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BM Elev: BM Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 7 03.28.19.1149 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �S Dosing i / J4 _ / � � Alt. B .p Aeration ( Bldg. Sewer Holding � . � St/Ht Inlet C::,, �S'T�1 (Sc S UHt Outlet - TANK SETBACK INFORMATION [ } 6 . S 7 TANK TO ! , lP /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / -7 Septic � i Dt Bottom Dosing � > / u Header /Man. Z 5� Aeration Dist. Pi;M_ Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover !� Mode! Number ' 1 GPM (� I' TD H Lift Friction Loss System Head TDH Ft s �. 2 0 1 Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Ey 157) BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 _j Yes �, No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:1/ Z 3 / d Inspection #2: ! ! Location: 535 Trillium Lane Hudson, WI 54016 (SE 1/4 SE 1/4 3 T28N RI 9W) Country Wood Lot 13 I Parcel No: 03.28.19.1149 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = Plan revision Required? ', Yes f _ � -- � -- - -- - - - -- -- - - - -' -- � r _ __ -- - -- Use other side for additional _ No I& information. _.— �= j _ _ L� _— ,—_� SBD -6710 (R.3/97) Date Insepcto Signature -- Cart. No. I _ — 1 z r 1 . >vs- Safety and Buildings Division County '' a ,! 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 ' irseonsin Sanitary Permit Number (to be filled in by Co.) 608 266-3151 ( ) )Department of Commq�/ce L�� Z12 =' Sanitary Permit Ap P licatian State Plan I.D. Number In accord with Comm 83.21, Wis. AJm. Code, personal inlunuatwn )Ou providc may be used for secondary purposes Privacy Law, s 15:04(1 xnt) Project Address (if different then mailing address) 1 L Application Information - Please Print All Information Prope Owner's Name Parcel # Lot # Block 0 Prop rty Owner's Mailing Address �© Property Location City. S e_ y, Zip Code Phone Number Section �- s circle one) L Type of Building (check all that apply) Tc N; RE or W ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision N e C$I1LNumber ❑ Public/Commercial -- Describe Use El ,t� State Owned - Describe Use nCity Il a t<ITownship of pecir culating e of Permit; (Check only one box on line A. Complete line B if a licab New S stem Y ❑ Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System Permit Renewal ❑ Permit Revision (1 Change of ❑ Permil Trunslcr to Now List Previous Permit Number and Dw haled fvre Expiration Plumber Owner of POWTS S stem: Check all that a I ressurized In- Ground ❑ Mound > 24 in. of suita soil Moun 2 in, of suits a sot - ❑ Single Pass Sand Filter ❑ d Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Synthetic Media Filter ❑ Leaching Chamber n Dri Line ❑ Gravel -less Pipe ❑ Other (ex lain) V. Dis ersal/Treatment Area Information: _ Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I System Elev •o o� d - S_o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel ibex lastic Gallons Gallons of Units Concrete Constructed Glass a Existing T an k Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber V11. Res opsibility Statement- 1, the undersigned, ume fur installation of the POWTS shown on the attached lass Plu 's N (P t)� plumbe ' 3 t t MP/MPRS Ku Business Phiw Nun i mbar' Address (Street, City State, Zip C VIII. Coun /De art ant Use Oni 10 Approved C3 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui g ant Signature (N Stamps) Surcharge Fee) Z C] Owner Given Reason for Denial I � `- IX, Conditions of Approval/Remons for Disapproval SYSTEM OWNER: u tS r 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. le J 2. All setback requirements must be maintained S� ���tt as per applicable code /ordinances. D. T Q Anna omphte piaru (to the County oa r the system on paper• act hse then 81/T x 11 his n $hra- B.6398 (R. 01/03) U L) Pte- . ` l&VX PAGE of PUMP CHAMBER CROSS SECTIO AN0 SPECIF VEWT CAP r VENT PIPE WEATHERPROOF _NPPiIOVEC LOCKING JUUCTIOM BOX MANHOL COVER wIT11 WAMIING LABE 2S FROM QOOR, IL�MIU. WINDOW Olt FRESH MR INTAKE GRADE { I y MIA1. COIJDUIT -- " la•Alu. PROVIDE - INLET AIRTIGHT SCAL 7 I III I I I I APPROVED JOIWT PIPE P A ( I I APPR Y E I II W/ PIPE I I I ` ALARM EXTE DIIJG 3' CXTCNDIIJG 3 I 11 ONTO SOLID SO!. OlJTO SOLID SOIL ! ON C CLCV. FT. PUMP _� -'� b OFF 0 COLICRfTE DLOCK TAWA RISCR EXIT PEKtilITED ULS IF VED DC TURZK HA T U H APPROVAL SPECIFICATIOKJS SEPTIC E OOSE TA IJ I( MALIUFACTUAER: A - /� IJtyMBCR OF DOSES: PER 0 y TANK SIZE: �= GALL US DOSE VOLUME y �/ .-- IAIGLUUING CACKi•LUW: �,1 GALLON;, ALARM MAI,IUFACTURCR: �- �� MOOCL IJUM6CR' CAPACITIES: A= - - 20 OR GALLOu; I - B ° �_ IIJCHES OR GALLOWS SWITCH TYPE: p PUMP MAIJUFACTURCR: C ¢ —Jr r OR CALLOUS MODEL MUMDCR: 0 - — �-- INCHES Olt 1 AlLO►J5 s 7� SWITCH TUPC: ���' MOTU PUMP AMD ALARM ARE TO eC INSTALLED OW SEP ARATE CIRC ITS MIIJIMUM DISCHARGE RATE ; � - GPM pp VERTICAL DIFFEKE DETWEEU PUMP OFF AIJO OISTRIbUTIOW PIPL.. --. - FEET + MILJIMUM IJCTW ORK SUPPLY PKCSSURE . . . . . . • . . . 4= FEET FT � FEET + �_ FEET OF FORCE MAIIJ X ��a �on►r,FRtCTIOU FACTOR.. TOTAL Oy1JAMIC HEAD .yam FEET A E GTH - iWIDTN • iLIRUID DEPTH IAITERAJAt. OIMEIJS us of 1 ►JK: L N I I I SIGIJEp; LICENSE NUMBER: cZ 2 f R POULDS PUMPS Submersible Effluent Pump WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase (60 Hz): can be operated continuously stainless steel. Threaded • Capacitor start motors for without damage when fully Specifically designed for the design. Locknut on all models maximum starting torque. submerged. following uses: to guard against component • Built -in overload with ■ Bearings: Upper and • Homes damage on accidental reverse automatic reset. lower heavy duty ball bearing • Farms rotation. • S1TOW or STOW severe duty construction, • Trailer courts oil and water resistant power • Motels ■Fasteners: series P ■ Power Cable: Severe duty stainless steel, cords. • Schools •'/3 and 1 /2 HP models have rated, oil and water resistant. • Hospitals ■ Capable of running dry NEMA three prong Epoxy seal on motor end • Industry without damage to grounding plugs. provides secondary moisture • Effluent systems components. • , /, HP and larger units have barrier in case of outer jacket prevent oil and to a ■ Designed for continuous bare lead cord ends. damage P SPECIFICATIONS operation when fully wicking. Standard cord is 20'. submerged. P 9 Three phase (60 Hz): O ptional lengths are available. protection • Class 10 overload Pump p ■ 0 -ring: Assures positive • Solids handling capabilities: MOTORS must be provided in seating against contaminants 3 /4" maximum. separately ordered starter • Discharge size: 2" NPT. ■ Fully submerged in high- unit. and oil leakage. • Capacities: up to 140 GPM. grade turbine oil for lubrication • STOW power cords all have AGENCY LISTINGS • Total heads: u to 128 feet and efficient heat transfer. bare lead cord ends. P rested to ut na and TDH. ■ Class B insulation on ■ Designed for Continuous CSA 22.2 106 Standards • Temperature: 1 /3 -1' /2 HP models. Operation: Pump ratings are By Canadian Standards 104 40 continuous ■ Class F insulation on 2 HP within the motor manufacturers ci us Association ( ) models. Fite #LR3 140 (60 intermittent. recommended working limits Goulds Pumps is ISO 9001 Registered. • See order numbers on reverse side for specific HP METERS FEET voltage, phase and RPM 's 40- 130 - r SERIES: WE available. 120 ° E1sr� SIZE: 114' SOLIDS' 35 RPM: 3500 & 1101..__ l 175 FEATURES WE2 H l —�► 5GPM 4 30 100 ■ Impeller: Cast iron, semi- 90i W le . 5Fr } - open, non -clog with pump -out a 2s W 80 f vanes for mechanical seal - V i 1` protection. Balanced for a 20 70 Eo r+ smooth operation. Silicon Z 60 - bronze impeller available as 15 50 w r , 1 i S an option. o eo H ■ Casing: Cast iron volute type 10- 30 (._ for maximum efficiency. I 2" NPT discharge. 5 20l, Weo3} l _. ■ Mechanical Seal: SILICON 10^ _. �..�' - _ ..�. . CARBIDE US. SILICON ° °a i0 20 s0 �6 50 60 70 ao 90 100 110 120 130 140 __ A 50 ��1" 60 GPM CARBIDE sealing faces. I 1 L....._. I ..._..__.t 1._.... Stainless steel metal parts 0 5 10 15 20 25 30 35 m /hr BUNA -N elastomers. CAPACITY ulds Pumps © 2003 Goulds Pumps 7 Effective July, 2003 www.goulds.com ITT Industries �3 . V I - - -- i 4ib ttc - � ,A- _ �-- s 4-o -,. r ` � �� i I � 4 � �� i ' -) f -�, i � ' � � �� �-- ��, � i N --� ;� , �; ' � � �. -� .- ,_,�. ^� � r � I" �� i I i � � �( D 312 I . 31 . Pf tC•lo d,... I ' � l � I JJ z 3- 3 C _ LL o 3 1 3 0 1 .O °' g Z y � i� p � Z i co H ai a m dl .e N c o I oz s cn H C "' -- 4 N r N (D CL C m o o q + a U o �/\ o Z Z D ' Z Q 0 — E N It + �_ o 12 m Y f m . ' to c C G a a c °- ° O f4 Clq 0 co U 3 ~ ~ a�0 hw C 000 Z� r`N o (+ N a ° L to J U c o o O J N o 'o V N O Z `` N �• �/ m ° c a I LO N - V ^i p p � p O y m E c,Y J p,,. �T U o t C V a 0 M C : N N 'O C N ' E � co co r, ~ O N o C O N -C J • N O O I- C M O Z -o i a • aa,.v d 3 � 0 0 I L Wisconsin pepartment of Commerce PRIVATE SEWAGE SYSTEM Count Safety and 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)). 370295 Permit Holder's Name: ❑ City ❑ Village ❑ Vbwn of: State Plan ID No.: Penshorne, Robert I Troy Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: / DO /ao "r 040- 1232 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e J 'Z oe Benchmark , (e > Dosing �S �O c� Alt. BM Z �► S/� Bldg. Sewer o ding St Ht Inlet z3. 79 �y TANK SETBACK INFORMATION 61/ Ht Outlet tv pG , TANKTO P/L WELL BLDG. vent to ROAD L y'`� /� Air Intake �a Septic 39 4 � Q ' > / �' NA Dosing 3 p Sp ' 2- > ' NA Header / Man. � .33 A Dist. Pipe z Holdin Bot. System 60 �•�s— �Z PUMP/ SIPHON INFORMATION q,5vwq i Final Grade k y fle. S3 Manufacturer Demand St cover Model Number / d GPM TDH Lift 2 '� L rictio System TDH Ft Forcemain Length 4/ Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM y BED / T N H Width 3 Len h , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN• S 2. DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI Man facture: INFORMATION TypeO HA BE M odel Number: System: t!?91 3q� � T DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length _LD Dia. 7 Length IL _'S Dia. Spacing ± d 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.) Inspection #1: z / 5'1a6 Inspection #2: Location: 535 Trillium Lane, Hudson, WI 54016 (SE 1/4 SE 1/4 3 T2//8N //R19W) - 03.28.19.1149 Countrywood Addn. I -Lot 13 3) 40�/ evj _ l�5 1.) Alt BM Description = d1o" s,/ KjW"ff) a 2.) Bldg sewer length - amount of cover = ­ y' Plan revision required? ❑ Yes No Use other side for additional inform tion. �Z SBD 6710 (R.3/97) Date Inspector ignature Cert No. b ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: .. .. _. _....., ..,.,_._,.� .,..,.... ,.e ,o 3.®.m.®. .._... »..8.... � � �_..��.. ,�,�,�y �a —4-4—_ Al E P a E 3 i g j I . -4 - - t�. .,,....._.. .. ..�.�..m_._»...,..�._ _._» �.....-.... C_... m._ �...._.. �............ �....._,.1=,.._........e.. ...�..._.�...-- .�&........ —._.. —. k---. ae.._.e..L.___.— .I...v.....,.. ......_....�.m. _._.... ,...«.e m,........»5..,.m ..... (-Li ww% ZEE Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue *isi P O Box 7162 In accord with Comm 83.05 A m Ma dison, Department of Commerce � 2 ad son, WI 53707 -7162 • Attach complete plans (to the county copy only) for the s n papWot ourity than 8 1/2 x 11 inches in size. N p • See reverse side for instructions for completing this ap ion RFcEiB S tg Sanitary Permit Number .�uN 3�29s Personal information you provide may be used for secondary purposes 3 2000 heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]- ST �( Plan Review Transaction Number 1. APPLICATION INFORMATION -PLEAS E PRINT AL Prope caner Nam Property i 1 , T , N, R E (or& Property Owner's Mailing Addr s e Block Number City, t e Zip Cod Phone Number ubdivision Na a or C M Num r T P ILDING: (check one) ❑ State Owned [3 It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 5 Town OF ' III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 03. 1 ❑ Apartment/ Condo ©'`O -- &0 — 7 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. Jw New 2. ❑ Replacement 3, ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an ------ System ________System __ _____ ___ _ __ Tank Only ---- -------- -- - Existing System - -------- - Existtn9System 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 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 to Seepage Trench 22 ❑ In- Ground Pressure 3 fX g- 42 [] Pit Privy 13 F1 Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill I AJ VI. ABSORPTION SYSTEM INFOR 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. /i ch) Elevation Feet eet ct n a VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturer s Name Concrete st un- Steel glass Plastic App T nks Tank Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst Ilation of the onsite sewage system shown on the attached plans. Plumber' Nam : (Pr' tX I Plumber' Si r : (No a ps) MP /MPRSW No.: Business Phone Number: u ber's Addre (Street, City, ate, Zip C de). t J T_ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) .� A roved Surcharge Fee) pp ❑ Owner Given Initial Adverse Determination 5-. i. I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber MfkUCTIONS 1. A sanitary permit is valid for two (2) years 2. Your sanitary permit maybe renewed befa ge 0irationda�e, and at a time of renewal any new criteria in the Wisconsin Administratiye Code will be applicable. _ 4.•L 3. All revisions to this permit must be approV611byq the permit issuing authority. 4. Changes ir1 ownership or plumber requires a Sat>a�ry Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained:_ he. septic tank(s) must be pumped 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 - 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 oe 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. 0 0 �i nl n J I cos o ys ' 09' sY' PAG of PUMP CHNMb[R CR055 SECTIO AW SP ECI FI CATJO NS ^ VENT CAP r VENT PIPE — WEATHERPROOF /APPROVED LOc.KiwG _ - JUWCTIOJJ BOX MA WHOLE CovLR WITH ? 23' FROM DOOR, IZ'MIl1. WMWING LA13 1. WINDOW OR FRESH AIR INTAKE GRADE � le'rlu. COWDUIT PROVIDE I - - - -- IAJLET J AIRTIGHT SEAL APPROVED JOINT A I I I) APPROVED JOILJ7 / i l W/ , PIPE EXTENDIU& 3' I I ALARM EXTEIJDIUG 3' OWTO SOLID SO: L. I I I D ONTO SOLID S01. � I Ow C LLEV. FT. PUMP -� bOFF 0 CONCRETC BLOCK - RISER EXIT PERMITTED OWLy IF TAIJK MAIJUPACTURCR HAS SUCH APPROVAL. 3" P<PPAoVEa BEDDIr+G uncicr Tr.wK SEPTIC E SPEC IFICATIOKIS DOSE TAUVA MA►JUFACTURCR: ' � IJLJV -^SCR OF DOSES: PER DA-4 TAIJK SIZE: GALLOWS DOSE VOLUME / IIJCLUUI/JG DALKFLUW: L, Ji - GALLON:. ALARM MAUUFAGTURCR: pp.� MODEL WUMDER: CAPACITIES: A = LI IJCHCSDR �d � c��pp GALLOw5 SWITCH TYPE: ` J - 13 = INCHES OR aGGd CALLOUS PUMP MAQUFACTURCR: r-.— INCHES OR , / Z2,,. GALLONS / MODEL JJUMDCR: D _�_ INCHES OR - /, - W iALLOIJ5 SWITCH TYPE: TL LJOTE' PUMP AUD ALARM ARE TO DE INSTALLEU OW 5EPARATE CIRCUITS MIWIMUM DISCHARGE RATE - -��� — GPM VERTICAL DIFFEKE OETWEEIJ PUMP OFF AUD DISTRIBUTIO PIPE.. 9 FECT + MIIJIMLIM NETWORK SUPPLY PRESSURE . . . . . . . . . FEET FT + ,�._ FEET OF FORCC MAIM X La?�a m oo rr.FRICTIO►J FAL FEET 7GR.. TOTAL HEAD = FEET 1UTERWAL. DIMEIISI WL OF TXQK: LEs4GTN I WIDT11 -- iL14UID DEPTH (�; I 2ZL CE/!SE uM06R: GATE: CLJr es Pump `►6MA4 FEET M OD E L 33E5 d5 �' SIZE 3 /4" ►i So ds Wow )0 WE 1011 O wEOIH— F yCLCP51. �0 10 wtOJA� I ' 20 w E 0J D — 10 I 0 0 10 20 00 40 w 60 70 w 9G 100 t 10 I ;U G Y M p 10 ^ �Q m'/h CAPACITY METER4 FELT rr;U_ DEL 3305 Solids 94 i ^�_ ._� - -r-- _� - rte — --- 1- � 1 I — —T-- — 1v s 7 7, - -- 0 10 20 30 0 10 _ ... . ;a0 in v h CAPACJ7 r • V" Oorwo Ivmpo, Ino 4llop"h An IV" I WiscoF'sin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Puildings• Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - Please print all information Re iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). k _ �Z p Property er Property Location Govt. Lot 1/4 > 1/4,S _3? 1 2 Zj N,R E (o(L�V Prope Owner's Mailing Address Lot # Subd. Name or CSM# 1 7 J City Stat Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 14 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow /dam gpd Recommended design loading rate bed, gpd/ft , .S trench, gpd /ft Absorption area required 4�6 ed, ft _ trench, ft Maximum design loading rate bed, gpd/fF . — trench, gpd /ft Recommended infiltration surface elevation(s) (as referred to site plan benchmark) Additional design /site considerations Parent material 4Z Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U PS ❑ U ® S El U 4 S El U ❑ S U ❑ S R1 U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots :. - ....,. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench t id Ground s elev. �— `ft. Depth to e f limitin q Z•4� factor >;LQLin. Remarks: Boring # El �2 az,,22 Ze Ground - _ elev. I j — yft. Depth to limiting factor >/_,�-Lin. Remark CST Name (Pie a 'nt) I Signature ' Telephone No. Address Date CST Number 3 �irO n ell PROPERTY OWNER S > —J 61 15&4 ,!� OIL DESCRIPTION REPORT ti e Pa � 9 PARCEL I.D.# ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench k i I" Ground elev. i 41 Depth to limiting factor ; n. Remarks: Boring # s Ground 1 elev. — S Depth to limiting factor >, in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. Depth to limiting ; factor >1-4-2Jn. Remarks: Boring # a. $" M . Ground elev. ft. Depth to limiting factor � Remarks: SBD -8330 (R.9198) f lee, 0 Ole r / mac 1 - ,r"�C zc-�2 z /v- /,3 0 a i i 7 � 1/3 ST CROIX COUNTY C N A N CE A 0 RE E. "Al ENT A " CERTIFICATION FDRMI Maiiing Ad`M.� ;%leriFra"or required lr Pian Deprtrnoni fbT Rew C Ldon N PiIT-,el Id, I LF,f, AL,_V F S CR I P T 10 N W, Tcwn Certiflied Survey Mop 0 Volume Page 'Warranty Deed GC3 W Voiurne Page # SPCC idcnrifiabj v D - L,o lincs e ­; nc SYSTEM NIAINTENANCE Proper, m,ntcrF, ri; in its p. - 3 C:i-0ul- con�ds of pumpl% out the scptic Lzrik cvLry i;ITCQ YcDrs or s000cr, if needed by a licensed purnp.cr. What YQlj pl-A ifl(o 0" can aritct the 6umct,on of i}i- scp!;c. ta�� is irevnicnt st:Lgf: ir; the waste di,.; S The pro7,^rt- owner aqrcc,, tovj),j v , s by thoor, •xpslews ter Is in pToper t'lcl lll�pvcnoll and prnpiri& 0W vpnc tank is II1 &5 thari 1/3 f'jl; D'Sk,Jj;c tht! have- rca( flee al)CYC leC dlid Agttt tQ mmintair, the pTiyatc $e'LYgge diePGSal ;YSItm -'v'th t1he: 4F b the Dcpannvw u."C ommerce and the Department or Nzl.ural Resources, State of %Vj5c:MSll', sf;wng lht t k wr(•( qy , (c•n III, om,ii tit t1 rcfunci is ill(' S! SIGNATM OF AP?LIC:AN: DATE Q�� MNV RACt^ —IFEQ — AJ�JJQ N I 'wO terili) �,m aII slvc;ll(- orl ! ! :rq In;c • Oest 0 , ,r yl) ' ;Our) Kr , c ., x ,i c d gc ( ii )c o-vm:ro,' alhcvc, ry (',C a ruccrdnd in ReJ15Icr 9r :)Ccds CM c c S IG NA TURE 0 P A F P L I CA N DA YE /"ny it) fo-mwlorl *Pl 1% ro pr.:Oer I mgy recnill in F a7i iai- pei.Tnit bciu1 fcvoked by tk! Z on i ng Dcpartmero. r , froi�i o,c �eg�ver of ..i o mti�cd sunn,, map i r fcfcrcnrc is made in the wammy died • r f STATE BAR OF WISCONSIN FORM 2 - 1998 613168 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number y��.1468�►�... 52. RECEIVO FOR RECM This Deed, made between T 11- 03-1999 10130 AN EXEMPT M Grantor, CERT COPY FEE: and ROBERT T PENsunRN and MICHELLE — nnfI CHER, COPY FEE. TWffER FEES IFA.70 — single per RECORDING FEE: 10.00 — - -.. —. PAGES: 1 _ Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following ., described real estate in s - Croix County, State of Wisconsin: Area Lot 13, Plat of Country Wood, Town of Troy, Name and Return Acidness St. Croix County, Wisconsin. Doi Rstura to: Pack>at►9 � E "Ping First Fedwai Savll"O B" P.O. Box 1688 La Cross, yyi r -1868 Parcel denttficalion umber ( IN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 1st day of November 1999 _ Richard 0. to r� � � (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of Fersonalty came before me this 151 day of Novomhor , 19 q 9—, the above named Richard O Stout TITLE: MEMBER STATE BAR OF WISCONSIN — _ to (1f not, me known e 7not,state regoing authorized by §706.06. Wis. Slats.) in and a THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 13rl ncawt�,4nu my; Hudson, Wi. 5401 6 Notary Pu Ic. State of W1scMy cam issi is permandate: (Signatures may be authenticated or acknowledged. Both are not " `' " necessary) , Names of persons signing in any wputty must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Go.. Inc. WARRANTY DEED FORM No. 2 - 1999 Mswaukee. Wis. M 7. 1 ' FILED ,z JAN 0 9 1997 ► 9 KpS} UM 14,WAM 81,10 I OCrid1 `54333 vt.CroixC0.,W1 CERTIFIED SURVEY MAP Located in part of the SE1 /4 of the SE1 /4 and the NE1 /4 of the SE1 /4, all in Section 3, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; being part of Lots 9, 10, 11, 12, 13, and 14 of the plat of Country.Wood. LEGEND OWNERS E1 /4 Corner of Section 3 o AT 19 Aluminum County Section Corner Monument Found Richard & Janet Stout 1 � 2" Iron Pipe Found 1353 Awatukee Trail / Hudson, WI 54016 = � 0 1" Iron Pipe Found \ � M ® Berntsen Survey 3 N M Marker Nail Found ` n N m 0 0 1" x 24" Iron Pipe Set, 4j(n weighing 1.13 lbs. per \ LOT 9 `" o of- linear foot. 33 o — -- —12 Wide Utility Easement �� *2.03'Acres h Q 4) 88,449 Sq. Ft. / U 0 * Area remaining in previously ® 1 O / o platted lots excluding that lying in Outlot 2. I a = 227.09' r t/ c w w��/ LOT 10 nn M .o m ao w i *3.04 Acres T- G�/ 132,274 Sq. Ft. N ° O 10 1: 10 NOTE •The .creation of Outlot 2 o shown on this Certified r►-3 19 1 �J+ N 89 0 52 1 31 "W ? Survey Map is for the j0 w 555.02 o 0 ltd � purpose of realignment and ►d o a` dedication of additional 03 N LOT 1 1 0 0 lands for the public street; �~ JH �o w --- "— °: h 0 due to unstabl soil conditions. rn *2.75 Acres N o m m IN "' 119,820 Sq. Ft. N N 4J Is-3 %_ rr� ► _ N89 °52'31 "W PC m m eo �ooj " U . ZU N C O, p 4d / � N N W OUTLOT 2 ; LOT 12 w_ r 0.66 Acres 2 750 S Ft.� *4.52 Acres o E 8 f•!� ' q•... 196,815 Sq. Ft. In L. 4J 0 5 �?O" _ 1 0 1 2115"E 6 S81 6. 2' W / 36.22 s LOT 13 *5.67 Acres (Ft p 246,900 Sq. Ft. a0 " LOT 14 •s �'��F` o m OT 14 o a *5.98 Acres ° z 260,368 Sq. Ft. — 1059.48' — 15 812.48' 247.00' SE Corner of y —_ S89 0 38 1 39 11 W 2626.51' Section 3 S1 /4 Corner of South line of the SE1 /4 of Section 3 Section 3 SCALE IN FEET 0 100 200 400 SHEET 1 OF 2 SHEETS VOL. 11 PAGE 3201 ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT N N Novell ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715)386-4680 Fax (715)386 -4686 Fax To: U�J� b�1 S 6 W�) From: Fam I Pages: Z Phone: 3 gj. 03 Date: CS i - ZAA Re: 5AW i TP V-`I' P G -du.- (C CC: L( (,A-`Vfl ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle c«. t4 Jlp �$-' i� ern 5 c -tom Monica Lucht Subject: #453429 Kim O. /Penshorne Location: T of Troy, Country Wood, Lot 13 ` Start: Mon 8/23/2004 4:00 PM End: Mon 8/23/2004 5:00 PM Recurrence: (none) i 1