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HomeMy WebLinkAbout008-1032-20-000 I ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY RE P •T A. Owner !� t 4 t ► M �d Property Address (/C. lFr� City /State S G2 Cry Legal Description: xaN °OrFicy Lot Block Subdivision/CSM # '/4 , L I /4, Sec. J_L, TAN -RAW, Town of C, , k 11 e P� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION. Tank manufacturer JY! �cIN.tS',ec Size ST/PC bGUI s Setback from: House Well P/L Pump manufacturer 7r, 0 �e •2 Model ! Alarm location _d E7 t c c 1?. 4 (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM 5 L S' Number of Trenches Ty of system: Width ength Yr Y Setback from: House L o ' Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark N a ► l ► h $ Elevation Description of alternate benchmark L - .,Q G f- L2 t s e, ,n a n -e We- Elevation f ? . t Building Sewer Ff.3 ST/HT Inlet f�P ST Outlet PC Inlet PC Bottom q Header/Manifold I b o • 1 Top of ST/PC Manhole Cover ' � �1. 3 3 Distribution Lines ( ) U , `l ( ) ( ) Bottom of System O q Final Grade Date of installation / / Permit number 3 y State plan number �l Z 3 3 Date L01 / `! Plumber's signature License number Inspector �S �� , �, Complete plot plan Or NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW .A �vkS P 5 a Ga 7 f r' INDICATE NOR Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buifdmgs 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)]. 344669 Permit Holder's Name: ❑ City ❑ Village 0 Town of: State Plan ID No.: MATHISON, Bryan EAU GALLE CST BM Elev -: Insp. BM Elev.: BM Description: Parcel Tax No.: 008-1032-20-000 TANK INFORMATION Z E EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � lO 6 Sb Benchmar a. 1 O 06 Dosing 4 1 f 9w• 9 Y Aeratio Bldg. Sewer Holding St /Ht Inlet /Y to TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto ROAD Bt 'ri Air Intake Septic �s f t �-- NA Dt Bottom �, 3 Dosing �� G ' NA Header / Man. Z, b �d Aeration Dist. Pipe �pp, Holding Bot. System PUMP / SIPHON N �; Final Grade Manufacturer 4,V Demand Model Number . �, GPM TDH Lift s� Friction System y TDH Ft Forcemain Length �( S i Di a. - Z tt Dist. To Well SOIL ABSORPTION SYSTEM E TRENCH Width f Length r N Of j re a che PIT No. Of Pits Inside Dia. Li ui th D EN I N l klrwl DIME N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man urer: _ INFORMATION TypeO CHAMB Mode Nu System: Z r ko 1 41A OR UN T DISTRIBUTION SYSTEM Header/Manifold , Distribution Pipe(s) u �� ol x Hole Size x Hole Spacing Vent To Air Intake N if Length 7T__ Dia - Z Length � Dia. T 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 [I Yesl E] No []Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) EAU G LLE 11.28.16.168A,SE,SE 2581 42ND AVENUE � ©mo % ���- �,R � > b • 0 ' 6 am c. 60S j r �) Ph'1 Oc"�O�i C tolu�^3 luerr ir. place Plan revision required? ❑ Yes J No Use other side for additional information. L t Z a SBD -6710 (R.3/97) Datk Insp' ctod Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �...� f � E EE w� L i ..... w e 3 i i 3 t a .... ....... .. �ma . ._,.�.. . ..�.. _.,�..q _. ., , € 5 s ... # m. t s i g 3 € = S L__a I e e �.._ ..,. ......; ,......_.�. ..,,.,, P . _ _.... �, .. ._&._ ... ,.... � —.. ... —,ewe Q e f t g I E $ _. ..... ... ;.„ ..... ,.�.. ....... 3 .. :....... �....,.....; a..e..� .. s wM e .. _ ...... . ;.a.A ... .a »....,.� ,„mom 5 3 � 3 T ! v ..a.�w »...«.,.m t P .. e n. l i Safety and Buildings Division 201 W. Washington Avenue SANITARY PERMIT Nvisc : f P O Box 7302 Department of Commerce In accord with ILHR 83. Adm. Co r Madison, WI 53707 -7302 Attachcom • let Ian (to n only) for n 1p XUa �Ca e plans (t a county co o ) o the s , o a e ss y p Y pY Y p p than 81/2 x 11 inches in size. • See reverse side for instructions for completing this appli ali" Skate anitary Permit Number ST ORQX Personal information you provide may be used for secondary ,a �, eck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. to Plan I.q. tuber I. APPLICATION INFORMATION -PLEASE PRINT ALL IN ti� G Prop y Owner Name tion gr 0..�� f , Sc 1/4 :5 1/4, S I T a �' , N, R I (p E (or)( / ) Property wner's Mailing Address Lot Number Block Number a Oo +-. P b. l3o X 1 ,City, State 2i C de Phone Number Subdivision Name or CSM Number U i ►� LA-2 v 1 ('715 ) II. TYPE B ILDING: (check one) ❑ State Owned it Nearest Road Public 1 or 2 Family Dwelling �. - No. of bedrooms Town OF C0. &aJ 16 III. BUILDING USE (If building type is public, check all that apply) . Parcel Tax Number(s) I I, 2 a. 110. to $ 1 1 ❑ Apartment/ Condo " 1 03%L. - �( O U 00 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. 0 New 2 ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5, ❑ Repair of an _ ____System _ - - ___ - System____ _________TankOnly__ - ____ - Existing System __ - - -__- Existing --- - - stem 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 ❑ Seepage Trench 22 �] E] In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation .375 9, 5 Feet /0l Feet VII. TANK Capacity in allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tank Septic Tan"rt OMMg Tank 1600 / mi / 6(1P5 � [0 El El 13 El 1:1 Lift Pump Tan la er 6.5 G / C71(m -k e-, t ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit for installa ' 6p of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: (N S m s) MP /MPRSW No.: Business Phone Number: _JvC �ar, � line ,9J '175 7/S �v 98 - �a& Plumber's Address (Street, Oty, State, Zip Code): 5040 W J I / 4)w DPI. (.v IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issu nature ing gent S / (No.Stamps) (�pp Surcharge Fee) /���� �W roved Owner Given Initial Adverse Determination � / X. CONDITIONS OF APP90VAL / REASONS FOR DISAPPROVAL: I� Al. Ru, .,... so Ae yr s tvw.r s 4e,.`n - 5&e, G*oow� SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS s 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -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 81/2 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. I\ Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 • • Tommy G. Thompson, Governor Visconsin Philip Edw. Albert, Acting Secretary Department of Commerce October 13, 1998 CUST ID No.267341 g ATTN: PO WTS INSPECTOR WEGERER SOIL TESTING & DESIG 9� Z . NING OFFICE 421 N MAIN ST � S'T'CROIX COUNTY PO BOX 74 O�� +' ;� HOU CARNIICHAEL RD RIVER FALLS WI 54022 a.r, ! HUDSON WI 54016 ST cR�` ,19� RE: CONDITIONAL AP VA zgy��N Qk 8 i` APPROVAL EXPIRES: 10/13/2000 '�i 'yG�n' i - Tdrrnt>...... on Numbers / �''cfi f ~` Transaction ID No 181239 Site ID No 161634 SITE• Please referto both, zlentification numbers; Site ID: 161634 above, m all correspondence with the St. Croix County, Town of Eau Galle agency, SE 1/4, SE 1/4, S11, T28N, R 16 Bryan Mathison FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 429462 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, y DATE RECEIVED 10/05/1998 FEE REQUIRED $ 180.00 rard M. Swim FEE RECEIVED $ 180.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us I Page of b MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SEE 1/4 OF THE SE 1/4 OF SECTION 1\ ,T N, R 16 W, TOWN OF jz P G>�'� LL , ST• ( COUNTY, WISCONSIN. E::1,s'E) INDEX O C T 5 1998 PAGE 1 'of 6 TITLE SHEET SAFETY & BLDGS. DIV. PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR C -O. SOX 3 I • T OF CO IL DEPART Y A ILD r 1S►0N SA E LE GORRESPOND PREPARED BY WEGEF;tEF=;Z E3 C3 I L TEST I Ni c; AND ��lgewM DES = C-.[V S1t=RV CE C Nv/41 P.O. B01 7 4 421 R. KAIN ST. } L RIVED. FALLS. VI 54022 ARTHUR L. 715 - {L 7-01SJ w o5 PG1 m S WOHT ' 9 -- JOB NO. PLOT PLAN Page '2._ 6 Scale 1"= o,l m 1 loo y CT �+ Y $N Ory B ra ) - eL.�uo•o' oN SQ1F � "u u� 6iaa� tn, PP �P of 1 per, zg �poss � $`� �ouu�wr� -K l.o G1'T►ory 7 � I i e•3 i / G� o � tE L9as j 0 ' \ J ak� Zs S y4 cJ'�o� Yivu S E l'o \aC Rfi L - S ST ZS' F-\z4)11 MU AA � c{�y IN L - N 5 b .'N�tR -psi" U w�, o�= Z � � Z v�-e �`�; � u T i s > S ' �.oi� w�o�►�D 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. ( Z required) 4. tank to be \ 0bO 16S0 gallon capacity manufactured by i ki c 5. Bench MarkS Slot YN-1iuUE 6. Divert surface water around system to prevent ponding at the uphill side. Page 3 Of Approved Synthetic Covering 033 Distribution Pipe Medium Sand _ _,r.fi Topsoil IG. F Elev'. ° L9 • S _1 E !i D - 3 e �{ % Slope , ( Force Main Plowed Trench of 2" - 2" From Pump Layer Aggregate Undisturbed B \ • O Ft. Soil E 1-Z Ft. Cross Section Of A Mound System Using F o $ Ft. I Trench For The Absorption Area G Ft. A S Ft. H )-s Ft. B S Ft. I 15 Ft. Linear Loading Rate= �,O GPD /LN FT J g Ft. Design Loading Rate= o.3 GPD /SQ FT K ti0 Ft. L q 1=t. p� e�ncitinn of Fnrro�Caaa W - 2 Ft. Force . B nOf a i W h _ A --- -- _- - LO.bservGtion ibution Trenc ipe Agg ecurely) Mound Using I .Trench For Absorption Area �{ Of 6 Pa ! ge _ :Perforated Pipe Detoil _ ..: .:... End View End Cop). ) Perforated PVC Pipe �' as Install permanent at end of each lateral Holes Located On Bottom. Are Equally Spaced Q End Cop PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Layout P 1'4 Ft. X 3 b Inches Y 16 Inches Hole Diameter ley Inch Lateral l I Inch(es) Manifold Inches Force Main " Z Inches # of holes /pipe tZ.- Invert Elevation of Laterals Ft. �ZX. 1.11= IV.U�xZ. �8.0� Place lst hole �`� from tee with succeeding holes at 3 6. intervals. Last hole to be next to the end cap. ' Combination Sept and PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS ' PAGE S OF 6 - T CAP WEATHER PROOF Juki bOX -(C .L. VENT PIPE 1 APPROVED LOCKING - - -- " - -- M&WHOLE. COVER wCM . 10' FROM DOOR. 1 wARN1WG L;14pE1.. dINDOW OR FRESH AR,INTAKE c s I 1 i tj "MItJ, G>i I `I" /Aim. a:: Ct S y'�IIJSPt'�IlotJ PIPk" , PROVIDE - -- 11DLET AIRTIGHT SEAL e S APPROVED JOIM A I I I APPROVED J01WT: C.I. PIP6aR I III W /C.I. PIPE�P'c W ( Tank construction I II ALARM shall comply with ILHIR ('13.15 and 33.20 !s I I I ow C I { M e'VP, - PUKE) LLLV B� .�S FT. - -� PUMP —� OFF 8 1- S' ,. D GOIJCRETE L L`'�• 83. C3 (3 BLOCK 3" APPROYEb RI5ER EXIT PERMIZT'ED OUL1 IF TAIJK MANUFACTURER HAS SUCH APPROVAL UDDIN4 SEPTIC E SPECIFICATIOUS DOSE TAWK MAN UFACTUR ER: �' p-p- M pl?-ZC4\ NUMBER OF DOSES: PEft DAy TANK :,IZE: IOOI) 1-16's GALLOWS DOSE VOLUME t ALARM MAIJUFACTURG.R: S • S. El- f� S���syylS IWC.I -UDIWG OACKPLOW: \S GALLONS MODEL ►DUMBER: 101 CAPACITIES: A= L y UJCHCS OR d0 IO GALLOWS SWITCH T7PE' "FICA -A -Y $ = Z IUCHES OR 3 � GrLLOA15 PUMP M.AMUFACTURCR: Z()ELL-(5z C 11KHES OR 1ST GALLOWS MODEL NUMBER: , 31 D= 9 I�OR 1 � GALLONS SWITCH TYPE: mC'(�� �f NOTE: PUMP ADD ALARM ARE TO 6E MIAIIMUM DISCHARGE RATE •��i GPM INSTALLED 00 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEU PUMP OFF AIJD.DISTRIBUTIOIJ PIPE.. \b'ZS FEET t tiI1DIMUM NETWORK SUPPLY PRESSURE ; .. 2.52 FEET 1.(,1 t + X35 FEET O F FORGE MA Y, F Z.�7 oF LFRICTfou FACTOR_. FEET TOTAL DtWAMIL HEAD = Z FEET Pump chamber DIAMETER I&ITERUTAL. DIIALWSIOWJ OF TAWK: LEKI&TH ;WIDTH ;LIQUID DEPTH 3 S_....� BOTTOM AREA 231= l GAL /INCH AS PER MANUFACTURER -- GAL /INCH • -413/16 7 7/16 HEAD CAPACITY CURVE MODELS 137/139 t- 6 1/9 MODELS 137/139 Ft. Meters Gal. Ltrs. 1' o a 5 1.5 . 93 352 413/16 10 3.05 79 299 _ 0 .q Z 15 CST 64 242 S2 6 20 6.10 36 136 , 1 11Y - 11 1/2 NPT 25 7.62 8 1 30 4 t5 137, 39 30 9.14 - - o t0 Lock Valve: 26 fL 28.0$ 2-- 5 I 13 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 -� LITERS e0 160 240 320 400 1 I 44 0 FLOW PER MINUM ,1 SK37 008421 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V, 230V or 460V. • Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an a lp, • Double piggyback variable level float switches are available for variable • Mechanical alternators, for duplex systems, are available with or without level long cycle controls. alarm switches. • Over 130 ,(54•C.) special quotation required. • Combination starters are available for 3 phase pumps. • Refer to FMO806 for 200° F. applications. • Control alarm systems are available for 1 phase pumps. 137 Series - 47 lbs. 139 Series - 51 lbs. SELECTION GUIDE Single Seal Control Selection Listings 1. Integral float operated 2 pole mechanical switch, no external control required. Model Volts -Ph Mode Amps Simplex Duplex CSA UL 2 Single piggyback variable level float switch or double piggyback variable level M137/139 115 1 Auto 10.7 1 or 1& 8 - y y N137/139 115 1 Nan 10.7 2 or 2 &7 3 or 5 &6 y Y float switch. Refer to FM0447. BN137 115 1 Auto 10.7 .. - y y 3. Mechanical aftemator M - Pak 10 - 0072 or 10 Refer to FMO495 D137/139 230 1 Auto 5.8 1 or 1 &8 - y y 4. Combination Starter. Refer to FM0514. E137/139 230 1 Non 5.8 2 or 2& 7 3 or 5& 6 y y H137/139 200.208 1 Auto 6.2 1&8 Y N 5. See FM0712 for correct model of Electrical A temator E - Pak. 1137/139 200.208 1 Non 6.2 2&7 3 or 5 & 6 Y N 6. Variable level control switch 10.0225 used as a control activator, specify duplex J1371139 200.208 3 Non 2.6 2&4 3 &4 or 5&6 Y Y (3) Or (4) float system. F137/139 230 3 Non 2.6 2&4 3 &4 or 5&6 y y G137 460 3 Non 1.4 2 &4 3&4or5&6 N N 7. Four( 4) holeJ - Pak, ju nctionbox, forwatertightconnectionforhardwiredsimplex ' G 139 460 3 Non 1.4 2&4 3 &4 or 5 &6 N N operation, 10-0002. No molded plug **Single piggyback switch included. 8. Two (2) hole J - Pak, for Watertight hardwired Pconnection or splice, 10 Pumps must be operated in upright position. CAUTION Three phase units require a contra switch to operate an external magnetic or combination staner. All installation of controls, protection devices and wiring should be done by For information on additional Zoeller products refer to catalog on Combination starter, FMO514; a qualified licensed electrician. All electrical and safety codes should be PiggybackVariable Level Float switches, FMO477: Electrical Alternator, FMO486; Mechanical Aftema- followed including the most recent National Electric Code (NEC) and the tor, FMO495; Alarm Package, FM0732; and Sun#Sewage Basins, FM0487. 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 ` £ Louisville, KY 40256.0347 Manulacturersol. . SHIP To. 3649 Cane Run Road Louisvile, KY 40211 -1961 rM11TY SINCE 19,2 9 r d PUMP CO. (52) 778 - 2731.1(800) 928 -PUMP FAX(502)774 -3624 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Dy sion of Safety 8 Bwlc ngs in accord with IL HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 61/2 x 11 inches in size. Plan must include, but I.D. # S� ` �' �x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL dimensioned, north. arrow, and location and distance to nearest road. 00 CS - I b Z.— ZZ APPLICANT INFO AA RINT ALL INFOR REVIEWED BY DATE. PROPERTY OWNER: rLM_K_� y_ ') SC PR L, ATION G VAC N 5 1/4 SE 1 14,S \\ T N,R 1(, E (orCW3 PROPERTY OWNER'S MAILING ADDRESS D BLOCK SUBD. NAME OR CSM # 3 g eotY own 13 - �?� �� tizo Pa8 esw] CITY, STATE ZIP CODE PHONE ER L� []VILfAG�' [MOWN NEAREST ROt 1ti00�U \L Jjl SVOt,8 l�IS7 .9 C�J -l_11 y7- I`Ql. " New Construction Use [�cj Residential / Number of s G r ; ` [ I Addition to existing building Replacement [ ] Public or commercial d Code derived daily flow 6rs0 gpd G loading rate bed, gpd/ft trench, gpolft Absorption area required S o0 bed, ft Sou trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevations) q G - S ft (as referred to site plan benchmark) Additional design/ site considerations 'N10vt�� W/ S 'X I OO �'T - - )vCjf • WI VV. I - Z" OF SA PLL Parent material LSSS (aU N V C \ - M L\,_ Flood plain elevation, if applicable t­a 19 _ ft S = Suitable for system CONVEMIONAL MOUND IN- GROUND PRESSURE TAT-GFRAD SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem OS ®U ®S O U O S R U ®U O S ® U' O S fo U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botnr�ry Roots Bed rends '.:`. 0 - Z M CS Zug .S •L q_ZS 10 -1 tZy/ si0_l .S Ground 3 ZS S7 5 V/C �i 5 , -t tZ S/g s e 1 `� -S 1vt `r - elev. q �•1 ft. Depth to limiting factor ZS" Remarks: Boring # �lJ — src) Z`�s1�h wi�� es ) U� • �I • s 3 Z4 -S 10 -f R 31 t, tip: Z Ground elev. 100. ft. Depth to limiting factor Zy Remarks: CS T Name,-Please Print Phone: Arthur L. W e e r e r 715-425-0165 egerer Soil. Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: / _ �_ �: 4 ` Date: C � / y CST Number. M00576 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 latgr and Human Relations Divaion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code r COUNTY �. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but -r ` 13'1 x not limited to vertical and horizontal reference point (BM), direction aril % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road.; APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R BY DATE �l :n e 96 PROPERTY OWNER: PROPERTY LOCATION Cf�LyN '1R`S?k18 pt.,) 49VF.t0T S f 1/4 5E 1/4,S 11 T Z ,N,R 1 fo E(orf 6 PROPERTY OWNER'.S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 3 t a 1304 on�n S N CITY, STATE ZIP CODE PHONE NUMBER (]CITY ❑VILLAGE (MOWN NEAREST ROAD tiv0 WI SVoZ5 (7f S') 6913-Z V--P GfT-t -E yZ ltlk hvE" D. New Construction Use Residential / Number of bedrooms L l [ ] Additign to existing building (j Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate bed, gIxW trench, gpdftt Absorption area required 5 '� bed, ft S ou trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 0 1' 3 1 - S ft (as referred to site plan benchmark) Additional design/ site considerations w/ S 'X t00 1 - �Lsve l# • f� lw . VZ," OF Sp - 4) nLL Parent material \ - . " o U ek C \ Z) LL flood plain elevation, if applicable t-3• 4 - ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S N U ®S ❑ U ❑ S ®U 0S ®U CIS Lou CIS W U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed reach y -9 �o �z 3 t Z s i t Z `� s bh r�, `F1� �s Z vi S - h� Z q-,ZS 13 [L- V/Y si c-) ZM S m v i •4 • S Ground 3 2.S 3`1 - 1_S Yk VAL �i. s `� cz sly s (a\ SbV� W1 i r elev. a�•) ft Depth to limiting factor ZS`' Remarks: Boring # Ll Cr- cS U f • L4 3 Z'43V 10D lR - .51 6 Ground elev. �l 100. ft t ,4f> co Depth to limiting j S T factor Zy ,, xoN/,YC� Remarks: Name: - Please Print Arthur L. We erer Pine 715- 425 -01b3 gerer Soi Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signature: �8 y Date: C1 `y CST Number: . clt 1r M00'576 PROPERTY OWNER _`I`'YP , '� I SOYV SOIL DESCRIPTION REPORT Z� Page _ of PARCEL I.D.# 00 1032. —Z0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITW& 2- 7 v� Ground 3 Zy -33 Lb`1R -3�6 S`lIZS��S S1 � �S1z, k elev. qq.S ft. Depth to limiting factor i Remarks: Boring # 13 o -� 1p`-tR . 3� 2 — Sl } `�Sb1Z v►1 �r c s 2v`P • 5 Z g - 2� 10�1� --y�y sil Z`�sbk vh�y. cs lv� •S� -1 3 21 3l, l�biZ 31� �; Still S�6 S1C� 1 �Sb1T Ground elev. C `x•7 ft. Depth to limiting factor i Y Remarks: Boring # 3 E lm , Ground elev. ft. Depth to limiting factor i Remarks: . Boring # _ a Ground elev. ft. Depth to limiting factor — 1 11 i --.- I Remarks: SBD- 8330(R.05192) i PLOT P LAN Pa of 3 y SCALE 1 "= x O ' W1 �Cl 'k1'1 S t)►V P � p ►v0. CAB- l03 L - Zp ` B �1i1 i - et.l�� -O'a.� SP�►�E 2 - �L.94_3' or-) Q_ p. W , L. u E ,! `Z" T'r3 o ul �iR4vf -JD lry A P �P of fit, 9 - 1 r ZS�'1 � I � I I A "oT t-- oM p+l -cT o1z r I r � � r g.3 i � tE L99 o o� � N o c7 's Cl,�o - �lvv s N 1'0 �C Afi L S'S 2. S' F:n z ark Q� . w�t� k � � s o' h • F�1tiCLC LOT LIAJE - rl� �'rfi L -`�ST S ' F M(Ohib , Z, (715 ( 715 ) 4L-0165 140 0 5 7 6 � CST Signature Date Signed Telephone No. CST # Wpconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Dirasion of Safety s Buildings in accord with 1LHR 83.05, Wis. Adm. Code I COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ��� not firrited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road.; APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION J RZIE DATE 9� PROPERTY OWNER: PROPERTY LOCATION t9 �f - 11�- 1S av ROff tOT- s f_ 1/4 5 ; E 1 14 ,S T ,N,R 16 E («63- PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER OCITY []VILLAGE [MOWN NEAREST ROAD 0 � w sq \L 1 S (Ifs) 698 -Z°tS8 �� C- ,rv'CE 1 41, K hllE' M New Construction Use [A Residential / Number of bedrooms Y [ ] Addkn to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate bed, gWt trench, gpolft Absorption area required S%% bed, ft 5 ou trench, ft Maxi design loading rate bed, gpo1ft trench, gpolR Recommended infiltration surface elevation(s) 0 !9- S It (as referred to site plan benchmark) Additional design/ site considerations W S 'X IOD " T'5 .5) vcd • I" l Vv • �Z OF S`A-AjO FJLL Parent material L l o tTm Q-\ TI Flood plain elevation, 9 applicable 1 9 _ It S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for stem ❑ S ®U ® S El ❑ S ]N U ❑ S ®U EIS LOU EIS U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. ' Roots Bed rer>ch S �o��z BIZ sil Z�sbh wIf>^ �S zv� •t, Fa q..ZS 1012R_ V/Y SIC-] IV4 S�\R v i -q s Ground 3 ZS -1`7 1 -5 YIZ WC ;- stitzstg elev. q ] fL Depth to limiting factor ZS'' Remarks: Boring # ] 0_ �a�� �Iz s�\ Z`sbh �`F►- � a vf- .s • S 3 Z� 3$ 10`48 3/ 6 �;•S C\ p �p .'Z Ground elev. \0r�It Depth to limiting factor Remarks: CS T Nane:- •qeasePrint Phone Arthur L. We erer 715- 425 -0165 I I W OW. rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 ' Signature: ` Date: CST Number: . L MOO-576 PROPERTY OWNER _ 1"') Pc'C1`� I S C Yy SOIL DESCRIPTION REPORT Page Z of 3, PARCEL I.D. 0 1O3Z — Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trendi 3 Q -7 tiZ H \I- 312 s ' Z sbl � `fir �-s Zv i . S - b 3 1 Ground ZU -,�3 t��� 31b �.S`ttZS�$ s� C� Ica s1�1t m�t. •z , 3 elev. C . S ft. • Depth to limiting factor i Remarks: Boring # i ) o —8 L�`--l2. 3l Z. — Sl I Z`�S�IZ 1ti1 '�Y� c s 2v`Q- • 5 ' • 1� 'Z. s -Z -I vi- yly - S i 1 Z� 3� cS lvi �; •Sy Ground R S)a S1C� LSbk Yti1 Z ;.3 ' elev. ft. Depth to limiting 'factor a I l i r Remarks: Boring # i i t 3 ' i Ground elev, f ft. I Depth to limiting i factor i I Remarks: Boring # }} I .' ,•+rat f ;, : Ground elev. ft Depth to limiting factor Remarks: SB D- 8330(R.05/92) I PL AN PLOT PLA Page 3 of 3 SCALE 1 "= HO ' �t'C111S pip ►v0. d48- W3 Z -Zo C) .1 to i 1"0 ip Q _ p. W • Lt W E J �Z-" t'r3 0 �� 6R avnrD fiv A P ''EDP of `M�- PAD, 4V r o i 1 r�UT �ot�tpR -cT� o�z R too - J � 1 S�tik. 'Slt�l s pn'L�M 3.Z N J r/I i / _ I � 1 cJco \ Y / l�vvS 1'0 �E Per LLf\ST ZS" F-lu" Y�GVrnJ. wELL k S FAJT\jV -C WT LIAJE'S - T - z j 8Q� A'r t_ �`�T S ' FP-b" Y- IOUNib . I I i I l -niu 14 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer V CLn Mailing Address 3 a 7 S K S+ P. U �5 l LC�L�d c� U e, Lk_)1 Property Address a s $ I �a ri d 4 ve , (Verification required from Planning Department for new construction) ______.9 City /State Parcel Identification Number Cj lr I o 32, Lo— 0 d LEGAL DESCRIPTION Property Location SC %,, 5 C '/ Sec. l l . T : -R W, Town of t�a Lk Q l f Subdivision Lot # Certified Survey Map # Volume . Page # Warranty Deed # S _ / S 5 �� : Volume Page # s �� Spec house ❑ yes q no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the 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 master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the 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 y the three year expiration date. OF APPLICANT DATE OWNER CEATMCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG TURF OF APPLICANT DATE * * * * ** 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 Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 133 t I r4 i HL r: E N H. 'fiat t� r ti ,IF _O Number _ _ i _— QUIT �_ CLAIM DEED - -- _ ; I . G; I y[ i Douglas Mathison anJ Jacalyn hathison husband acd N quit-claims o Bryan D. Mathisw and Nadona R Malfison !' and wife h as survivorship mar. ;ai property, the following ,cube-: real estate in St kill CLAIM �FEd ; Cjoix Cour, y, State of Wisco ^sin tEMT T 0 9 ':ERT '00 f E: E lif 4E.- 1 Recording Area s %iwm and Return A. d t t ir { Thomas A, MLCotniark , 740'Na.r Ctre.rt '; W- 1 032-20-000 (J P1rce? d0rt,f Cation :'lumber) R f t t. •� i West one -half of the Southeast Quarter of the Southeast Quarter tW 1 /2 of SF +/. of SE ':} of Section Eleven (11), Township Twenty -eight North (T28), Range Si -teen West i 15V1`) f .. , bF V his is r . i homestead property Dated *t :s 1`3y of 1998 I 'LZ ©ugta�`Matrnson •fj_ �: dacaiyri Matt1!"on AUTHENTICATION ACKNOWLEDGMENT - i " Signature(s) STATE OF WISCCMS!'k' ST CROIX COUNTY - -- _ Personalty came be`ore me this day of 1998 the above named f'cuglas and Jacalyn Mathison to j. authenticated this _ day of 19__ me known to be the persorn(s) who eztgt6A. we foregoing r instrument and acknowledge the srg ' signature - - -- s gnature G j f8 ^r prin n� ne r ry .. TITLE. M -_MBER STATE BAR OF ` VISCONSIN ;) ` (If not, Notary Public St, Croix County, Wisconsin , aut: oozed ny ' 71h3 06, Wis S - its) — My commission permanent. (if not, , soli , ! expi f rate: '" '•: j 'ru INSTRUMENT WAS DRAFTED 63 'N amen of oe+ sors s,9mng o any capac ry shouid c3 typed or x' Thomas A McCormack noted j , to = - !t)ec: sxaratures Bald. W t %n, 54002 .._. a., k