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HomeMy WebLinkAbout040-1234-70-000 I ST. CROIX COUNTY ZONING DEPARTW' j AS BUILT SANITARY REPORT Owner` Property Address ZZ Z11— City /State I Legal Description: �.- Lot Block Subdivision/CSM # A /4' /4, Sec. 2 , TAN -R�W, Town of PIN # ~ — a SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer — & k-' S kA Size ST/PC /7 57>7 Setback from: House 2,L Wel n � P/L -- Pump manufacturer Model G✓,Ed s" Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fres take Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM s Type of system: ,L� mil Width �— Length _ Number of +rerZhes Setback from: House -, Well P/L Vent to fresh air intake ELEVATIONS i Description of benchmark /X9T,,47 0 /�Sf' ��5 �� Elevation ,�,Va 0 Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet ----- PC Inlet PC Bottom Header/Manifold to , ,f-r Top of ST/PC Manhole Cover Distribution Lines O a .Z. `1' ( ) O !Ok /Ol •� Bottom of System () f0.2. 3 () ( ) Final Grade O O ( ) Date of installation /2 / Permit nu er ?X "9"f State plan number Plumber's signature License number Date /2 Inspector Complete plot plan p' 1 NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the em. • Two horizontal reference points to center of septic tank manhole eover. • Show alternate benchmark, if a 'cable. LAN VIEW y �r r s. Z d� Z /N INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ST. CRO X Permit Holder's Name: ❑ City ❑ Village Town of: State Api MEALY, ED I TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: U c>O s Y o _ _ _ TANK INFORMATION ELEVATION DATA A9900208 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S v Benchmark ,Z?-( Dosing O !� tion Bldg. Sewer `IS. Holdi 5 Ht Inlet TANK SETBACK INFORMATION utlet TANKTO P/L WELL BLDG. Ventto ROAD D Air Intake Septic .7 3' f f s l NA Dt Bottom Qa q �p Dosing 7 -� �r 4- V I f 7 / NA Header / Man. 0 Dist. Pipe /O Z r{? 3 oZ -o' Ho Bot. System ; Z /o Z - 3 z9 D PUMP/ SIPHON INFORMATION (;A Final Grade Manufacturer �j emand pk q , 7 Z Model Number �l) -4+IG PM TDH Lift Z 3u `riction� �, Systerrt S TDH 11,t Forcemain Length /t�5"/ Dia. H�or Dist.ToWell SOIL ABSORPTION SYSTEM D TRENCH Width / Len th r No. Of Trench s PIT No. Of Pits Inside D y DrfVTN61QN nufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O ::Z P W BER Mod er: System: ±t;S -7 /00 7 7 f OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) e ,r x Hole Size x Hole Spacing Vent To Air Intake u( i I/ rr Length =1 Di Length �Q_ Dia. � Spacing ( 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.) s� `�� �jU►n s �'�g O� T pN- TR03.28.19,NW,SW`r5� LIUM L M � O A / E - COUNTRYWOOD L C�U&.-I- 4p T 6 L � T S • �`�} � / L 6 4' �� �w�a :+� sue( z 9' 0f �l� QW&Y o tope✓ -tsz.6 Plan revision required? ❑ Yes No Use other side for additional information. Z� Oq Aq L SBD -6710 (R.3/97) Da Inspector's ature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e `s 3 e e r G A w.� e E _ 4 ..._, F e e E _ as _.., �m�. ,.. �. 3 e 2 I ae _. a . ate_ t g a ....,a .. e .. .. „e,e F e , . .� ..,.. .. ..... _.. e• 5 ®m —a q e .. .. ..«� �_, ., a pee.. E 3 t e Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue NAiscons 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 than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary , Permit NU ber Personal information you provide may be used for secondary purposes El e Check if revision r�pi loa pplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION 17 X- Property Owner Name Property Location E' Ztf A IW 14 114, S j T , N, R E (or 4v Property Owner's Mailing Address Lot Number t u m be r o` G 'O"'m ,e City, State Zip Code Phone Number Subdivision Name orbs N ( . kA) P6 D IL _ TYPE OF BUILDING: (check one) ❑ State Owned 0 Ity Nearest Road p Vil Public 1 or 2 Family Dwelling - No. of bedrooms Town OF ,E' III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) > _2� 19 . 1ln Z5 1 ❑ Apartment/ Condo e d - .23 y- 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. 0 New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an -- ____System ____ - -__ System __ _____ ______Tank Only_____ ______ Existing 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 210 Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure If 42 ❑ Pit Privy 13 ❑ Seepage Pit g X 63 r B off,D 43 ❑ Vault Privy 14 ❑ System -In -Fill p 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 � iv Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation D b / . 2- , 3 Feet Feet VII TANK in Capacit g allons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing strutted T nks Tanks Septic Tank or �l_.�? ;n k =SA E' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Spcw�4iber Q C I ❑ ❑ ❑ ❑ El VIII. RESPONSIBILITY STATEMENT p-WA w Z *.3ffL I, the undersigned, assume responsibility or installationAf the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N amps) WIPI'IVIPRSW No.: Business Phone Number: � Plumber's Address Street, City, State ip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved pp [ Given Initial SanitaryPermitFee (Includes Groundwater L I ssued Issuing nt S (No Stamps) roved surcharge Fee) /��S p0 Adverse Determination r� J 10 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: D- 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 isto be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. 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 isto 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,jocation 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. � •2� �,�.c. s• 7' w J olm —?4 1 I= IYO i F P,5• 30� of ® � 14" ?tic 0� � g / I � Slt�c�1 v 1 � Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 19, 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: 05/19/2001 Idea tfccn Numsers Transaction ID No. 225178 Site ID No. 172267 SITE: Please refer ta�: both identification nunrs, ST CROIX County, Town of TROY above, iii alI c orresponden�wi#hthe agency' , NW1 /4, SW1 /4, S3, T28N, R19W Lot: 36, Subdivision: COUNTRY WOOD EDWARD MEALY FOR: Description: MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 467959 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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. Since y, DATE RECEIVED 05/05/1999 FEE REQUIRED $ 180.00 w FEE RECEIVED $ 180.00 k. ETER E PAG OWTS PLAN REVIEWER II BALANCE DUE $ 0.00 Integrated Sery c s (608)266-2889, M - F, 0745 - 1630 HRS PEPAGEL @COMMERCE.STATE.WI.US i r— Page of 6 MOUND SYSTEM MAY O 1 9 FOR SAFEry A BEDROOM RE DENCE E ROOM SI & -�- LOCATED IN THE t-�W /4 OF THE Sw 1/4 OF SECTION 3 ,T N, R 1q W, TOWN OF %'j.L..�zzlx COUNTY, WISCONSIN. \,ZT 3U QF Couk-' �y wove INDEZ PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION: PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR �D so�v , w i Sal U l b PREPARED" BY WEGEIREF=;Z E3 C:) I L TEST I t\1 (3 �� AND. ` SCONE® o DES Z C3 1M � •••~••••`+ { ? .� �� AQ F.O. BOX 74 421 K. KAIK ST_ j WE HE ER � 'Z f �; p► RIVEP FALLS. YI 54022 �SWORTH, p 715- 42`5A165 l L' o 1 S o S� 4eoo� i S I G N �' �► c JOB NO. � -� 1 PLOT PLAN ' Page - 2— of � Scale i LJAU.. "Rt 8Q { " So w ' - g F - T Z O -1 MUUM*) ()"j J 0 p�S 30oF � Lj ID 1Z Q�P 0 i2 .n i f _ bo DoT ��.a�r�T � � �►�1vwZ. �L , tioo- � ' o�Z bts�i / ��<COw� OF- ea �LSo - �t"1 s PC�'�'R — Z� o ,� � LSL i u L� , to 2. • � ' i I / / /' s. 2 a 3M � Lo CAKnb "l NOTES .1. Elevations shown are existing ground elevations unless o �i.se noted. 2. Install permanent markers at end of each lateral. ( y required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be Yz-oo / gallon capacity manufactured by RAJ � �MC ' ea.. e iZ� j��z o� u eTS Lv / 7-003 et. r L_ 3:n2 . 5. Bench Mark � _ too• o' w tZ et . Ttut►SR�rZn LTrz _ . P'�'T• AM K loo• .11 k ti 6. Divert surface water around system to prevent.ponding at the uphill side. - Page Of Approved Synthetic Covering FIfS- '" C- 33 Distribution Pipe Medium Sand Topsoil - - - -- F Elev 'LOZ- 3 —J D E 3 I ` b y % Slope Bed Of i « - "2 Force Main Plowed Aggregate From Pump Layer D - Z Ft. Cross Section Of A Mound System Using E -Z Ft. A Bed For The Absorption .Area F b -`b Ft. G \, o Ft. A 3 Ft. H \ -S Ft. Linear Loading Rate = °► - 5 GPD /LN FT B 63 Ft. Design Loading Rate= o -'f GPD /SQ FT I lb Ft. J \ o Ft. K �q_ Ft. i ion L q I Ft. of– Fo rce Main W Ft. — L j Observation Pipe --, A - - W o - - - - -- - �� - - -- --- - - - - -- --------------- - - - - - •I Force Main Distribution Bed Of 2 - 2 % °� P pscT Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page j Of Perforated Pipe Detail 0 End View ) Perforated / End Cop �� PVC Pipe one` ` c Install permanent marker �o <` at end of each lateral Holes Located On 13otfom, Are Equally Spaced Q S PVC Force Main Q PVC Manifold Pipe w Distri ution Pipe Last Hole Should Be I Next To End Cap End Cap P 3o Ft. Distribution Pipe Layout S �_ Ft. X y $ Inches Y 4 8 Inches Hole Diameter ley Inch Lateral Inch(es Manifold Z Inches Force Main Z Inches # of holes /pipe Invert Elevation of Laterals IOZ.$ Ft. Place 1st hole Z 4 0 from center of manifold with succeeding holes at '(Q" intervals. Last hole to be next to the end cap. Combination Sep•t.-,:ic� lank aiid Pd-MP CHAMBER CROSS SECTION. ARID SPECIFICATIONS' PAGE S OF I O VE T CAP WEATHER PROOF JUUCTIOLI box 4' C.Z. VEMT PIPC APPROVED LOCKIMG 10' FROM ODOR, MANHOLE COVER k :iIUDOW OR FRESH u'ARr�lN LA6EL.. 1 ►.�SWl T G101J C' IPEr \ A!k INTAKE cwaDuiT tj \ dr � 6`.nw.LsZ'���o i `f�h11A1. �fj - - ---------- c � i., PROVIDE I - - -- — I/J LE T AIRTIGHT SEAL 34FF��S A I I I APPROVED J01uT: APPROVED JO W /C.I. PIPE6RP6)C PI PE or- Tank construction I II ALARM shall comply with "I II ILHLk 1;3.15 and 83.20 8 I I I oil C I I � 3- 6� I ELEV. FT. PUMP - -J �. OFF D COtJCRETE ��, 83 - QO � BLOCK IJ 2 3 " APPRne 604t N av6 DoIr. RISER EXIT PERMi1TED OLy IF TAIJK MAIJUFACTURER HAS SUCH APPROVR.L g 5EPTIC f SPEC.IFICATIDQS DOSE Wl�� c 3.53 TAUK M/�I.IUFACTURGR: tJt1MF5ER OF DOSES. PER DAy TAWK SIZE: VLC30 "150 GALLOAIS D051` VOLUME r ALARM MANUFACTURER: S -S• E1-kzC—j)20 S"1`JaTL�1 II.ICLUDIMG 15ACKFLOW: '`O GALLONS MODEL IJUMBER: HW CAPACITIES: A- ZS IMCHESOF, q0) GALLOUs SWITCH TYPE: m (2u B= IUCHES`OR 3 - 3 G61-LOUS PUMP MAIJUFACTURCR: GC) UI_DS C= l� INCHES OR 1°l3'� GALLOUS MODEL ►DUMBER: D= INCHES OR � GALLOIJS SWITCH TYPE: �'lU2CLiRAf MOTE: PUMP AUD ALA M AR TO 5L MIAIIMUM DISCHARGE RATE 3 - 'q GPM IN5TALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEU PUMP Off AU0.,015TRIBUTION PIPE.. �a' �' FEET t /, tiw1MUM METWORK SUPPLY PRESSURE .. . . . . . . . . . 2 FEET + ��S FEET OF FORCE MAIN X Z ' F do FT FKICTIO N FACTOR_. g ° q7 FEET . = TOTAL 09MAMIL HEAD = 7- S. 6 FEET Pump chamber DIAMETER �1 IIJTERAIAL. DIMLW5101J� OF TA1JK: LEIJ6TH - .WIDTH ;LIQUID DEPTH • BOTTOM AREA — - 231= GAL /INCH AS PER MANUFACTURER = �(J`13 GAL /INCH ' PU�'�1P P�1Z�Oa- 1'�1�►'jvCt =, CUtiz -UE �� 6 ar- 6 0 U77 Submersible VIA Effluent Pump I1 u 3885 APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously Specifically designed for the be provided in starter unit. bronze impeller available as without damage. following uses: • Shaft: threaded , Bearings: PP 400 series an option. ■ Bearin s Upper and • Homes stainless steel. ■ Casing: Cast iron volute lower heavy duty ball bearing • Farms • Bearings: ball bearings type for maximum efficiency. construction. • Trailer courts upper and lower. 2" NPT discharge adaptable m Power Cable: Severe duty • Power cord: 20 foot for slide rails stems. • Motels standard length (optional y rated, oil and water resistant. • Schools lengths available) ■ Mechanical Seal: SILICON Epoxy seal on motor end . • Hospitals CARBIDE VS. SILICON provides secondary moisture • Indust Single phase: Industry •'' /s and '' /2 HP –16/3 SJTO CARBIDE sealing faces. barrier in case of outer jacket • Effluent systems Stainless steel metal parts, damage and to prevent oil with 115 V or 230 V three BUNA -N elastomers. wicking. prong plug. SPECIFICATIONS • % -1 % HP –14/3 STO with ■ Shaft: Corrosion - resistant ■ 0 -ring: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. 3 •'/z -1'/2 HP –14/4 STO phase models to guard /" maximum. • Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities: up to 128 GPM. listed models – 20 foot on accidental reverse rotation. • Total heads: up to 123 feet length SJTW and STW ■ Motor: Fully submerged in co Canadian Standards Association TDH. are standard. high -grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat U� Underwriters laboratories carbide -rotary seat/silicon FEATURES transfer. carbide - stationary seat, 300 ■ Designed for Continuous series stainless steel metal • Impeller: Cast iron, semi- open, non -clog with pump - Operation: Pump ratings are parts, BUNA -N elastomers. out vanes for mechanical seal within the motor manufacturer's • Temperature: protection. Balanced for recommended working limits, 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. • Fasteners: 300 series METERS FEET so — — stainless steel. _.._ .._. SERIES: 3885 • Capable of running d 25 _ SIZE: 1/4" SOLIDS P 9 rY — RPM: VARIOUS without damage to "' - 1 ---- _ 1-- 1 { components. 70 w j � Fr 20 - Motor ° a so Single phase: _ WEO • '/ HP, 115 V, 200 V, 230 V, 15 50 - - 60 Hz, 1750 RPM; 1 /2 HP, . r -- , 115 V, 60 Hz, 3500 RPM; 0 4 w E05R '/z HP –1'/ HP, 230 V, a _ 60 Hz, 3500 RPM. ° 10 3o • Built -in overload with wEo automatic reset. 20 - -...- .___. t - -- AN • Class B insulation. 5 to _ Three • % HP – % HP 200/230/ OL 0 ' I 460 V, 60 Hz, 3500 RPM. 0 10 20 30 40 50 60 70 80 90 100 110 120 130GPM • Class B insulation. 0 10 20 30 m CAPACITY n 1995 Goulds Pumos. Inc. Effective May 1995 Wisconsin Department of Industry SOIL AND SITE E V A L U A T IQR T Page 1 of 3 Labor and Human Relations j Division of Safety & Buildings in accord with ILHR 83.05, .W "AdITT: Code AUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size must inc ude, `but St. Croix not limited to vertical and horizontal reference point (BM), direction and ° /_of diope,, ,cale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. � 7 040- 1234 -70„ APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATI�,N " !R!EW� DATE 11 9 PROPERTY OWNER: PROPE ATt ©N Edward C. Meal OVT LOT NW 1/4 ;SW /i4,S 3 T 28 N,R 19 fir) W PROPERTY OWNER':S MAILING ADDRESS LOT 8L4CK at W. NAME OR CSM # 480 G reen Mill La. 36 1 ``` Country Wood CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE g9OWN NEAREST ROAD Hudson, WI. 54016 (115)386 -8619 Troy Tower Rd. [x] New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 4 bed, gpd /ft •5 trench, gpd /ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 101.30 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem 1:1 S )F21 U ® S ❑ U ❑ S [2 U! ❑ S KI U [I fo U ❑ S 13t SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 4 .6 1 2 12 - 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 27 -36 7.5yr4/4 none is Osg mvfr gw if .7 .8 elev. 10 4 36 -60 2/5y7/6 none fraC9URED LIMESTONE na na np np Depth to limiting factor 36" Remarks: Boring # 1 0 -8 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 8 -18 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 2 A 5 3 18 -31 7.5ry4/4 none sl 2csbk mfr gw if .5 .6 Ground elev. 4 1 31-60 2/5yr6/6 c2p 7.5yr5/8 cl M na na na np .2 10 ft. Depth to limiting factor 31" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th.-Aw., New Richm WI 54017 Signature: Date: 4 -20 -99 CST Number: m02298 PROPERTY Edward Meal SOIL DESCRIPTION REPORT Page of P v 2 _ g — 3 PARCEL I.D. # 040- 1234 -70 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch 1 0— 8 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 8= 18 7.5yr4/4 none sici 2msbk mfr gw if .4 .5 Ground 3 18 -26 7.5ry4/4 none scl 2msabk mfr gw if .4 .5 elev. 99.1 ft. 4 126-48 2.5y5/6 flf 7.5yr5/8 cl /w' h fractu ed limes one particles np np Depth to limiting factor 26" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # i mom Ground elev. ft. i Depth to limiting factor t Remarks: SBD- 8330(8.05/92) M STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Edward C. Mealy New Richmond, WI 54017 MPRSW -3254 NW4SW s3- T28N -R19w (715) 246 -6200 town of Troy lot #36- Country wood N 1 =40' BM.= base of elec. transformer @ el. 100.00 Alt. BM.= base of elec. transformer C el. 100.30' N IZ Z r a k (PA Cm 53 1 Gary L. Steel 4 -20 -99 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownerghtyer Z_P kf Mailing Address _ `�� 014 r /� 141W e ,_,.44a d i., Property Address 5 07 7_EtZ//t-fwi (Verification required from Planning Department for new construction) City /State { rtDSr .4 w-E Parcel Identification Number jY0 - 11-rV —70 LEGAL DESCRIPTION Property Location Vw ' /., c c L '/4, Sec. 3 , T -)-X N -RAW, Town of Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # S'�S` - 97d , Volume /3s'L , Page # .2 �Q Spec house ❑ yes 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. Uwe, 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. Z7-� X11 - 1 IGNATURE OF APPCICANT 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. S� 12 I 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 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor a�fid Human Relations , Divisior� 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 PIAI # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION r �, ,EVIEW 134 ' DATE PROPERTY OWNER: PROPER ATION Richard Stout GOVT. L ' ,14 l4 °; T ,N,R 19 XR(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # J �StMK# S NP�ME OR CSM 1353 Awatukee Trl. 36 W r CITY, STATE ZIP CODE PHONE NUMBER ❑CITY It E.QV1� t_lv� {� EST ROAD Hudson, WI. 54016 V154549 -6731 Tr ower Rd. ] New Construction Use [ x] Residential / Number of bedrooms 3 existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 4 bed, gpd /ft2 - 5 trench, gpd /ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate • 4 bed, gpd /ft • trench, gpd /ft Recommended infiltration surface elevations) 102.7 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 101.7' Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ❑ S ® U CAS ❑ U ❑ S ®U ❑ S CR U El ® U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench U 1 0 -10 10 r2/2 none 1 2msbk mfr cs 2f .5 .6 2 10 -33 10 r4 4 none sicl 2msbk mfr gw if .4 .5 Ground 3 33 -41 7.5 r4/4 c2 7.5 r5/8 sicl lcsbk mfr gw na .2 .3 elev. 102. 4 41 -55 10 r6 4 Fractured Limestone na na n inp Depth to limiting factor 33" Remarks: Boring # 2 ::. 1 0 -15 10 r2/2 none 1 2msbk mfr cs 2f .5 .6 ....,.:_:;< 2 15 -29 10 r4/4 none Ski 2msbk mfr if .4 .5 Ground 3 29 -40 7.5 r4/4 none s lcsbk mfr gw na .2::.3 elev. 4 40 -60 7.5 r4 6 none cl m na na na np 2 10 ft. Depth to limiting factor 40" Remarks: CST Name:— Please Print Phone: Gary L. S 715-246- Address: 1554 200th Ave., Richmond, WI. 54017 m02298 Signature: 5 -16 -96 Date: CST Number: i PROPERTYOWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending — Lot #36 Depth Dominant Color Mottles Texture Structure Consistence Bourry Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T ram 3 1 0 -10 10 r3 3 none 2 10 -19 10 r4 4 none Ground 3 1 19-29 7.5 r4/4 none scl lcsbk mfr Qw na .3 elev. 100 ft. 4 1 29-54 10 r6/4 Fractured Lirrestone na na n` n Depth to limiting factor 29" Remarks: Boring # RIK i Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # i;:ri: Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) I STEEL'S SOIL SERVICE Gary L. Steel Richard sTout 1554 200th Ave. CSTM2298 NW4SW4 S3- T28N -R19w New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #36 Country Wood t N 1 " =40' BM.= top of 12" pvc pipe alt bm= top of wooden post C1030' t o A � & e �. i ✓� ISH) VA (Q 2 � 2.2.E Gary L. Steel 5 -16 -96 SIC PIT) A Mi1. BAR OF \VIAC.? ^:YN !C?i: M �VAKR:�NCY Uht:l� This need, ' • ma rd r �t °u.��! ,r�Yvs I Ito .Jpo-x AUU - r ' t �' i1. CIE' a 1 � ' Edward Jul `c _._ l itnessCtll �hx :. C, rd dfid J1111 l'"IF_'11y - I,ot 36, Country : mod . j:-st Adc it ion ti:e 'Pown 480 0 r ,n alil l 1, Troy, St. Croix County, Wisconsin i;u''�'on, Wisconsin 54016 FIti �.;��- 1234 -70 TRANSFER FEE rurth r - and ,ttgr n � � t nc.• 1 - _ •K4Znon Bast as - - S S Or Richard 0. Stout AUFHEN11CATION 1CKNO"Lt_DGMFNt state ofV''.tiiansin. i v C �r y � Stout �Z t7p l y "' V a O 1 M - 1 o N 1 \ V 1, \ (X1 OJI 1\ Co -J I �� o a ti " , °• io M o I� N N I ,ZS'£bb m "t'l.Sb,£ON 1 i U �t N I O �1 I M >I ' ril n / 1 _ I vil � 3 a y i Ul it >I 6 I M N ° o I pN N G oo ,00 A, 2 �h0��0 3 „6S, 9 f rO/V e ,69'16£ 3„69,5:£,ZON If � I � / •FF C) I � a N I I o l N �I o I 1 I a]% 1 � I l 3 3 „II,Zb,00S I \ i \ _JI 1 N LL \ \C I— ' ^ g a I V N � I OD a t'� �• \ 71 Z N o ^ \ Cjl CSI N 01 Z ` g g ,69'LOb 3 „0£,GbpZOS \ \\ L!_ - 0 I � O (.01 c.l l p 1-1 2 N Q O / r1 _J I A I y Al y ry �. / w / W , p8