HomeMy WebLinkAbout020-1330-30-000 ST. CROIX COUNTY ZONING DEPARTME t
AS BUILT SANITARY REPORT
Owner C
Proper Addres ► 1 ► _� _ - ( Z Z
��vrri
City /State fazed WE 5 GY 6,1 FA;
Legal Description: ` f'
Lot ;L_ Block — Subdivision/CSM # A )Q 1t1r yp pp
S '/a Imo' /a, See 3 , TaaN -RAW, Town of sor) PIN # Z 7, z #: j Q j: Z 17
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer
ei s i r Size ST/PC AvO / 6m Setback from: House Well c�3 P/L kLL
Pump manufacturer M I e v Model A4 rHo
Alarm location lleqs
(HOLDIN TANKS ONLY)
Setbacks: Se ce road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width Length Number of Trenches
Setback from: House 3 Well ho P/L Z15 Vent to fresh air intake
ELEVATIONS
Description of benchmark 3 1y T Elevation 10 0,
Description of alternate benchmark Elevation /D /, ,2
Building Sewer 10 1 ST/HT Inlet 0 1. 0 3 ST Outlet `` PC Inlet
PC Bottom 7 7. qT Header/Manifold 104. 7 7 Top of ST/PC Manhole Cover �d 3.510
Distribution Lines ( ) _ !6 4, $ 7 O ( )
Bottom of System () 16 0 ( ) ( )
Final Grade () () ( )
Date of installation / / Permit number -4 -f State plan number
Plumber's si g naturZ01 License number v��Z��' y61 Date 31/4 /Oo
Inspector CJ t`3 L1
Complete plot plan �
Ik
Scale 1"= So'
, Page - 2 - of 6
NOTICE:, r ide the tollowmg r °. ' 3,,
• A pt view sketch showing everything wit im 10 ee o
O k, 311
• Two hoA n I re r '�oifttk*penter of septic tank manhole cover.
• Show alternate benchma 'lf"a �
or—
coutuvR, � ,
PLAN VIEW �` V°L ,-
$�'► . lUb,0 0,.1
- V O F Z" PVC PI Pe .
�o ►von eo�Pe�•e -r �� �2�
Ott O \ S1ti�L�3 0 � � tUb a 1'►°vt�j�
X1 S
S �
81 ZY __ O N-
Y1S
r�
1 N vi I L0 p z P�tuu`i .QIAW 51 RT' Lc�hsT r
77 + a e 1 v1 °9 \ �� W "O "P �o 91 "o, up
k1.103`d�l S ' �• ► Zhu ��- P1`1`'l
oo'�
I u of
L &PVC tp'pp �l4P�C
I
1 313D�
ZS. ' ��►� I 3 B bd r
t'L LO
A"
I
of
�
CDt •
,,, � pND Bu
�ti ii a
r-- �--- -- �, 1VISIAN
'1 r) L 01� a t=om
FU Npr
NOTES
GORRES
SE
1. Elevatio s Yee I O � *round elevations unless otherwise noted.
2. Install
3. Install 4" observation pipes with approved caps. ( -f- required)
4.-Septic tank to be lo gallon capacity manufactured by
5. Bench Marks szi� pM61jE- irLjb0.0 <)vj 3)U" T�O�Uwt LL, �tP� ��t Pb�� pW-F.
6. Divert surface water around system to prevent ponding at the uphill side.
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanita Permit No.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(mp. 344659
Permit Holder's Name: I ❑ City ❑ Village [R Town of: State Plan ID No.:
Silver dge onstruction Company, Town of Hudson
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
jav i6v 3 ,/
020 - 1330 -30 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic IUGo Benchmark
Dosing �p (�!� Alt. BM al (o L
A ation Bldg. Sewer (G
ing 6 dHt Inlet 91 Z to
TANK SETBACK INFORMATION
TANKTO P/L WELL BLDG. Air to
i ntake ROAD
Air
Septic > /06 "3-0( r Z NA Dt Bottom 8 7, Kr
Dosing 1� ,901 >�/ z / NA Header /Man. 3 F
Ae NA Dist. Pipe ' 3; T l0
H g Bot. System S' U
PUMP/ SIPHON INFORMATION LV,0P Final Grade
Manufacturer A-/PAS IJ Demand St cover �• d 3. YG
Model Number M � q0 ,F OFGPM
TDH I Lift�g Friction 03 System, S TDH� 3 Ft
Loss Forcemain Length I zG r Dia. Z Dist. To Well
SOIL ABSORPTION SYSTEM
X TRENCH Width t Len th No. Of Trey hes PIT No. Of Pits Inside Dia. Liquid Depth
EN I N e4M DIMEN
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM L F M urer:
INFORMATION TypeO ��� / /Q� r CH del Number:
System: R
DISTRIBUTION SYSTEM
Header/Mani Distribution Pipes) , �i �� x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Z Length �� ia. acing - 1/ 3 rr
_1 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:/0 /z 4 / f4 Inspection #2:/6 /z-'Qp
Location: 722 A & B Waldroff Farm Road Hudson, WI (SW1 /4, NW1 /4 Section 23 T29N -R19W) - 23.29.19.1727
�f� �! Z, tF fit• b , '� 1� /aS " ,! l �� ` �(Cer� /s /u 41/a✓ �k s�n�co� { / %y ,r
�:/ f�7 r a¢ d��� f� ✓ C�� o� -dray sASe�c�. (No 1 er yw) / , /
A reA - drd a aelQQl - 1 6l �`fll f4 / 6lj aR)
Ali /!/t &14 Very Cave ��/P�
� ewt eet (le�
B X rd t0Aertf Sf�t „,r f� <r(c errs o I /y
Plan revision r qulred? ❑ Yes [a No
Use other side for additional information. 3 2. Z QO
SBD -6710 (R.3/97) Dat Inspector's SignaKure Cert. No
r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
@
v �
u
#
. f i
c
, :. ..
3
@
I �
a
�,. .-.r,i .. �m .. m. .-�. ..« �.� .. . ,. ,. ,.... m .. ,.
3
€
€
m. .a
.a e
¢ F
,..,,._e. ,__... __,_.._ ..e.._._ . .. ......... _, _ ,.. ._ ._
a
€ a r E mm
a
E E
S . _ ..... ._ _ ._.. ...,,.. , ....
t
F
a � m
s '
e G I 2
f
E ' €
y i
# � f
S � I
d �
1 3 F
E
I � i
a t @ {
. ....... ...�
@ � 9
e
.mmm .r.,,
S � t
� C
r
Safety and Buildings Division
A PERMI
15h 2 01 W. Washington Avenue
n P O Box 7302
Department of Commerce accord with ILHR 83 Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) f the syss county 8 112 x 1 1 inches in size. • See reverse side for instructions for completing this applica State
Sa6itary Permit Number
Personal information you provide may be used for secondary purposes pX El Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State
an I.D. Numbe Z42
I. APPLI ATI N INF RMATION - PLEASE PRINT ALL e �. `,
Property Owner Name j4 ocicr COejl n Z P Tp -AJO
t' On �• V - e�3 T a9 r N, R 1 9efe�
Property Owner's Mailing Add Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
ud
son, W c1 d ap
I . TYPE OF B IL ING: (check one) ❑ State Owned Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF t-Eud 5c�h ILb ld rrff -arm 1�
111L BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) a o�
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 02A � rD ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/
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 on line B, if applicable)
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ E) Repair of an
______System ________ System_____________ Tank Only______________ Existin�System _____•___ 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 21'Joound 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:
Ur fi) y
'
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Sys em Elev. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) Min. /inch) l Elevation
10 5r 5 Feet / Feet
VII TANK Capacit in gallo Total # Of Prefab. Site Fiber- Exper_
INFORMATION Gallons Tanks Manufacturers Name Concrete con- steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank ep4o�yk L l000 ca ❑ ❑ ❑ ❑ ❑
Lift Pump Tanker �00 (000 VDCa , ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibili for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) P is Igna r : ( o Stamps) MP/JKPRSVIFido.: Business Phone Number:
e- d, ei GE C a a� ys l C7is �zs s��
Plum er's Address (Street, City, State, Zip Code
go
Zo s1#1 . Ki ver is Igo -?
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issui ent Si nature (No Stamps)
Approved [:]Owner Given Initial Surcharge Fee)
Adverse Determination 32 , 06
.CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROV .
SBD- 6398 (R.11/97) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber
1
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 B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than .8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance turve; 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
2226 ROSE ST
LACROSSE WI 54603 -1905
TDD #: (608) 264 -8777
Nviconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda I Blanchard, Secretary
August 19, 1999
CUST ID No.267341 ATTN: Rod Elsinger
WEGERER SOIL TESTING & DESIGN ZONING OFFICE
421 N MAIN ST ST CROIX COUNTY
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 08/19/2001 Identification Numbers
Transaction ID No. 241289
Site ID No. 179082
SITE: Please refer to bath identification numbers;
Site ID: 179082 above,: in all correspondence with the agency.
St Croix County, Town of Hudson
SW1 /4, NW1 /4, S23, T29N, R19W
Lot: 3, Evergreen Estates
Roger Roenfanz -Unit 2
FOR:
Description: New 3BR Mound; 1 Side of a Duplex
Object Type: POWT System Regulated Object ID No.: 486353
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Adm. Code.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Nincerely, DATE RECEIVED 08/11/1999
FEE REQUIRED $ 180.00
Dennis R. Sorenson FEE RECEIVED $ 180.00
Wastewater Specialist BALANCE DUE $ 0.00
(608) 785 -9336
dsorenson@commerce.state.wi.us
WISMART code: 7633
TITLE S \� E 1 '
Page of 6
r
MOUND SYSTEM
FOR
A 3 BEDROOM RESIDENCE
j
LOCATED IN THE S 1/4 OF THE NW 1/4 OF SECTION Z3 ,T Z`� N, R 1 9 W,
TOWN OF l t l r'}bscty ST- CRJU( COUNTY, WISCONSIN.
UST 3 0�= L=\)E,SZG2SE7V
6w emTZ�LLY vyv1T OF - wl" N EB
INDEX
PAGE 1 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW -CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PA GE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
�
YNDs�h, w SqZ j 7 99 9
D `D o
PREPARED BY
WEGEE:ZEF:;, Sp = L. TEST = NG
AND. �o�e
DES 2 (BU4 S>EIFRV I CE #,� 5C y�
F.O. Bill 74 421 K. SAIN ST. A"e
-RIVED FALLS. VI 54022
C ARTHUR L t
715'425-0165 WEGEHER }S
D P
ELLSW pRTM,
i wis.
I G IA
JOB NO.
r PLOT PLAN
. Page Z of 6
Scale 1 "= So '
•
- zl _ 14�,p' U� r 31 14 - Wh�� -Rte Plp�
I I
�b�or'I tlF t1t_�t -hl
1_rL Lp L 1'
$ �a- 1 tt,
"F Z y P\, Pe .
Co LA
euLLY Quiw shE RT rrtsr r
CT d s .� � / / by " DAP In 82Xhk. tip `T?it' M
III L Sy s ' lu OF oy too' r- 2 n� Ply SZ R uC7vRt . '
Vic 1 WI/PVC tp'pF�yp�C
f I t
V'MML Bp�y1 i
O
N1. lass � ► Lo �� N g�(5
A 'y�
s nary
� � so
� 0 t j
I
o - Zs ,> • AND
- - Ov�S10N
► Li F )L
C
NOTES g�E CoRRESF
•1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. tank to be vOobl6SO gallon capacity manufactured by
5. Bench Marks ' Oi� 3)y P y�'V_ POD Po\
6. Divert surface water around System to prevent ponding at the uphill side.
Page 3 Of 6
ti
Approved Synthetic Covering
T)ZTrm, c - N 3 Distribution Pipe
Medium Sand
Topsoil I
F Elev'_ \b S. S
3 E
u
b
7Z_% Slope
( Force Main Plowed
Trench of 1,2 "-2,1,2" From Pump Layer
Aggregate
Undisturbed D -o Ft.
Soil E 1 Ft.
Cross Section Of A Mound System Using F t.Ib Ft.
I Trench For The Absorption Area G 1:a Ft.
A S Ft. H t• S Ft.
B S Ft.
I S Ft.
Linear Loading Rate= � GPD /LN FT J S Ft.
Design Loading Rate= 0.3GPD /SQ FT
K N 1 Ft.
L o f S Ft.
W Z_$ Ft.
L
J Force
- - - - - —_ —_ —_— —_ K Main
W
Distribution Trench Of 2M - 2 2
Pipe Aggregate
I
Observation Permanent-/
Pipes
Markers
(Anchor securely)
'E SYSTEM
c 'mally
Mound Using I Trench For Absorption Artl' � � k
Boa DF SAFET I1ND BI�ItI�I�vL
„ :F CORRESPONDE-r�c t:
pag Of - 6
Perforated Pipe Detail
End View
Pertoroted
End Cop. " PVC Pipe
l
Install permanent
at end of each lateral
Holes Located On Bottom.
Are Equally Spaced
Q End Cap
SELWAGE SYSTEM
Pf', ditionalty
PVC Force Main
A V 4 'VE
R
Distribution VISION OF SAFETY APIA BUILDINGS
Pipe " \ �R� m��
Lost Hole Should Be �'— -
Next To End Cop SE CORRESPONDENCE
Distribution Pipe Layout P 3 y. S Ft.
X Inches
Y 3 Inches
Hole Diameter lJY Inch
Lateral 1 Inches)
Manifold Inches
Force Main " Z Inches
of holes /pipe \
Invert Elevation of Laterals tt& b Ft.
�ZX�.17 = 1U .o�lx Z =ZB -�� GPwi
ti
Place 1st hole 1$ from tee with succeeding holes at 36 intervals..
Last hole to be next to the end cap.
Combination Septic Tank and
PUMP CHAMBER CROSS SECTION ADD SPECIFICATIONS ' PAGE S OF
-VC UT CAP WEATHER PKOOF
JUUCTIOU BOX
y r C.I. VENT PIPC , APPROVED LOCKI✓1IG
-.10 FROM DOOR, MANHOLE COVER w ►"M
',iI NDOW OR FRESH wAR1JlIJG LI�gEL.
AjK IMTAKE ao1JpU1T
61r Pi
' : �MI1J , • 6RJ'M1 _ I , `i" HIAJ.
I
P . --- - - - - --
18 "PtID.\ ---- - - - - --
y `1 1uSV�Tct1o1J PIPC l � , _ -- _ —
PROVIDE I — —
IAJL -E T AIRTIGHT SEAL I I
APPROVED JOIMT 1 A I I APPROVED JOIIJTS
W /C.I. PIPE W /C.I. PIPE�P
. ; b a nk construction I I I
,%M all comply with ALARM
'90 14 P � t, s !,3.15 and 83.20 b I 1 1
OT ,d I I o
C
CV. �I.S� FT PUMP -� - -� OFF
iSt
C O U C KET E
3" APPRO+F�,
R15ER EXIT PERMIT(ED O►JLy IF TAWK MAIJUFACTURER HAS SUCH APPROVAL g
SEPTIC +E SPEC.IFICATIOUS
wt p GT- 100
DOSE �"7Mt ) 1FIM DUMBER OF DOSES: PER D" 3' 6Z
TAUr< MA►JUFACTURCR:
TAWK SIZE: 1014 1 b00 GALLOUS DOSE VOLUME I
ALARM MANUFACTURER: S S- ElLe;M INCLUDIAIG BACKFLOW: \SO.S GALLON:
MODEL DUMBER: l01 HW CAPACITIES: A= is IIJCHES OK 3 �' O GALLOIJg
SWITCH TYPE: 1IENZCLP -Y g= Z I U CNESOK : ' L / GrLLOIJS
PUMP MANUFACTURER: M Lf C= 9 INCHES OR YSo•S GALL01.15
MODEL DUMBER: 4 o D- -7 INCHES OR " GALLOUS
- MTW - 6o I.9
SWITCH TYPE: W1 2C Z'�►' MOTE_ PUMP AMD ALARM ARE TO 6C
MIMIMUM DISCHARGE RATE Z<L3b GPM INSTALLED OD SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEU PUMP OFF AIJO..DISTRIBUTIO PIPE.. lU'y,Z FEET
+ Mll.ltKUM DETWORK SUPPLY PRESSURE , , , . . . . . . , . 2.50 FEET
+ 1 bo FEET O F FOR MAID X � _ I F �of r. FRtC 7 toU FACTOR.. 1' FEET
TOTAL CtJ JAMIC HEAD = 1�. SO FEET
Pump chamber DIAMETER - 611
IMTERLIAL. DItALWStO4 Of TAWK: LEAIGTH ;WIDTH - ;LIQUID DEPTH
BOTTOM AREA -- - 231= GAL /INCH
AS PER MANUFACTURER GAL /INCH
Series M yers
4/ H P Effluent
and Drain Water Pumps
Performance Curve
MODEL ME4O EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40 12
35
10 N
30 W
IL W
H 25 8 f
Z
20 �QQ
kc ' S ° 6 W
2
15 J
O _ _
E- - .._ - 4 0
10 F.
5 2
0 0
0 10 20 30 40 50 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -6658 Telex 98 -7443
K3326 7/91 Printed in U.S.A.
Wisconsin Department of Industry SOIL AND SITE EVALUATION Page of `3
Labor and Human Relations
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and 57 G/t?O/ X
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I.D. # PeAjDiA3 6--
APPLICANT INFORMATION - Please rint all Information ormatlon. Reviewed
by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
G4AIP 49d° e . Govt. Lot SW 1141VW 1 14,S i T 2 ,N.R E(or)(0
Property Owner's Mailing Address F S Lot # Block# Subd. Name or CSM#
33Z N � N,J IZsaT - sT � "' U- ' 3 �vE'R�r,PE� �v ES r1' 7E5
City State Zip Code Phone Number Nearest Road //IV/. 11.
ST PAu L_ J MIAJ.Jj 5 s l o l (�f z) ZZ2 - SSSS 11 41ty O village Tow ct%►+ml� /�'�Gc y ��
New Construction Use: Residential / Number of bedrooms 3 - Addition to existing building
❑ Replacement qSo -
El Public or commercial - Describe:
Code derived daily now & O D gpd Recommended design loading rate bed, gpde trench, gpd/ft
Absorption area required 500 bed, ft -sad trench, ft • S 2 Maximum design loading rate bed, gpd/ft trench, gpcW
Recommended infiltration surface elevation(s) SEE / t i ` ' 3 ft (as referred to site plan benchmark)
Additional design /site con ations 715'r 5 %rE At V 705 sysrE•'9 .
Parent material 5G-5 8 " PI'1 /D T 1 - 7 le f, fS • Flood plain elevation, if applicable A It
Suitable for system Conventlonaal Moou In-Ground AT- Grade / System in Fill Holding Tank
U Unsuitable for system EIS L(U ITS El C] S L_'T U E] S B ❑ S �j El S
SOIL DESCRIPTION REPORT
Boring # rHorizo Depth Dominant Color Mottles Structure GPD /ft2
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
-- Bed ,Trench
/ 0 - 12 - /oy,P
Ground 2-r3 10 e /y - 7
elev.
/ 41,-4k ft. 33 -3 /o SL / f SI)k �.p a . s
Depth to - 5 � Z S •1/�
f cto ►g �S i� G♦0 �� s ; . Co
3f — In. ,
Remarks:
Boring #
o- q /oyve 3/3 Go M /fJA/_- / 4P_ c,5 5
Z Z 9 Drip « GS / ,C CS — • 7 ' .9
3 y za /o y C o,
Ground J /D e 6 7.5 VA S& C L Ifs K
, ,/ GQ 5 5 z
/ 7 . elev„ ft. 1 p Y 12 ��Z
Depth to
limiting
factor
m in. Remarks:
CST Name (Please Print) Signature Telephone No.
ROQERT 2tL(3P_i C4T' 7/.-• 396- 491,?5
Address Date CST Number
Its AVOV /6 CSrM 7- vez
Private Sewage Consultants
655 O'Neil Rd.
Hudson, Wis. 54016
0
�
w
SOIL DESCRIPTION REPORT 2—
' PROPERTY OWNER Page of
PARCEL 1.01 L O T 3
Boris # Horizon Depth Dominant Color Mottles Structure 2
g Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
E o• 9 /o rye ziz /- el" /fJ'Ae fk e•S 17 . `� ; • S
Z 5?- /0 Y9 3 ! / 1'ew"q lf y es //C •y '• S
Ground ,3 6- 1 iLNJC. g
elev.
Depth to
limiting S VA
factor
—
21 —in.
SSS Remarks:
Boring #
Ground
elev.
tt.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D/
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
Ground
elev.
ft. '
Depth to
limiting
factor
In. Remarks:
Boring #
Ground
elev. ,
tt.
Depth to
limiting
factor
In. Remarks:
SBDW -8330 (R. 08/95)
i
}
R
0
o
y N �
wo
1
r
N
I
o 00
N
z E
G
�` \ �o
0 �
o
C �
c o 0
kA
Cl io
� I �
I
1 4
O
IZ
I � n
w �
e � o L
o,
" ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 5 /��'iz- �2VCsFL 1 �
Mailing Address
7Z . A a►
Property Address 40AOdMP r- r4
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location SU) '/4, Al LQ '/4, Sec. L b , T Z` -R,] J _W, Town of 58�
Subdivision Z 7 3 R-6 rR tF- 5 , Lot # 23
Certified Survey Map # Volume . Page #
Warranty Deed # C'5 3 C , Volume JV Page # �� S
Spec house � yes ❑ no Lot lines identifiable A yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
mastorplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expi date. D
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.
�il.G�z'!2 �lYnFv•ST. L rt
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
. ' VOL L 1448P
KATHLEEN H. WALSH
i
STATE BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF' DEEDS
CROIX CO. WI
ST. ,
This Deed, made between LaCasse Custom Homes Inc.. RECEIVED FOR RECORD
Grantor, and 08- 10-1999 10:15 AM
S ilver Ride Construction Company WkXEINNZy i
Grantee. CRT COPY FEE:
Grantor, for a valuable consideration, conveys and warrants to Grantee CORY FEE:
the following described real estate in St. Croix County, State of Wisconsin TRANSFER FEE: 309.90
RECORDING FEE: 10.00
(The "Property "): Pas:
Recordina Area
Name and Return Address
020- 1330 -30 & 020-1330 -40
Parcel Identification Number (PIN)
This is not homestead property.
Lots 3 and 4, Evergreen Estates in the Town of Hudson, St. Croix County, Wisconsin.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any
Dated this _+T io r day of August, 1999.
LaCasse Custom Homes, Inc.
* Richard W. LaCasse, esident
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
��++,,..
) SS.
5T 4e
authenticated this _ day of _ yo County )
Personally came before me this fday of
* August, 1999, the above named LgC_gme Cugpm Homes,
Inc by Richard W. LaCam, President
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s)
(If not, who executed the foregoing instrument and acknowledge the
authorized by § 706.06, Wis. $tats.) same.
THIS INSTRUMENT WAS DRAFTED BY �I'•
Attorney Kristin Ogland
Hudson, WI $4016 Not b , State of Wisconsin i
(Signatures may be authenticated or acknowledged. Both are not My o pission is permanent. ) (If not slat expir*n dat
•
necessary.) p B c `
, P L
,,�� ,.ti• �Q
of Ill
*Names of persons signing in any capacity should be typed or printed below their signatures
wARRANW D EED STATE BAR O WI SCONSIN
FORM No.. t - tsae
..�....... �... n...+r�n n.'.0 •. , nnun•uv Cn•.n n. 1 i Ar MII YMARR _'M9t
. (R J � sS
-- W ti op S
d (` f w �S
a
u N
a �
o p"
cV i 8 : s •,
d�
R C\ji S �,
�1 Ni
• , r
�t u)
�..
M a < ( �.
W i
U-1 pl O1
F--i
cri Z, in
w4 —,
W R IN
+ M M I
Os Ol
a r
1
i M
N � o p •
� J O
M LL 0 N N
Z ¢ OD '
�— `° �--
N F io vi � c
N W n=
z �
+ N
W"
ax
i Ol 3 0; 0
W i = it0 509 as
> �� H 358 \ ,�
r� I �l ° ' 1
k--• i cnR
,ai t�F Oi
-
F—
0 I �' 3 ►- ` 1 t1 -1 0� p• aS
LL
f -
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
Nxxppurn■ --
.�.r ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680 Fax (715) 386 -4686
May 1, 2000
Silver Ridge Construction Co.
Attn: Roger Roenfanz
811 Harbor View Road
Hudson, WI 54016
RE: Septic Inspection for Silver Ridge Construction Company located at
722 A & B Waldroff Farm Road, Evergreen Estates Lot 3 — West Side,
Town of Hudson, St. Croix County, Wisconsin
Dear Mr. Roenfanz:
A septic inspection of the above referenced property was conduct 10/27/1999. This
property is located in the SW' /4 of the NW'/ of Section 23, T29N -R19W, Evergreen
Estates, Lot 3 (West), Town of Hudson, St. Croix County, Wisconsin. At the time of the
inspection, this septic system was found to be code compliant for a three (3) bedroom
home.
If you have any questions regarding this, please contact our office at (715) 386 -4680.
Since ,
on Sonnentag
Zoning Technician
/sm
cc: file