aa ■ ■� ■11 ■ ■ ■ ■ ■ ■ ■ ■ ■■ "IN I'MiNEWEENEENNNE ■1■ NOR ■■ ■ ■■ 0m ®mmm°a0m ®m ®m0a 0�0 ® ®00�o�0m ®0 �� \��1�1I� ■ ■ ■�� ■ ■ ■■ as ® ®ma ® ®ovmmo ®0a aaam ®0oo ®m ®mmm0m aaa 00ea0mom■®m0m No 6 11 ►��1 ■ ■ ■ ■ ■ ■ ■ ■■ aaa� ® ® ©ovm0a aS \14 111010 ■■■■\\■■ \ \\■■■ \\■ 0 ml, \LN Ix101s \\■■■\■ ■■\ \g21■10 \►iI \' ■■■■It to less than 30 feet TOW D EWATERING © mom 0�mmm ®m ®m ®m mmmm ®� ®m�mmmm® m m ®mmomomo mmm ® ®mmo ®mmmm � m mmmm mmm o ®mmmmmmmmmmmm ■■■■ ■ ■ ■■ommmm��m ■ ■ ®mom ®mom m mmmm■i■mmm mmmmmmm ®mm NONE mmmm ■ ■ ■© ■ ■ ■ ■ ■ ■■ ■■ ■ ■m ■m ■mmmsm � ■■',■■■■■® mm ■ ■mm■ ■mm ■m ■ ■ ■ ■mmmmm ■ ■ ■ \� \ ■ \\ NOON■ ■ ■ ■ ■ ® ■ \\ ■r�i■ ����■ i subjected to less than 15 feet TDH