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HomeMy WebLinkAbout010-1051-70-000 o �° a�i ° o p p ^+ c c 4 0 0 w b C pC� i N c m a �= a > (D V- 0 0� A a Ns cp 0 0 0 E o c N . E 0 ' N I a� I O a z a z �� I C Z — O L c6 LL c 0 LL C O Y N O - 0 3 E CL M d M 0 0 = @ I E E z 0 0 u v ° E ° E_ V C. z a m N F Z a m a c o o 0 0 z g ! v L= I 0z� v c o c Q) o U) I- r 0 z 0 0 z 0 E -o E 0 0) o 2 M _ �O M O N CD N a° c •� y t O C 7 0 cA 7 a w= O d z z z z z I z I E , • E � . C l) � � R � N r O d O d d 0 }y��y 0 CL \l d IL U) > O C a m W O G o a n J O N CD 0 000 FL co z X E 000 Zo • w ° a a a �, ° a ° a a CL c9 W f 0 V O I W N C O 00 Z m rn rn 4) C M M N N N .•C' O 3 O O = E I C 00 00 E N O r •O > > O O b L) sl 0 a t o 'I a m w U m N N >- fn o 7 « I � 7 « O y N E\ ` 0) c� C 1►1 Q C 0) N� o E It LO $ 04 ao O p m 3 o W N O = O d m p O � C N 0 d N N CO c 0 N € = O V w O C c m O r O M M o r C 0 N 0.0 O cp N w 7 O Z C y 0 0 y CO d 0 G C N a0 UU w 7 j z O I I U =€ =€ ^" - ... _ a � a � I Z� • � a d o d d 0 d m c rr`�Iv o w 3 'o 3 '0 _1 A Ua2 om() orn� AS BUILT SANITARY SYSTEM REPORT OWNER -C`f r�//e r ��.1 era rl TOWNSHIP SEC'2 T_3e)N - RLW ADDRESS e f 67 41 ST. CROIX COUNTY, WISCONSIN. SUBDIVISION / _ LOT /1/� LOT SIZE 1W PLAN VIEW Distances and dimensions to meet requirements of H63 4UBYTIII "]C WillitiN IOU E LL'i Uk I _. �.._ 2 L NO 1 35 - t, - � 30 e - z'- I di a e 4o t--hl Arrow S C L BENCHMARK: (Permanent reference Point) Describe- N Elevation of vertical referen ,pe ;oint: >�� -�? _Slope at site. SEPTIC TANK; Manufacturer: ? Liquid. Capacity Number of rings on cover _, r Tanl�manholc cover elevation : Tank Inlet Elevation: Tank Outlet Eleva tion: PUMP CHAMBER Manufacturer; ,� Numbex of gallons Number. of gal. pump set for a cyc�e 9f gallons; gallons; tota capac ty of distribution lines gallon; size U pump ,< head; gallon per minute _;l horsepower_ _'' ;�r.an name of pump �_{ and model number � , , >, �`, �.� l � Type of warning eVice , d ,,Z Fi07_,L)IN(. 'TANK: Maczufac:turer Number of gallons I- Aevation of manhole cover E'y at> ()t warning device _ - -. SE�.'1,J'A ;E, PIT SIZE Number o�` p it s � - feet diameter i t:•t>t 1.tquid dept seepage pit in - Ii i t pipe - elevation til: SI : age p - t of l at �_0�1 feet. � seepage P inr_s widt.�t_ _f __leiigth i -- tile dt-pi h 'i t�PitCi!:, TKE?NCH. width length o ,k;l,A C lON RATE ` A EK E UYI�ED / , AREA I1 BIJTLT �, INSPECTOR PLUMt3r:l� ON J011 ._ �- LICENSE NUMBER " ' ; 4' DEPARTMENT OF INDUSTRY; INSPECTION REPORT FOR SAFETY & BUILDINGS LIBOR &•HUMAN RELATIONS ALTERNATIVE PRIVATE DIVISION P.Q. BOX 9969 SEW E SYSTEMS BUREAU OF PLUMBING MAbISON, W153707 F Mound Pressure Distribution NAME ERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPECTION DATE: PLAN ID NUMBER. BENCH MARK (P Rent refer., p� ntl OESCHIB F Dlf LN'T FROM PLAN �— R -- —'— H[F. PT E1..6V.: CST At F. PT, ELEV.. SEPTIC TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV. PHOPEHTY LINE: WFLL; BUIL)ING. DOSING CHAMBER: MANUFACTURER: LIQUIDCAPACITY: PUMPMODEL PUMP MANUFACTURER: WARNING LABEL LOCKING COVER 1 P O IDED: PROVtOEO'. YES ❑ NO KYES ❑ NO GALLON PERCY LE PUMP AND CONTROLS OPERATIONAL. PROPERTY yy L� JBUILDINt: AERINO�RESH DIFFERENCE BETWEEN I»I* LIrvE t PUMP ON AND OFF El ❑ NO J �� �' .� SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. DISTRIBUTION SYSTEM: er: WID7 : , LENGTH: NO. OF SPACING CENTER L NGTH: DIAMETER, MATERIAL AND MARKING: T RE N EE TO CENTER: CH S: 1 1 w' I v C D DISTRIBU DISTR. DISTR. PIPE TION PIPE MATERIAL &MARKING: MANIFOLD: PUMP: MANIFOLD PIPE MATERIAL AND MARKING: D IA .. NO. PIPES. DIA,: PP T ROVED O A R PIPE S VERTICAL LIFT CORRESPONDS s �`: DRILLED CORRECTLY: DEPTH OF GRAVEL HOLE 512E: HOLE SPACING: D ILL D COR Y: OVE L PLANS ❑ YE S ❑ NO El YES NO SOIL COVER: TEXTURE: DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OFTOPSOIL: J SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑YES ❑ NO COMMENTS: SIGNATURE: itT l E: DI LH A -SD D -6227 (R. 05/81) DEPARTMENT OF APPLICATION SAFETY & BUILDING INDUSTRY, ' FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property wner: Mailing A dress: eN�v�ze•- - rn &-R Property L tion: Cil"pUglago -or To wnship : County: 14J t /a /V�J %S Aol iT SO N/R (or) _X AL 6 �' Roy A Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: li 0 UN ! R �- C.L (If as ' �i) O 7 TYPE OF BUILDING Number of ❑ Public ❑ Variance ❑ Other (specify) /Y) d b f fL 1�61 lc-- Bedrooms: 1 or 2 Family *State Approval Required. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY 0n/e- '?C HOLDING TANK CAPACITY LIFT PUMP TANK/ Da 0A)t MANUFACTURER: JAJ P, sC K S U /J C - R� C p c( U c+ S EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New D�r Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit ,y( 0 / ❑ Alternative (specify) „ 6 cg&4)pjcl PiPeS,SVKe ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): 9 Private El Joint El Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: Sign ure: 4 MP /MPRSW No.: Phone Number: ✓ � P. e, 4 4- 60 1 r» P 44y9 1 (71f) & J ?V -3-37,? Plumber's Address: Name of Designer: � ,r; caw, ,� C�c.� , `s ✓ e R e � �- J o L� � COUNTY /DEPARTMENT USE ONLY ign ure of Is i Agent: Fee:: O Date`. APPROVED Sanitary Permit Number: P. 0 44ALI 1 tfl� �- lO 3O" ❑ ISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: f Form Change of ownership, building use or lumber requires a Sanitary Permit Transfer o m (67 -T1 to be submitted to the count prior to in- 9 P. 9 P q Y Y P stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod- Plumber r DILHR -SBD -6398 (N.03/81) Ulu INSP�:CTIUN INU-1VIDUAL SEWAGE SYSTLM S 4 it 1, L d r y P t; r tit La-- S L 4 L L S U 11 L I L MI': e 1 C w N I I I lb C1'U1X Ct)UIJL y 4TI O N u L 11 S u L) d i v i b i 6 It 1 " I ' l C T A N K I u 110 N"wOer of cumpartilik!LIL6 L UiIC V I I U111 wull ;NPING CiIAMHER 44110PIO PUQIP Manufacturer )LUINC TANK S Ion" Nutuber of CuwpI;4rL4jAgjjL:., P u 111 1) 0 r_ A 1,A i tit S y u t e. Ill I ksLonev P row; Well 1 $ U J I d 1 Ll slo "SURPTiON SITE bed I runs; Woll 127. t0'( SI'vL ult L �NSIUNS A T w1dL11 UT Lretich f L Requircd Lgogt.h tit 04CI► DepLh of Luck below rile 1n. N ti m b u I" o f I i n u is UapL ji ui ruck over L11e - in TQtill lal►gLj► of l lnaa► t L Uapt 11 t.) I L I I.e below grade i U'to Latic U Lit. Lwaon I tiles f L slupu of pu r I Uu t L TOL41 f L Ty pe u I CuV u 1 iT DIMENSIONS Numboi of Gravcl arULIJ►LL pjCb YUtj n u Uu I, ti I d v d lawij L w r I L uepch Ijt;:luw jlkle-t: Tutal abti01'1i)L lull IL Arco it I i.,lr ccl IM V V D AT L D AT' tItS WN n y �! 05� �.d q I ��, CAN At W i — r i ���.•...�•�� i��. �, I 0 ol a p � ,�, �.�• �•, ��, * RE EIVED , �EP 81981 ^� w PLUA4BIp G SECTIOAI 13°° t - E fb o't y T- ; � . t _ N --. c S • oz s t 010 0 REOtwE jL LA =7i o • L ro z '" t b S 8 1981 n cv a Z" PLUMBI SFCTf3lol x > (A (� i S✓R 0 i? (b cf.Z La tok r =� - 0 0, Til Q Abp . G ,fb �a" 4 c � \ u 41 V ID O �, G ta )G Too w 4 *Zb Cq ° 9� RECEIVEQ x r $LP28198. J;MsIK SEC�Ci •� Q� 1O- -- -- cab - = f. r �- t r iLA l� 7 i G d 4 �/ Z — i CI- LA - 0 { _A♦ I � � � 3 V • O z 3' Oc A z Jq w le i 1 r a a 1� 1 11 1: 1• 1. 1 1 iil ®ilrir "!� ® ®�i "� ®i�lY • ® ® ® ® ®iiii ®i►" ® ®® - ®®iii ® ®OY ®i e � B• 1 1' 1 1, ! 1 ®i ®i ®ii ®ii ®i ®'a�i�►�i ®iiiiii �`� ®il♦►�® iiii® L OX= M—mm liN�w' !� 1� ill " : • i i ®R� ® ®i�iiil�illlllll i ®V� ®11:ii1®fi ®Iii ® ® ®i ®i ' iii►!. 7i ►�rllii ®i ® ® ®i ®i ®i ®Il�iii�%!! ®li ►� ®il ®i ®i iiiiimii Mb=-"N= i ®iii®i® ®i ®® ii®l1.::!�I ®� o®®®i®i® ®ii® ®I■�i®iisl::�. iiiiiiilii®iiiiif� ®i apt cr . w LO t s State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 , ` '' Plan Identification Number PRIVATE SEWAGE SYSTEM ONLY— A l l The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed a the above - mentioned location. The plans and specifications were prepared by � t t and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in Chapter H 63, Wisconsin Administrative Code, for the use of C �.f�.. ,\ALL •. � . 1, `. F. �� A� K- C. i.s_. -s . k ., '_- ,� � •; � �. ' (". - \ _ _ _ a . The proposed system is fora Wastes from the building will discharge to a <T'f�`'P gallon capacity septic tank which will discharge to a R (2 C ) gallon capacity pump chamber from which a pump having a capacity of .:v° gallons per minute against a total dynamic head of l r Q( feet will discharge through a cN inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: O By: B ounty btkt�r T Enclosures '`- �`• "1' j �G1i�/ DI LHR -SBD -6159 (R. 7/81) me s Sargent, B erector l State of Wisconsin ` Department of Industry, Labor and Human Relations Please Reply to: SAFETY & BUILDINGS DIVISION r- -- Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 WA .+... -.�'� ( � Plan Identification Number L J Re: CLWZ. S1 r k"= = P. b� PRIVATE SEWAGE SYSTEM ONLY— �(' t The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above - mentioned location. The plans and specifications were prepared by A $ 1 and received for approval on nC)*__C� 'o Q_x_ The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wi consin Administrative Code, for the use of The proposed system is for a �aGl\ 'r \'—�� Wastes from the building will discharge to a JSI gallon capacity septic tank which will discharge to a Re)n gallon capacity pump chamber from which a pump having a capacity of :: �6 _ gallons per minute against a total dynamic head of to?, O ( feet will discharge through w inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145 Statutes and ch. H 63 Wis. Adm. Code he plans and specifications area roved contingent u n compliance with t p P PP Po the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS By: County Other p p Enclosures DILHRSBD -6159 (R. 7/81) mes Sargent, B erector '� y__: {, .c• y�. kit r:, �� Ptb 10001 -12178 .k _]Up�per ptv, x . ' Pa tai Of This Tonn With ' Aivo IfiIIF t+ sy s ­AA #u i pa►ndence MAIL ALiISREf k ox , MADt &OAr;.yY iSIN 537rkt bAi'E: October 1, 1981 ' 01VFr ,+► PROJECT: . 3i _ Cc, f OCT 1 1981 Eugene KruizeW -� idec i ZONING Alternative Sysstl�''' - OFFICE • Nwst, N04, sec - 32, T. ` + Town of Emerald, Boldt's Plumbing & Heat St. Croix County,. WI Baldwin s , Wisconsin 54002 $1- 05177; .� PLAN ID. # DETACH HERE in. i »r+..r..::: +......v%:. -:. , .:�: . .= . °-•.. r w:: — ..._ ..a: — — — — — — — —'—s ....� ...:: +. ...•;a3Ayz.,r .ii g w a... r.+* Y Eugetse K R e s idence k 81 -05177 PROJECT NAME PLAN ID.,# This is to accrtc►vslsd r of your plans and specifcati ins r the above�indicated project. I le#unirtarsl, r�riew incl�ttes ths,.plan review fee,:#equired is $ v f ,. Plan accepted review. Fee received is $ ., �.. Fee is being returned because of . ❑ Overpayment h.t Underpayment.. i. I Providing -one of the two c3tagories above is checked, remit correct fee in one payments k �U ll No fee has remitted. Plans submitted with no fees will beheld in abeyance. "�k 4 �� l m 0 Plans being returned. A+dclitional information required. SEE BELOW. 1. Plan.Submission ` ❑Additional information shall be!submitted in triplicate unless specifically noted. ❑ Plans not clear, legible or permanent. ED All information submitted shall be signed, sealed or stamped in accord with Section H 62.25(2 )(a) tNisc nsn bode, _. ❑ Affidavit enclosed. #l. Alternate sewage Disposal. Systems (Mound Systems)a D PLB 108 (Application for use of an alternate system). ` County onsite required (1 copy). ❑ Design calculations for pressurized distribution ❑ Cross section of mound. 0 Pipe lateral layout. ❑ Plan view of alternate. 111, Private Sewage Disposal Systems` s t C] Ground slope with 2' contours in entire area of soil absorption system extending 25' on all sides. El Elevation of permanent reference point (benchmark). ,. ❑ Location'of area suitable for replacement system - provide soil test data..)" Q Plot plan showing lot size and all lateral distances from sewage disposal system or holding tank to bldg%, lot lines, vae1. #, let rse . Q Construction detail of septic, holding or lift pump tank if site constructed or tank manufacturer if precut.. , Construction detail and cross- section of soil absorption system. • 3: i e e' ❑Soil boring and percolation test onEHA16 completed byvert(fiedsoil tester (1 copy). . a" ❑Complete data relative to anticipated use of bldg.: Q 3 copies - of RLB 60 enclosed:` J y3 QDeed restriction required (f copy). IV Holding Tanks �* ..., �.l�+Cy #ite; A€. #iQl€l�(sg-ter11C. •., _- , � g._ aA } Moldtn 'tank.`greementsigned by .owner and local unit of government '(sample,enclosed). t Reason: for•installing holding tank soil test or statement from county (1 copy). r {' culations for" total lift pump discharge, head and gallons pumped per cycle.. r e, length & depth of force main. r , tait, & model of ' pump or automatic siphons including size, -pump curves, drawdown. and average flow rate,f : 0 CroSSL soction of lift purnp tank showing pump(s) or siphon(s)._ I JI AIF Vk; Systams In Fi14 (Fi {{ must be placed prior to plan submission) s ; i Total area. , filled (fillAo oxtend 20' beyond edge of trench be f ore side slope begin)..: .. ❑ Depth.and type of fill. ' �QCRpY ofi at�ite �portkf�. county or district plumbing upervi�r_ ... � ti :�t +�� z � � � A � l w � Length of, time fill has been in place: fi f `F r u a� d '�`- �.� °' �'�, � fig- k'�� # � •'tie$ ia� f �; e a •: W 3" =.;.3. Y _ L MA 1� C x I l "�' 5" C 1 F � h e ll , t p t �a s Rof S� s c r r ' O y. b -P4� X £ z �;_r�x $$ '$: _ arc 4 } # may .5 L. a k„ c a ' t � l y , € .FM { PM.Lrti t ko 7T" tj a ;� ° . > r - DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY &BUILDINGS INDUSTFYY, CC DIVISION HUMAN f AND �EL ATIONS PERCOLATION TESTS (11J) MADISON W BOX 53707 LOCATION: SECTION: 0 TOWNSHIP /MDti�PAtiW: T NO..BLK. NO.: SUBDIVISION NAME:. Nw �/ �/ A-1 /0 N/R � lor► W �M r— A 14'L q COUNTY: OWNER'S BUYER'S N 7 )qulze_e44A MAILING ADD S: 7'`: C RO /x �v c,�e E, n e.RAL_ J USE DATES OBSERV O S A( E, F5 BEDR .: COMM R.. AL DES I P ION: TESTS: Residence NO. ❑Neweplace RATING: S= Site suitable for system U= Site unsuitable for system LI t i� CONVENTIONAL: MOUND: IIV- GROUND S STEM -IN -FILL HOLDING TANK: RECOMMEN SYSTE osou osau sou os❑u EIS FA �F• If Percolation Tests are NOT required DESIGN RATE: S If any portion of the lot is in the ly under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevatio� PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B / 7 11 9 , �r �r0 1,no -06 O _ N - � a� 5 1 L 4 ;.�P 17-- - 5C, L B- a ,�L ?9 / B- 3 Ta'' 99 1o' `' 0-6 r �a « �� -7z B- ?" - 7 D ; e,e 0 6,e-, t. M �j B" y d / �✓ �x o �.v� e C A u se In U f fL i•.� /- RO r�-� B- ('r" — 9 _/D /S`' w Sli '7dp Sol L5 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PE RIOD 1 PERIOD PERIOD 3 PER INCH P - ffo 90 3 3 P- 2 v " 5 P- '7 lf 3 ' P -. P- P- PLAN VIEW: 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 slop. SYSTEM ELEVATION 9 S 7 " I C 1 � 3 � � i •f -� - � E 1 h �. I l 3 9. mom -� ►- - - Y �O 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print :- TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION NUMBER: 5; NUMBER optional): .Q4.Q 6J, S v�"�' 4 A � �85� -337 SI URE: DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page- Property Owner, 4th page -Soil Tester. DI LHR- SBD-6395 IN. 03/81) r ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner _r s 69 t c e S d Property Address r r4 1 L _ 4 a City /State AFr ) J Lat ,*z p � cc) i s Legal � Description: ��rA i Lot A Block � Subdivision/CSM # N aA ' /a '/4, Sec.. , T .Sd' N -R /( W, Town of t=ar► e� D PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer hit o L ves w-wA Size STIPC 16 Setback from: House 4L Well Pldk; �Aiz) Pump manufacturer mac, t AO „ 4Mode1 '5 t4 elo Alarm location r �j (HOLDING TANKS ONLY) Setbacks: Service road ent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: J Width 9 Length Number of Trenches Setback from: House R6 Well/�� P2 ' S Vent to fresh air intake �9 ELEVATIONS r Description of benchmark C X7'+'1 � 'T" c�it3 f f -� / 1k` -x- Elevation Description of alternate benchmark d 4 c U N, T Elevation O Z, Z 3 Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom ` / ►/ ! 7 Header/Manifold c Top of ST/PC Manhole Cover C� Distribution Lines 9 9,, O ( ) Bottom of System ( ) ( ) ( ) Final Grade Date of installation / / Permit number - �� /`��„ '� State plan number :2-3 9 0 � Plumber's signatur j> - t oin License number - zY Date / / Inspector Complete plot plan � 1 Y s i 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 VIE , �L e c 66 A (` 6e, Cl) A INDICATE NORTH ARROW III Wisconsin gepartment of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 34463 7 Permit IX Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)]. Per - 'b1V' : MARCUS ❑ CitYEl Town of: tate Plan ID No.: CilZ1C:1C V1V PPIIEERRAALL ���9 _ - r,,,�„s • �a � CST BM Elev -:- Insp. BM Elev.: BM Description: rcel Tax No.: �. 1 4�_� 010- 1051 -70 -000 TANK INFORMATION EL VA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -^ ISWA Benchmar00 3. 2 -( 03.4 (&D • D Dosing U .q �} /02.2-3 Aeration Bldg. Sewer ' So ?'K. �Z Holding St/ Ht Inlet c t,2} TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. Air I ntake ROAD ir Septic feo >60 .25 -- NA Dt Bottom Dosing , >/OD $'O 25'� _?$�f NA Header/ Man. Aeration NA Dist. Pipe 1 3- 3 1 9 Holding Bot. System 3.q9 q LL PUMP / SIPHON INFORMATION Final Grade Manufacturer J aw Aoio Demand Model Number s�� �g4lGPM TDH Lift&O;V�J Lriction / System TDH t Ft mead Forcemain Length Dia. 2 W Dist. To Well ESQ SOIL ABSeR.PTION SYSTEM OW TRENJCH I Width / Len th If No. f T enches PIT No. Of Pits Inside Dia. Liquid Depth DIM N 5 I - DIMENSION S SYSTEM /L BLDG WELL LAKE /STREAM LEACHIN Manuf rer: SETBACK INFORMATION Sys e m / 3 3` > rJ. OR UNIT CHAMBER Number: System: �'—'°" DISTRIBUTION SYSTEM Header /Manifold u Distribution Pipe(s) 0 x Hof $i e x Hole Spacing Vent T�± Intake Length Dia. Z Length Dia. �_ . Spacing /'/ .7b r � 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.) � �,J LOCATION: EMERALD 22.30.16.321B, W,NW 2411 CTY RD 4 Mil S; yy l.J � ,2 f S, c I �.:.{t I�O.� tf f o+1 i ` 4,L is W eu >--L� fe C_�� . P � tee. lan re I iedd?�p Yes A No 0L 2� DO Z 6 Use other sloe for additional information. at_ .Ins Sin _ eJ Cert. No SBD -6710 (R.3/97) Q. ��q 6 �f ���l T ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: V. m: m v € T- - n P zj- a - -A.... t . ... m c a... ... __,; V.. i.d j I j [713 ikkvi t Lt till _ 9 � 7 e 4 n.. 1 v f 1 1- - 4 1 t T i kld 1 TAIT d A . ......... ... .. 14 T- Ll J. 4 A ? + 4-1. 0- { i i t a E t € 7 4 - 4-4 8 ° t t § e_. a ...... e • r g E '. 3 f S � _. q_ i E t , 3 I t = S s i � i E _ ppp � we e va .... - [111711 1 .. _: — u m... ..__. �....,... y a c ,. _... 1 _. r ..._._. __ Safety and Buildings Division SANITARY PERMIT APPIXATION Bureau of Building Water Systems 201 E. Washington Ave. in accord with ILHR 83,05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for t�e' system.-on *per not Cou 6 than 8 112 x 11 inches in size. Crat X • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government programs S- C F" Q Check it revision to previous application 30(jP4T,y State Plan I.D. Number [Privacy Law, s. 15.04 (1) (m)). _;q1j 90 1. APPLICATION INFORMATION - PLEA Xt K 23 49 Property Owner Name Pyope(t tion o / f(or) W Clete /C_S,0/j 401 , 4 1/4, S T 3 , N, Rlep Property Owner's Mailing Add Tin er ss er Block Nu b e4vil ;ZLO 4- <9 City, State Zip Code 0!11 a jPhone Number Subdivision Name or CSM Nu b 72' I V7 er .4 C/ II. TYPE OF BUILDING: (check one) E] State Owned 0 Lay Nearest Road - P [] Village 0-01- 0 Public Pg 1 or 2 Family Dwelling - No. of bedrooms kTown 0 1 ,, BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) - I Ill... /1; - 1-1 1 [-] Apartment/ Condo - (2110-16-"3�7 2 E] Assembly Hall 6 E] Medical Facility Nursing Home 10 E] Outdoor Recreational Facility 3 E] Campground 7 E] Merchandise: Sales/ Repairs 11 E] Restaurpiritif Bar/ Dining 4 [-] Church / School 8 n Mobile Home Park 12 E] Service Station / Car Wash 5 E] Hotel / Motel 9 [:] Office/Factory 13 E] Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 n New 2. pd Replacement 3. E] Replacement of 4. E] Reconnection of 5. [:] Repa i r of an System System Tank Only --------------- Existing System ---------- Existing System B) E] 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 E] Seepage Bed 21,4 Mound 30 [-] Specify Type 41 E] Holding Tank 12 El Seepage Trench 22 [-] In-Ground Pressure 42 [] Pit Privy 13 E] Seepage Pit 157 K 64 43 El Vault Privy 14 E] System-In-Fill 0",Ailiiilo 2 - 0 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7 E , Final Grade ti q Required (sq. ft.) Proposed (sq. ft.) (Galsidayjsq. ft.) (Min./inch) eva ion :S-0 Z 7,5_ :�S _7S_ </—SQ/ A Z� q Feet 1-Z Feet Vil. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION =� Gallons Tanks manufacturer's Name Concrete Con- Steel glass App New Existing structed Tanksl Tanks oQ ZjJ6A 125K Septic Tank or Holding Tank 106"o // 1:1 El 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber 445z, El r_1 I El Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er'sNa e: (Print) ignat e: (N tam s) PRSW No..; Business Phone Number. I Plurrkr' S 7 U;�M FPN oorA� 46 17 141JA', /--)� i 'Z Plum belills 1Wd ress (Street, City, StAV6, Zi �,pc14� 14 .5 _ 47 IX. COUNTY / DEPARTMENT USE ONLY [] Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued o Stamps) Approved F] Owner Given Initial N Surchar Fee) Adverse Determination X. CONDITIONS OF�_APPROVAL /REASONS FOR DISAPPROVAL: SBD-6398 (W OV94) DISTRIBUTION: Original to) Conro One cop To: s & Ruililin niviion, Owner, Plumber r • INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority_ 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 15837 USH 63 HAYWARD WI 54843 -8107 TDD #: (608) 264 -8777 N visco ' nsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 10, 1999 CUST ID No.227618 ATTN.- POWTS INSPECTOR ZONING OFFICE TOM GUSTUM ST CROIX COUNTY SPIA N13450 937 ST 1101 CARMICHAEL RD NEW AUBURN WI 54757 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08 /10/2001 Identification Numbers Transaction ID No. 239049 Site ID No. 177963 SITE• Please refer to both identification numbers, Site ID: 177963 above, in all correspondence with the agency. ST CROIX County, Town of EMERALD; 2411 CO RD G, EMERALD 54012 f NW1 /4, NW1 /4, S22, T30N, R16W Facility: MARCUS ERICKSON 2411 CO RD G, EMERALD 54012 FOR: MOUND, 450 GPD. Object Type: POWT System Regulated Object ID No.: 483398 c(1l' t t� The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in OF SAf chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: f — sEE CO tF 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. 4. Abandon failing system per COMM 83.03(2). 5. The designer proposes to install a Midwestern Pre Cast, Inc. 1000/650 combination tank. 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. SM 5 ely, DATE RECEIVED 07/26/1999 FEE REQUIRED $ 180.00 l ^ ,� FEE RECEIVED $ 180.00 A RICIA L S ORF ,POW �PLANREVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART'code: 7633 MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Project 3 Bedroom Mound Owner Marcus Erickson Address 2411 Cty. Rd "G" Emerald, WI 54012 715- 265 -7725 # Legal Description NW NW S22 T30 N,R,16W ! :1F `iiC� RAE Township Emerald County St. Croix w1Y tLD►NGS Subdivision Name csm vol. 4 -page 1141 Lot No. N/A PENCE "SPUN Parcel ID Number 010 - 1051 -70 -000 G� �j Plan Transaction Number Z ` 0 � 9 Index and title sheet Page 1 o w� % C1 Mound calculations Page 2 Mound drawings Page 3 OMASD. =N Pres. dist. calcs. and laterals Page 4 W GUSTUM @Z TDH and pump tank drawing Page 5 1201 Plot Plan Page 6 Pump Curve Page 7 Designer Thomas Gustum License Number D1201 Signature Phone No. 715 -658 -1344 Date 7/23/99 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. SBD- 10462 -E (R.05/98) Page 1 of 7 • Performance Data 32 Pump Characteristics Paagt /Motet Unit St1ltnersihle Meaeal Models OSP33M1 OSP33M2 It 24 Amemalk Melds OSP33A1 OSP33A2 P x Horsepower 1/3 10 Fell load Amps 1.8 4.6 Motor Type Split - Phase R.P.M. 1750 o e Phase 0 1 Voltage 115 230 0 Holtz 60 0 10 20 0 50 CAPACI -U.S. Operation Intermittent Temperature 140 °F Ambient Total Neva oet) 4 8 12 16 20 24 25 NEMA Na R GPM I /3 NP 60 55 48 39 28 7 0 lnsdotiem Chess F DUMP S114 1 -1/2 NPT SA& ttendan S /8- Dimensional Data Unit wool SO lbs. 3.7/8 e-3/4 S•t/e Power Cora 1a /3, sJTw, 1 181 3, SJTw 101 :tae X20 opt.) o� std. 1. #j t„Mtixwin kdo 4•1!4 1 -1/2 NPT 2 u" my my 11/1 lnd Nd for Materials of Construc 3. PWPM MW 1111 041110 steel 3.3/4 4. k w4ia8 ad 1t Ok wr Ip $xW* Lrbrketieg OIT Dielectric 011 S. We "I 61 del N Motor Housing Cast Iran wA. y" Kodxtls.�i thw Pomp Casing cost Iron saoficalrnswt�rxl own Shalt Steil Mednekel Sal Foos: cater /Ceramic , Shaft Seel Seel {oily: Ness Sprkw Stainbss Steil Ioiows: tang -H 12 -1ie s - M Impeller P tr0ate 11.3/4 PUM ON tipper tearing Sb* Row tat Be&* Lower Bad" Single Row tell taring Ieso I Cost Ina FestemKS Stainless steel PUMP OFF AURORA /MYOROMATIC Pumps Inc. 1840 6ansy Road, Ashland, Ohio 44805 (419) 289 -3042 aeon 70� 7- _' •'�. i � ����� w � " �� \+ ri , �� Cs. i� tscons n Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to new - moo 010- 1051 -70 -000 APPLICANT INFORMATION- PLEASE PRACL.-- tNFORMATIO EWE Y I Y ATE y PROPERTY OWNER: PERTY LOCATION Marcus Erickson ' ` <J LOT NW 1/4 NW 1/4,S 22 T 30. N 16 )&or) W PROPERTY OWNERS MAILING ADDRESS " � BLOCK # SUBD. NAME OR CSM # 2411 Ct . Rd. "G" `` t na csm Vol. 4- g 1141 CITY, STATE ZIP CODE - 1{ONE N X Y VILLAGE gYOWN NEAREST ROAD Emerald, WI. 54012 (1 -^ Emerald Ct Rd. "G" New Construction Use [xi Residential ! fi . b6r room [ ] Addition to existing building Replacement [ ] Public or comm era i al�tie�cr Code derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 375 bed, ft2 375 trench, ft Maximum design loading rate • bed, gpd /ft2 - 5 trench, gpd /ft Recommended infiltration surface elevation(s) 99.20 ft (as referred to site plan benchmark) Additional design/ site considerations system el. based on contour line of el - 98.20' Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDINndNK U = Unsuitable fors stem El S [3 ®S ❑ U El S ERU E] S C$U ❑ S E2U El S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Barxiary Roots Bed Trttch 1 -11 10yr3 /2 none 1 2msbk mfr gw 2f .5 1 .6 La 2 1 -21 10yr4 /4 none sicl 2csbk mfr gw if .4 .5 Ground 3 1 -37 10yr4 /4 none sl 2csbk mfr gw na .5 .6 el ft. 4 7 -55 10yr4 /4 c2p 7.5yr5/8 sl 2csbk mvfr na na .5 .6 Depth to limiting factor 37" Remarks: Boring # 1 0 -17 10yr3 /2 none 1 2msbk mfr cs 2f .5 .6 OEM 7 .... .. 2 17 -25 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 25 -35 10yr4 /4 c2p 7.5yr5/8 sicl 2csbk mfr gw if .4 ':.5 Ground 4 35 -65 7.5 r4 4 c2 7.5 r5 .6 elev. Y / p 8 sl 2csbk mvfr na na .5 Y / 9 8.5 ft. Depth to limiting factor Remarks: CST Name: -- Please Prin Gary L. Steel Phone: 715 -246-6200 Address: 1554 200 New RichrnovQ, WI 5401 Signatur : Date: 6 -12_ CST Number: m02298 r PROPERTYOWNER Marcus Erickson SOIL DESCRIPTION REPORT 'Page 2 'of 3R PARCEL 1.134 010 - 1051 -70 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench 1 -11 10yr3 /2 none 1 2msbk mfr cs 2c .5 .6 2 1 -28 10yr4 /4 none sicl 2msbk mfr gw lm .4 .5 Ground .,.. d ..'.. 3 8 -37 10yr4 /4 none sl 2msbk mvfr gw if .5 .6 elev. 9 4 7 -55 10yr4 /4 c2p 7.5yr5/8 sl 2msbk mvfr na na .5 .6 Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. — Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Marcus Erickson 1554 200th Ave. CSTM2298 NW 1 4 NW% 4 S22- T30N -R16w New Richmond, WI 54017 MPRSW -3254 town of Emerald 715 246 -6200 N 1 =40' BM.= top of concrete slab by entrance door of garage @ el 100.00'✓ Alt. BM.= top of air conditioner @ el. 102.40 I � D Ir �"3 2 ,� /�' 3 1 o p- Gary L. Steel 6 -12 -99 I I I _ t , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C D Mailing Address of .� t t Property Address (Verification required from Planning Department for new construction) City/State ,_= 0 1 Parcel Identification Number LEGAL DESCRIPTION Property Location d>w %4, Ad&. % 4, Sec.P , Tje) N -R_&_W, Town of d Subdivision /y A Lot # . Certified Survey Map # , Volume Page # l 1 Warranty Deed # �t , Volume Page # Spec house ❑ yes g no Lot lines identifiable lA 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. I 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, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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 Uwe, 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 days of the three year expiration date. O l SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 W. I 432PAGE 2ft /° STATE BAR OF WISCONSIN FORM 2 • 19" K ATHLEEN EGISTER OF DEEDS ELY DEED WARRAIN ST. CROIX CO., WI �a 3 This Deed, made between B ernard J. %fortel and Bet tv_J_Mior tel• RECEIVED FOR RECORD husband and wife. _ __ — 0647 -1999 9:30 PA Grantor, conveys and warrants to M arcus G. WARRANTY DEED Erickson and Dianne H. Erickson, husband and wife, s survivorship m arital CERT 11 ERT COPY FEE: pr operty , COPY FEE: TRANSFER FEE: 119.70 Grantee. RECORDING FEE: 10.00 PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, Sate of Wisconsin (The "Property "): Recording Area Name and Return Address L)AVI( - ' J. ESTPEEN 304 LOCUST T' ' kJOSON, VA 54016 lo- wsl- �o-000 Parcel Identification Number (PIN) This is homestead property. That part of NW1 /4 NWI 14, Sec. 22- T30N -Rl6W described as follows: Lot I of Certified Survey Map recorded in Vol. 4 of Certified Survey Maps, page 1141, as Doc. No. 375247. Exceptions to warrant ea. Easements, restric ions ant; Al.�nts - way of record, if any. Dated this —�--- ^day of June, ! 099. z� ' Bernard j orlel / • Betty J. Morte ALMHENTICATIJN ACKNOWLEDGMENT Signature(s) Bernard J. Mortel and Betty 1. Mortel, husband and STATE OF WISCONSIN ) wife ) ss. authenticated this JkV day of June, 1999. County ) Personally came before me this day of May, 4 ~ ' ' . FORM NO. 985-A MGMi1N.Cmp�,® 37 5247 CERTIFIED SURVEY MAP N0. 1141 Part of the NW4 of the NW4 of Section 22, T30N, R16W, Town of Emerald, County of St. Croix, State of Wisconsin, as described in Volume of Certified Survey Maps, Page 1141 as Certified Survey No. 1141 CERTIFIED SURVEY MAP NO. 1141 BEARING REF. TO WEST ` I LINE NW V4 SEC. 2 2 T30N R16W ASSUMED I BEARING NORTH UNPLATTED . LANDS . f 1 NW C01 NER SEC. 22 , T30N , R16W _ P.O. B. "G" — _._ _ — N V4 COR _ 4 H. �� N87�045 ' 00' �'-w SEC. 22 1 320. 00' 0, ' 45 .00 Q 1286.97' 33.03 10 O Q 920 33 , QQ .. O Q O J 386,760.00 SO. FT. t Q ( q N 8.88 ACRES INCLUDING R/W = 33.03 LOT I 8.65 ACRES NOT INCLUDING R/W N I3 92 OO E " _ 1286,97' 8�o p I ��. S 87 ° 45 00 E 2 ' 1320.00 0 z n' M Z• M q c0 N �. • 3/4" ROUND IRON BAR WEIGHING 1.502 LB /FT. W 2" IRON i . ALUMINUM PCAP WITH APPROVED Q x f- a 0 Z• N SCALE 1 "= 200 R 14 1981 ST. CROW COUNTY W V4 COR. SEC. 22 COMPREHEkSIVE PARKS PLU*aja AND ZONING C SURVEYOR'S CERTIFICATE I, THOMAS G. KUESTER, Registered Land Surveyor, hereby certify that I have surveyed, divided and mapped a part of the Northwest 1/4 of the Northwest 1/4 of Section 22, Town 30 North, Range 16 West, Town of Emerald, County of St. Croix, State of Wisconsin, more particularly described as follows: Commencing at the Northwest corner of said Section 22; Thence South 45.00 feet, to the point of beginning; Thence continuing South 293.00 feet; Thence S. 87 45' 00" E., 1,320.00 feet; Thence North 293.00 feet,.; Thence N. 87 45' 00" W., 1,320.00 feet, to the point of beginning. Said parcel contains 8.88 acres, more or less. That I have made such survey, land division and plat by the direction of Eugene Kruizenga. That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin Statutes and the subdivision regulations of the Town of Emerald and the County of St. Croix in surveying, dividing and mapping the same. 4 DATED THIS _ DAY OF 1981. THOMAS G. KUE TER Registered Land Surveyor � 1 � � '�'��► � FILED s Volume 4 Page 1141 J AN'7 1982 S yea a cow" MIS am w DoW wbono i t Y Shef40 Performance & Dimensional Data 40 SHEF40 30 F- W 20 Y. 10 0 10 20 0 (98.4298.42 0 50 60 10 P 6 (168.27) 1.All dimensions in inches. (Metric for international use). ) 5 5" 11 (1 (127) 2.(omponent dimensions may 3 -718" vary ± 1/8 inch. (98.42) 3. Not for construction purpose j unless certified. 3 -718 DISCHARGE (98.42) 1 -1/2" NPT 4. Dimensions and weights are approximate. FLOAT SWITCH 5.We reserve the right to make revisions to our product and their specifications without notice. I0 HYDROMATIC 11 -3/8 " 10 -3/16 " I (288.92) (258.76) . 3 -5/8" f (92.07) 2'(50.8) 7 i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT G&ERAL INFORMATION (ATTACH TO PERMIT) Sanitary 3446 37 Permi IX Personal information you provice may be used for secondary purposes [Privacy La K s.15.04 (1)(m)). Perl)ftld @ift 'A e: MARCUS j���j ❑ City Y Town of: State Plan ID No.: CST BBM V1V Insp. BM EVev.: BM Description: Parcel Tax No.: 010 - 1051 -70 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto Airintake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH I Lift Friction I System TDH Ft oss H ead h rcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK CHAMBER INFORMATION Type O Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header ! Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Oepth 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.) LOCATION: EMERALD 22.30.16.321B,NW,NW 2411 CTY RD G Plan revision required? ❑ Yes ❑ No Use other side for additional information. F7P 11,,, — Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT ilPPL TION Bureau of Building Water System 201 E. Washington Ave. In accord with ILHR 8 05, Wis. Admr Cpa P.O. Box 7969 J Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for th'e system on ijaper no�ti'es Coun r "' 1 it , ��, ` 71 C t X than 8 112 x 11 inches in size. ;,r -,� ! c CO • See reverse side for instructions for completing this' application State Sanitary Permit Number Ica The information you provide may be used by other government ritypiograms ST CrO(X El Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. -; (/1 � COUNTY � State Plan I.D. Number I. APPLICATION INFORMATION - - PLEASE �Nk i17 Cto f�? 0 Property Owner Name \ P *6 o tion � O `�4.: 114, S Z T , N, R /W/ re (or) W Property Owner's Mailing Add Less L'otNUtrrber ` ,^ Block Nu be /LJ /Fi A Ciiv, State Zip Code Phone Number Subdivision Name or SM �ugtber '-' Z f II. TYPE OF BUILDING: (check one) E] State Owned [] it Nearest Road Public Pg 1 or 2 Family Dwelling - No. of bedrooms O jif Town g OF lin. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1�2. • I �• 321 1 ❑ Apartment/ Condo 4' _066 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 online A..Check box online B, if applicable) A) 1 _ ❑ New 2_ $ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an S yst em __ System_____________ ________TankOnly______________ Existing System ____ ____Ex1st)ngSystem 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 XI Mound 30 ❑ Specify Type 41 []Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pressure r j_., � 42 ❑ Pit Privy 13 ❑ Seepage Pit )C� 43 ❑ Vault Privy 14 ❑ System -In -Fill 9,$'• ZO 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 (sic . ft.) Proposed (sq. ft.) (Gals/day sq. ft.) (Min. /inch) Elevation 7J 3 '7S'r s�"� A L q 4 7, 20 Feet • z Feet Gapacit VII. TANK in allons Total # Of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks r Septic Tank or Holding Tank d0{) El El ❑ ❑ El Lift Pump Tank /Siphon Chamber 45z ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT - I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's Na e: (Print) Plum is Sign ture: (N tam s) IMPNPRSW NoZ �, 17 Business Phone Number: Plumbe s ddress (Street, City, Sta , Zip ode t l S7! IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Iss ng gent Signature (No Stamps) �pproved [] Owner Given Initial ' Surcharge Fee) Adverse Determination X. CONDITIONS OF_APPROVAL /REASONS FOR DISAPPROVAL: AAa ST4V Cra +. at. PA." CL ST CROIX COUNTY r SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ZT I Cle - set J Mailing Address c;� ~ � ,� r a Property Address ! (Verification required rom Planning Department for new construction) City/State . 60AS -' gi t Parcel Identification Number <.I/& -- 16 5--/^ ? LEGAL DESCRIPTION Property Location A&f 1 /4, Ajd� I /4, Seco , T3d N -Rjj�—W, Town of h2ZAgZA Q Subdivision 16A Lot # (Jib Certified Survey Map # Volume Page # Warranty Deed # 4 Yycry , Volume 1 Y3 Page # Spec house ❑ yes �' no Lot lines identifiable lA 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 fimction of the septic tank as a treatment stage is 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, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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. Uwe, 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 days of the three year expiration date. A� ` c ,cam_.. �� FLl /kJ 9 9' SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE 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 MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch- pounds Metric Residential or commercial? r (r or c) (y or n) L� Replacement system? Creviced bedrock site? n (y or n) Slope 2 % Wastewater flow rate 450 gpd 1703 Lpd Depth to limiting factor 25 in 63.5 cm In situ soil infiltration rate 0.5 gpd /ft 20.4 Lpd /m Contour line elevation 98.2 ft 29.93 m Use standard fill depths? x OR Design depth? in cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. Center or end manifold a (c or e) Hole diameter 0325 I in 0.125, 0.156, 0.188, 0.219, 0.25, 0.281, or 0.313 inch only. Lateral spacing 0.00 ft Use 0 lateral spacing for trenches. Estimated hole space 3.00 ft Not a final calculation. Number of laterals 1 Pump tank elevation 87 ft Outside bottom of tank. Forcemain length 70.0 ft Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only. 2.067 in Actual I.D. HOLE DIAMETER CONVERSIONS 118 =0.125 114 = 0.250 SYSTEM SOLUTIONS Inch-pounds Metric &32=0.156 9/32=0.281 Estimated daily flow 450 gpd 1703 Lpd 3116=0.188 5116=0.313 7/32 = 0.219 Absorption cell Design load rate & area 1.2 gpd/ft 375.0 ft 34.84 m Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd /m Design width (A) 5.00 ft 1.52 m Celt length (B) 75.0 ft 22.86 m Depth of cell (F) 10.0 in 25.4 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 13.2 in 33.5 cm Basal area required (gpd/infiltration rate) 900.0 ft 83.61 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.15 ft 3.09 m Up slope toe length (J) 8.00 ft 2.44 m Down slope toe length (1) 9.40 ft 2.87 m Total mound length (L) 95.30 ft 29.05 m Total mound width (W) 22.40 ft 6.83 m Project: 3 Bedroom Mound Transaction Number: Page 2 of 7 MOUND PLAN VIEW observation pipes (typical) J 22.4 ft A= 5.00 ft 1.52 m A 6.83 m B = 75.0 ft 22.86 m W B J= 8.00 ft 2.44 m I K i= 9.40 ft 2.87 m K= 10. 55ft 3.09m _ 95.30 ft 29.05 m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension O = plowed area (LxW) k K = end slope dimension 5' (152 mm) T MOUND CROSS SECTION subsoil cap D = 12.0 in 30.5 cm lateral topsoil G H E = 13.2 in 33.5 cm invert 99.70 ft _ _ _ F = 10.0 in 25.4 cm elev. 30.39 to F G = 12.0 in 30.5 cm ASTM c 33 H = 18.0 in 45.7 cm D Sand Fill E sys. 99.20 ft y elev. 30.24 m 98.20 ft contour 29.93 m elev. 2 % -� slope D = upslope fill depth plowed layer E = downslope fill depth Note: Absorption cell media will consist F = absorption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered across AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Deep chisel plowing to break up top layer Project: 3 Bedroom Mound Transaction Number: Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 5 ft 1.52 m Length (B) 75.0 ft 22.86 m Lateral specifications Number laterals 1 Holes/lateral 25 holes Lateral length (P) 72.00 ft 21.95 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 29.13 gpm 1.84 Us Sys. dis. rate 29.13 gpm 1.84 Us Hole spacing (X) 36 in 91.4 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) Place X in red X' one choice 1 1/4 in (32 mm) box of chosen from the options 1 1/2 in (40 mm) diameter. provided. 2 in (50 mm) X X 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) _ X' one choice 1 1/4 in (32 mm) None required. from the options 1 1/2 in (40 mm) No choice necessary. provided. 2 in (50 mm) 3 in (75 mm) 4 in (100 mm) Distribution system contains: 1 Lateral(s) LATERAL DIAGRAM - END CONNECTION Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. Laterals centered over the A & B dimension end cap P Last hole dirilled next to end cap I<- X-->I Laterals & force main of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 84.30 -5) equally spaced • = permanent end marker Inch-pounds Metric Lateral length (P) 72.00 ft 21.95 m Lateral spacing (S) 0.00 ft 0.00 m Hole spacing (X) 36 in 91.4 cm Manifold length 0 ft 0.00 m Hole diameter 0.250 in 6.4 mm Lateral diameter 2.00 in 50 mm Forcemain diameter 2.00 in 50 mm Project: 3 Bedroom Mound Transaction Number: Page 4 of 7 TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 11.90 ft 3.63 m Are laterals the highest point in the Friction loss 1.03 ft 0.31 m system? Yes 'Where. u Total dynamic head 15.43 ft 4.70 m If no, what is the highest elevation Dose Volume downstream of pump? —J Dose is > 10 times lateral volume Forcemain drain Lateral void volume 12.5 gal 47.3 L back to tank? ('X' one) Minimum dose 125.0 gal 473.2 L x Yes Drain back 12.2 gal 46.2 L No Dose volume 137.2 gal 519.4 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with 7F I tether proof warning label and locking device grade levels junction box alp rade levels disconnect g alternate 4" vent pipe electric as per NEC 300 and E-- outlet Comm 16.28 WAC location 16'(46 cm) min. wall of pump approved chamber or outlet joint combination tank A Provide 1/4" weep hole or anti - alarm on siphon device as necessary pump on B Grade levels pump 87.8 ft C - pump tank manhole = 4" (10 cm) Off elev. 26.8 m i k minimum above finished grade D - vent =12" (30.5 cm) minimum above finished grade 87.0 ft Pump tank elevation 3 " (75 mm) of bedding under tank 26.5 m bottom of tank Tank manufacturer Midwestern Pre -Cast Pump tank capacity 17 gal /in Pump tank volume 650 gal Pump manufacturer JHydromatic i Inches Gallons Pump model number Josp 33 o A 22.2 376.8 'o B 2 34.0 Alarm manufacturer S&J Electro E C 8.1 137.2 Alarm model number 1101 p D 6 102.0 Project: 3 Bedroom Mound Transaction Number: Page 5 of 7 t � ouA l/ q rC U S k h P I c PIA h c w, era / W NLJ 5-dz T30 NR 16 k1 -own Sys � kV h / o 65' Ca�►�6o�i�( � M A Z U7�i57vi6�C/ M h'•�a+�� T^.� end m 6M / - EC loo, 6 S / 1 / J /4 L 6 ed- ob- a hce., T 8 M 2 Top aF ji CohJ i�,'or+ c✓� L 102 YD Sca l` �-r 'o {�