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HomeMy WebLinkAbout020-1329-80-000 ST. CROIX COUNTY ZONING DEPARTME 7 I_ AS BUILT SAMffARY REPORT t ivED � Ownerr Property Addr ss .- � 1_1 C 2 ? 1 ,999 $� City /State s� cR s� � .a �, yn.► . .� g`�b� 0 , �NTM � j ��tdWr�FFtG� ; Legal Description: Lot Block Subdivision/CSM # w 5 %a t / a, Sec. .:?$, TAN -R-L7 W, Town ofC PIN # O 4' amr SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: i Tank manufacturer Lo wt"r Size ST/PC 161-7 Setback from: House _ 90 Well PAL, Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road ent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTI N SYSTEM: Type of system: r �idth J _ Length _ Number of Trenches �. Setback from: House ._ Well 47 _ PIL 5_ Vent to fresh air intake 7 i ELEVATIONS Description of benchmark '"rte D� 5 0`4� &A$ 5 Elevation _ Description of alternate benchmark Elevation Building Sewer ST/HT Inlet 9 10 O ST Outlet 9 3 '1 PC Inlet ' y J PC Bottom Header/Manifold _: bi� Top of ST/PC Manhole Cove / Distribution Lines C �� (3) Bottom of System Final Grade %) Date of installation �i�/� P it number 33BY�/ State plan number �— Plumber's signature License number b�3 7 Date �1a71 Inspector Co lete lot Ian .r mP P P I NOTICE Please provide the following: • A lan view sketch showing everything within 100 feet of the s p g � g stem. Y • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW e ��T L. vo w 35 � r � ^ p 3° y7 INDI ATE ORTH ARROW H A Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety and buildings Division Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: ST CR IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 338891 Perrraik HnldQr ;Nam, ❑ City E) Village Town of: State Plan ID No.: 11 AAl1CC11,, C� HUDSON CST BM Elev.. Insp. BM Elev.: BM Description: Parcel Tax No.: 00 . 020 - 1329 -80 -000 TANK INFORMATION � 2 - ELEVATION DATA A9900152 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �- S s Benchmark Aeration Bldg. Sewer Holding Ht Inlet , - Z TANK SETBACK INFORMATION © Ht Outlet TANKTO P/L WELL BLDG. vent to ROAD let Air e Septic ­--56' ma r ZO Zq l NA m Header / Man. yro Aeration N Dist. Pipe /'� . 7 2O 9 __ Holdin Bot. System PUMP/ SIPHON INFORMATION Final Grade ufacturer 9 Model Numbe GP TD H Lift L rictl System TDH F Fo main I Length Dia. Dis . SOIL ABSWTION SYSTEM (/ v BED / REN Widt Leng h � No. Of Trenches PIT No. Of Pits Inside Dia. Depth DIME 3 DI N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STRE LEAC Manufacturer: ER INFORMATION Type Of f , Model Number: System: v ( �J OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution P x Hole Size x Hole Spacing Vent To Air Intake � Length Dia L/ Length lif Dia. Spacing 7 > 6 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.) L CATION: 24 .29.19.1721,SE,NE 874 WYLDWOOD LN — WYLDWOOD LOT 8 116U &r, 44oyn 5 a*_.W W el b Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date nspector's i na re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i a E S F g k P T 2 i r j ImW m � 6 s b x e i 4 t 1 i 3 a g g � x n a.� r. ,, .,.. 4 , m }. _ .�. _ ,,.�,. .,.. ,»„, _ , _ ., ... .3 = u e .... ., ,.. .. .... _ .md . a. _ .�, -a ..�1,..� b... e- .«, -•2= ..,a s , e t i t } q i € e s c � v 5., r - - 0 i c F f 44 y ... >. .., } ... a s y w } } 4 I I I ` s E } i 3 � r i i 3 � d j x a g ' 1. , <-, . , ..t -... ,.. ,...., .... .,.... <....,. 3 � ....,.,......,.�A... ....,...«._., i ....- ..,....... Safety and Buildings Division SANITARY PERMIT I 201 W. Washington Avenue NVI sconsnn In accord with ILHR 83.0 , i . Code ,' P O Box 7302 Department of Commerce r' � Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the sy t on Afi ess < you t than 81a x 11 inches in size. I i • See reverse side for instructions for completing this appli a n 43111P 5 .6te Sanitary Permit Number t ST CPCgX 3 3 g g77 I Personal information you provide may be used fmolary pu�9ses I ck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. !_ l vlJ 71tale Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL 1 TI Prope wrier Name rP l b n 0. 1r4, S a T QZ , N, R E (ore PropgLt Ow 's Mailing A�dy'SS C W Lot Numb y Block Number 3 g G l NA_ u J Cit Zi Code Phone Number Subdivision Name or C �p Number iSo eP ( ) d v� I. TYPE OF BU ILDING: (check one) ❑ State Owned E] ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms C Town OF 111. BUILDING USE (If building type is public, check all that apply) arcel Tax Number(s) 2 Z j J q - 17 U 1❑ Apartment/ Condo Q ao — t a 0 -- a 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. 0 New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an ...... System -------- System ----------- Tank Only _____ Existin�System ________ Exijiin�S�rstem 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 C=Z_ 21 E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trenc22 In-Ground Pressure Pit Priv y ❑ d essu e 3 ❑ 1 See a e Pit C V 42 3 X to 9 7 S 43 autt Priv p 9 14 ❑System -In -Fill 32 CIKpvs Ca .�ylt,KC+� 3 x31.$: 1D�7• VI. ABSORPTION SYSTEM INFORMATION: s^ 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade C000 Requir q. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) cgg,(C Elevati 16 3 ? r f Feet 9 4- 0 Feet VII Capacit TANK in allo Total # of Prefab. Site Fiber- Exper. Con- INFORMATION New Existin ' Gallons Tanks Manufacturer s Name Concrete st ucted Steel glass Plastic App Tank Tank Septic Ta or ing Fmk^ IQs. El Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: PI (Print u er's Signat rer Stamps MP /MPRSW No.: Business Phone Number: U# # >^ PO r2�-- Mme. - 71 Plumber's Address (Street, City, State, Zip C e): 19 co F< IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued ISSUin gen ignat re (No Stamps) � pp ❑ surcharge Fee) roved Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.111 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 I I 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 toinstallation S. 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 isto 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. Complete1ine 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, etcJry 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 volyme; 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 and establishment of standards. t 3 L: 13 &o Oo 1a so a TDp iQ ry ry ® n w� S.¢l� i/ , Wisconsin -Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page 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 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and :5 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. If CS ()•- / 3ii) - 6`6 - ljbb APPLICANT INFORMATION - Please print all information. Re wed b D Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 Prope wrier Property Location k, Govt. Lot _S IC 1/41/4,S a T N,R l E (or Property O prr Mailing Address Lot# Block# Subd. Name or CSM# Cj Co L-4 [ s � i �ChZ -S '_j ; ' w rU` City State Zip Code Phone Number ❑ City El Village I I Town Nearest Road C New Construction Use: Residential / Number of bedrooms _ Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate ,Z bed, gpd /ft ' 1 trench, gpd /ft Absorption area required r Q (nO bed, ft J OVD _ trench, ft2 Maximum design loa g rte i -5 bed, gpd /ft � trench, gpd /ft Recommended infiltration surface elevations) 4 lr"d 93, -- ( It ( referred to site plan benchmark) Additional design /site considerations 3 Tr "C 7 �a I Art Parent material t!, Flood plain elevation, ifppplicable ft S = Suitable for system Conventional Mound In Ground Pressure AT -Grade System in ill Holding Tank U = Unsuitable for system S❑ U ❑ S EXl K S ❑ U ❑ S [V U El S U ❑ S� 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 C '4) 1 5 , 6 Ground elev. q -7- 3 .f L c Depth to limiting factor Remarks: Boring # 1 0 -0 am s bK r, -s-,r m °fi rat !k rn '.14 V- Ground Gr elev. ay a 2 Depth toT v limiting factor >Ain. Remarks: _ CS ame (Plea e P t) Signature R � Ad less Date "Z G At. _nl1 1 k, E SOIL DESCRIPTION REPORT . PROPERTY OWNER 4 gage of PARCEL I.D.# oao - J 3 ,a Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Sbk off % 51 a rn Stik r C l" Ground - D f' S S yY16 �► C►.t? yn ,7 , .� elev. Mai C.W �S ,L Depth to gsw` •�d Y _n limiting . p u� �. factor 3 ► in. I I ' 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 # E3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) P 3a `f ld. � LoT .4' 111 Co��t sw rn � Qo+ S37 4 ' JW I i • , r a yo P^K b y G al- 5tai ID 6 -9d t° 3 w�� sc� 1. i L _ a A af a f N Y 4 N m • o ft C T G co u QQ C 5 ° N. a W Q O �cr nr ^ �N o� � p N O K n] n� N y � y' F b a V � O `z ZOrr 0 ZE (D o rD O O O �� _ =�=) CD r CL (a $ x c cr ° = N � ao o 2 CD 0 �-�-c 57 O _ o �' (0 CD o N ° o (D .-. v, ti w n s m OL (D 70 L CD L 3°, n -o l< cr; CD S, � r � or , 0) x CL 3 to Q JA f .�r .. � w w z (0 CD �-- Invert i i "---►� 00 , o CIO RD f 0 Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 Box Washington 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. ,S`t' C ` • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used for second nt 4 y ` Personal information / y p y ry purposes 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 RMATI N ' Pro y Owner a Property cation t 1; 1/4 JV� 1/4, S T , N, R E (or� Pro erty wner's Ma ing A r Lot Numb k vJ ty, State Zip Code Phone Number Subdivision N e or CSM N mber h (SO) 1 11. P BUILDING: (check one) ❑ State Owned E] it Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ow of l,f r III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �{�, Z4. q • 1, 2 , 1 ❑ Apartment/ Condo 0 — 13oZ — g0-001D 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 l� New 2 E] Replacement 3. E] Replacementof 4 E] Reconnection of 5. E] Repair of an 1 System S _____ -__ ystem Tank ank Only E - ____-- _______ xisting 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 effSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tan 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure , 42 ❑ Pit Privy 13 ❑ Seepage Pit /a �X ��- 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SY STEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (s . ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Cap acity . 4 7, ; 1 '0 9 Feet Fj• Feet VII. TANK in allons Total # of Prefab. Site Fiber Exper. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete strutted steel glass Plastic App Tanks Tanks eptic Tan an -a �.(� S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank `7 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the site sewage system shown on the attached, plans. Plumber's Name rint) P er' Signat e: No st MP /MPRSW No.: Business Phone Number: no� Lo f ;), a s 3 - 7 / - oZ (D 1-15 Plumber's Address (Street, Cit State, Zip Code 51� k v 2 A W a�_ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing A ent Signature (No Stamps) —/ OR/Approved Fee) pproved Owner Given Initial ��'S"� tl 30 / Adverse Determination �t X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (11.11/97) 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, 808 -266- 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. 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. ;l Rck. 7 - 50-NO S!, � A ev• m d S s 9 1 6 Q. oi- o a p - Ar F pro W Via wooa� - 741 w *?P_ 7 5� vb , � 3 a 5 7 Nb JI-L v fp 79 0- 4 SEPTIC TANK 8 "_PUMP CnAMBE CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHER PROOF' 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE- WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 FINISHED GRADE 4" Cl RISER WARNING LABEL 6" MIN. ABOVE GRADE 4" MIN. Ic 18" IN. 6" MAX. INLET i WATER TIGHT SEALS GAS- i T TIGHTt , f E A SEAL APPROVED 4" BAFFL --I ALM JOINTS W/ CI CI PIPE ' PIPE 3' ONTO 3' ONTO _ ON SOLID SOIL SOLID SOIL PUMP OFF ELEV . FT. -- RISER EXIT Oh�F D PERMITTED ONLY IF . TANK . MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: /aSa tSn Lww NUMBER 'DOSES PER DAY: TAN SIZES SEPTIC GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: I GAL. ALARM MANUFACTURER: 5.7 &,l f tg, jv g'}t.6,APACITIES : A = L4t7 INCHES = GAL. MODEL NUMBER: ;y SWITCH TYPE: P/pq t B = 2 INCHES = _ AL. PUMP MANUFACTURER: C- .�lc C = a.3 INCHES = �,a GAL. MODEL NUMBER (,�} �p 3 1 y3 tt P, SWITCH TYPE: T -t D = 6 INCHES = S�f� AL. REQUIRED DISCHARGE RATE �jG(� GPM PUMP 8 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE IS FEET + MINIMUM NETWORK SUPPLY PRESSURE . . .. FEET + _ 7 s FEET FORCEMAIN X FT /100 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH •�iO ; WIDTH 9.2 ; DIAMETE� LIQUID DEPTH 5/ 15�! 7 ,� SIGNED: - LICENSE NUMBER: aa 6•5_37 DATE: 1/88 • C rUSS S `C�IDr 1 O i' r( �✓�i7 �� Si"Cn� - al p s r`f' m ss4 ©a flesh Alt Intel► An0 ODtl(V0110A Pip11 Sr ytf Vt y� Sa - ra -ct t R [9 Lej T\ Appterl4 Venl Cop �r i. OY� UfAlnvn 12* Abort i ►Inolcted• � $T e - eOi ' r - 20. 42' Above Pip' — 4' Cott Iton To Mel OteOO, Venl Pipe M&lh flat Of StnlhOk Co.vinq Lin 2' Aypnpete - O.er 1. 1p 11 OIIU1Dvllon t tip, e o o --Tea b' CeneU" s Plpe 010 o Petlotelo0 Pip. below ' o �C4,01no Teeminelinil At r r1011ome Or Stelero n�c0 �I�t -� 1 �jrr.c 1 c C/ •.7 SOIL FILL DIS7RlbUT101.1 PIPE APPROVED S4)JP COVCR •'— tihT :R1JM- ort 9 OF sTrumd cl 2" OF &GG RE G,& - 1 F — a � 0F"'t -2 AG6MCGATC ELEV. of DIS'l'RIBtUTIOU PIPE TV BE AT L6A5T l IUCHES BELOW ORIGIMAL GRADE AUU AT LCAS'r LO INcI4CS BU7 L10 MORC THAVJ 42 MUMS OELOW FINAL GRAOC M IM DSP OF F-XcAV rKOM OR16 AL 69AK WILL BE �� 11JGHE5 NNIM M OEF of EACAVATION r-AOA 0 GR4Pf- WILL BC ImCHcs SIGUCO: LIC -CUSC UUMBER:.�_ DATE: 110 _ I ,Q, C Octr 1 Sv�cl�' "iUMERMLE 3 De .Qs. m� s 1 fry: r �� 'AND EFFLUENT ulY�P. N� s,,.4�. T as N ►�c' ►9 ;;`'• .cWti,� 'S. r 4 t: ;'�''. ^ W A 5, , X 2 I 1`JJ 3 ei`O.J� Q311 {:'�c ;� +:.:.:. . RISC. miTEP0311 142 M0311 1/3 I(P 115 V ECClucnt Atrp 1/2" so lids 256 172.10 ` rs � T1 Effluent° Pum . MODEL EPO311 )AMA fEET SIZE 3 /a SOLIDS . Sfn: 5 20 ' xX Y.1 2 ,4 ;'t� •J �e� • ., 1. S Ali ° 0 0 4 e 12 45 20 24 2e 32 36 40 t t GPM t . 0 2.5 5.0 7.5 mYA. _ CAPACITY - V f - Petiormance tt; Curve mCrEA& M? — MODEl3£1f1S SIZE 3 /4" Solids t Q v/XOnt- t . 15 • S0 Ao 40 20 to \ y .l . ;,^' '}� • . 0 0 0 10 20 • 00 to to - . 10 M tq too 110 •' 120 OM E ..- ...... _ .... _.._. 1 20 - b rn•m CAtACITI 's'.'!'. 1.252 RISC. MI =3111. 1421 WE0311L 0 tip 115 V Cow It 3%4' rolids Cl711F1,'E0311M 142 WEO3tIH 1/3 IRS 115 V Mad 11 3�4" e5lids 491.55 329.35' �. f3;'.:r. J.'. • 3%4" .o61'idn. '�b4.25 '4.1:03 fXx1F)+2o�111t 141 5>rE05'1`itl 3/1 1R+ 115 V Iligli tt n 03UNT071211 142 WC011211 3/4 IRS 230. V lttgh 10, 1/4" t+olids !44].65 56S.25 �(.•.�i„ �••''•Z�z F al-olzM NICE Fm I'EItF�CtCdAt;1GE Am SPDClFICATIOtIS. .• }'•''. �r .. . Vr•• 1 . , .: • . t. ° MTS 10/68 M 30 PAGE Vu tNisconsin' Department of Industry SOIL AND SITE E V A L U AT I O E P O R T Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05 is ! COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in sie^*P `n mu ci, but St. Croix not limited to vertical and horizontal reference point (BM A' - ), direction an A' slo K y . RCEL I.D. # dimensioned, north arrow, and location and distance to nearest road -- ' anp nA ' APPLICANT INFORMATION PLEASE PRINT ALL INFORMA'TfiON 1 t VIEWED BY DATE PROPERTY OWNER: PROPERTY10r TION Geeenwood Enterprises, Inc. bOVT LSAT va.'" vas 24 T 29 N,R 19 fir) W PROPERTY OWNER'-S MAILING ADDRESS 1-OT g'; BLOCK # ,, . NAME OR CSM # 1416 3rd. St. `5�� W ldwood CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE [OWN NEAREST ROAD Hudson, WI. 54016 715)386 -3674 Hudson Badlands Rd. (x] New Construction Use k ] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate _ bed, gpd /ft gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate _ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 95.09 ft (as referred to site plan benchmark) Additional design/ site considerations alt. system area el . = trenches C 93.7' & 95.4' Parent material outwash Flood plain elevation, if applicable na ft L S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK = Unsuitable fors stem KI S❑ U �7 S❑ U CA El U ® S El 0 S [:] U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trt tch .................. ................. 1 0 -9 10 r2/2 none 1 2msbk mfr gw 2f .5 .6 1 2 9 -42 10 r4/4 none sicl lcsbk mfr gw if .2 .3 Ground 3 42 -84 7.5 r4/4 none cos osg ml na na .7 .8 elev. 9 7.2 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -8 10 r2/2 none 1 2msbk mfr 9W 2f .5 .6 �� 2 <> >...._.....: 2 8 -24 10yr4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 24 -84 7.5 r4/6 none cos osg ml na na .7 .8 elev. 9 7.2 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ve. New Ric mond WI 54017 Signature: Date: 10 -16 -96 CST Number: m02298 PROPERTY OWNER Greenwood Ent. SOIL DESCRIPTION REPORT Page 2 'of 3 Z PARCEL I.D. # pending Lot #8 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 0-9 1 2 none 1 2msbk mfr Crw 2f .5 .6 2 9 -20 10yr4 /4 none sl 2msbk mvfr gw if .5 .6 Ground 3 20 -84 7.5yr4/6 none c os osg mi na na .7 .8 elev. 9 8.9 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -9 10 r2/2 none 1 2msbk mfr gw 2f .5 .6 € 4 2 9 -30 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 Ground 3 30 -80 7.5 r4 4 none cos osq I ml na na .7 .8 elev. 9 Depth to limiting factor +80" a , Remarks: Boring # 1 0 -8 10 r4 3 none sicl 2msbk mfr 9w 2f .4 .5 5 2 8 -20 10 r4/4 none sici 2msbk mfr gw if .4 .5 Ground 3 20 -84 7.5 r4 6 none cos osg ml na na .7 .8 elev. 99 . at. Depth to limiting factor +84" ak Remarks: Boring # Ground elev. ft. Depth to limiting factor I L Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L . Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 SE 4NE 4 S24- T29N -R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246 -6200 lot #8- Wyldwood N 1 " =40' BM.= top of NE lot stake @ el. 100 X61 ��` 2�' 2g.5 r c� �o Gary L. Steel 10 -16 -96 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address .3 EX I, ech he 5 *e Property Address O c�, - 741 0- \//d woo l a h -c_, (Verification required from Planning Department for new construction) - City /State Udson 0 (A_� r Parcel Identification Number U a O - I _Ia -RD — V O LEGAL DESCRIPTION Property Location .S %,, A E '/4, Sec. , TIN -RI-9-W, Town of �- Subdivision � tL9V 0_We)0d 1 Lot # Certified Survey Map # . Volume ,Page # Warranty Deed # S S j a f 0 , Volume 4 lam_ Page # Spec house ❑ yes P no Lot lines identifiable)V yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance' consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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/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 expiration date. c SIGVMM OF APPLICANT D TE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. R , -rte / SIGNjftURE 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 04:26/99 MON 10:47 FAX 715 386 4687 REGISTER OF DEEDS [it 002 VOL KATHLEEN H. WALSH C WARRANTY DEE® REGISTER O DEEDS i :�.: Lteaement riumfiar 5T. CROI?f CO. t 61T Reow FOR idMD a... rak need, made between Greenwood Enterprises. Inc., a 03-e!4 -1999 1s 10 ttil orporation, Grantor, and Raymond L. Takle and Elsie H. Ii � DEED Grantee and and w "IfB 35 Survivorship marital property, CElti CUF; FEE: eseeth, That the said Grantor, for a valuable consideration 11ifll EE149.70 r and other good and valuable consideration conveys to 1 F = fogowing described real estate in St. Croix Cou nty, State IM FM 10.00 n: Racovg g Area i 13 reSti " r' 020- 1329 -8 - 00 0 i iParcol Id Numbed t y Lot S of the Plat of Wyldwoed, recorded in the Office of the Register of Deeds for $t. Croix Cou nty, Wisconsin, 1. on October 28, 1 g9 6 in Volume 6 of Plats, at Page 72, as Document Number 5550 This is not homestead property. : Lh @revnto belonging: Together with all and singular her ®ditaments a aPq I r And Greenwood Enterprises, Inc., warrants that the title is good, indefeasible a nd 1( an and clear of encumbrances except easements, reservations and restrictions, if any, and defend the same. Dated this 6 day of March, 1999, lya GR ;;cs W E. Rusch, OOD ENTER 5, It V. BY �— •J ' pre sident IN 1 BY h • ary its se I ACKNOWLEDGMENT AUTHENTICATION STATE OF ST. CROIX _ - _ _ L Signature James E, Ruscfi, its pr2sid@nt g-I T. CROiX COUNTY I r 7 day of JU4 1998 Personally came before me this Y i, the above named Mary Rusch, its secretary to me k r — � r of Martri. 1999. _ known- the persons who executed the foregoing a e tics this -,� day instrvm and acknow age the same. siene 13Cti a Poulin MurreY :'tithlic typc or pnnt name slop uf ype or print State C. wt c(in`tn Notary Public St. oix v% i sconsin I' Co y nty, I , TITLE= MEMBER ST BAR OF WISCONSIN My commission i perm- (It not, state expiration r: (if not, — — _ — date:_ / a! by 1 706.06. Wis. Stats.l j THIS INSTRUMENT WAS PIltAF reb BY 'Names of Parsons signing in any capociry should ba types of Zilz, Estreen & Ogland, LLP L81S A. Murray, printed bclow thair signatures. 304 Locust Street, Hudson, WI 54016 i (Signsturog maybe authenticated ar acknowlcdged, Gott, ,re not nec"sa ' fw.! tlJ Lk- W •O ° M1•- $DO.666•R02t Ix >I �I C ( C O ca ( d u I >I -i t ' 3 3'°19' -t l N 1$•20'0 9.661 n6 c q1 OE 0 N ,0 �, , Y 1 .5� 3 � 1 qq o.ec9r 3 - bZ,O N N 1 AA5 %D X11.51 2$ 8 c A W) c u W O � au ..... 11.51 CN 1�• 20 0 o , N `o W ° S 0'11'21&.V Z �''r 130.00' IN ON CO M r W rn ^io 2 %D 4- \_ . 00'9 6 (U y / ( A .6E.8r.0 N l,J W ZD (U Q > I C1 tU �• �`� i� OS 3 •o� u Z A M ou ~ ti r .J in c�v > Z J ♦p 3,12.11.0N PIP * 3 .12.1 LO N '�, . .00'0 1 L .00'SB -- r�1 3 'OO.9 l 2.11.0 CO �W tn > ^ 69is dc^ Ln I W I '6 d 9• o x, z • ir�1 <<� ` f� a w n t 'OA X = h 'O6 pd �� w �� w '3 O • ti cti Ul O f+ , .. 4w4y h«�c�- YP,w►�:�:tyt '�.'St' sfif ,Ar �''�1�, ���M` +. 3 y : 2 ' ' 7. � ��•� ;� r+q4 y, !,rlct1 f �*,q4 F ; E� i ; �. I 4 �,' � L �P f .ir� y *• I 'I �. 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