HomeMy WebLinkAbout018-1082-10-100 ST. CROIX COUNTY ZONING l)EPARTME TC _. ..
"lei k
AS BUILT SANITARY R1 PORT
Owner
Address 720 / sr" r' }
City /Stat 41/-
Legal Description:
Lot /0 Block Subdivision/CSM #
t/4 1 � t/ ,Sec. , '1��N -RAW, Town of PIN # - - E�/
SEPTIC TANK -- DOSE CHAMBER -- HOLDING ' CANK INFORMATION
Tank manufacturer Size ST/PC /0 / 6 Sett ack from: House � 3 Well '>ZS P /L-
Pump manufacture - Z Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: c i Width '?/ Length of Trenche
Setback from: House ? 2 Well - 7S - -O P/L 2 S Vent to frel h air intake
ELEVATIONS
Description of benchmark mil!/ Ze r C- en� l- a Elevation
/o a
Description of alternate benchmark Elevation %G 2-e-?
Building Sewer 3-3 - 61HT Inlet ST Outle PC Inlet
PC Bottom /�' Header/Manifold Top of STIPC Manhole Cover /
Distribution Lines( /v 3 - L 3 (} ( )
T
Bottom of System ( ) �� z • S Z ( ) )
Final Grade O (} }
Date of installation / / Permit number 7� SC tte plan number
Plumber's signature License number Date
Inspector
Complete plot plan
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Wisconsin DeparfinentofCommerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX
Personal information you provice may be used for secondary purpos [Privacy Law, s.15.04 (1)(m)]. 338875
El Perr tA►�o1�JeL{'s LDERS , INC. CitriA❑MMOND ffl'Towncif: State Plan ID No.:
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.:
ed ld� S vkel f 018- 1 08 -10 -100
TANK INFORMATION A ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic A Benchmark 3
Dosing D v &A 3,36 O-
ation Bldg. Sewer
Holding / Ht Inlet Z ,-Z0
TANK SETBACK INFORMATION itL4 et
TANK TO P/ L WELL BLDG. A ir ir I ntake ROAD et
Septic 716 d ) " l Yo, NA Dt Bottom
Dosing 5 1,)61 NA Header/ Man.
AiNlian Dist. Pipe 103. Z 3
Holding Bot. System Z S Z'
P / SIPHON INFORMATION .� Final Grade
Manufacturer q oeff Demand S 61
p Model Number (� Zq - ?GPM ,
l d
1 TDH Lift S Friction System TDH �1Ft Head
OSS / Forcemain Length �� / Dia. � // Dist. To Well , 7
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Leng ,, No. Of Tr nche PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O , S-' y o r �� OR UNIT Mode Number:
System:
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake
/ N /
Length _ Dia Z Length 3V Dia. Z Spacing _sue f
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
x Seeded/ Sodded xx Mulched
Depth Over Depth Over xx Depth Of x
Bed /Trench Center Bed /Trench Edges Topsoil
E] Yes E] No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HAMMOND 30.29.17.573 , SE, SE 720 159TH ST — MEADOW RDGE LOT 10 14fle 4 ,00 y - k x
ea Je•✓
Plan revision required? ❑ Yes ( No
Use other side for additional information. Od
SBD -6710 (R.3/97) Dat Inspector' gnature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
VLCOnsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code
Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. C / 01 i
• See reverse side for instructions for completing this application State Sanitary Permit Number
you provide may be used for seconds ��
Personal information
y p y second purposes ❑Check if revisio to previous app (cation
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
A PPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N
r rty O iner Name pe tion
1 Y et f r�/Si i'? l I ff ' . 1/4 tia, S T oz r Nr R �� E (or)9
Pr erty Owner's Mailin Address Lot Number Block Number
U crag/ T % e
Cit state Z ip N Subdivisig a q7 CSM Numlr
L cs uu00 `i i✓ u
11. TYPE OF BUILDING: (check one) ❑ State Owned o lt I yy Nearest R
Public 1 or 2 Famil Dwelling - No. of bedroo ° Tow OF 11 64 ",n j attiE.
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Q. . S7
010 �lOgz - 100
1 ❑ Apartment/ Condo
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. IS New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
______System ________ System_____________ Tank Only______________ ExistingSystem ________ Existing System
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 21E Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION: �Ul,
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17 . Final G ade
Re uired (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) Elevat'
�� J 7) S / Z_ -- 1 /0 Z r Feet Feet
VII. TANK Capacit
all0 5 Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name concrete Con- Steel glass Plastic App
New Existin strutted
T nks Tanks
Septic Tan or Holding Tank /0,XD /0 o 0 r® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber QV O(? '" ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans.
Plumber's Name: (Print) PI is Signature: (No ps) M MPRS Business Phone Number:
Plum er's Address (Street, City,S�te, Zip Code):
( IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing /// AAAnnn CCC ent Signature (No Stamps)
',Approved E] Owner Given Initial ?�x Surcharge fee) ` -
Adverse Determination vv J
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL.
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS '.
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
i
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
f Buildings Division , 608 - 266 -3151.
Wisconsin, Sa et and Bud s
Y 9
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 practiceswhich can
effect 9 roundwater.
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
\Vhsconsin www.commerce.state.W.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
April 16, 1999
CUST ID No.221471 ATTN.• POWTS INSPECTOR
ZONING OFFICE
DENNIS J GILLE ST CROIX COUNTY SPIA
372 140TH ST 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 04/16/2001 Identification Numbers
Transaction ID No. 219291
Site ID No. 170242
SITE: Please refer to both identification numbers,
Site ID: 170242 above, in all correspondence with the ,agency.
ST CROIX County, Town of HAMMOND; MEADOW RIDGE, HAMMOND 54015
, S30, T29N, R17W
Lot: 10,
Facility: BOB FEYEREISIN MEADOW RIDGE, HAMMOND 54015
FOR:
HOLDING TANK, 450 GPD
Object Type: POWT System Regulated Object ID No.: 461680
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use: C�
1. This plan action is subject to designer comments on the plan. , �� _01
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular A!
to the direction of maximum slope.
3. The area 25' below the downslope edge of the mound must remain undisturbed.
4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a).
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 oil, '
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, / DATE RECEIVED 04/05/1999
FEE REQUIRED $ 180.00
—PATR ICIA RECEIVED $ 180.00
P L S DORF , PO S PLAN REVIEWER 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 WSMART code: 7633
r�
i
MOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project BOB FEYEREiSIN
Owner BOB FEYEREISIN
Address 720 ORANGE ST 1- 715- 386 -1295
HUDSON WI
Legal Description S30 T 29 NR 17 W
Township HAMMOND County ST. CROIX
Subdivision Name Lot No. 10
Parcel ID Number
Plan Transaction Number wally
Index and title sheet Page 1 VED
COMMEROE
Mound calculations Page 2 AND 8 GS
Mound drawings Page 3 a,
Pres. dist. calcs. and laterals Page 4 �':....
TDH and pump tank drawing Page 5 'PONDENCE
°si �e5�5
Designer DENNIS GiLLE License Number 221471
Signature Phone No. 715- 268 -6637
Date 3 -30 -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 (1Xm)I.
SM10462 -E (8.05/98) Pagel of
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 gpd maximum design flow.
In ounds Metric
Residential or commercial? R (r or c) (y or n) Replacement system?
Creviced bedrock site? n (y or n)
Slope 1 %
Wastewater flow rate 450 gpd 1703 Lpd
Depth to limiting factor 34 in 86.4 cm
In situ soil infiltration rate 0.5 gpd/ft 20.4 Lpd /m
Contour line elevation 101.5 ft 30.94 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 E (core) Hole diameter r 0 in 0.125, 0,156, 0.188, 0.219,
0.25. 0.281. or 0.313 Inch oniv.
Lateral spacing 6.00 ft Use 0 lateral spacing for trenches.
Estimated hole space 3.00 ft Not a final calculation.
Number of laterals 2 Pump tank elevation 93 ft Outside bottom of tank.
Forcemain length 90. 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 1/4-0.250
SYSTEM SOLUTIONS Inch -pounds Metric 5132=0.156 9132=0.281
Estimated daily flow F - 4 - 50 -- 1 gpd 1703 ]Lpd 3116 = 0.188 5116 = 0.313
7132 = 0.219
Absorption cell
Design load rate & area 1.2 gpdW 375.0 it? 34.84 m
Linear loading rate (LLR) 11.84 gpd/Ft 146.8 Lpd /m
Design width (A) 10.00 ft 3.05 m
Cell length (B) 38,0 ft 11.58 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 ftZ 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 (ln 10.15 ft 3.09 m
Up slope toe length (J) 8.30 ft 2.53 m
Down slope toe length (I) 13.70 ft 4.18 m Basal adjustment made.
Total mound length (L) 58.30 ft 17.77 m
Total mound width W 32.00 ft 9.75 m
Project: BOB FEYEREISIN
Transaction Number: Page 2 of
MOUND PLAN VIEW
observation pis (typical)
J
32 ft
A
A= 10.00 ft 3.05 m
B 38 .fl ft
- 11.58
m
9.751m >';:
�-- g J = 8.30 ft 2.53 m
l K 1 = 13.70 ft 4.18 m
K= 10.15ft 3.09m
L 58.30 ft
L 1777 m typ. obs. pipe
(anchored se=ely)
I = down slope dimension (€ = absorption cell (AxB)
J = up slope dimension = plowed area (LxW)
K = end slope dimension 6" (152 mm)
T
MOUND CROSS SECTION
D = 12.0 in 30.5 cm
topsoil H subsoil cap E = 13.2 in 33.5 cm - - invert 103.0
lateral F = 10.0 in 25.4 cm
0 ft - -
elev. 31.39 m _ >?> ; < F G = 7 2.0 in 30.5 cm
T ASTM C33 H = 18.0 in 45.7 cm
D Sand FiN y
sys. 102.50 ft
elev. 31.24 m 101.50 ft contour
30.94 m elev.
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 AxS media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Project: BOB FEYEREISIN
Transaction Number: Page 3 of
I '
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch -pounds Metric
Width (A) 1 10 Ift 3.05 Im
Length (B) 38.0 Ift 11.58 Im
Lateral specifications
Number laterals 2
Holestlaterai 12 holes
Lateral length (P) 34.83 ft 10.62 m
Hole diameter 0.250 in 6.35 mm
Lat dis. rate 13.98 gpm 0.88 Us
Sys. dis. rate 27. gpm 1.76 Us
Hole spacing (X) 38 in F - 9657 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm) Place X in red
Wo one choice 1 114 in (32 mm) x box of chosen
from the oP tions 1 112 in 40 mm) x diameter.
provided. 2 in (50 mm) x K
3 in (75 mm) I X
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm)
�X' one choice 1 114 in (32 mm) x Place X in red
from the options 1 112 in (40 mm) x box of chosen
provided. 2 in (50 mm) x X diameter
3 in (75 mm) x
4 in (100 mm) x
Distribution system contains: 2 Lateral(s)
LATERAL DIAGRAM - END CONNECTION
Place correct lateral dia ram b clicking in one of the drawings at ri t and dragging the diagram into this area.
E — St — eril z oenteted ovef t A fx Is cli Last hole drilled next tt+ end cap o .i caP
4 -- P
•
Ali laterals are ident" 1# X —�! Hot es drilled on the bottom of the lateral
equally spaced
•
Forep main connection Via tee or crass to manifold at any point. Laterals & forCp main of PVC Sch 48
a = permanent end matker (per COMM Table 84.3U -53
Inch - Metric
Lateral length (P) 34.83 It 10.62 m
Lateral spacing (S) 6.00 ft 1.83 m
Hole spacing (X) 38 in 96.5 cm
Manifold length 6.00 ft 1.83 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 2.00 lin 50 mm
Forcemain diameter 2.00 in 50 I mm
Project BOB FEYEREISIN
Transaction Number: Page 4 of
I
i
TDH and Pump Tank Drawing
Total Dynamic Head
Operational head 2.50 ft M394 m
Vertical lift 9.20 ft m Are laterals the h ighest point in the
Friction loss 1.23 ft m system? Yes ° X" here. Total dynamic head 12.93 m If no, what is the highest elevation _
Dose Volume dow of pump?
Dose is > 10 t imes lateral vo Forcemain drain
Lateral void volume 12.1 gal g45.8 L back to tank? CY' one)
Minimum dose 121.0 gal L x Yes
Drain back 15.7 gai L iNo
Dose volume 136.7 al 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
weather proof warning label and loclang device
grade levels junction box disconnect grade levels
-._._ �1 alternate
4" vent pipe electric as per NEC 300 and 4 outlet
Comm 16.28 WAC location 18" (46 cm) min.
wall of pump k— approved
chamber or outlet joint
combination tank
A Provide 1/4" weep hole or anti -
rr-� alarm on siphon device as necessary
pump on B
(trade levels
pump 931 ft C - pump tank manhole = 'v (10 cm)
Off elev. 28.6 m de
minimum above finished graft
D - vent =12" (30.5 cm) minimum
above finished grade
93.0 ft Pump tonk elevation
3 " (75 mm) of bedding under tank 28.3 m bottom of tank
Tank manufacturer HUFF UTT
Pump tank capacity 12 galfin
Pump tank volume 600 gal
Pump manufacturer OELLER Inch Gallons
Pump model number 198 o A 30.6 367.3
• B 2 24.0
Alarm manufacturer [LEVEL ALARM C 11.4 136.7
Alarm model number 1DVL Q D 6 72.0
Project: BOB FEYEREISIN
Transaction Number: Page 5 of
I
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W w HEAD CAPACITY CURVE
2 30 MODEL "98° 4 5/8
8
25
6 20
3 5/8
U ® L
Q �I
Z ,5 O
D
4
J
0 10 4 3/16
2
s
0 1 1/2 -11 1/2 NPT
U.S. GALLONS 10 20 30 40 50 60 70 80
LITERS 0 80 160 240
FLOW PER MINUTE
MODEL 98 60 CYCLE
Feet Gallons Meters Liters
5 72 1.5 273
10 61 3.1 231
Is 45 4.6 170
20 25 6.1 95 12
Lock Valve: 23'
009971
P 16
SKI 102
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available
with or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - 1 /2 H.P. 2. Single piggyback variable level float switch or double piggyback variable level,
98 Series Control Selection float switch. Refer to FM0477.
Model volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075.
M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator.
N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4)
float system.
D98 230 1 Auto 4.7 1 or 1 & 7 —
6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in
E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002.
7. Two (2) hole J -Pak, for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Piggyback Variable Level Switches, All installation of controls, protection devices and wiring should be done
by a qualified
FM0477 ;Electdcal Alternator, FM0486; Mechanical Altemator,FM0495;Sump/Sewage Basins, FMO487; licensed electrician. All electrical and safety codes should be followed including
the most
Single Phase Simplex Pump Control, FM1596; Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. BOX 16347
` Louisville, KY 40256 -0347 Manufacturersof. .
7 � SHIP TO: 3649 Cane Run Road G
Louisville, KY 40211 -1961 QUquTY PUMPB �/�NCE /9,79 http.lAvww.roeller com (502) 7 FAX (502) -3624 PUMP
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I w isconsin Department of Commerce SOIL AND SITE EVALUATION
Djvision of Safety and Buildings Page —L of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County ,
include, but not limited to: vertical and horizontal reference point (BM), direction and Sf
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information. Review by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner I Property Location f
Govt. Lot 1 1/4)(5 1/4,S ,20 T ,;Z cy' ,N,R I? E (or)c
Property Owner's M fling Address Lot # Block# Subd. Na we or CSM#
s7 1 iv !O 1 44C
a State Zip Code Phone Number El City ❑Village b� Town CI Nearest Road.
;vt 4,Lj 1 S q0 r (1►s ?� SI �d'' /3 7a
,® New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building
❑ Replacement ` ❑ Public or commercial - Describe:
Code derived daily flow 7s° gpd Recommended design loading rate A 2, bed, gpd /fF trench, gpd /ft
Absorption area required ,3 �' _ bed, ft >J:�j trench, It 2 Maximum design loading rate /i l bed, gpd /ft / ? trench, gpd/ft
Recommended infiltration surface elevation(s) ��� It (as referred to site plan benchmark)
Additional design /site cckn iderati s
Parent material e 1 Flood plain elevation, if applicable ft
Fu Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
— —Unsuitable for system ❑ S [�t} � ❑ U El -[] U I DS P�kU ❑ S RI ❑ S FI U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
2 F -3Y ?. , S � 9' /1 ! hi L ca U, IBC 16'
Ground y 7. n1 0 �� j $` s L.
elev.
ftl ft.
Depth to
limiting
—tor ;
Remarks:
Boring #
s I MA0 0 <
Z10 s
Ground
elev.
Depth to
limiting
faclior
27-in. Remarks:
CST Name (Please Print) Signature Telephone No.
Address Date CST Number
l4
S m -t r -" S Voy i 3 3c /
PROPERTY OWNER k f %a SOIL DESCRIPTION REPORT
Page Z of
PARCEL I.D.# `
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground S /A g Zb S /1 SA ,rte$ �7L i
elev.
Depth to
limiting
c
fa r
5 in.
Remarks:
Boring #
Ground
elev.
ft
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
r S3oT29 Nkf7 'zziv-7 i
k�
I
I
l
t 38 3'9 24
S3oT;•�9
NO( / ?c•✓ ti�r7 r
O T
1
f
ST CROIx COUNTY
SEPT ArtK MA,1NT'I?NANCE AGREEMI ? NT
AND
OWt, ERSHIP CERTIFICATION FORM
O%Vtter /Buyer
Mailing Address
Propetty Address
(Verification rcguired frou i Planning Department for new construction)
City /Statc Parcel Identification Number / � - /-- D - Op
LEGAL DES CItIPTIQ
Property Location — t /t� -- ti $d C. SQL T -N -R,
J
Town of
Subdivision Lot # �-
Certified Survey Map # Volume Page #
4
Warranty Deed # 4 4C 3_ Volume �_ - . Page # _.�.1___ .._.___..•
S ec house es n 1
� a
P Lo t tines identifiable a e es ❑ no
Y hfi bl f� v
SYSTEM MA — XjENAKCE
Improper Use and maintenanceof your sel Oc system could result in its prematuxe Mum to handle wastes. Proper ma,intenance
consists of pumping out the septic tank every tht' a yeAO or sooner, if tteedodby a licensed pumper. What you rut into the system ('
can affect the function of the septic tantk as a trm lment stage it the waste dlspnsal oyste m. j
The property owa r agrsties to subuxit to 5t, Croix Zoning De;partmeut a carditca,tion form, signed by the mrmcr and by a
master, lumber, jome an lutuber restricted l tmber or a licerhie i um verifying that a on -site wastewaterdis sal s ystem
P � P � 1 n 1 the .
Pte' Ymg () Po
is in proper operating condititw and/or (2) after in: section A-0d Pumping (if n ecessary), the sep tank is lass than 1/3 full of sludge. I
Vwe, the undersigned have read the above rcquirmi dents and Agreo to maintain the private sewage disposal system with the standards
set forth. here4 as set by the Dep=nent of Cove "me and the Department of Natural Resottraea, State of Wisoonsia. Cetlifimtion
stating that your septic system has been maintained MUR be completed and ratuirned to the St. Croix County Zoning Offiee wid3in 30
days o e ye C e iration date.
I A OF A}? IC ANI' DATE
O _ R CERTIFI
I (we) ce,Ttify that all s.tatomonts on this ; 1rm are true to the best of my (our) baowledge. I (wit) am (are) the owncr(s) of
the property described above b v irt ale of a wamt l ty d e ed recorded in Righter of Deeds 01 -Tice,
SIGNATURE OF APPLICANT
' " "" Any information that is mis- represented u ay result in the sanitary permit being revoked by the ZoniDg Department. ••'�"
Include this applicati a
de evitlt t >zppl t stamped ware Inty deed from the Register of Deeds aft5re
a copy of the c, rtifsed survey to ap if mference is shade v) the warranty deed
S T C - 100
- This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner /contractor, (spec
house) , then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
-------------------------------------------------------------------
owner of property Ile, /r� 1✓ �f� �� s ����� yas,�di s
Location of property 1/4 1/4, Section ,T N -R W
Township & o ti 6 Mailing address
Address of site ,,�� '���
Subdivision name l�o.� /r,4., Lot no. /o
Other homes on property? Yes No 2 ,q A ( 17
Previous owner of property
Total size of property
Total size of parcel ;7 ACf e s
Date parcel was created -T w A , Af # I , P
Are all corners and lot lines identifiable? Yes No
Is this property being developed for ('spec house) ? Yes _ No
Volume and Page Number as recorded with the Register
of Deeds.
-------------------------------------------------------------------
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY:DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
S gnatur of Applicant Co- Applicant
�Z .7
Date of Signature Date of Signature
a
WA;?yA "'TY CEED
REGiSIEtc
ST. CROIX CO., Vi
Recd for Record i
D E C 3 0 1992
.t): 10 A. M
,nd uarru. t., HALLS 't
corporation, Craatee
PApW d Deaft
tic fo:i,,%, :: + ( rea! estate m Jt. CroiR
sta of W- oonsin:
'rax
i
Southeast Quarter of the Southeast Quarter of Section 30 -29 -11 EXCFT'T South
12 reds of the East 20 rods therecf.
I
t' 'Eli
li
FEE
TOCEIHER WITH and SUBJECT rU reservations, restrictio.:s, easements and
rights -of -way of acoru, if -ay.
is not
T':i� hoc .gad {.nC
C{3Q ( i> not)
F.xcep-on h „;arrant-s:
December 9 -'
EA[. s.t r `tomaG L
n :LD �: "_`1I1H
AUTHENTICATION AC KIN 0WT:EDGMENT
sTATE OF Wl =CuN) ,[1
_ __
Wit. Croix
.,at};enticated this __ _ day of _ 19 [ ..,[! 'wn'.
r:?1bC.
• eraiJ J. ^.ith s JC,tCnine t . - 7itc
TITLE: MEMBER STATE BAR oP
(I e not,
authoei-�ed by § 706.06, I4
tr t t
,.a,_�MENr WAS c. r. >Frco
t n
yy
Je C nd t2r::
Si -nature; re; 1y he n.,.entieate,i or
:,re not r.ece. , ,rp.)
LL'wRrZ4 QTY pEEp ? P - 'i. \i3 ('R R; L C t ,iti .. .
No
MLAUVW KIU%.7r.
LOCATED IN PARK' OF THE SEA OF THE SEI /4 OF SECTION 30, T29N, R17W, IN THE TOWN OF
HAMMOND. ST. CROIX COUNTY, WISCONSIN; BEING LOT 3 OF CERTIFIED SURVEY MAP RECORDED
IN VOLUME 9, PAGE 2684, AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE.
57 0861
con-am R8t8S'fiR'1
mu 6oT e111tt erm mu CIO!! 11C T►Iw TANGO? [?. CMOf7f t)t>. w il.
10. 10. Ulm AM 4511110 um um 1111110 111111!0 f1224202ed
1.2 1 373.00' 33 116 132.75' 134.20' 100 133001'SPr V
3.4 2 161.00' 10 112 1!2.11' 204.7'6' 137°01'54'1 131
N 3 217.01' i1 /�0NN' 114 361 S8' 417.41' 337 0 13'06'1 166
211.
1 !3].10' p IO2 Zp.0 /' 51' r77 131 %0' /T1
6 233.00' 15 I79 U.'6 /' f3.N' 131 111
1 133.10 1f IS7 79.13' IL I 141 1 IffoS1'S /9
1.1 fig 43 23 171 174.12 116.11 m 54 1 5150 1 10 I
° 1.11 f 367.01 73 11110 3'42 1 111.11 14l.71� 1115 1731 t f6f 1 54 '16 1
54 f
11.12 11 167.04 114 ' 00 • ill 51'51 ! 363.43 113.57 K6 54 1 13
70 13.14 11 233.01' 11 i12 261.12' 215.61' 931 113
a 15.16 12 167.10' 33 116 94.6P 16.19' 53341/61 M 5411
�a
y ^'
i I i i, I
a _UNPLA_T_TED IANCS
�a
._$9 WE-. .1315.69',_. -_
Y ci SOL" 326.57 410.25 207.00 �• I A
as. --- -- -- last." -- 1 °s
p Z g�.. ®I ......_.�.._.....�._..... LOT 8 LOT 7 LOT 5 N m
2.#G ACRES - ACRES i
116,924 SO.". 2.00 ACRES y A Q5 Ir
67.123 SO. FT. 64 511.547 O 11
irn
a
"C3 f $ Ni9•, \ " o'' LOT 6 S 1 y I Ic
_
134.21 '_ �� b• �'`. A► 2.00 ACRES i 1 IN
�T r
Ir- I CENT OFPL - DE -Sx m �'� ,�to,s� `'•+•r
411. I SO fo. 9• 7 ,M it
IQ .s FROM THE Gwi CORMER Of / p i Y
LOT 10. ® '1 I
1 P 1 -1 IC
Icy _ ».._..__.._._.. a '' a ii I 1 IL
0 3 y I ,� '". � ,c 1`\ LOT 4
z LOT 9 3' ' "
-•� 4,rI±C/t H ] ♦ sq'a9'oTw tN.n' Hso ACRES
_ 2.72 ACRES eo 'ar, 3 q,e47 24 so.Ft F
y la.3e 90. FT `IC 1 ,�, 1. I
!^' 11.117 Aca[s
1 90,9O8 f0. TT. \ 1 A
_ \\ LbT 3 ' 1
33' 33' 11.00 ACRE! w ! 257.00'
I
67. In b. FT. S8158'06 "W 330.00' i t
• 2.Ot N89'00' - W 301.04' � \ �• O
t -7 a
° SSV58'06 "W 325.00' r'' ' / 1 1 O 2 0,41
PLAT ILOC
LINE DATA I OIT I / I ; SECTK
STORM WATER RETENTION AREAS LOT 4 H• L x s
A N00 w 79.23' 4 ACRES Z .�• H 1 1 1 0
9 s" 41.44' 8 07.N 7.4 ' (1 I
0 $o. 0 W
i �/J T 2 � _ 4,= • _,
1 5811'2614'E 196.70' v
J D NI4 201.31' C. S. M. 6 1 - I 1 �
_ N , 2.00 ACRES
.. N77•ri'46•w a9.ss' 07.111 SO.".. y PG. 2684
F s77.26'22•w W-59 yQL. 9, � ,
a $36•54'0e s4 23' `.'~
"1
M S14'44'31 27.89' 1 "
E
T 500 - E 121.00' PG. 2684 -4 K .� �� O
J NW411 x1.00' _ I
N
K N'30`w 121.00 0 '
L 399.46'30 IN WI- r - R 9 0 Iro 20 ti [ Sao.4s 4�6 s _
Nor[:
NORTHEAST CORIEp 033113311E 6 • \ 7 6 LOT I I
ENCROACHES WEf, I.iIE of �.�{� •
FLAT eY o 3W
FEET
y :LOT I X54 S"Im -
LOT 12 w :11.00 ACRES
2.00 ACRES o O 0 (.57,1111 so. Fr Y I
87.1to $o. FT. Y'' ' �Q , i
j� N w.L. • a3s.o L
s��a I 4 rRac_
0 / 492 � ( ��j
„ 711
T29N,
- - _ -
si9•ee'o 8 sa: -02 _ -- _ �- T OM OF
S89•58'06'W ROAD u DEDICATED TO THE PUBLIC w - SSW58 _
SW4 CORNiR 90YTH LINE 0 THE s CIN 58 662. Li 330.00 SC CORKS
SECTION 30 1317.06 -- tECT1ON 30
�sH AY - 5 - y seal
Proposed accioss to Lots 2. and 12 are to be from now Public Rood.
UINPLATTED LANDS
0 A� LUw Nur coUmrV fccrioN Mowumaw FouNO each Parcel shoes] on this map (plat) is subject to State. County
and �w�.. law, rules and regulations (i.e.. wetlands, minimal!
• 1 IRON PIPE FOUND lot s xe.e. socass to parcel, etc.) . Before purchasing or
0 unEA IFO"i OWE SET. WCWHM 3.6 inning office
PER developing say parcel contact the St. Croix County inni Office
and appropriate Tom Hoard far advice.
NOTE ALL OTHER LOT COONENS MONUaENTEO WITH M= - •� =��
I* a 2401 I� S FIPE . w9mmo LM Los. Fa C 4..5.
---- It' wlOE UTILITY [Ai[MENT no pas er buried cables are to W plan" much that the �ko a
instailatjm would disturb say survey stage. or Nbetr,30C viol am '+T &ak w
along any lot line or street line.
.............. 104 ROAD NAY SETeAtR I" The dietltsbance of a survey sta3re by is a violation Of
Section 234.39 of Viacom in Statutes. utility lasagents as bersin.
•--- -A EXISTING FENCE LM set forth am four the use of public bodies and private public
Utilities ?Novum the right to Marva the area.
SCALE IN FEET _
Rs o I
SHEET I OF 2 SHEETS