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HomeMy WebLinkAbout040-1229-80-000 • ' l Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanit Permi 850 ST . IX Personal information y ou rovice may be used for second p urposes [ Privacy La s.15.04 1 m 338850 Y P Y rY P P [ Y O( ))• Perrot cal l`'" OMES , INC . E] City o Vlage Town of: State Plan ID No.: CST BM Elev. : - Insp. BM Elev.: BM Description: 1 Parcel Tax No.: $Nt 1 o3i:G3 040- 1229 -80 -000 y S�vy,t erev� ro TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� c enchmark "y 0 15'e i�Yy. 0 Dosing .� 000 3. Aeration Bldg. Sewer ,Q o32.� Holding St Ht Inlet 107 : (R TANK SETBACK INFORMATION St et TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic 4100 Ir NA Dt Bottom /027 SG Dosing + /Dv l `� Qd —+16 t / NA Header/ Man. O .6v Aeration Dist. Pipe Y �� �? FO Holding Bot. System /d 3 7 - 'q'R PUMP/ SIPHON INFORMATION Final Grade Manufacturer �(/��, Js (� �;� Demand �ic�� `• Z /U3 7 Z �' Model Number Al 1 5 yC7 S ,� GPM 2 TDH Lift Q, �� Friction .31 System 2 - TDH / ?.� Ft mead Loss Forcemain Length - Dia. 2 " Dist. To well SOIL AB RP ION SYSTEM BED / TREN Width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME -N " I I DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION TypeO CHAMBER 2 1i f q�r OR OMIT Model Number: m Syste DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) y x Hole Size x Hole Spacing Vent To Air Intake Length q- Dia. Z Length _T r Dia. LA� Spacing / ' �,, P -� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 16.28.19,NW,SE 3 SOO LINE RD — GLOVER STATION LOT 63 `fU G�r`� u�x �• C 3 = l4 3 6 - 3(p LJ >! &I ) V of Su Seer o�'F �¢tt 8�1 /� ( / `/ ! S e�O e^v 3 dCck - rr� W r W ; 44\- O Sl Ver - �'t iC�GI (o t Ost o � SY SIY�^� v d A(K Lor;rys. bee&k3P GjeUj /os,s didr4 Vr-a CA 'tt,p, 5+1�r++ -i�#_e K de vodlo'_5 --s« 'OR ;,ms e Gf;-;"- Plan revision required? ❑ Yes ❑ No Use other side for additional information. (Z L'P ! 1 n, _ SBD -6710 (R.3/97) Dat Inspector's ignature Cert. No L � � ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a E z k E i s .. ......_.. >.... ... _ .. ._ . 3.. .. e. . _ _,... _ - ... _ .. _ f ' e .a...� A .. . - - - -.m ., m e .. E ee m, < c r a...... ..� A .�. ......,...e ., ..,_,. � _ee. a e. . m... 3 � 3 j s �e e va e 3 i te a, .. .se ..e.e i ,.. e e E 3 t am. e G E 4 4 i g. 3 � v ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338850 Permit Holder's Name: ❑ City ❑ Village IN Town of: State Plan ID No.: BIERMAN HOMES, INC. TROY CST BM Elev.: Insp. BM Elev.: — 7 — = ion: Parcel Tax No.: 04(}- 3229- 80-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic r 6sr� Benchmark 3 6 .3 6 3 Dosing � to VJ0 Aeratio Idg. Sewer Holding / Ht Inlet �5 TANK SETBACK INFORMATION utlet I b Vent to g TANK TO P/ L WELL BLDG. Air Intake ROAD .1150- Septic 4-100 O T V/ NA Bottom Z 0 Q Dosing - �-1�U� ± 0 �' ( NA Header /Man. � p \, D Aerat n Dist. Pipe Hol Bot. System PUMP/ SIPHON INFORMATION Final Grade l anufacturer (, P e Demand %off p. Model Number �, 0 GPM Z 10 31.0 TDH Lift Friction S stem TDH Ft ,� L - 31 �' Z. /Z.3( Forcemain Length3 Dia. Z Dist. To Well e SOIL ABS PTION SYSTEM BED 1AENCW Width / Len th 1 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Numb System: hAb 3 Qd OR UNIT DISTRIBUTION SYSTEM Header /Man Id Distribution P�� le // x H ole Size x Hole Spacing Vent To Air Intake Length Dia. z Length Dia. �y Spacing I& ' f( 4 9 6 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes El No ❑ Yes ❑ No OIL COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 16.28. -4 4 9 , > , SE 337 SOO LINE �rut — GLOVER STATION LO 63 CO�1�d1tt ed eax� l r 5 LDbuY GcT �0 4�i 1 7YX11� �J� ` Q� �J(�� iP4l oco f rOY e h4Y�oe i/ � �'� pN u�S ly S l w� o k c1U �c'. � UPV ft" � l 4ew, Kn S d l e ]`fie ji(5 Y e6e was 6faif�4 0.f P ( aU D(� y b1e(JI �^ V Plan revision required? ❑ Yes ❑ No Use other side for additional information. I FF1 11 SBD -6710 (R.3/97) Date Inspector's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r s � r s — F . .meA.e.: e. ,d...i ( � I x F 1 1 3 s A .�w mom, e .«.� d � € 5 t e .. P ee x em v � A e 3 € E �r W I' f t i E E « { « - e.,.e..,« _ s.,,..,. ,adm me` �...__e. i _.&«...».. ,.C.em ® a . .,....m.W, m ®...m- gg «. «.. .. �......».... _ s 3 e � : s ' - .... ..... _.. ._.. ._ .. r i ' E m �. m �. . ST. CROIX COUNTY ZONING DEPARTMEN � AS BUILT SANITARY REPORT `�,�,- Owner I i C % �J Property Address � p,� Cit �o Rc � tY ING ! Legal Description: Lot 63 Block Subdivision/CSM # Af 1j) 1 /4 5E 1 / 4, Sec. &�, T -R_/jW, Town of 7 7 ,01/ PIN # D-Z82!2 EL- Ij SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC S/ Setback from: House Well P/L Pump manufacturer S Model 112 — V Alarm location Pr5 tyrA (� ti (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 �D Number of Trenches Setback from: House (_ Well ;, U P/L Ig Vent to fresh air intake : ELEVATIONS / Description of benchmark C 5� 0M ( d el V G . Elevation Description of alternate benchmark u U,JoA- f-roA/ Elevation 10W, 7 7 W :Q e- iVi SRc G�: o+-- /ego" S Building Sewer /D36 Inlet 1Q36. ' 2 / PST Outlet ' ._ PC Inlet PC Bottom M54 Dw Header/Manifold MV 1, Top of ST/PC Manhole Cover Distribution Lines( ) �Q 0 ( ) ( ) Bottom of System ( ) & 3 () ( ) Final Grade ( ) 10 �1 t 3 () ( ) Date of installation 6.6f9 Permit number 3 3935 State plan number Plumber's signature License number m P66 Date f 1 Inspector �Dh� Complete plot plan k qo I ✓ �.L d� F l� 6 M` p t 1 Safety and Buildings Division N*LSANITARY PERMIT APPLICATION 2 01 W. Washington Avenue onsin I n 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 81/2 x 11 inches in size. (P-0 �x • See reverse side for instructions for completing this application State Sanitary Permit Number 3 9-Is57F 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 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Z Pro rty Owner Name Pr perty Location JeW �A. L c f cy �l� g o ,v (7/a 1/4, 5 � T Z g' , N, R E (or)e Propert wner's Mailing Address Lot Number Block Nu mber Igo A ®x / Cit t to Z O (�on�e ber Subdiyisit- 0L)Fo^rCSM?44 /d� (TAI II. / B U ILDING: (check one) E] ° owa State Owned O(D 'itlia /��� Nearest Road Public. 1 or 2 Family Dwelling No• of bedrooms n OF 1'� S!9 D INE 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment /Condo - Z — —000 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 KNew 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ________ System_____ ________TankOnl�r______________ Existing System ________ Ex- 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 ELMound 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. 7. Final Grade Required (sq. ft.) Pro osed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) oQ Elevation a �3Oi eet 0, S"Feet Capacity VII. TANK in allo Total # of Prefab. - Site Fiber- Exper. INFORMATION g Gallons Tanks manufacturer's Name Concrete con- steel glass Plastic App New Existin structed T k Tanks ptic Ta an- ❑ ❑ ❑ 1 ❑ ❑ ift Pump Tank /Si h mber ❑ El El 13 ❑ Vill 79EMNSIBI LITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Name: (Pnn) Plumber's Signature ( Stamps) MP /MfiR"7 No usiness Phone Number: U 6 CLS .A/ ` ° Z 73_ PI tuber's Address (Street, City, State, Zip Code): 2 A /f 3 � G s ws �,� LtI D IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved } ; Sanitary Permit Fee (Includes ter Groundwa ate Issued Issuing Age gnature (No Stamps) ? i Surcharge Fee) proved E] 2 Owner Given Initial Adverse Determination 3 /C� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL. SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS i 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Page of 6 MOUND SYSTEM FOR A 5 BEDROOM RESIDENCE e 6'� 6 z.8 l l A ED IN THE o�k11 4 OF HE S� 1 4 OF SECTION ,T N, R 9 W, C T / T / � OWN OF COUNTY, WISCONSIN. _ _ coT 63 __o� " G�ov�4, ST�ht1N �L`� t� INDEX PA GE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW +CROSS SECTION Of MDuWb PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT , .PAGE 5 of 6 PUMPING CHAMBER L Ro5S S Et-Tlbr-f SPECS, PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR �►�� Yom t� ►vOL�1ZSON c/o Bt�2tn ttow��S Ys - SST? jv G S , � N 5 So 33 PREPARED BY WEGEE�ER SOIL TEST I NG AND. '� , ��, 0 ► � DES = CPi SlEfzV I CE F .©.W.T.S. P.O. BOX 74 421 N. 1<AIK ST. ARTHUR L WEiFRER } Conditionall RIVER Fats. NI 54022 euSV:uRnl. S A P wl) R 0 V E ® 715 - 4.,-0165 � t W�. / t� -J�-.- DEPARTMENT OF COMMERCE 1' > •.•...... DIVISION OF SAFETY AND BUILDINGS x9� < c dG,�r 4t SLE CORRESPONDENCE JOB NO. Safety and Buildings . 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary April 05, 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: 04/05/2001 Identification Numbers Transaction ID No. 218196 Site ID No. 169328 SITE• Please refer to both identification numbers, Site ID: 169328 L above, in all correspondence with the agency, ST CROIX County, Town of TROY; SOO LINE RD W1 /2, SE1 /4, S16, T28N, R19W DAVID ANDERSON RESIDENCE FOR: Description: MOUND SYSTEM FOR DAVID ANDERSON Object Type: POWT System Regulated Object ID No.: 458977 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. Sincerely, DATE RECEIVED 03/29/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 KEITH A WILKINSON, POWTS PLAN REVIEWER BALANeVVUE Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US ?S ' T+' `h FhOT PLAN _ Page 2- Of Scale 1" = 40 ou t A 30� oti C S . U z5' oF .t'4�c, S � It f I I I 1 f _ � � i' � + L j moo o onr - W tlQ t) LEM31 • � tv .� �a`t.o'� r -�o�wp f'riw f 7T U-M -V • Mkt. l0� e.01 NOTES •]-. Elevations shown are existing ground elevations unless otherwise noted. e t en of each lateral. r e q uired) 2. Install permanent marker a d e ( `1 u q F 3. Install 4 observation pipes with approved caps. ( z required) 4. -Sdptic tank to be I t46S JtOoo gallon capacity manufactured by �v1C''S� � • P��UcTS 5. Bench Mark aj*L a > s o-v Z" tUPQ PI Pt 1 © - --- , VAM *Z - et to S` 11 1. �_ 6. Divert surface water around Sys teh to prevent.ponding at the uphill Ba de. APR -05 -99 MON 02_04 PM NELSEN WEBER SURVEYING 1 715 425 6564 P.03 BLOT PLAN p 7- of Scale 1 DLO ' o' 3 ° d \ a U ° o ZS' OF tlyp�, \ I Lo lls li TV I � ° I �I 'I L ��f•1 S h112�9 -�...� I-° �1 � °� o � �.I 1.M3 egnPmv� kMkj .\ P'PW INN L(M-,v I' 2 S 1- Roy °1 rM)4 OP }ski -,* NOTES .1. Elevations shown are existing ground elevations unless otherwise noted. 2. install permanent markers at end of each lateral. ( Y required) 3. Install 4" observation pipes with approved caps. ( - T - required) 4. - Septic tank to be 1 96.5 JLW-b gallon capacity manufactured by 5. Bench Markawli�-l_ Et.1o a� Z" 11tsN �t _- 6. Divert surface water around systean to prevent .pondin at the uphill side. APR -05 -99 MON 02 05 PM NELSEN WEBER SURVEYING, M 1 715 425 6864 P.04 l p age Of Approved S Covering Distribution Pipe q STY•-► G 3 Medium Sand / Topsoil -_ -_ F Elev. W'3$. O 3 l b -7 %Stops Bed Of 2 i2 (Force Moin Plowed Aggregate From Pump Layer 0 \•U Ft. Cross Section Of A Mound System Using F 1.5k- Ft. F Ft. A Bed For The Absorption Area o - $ G o Ft. A 8 Ft. H Ft. Linear Loading Rate= q .S GPD /LN FT g 9 Ft. Design Loading Rate =o -`f .GPD /SQ FT j V, Ft. 0 - 7 Ft. K 11 Ft. A-1t-er~n Pes,t,, L \p\ Ft. a.€ Force-Ma4r, W Ft. Observation Wipe I J � K - A - -- -- --- ------------- ----- W o - ------ ------- Force Main Distribution Bed Of 211 - 2 .2 Pipe Aggregate I Observation Pipe Permanent Markers (74+cho� SecuuCely) Plan View Of Mound Using A Bed For The Absorption Area APR -05 -99 MON 02 :05 PM NELSEN WEBER SURYEYING.M 1 715 425 6864 P.05 Page LI Of l� Perforala4 Pipe 00011 0 End View perforoled End Cop �� PVC Pipe In p ermanent 'marker at end of each lateral so sco� cis Holes I.ocaled On Sollotn, Are Equally Sp aced v s PVC Force Main P PVC Manifold Pipe F pislri ulion Pi e L�osl Hole Should Be Next To End Cop End Cap P Z-S Ft. Distribution Pipe, Layout S Ft. X 1 4a Inches Y ub Inches Hole Diameter pr y Inch Lateral _1!! Inch(es Manifold :" Inches Force Main ry � Inches #of holes /pipe t0 Invert Elevation of Laterals 1 08.5 Ft. Place 1st hole :From center of manifold with succeeding holes at 46 intervals. Last h ole to be next to the end cap. APR -05 -99 MO_N 02:06 PM NELSEN WEBER SURVEYING,M 1 715 425 6964 P.06 Combination Septic; Tank acid PUMP CHAM�EFI CROSS SECTIQIJ ArVD SPFCIFICAT141`15 PAG}✓ S OF jo -VC T CAI WEATHER PROOF• �u►JCrlou BOX •I'e.I, VENT PIRG , APPROVEp LOCKINro '—.1O FROM DO M&wHOLC [OVER �t'M wA¢ti►I�.16 L_ A.%EL. ,rIIJDOW OR rRCSH Cot..+Dv1T AILJTAK� f tj ,i ,6 ntN• YsRA _ ( 4 P1P" 11, PROVIDE I I IAILE T � AtRY1GNT SEAL _ sa 41ry- L�5 I I APPROVED ) OI IJ Y: APPROVED JOItJT A I I ( W /C.X. PIPEORPJC W/C.I, PIFE.CR Tank r_onst7ruction I II ALARM shall comply with I ►I ILHR 13.15 and 83.20 d ( I I I ow C 1 I CLEv 1 oZS FT .D __� PUMP -� OFD O COt'JCRETE v LOZ O t DLOCK . �3" AvPs�e� K C) RISELIT P LRPIIUED OWLS IF TALJK MAI I` JUFACTURR HAS SUCH APPROVAL BFOO $EPTIG F 5PCCIFICATIOW p pSE I -5ZR CA1JC,R IJISrhIlER OF DO$[S: S.bc, PER DA3 TAWK MAW U FACT UP.r, K. luo VOLU r TAIJK �IZC, L4(- l O GA DOSE E M ALARM MANUFACTURCR r : S.S ' INeLUDINO eACKLow: �S G AI,�DNS MODEL ►JU)A6CR: CXPACITIES: A= � IMCNCS OK SI��� &ALLO SWITCH T�PC: 1 8= �' IWr_XES"OR �'� G(LLOLJS Bump MAQLJF'ACTUREK: " LS C w INCHES OR 2 li,'� GALLOUS MODEL 1JUKbER: 11* y� Dw '" INCHES OR GALLOJJS SWITCH TYPE: P - 1�.�R MOTE: PUMP ARID ALAKM A z 1 S MIMIMUM DISCKARGL RATE ' GPA INSTALLED OW SEPARATE CIRCUITS VERTIChL (]IFFfrCEMCE DETWCEW PUMP OFF ALJD. DIST RIBUTIOW PIPE.. 3.5o FEET + MIWIN►UM WCTWORK SUPPLY PRESSURC • , , . . . , , , . . 2.50 FLET o rr_ + O FLET O F F0P,cE /•'� im Y, b 50 F io� F9ICTIOIJ FAtYOR__ OAS FEET TOTAL O�JAJAMIC KCAD = �b'3S FEET Pump chamber D IAMETE R IIITFKWAL, DIrALWSIOWP of TAWK: I.,CM yTH- .._.._,•.,_ :WIDTH ;LIQU10 DEPTH �__...._ BOTTOM AREA 231= GAL /ZNCII AS PER MANUFACTURER - 9,bS' ­ GAL/ INCH I APR -05 - 99 MON 02:06 PM NELSEN WEBER SURVEYING,M 1 715 425 6864 P.07 J ME40 Series 4/10 HP Effluent a Drain Water Pumps P erfor ma nc e Curve MIX EL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N tj 30 H 25 6 Z 20 6 10 5 2 0 L 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio x4805 -1923 419/289 -1144 FAX 419/289 -6656 Telex 98 -7443 K3326 7/91 Printed in U.S.A. r -Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 �jw bo! and Human Relations vision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, a n ardi nce to nearest road. REVIEWED BY DATE APPLICANT INF MATION- PLEASE PRINT ALL LL ATION PROPERTY OWNE : \jt A C� T'\ / PROPERTY LOCATION GGVF{f ivW 1/4 SE t /4,S It T Zb ,N,R 1 E ( W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBO. NAME OR CSM # - 1.10 N . 1'�t PrtW g T-. 63 — GLOU lan S`f�il0►J A PrDplY7i3N CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE (MOWN NEAREST ROAD RLU`1a1L GYuL 5,kJI o'_( 1 soo L11t,1e� szwht� �j New Constriction Use ReWenfial / Number of bedrooms 5/ () AdRgi lo eAstiN build ng t 1 RepbMent [ I Public or commerdal describe Code derived daily now boo cgid Recormterided design badaig rate y bed, gpiYlt2 _ trench, gpolft Absorption area required 'S oo bed, ft s 00 trench, ft W mum design loariN rate a, • bed. o - L trench, gpdNt Remmmended infiltration surface elev b*s) 3 °► , o It (as referred to site plan ben� A d d it i o n a l design / site =sideM#= R , E r � M e , j t 3 VI ODUt) w / 8 `x 3 l 3 e b . M I /v , z.' o f S Rib Fir—L. Parent material S Ijj% evT ;/ Yl L t_ Rood plain elevation, if applicable N •A . ft L S = Suitable for System CONVENTION& MOUND M-GROUND PRESSURE AT -GRADE 8Y 131 IN FILL FIOLDWG TAN( L = _ unsuitable for [I system 100 IBS 0 []s ®U- []S IZu []S C?u 11 (�u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Cor>sistenoe Bolnc,3y Roots GPD /ft Boring # Horizon in. Munsell (XL Sz. ConL Color Gr. Sz. Sh. Bed ierdt �O`1 Q- 3/ i — S i Z i.3b 'W% C S - 'a-5 I o. V Z 7 -t8 1 O`1Q -4/Ij SL) Z 0.5 0•l. Ground 3 A -31 -')- S `i R 3 L I 1 >K sbk rKft: e s 0- o. 3 10 elev. fL y 31 -3y, 10 ytz -8l3 LS - _ - - Depth to Gmi6ng fatftor 3 1" Remarks: Boring i ) o_ t 1 t o �t Q 31 z — s� 2'F Sbk 1Y1 '�h C_ _ o . s o_ 6 s Z�S b►1�'}, Cra, — o.S o .b 3 zo -1Z S`1R -3IV 5bk tnv S Ground Z S l - \ e S Vk _ _ elev. 4 3zsL - `�l� 3 / • s V2 SJS 30- - 103 -S It wpm to limiting faW 3 Z" Remarks: T Name: — Please Print Phone. 715 -4 2 5 -016 5 Arthur L. We erer , g rer Soil. Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Date: CST Number: Sgnad�e. G q_3OZ- 6 /- 30 -g-5 M00576 Wisconsin Department of Industry SOIL AND SITE E V A L U A T KI W R E PORT Page \ of 3 .Labor and Human Relations „ � - `�." Division of Safety & Buildings in accord with ILHR f�5, °V►/tS1�r1r COdP.' `� COUNTY J �. Attach complete site plan on paper not less than 81/2 x 11 inches 1n stye. Pl;4nrust indode, but - ARCEL I.D. # not limited to vertical and horizontal reference point (BM), directio ai4 %of slope scale or dimensioned, north arrow, and location and distance to nearest «4d• U.a EVIEWED BY DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFO -t,ION . PROPERTY OWNER: PROP 1 /4,S I t T Z,8 ,N,R 1 Q E( W PROPERTY OWNER':S MAILING ADDRESS L ~ #1 OL kt4UBD. NAME OR CSM # __1 1K3 NS- v-t PIr 1u S T' . jGLtNCSNt ST W? Lj 0 RDO jT7 qN CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD (y(J New Construction Use Residential /Number of bedrooms '/ [ ] AddibQn to exissting building j J Replacement [ J Public or commerdal describe Code derived daily now blao gpd Recommended design loading rate y bed, gp(/ft - trench. gpd/ft Absorption area required S 00 bed, ft S 13 trench, ft Ma)dmum design baring rate o S bed, 91XW 5 • — trench, gpd/ft Reoommended infiltration surface elevation(s) 1 3 01. o it (as referred to site plan benchmark) Ad�tional design / site coaderations tZ TC0X4 " l�►O V15UtA w/ 8 `X 63 l3 @D . M I ti . i.' 01= S f�w� Ft r.L . Parent material S pD kM QXvT ;/ 1rj L L wt Cl Flood plain elevation, 6 applicable N •A . It S =Suitable for system cMIENTIONIL ND IN41FIOUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLONG TANK U = Unsuitable- for system 11 S @i1 [RS ❑ U I ❑ S IOU ❑ S IYU O S (Er ❑ S [all SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence B=13y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch 0_1 \ o 1 1 - 1 ?__ 3 J Z - Si Z C S o. 5 0. t. Z - ) -t$ 10 `itt 4/!3 - Sl I Z'FSdk t�'f1- c.'i 0. 5 0• L Ground 3 A-1 I '� S `1 3 L s c \ ►►� Sb k y++t'�}. C S o• Z 0. elev. \33 ft. y 31 - 3'1i f4 `-iR -813 Depth to limiting f � Remarks: Boring # Ak o . S o_ 6 o_t) to�tR- 3! - sl 2 h1'� cS Z 2 11 -ZO 1Dy V11 s1 Z'QSbk bt-t'�'1, et - o. o. 3 Zo -3Z S ` D_ 3 I C 5bk Wt k) o•y o. S Ground .(� Z s 1 - elev. �J 3Z-SL �.S` R- 31 _). SJ B Sc WN h lb3 -5 ft Depth to Nmiting f�tor 3 Z" Remarks: T Name: Print Phone_ 715 - 4 2 5 - 016 5 Arthur L. [de erer , Ad dress: Soil Testing & Design Service -P.O. Box 74 Rive Fa 11s,WI 54022 Sgnature: Date: CST Number: G q -30Z- 6 3 J- 30 -45 M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page & of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends �v x: � -n _8 V; �-t z, 31z si1 Z. `FT wii C-S - o.S 6-6 Ground Z S`I%L31y S C- CW o•y 0 • S elev. 1o 27 -30 - )•S 7R V /L SCI 1 Yn 3VIZ y rz Z Depth to 5 3v -3 (, t o `i R !3 - LS B R - - - limiting factor 3D ' } ; Remarks: Boring # t Ground elev. ` ft. Depth to limiting i factor i i Remarks: Boring # i Ground ! elev. ft. Depth to i limiting factor ! Remarks: Boring # I i Ground ! elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1 "= yo' NO 17, i O l� Q NOTE: House to be at least 25' from mound. Well to be at least 50' from mound. For a 3 bedroom home, design mound with a 6' by 63' bed. c�Yuvtz tL t o �`t. o' BO' rttM of M LrL. 1639. p' L`L t0:&B I Z s• / I / o I all �o r� oT �naPt�T L i / Z atsIuRB `MI% , / OO V 3S' B•2 / tR.tu3g s 1038.93' oN J � a 0 qy -302- 63 1 - 3o -9S ( ) M 00576 _ 715 4 2 5 - CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 'Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY ST • c-Czv 1 x Attach complete site plan on paper not less than 81 /2 x 11 inches in size. Plan must include, but PARCEL I D # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION VgLj E Pi><� lJ \ S SC VWL Tz 6BVi iA� "V31/4 SE 1/4,S It T Z ,N,R 1 E ( W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # l0 N, ih Atw g 63 — GLOV�l'i SlRfi W L1_V ftbj - r70N CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE MOWN NEAREST RD L O RLUeTL I- YLL 5 1 ki 1 _S o LZ_ (7IS) LI1S - 1t 1 6 1 o Y p(J New Construction Use Residential/ Number of bedrooms y I I to eAsting buildutg j I Replacement ( I Public or commercial describe Code derived datiy flow bvo gpd Recommended design loading rate 2 4 bed, gpolft - trench. gpd* Absorption area regtdred S oo bed, g2 s uu trench, 9 Ma) fru m design loading rate o •s bed. gpolft 0 - L trench, gpdfft Recommended infiltration surface elevation(s) _1 0 3 °t . o t ft (as referred to site plan benci nu* Adolti d design / site considerations \Z' .V:eo" " Ie,►O V'1 bUijb W/ 8 ` 6 'S ' S tb . M I Pu . Z' O F S R+iD F=t t. . Parent material S LD \M Q1yT ;/ 'n L t_ wt t 'rt Rood plain elevation, d applicable N .1 It S = Suitable for System CONVENTIONAL MOUND N.GROUND PRESSURE AT -GRADE SYSTEM IN FI L HOLDING TANK U = Unst>itable for tem ❑ S O� INS ❑ LI ❑ S IO U ❑ S 1ZU ❑ S LSdU [is wi l SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Corlststenoe Bourd3y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz- Cont Color Gr. Sz. Sh. Bed wnch D -1 O`1 3 - SL Z i A 4 C S - 4.S 10. Z - I-t8 1% 4v-- 4/ 1 I - S L I 2 i 'adk 'F{. Ctii a -5 0. Ground 3 A-31 - )•S�IZ. 5 11 sc \ ►�SMt es o -7- 0.3 Wo1 6 fL y 31 -31& t yR 8 [3 i s B Rz - - - — Depth to limiting factor Remarks: Boring # - 2 Sbk h\ c g _ o -S o_ l o_l tFN yQ 312 13 Sl1 o. b 3 Zo - 1Z � - s) \c Sb4c ►nv�►- �Cv o•y c.S Ground ziSL elev. �/ 3Z.SL �•S`1R 31 �•S`1R SIB w h 103 -S It Depth to limiting factor 3Z Remarks: T Name: - Please Print Phone: 715 - 4 2 5 - 016 5 Arthur L. IJe erer , Ad dress : Soil. Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Sgnature: Date: CST Number: q q -301 E3 l- 30 -g5 M00576 PROPERTY OWNER a'( t�! — s CWQ t-TZ SOIL DESCRIPTION REPORT Page z of ' PARCEL I.D. # Depth Dominant Color Mottles Structure GPO /ft Boring # Horizon Texture Consistence Boix>clary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3lz sil '2.. `Fsb wlih C-S - o.s 4-6 1 'vsti: Ground 3 1Z -Z1 n•S`7tZ3ly S� 1 CSbh wiU`Fh C►J o•y m• 5 elev. 10 z� -3o �•s7R V/L 3 rj Zl�. Depth to LS i3 R limiting factor ., i Remarks: Boring # i Ground elev. ft. Depth to limiting factor i Remarks: Boring # Ground elev. , it. Depth to limiting factor I Remarks: Boring # yy \: • Y id:Sk'.wi:2vs: Ground elev. ft. Depth to limiting factor Remarks: SBD•8330(R.05/92) PLOT PLAN 3 3 Page o f SCALE 1 "= 4o ' i bZ / O 4� � Q NOTE: House to be at least 25' from mound. Well to be at least 50' from mound. For a 3 bedroom home, design mound with a 6' by 63' bed. 1vvR tt_ . 1 BQTrom of m EL, 1p39.p' tL 1038 6 - - -- 3S' va I ' � s.3 I / � -c � all oiZ t7 l s IURB 'Rtl S , 0 1<t..1o38 I L.. 1038.`t3' ory L L R.o l Pt pe J � o / 1 / qY -30Z- 63 _ 14 005 66 (715 ) 4 2 5 cl 7 Fi 5 CST Signature Date Signed Telephone No. CST # r 01/07/1995 08:34 7152737753 NELSON PLUMBING PAGE 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 33 Property Address (Verification required from Planning Department for new a ruction) Cell City /St Parcel Identification Number Dy6 122,9— go - 0 b D LE L J = atie ION Property Location ALL '/., '/., Sec. l Town of DLO Subdivision S?��yQ•r \S5(1 `�( _\� \p(\ , Lot f$ Certified Survey Map # , Volume , Page # Warranty Deed # , Volume y� , Page # r Spec house ❑ yes Xno Lot lines identifiable 14 yes ❑ no SYSTEM MAINTE NCC 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 stem can a ou um er. What put into the s t t r ea tment p p you y Cfec the function o the c sc tic tank as a � 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 mastcr plumber, journeyman plumber. restricted plumber or a liccusedpumper 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 lark is less titan 1/3 full of sludge. Uwc, 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 bas been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the ear expiration date. 9 Jig -� SIGNATURE OF APPLICANT DATE OWNER CER11FICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of the prope scribed above, by virtue of a warranty deed recorded in Register of Deeds Office. 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 decd yet 1416w613 f STATE BAR OF WISCONSIN FORM 2 —1982 0 0081 O WARRANTY DEED REGISSTER OF DEEDS DOCUMENT NO. s{ ST. CROIX CO., MI -' IEM70 FS X= Davit.' D. Anderson 64-061-1999 Ps30 PM UMMM KO am I1 14 � FFEEs FEES conveys and warrants to H ermann Hanes, TMOU FEES PEMIM FEE: 10.04 i� I 1 1 THIS SPA RESERVED FOR RECOR DA NAME AND RETURN ADDRESS _ -- the following described teal estate in St rrni is Coun[yG State of Wisconsin: RETURN TO: TITLE ONE ?� 70619TH STREET SOUTH !' HUDSON, WI 54016 040- 1229 -80 PARCEL IDENTIFICATION NUMBER i Lot Sixty -three (63), Glover Station Fourth Addition, St. Croix County. i Wisconsin. I I i I i 1 i� This is not homestead property. ,I 7)= (is not) II Exception to warranties: Easements, restrictions and rights -of -way of record, if any. i Dated this day of March . A.D., 1y 99 t ii i i (seat) (SEAL) i j David D. Anderson (SEAL) (SEAL) i AUTHENTICATION ACKNOWLEDGMENT it i Signature(s) David D. Anderson State of W»�es� i •a I ;I Countlr. h authenticated this day of March .19 99 personally came before me this 14 day o[ 19A , the above named i • Kristina Ogland 11n�i4� D• t'+hy^ -� TITLE: MEMBER STATE BAR OF WISCONSIN (If not, TARY P�1 �i authorized by 9706.06, Wis. Stars.) to me latowrl t �NIASft[Ni3TC�e Ing i . instrumrnt and c g Ej*N JIM. 31, 9NO j THIS INSTRUMENT WAS DRAFTED BY i Attornzi+ Kristin Ogland ; Hudson, WI 54016 Notary Public, County, V4r -K-J, (Signatures may be authenticated or acknowledged. Both are not My commission i permanent. (I not state expiration date: necessary) KAM[ L TELSCFIOW • Names of persons signing in any capxity should be typed or printed below their signatures. _ NOTARY iPU81.1C • k* A STATE BAR OF Wi5CQN5iti WASHMTOR ,n Pe.* co_ kv WARRANTY DEED Form No. 2 — 1982 aaJIL$1,we ��'�� ii a 00° S 89 V 23" E o 272.09 �'�p 57 2.000 AC 87.116 SF ��• 58 4 _S 2.151 AC STRICT °s, 93 .695 SF 0 61 2.110 AC 2 1. 91,922 SF te a: •/• 6��i •5, AC 6 � X25 SF EASEMENT FOR s DR IVEWAY B �� DRIVEWAY SHAREO 8Y LOTS 58 do 61 WITH LOT 63 °� /• i / % G 1 i $ 0 63 G � LOCAT 2.003 AC 6 87.239 SF / oe i t i i NW —NW i i Cd P tv q. •/ bt SW —NW cl A AGISTER'S OFFICE, NW -SW ST. CROIX CO., WIS. — / Re rood I91 Reootd IN of_A6 - L101.,11911_ o'dodl.— — Ii.R9mm in T cot? - - velMee - ei sw -sH SE —SW RrAM d Deeds SCALE 1 100 MADE TO THE CO AND , AADE TO THE ����/� D TO THE �} OGDEN 36 AND 67 IS A 8882 = FRANCIS H. OGDEN S -882 'O WILL fWFA" = REGISTERED LAND SURVEYOR DUCTED N T4 < n' OGDEN ENGINEERING COMPANY r rANNnT ca< .' _4�. 11 WFST WALNUT STREET I