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HomeMy WebLinkAbout032-2030-10-000 T ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner - ���g Property Address City /State Legal Description: Lot Block Subdivision/CSM t /4/ t /4, Sec. 9, 'TAN -RAW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION manufacturer Size ST/PC / Setback from: House , Tank f� -� Well P/L, Pump manufacturer Model A) 3�) Alarm location L"c.-J L (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: ,&,,A Wid _1� Length �� Number of Trenches Setback from: House Well P/L r /6a Vent to fresh air intake �4/ten ELEVATIONS Description of benchmark y / Elevation �4D_ Description of alternate benchmark f -s11,6Q Elevation 9S._ Building Sewer ST/HT Inlet 9/. G/_ ST Outlet 91._ PC Inlet ,02 /S PC Bottom A7 y7 Header/Manifold X 99. �9 Top of ST/PC Manhole Cover Distribution Lines () 9!�, 92 () ( ) Bottom of System Final Grade () () ( ) Date of installation // /0 Pe it nu ber 3,3,e 5 State plan number 51 Z Plumber's signature License number Date Inspector �� . Complete plot plan �+ NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW s��xv GG 30` dJ/� d INDICATE NORTH ARROW a)e C, 4541)4- NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW N 6 46 33 I INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety Count and Buildings Division 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)]. 338885 Perrre*61 hllam8ALE ❑ Cit OMERSET of: State Plan ID No.: CST BM Elev.: Ins. BM Elev.: BM Descri tion: Parcel Tax No.: p p 032 - 2030 -10 -000 TANK INFORMATION ELEVATION DATA 7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W ZT, IZOD / Benc S , �O 1p }.qo Loo. 0 Dosi ng � � C we / g� -gg 3 • o ` �� , d . Aeration Bldg. Sewer 13 •�} `� .6 Holding St / Ht Inlet 6.24 I j. && TANK SETBACK INFORMATION St/ Ht Outlet rb �j(, TANK TO P / L WELL BLDG. Air I to ntake ROAD Dt Inlet (b• "� Q �. r � ir Septic > (OV �` f NA Dt Bottom �.�3 $�• c f 4 Dosing ? (&D - r NA Header/ Man. q . Aeration NA Dist. Pipe Holdin Bot. Systeni(A 4 k `jQ, D PUMP/ SIPHON INFORMATION Final Grade Manufacturer / Ze d •�, SAA `( `t'3 $. /3 Model Number 31( J `• ""C� d TDH Lift 1 0 0 1 Friction a SystemZ TDH �Ip•b t 1 H ad Forcemain Length Dia.'Z " Dist. To Wel .SOIL ABSORPTION SYSTEM BED ) TREM'CM Widt • Len / N O Tr n es PIT No. Of Pits Inside Dia. Liquid Depth EN I N -7 01 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER i mod Number: System: 7 /W I _-� "00 OR UNIT DISTRIBUTION SYSTEM j ; Header / Manifold Distribution Pipe(s) ,� , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. 2 Spacing 3 �r/� 5 .0 , I SOIL COVER x Pressure Systems Only x 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 El es E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 9 s LOC TION: SOMERSET 8.30 19 582,NE,NE 1692 50TH STREET 9- Plan revision required? ❑ Yes No Use other side for additional infor ation. 1 10 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E s F = 3 e a , i qq e i 5 ame , i V e , a i , , e � t L ...... >e .� .. .... x d E s i 9 e d .. �.. t.- .. . . .... I r E 7 g ...,.. -m ,m.p� ���. ......... �s. me .. t ...... �...... .. .. ...s e ; ....._._ . . s ®�e ( @ t E a � s 3 6 4 f t i . ..,,.. .._ .e.�.�. ... e ... ._....e.. i .., �.. .. y Safety and Buildings Division N)Lconsin SANITARY PERMIT APPLICATION 201 B. Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less county than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 2C-Z (0 Personal information you provide may be used for secondary 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 Prope Ow r Na Property Location 1 /4 1 /4, S T , N, R E (or� Property Owner's Mailing Address of Number Block Number Cit Zip Code Phone Number Subdivision Na e r CSM Number e4 k ) Z. ( ) S II. TYPE OF B LDING: (check one) ❑ State Owned !t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms c3 ro w a n OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 8 , �3j 1 S S 2 032 -2o Jo -� 1 E] Apartment/ Condo 3 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2_ ❑ Replacement 3_ ❑ Replacement of 4. g Reconnection of 5. ❑ Repair of an S stem -- - - - - -- System ------- - - - - -- Tank Only -------- - - - - -- Existing System - Existing System B) JR A Sanitary Permit was previously issued. Permit Number 3 Sj? 8$,5__ Date Issued tL _ 99 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 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault'Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area Al. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min.khch) Elevation Feet Feet VII.. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper- INFORMATION New Existin Gallons an Manufacturer s Name concrete st C on ed Steel glass App. Tanks Tanks Septic Tank or Holding Tank © ❑ ❑ El 11 ❑ Lift Pump Tank /Siphon Chamber / — ❑ 1 ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insthlatign o the onsite sewage system shown on the attached plans. Plumber' Nam : (P Plumb 's na N t ps) MP /MPRSW No.: Business Phone Number: P umber's Address Street, City, State, Zip Code): < �D IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved [:]Owner Given Initial Surcharge Fee) p Adverse Determination X. CONDITIONS OF APPRO�V�A�L�/ REASONS FOR DISAPPROVAL: SBD- 6398 (11.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS - 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit. Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. f h n n li A. Complete line B if permit is for tank replacement, reconnection, or re IV. T e o ermit. Check only one o ne t o YP p Y P P p air. P 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 orwith 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. I ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect g roundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings Division 201 W. Washington Avenue A iscons i n SANITARY PERMIT APPLICATION P O Box 7302 In accord with ILHR 83.05, Wis. Adm. Code Department o f Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ' • See reverse side for instructions for completing this application State sanitary Permit Number 3 3 S Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pro pe O ner me Property Location 1/4 1 /a, S T , N, R (or Property Owner's Mailing�ess Lot Number Block Num er Ale 22 Citr,.Sute Zip Code Phone Number Subdivision Name or CSM Number JI II. YPE OF BUILDING: (check one) ❑ State Owned It Nearest Road El Village Public 1 or 2 Family Dwelling - No. of bedrooms is Town OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo O7 O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. 54 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only 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 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /i ch) Elevation Feet Feet VII. TANK Capacit allo s Total # of Prefab. Site Fiber- Exper. INFORMATION New ExistIn Gallons Tanks Manufacturers Name Concrete st acted Steel glass Plastic App =alp Tanks Tanks Septic Tank o Ing an ❑ ❑ ❑ ❑ ❑ on am er r670 — / I ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for iq9tallation the onsite sewage system shown on the attached plans. Plum Nam r(Pt,- Pl umb Vs 46n S m s MP /MPRSW No.: Business Phone Number: r Plu in ber s Address (5 tree city, Sta Zip Cod IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwat te Issued Issuing Agent Signature (No Stamps) proved ❑ Owner Given Initial 3�S oo I Surcharge Fee) / Adverse Determination !� (11 '`�i � �. X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS • ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 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. 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 online 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. I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations April 29, 1997 15837 USH 63 Route 8, Box 8072 Hayward WI 54843 K O CONSTRUCTION KIM 0 CONNELL 504 THIRD AVE OSCEOLA WI 54020 RE: PLAN S97 -20153 FEE RECEIVED: 180.00 CROONE, DALE NE,NE,8,30,19W TOWN OF SOMERSET COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, *omas L. Braun Plan Reviewer (715) 634 -3026 7:00 - 4 :30 2212R/ 1 SHDA -Mb (R. 10/94) I i Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID # Owner' Leg / cription Address Z X - e - 4d CityNillage/rown County r Contents Comments /Special Instructions Page # Included Two copies needed for all plans I Plot Plan 2 Plan View/Lateral Q Return by Mail A - 2- Cross Section 4 Tank & Pump/ Q Fax Letter to (County) (Submitter) Siphon Information Circle One and Provide Fax #: ( ) d System Sizing ( c) Z-4- - Call for Pick -Up: ( ) Q Other I, the undersigned, hereby certify that the � j a (�tlIt'�t�� plans and specifications submitted l�a y herewith were prepared under my direction and control. APPROVED Plumber i LicensNRegistration # —C' K". OR Law i I" OUT= Address ity State AN an=a: Signature kE COR&WONIDENCE For Office Use Only Attachments: Application Soil do site evaluation Fee Needed for Holding Tank Submittal: �7 ✓ (] 7 - 20153 One copy of notarized holding tank agreement. (Orifiaals to County) C Needed for At - Grade Submittal: RECEIVED Original signed and notarized APR 2 9 1997 Application for "Use of an At- Grade" County on -site S AFETY b e'^__/L►�Q • ENV. One additional set of plans SBD -10268 (N.01/96) �� \\ §� « \ \� ^� v \ a:� ,f , + % �\ � 7 f 2 ® � / {}ƒ\(\\z� ° w \ \� � / �# 6 � % B � k y / £ :�!«!¥ *S� a� #� �qfq� �" � K6�*s� « Y� wa � �,� $ _ . �� �� � �� ����a ^ ~ �� � oS 7 1731 � Y ✓J�cw�7 •SiZ� ��/� /may loa C 4e zs Page -2 Of 7 Straw, Marsh Hay, Or Synthetic Covering\ I Distribution Pipe Medium Sand _ H G Topsoil = -_ F +1 i 3 E p b y % Slope Bed Of j- 2 %2 Force Main Plowed Aggregate From Pump Layer D _ Cross Section Of A Mound System Using E -�- A Bed For The Absorption Area F -- G AoFt. H 1_5 - Signed: g , J/ Ft. License Number: I -J/ Ft. Datei J Ft. K 5 Ft. L Ft. W Ft. L J Observation Pipe A �• - - - -- --------- - - - - -- ------------------ - - --•I Force Main W ° —- - - - - -- - - -_ From Pump Distribution Bed Of % 2 % 2 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area pAge� 0f 7 Perforated Pipe Detail n End View )Perforated End Lop ' PVC Pipe i Holes Located On Bottom, �s Are Equally Spaced R w PVC Force Mover Z Alternate Position Of pipe ip•ilion Force Main P Last Hole Should Be Naas To End Cop End Gap � Distribution Pips Layo P R 9 S X -k6 Y Inches . Signed: Hole Diameter Inch Lateral _,L2!Inch(es) License Number: Manifold " _-Inches Date: Force Main " Inches f of holes /pipe Invert Elevation of Laterals_2ZLS -Ft. . b r • N a c� � a � o y >� rt O A rt n N N N (D n rt P . .P O ' O O M fi N 1 (D N O N rt 'd ---------- - - - --- w N a W d (D M C M - -- a m �► rt n P. fD 0 c rt rt� d N �J n O ft O rt �1 r• a w K a a CD PAGE of PUMP CHAMBER CROSS SECTION AND SPECIFICAT(ONS V E NT CAP 4 VENT PIPE WEATHERPROOF APPROVED LOCKING JU WCTIO)J BOX COVCK WITH 2S' FROM DOOR, _ AANING LABEL W1400W OK FRESH IZ MID. I AIR INTAKE GRADE I y" MIIJ. COUDUIT __________ le•MIN. X ---- - - - - -- � 11� IIJLET PROVIDE I 1 - - - -- AIRTIGHT SEAL I I I I 1 I I APPROVED JOIAIT A I I APPROVED JOIWTS W/ PIPE I II W/ ' PIPE EXTEHDIM( 3' I I ALARM EXTEWDIIJG 3' OWTO SOLID SOIL B I II ONTO SOLID SOIL I 1 I I ON C I Et_EV. FT' PUMP --- - -� .� O FF D tnsmll per manufacturers E uiremerifeOAICRETE BLOCK RISER EXIT PERMITTED OIJLH IF TA►JK MAMUFACTURER HAS SUCH APPROVAL 3" �PPfZoVEa BEDCIr�G Lar�dcr T�I.tlt SEPTIC E SPECIFICATIOUS DOSE 1 TAIJKS MAWL)FACTURER: IJ UMBER OF DOSES: 1 -PEK DAM TA WK SIZE: � " ' GAL OWS DOSE VOLUME ALARM MAUUFACTURER: � IMCLUDIMG 15ACKFLOW: / S GALLONS X2414 402 MODEL WUM15EK: CAPACITIES: A= WCHES OR GALLOWS SWITCH TYPE: ire g = // __ IMCHES OR _�. GALLONS PUMP MAMUFACTURER: -- C = OR / L G LL0U5 MODEL DUMBER: D - :� INCHES OR 7 L GALLONS SWITCH TYPE: //�� -L MOTE' PUMP AMD ALARM ARE TO BE MIIJIMUM DISCHARGE RAT E�GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE 6ETWCCAJ PUMP OFF ARID DISTRIBUTION PIPE.. FEET + - MIUIMUM METWORK SUPPLY PR - URE / , 2 . 5 FEET + 1 FEET OF FORCE MAIN X�-�1CL._ FAC c FEET TOTAL 0y1JAMIC. HEAD = 1 FEET / IUTERMAL DIMEWSIO S OF TAWK: LCWGTM jWIDT li JJJ"` jLIQUID DEPTH --1� -- �IGrJED:_ _ LICENSE NUMBER' LATE: i ���� i��1��� .�:rn��F����rn�� vertormance I UVI I t Curves Pumps >����� METEA8 FEET 90 MODEL 3885 25 so SIZE 3 / 4 " Solids WE15H 70 20 WE10H J� F—I 60 -WE07H 15 50 WEOSH 40 10 30 WE03M If 20 WE03L 5 10 0 L 0 0 10 20 30 D 50 60 70 60 90 100 110 120 GPM I I 0 10 20 30 m'R► CAPACITY GOULDS PUMPS, INC. SDECA FALL t'CW YCP: METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3 /4 " Solids 100 90 25 70 20 60 O H 15 H WE05H i 40 t 10 30 20 S 10 0� 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L L t 0 10 20 30 ml/A CAPACITY •tM Gould& Pumps, Inc. ENO"" July, I"S C38p1 7o J )PTIONAL WORKSHEET 1. MOUND SYSTEM II. IN GROUND PRESSURE SYSTEM-Continued. 1. Wastewater Load, Total Dally Flow = ,F% gal. 10. Force Main: �G Use section F1 63.15 (3) (c), Wis. Minimum Dosing Rate = __f gpm• Adm. Code and PROVIDE A DETAILED Diameter = -- �" LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor = ft. System Head = 2.5 ft. 3. Landslope = % Vertical Lift = - ft. 4. Distance from Dose Chamber to Friction Loss = ft. i Distribution System = ft. TD '_ �f t. Pump 5. Elevation Difference Between 12. P Selection: r Pump and Distribution System ft. Pump will discharge at least gpm 6. Absorption Area Sizing: at J ft. total dynamic head. Area Required = I sq. ft. Pumpplodelp manyf�lct ��Y' AJ tWe Bed or Trench Length (B) _ _g.1.L ft. Bed or Trench Width (A) ft. 13. Dose Volume: Trench Spacing (C) _ ft. 10 Times Void Volume of - � q 7. Mound Height: � Distribution Lines= /, �R gal. Fill Depth (D) _ __1tll. ft. Daily Wastewater Volume r Fill Depth Downslope (E) ft. 4 Doses In 24 hrs. = a gal. Bed or Trench Depth (F) _ i ft. Backflow = gal. Cap and Topsoil Depth (G) = 6 ft. Minimum Dose = gal. Cap and Topsoil Depth (H) = 1 " - ,5- ft. 14. Dose Chamber: 8. Mound Length: Volume = �tlri gal. End Slope (K) _ Z ft. Total Mound Length (L) _ � ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal. Upslope Correction Factor = �9 Use section H 63.15 (3) (c), Wis. Upslope Width (J) = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (1) = ft. 2. Required Septic Tank Capacity = gal. Total Mound Width (W) _ ft. 3. Percolation Rate = min. /in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 In chapter H 63 Natural Soil = -7 gal. /sq.ft. /day and PROVIDE A DETAILED LIST OF Basal Area Required = 2:5 sq. ft. SIZING ON PLANS. Basal Area Available = / 7Z6 sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter Length = ft. H 63 are Used, Indicate Table No. Width = ft. 12. For the Distribution Network, Use Numbers 5 -14 in Section II. Number of Trenches = Trench Spacing = ft. 11. IN- GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor = ft. Lateral Length = ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = min. /in. Lateral Spacing = in. 4. Proposed System Elevation = ft. Distance from Sidewall to Pipe = in. 5. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM -IN -FILL LIST OF SIZING ON PLANS. Fill In All Items from Section III Required Septic Tank Capacity gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = min. /in. 1. Capacity = gal. Area Required = sq. ft. 2. Manufacturer: System Length = ' ft. 3. Show Slte Constructed Tank Details on Plan System Width = 7 ft. 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Size = in. 1. Capacity = gal. Hole Spacing = H. 2, Manufacturer: Lateral Length ft. 3. Pump Manufacturer: Latef.d Size In. 4. Pump Model: I.Acral Spacing; fl. 5. Operating Head= ft. Disl.nice from Sidew.ill•lo Pipe 6. Flow Rate= gpm• H. Distribution Pipe Discharge Rale: 7. Show Site Constructed Tank Details on Plans Number of I loles Per Pipe I low Per Pipe 91111. VIL HOLUING TANK 4, Manifold tilling: 1. Capacity = gal. I ype (ceniel or end) Ei�✓1 2. Manul'adurer. Length = 5 ft. 3. Show Site Constructed Tank Details on Plans Diameter = _,_ In. -SHOW ALL INFORMATION ON PLANS - fill 4�n ^n ��51 In n�•o�� / r'? Wisconsin pepartment of Industry SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information Re ' wed by Dale Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Propertv Owner Property Location e Govt. Lot A /Z 19 19,S T� N,R (or Property Owner's Mailing Address Lot # Bloc # Subd. Name or CSM# City Stat Zip Code Phone Number }� ( ,7 El city El Village 01 Town Nearest Roa \ a.� � � tL � t7 •. New Construction Use: Residential / Number of bedrooms_ Addition to existing building Replacement i Public or commercial - Describe: Code derived daily flow Z & - _ 1 9pd Recommended design loading rate _ bed, gpd/ft2 gpd/tt Absorption area required Q bed, ft2 ft Maximum design loading rate �bed, gpd/ft _ trench, gpd/ft Recommended, infiltration surface elevation(s) (as referred to site plan benchmark) Additional design /site considerations Parent material' Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S U 0S El 1_1S ®U EIS M U I ❑ S O U ❑ S M U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / 10 _- G Ground Depth to limiting ; factor in. Remarks: Boring # p s S O / d ; ,f Ground t 1 , / o pp elev. Depth to limiting factor .in. Remar s: CST Name Z(PIas rint) A Signature Telephone No. Address Date CST Nurpber PROPERTY OWNER SOIL DESCRIPTION REPORT page of '. " PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. Bed , Trench o 3 1,1, 1 v AS K GJ Ground elev. -- — r l Depth to limiting factor IV_in. Remarks: Boring # � f Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # ; Ground elev. ft. Depth to , limiting factor in. Remarks: Boring # Ground elev. n Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) 3 3d \ j .s f CROIX COUNTY SEPTIC T, MAINTENA1 AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer biqLf- Az LAIA OCR E -1 Mailing Address Property Address (Verification required front Planning Department for new construction) _ City /State aoLfI j Parcel IdentiGc, Number _ LEGAL DESCRIPTION Property Location 1 4, „ _ t /4, Sec. 9 , T,�O N -R /Q W, Town of y Sy,,F,.M_,T _ . Subdivision _ , Lot # Certified Survey Map # Volume , Page # Warranty Deed # Volume � , Page # Spec house O yes no Lot lines identifiable –yes D no SYSTEM MAINTENANCE Improper use and maintenanceof 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 iwo 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 c tier and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site was Le water di:.posal 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 Commence and the Department of' Natural Resources, State of W isconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three year expiration date. / ow NATURE OF APPLICANT I OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) ti:e owner(s) of the ro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. - -� I NATURE OF AP _ICANT DA'f E " * * ** 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 f ,,m the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V 'Vt.. * DOCUMENT NO S TATE BA?!k OF WISCONSiPT FQBDt 11 — 16,16 *'Ace ee ra rtt[av 6acott0 e.ra i!N! LAND CONTRACT WW c6lpfab (To NZ USED folk ALL TRANaAMON8 MHtas Ov C w OSLO" 1a f /NANf`iD AND IN OTHYR NON - CONSUI&M ACT TRANSAMONS1 - - i' ST. CR= M W 1 _ Leonard A. J. udte i COritrB Ct, by and betw _ L d A J Xl k .. ... %ed for „K2udtke, .hushan ....afid,.ltr ife,�........._ . bw 8_kr.y YET $.hj p... 14u is 1..R T QP.P)- Ml _........... ( "Vendor". N OV 2 1 1 whether one or more) and ... De._L.. Cror-le and Lauren B ............................ fro.Qne.-- .husband- and-. wif�.,... as..swrylxQ.r-abip ............. marital - p- ro..e-r_ty. ................. ("Pnrchr 1 . whether one or more), j Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- �►Ofa� I formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), In . ..... ......... ...... ......................... County. State of Wisconsin: nsTUw- TO The Northeast 114 of the Northeast 1/4 of Section 8, Township 30 North, Range 19 West. _ - ! I Tax Parcel No......................... ......... it ii This i S no L homestead property. (is) (is not) I Purchaser a ees to urchase the Property and to pay to Vendor at .SOmeTSet Wisconsin 6r the sum of $ 40:. - - Q ..... ............................... in the following manner: (a) $_lA t: .�Ob - --- - ....... ..........._......•-- at the execution of this Contract; and (b) the balance of $1 0. 1 .00.0_..00 ................. together with interest from date hereof on the balance outstanding from time to time at the rate of .. .... e.i$ht. - 1 per cent per annum until paid in full, aq follows: !� 1. A principal payment of $10,000.on January 1, 1991. Thereafter this contract shall bear interest at the rate of 8 %. it 2. A principal payment of $10,000 plus $1,600 interest on January 1, 1992. 3. A principal payment of $10,000 plus $800 interest on January 1, 1993. Provided, however, the entA outstanding balance shall be paid in full on or before the...... 15A ............. day of Jauar y________________________ 19 . ... ( the maturity date). i K)1& 4XtXKA1X% x Y-I tX 1Ct71 � t t �t i�� � pYti)(rl PUXl(:ifUX Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antics- 1 paced annual taxes, special assessments, fire and required insurance premiums whets due. To the extent received by Vendor, li Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, ht shall not bear interest unless otherwise required by law, is �� y,/����y( X ��/y R � }}�ky � { � ��yp X � �( € � 1Q? � l y f � � is7 y i } � t 5. � y k4 � (D y � X r � � ) i ( . 4` y t � y. � �, k i � Y t v 1Y Xa � t , D v � , X � t] µ � , b � Jd , �G y Y, rtlEe� � X e d d 'o I� /C7�T`Yl'T�lCel ltT l[���`S�i�1ll'KT7AilC ll Xl�ASF.Y'r1'r1AYY A•�iK�lPX/4�11WMF11YlriA �A X.A.Al►dX./lAX ?l��XbA1�X '� There may be no prepayment of principal without permission of Vendor.* In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated i as unpaid principal) is less than the amount that said :adebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds i! of insurance or condemnation, the condemned premises being thereafter excluded heret'rom. l Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser ' for examination except None i i' Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. i Purchaser shall be entitled to take possession of the Property on_ C) a- te — of.- .this_..can.t.ra_ct -..:�� .M. •ate.. o�: o,,.. i; i 1.A .ND C0yT1tACT IndivAo;.1 and aT %TE Is tit OF Wls.0N,1 W ..••c.lr. 1 enl Il—k t',. I,- Curporaw WORM \n. It 7 fib: • Y isit sad deliv W pro whe ar du receipts ' a'aowin sock to levied on the Prupertp or upon w�s b est ek payment. baser shall keep the lbaprovementa on the Property insured against loss or damage oeaefiorst i tended cove •y hazards as Vendor may require, without co- insurance b , Wrou wt Vendoe in the sum of — ""'�_._ ,but Vendor shall o ht as Waowt uwr+ y i than the balance owed under Nis Contract. a ce pram uma when 9ne, The plid�s don contain the standard e4use in favor of the Vendor's doe otherwise agrees h fire oeigitat of all policies covering the Propert a 1 with Vendor. Pu mPtiy give et Was to insurance aompauies and eq Purchaser and Vendor otherwise sspgree In w vessels shall be applied y oasibla ,r repair at the Property damaged, provided the Vsador deems the rceLera Purchaser covenants not to cc+mmlt waste nor allow waste to be committed on the Property, to Its t� t!a PraDeety in good tenantable condition and repair to k the Property free from liens superior to the lien of this Coateeet, race to comply with all laws, ordinances sad regal ons afect;ng the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fuller paid ad an eooditio shall be the Pbe fully p 4 omed W the times and In the manner above specified, VAador will on daound, wenq sad daliver to Deed, in fee simple, of the Property, free and clear of all liens and esenathrances, swept any liana or encumbrances created by the apt r default o Purchaser, and except: .... MU1LiC. PJL1..ZQZdAg..... ordinances and easements of record. .......... ••• . .............. ...__.._..._•.. .. - ... ... •- Laren Cr_ req e hereon er. --- o_n s oe i ns this contract• . to uaraiif "ee -- - tY1e - " "" a - "� e "tits " "'• " ° "�' "• "' - • - ' ............. .• -• - .- ...- - .- - - - -.. ----------- •-- •----- --- ._.-._-..... ------- -•---..------- uird .. -•- ••-•---•--•-•• .............. .......... ............... . .•• -• ........................ .................... ............... .............. .. ..................... Purchaser agreer, that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of ..60... days following the specified due date or (b) is the event of a default in performance of any other obligation of Purchaser which continues for a period of ------ 6Udays following ritten notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vender may, at his option, terminate this Contract and Purchaser's rights, title r 1 interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereonfrom the date of default at the rate in effect on such &A-t and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale sad Parehaeer shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title is a quiet - title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from posaeas of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all coats and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract Perchaser consent to the appointment of a receiver of the Property, including homestead interest, to collect the rents, ewes, sad 1y of the Property during the pendency of such action, and ouch rents, issues, and profits when so collected shalt belNY and f applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or a - citable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long- termlease or in any other way) without the prisi written t consent of Vendor unless either the outstanding balance payable under this Contract is first paid in fail or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for as indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of j this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made b_: Purchaser shall be considered payments mrde on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and sasi .a of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins Lrein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this ._.- - - - - -. - " ! .... day of......... .. November...... ----- ••••......... 1a. t •*l,( G. (� .,(� /�?_ L'C St:AL) ----�- -- -�_ - - -- (SEAL) .Leonard A. J. Kludtke Dale L. Croone - - . • . .. ....................... - - -- . _• __.. (SEAL) .,�..... ... .. ........ .........(SEAL Frances L. Kludtke Laur,,6n B. oone ............. - - - -. .. -- - ...... ---- ...-- •-- . -------- ...... --'� .�.. (SEAL) * oven C ode AUTHENTICATION ACKNOWLBDGMBNT Signature(s) . of_ . Leonard" A -. . J._Klud STATE OF WISCONSIN Frances L. Kludtke, Dale L. Croone, ... L .... r ---&; --1oren---Eroone------ ...... ...... ...County. y _� -•- Personalty came before me this ... „ authenticated this�!?rda of._. .November 19.. . day of ._.. ............. ......... .........-- ..__--------------- , 19 ........ the above named G. E. Norman ° ....... .................... - -- -- -..... ---. ...........•................... TITLE: NIF:NIBF:R STATE BAR OF WISCONSIN X4N.- U...._... --- - - -- --- --- X ?�t)Firl�����t)1•x to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INS1aUMENT WAS DRAFTED BY BAkKF., NORti1AN .. ............ ................................ ............................... F �q T E SCH S C Uh1ACfilR, .. e2L Ne�T!Z�chmdn�lA 54017 - - -- ................................... C2 . Notary Public .......County, Win. (Signature; nuty he authenticated or ucknuwt.dgrd. Loth M Conuuission is permanent. (It not, state expiration � dire n necessary.) - date: -._._. •Nee.. „f Peron, u•. n;nF n :.n, r+4•.. ity •I tld 1, t1, , 1 •i —A"t b.l­. 91 -1. Ol ti} ACT- -Indly nlusl and tbrporata — Stets liar of F•.rm Vo. It— 1­1 O 1