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HomeMy WebLinkAbout020-1323-10-000 Depan`rWit t of commerce PRIVATE SEWAGE SYSTEM oun Salety�gaddingsDivrsion INSPECTION REPORT St Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal k*m aWn you provide may be used for secondary purposes (Privacy Law, S.15.04 (t)(m)). 338836 Permit Holder's Name: 0 City village Town of: State Plan ID No.: elta Construction Hudson Township T BM Elev.; Insp. BM Elev.: BM Description: Parceffax No.: Z 7 020- 1323 -10 -000 TANK INFORMATION ELEVATION d� TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic z c) �t._B Dosing (� e 5 Al M Bldg. Sewer /-3.(0 Holding-- St/ Ht Inlet Z 0. 0 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I to ROAD ()t Inlet Air I ntake P46 • 6 Septic > Sb 3 1 Z NA Dt Bottom 1,1 y ? 5� 1 �� /Y Dosing > p ' S6 0 Z 2 NA Header / Man. S �? Aerate A Dist_ Pipe R yz 93- Holding Bot_ System C� tz , z Z PUMP/ SIPHON INFORMATION Final Grade Manufacturer I C Demand St cover p. yS �! 3. 33 Model Number a 0 4( ZS GPM TDH I Lift y L Friction/ S term TDH /(� 3 Ft ead Loss F orcemain Length 3' 1 Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM BED / CH Width , Length , No. Of Trenches PIT No. Of Pits Inside Dia. th IME SETBACK SYSTEM TO P / L BLDG WELL LAKE/STR EAM LEAC C HANf BE R - M anufacturer: INFORMATION —Type—O O R UNIT Mo e System: OR DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Z Length � Dia. Spacing _ 32-,3 Z 3 7 /0O 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 o l e o. I. Iy } 5r lSy . # � n ection #1: (D /I /fq Inspection #2: Location: 670 Todd Lank, Hudson, WI 540 Y6 (SW 1/4 SE 1/4 10 T29N R1 9W) - 10.29.19.1671 Scott Acres -Lot 11 l.) Alt BM Description = top of foundationibottom of siding 5.) textures were verified — see original inspection sheet 2.) Bldg sewer length = 13 ft. - amount of cover = >18in. 3.) 2 ft. between tanks 4.) BM's were lost, but found/re- established by plumber at a We C9ci+, Plarl ftVisidatmqui red? ❑ Yes ❑ No Use other side for additional information. L j cert. No. S8D -6710 (R.3/9� Dat inspector's nature VW 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. o u�A Am PLAN VIEW � ®a.a �Gf s' a L It h �C' 1 v o� zt' INDICATE NORTH ARROW v ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner _ A 7eL Property Address City /State Legal Description: Lot _ / Block Subdivision/CSM # S '/4 SF ' /4, Sec. z, Tz�N -RW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer fU .tf _ Size ST/K / Setback from: House Well P/L Pump manufacturer / Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to ft take Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM r Type of system: Eg&&Ct Width 57 Length _ J Number of Trenches .Z- Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark � D Elevation Description of alternate benc ar Jet Building Sewer U 2 ST/HT Inlet ST Outlet 9YI.. gd' PC 0� 4k rA4 PC Bottom � Header/Manifold Top of ST/PC Manhole Cov Distribution Lines () 0•• () ( ) Bottom of System Final Grade' Z () g () ( ) Date of installationf Permit numb State plan number Plumber's signature License number �� /C d� Date ��/ / Inspector K-- Complete plot plan A r v4nNV1-4 03 AS 0313V80 1N3w CJ I ZT. K) I IY) I r CJ I CJI Ol �� s I ctl —I sl tr) i I rn CJI C"JI t)I co I J1 _JI 01' -JI v a C'JI C)t my >I m w p � vV08 1 L 0 ` M M 17/13S 3H1 30 b/IMS 3H1 30 3N1 1SV3 ,68'Lt?01 - 3.62 5'( ►� J138f1d 3Hl Ol M ,£L'86Z 3 „£0,LO ° OON 0 z O NW _ °° 1 `` rn W 3 3�IQ w L.iact a lloz to Q'�9 +� -�' Ul v �O W F= �•` 3 ,N N 00 YE 0� T m O w� x a I = 1 CD OD ao o 0 Z f ^l o W cn z \ F. Z U..J U N tJ ` I I W N - N Q� \ I H N W to w 0 O O �� 1 O x OR N —p ££ ,££ a wN CY Q O �! 0 in o O N \ N O N O O \ ,18'9Z£ M „6£,5Z ° OOS \ N / \ OD \ z O ~ mo \ M (n LA. N 0 w - 7 w lm V N V W 00 1 O \ CJ1 N O Q O w v . to N a \ \ �! F sCb � , o£ £s• LL i tn Sa \ M — 'I C\j O _ ,£I'bZS 3 „6£,9 Z ° 0 0 N \ 1 ^ 1 �-- 3r Is i e � m `� I-. Wisc'*nsin Department of Commerce Count PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: OT� Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3 Permit Holder's Name: ❑ City ❑ Village [X Town of: State Plan ID No.: DELTA CO =7STRUTC'I'IO *: HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9900090 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� e S Z Benchmark Z N /0 Dosing Poo ration Bldg. Sewer 1 17 , 10 g Qt/ Ht Inlet TANK SETBACK INFORMATION Ht Outlet TANK TO P/ L WELL BLDG. qe n ake ROAD Dt Inlet N OS �+ Septic �'b l ��/ �/ 2oi NA Dt Bottom Dosing 7 f 7wi Z Zf NA Header/ Man. j; / / Dist. Pipe L (7 Z, At Holdiag, Bot. System ! /oz, o.' PUMP/ SIPHON INFORMATION 1;t Final Grade p Manufacturer D nand -� ,�✓ �r 9vY Model Number GPM -/ TDH Lift2�j Friction Syetem ( TDH 'j Ft Forcemain Length C / Dia. Z Dist.Towell F7 I I I SOIL AB ORPTION SYSTEM BED/1%fNGA Width / Len th No. 0 Trenches PI No. Of Pits Inside Dia. uid Depth DIMENSIONS DIM SETBACK SYSTEM TO P / L BLDG WELL LAKE / STR HING Manu acturer: INFORMATION Typeof CHAM System: two )���/ 7 ZO' > J�C> OR UNIT DISTRIBUTION SYSTEM Header /Manifold Z /r Distribution Pipes it x Hole Size x Hole Spacing Vent To Air I take Length Dia. Length ? Dia. Spacing 1 -32- 33 1 3 Z 3 3 1 7(6 Q 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 Ljj COMMENTS: (Include code discrepancies, persons present, etc.) q' Ill 4__ LOCATION: HUDSON 10.29.19,SW,SE 670 TODD LANE / — SCOT7 ACRES LOT 11 Y O ( 6� rb ldy �aGk) >< <u +�• �4ue CS?' CrYah 0 - N tsa1 s,�,;�s►- �o a� f�` Plan revision required? ❑ Yes ❑ No Use other side for additional information. } SBD -6710 (R.3/97) Date Inspector's Signature Cert No. /V ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i { { Mas € t a, � t m m t 3 3 , r W a 3 a ...:� r = € E e �a c __ ... s _ t � i # �IU jl T �a }_ « H . ._ �i 3 I r ¥ t { � r } I €e m .��. m .. .,a - , t y s ¢ I �... .emu. .., .', � _d... ................. . t ...�,.�. _ m .m. .,.. m .... o e v _, _,�.. ._. a a �' i l r E { , „ . m ....... �.� m.. , a Safety and Buildings Division N*I sconsin SANITARY PERMIT APPLI I$. 201 W. Washin Avenue i i � , ;� P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. �b ,X Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste aper ts Coun than 8 112 x 11 inches in size. s" 4`r`; � • See reverse side for instructions for completing this applicati State ary Permit Number _ � � , / f � � 8 3 So Personal information you provide may be used for secondary purposes 41 �.Ir C 'iyr l -revision to p revious a [Privacy Law, s. 15.04 (1) (m)]. / P a pplication rf � Y St* I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF MAT Property Owner Name P #liperty Location ' .`` ,,�) �4 f 1,14 a 114, V` O T Z N, R E (d 'K.JI' Property Owner's Maili'm Address Lot Number Block Number City, State Zip Code Phone Number Subdivis on Name or CSM Number O ( Teo 27 E F BUILDING: (check one) ❑ State Owned it _ / Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Gtj)SO�I/ L/l1 III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1q. Xo7� 1 ❑ Apartment/ Condo — O 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 New 2. E] Replacement 3_ [3 Replacement of 4 E] Reconnection of 5_ ❑ Repair of an _ System________ System_____________ TankOnly______________Existing System _Existng5ystem B) ❑ A Sanitary Permit was previously issued. Permit Number 3?j If' C-- Date issued O� V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 �5eepage Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank 1 rA Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit T9! -LrA /C 43 ❑ Vault Privy 14 ❑ System -In -Fill . S. VI. ABSORPTION SYSTEM INFORMATION: 1, Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Syst �1 ev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) *l W- Elevation 4049 D Feet Feet Capacity VII. TANK in Ca allo g Total # of Prefab. Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Sep c Tank "diwgZ"k 1 WCrc ❑ ❑ ❑ ❑ ❑ p a n /Sipkte�rEhtnrrber t ❑ 1 ❑ 1 ❑ ❑ I ❑ MU—AkO ONSIBILITY STATEMENT AqA r/r_ 4 WAlLA7 " I Zr /b1�7) :rr A<A00-s /X I, the undersigned, assume responsibility for installation of th onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stam ) i1RP><MPRSW No.: Business Phone Number: f Z4 " _ _�JP24_t PI Me Ad ress (Street, ity, State, Zip de): M 4/az -3 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitar Permit Fee (includes Groundwater ;74 Issuin ent y gnature (No Stamps) proved ❑ Owner Given Initial Surcharge Fee) , Adverse Determination 1 X. CONDITIONS OF APPROVAL / REASONS FOR DI APPROVAL: 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. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings - Division, 608= 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing,.address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. 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 8 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. -------------------------------------------- - - - - -- ------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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 Division ` SANITARY PERMIT APPLICATION 201 �w7�gt Ave. Vi sconsin P. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit hum ber 33 883 The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATt N Property Owner Name Property Location 4CJ1 14 1 /4l,5 O T ,N,R E(o Property Owner's Ma ng Address Lot Number Block Number L City, State Zip Code Phone Number Subdivision Name or C'SM'fCUMl �r of WA lli IL PE BUILDING: T ING: (check one) ❑ State Owned ❑ it Nearest Road ❑ Village ✓ Ej Public 1 or 2 Family Dwelling - No. of bedrooms 3 own OF t:/ Ox L III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Sze - /.3Z 3 -- /4' 19.1 6-11 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. V New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ________ System____ _________TankOnly______________ Existing System _,_______ExistlngSystem 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 V1 Seepage Bed 21 ❑ 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 5-' 51 1 7 115h S I SSY VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate j S stem Qev. 7. Final Grade _ Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) o, P Elevation J S63 . 9 , 3 " O.D Feet Capacity VII. TANK in g all0 S Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank f ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ I ❑ I ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation o the onsite sewage system shown on the attached plans. Plumber's Name: ( Plumber's Signature: (No S m s) * WMPRSW No.: Business Phone Number: Plumbers Address (Str , City, Sta , Zip Code): (' 2 IX COUNT / DEPARTMENT USE ONLY E] Disapproved 5 itary Permit Fee (includes Groundwater ate slue Issuing A ent Sig ure (N amp Approved ❑ S � Surcharge Fee) 00 Owner Given Initial � / Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD -63M (Ft. 11/96) - DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber i 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. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 -266 -3151. To be complete and accurate this sanitary p application permit a lication must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted.to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 00 At S I O U 0 - 11 p u� m � c l ot P 4 w� VN I i N 0 w �1 a� b N h r - PA (: F F PUfAP CHAMBER CROSS SECTIC)IJ AND SPECIFICA'rimS VE UT CAP `i "C.I. VENT PIPC WEATHERPROOF APPROVED LOCKIKJG C-5' FRO•^1 DOOR, JUNCTIOAI BOX MANHOLE COVE 0 Q WINDOW OR FRESH IZ "MIU. AIR INTAKE GRADE I 41 I `1" m1w. COIJDUIT 18 "MIN. v -- - - - - -- INLET PROVIDE T AIRTIGHT SEAL I III I I I ALARM B I II I I c *APPROVED I I ow JOINTS WITH { I = ELEV. FT. APPROVED PIPE I 3= ONTO PUMP �-� oft p SOLID SOIL COWCRETE BLOCK RISER EXIT PERMITTED OIILy IF TANK MANUFACTURER HAS SUCH APPROVAL . /t'/-k- SEPTIC E SPECIFICATIOMS OOSE TAWKS MAM FACT LIKE R: - �h �� {DUMBER OF DOSES: 'Z PER DAy TANK SIZE: GALLOIJS DOSE VOLUME ALARM MANUFACTURER: S. L r^1' ' IMCLUDING BACKFLOW' �'Z� &ALLONS MODEL IJUMBEK: 16 IKC4) CAPACITIES: A= ZZ IMCHESOlk GALLOWS SWITCH TYPE: 2- INCHES OR -. GALLONS PUMP MAIJUFACTURKR: ULA C = �7 INCHES OR GALLONS MODEL NUMBER: �f_JY D- INCHES OR JUL GALLONS SWITCH TYPE: .4&C & NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE �' GPM INSTALLED ON SEPARATE CIRCUITS I VERTICAL DIFFERENCE CETWEEAI PUMP OFF AND DISTRIBUTION PIPE.. FEET /7 f- �l�-/-�'/J eff - MINIMUM NETWORK SUPPLH PRESSUItE . . , . , . . , , , , - 2-G - FEET / - f Z FEET OF FORCE MAIN X , �,� /p FACTOR.1 FEET TOTAL Dy1JAMIC. HEAD FEET IIJTEP0JAL DIMEMstoNS OF TANK: LENGTH ;WIDTH - ;LIQUID DEPTH _7.L._._ Am I MODEL • Su • • i GOULDS l i pump Speciftt8tions 1 _ t 4 METERS FEET l ; Up;to 40 GPM 19 30 MODEL: 3871 Discharge size i %" NPT�t Solids 3 /8 maxlmum'� " Motor 7 26 Single phase:115V Materials of C astructlon `,+ ' = 6 20 Brass/thermop stic s � 16 i Features and Benefits 4 05 *Top suction eliminates Q 3 t0 •� impeller clogging. s 2 5 EM } • Corrosion resistant 1 construction. • Float actuated switch. ° ° 0 10 2 30 40 so US.G'M 0 2 4 6 8 10 12 mjmr METERS FEET ' CAPACITY ' 25 MODEL DVP03 Pump Specifications Features and Benefits 0 6 20 4 /m and 1 /2 HP • EPO4 impeller- semi -open design = 6 Up to 60 GPM with pump out vanes to protect 4 15 Maximum head to 32' mechanical seal. 1 0 3 10 Discharge size 1I ' NPT • EP05 impeller - enclosed design 2 Solids: 1 /4" maximum for improved performance. 5 Motor • C R a ug a ged gla ss-fil l e d thermoplastic '( All motors feature ball $ base design provides 0 00 6 '° 16 20 zs 30 3s 4o U.S.GPM bearing construction. superior strength and corrosion 0 2 Single phase: 115V resistance. CAPACITY 6 a 10 � m ` Materials of Construction ' Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. ij All Models are designed for continuous operation and feature stainless steel hardware. I 1 ' W p 4 * t Ile 0 •�'�. A � N _ � 3 1� 5 ,� Q m � '` • `O h w f Wiscortgin Department of Industry SOIL AND SITE EVALUATION ,labor,pnd Human Relations Page _L of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and r C dl percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Pleaseprint all information Reviewed by Date Personal inforrpation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location G Govt. Lot SW 1/4 E 1/4,S T ,N,R E (go Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# .fix ;! / / fC&77 !fC 6,s City State Zip Code Phone Number Nearest Road //6 f [:1 city ❑Village Town New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4 4PIP gpd Recommended design loading rate L,7 - - bed, gpd/it . f trench, gpd/ft Absorption area required f�f bed, ft 2 47. tr ch, ft 2 Maximum design loading rate _ bed, gpde • f trench, gpd /ft Recommended infiltration surface elevation($ 5 1 7, 3_ ft (as referred to site plan benchmark) Additional design/site considerations P PP Flood lain elevation, if applicable �/ Parent material e it S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system Z S ❑ U El D U ® S El ❑ S 71 U ❑ S Z U ❑ S 1ZI U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s. ,_.._ c 1 • o ro 3 z _2 m 1 L Ground e lev. Depth to limiting 77. factor in. sS. Remarks: L C L mS€ ?y SD ,sd G aAl /t'.4•T €Q) Boring # , 13 L L '95 IF-. S — ' 12 a &f Ground elev. Depth to limiting factor -- in. Remarks: CST Name (Please Print) Signature �— Telephone No. Address Date CST Number Ikk v 20 G' 47 o .� -t31 SOIL DESCRIPTION REPORT ' PROPERTY OWNER yeLr� Page of PARCEL 1.04 LD Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 77 Z — D L es Ground _ p .. !, ^- S Ir elev. �Q�Qft. Depth to , limiting ^+• factor Remarks: < a' T..Ci 7 - lVWAI.eAO;i She NOTE 9077-M /F ? 4S. Boring # �. AQ AE Z - - 9s. . S -- s' AX 10W lip YL CS — ,O ' . Ground V -- elev. Depth to limiting factor in. Remarks: > So 9a�_j.T Horizon Depth Dominant Color Mottles Structure P / in. Munsell Qu: Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # ©–,y _ 4 HA4t MAX ' Av 4 2 _ V/59 A44 C -- S p G L .8 9�3 , Ground JF elev. /Bp.D Depth to limiting factor -- in. Re at ? Sty% t 2="r Boring # O /r/ ® o GE f w L -r-ro IN, �. ::.A Via. fj�0 Z01W !� COLD 2 Ground Z E /Skr " 7 - 0 - C,*A--*A elev. &F �t Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) y b / t P Ir � W t a 1 C aq M b s � oe+ j I I i : M 1 _ r r - i i r l a I 06A .0 " I . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND �((��.��0,, WNERSHIP CERTIFICATION FORM Owner/Buyer Q S(�.�tt / o Mailing Address zgG 2 � � Property Address 6 (Verification required from Planning Department for new construction) City /State 1,1creA4,, Parcel Identification Number P-za LEGAL DESCRIPTION Property Location SAl '/4, • S _ '/., Sec. /0 , T L _W, Town of " . Subdivision Lot # 1/ Certified Survey Map # , Volume , Page # Warranty Deed # AM x 5'40 , Volume // 77 , Page # -71f Spec house ❑ yes] no Lot lines identifiable yes ❑ no SYSTEM MAI Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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 day of the e y r expiration dat . Y r SIGNATQO 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 pr " erty desc �, d :ve, by virtue of a warranty deed recorded in Register of Deeds Office. �I SIGNATURE F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa ** 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 III WARRANTY DEED r ii 1 PA :.j�U Document N-'mber _ `vi MA; 10 Return Address " . 11.00 A•, s`'� ► s ... Parcel I.D. Number: 020 - 1011 -00 Joseph A. Klewicki. a single person, conveys and warrant. to Delta Construction, Inc., a Wisconsin Corporation, the following described real estate in St. Croix County. State of Wisconsin: Part of SWV4 of SE114 of Section 10. Township 29 North. Range 19 West. St. Croix County. Wisconsin, described as follows: Lot I of Certified Survey Map filed April 24. 1996. in %'ol. 11. page Doc. Nu. 542664. This is not homestead property. �► ` Exception to warranties: Easements. restrictions and rights -of -way of record, if am. Dated this day of May. 1996. (SEAL) --(SEAL) Atv 9 seph A. Klewicki ACKNOWLEDCNIENT STATE OF WISCONSIN ) ss COUNTY ) ��7 y l� 1996, the abo%c named .Joseph A. Personally came before u.e this _ � ' _ day of Klewicki, a single person, to me known to be the pz: soi,(yk who executed the forcgoing instrumetu and acknowledge the same. Notary Public County. WI M commission expires wrs AuNotary Public THIS INSTRUMENT WAS DRAFTED BY: St4tc � = -f Waco ntn Attorney Kristina Ogland Fludson. 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