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HomeMy WebLinkAbout040-1234-40-000 ST. CROIX COUNTY ZONING DEPART �t � W r AS BUILT SANITARY REPORT l , Owner 14, Property Addr ess U /y " 4 �s Tk C•. t 7 City /State J� Legal Description: Lot ? Block Subdivision/CSM # Sec. , TLS N -R&W, Town of PIN # � SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer ' Nl �'C`5!Siz C CL I/ 5f> Setback from: House �, Ve11 X54 P/L Pump manufacturer , °.z Imo_ Model ' f'C► Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width Length Number of Trenches Setback from: House cam' Well -La P/L Vent to fresh air intake - ELEVATIONS Description of benchmark / - < Elevation /G D Description of alternate benchmark Jc� e -1 ' S Elevatio Building Sewer ST/HT Inlet / d ` ST Outlet PC Inlet PC Bottom Header/Manifold 6 Top of ST/PC Manhole Cover /'I . Distribution Lines( 0 Bottom of System Final Grade Date of installation /� /� Permit number State plan number n � .7�D � Date Plumber's signature License number �- Inspecto 41 -Z... Complete plot plan x l 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. �C3,7 PLAN )`m Um. ico.� i / qc 0 p. i b INDICATE NORTH ARROW t Wisconsin Department of Commerce -Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No,: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)( 353174 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No -: Nordahl, Thomas & Deborah Town of Troy 0Z ,5 1 - a- CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: j 0 Ud 040-1234-40-000 00 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se AkLk� Benchmark �- aa� . �S /00 Dosing 6 p Alt. BM Aeuati n Bldg. Sewer b Holdin St /Ht Inlet ( ctg TANK SETBACK INFORMATION / TANK TO P/ L WELL BLDG. Air ir i to ntake ROAD A Septic > rap 4 NA Dt Bottom Q.6 D p5 3S' Dosing > I Lr D r } rte ' NA Header / Man. c 2 , - 30 Aeration Dist. Pipe a. q D 1 0 2 , Holdi Bot. System �•a`�� c� UMP /SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number �� ` GPM = •,{L/ S o �L ('� TDH Lift L Frictin , Systema TDH p. Ft H Forcemain Length - +0 Dia. 2' Dist -To Well SOIL ABSORPTION SYSTEM / TRENCH Width / Leng No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ME I N 7 1 DIM SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA M urer: SETBACK INFORMATION Type of CHAM t ` r Moe m er. System: - OR IT �tkvj DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes) < � x Hole Size x Hole Spacing Vent To Air Intake Length Dia - _� Length 3 k.a5r < Dia. I 2 Spacing 7T9e_- / q it SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over TBed th Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code 3 discrepancies, persons present, etc.) Inspection #1: d /9f Inspection #2 ( t ,, rd P ?l49 H udson, WI NW x Location: 501 Trillium Lane, ( , SE1 /4, Se � . T28N - R19 3.2 .19. 170 �k �o�0 � y ` —�. ,,,� tl Imo -1 , �6 k ✓ % . �� ��� suer w � � 71>� „ o� v F / 6] er- ! 4r(-Af(6 44 Dl owl'w� � � � I 1K Vef I So bldcg, cw,u.c/ 2 .�QkJ'�*�� Plan revision required? (:]Yes EpNo I 1 (3 00 { I Use other side for additional information. O SBD -6710 (R.3/97) Date Inspect ' Signature ert o f r a ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: �... ... r ry �.... " . . _ _ . _., _....... ...._ _._ .... _ .. w_ ...... a _. ._ .,� ... { i s i s v s u r ; } 1 a � k } ¢ } j L i i b A.�,. 4 t � f g , j � 5 } F.,.... } t } " t t x { o [ i } $ e e 5 1 t e x w k .. 4 i f S S r .. a u a., } S f 3 I I I I Safety and Buildings Division V-A sconsin SANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 n • Attach complete plans (to the county copy only) for the system, on 1" f. s (99bq ty ^ • than 8 12 x 11 inches in size. • See reverse side for instructions for completing this applications StatvS� tary Permit Number n ou may Personal information p rovide be used for second `' , Y P Y ry purposes Che4k i t vision to previous application (Privacy Law, s. 15.04 (1) (m)]. I r o ' to Pli gPID. Number L APPLICATION INFORMATION -PLEASE PRINT ALL IN M _TI Pro caner Nam ropert S Aj � T �� , N, R E (orX Property nQr's Moiling Address t w� r r t �_ Block Numb r- C St a t , Zip o , Phone Nu b r Subdivisio r SM Num I. TYPE F IL IN : (check one) ❑ State Owned o it Nearest Ro j' � 11 Public 1 or 2 Family Dwelling - No. of bedrooms o Town of III BUILDING USE (If building type is public, check all that apply) 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 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. ❑ Reconnection of 5. ❑ Repair of an ______System ________System _____________ Tank_Only___ Existin�syst ________ Exlstingsystem 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 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 5. Perc. Rate 6. System Elev. 1 7. Final Grade / Requir d (gyp. ft.) Pro osed (sq. ft.) (Gals/da sq. ft.) (Min. /i ch) ''++�� Elevation v 5 r le ,2, t Feet $� Feet Capacity VII. TANK in Ca allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews shown on the attached plans. Plum er's Name: (Pri t) PI is Signature: (No t mps) I M91VIPIRSWNp�/i B, mess Phone Number: Plumber's Address St eet, Ci to ip Code 'ei[FkA IVVOe" IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stam A roved Surchar fee) pp ❑Owner Given Initial � � , / 95 � Adverse Determination :)1 ' 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 ' • r 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 9 and Buildings Division 608- 266 -3151. To be complete and accurate this sanitary permit application must include: L 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. Vlll. 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 incheshust be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with compleete 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. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 M TDD #: (608) 264 -8777 1sconsin www.commerce.state.wl.us Department of Commerce Tommy G Thompson, Governor Brenda J. Blanchard, Secretary October 14, 1999 CUST ID No.267341 ATTN.• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 10/14/2001 Idehtifica bers Transaction 19-No Site ID No. 18 -- SITE: Plae ree�rfithrirlenticaon►tun�, S, r Site ID: 182210 above; m "llcorrep'psdee 4 St. Croix County, Town of Troy NW1 /4, SETA, S3, T28N, R19W Subdivision: Country Wood I - lot 33 Facility: Thomas & Deborah Nordahl Proposed Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 495291 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. " The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/05/1999 AA� FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Oerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM WON jswim @commercestate.wi.us w �, ��- Safety and Buildings • Vi sconsin 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 14, 1999 CUST ID No.267341 ATTN.• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 10/14/2001 Identification Numbers Transaction ID No. 251332 Site ID No. 182210 SITE: Please refer to , b e{�t}"}t numbers, Site ID: 182210 above, in all s en6�th, jagency._ St. Croix County, Town of Troy NW1 /4, SETA, S3, T28N, R19W 1, Subdivision. Country Wood I -lot 33 Facility: Thomas & Deborah Nordahl Proposed Residence �, f FOR: CCU 1 999 Description: Three Bedroom Mound System 'V11k Object Type: POWT System Regulated Object ID No.: 495291 "�- / 2O1VUyGOFFjCE The submittal described above has been reviewed for conformance with applicable Wisconsin ve Codes and Wisconsin Statutes.. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection b authorized representatives of the Department, which may include local inspectors. All mits P Y P P � y er P P required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/05/1999 v FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 eerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMARoi�e: I • Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE MW 1/4 OF THE S' 1/4 OF SECTION 3 , T N, R F9 W, TOWN OF �-�� , c�T-. CXZZ LY_ COUNTY, WISCONSIN. �T 33 OF C-0 v�,t� Wcwfl __. INDEX PAGE 1 •of 6 TITLE SHEET�4 PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW - CROSS SECTION FF Fh PAGE 4 of 6 DISTRIBUTI(7N PIPE LAYOUT 1,99 PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE V4'o /'' PREPARED FOR 1P.0 llalt� 1 � S O) j , 1 S 4.01.�6 o� �pc,s L 4 � O ��,pR Ft• _ GO PREPARED BY WEGE�ER E C3 I L TEST I NCS sp 0 AND �"A° �1 D E � = Gil SER tJ 2 C E .� •�'� ••N•«.••• .1? `+ti F.O. BOX 74 421 N. KAIM ST. w " Eq } RIVES? FALLS. MI 54022 ELLSWORTH. j 715-425-014 to -z- 9.9 JOB NO. 9 q - Z 5 PLOT PLAN Page ?- of •6 Scale 1"= L:. 102,0' i / r i e.3 Byy� / �a�tj5 J `j Uo tip"C' C.O��►tej QR � � , i 2S, I i i Z "VAJC F.M. z loO�oF 4'`pVe 4.2," coves 1- Page Approved Synthetic Covering 1`1zTM C 's 3 Distribution Pipe Medium Sand H � _ Topsoil - G F Elev'. LOZ-•O _ 3 E D u b 3 % Slope Force Main Plowed Trench of - From Pump Layer Aggregate Undisturbed D Ft. Soil E 1.15 Ft. Cross Section Of A Mound System Using F o -S Ft. I Trench For The Absorption Area G 1•'iz� Ft. A S Ft. H I. S Ft. B - 1S Ft. I l Ft. Linear Loading Rate= 10 GPD /LN FT J `8 Ft. Design Loading Rate= d- '--GPD /SQ FT K h Ft. L °lS Ft. Alternate Il..,.dtie of For Mai -m —� W Ft. L J Force - K Main .. A � -- -- -- — — — W _ Distribution Trench Of 2 2 2 Pipe Aggregate Observation Permanent,/ Pipes - (Anchor securely) Mound Using I Trench For Absorption Area Page `1 Of _lO Perforated Pipe Detoll 0 End View Perforated End Cap) b\cy' PVC Pipe Install permanent-marker at end of each lateral Holes Located On Bottom, lit Are Equally Spaced Q / \ End Cap PVC Force Main Distribution Pipe Last Hole Should Be Next To End Cop Distribution Pipe Layout P 3 CjZSFt. X 3o Inches Y "0 Inches Hole Diameter L l4 Inch Lateral 1 Inches) Force Main Inches # of holes /pipe 15 Invert Elevation of Laterals Ft. Z S Y-Vx) -- .3S.1 GPM Place lst hole � from tee with succeeding holes at 3o intervals. Last hole to be next to the end cap. Combination Septic; Tank and PUMP CHAMBER CR055 SECTION AND 5PECIFICATIONS ' PAGE j OF VE►0T CAP WEATHER PROOF Ju►JCTIOW Box 4"C.I. VEMT PIPC APPROVED LOCKING 1 10' FROM DOOR, MAIJIi0LE COVER rvJV - .huDOW OR FRESH wAR►.JIQ4G L.N%EL. AtR IJJTAKE 40. r 51 Nl FK .- 6 "r+�N. GRA - l0 } I WAIN. y�1usl��cnor.� AIFt J - - - -- PROVIDE i I1JLE T - [ SEAL I I I APPROVED JOIAIT �4FPL�S A I I APPROVED JOINT_ w /C.I. P►PEOR Tank construction I III w /C.I. rIPE0Ap'c shall comply with ALARM ILHR ('33.15 and 33.20 i ON q.Z.ZS I LLEY. f-T PUMPS - OFF D COIJCRETE �L�U• aZ . Op 5LOCK R15ER EXIT PERMITTED OIDLy IF TAWK MANUFACTURER HAS SUCH APPROVAL 3,•APPJ^toYFD 860DIN� 5EPTIC f SPEC.IFICATIOKIS DOSE TA►JK MANUFACTURER: _IVtW� 2� Pt 3?" ►JUMEiER OF DOSES: 3 PER DAB TAWK t IZE : l Oy0 L 6 S O GALLOAJS DOSE VOLUME r ALARM MANUFACTURER: S. S.�,t�}Z() js IAICLUDIAIG 6ACKFLDW: GALLON; MODEL ►DUMBER: t�w CAPACITIES: A= Ia IUCHESOK 30 l 6 � GALLONS 3wITCH TyPC: I 8= GG I►JCHES'OR ___= _L_G�LLOAJS PUMP MANUFACTURER: G O UL�S C =_ OR k GALLOWS MODEL NUMBER: 3$�) 0� D- 9 INCHES OR 153 CALLOUS z. Y1 Z MOTE: PUMP A ALARM TO 5L SWITCH TYPE: � C MIWIMUM DISCKARGE RATE 3 S '� GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE CETWCEU PUMP OFF AUD.,DI5TRIBUTIOW PIPE.. 9 FEET t MIIDIMUM NETWORK SUPPLY PRESSURE .. 2.5p FCET FEET OF FORCE MAIN X �' -42F of r.FRICTIO U FACTOR.. 1 •��O FEET TOTAL OyWAMIC. HEAD = FEET Pump chamber DIAMETER JUTERWAL DIMLWSIOW� OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231= GAL /INCH AS PER MANUFACTURER - \-?: O GAL /INCH 7 - Goulds Submersible Effluent Puny EPO4 3871 P E 05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: g • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Motor: Available for automatic and • Farms , manual operation. Automatic and float switch attachment Heavy sum p • Hea du • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- * Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4 " maximum. • Power cord: 10 foot with pump out vanes for •Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. • Total heads: up to 24 feet. with three prong grounding SP Canadian Standards Association • Discharge size: 1 1 /2" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (GSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with Plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10- i • Capable of running dry without damage to s 30 . 5GPM components. j Pump: EP05 s I t2 FF • Solids handling capability: c 25 1 % maximum. a z ( j • Capacities: up to 60 GPM. x • • Total heads: up to 31 feet. 6 20 • Discharge size: 1 1 /2" NPT. • Mechanical } 5 Ica seal: carbon - 0 15 rotary/ceramic- stationary, a 4 BUNA -N elastomers. EP05 • Temperature: ° 3 10 104 °F (40 °C) continuous o P o E 0 140 F (60 C) intermittent. 2 ; - -; - 5 1 I i I I 0 I I I 0 0 10 20 30 40 50 GPM L 0 2 4 6 8 10 12 ml /h CAPACITY © 1995 Goulds Pumps, Inc. Effective May. 1995 Labor and Human Rstadons v v. r+ v v r r r. c r P%L. V i1 t I V im n C C V n 1 rage l (x_ I)Lv ision of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BR. direction and % of slope, scale or PARCEL I.D. t dimensioned, north arrow, and location and distance to nearest road. I P APPLICANT INFORMATION- PLEASE PRINT INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Richard out ��� L GOVT. LOT NW 114 SE 1 /4,S 3 T 28 ,N,R 19 hda) W PROPERTY OWNER' MAILING ADDRESS LOT a>i BLOCK a SUED. NAME OR CSM 0 CITY, STATE ZIP CODE PHONE NUMBER EICI TY FIVILLAGE SOWN NEAREST ROAD Hudson, WI. 54016 (71% 549 -6731 Troy Tower Rd. [14 New Construction Use [u [ Residential / Number of bedrooms 3 () Addition to existing building [ I Replacement [ ] Public or commercial describe Code derived daily n 450 gpd Recommended design loading rate • 4 bed, gpolit2 •5 trench, gpolft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate • 4 bed, gpd/ft • trench, gpd/ft Recommended infiltration surface elevation(s) 101.85 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 100.85' Parent rtlaterial limestone uplands Flood plain elevation, if applicable na ft S - Suitable for system CONVeMO MOUND KGROUND PRESSURE I AT-GRADE Snilw , I FU HOLDING TANK U- Unsuitable for O S 42 U ® S ❑ U ❑ S (KU ❑ S K] U ❑ S LI U 0 S $) U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture If. e Co sistence Bmrd3y Roots GPD /ft in. Munsell tau. Sz. Cont Color h. Bed Twd 1 1 0 -11 10 r4 3 none 2 11 -21 1 r4 4 none scl 2msbk mfr I aw if .4 .5 Ground 3 21 -30 7.5 r4 4 none S1 2msbk elev. 101 ft. 4 30 -50 10 r5 6 2 7.5 r5 6 cl m na Depth to limiting fac tor i Remarks: Boring # 1 0 - 10vr4 none ail 7mrbk 2 2 10 -27 10 r4 4 none si Ground 3 27 -37 7.5 r4 4 e s ic ' 2msbk mfr aw ILA elev. 4 37 -53 10 5 101 ft. c Depth to limiting factor i " r +53" s N Remarks: T Name: — Please Print Phone: Gary L. Steel - 715 -246 -6200 ress: 1554 200th AVe. New Richmond, WI. 54017 m02298 S+gnaNre: Date: CST Number: Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 I,AZor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REV B _ ';_ F - % ,! ; ®,DATE PROPERTY OWNER: PROPERTY LOCATION Richard Stout GOVT. LOT NW 1/4 S ^ 14s 3 T 28' AR 1�,.. or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUB _I`tA�VIE OR`CSM # - 3 Awat 1393 niktmt- rl. CITY, STATE ZIP CODE PHONE NUMBER (]CITY EIVILLAGE g0 !REST D ;~ Hudson, WI. 54016 (71$ 549 -6731 Tro t° taer R ; �-I" [ New Construction Use be ] Residential / Number of bedrooms 3 [ ] Additioc to xtsting builft Lo (J Replacement [ ] Public or commercial describe ( " Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft • trench, gpd/ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate • 4 bed, gpd /ft •5 trench, gpd/ft Recommended infiltration surface elevation(s) 101.85 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 100.85' Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I Cl S ta U EIS ❑ U 1 ❑ S [3 ❑ S 93 U [IS ID U I [IS E U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxtdary Roots Bed Trench 1... 1 0 -11 10 r4 3 none sil 2msbk mfr Cs 2f ..... 2 11 -21 10 r4/4 none scl 2msbk mfr qW if .4 .5 Ground 3 21 -30 7.5 r4 4 none sl 2m elev. 101 .45 ft. 4 1 30-50 10 r5 6 2 7.5 r5 6 cl m na na na n !.2 Depth to limiting factor 30" Remarks: Boring # 1 0 -10 10 r4 3 none sil 2msbk mfr 217 -9 .6 2 10 -27 10 r4 4 none sil 2msbk mfr aw if .4 1. Ground 3 27 -37 7.5 r4 4 none sicl 2msbk mfr aw na .4: elev. 4 37 -53 10 r5 4 none 101 ft. Depth to limiting factor +53" Remarks: CST Name: Please Print Phone: Ga L. Steel 715- 246 -6200 Address: 1554 200th AVe. New Richmond, WI. 54017 m02298 Signature: Date: CST Number: 5 -16 -96 PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2, of 3 PARCEL1bD. #t Bending Lot# 33 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTirench 3 { ` 1 0 -13 10 r3 3 none 1 2msbk mfr cs 2f .5 .6 2 13 -28 10 r4 4 none sicl 2msbk mfr 9w if .4 .5 Ground 3 28 -40 7.5 r4 4 none sl lcsbk mvfr 9w na .4 .5 elev. 99 ft. :: 40 -55 10 r4/4 c2p7.5yr5/6 c1 m na na na np .2 Depth to limiting factor 40" Remarks: Boring # tiv I Ground elev. ft. Depth to limiting factor i Remarks: Boring # i kr • Ground elev. ft. Depth to limiting factor FT Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NW4SE4 S3 T28N - R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #33- Country Wood N 1 " =40' BM.= top of 1" steel pipe el. 100' Alt. BM= top of wooden post C e1.103.7' 011 �a i U� N 4 1 ; ,7` 1-7qq i G ry L. Ste 1 ST CROIX COUNTY ,- SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION . ORM C O7ne 6uyer f � i ,( ✓ � Mailing Address __ G � f /.� 1� j1' rc d s zz Property Address O -- T _. (Verification required from Planning Department for new construction) City/State u4:::E40 Parcel - Identification Number LEGAL DESCRIPTION a Location 1 3 1— Property rtY � /a, ,Sec. � , T D � N -R h W, Town of fe Subdivision Q (n J Lot # Certlfed Survey 'Msp # Volume . Page # W :mutby Deed* Volume , Page # 7 i Spec house ❑ yes no Lot lines identifiable X 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, restrictedplumberor a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank, is less than 1/3 full of sludge. Itwe, 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 ee year ex iration date. 4 ` SIGNATURE OF 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. A 4G� X l/ P/ SMATURE OF AP1'LICANI' DATE * * * * **. Any information that is mis- represented may result in the sanitary permit being revoked b the Zoning De * * * * ** GYP g Y g artment. P ** 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 I i 14G3PAGE 4g KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS DOCUMENT N O. ST. CROIX CO., WI RECEIVED FOR RECORD This Deed made between JEFFREY M. 10 -18 -1999 9:00 AM SULLIVAN and PAULA M. SULLIVAN, husband and WARRANTY DEED EXEMPT # wife, Grantors and THOMAS J. NORDAHL and CERT COPY FEE DEBORAH J. NORDAHL, husband and wife as COPY FEE: TRANSFER FEE: 133.50 survivorship marital property, Grantees, RECORDING FEE: 10.00 PAGES: 1 Witnesseth, That the said Grantors convey to Grantees the following described real estate in St. Croix County, State of Wisconsin: Lot 33, Country Woods First Addition in the Town of _ Troy, St. Croix County, Wisconsin. Tax Parcel No 040- 1234 -40 J RETURN TO: — -- This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this day of October, 1999. zajj—�— (SEAL) e . Sullivan •lr � (SEAL) Paula M. Sullivan STATE OF WISCONSIN )SS ST. CROIX COUNTY Personally came before me this 'A " A day of October, 1999, the above named Jeffrey M. Sullivan and Paula M. Sullivan, to me known to be the persons wh e cuted the f regoing instrument and acknowledged the same. No State of W' consin My Commission expires THIS INSTRUMENT DRAFTED BY: •• "`t . Hgtn" �. Robert W. Mudge, Attorney '••`� N RY ��� MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. O f I A 110 Second Street, P.O. Box 469 g Hudson Wisconsin 54016 = f 150 VOL . i i , �3 O$ a 2.40 AC. �r. X115 � 104,514�Sl f 2.33 AC. EXC. ES' I� o a� 101, 582 SO. FT 5 ' * 24'0l"W 230.00' \\ 32 2.39 AC. 104, 058 SO. FT. / .n 2.32 AC. EXC. ES MT 1 34 33 101, 068 SO. FT. N 77 2.23 AC. t� 2.76 AC. in 120, 302 SO. FT. 97, 005 50. FT. •� � o 0 a' � G i 90 • 11C T1161R TUGW Jig Bmis B111IX 11.06' S11 $09 0 23 1 33 1 1 11.12' 999 S07 11.12' S16 S17 11.13' S17 S19 13.12' 130 132 A . ... ..•wfl�r�w�A 47�01L�1L�t