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HomeMy WebLinkAbout028-1018-40-000 I o 0 vp o ao i o M c M a ' O t3 C h, O i O n O C i O Z N Z C _ 7 LL c O � � I ( E 4 Q m zlt ;' C co r w E z a m N � 04 � I o I o z v : v c o a Z in H o z CD ch CL �a o a, I cn ^a cn c o I •� a L) O U z a) < s= I N �N Z C: N iv �° ca a w o c v N N Cl y c d o o a) 3 D D a m @ N E H H H o a O Z 0 0 0 a° IL I ' � p'1 o N 1� 0) a) in -j c U rn rn o Z d) M TV U O N O O C) 0 0 .j j N ml CL N r �+ O 7 w c od N N 3 .° w c c O O E N r C Q7 p° 0) C E m a � N N L O' G N C t^# O 4 ( O c a) w 2 - o O •! ) ?� N nj 7 M 7 O O z U ►►►VVV O d' (n M O z Z d' co Q ce I i+ • E N `N v o o 3 :°. o A U a O to U i � Li00r ano M Xrdkn ROWO n,'i •� • ^ •• v .- ...... .. — e � a .. r A'�iV I_ V1 Dnision of Safety a BWkhngs in accord with ILHR 83.05, Wis. Adm. Code t COUNTY Attach complete site plan on paper not less than 8 1/ 11 9 �i�f; an must include, but CIe0 I�C not limited to vertical and horizontal reference poi re ion and °V PQ , scale or PARCEL I.D. i dimensioned, north arrow, and location and diet n ��,� O 2 f 1 0 1f- '4 0 APPLICANT INFORMATION PLEASE P ALL4Nf'� TION REVIEwEDB' DATE PROPERTY OWNER. (0 JU L V t IZIZ P RTY LOCATION C,E" j) /1/ AV-'4 S SS Ciok ,5Vj 1/4 .SE 1/4,S 1 T Zg N (r7 W P 2 O T MAILING ADDRESS ce tp p BLOCK s SUED NAME OR CSM if ' CITY, STATE ZIP COLE P Z, CITY []VILLAGE MOWN NEAREST ROAD C LowIA! r)I C.LIA.N 41 (J New Construction Use Residential / Number of bedrooms ( Addition to existing building �Q Replacement ( Public or commercial describe Code derived daily flow (20Q gpd Recommended design loading rate (),S bed, gpd/ft 0__,_b trench, gpd/ft Absorption area required _ 4DO bed, ff _+ trench, ft Maximum design loading rate _ D • 5 bed, gpd /ft 0. (0 trench, gpd,'tt Recommended infiltration surface elevations) T $E_�iET� �' AA ft (as referred to site plan benchmark) Aodiraonal design / site considerations Parent material GoLAC - I L.L_- _Flood plain elevation, if applicable _ NA S - Suitable for system CONVENTIONAL IN GROUND PRESSURE A' GRADE. SYSTEM IN FILL HOLDING TANK U - Unsuitable fors stem ❑ $ U S ❑ U C1 S U ❑ S U El U ❑ $ U SOJL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Ccnsistence F3a�iry Roots GPD /ft in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed T 0-1 l OYt� ZL 2 - ZZ 164K 3 LA _ rns>D Ground Z 2 - 1 I lee elev 9q ft. rn K M- % 5 0 -y p S Depth to S 29 -y C limiting — factor Remarks: HoPj?_OAI p,4 M Z y +}o_LC N 3 /4 a.__ Boring # Z/Z_ 1 r _ ab — I DS Z -19 3 s1 I Zm ( ml c ` 0.6 3 ( - 10v N4 — s.i 3msbK _ ( _ 0, 0.6 . Ground -- - — geley I ft. 4 ,l'S 21 10 VIC _ SCI Lr!lsb i —_ — 0.2 . -F Depol to S y�� limiting factor - -- — -._- — 2S'° ` I Remarks: } Q�I 7n/' 1 _ _ .. � OR.1 ._N A,!, Phone: CST ScIJ� , ,C_L �V'aK tJ ti0 '►S�1P. _ 7I5� L A2-1. - 77 ' -M� �2 0� A V I*.K FALLS T- _ -'� — SignaC Date: CST Number: MAY 20, 1227 W D3�707 ARCEL I.D. i Depth Dominant Color Mottles Texture Structur© C;t ,sistencc;!axyrivy V R�cts� - -�' -? Boring At Horizon in Munsell au. Sz. Cont. Color G Sz. Sh. B ed •.�� € -S IDYK A ®�V 2 5 _1 , 2-yz- s i ._ 1 ?K._ .._.A o.s Ground 4 b eiev. 4 b,4V R. ZD - Z 'I 7t,5 YIR 3 f �{ 5 _ w._m_bK )YLC _ _ �5 _ ` - _ 0 0•� Depth to 5 }y2! 7, y ._01� . 6 limiting —' I factor ►t _ -3S 7.5 IF, ' k_ in AK `AL(o I 0 S Q, b 32, � Remarks' Boring 0 Ground elev. Depth to —_ limiting faces i�- Remarks: Boring #► i , i Ground elev. Depth to -- imiting factor — I Remarks: — Boring # r� ? Ground elev. _ Dept to -- limiting — — factor - Remarks: SBD- 8330(R.0"2) ` Page 3 of 3 ` PLOT PLAN Property Owner 5t,ISS/1DEtZ G-E�� -D NQV Legend: �� =����� Wt EM y�� 11 NU�L� Legal Description PAK -i DF IEnA'I BM 401 &rrLVA of S%Ow6 NyJ QF ov `iE 5� '1 SAC. l2 U� i2 of s1aING C 'f�N of V V` ti 9-k V� 5T. IC R GD u N-T I/ (� = soil �r�a -I � WISCOWSIN. 5"1 IDO,O el- 10D. i2' M 1ip � # 2 = 104. It 1 0C31 s rr� iN ��wnl �L 4q -4L' Z3-'76 � Q 4AKa (40 L Gt - 44.2 5 D82 � W � HOUSE OYO (AIDT -M SM4 SF1P� � � - TrwK DIZI W EU. 51TV LWA % CT K. Signed CST L _ Mo37o7 Date MfW 2Q 1997 uitia -- .r.. .h..T vr I rtP Uf p+visimi of Safety a Bultdhngs in accord with ILHR 8105, Wi,;. Adin. Code q COUNTY J Attach complete site plan on paper not loss than 8 1 a e ii Plan must include, but _ _ __ �,_�I� �- �.___ -_- not limited to vertical and horizontal reference t direction alt o elope, scalu or PAHCEL I D t dimensioned, north arrow, and location and ds o n r d !1, D IK 40 APPLICANT INFORMATION PLEASE T AL ATIO -f REVIEWED BY DA ?E PROPERTY OWNER: ill L PEHTY LOCATION ____ --_- -- - - - - - - - - -- G _ 1� MAf S cpo)X -;4GT .5W tie 5 1/4,S 1 2 - T Zg N,R 1 '7 oaf; W PROPERTY OWNER'S MAILING ADDRESS - - -- - - - —' - S ?b� C T H ` f y+ x BLOCK UBD NAME OR GSM r i _ CITY, l STATE ZIPCOCE - - - - - -�- dW Z ❑CITY (]VILLAGE �FOWN NEAREST ROAD n I F- c',T. N. N (J New Construction Use p(J Residential / Number of bedrooms ( J Addition to existing building �Q Replacement [ J Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate ()­S gpd /ft 0___ . 6 trench, gpd/ft Absorption area required _ 1�-00 bed, R ), nil trench, ft Ma)dmum design loading rate A * s__ bed, gpd /ft 0.(o Vench, gpd/ft Recommended infiltration surface elevation(s) TO 8c Mtl ffiy FD gy h ( as referred to site plan benchmark) Additional design / site considerations _ Parent mat C- erial Ls CfAL -T I L-L. -- - - Flood plain elevation it applicable _1y�4 _ ft S m Suitable for system CONVENTIONAL IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U - Unsuitable fors stem O S U S U CJ S U ❑ S U ❑ S XU [IS U SOJL DESCRIPTION REPORT Depth Dominant Color Mottles Structure PD /ft Boring # Horizon Texture Ccnststenw Bourxiri Roots -- - -. - -- in. Munsell Cfu. Sz. Cont. Color Gr. Sz Sh. E3ed iTr -1_Y_ __ Ab — 0 S 0, 2 3 S� 1 2msb1; CS D.� O.(� e ev Grou - 2 - 29 I 0 31w._ _ Sc l_ a m JD lS 4q y b tt.� � 2V -2 4 5CI 2 rn %6K m 1 r � — �5 I 0 -4 i 4 s Depth to S ,29 -�4 C. W -- ---- - - - - -� _— __ limiting { -- factor !t - -- - - -- - - - - -� - -- - - — Remarks: HojIl 2_ 4 M 2.r , r�j ►ZDN_ ti s•_ _4!� .G 4 E L • Boring # I -6 z R ZlZ I 1 -mom_ d s oLb t .� Z _14 3 Zm mfr cs — D•6 o. to Ground SloK � �� _ fl,S O.G elev. 4 13: 2� 10 VK _ `° 5el .__ .__l- �'!]s� _ !___ -' O.2- gq_.2 ft. __.__ _ __ Depth to 2 - 10 YlC i y S _' -- 0.7 Og Limittng Remarks: A4CZ LAL� Jm�� t} Ol�t�4��._ � ± : W',L, sS CL � L- t�5"rd/U� - ~y t a AOLUNST�1P. —__ Phone. 715 UZl'o- I !M �� -9 30 A VE FAL S_ W S4@22- Sig a - - - -�� Cate: CST Number: AAY X, 1gQ7 W bI3*70-) J OARCIII I.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure CO,,sistencO Rcots GP., in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. WIN 2- 5-11 10 YK 2- 1 2 - 126 Ground 3 YR-Me bK elev. q6fk ft. 4 -1 0- rl- 5 -- C Depth to r ry\-�r 11MIbrig factor 7.5 1 F, 4) 32-- Remarks- L Boring # � Ground elev. Depth to limiting `acto( Remarks: Boring # Ground Depth to irniting factor Remarks: 3oring # .4 U - . -- _ - - � Ground elev. ft. - a- - -- - - i Dept to firrIlting factor Remarks: SBD-8330(R.05/92) Page 3 of 3 R PLOT Property Owner IeALD MAKY i = yD " EK� T W♦ � Legal Description eA= DF - rtjE SW'jy BM = 4J 1 Bu rO.#A UP: StDw6 NvJ Of -µrE SEyti SEC. t z� TA N le_? W — wjl 11 ® *,k2 of sIawG (DA T 0 \n1A1 OF Ru sr1 9 Vej� ,ST, R X Co u NZ s oil �a c ho. ' W ISC N. POLE- 5Hmo $N141 Assn n►�D / Ap. b �laa.a � �p. # 2 = /DO.ILI [3(31 s rrG - iN LAW/J t L gq.41►� 2 �cIC� SPA ZtL d1o 91- �✓ t3$2,. Lb a Houses C "O (AIDT -0 S&4 SW 'c TAR K DRS v��1�U. Wrt (_t- A-T%WQ vP ao X. (r X 4' /v M t lt h CT H, N C.r'.af, n) tZti6 HT- OF vV1�Y Signed CST M037o7 Date MRV 2Q 199 T 1 ST. CROIX COUNTY ZONING DEPAR AS BUILT SANITARY REPORT Owner 4 7 4 0 j - V &fS7 n c le Property Address 2 0 ri i v City /State 134 � ► ► � � �` ti�yuG r s Legal Description: Lot Block Subdivision/CSM # S '' II ,,,,�� SL/ '/4 S r 1 /4, Sec. t'X , T2LN -Rl?W, Town of r' e, P " lo� `g b SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer 1���w�S��Mh Size ST/PC 0 / Setback from: House y� Well l 20 P/L Pump manufacturer 2 /!c2 Model 3 Y Alarm location $ a 6 - 1 { c- y' (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Ue. n a Width Length `� Number of Trenches Setback from: House Well Z t U P/L 340 ' Vent to fresh air intake ELEVATIONS Description of benchmark Tax► o ��!a e- Elevation Description of alternate benchmark G 6. Elevation Building Sewer ► 3 ST/HT Inlet ST Outlet PC Inlet PC Bottom 2 2 Header/Manifold Top of ST/PC Manhole Cover U �~ Distribution Lines Bottom of System () () ( ) Final Grade O O ( ) Date of installation I *Ull Permit number 1 State plan number Plumber's signature License number Date /�k/ ?.11 Inspector Complete plot plan � � F NOTICE. se pvide the following: ,d • A etch owing everything within 100 feet of the system. • Two h "' ntal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. PLAN VIEW r r �e 04 `( �' i 2 � M^ V. INDICATE NORTH ARROW $isconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT IX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarype 1/ ,�rMi�f� Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 33 33 ttSS Perrgtf§ Ij fjj & MARY ❑ Citt lv kr of: State Plan ID No.: CST BM Elev.: / . Insp. BM Elev.: BM Description: a Parcel TcNii._1018 -40 -000 � , t?'O � / �, t! L 2f TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI r FSS ELEV. � Septic /1.L i �urc '6 c- as'f / .2 0 40 Benchmark ;'5 /O$' -g2 & Jv l Dv Dosing �. O k_1 4S / 6 lcs?1 Aeration Bldg. Sewer Holding I go. 3 6 TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet Air Septic CD& 01 el 3 NA Dt Bottom 73 13, Jr 9011 3 3 Dosing " `' NA Header / Man. /OS�6 /,� S �7 Aeration A Dist. Pipe loS.l ?• g7,�� Holding Bot. System pS �• 3'� 96 •79 PUMP/ SIPHON INFORMATION �/ Final Grade a ,�6 y/.7 /OO•� Manufacturer ��A-1- Demand j � C� a�,g li.t �.(0 It odel Number GPM DH Lift(? L Fi riction / System TDH&. Y2f Forcemain Length Q �j � Dia. Z Dist. To well SOIL ABSORPTION SYSTEM BEDaREUGH width �— Length No. Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J 65 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK odel Number• INFORMATION SyPe A / O '� CHAMBER ✓ OR UNIT DISTRIBUTION SYSTEM I Header /Manifold r. Distribution Pipe(s)t �/ a I x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. 'C Spacing �O k� �^'� Z 7__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.) LOCATION: RUSH RIVER 12.28.17.95B,SW,SE 2064 HIGHWAY N IL W�tD 1/H l e UrC% / ci �y� ✓bV� Gl^- G� � 4 d �/ �!S/ L ['t5 i J y limit t Plan revision required? E] Yes Q'No � �-� Use other side for additional information. F 2 6 1 SBD -6710 (R.3/97) Date Inspector's Signa ure ert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 6 „ em , , °s e t f , e E E meemA. E F , E s 9 e } E' E J } f r i t 1 � 3 , ... .....s- � ,., e. , ...�.. .........., a .., aW. � .... , <. . .�. a .. } P , k m m ,. , } , a - E } 1 3 } 3 ... } »..,,,. ,,. 3 > e ID@ 3 � S s } 8 t ' -- - -., j } r 3 9 e i E } } k € N._ �_�.m _..,e..e. ......_ S _ �..... _.. ...... F �. .. ... ... ... q 3 a a } } Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue ' Visconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County Vi I than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used for seconds �� Personal information y p y second 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 Property Owner Name Property Location , j�v4 1i4, S j,� T 8 , N, R R tor) W Pro rty 0 n 's Mailing A dress Lot Number Block Number V �L I- IV Cit Stat Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OkhILDING: (check one) ❑ State Owned its Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town OF GS f rl w 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) IS - 2.6 . Iq 95 S 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 S ❑ 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. Cg Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5, ❑ Repair of an ------ System -------- System __ ____ ___ _ ___ Tank Only -------------- Existing System ________ ExistiQgSystem 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Qj Seepage Trench 22 ❑ In- Ground Pressure t 42 ❑ Pit Privy 13 E] C Seepage Pit 30 S x V 43 ❑ Vault Privy J 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade PP'' Required (sq. ft.) Proposed (sq. n ft.) (Gals/day /sq. .) (Min. /inch) Elevation L 0 U v MO `�1� /S . � �?Gr� y4.�� Feet 161 Feet Ca at VII. a I NFORMATION in gallo Total # of Manufacturer's Name Prefab, Con- Steel Fiber- plastic Exper. New Existin Gallons Tanks concrete strutted glass App. Tanks Tanks e tic k V I go I M . 4 c,res t e ❑ ❑ ❑ ❑ ❑ L ,ft Pump Tank /Si r I/ )poo 1 t ❑ ❑ 1 ❑ ❑ ❑ VIII. NSIBILITY STATEMENT I, the undersigned, assume responsibilitX for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum is Signature: tamps) PRSW No.: Business Phone Number: >t�n23 Plumber's Address (Str et, Cit State, Zip Code): b l) G cam ` to �,., P IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Ag t *ature (No Stamps) _ tl El Owner Given Initial Surcharge Fee) 1 920 - Adverse Determination /u6 K / � X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.1 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: 1. 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. Ct e• A /� uRY 5L49Snc R 2UL�� Ctrl N cr6 223y 13G l� w c✓, s�lvU2 S I,J 'i, S r S i 2 r 2 N �✓ t OW 4 v /lu 4 1 ) UUD R tyj, WL S - re I Sys 'n vt ta� 3 T,? 8.1 3 , 3 ►vo .W U old t tL I 3u' b 1 to ^k top �4 L&ve+2 d ►,,/ 26 L � a P,;1�P CHAI�SLP, CRC.`.5 5[C'IdIJ A'�G SI' ilit il~R1 IJ�ii < C vC!�;T PIPE • I�� t APPROVED L,G. :.M - ^.IC• VrCATOERPKOOF i �MkkjHO_E COVE J110CTIO$ BOX QOM OOOA. 'r wiq ).J OR F'RCSr MIU. ! AIF \IrAKE j ' GRAOE l rT y "r1W. � I LI couo L PROVIDE { r E A10.TIGNT SCAL J I f _T { �i A 1 ALARM 9W? 1 1 41 I i { APPROVED ou { JOINTS WITH I ELI FT q3. 2,j APPROVED PIPE PUMP 1 Or 3 ONTO p SOLID SOIL t� l Co"KETC OLOCK _ Fla & 0 KISEK EXIT PCKAMED GW.S IF YANK MAUUFACTURfR AAS UCH APPROVAL. k . I (P� � q. �r� 'ric eT SPES.IFICAT.,QU 60 1 C 7 1 L't �u fps �, 7 IJUMDEit OF DOSES: + PE //Rff��OAyQQ�� 1 .1 AS MA►JLIFAZTURC[R : � 6ALLOfJS DOSC VOLUME U/� /•(� T ^I.l1t. SIZE ; INCLUDING. DACKFLOW-* / GALLONS P %UkA MAWUiACTURKR. MODEL ►JUMSER : : y J� � � �- y _ CAPACITIES: A= 2 U 1 iwCMCS OR L ' � 0 GALLONS SWITCH T`JPC: ../�,�_.,�Z. GALLOPUS "� •. C; 7+ V IIKHES UR /LO GAL•LOUS F • .P 1'�lA1.iU�'ACTURCR' � - � nn QQ «� MODEL IJU MDCR: �^ 3 O � .L�...4.- INCHES CR GA LLOW SWITCH YyPE: iv � k /P _ NOTE PU!"IP A%JD ALARM ARt TO Dt KIIJIMUM QISCNAIt RATE / 3 0 6PM INSTALLED ON SEPARATE CIRCUITS i :'PICA, wrFLRELI BET WLLLI PUMP OFF AIJD OIST1tIDUTIo#j PIPE., q FEET KIIWMUM WrTWORK SUPPL'! PR - , .. _ AT! --- MET 40 FLET OF FORCE MAIM X 1'/ WI'OR_ � � � FCE'r TOTAL 0 HEAD - ! FILET i 1. IattJA� (? EAiS10►Jt cr A K: LEAIroTH ;WIDTH ;LIQUID 'DEPTH ---- &JUMDER: "`J DATE: L n I 3 15/1+ -6 5/32 pfv O OF ti f, HEAD CAPACITY CURVE _. "53 - 57" - "55 - 59" SERIES 4 5/8 1 1/2 _11 1/2 NPT TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWATERING 3 15/16 6 _ 4 50 SERIES ° 4 1/16 Ft. Meters Gal. Ltrs. U_ 15 5 1.52 43 163 4 10 J.os 3s 129 4 15 4.57 19 72 J 10 2 1 y V" O F 2 7 08 S " 10 1/16 0 U.S. GALLONS 10 20 3 40 1 50 1 3 3/32 LITERS 60 0 80 1 FLOW PER MINUTE sKZas sKSM CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Available with special cord lengths of • Variable level long cycle systems available. 15', 25', 35' and 50'. • Alarm systems available. • Duplex systems available. SELECTION GUIDE Standard cord length - automatic 9 ft. 1. Integral float operated mechanical switch, no external control required. Standard cord len th - nonautomatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float M53155 and 57159 Series Control Selection switch. Refer t0 FM0447. 3. Mechanical aftemator'M -Pak' 10 -0072 or 10 -0075. Model Volts Ph Mode Amps Simplex Dup 4. See FMO712 for correct mpdel of Electrical Alternator, E -Pak. M53/55 & M57159 115 1 Auto 8.0 1 or 1 & 7 — 5. Variable level control switch 10 -0225 used as a control activator, with E -Pak (3) or N53155 N57159 1 0 3 or 4 5 53 5& D57/59 30 1 Auto 4.0 1 1 7 (4) float system. E53/55 & E57/59 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in simplex or 2 pump operation, PM 10 -0002. 53 Series - Wt. 22 lbs. 57 Series - WL 27 lbs. 7. Two (2) hole J -Pak, junction box for watertight connection or splice, 55 Series - Wt. 24 lbs. 59 Series - WL 30 lbs. P/N 10-0003. CAUTION For information on additional Zoeller products refer to catalog on Combination starter, FM0514; All installation of controls, protection devices and wiring should be done by a qualified Piggyback Variable Level Float Switches, FMO477; Electrical Alternator, FMO486; Mechanical licensed electrician. All electrical and safety codes should be followed including the most Alternator, 1`100495;SumplSewageBasins, FMO487; and Single Phase Simplex Pump Control/Alarm recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Systems, FM0732. .s RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. r MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturers of.. SHIP v Cane Run Road e Louisisville , K K Y 40211 -1961 Qom" P iru P9 SNCE ���9 ' P l0. ( 778 - 2731.1(800) 928 -PUMP FAX (502) 774 -3624 . Wisconsin Department of Industry, SOIL AND SITE EVALUATION 2 Labor and Human Relations Page / of Division of Safety and Buildings in accordance h s. I R 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inche z . Ian must fi County Include, but not limited to: vertical and horizontal reference poi, ( dir Ior4h ST C'� Ol x percent slope, scale or dimensions, north arrow, and location ` tance n 'bad. arcel 1. D. # APPLICANT INFORMATION - Please print all i atg? " 'Rleviewed by Date Personal information you provide may be used for secondary purposes pve Law, s. Property Owner /� r (' ZC� a on Govt. L 1/4 SE 1/4,S TZ 8 ,N,R / 7 E (or) W_ Property Owner's Mailing Address Uotl# k# Subd. Name or CSM# T 0 Y3.7 ,fiU 5 City State Zip Code Phone Number l Nearest Road �3ALD. WJAD W1 . SY 00 Z ( 7/f ) & ,S y ��(o ❑City Vilag ' IS Town btv Y. N r ❑�-, �New Construction Use: esidential / Number of bedrooms Addition to existing building L�r+eplacement El Public or commercial - Describe: 4/ /,& = IV07- CD�l.�IENUE'L� T' Code derived daily flow gpd Recommended design loading rate AXX bed, gpdfft • trench, gpd /ft Absorption area required bed, ft 1 2 trench, ft Maximum design loading rate' bed, gpd /ft S trench, gpd /ft Recommended Infiltration surface elevation(s) sue- p Q • 3 ft (as referred to site plan benchmark) Additional design/site considerations YS $ &P, tom' Parent material F.jTf csa4X S,fi,vD)/ 0 Af Flood plain elevation, if applicable ft S = Suitable for system C � Mound d In-Ground AT Grad System in Fill Holding Tank U = Unsuitable for system S El U L�fs LJ U 1!1 I❑ U 1]'S ❑ U C s ❑ ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l ., 1 0 - /if) W 312 L /-l'Shk - fie eS i-F .4 :. 5 2- 9. 17 loy,,ie 31 1( J � _ /fSAe e 174- 4; . 5 Ground 3 1 /0 Y' IL 22, C5' -5: • �o elev. 101•Ab-ft - - /0 Yle SL A- Y i e .5 Depth to S D /C� tiiix .e 15Z /-fLs - k �i " 4� . k : • S limiting �r 6 O� S- 6 r' . ? , • 8 factor 7 4Z— in. Remarks: Boring # 0 - 1 q /0 yR 2 - 13 Sim 2 - FS be nom► �2 S l - f - - S ; 2 Z /y 3G /a 3! YI L 2,,-, f • 5*: - 6 Ground 5 elev. /D / • e ft. Depth to limiting factor 7 f Remarks: CST Name (Please Print) Kog e T G(:� Signature T �% Telephone No. K 2lI B{? i ��T 7/S• 386 ',919-5 Address Date CST Number Ulb Private Sewage Consultants 855 O'Neil Rd. s'�Q, A a Hudson, Wis. 54018 n, c 11 !mil J`L Z ­-�'V s- G� Te T�S7 rW,-(- �- a� u s � �-� � � - � max.• yea" s(f�'s'�t/E� SOIL DESCRIPTION REPORT -z ` 3� PROPERTY OWNER Page dl PARCEL I.D.# 02 V Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots �.. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 3 ` a•F A0 2 '13 2�sb� -�,� s / • • cam Z I - /0 0 1 3 A t cs If 'q ; • S Ground 3 Y J Y/ Z— � e Cs elev. / ft. A9 �'L ' 2 Depth to limiting /d y� G / �'• SL �T �U� a� • 5 factor L•✓ �/WI l� �C, j Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots QPD/ in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # ' Ground elev. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) `IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer.textured soils (loams,silts, etc.) can & will be easily smeared Or compacted even by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 (4), the installer MUST be'very careful to properly hand rake the sidewalls & bottoms to re- expose all of the soils natural structure. Minn. even recommends that scarifying devices be mounted on the sides of the bucket. Only in this way can treatment & absorption be most enhanced for normal longer system life. L • o � kA \ \ Vi � I � N I Iii jai ,�I w UP I ( I L l O \ .......... X1°3 Vi 0 e � _ r .v ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e, � !? [ Y �iLr�J E �Lr �' C J1 fe Mailing Address i'v -u Property Address -54 P (Verification required from Planning Department for new construction) City/State 8 Cl lc�ti I t, Parcel Identification Number LEGAL DESCRIPTION Property Location ' /a, � '/4, Sec. 1 , T N -R 1 7 W, Town of / ?k s �t ✓.e �' Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # mot = �� , Volume , Page # 10q Spec house ❑ yes C/no Lot lines identifiable ❑ 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. 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. -r / 3/ / 99 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 • DOCUMENT NCI WARRANTY DEFO THIS s►ACA Mai1WICD "a Raccoomo DATA 1 STATE BAR OF WISCONSIN Ft1$M S -19U --s— KOiSTERs OffiCE Em nd mit Gall ene agher, .a /k /a Emmit J. Gallaher ST. CRQq( CO., WfS, a Marl__G alla ghPr husban , .d a d n W 1 fe �'d f Recd d Mkt 77t h . a$.. joint •. te.nant's . ......... ..... .,.. +iaf May �D119A6 .......... ........................ -.- ...... ............ , ................ ............... ..... ......... conveys and warrants to .... Gerald L. Sussner and Mary A. 11_:50 A j _. Susnex... .. j.Q1nt. tenants .............. .............................. I.............. •-•••.......... ...._.....••-- ................. ..... ............................... ............................................. ............................... NXTUNN TO ......................... - .......... .................. .... ........ ._........................................ . the following described real estate in St • CIO1X ,.County, State of Wisconsin: Tau Parcel No: .............................. The East four hundred thirty -seven (437) feet of the South Three- quarter (S3 /4) of the East One -half (E�) of the Southwest Quarter (SWJ) of Section Twelve (12), Township Twenty -eight North (T28N), Range Seventeen West (R17W). This deed is given to fulfill that certain land contract between the parties, dated April, 1981, and recorded May 12, 1981 in the office of the Register of Deeds for St. Croix County, Wisconsin, I in Volume 629 of Records, at Page 71, as Document No. 370774. r • Q FED This ._- i.s -- nOt.__- ..._._ homestead property. XX) is not) Exception to warranties: Easements and restrir-ticr.�; o record, and except any liens or encumbrances created of suU- *.ea to be created by the acts and defaults of the grantees, their heirs, successo s, or assigns. Dated Ods _ _..... . .- --•- --------- --- --- - -- - -- ------ day of ...... r1-�. ----- -- -- -•- ......... 19 ------ .. _..(SEAL) X� y - f/...-- - - -- (SEAL) . _ . Emmit -- .Gall, he /� _.....__ .._.. ...... ..............(SEAL) x-41 Y_ cz/ ` .(SEAL) ' -- -- -• -- - --- - --- ------ -- • - Marlene..- Gallagher........ - - -- - --- AUTHENTICATION ACKNOWLEDGMENT Signature (a) ----------------------------- -- ---- --- ------ ------ ------- - -- STATE OF WISCONSIN as. ------------------•------------------•-------- ................................. St. Croix ......- •----•..... ------------ County. authenticated this ........day of ...................•.•...., 19...... Per onally came before me this ... / ...... day f.I- -- ----- -- --- ----- -- -- - - -- -- 1986__ the above nw-,.A mmit Gala her, a /k_ a Emmit g = - - - - - - - '------------------ - ------ -------- - - J. Gallagher and Marlene TITLE: MLh(BER STATE BAR OF WISCONSIN Gia Llaghe: -- - --- -- -------------- (If not, .......... --- - - - - -- ------ - authorized by 4 706.06, Wis. Stats.) - -- _.- .. own be the person to me know ccut & he hoe foregoing i s ment and acknowled the fe. ' THIS INSTRUMENT WAS DRAF'TEO BY 1, _ �. •�, r• :J �I Thomas A. McCormack • `� - - --- - - - - -- - Ba?dwl.n, W1 54002 St. Croix ' .. -- ....._.. ........... ......... Nota Public nt -- , (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If no , �$ T g �a 10 t ; , J1 are not n_�essary.) date: .......... .............. - -- - -- ....... -- 19_- ....... I� ----- - - - - -- - -- -Names of persona struing In any capacitT should be typed or printed below their signatures. - I WARRANTT DEED STATIC BAR OF WISCONSIN Wisconsin Lgtai Blank C,, In, FORE No. a— 1982 11Jueuk -, Wis. W6consin Department of Industry SOIL AND SITE EVALUATION 2 Labor and Human Relations Page _ / of 3 .. Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than B 1/2 x 11 Inches in size. Plan must County .�• Include, but not limited to: vertical and horizontal reference point (BM), direction and •s CIp �l •� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 02 /O /�• y0 APPLICANT INFORMATION - Please print all Information. Re Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).'I 1 i`� /� 'J Property Owner n r (' Property Location c "" - ��� " G A C y ✓�.SSi� /� Govt. Lot :5&) 1/4 S 1 /4,S 12— TZ S ,N,R / 7 E (or) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# z o ce q Ff `uy• >u Pq* 7 o y 3.7 1f4e 5 city State Zip Code Phone Number D Nearest Road • �3�c.Dwl� w i . yy t70 Z (7 /S )�Osyzd�/ ❑ City villag / L�'1 Town ,yj„ Y. ❑ New Construction Use: esidential / Number of bedrooms Addition to existing building ©'f eplacement ❑ Public or commercial - Describe: /V//I? IV0 7' � 'C•O.�I,t�E,uG�� L� Code derived daily flow gpd Recommended design loading rate u //Q bed, gpd /fi 1 41 trench, gpd /ft Absorption area required 0 1,le bed, ft' trench, ft 2 5 design loading rate ��bed, gpd /ft S trench, gpd /ft Recommended infiltration surface elevation(s) 5 � p a . 3 ft (as referred to site plan benchmark) Additional design /site considerations -SC Q �a Parent material XD0rt V ,SEP111 10047e .Si�Nf)� � ��5 Flood plain elevation, If applicable _ V— l f = ft S = Suitable for system Conven nal �M;oundd In-Ground Pre �AT -Grad System in Fill Holding Tank I U = Unsuitable for system S❑ U LJ S O U M l❑ U (�S L U C s ❑ [Is SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. Bed , Trench U /0 Ye 312- L 1-7'Csh,:- 4r-6 eS -2 • 4 .5 Ground 3 17. L !0 W 5_1L 21 Ma. X4 C S .5: . (o elev. Depth to /.0 SZ Htf/, 'oh A/ . ae l limiting t. 51 6 o s!j it - , g factor 7 f6,- in. Remarks: Boring # r 0 I /0 Y,e 2 �(3 Sim 2- /U4 7 s I f • s y 2- 1 y36 /a 31� a s • s , 3 36 -54 /o L-5 14s C .7 Ground /d L i5 ; elev. / ft. Depth to L limiting factor 10 7 f Remarks: CST Name (Please Print) po �ieT ?1 I ,,,,Signature J � �/ Telephone No. K 75.381 • -9/ 9 Address Date CST Number , � f rc Prlvats Sewage Consultants 855 O'Neil is Ste, M �,Q Hudson, Wis. -� 54018 r l p�N� v� ofi'� °F l• 3 d o� c t�.Q- � ��, � Soi G �. col D�� X p pl T7,0 , a NA T " -ry s e ��� s y sue• -7 '.ems f/Plfvl rY D /s TXI ? � T �� T6 TEST - �'� r �� ..S�v,2c u se � *> fi x,• f .j (Jssll &,- SOIL DESCRIPTION REPORT z PROPERTY OWNER � Page of PARCEL 1.01 �2 9. i6IF• 7 / O Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots OvDift2 t In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trench 2 . /k 6 Y14 313 1 ,- 5 b,� ,►�, -f,e �s / f ' `f ; • S Ground p 3 — elev. a Z- �! 2 f' /1 YX 27 C 5 Depth to �/C , limiting 7 ) �d �� ty SL- AT J � Q� • � � 5 factor e n 16 y-C 51 dam` • L J �/LN � � � � • 7 ' '. Remarks: Boring # L I f SO s s z , s /o SAC. 144 SA "fie c s !f • S*: . 3 141 Ground I 5 L /T.S�/� VIR a -1 elev. Depth to limiting factor Cf �In. Remarks: .s 3 T•pL� 4i E" Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # i , Ground elev. ft. Depth to limiting factor in. Remarks: Boring # ° Ground elev. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) IMPORTANT NOTE TO OWNERS & INSTALLER: All the finer .textured soils (loams,silts, etc.) can & will be easily smeared Or compacted even by a backhoe bucket during trench construction. When this occurs premature failure will result. As per ILHR 83.13 (4), the installer MUST be'very careful to properly hand rake the sidewalls & bottoms to re- expose all of the soils natural structure. Minn. even recommends that scarifying devices be mounted on the sides of the bucket. Only in this way can treatment & absorption be most enhanced for normal longer system life. r t� � 1 � m car o a y EN IJ4 N . s N N + I A W ! � 1 I i I I I I -y 1 1 v IN z O� A�l d v t r