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HomeMy WebLinkAbout022-1043-30-000 CROIX COUN'['Y ZO'a1G Ut['i`C 'I'M AS I3UII;I' SANA�' RL ^ ' -IF P <Y E EVE. Owner �Z �E ��.�1��� 4. Address .t d r A r, T 9� 19,q Ja 0- � � 998 ST c taa !t /Slate c City/State J v'P Y �- C STCROX cou tvrr COUNTY %f �� Z AING2 r1 it; NG �� Legal Description: / Lot OF — _ Block t-- Subdivision/CSM It ,Sec./ , T Town of �Cf�,� «.�i'i�r��_ PIN # E1�.`2r ,/0 y/' �e SEPTIC TANK - DOSE CHAMBER - FOLDING TANK INFORMATION: Tank manufacturer _ 1�ti Size ST/PC Al20 Setback from: House ZC Well � we) PIL >1 Pump manufacturer _ Model Alarm location —_ &,4*,,v7 (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh a' e Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: / C /~ Width -r Length ra Number of z =c t Setback from: House >,er Well Vent to fresh air intake > lee ° ELEVATIONS: Description of benchmark z l� 4.3411 °1 Elevation Description of alternate benc ar Elevation Building Sewer , T ST/HT Inlet /CIO, -.5'z ST Outlet r/ YS PC Inlet Irl .15 PC Bottom --f-7-,iL Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) ( ) ( ) Bottom of System ( ) —` w— ( ) 2!;� -5Y ( ) Final Grade ( ) ( ) ( ) Date of installation fO/ Pcrmit number , - Z Q. 2 Cl(' ^ ) State plan number I _( — _, c >oZ / Plumber's signature License number Date el t / B' Inspector c •ompicic pIn( plan .� NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW r� I r �T• 7K C. II , � P J'o INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pers information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 320240 �`, NRALD KITCKN IC n of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 022 - 1041 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e ti (,J /00 D Benchm 4 /Do.4 /Do o i I,J 14,A0 807) t 01 , 1qS Z,87 IO Z. 97 /a D Aeration Bldg. Sewer Holding Inlet loa.br7 3. 97.07 TANK SETBACK INFORMATION Kt Outlet ! �.00 94. $7 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 6? r 7 / • 2 eptic �r it /p1) �' +r�� NA Dt Bottom /f ci 7. ( ff NA Header /Man. •7,72 9S -/ 5-- Aeration NA Dist. Pipe 7?8 qC Holding Bot. System x'.33 c 6 , 3n 0y.sf 94f f 9 PUMP/ SIPHON INFORMATION C, ti ,_,,,,��,• Final Grade Manufacturer GoLIICIs Demand Model Number lv ) F yD GPM TDH Lift 7 al Friction �` S System 2 . TDHI J, � 4R mead oss Forcemain Length 131 Dia. ?'r Dist. To Well SOIL ABSORPTION SYSTEM Any/ TRENCH Width / Lengt U No. Of Trenches PIT No. Of Pits Inside Dia. Liqu d Depth DtM ENSIONS _ DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM L rA ING Manufact SETBACK INFORMATION Type O / Model tuber: System: 0104 4 1 () +�a� O IT DISTRIBUTION SYSTEM Header/ ifold Distribution Pipe(s) « x Hole Size b x Hole SpaSp Vent To Air Intake Length } Dia. 1 � Length � Spacing. 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 r! g Bed/ Trench Edges (2 Topsoil �' VYes ❑ No L 'Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ': 77.94 LOCATION: KINNICKINNIC 15.28.18.227A,SW,NE 1250 COUNTY ROAD J Q v ) & ' c Saud i rva✓i�, frAd( Plan revision required? ❑Yes Q' No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: } e Vi sconsin SANITARY PERMIT APPLICATION 201E wasnngto AV e� sion In accord with ILHR B 3.05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • 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 Number The information you provide may be used by other government agency programs ❑ Check if r isi�previbus application [Privacy Law, s. 15.04 (1) (m)]. Is ocrylic, State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION ,Z/ 7 Property Owner Name ` dL-TZ W � pew iii S — T 8 , N, R r E (O Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 2 w v ( 5 13 f4fm I. TYPE BUILDING: (check one) ❑ State Owned El Cit Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms y� Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) '� • �� � 1 ❑ Apartment/ Condo O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2_ V 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 21 ZMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq-ft.) (Min. /inch) Elevation ro J Q Feet Feet Capacity VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks e Ic Ta or �7 ❑ ❑ ❑ ❑ 1 ❑ Lift Pump Tank er ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation he onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: I rolnps) r . PRSW No.: Business Phone Number: �"X Plumber's Address (Street, City, Stat , Zip Code): of v IX. COUNTY f DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) g Adverse Determination ��� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �.t►� -� COQ X63M !F.t 1W DISTRIBUTION: Original to County, one copy To: Safety a 8uil6 ings Division. Owner, plu i 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 owner:ihip 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 avid Buildings Division, 608 - 266 -3151. To be complete and accurate this "sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one 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 numbef 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. Qomplete plans -and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must i include the following: A) plot plan, drawn to scale or with complete dimensions, location holding to 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 1. 1983 Wisconsin Act 410 included the creation of surcharges (fees) for 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. -- -- .. n ZIP 1— v w j o o r f SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin f Ind or an � Depa rtment o dust y, Lab d Human Relations May 15, 1997 15837 USH 63 Sw /p q/ 6o Route 8, Box 8072 Hay WI 54843 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S97 -20217 FEE RECEIVED: 180.00 EMHOLTZ, GERALD L �� 15 28 18W TOWN OF KINNICKKINNICK COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above- referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, W's consin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Cofle, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincere , Thomas L. Braun Plan Reviewer ✓ / (715) 634 -3026 7:00 - 4.30 z7 2832R/ 1 i i S SUDA -6028 (K. 10/04) ULBRICHT `& ASSOCIATES CO. 655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # S97 - 20217 Date May 14, 1997 Owner Gerald Emholtz Phone 715- 425 -6593 Address 1250 Cty. Rd. "J" River Falls, Wis. 54022 Legal Description part of a 175 Acre farm parcel. Tax #022 - 1043 -30 -000 SE 1/4, NW 1/4, Sec. 15, T28N, R18W. Town of County S Croix C.S.T. Dave Fogerty CSTM 3233 Installer Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION Replacement system, for an existing 3 bedroom sized home. Estimated daily wasteflow: 450 gals. All existing treatment tanks (non- conforming) shgll be properly abandoned per code. Soils are fairly permiable in the upper 12" (.5/ .6 GPD /FT ) but seasonally saturated at 19 ". This site meets the requirements of the A plus 4" rule. A minimum of 18" sand fill shall be used within a long narrow mound system. PRIVATE SEWAGE SYSTEM Conditionally APPROVED DEPT. OF INO STRY, LABOR & NUMAN RELATIONS ulvTff OF SAFETY AND BUILDINGS i SEE CO PONDENCE �` S ��''� .. �. f ROBQR W. `C ULBRICHT '- D1160 Pg .1 PLOT PLAN VIEWS 1� HUDSON, W ... Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS SIGS riri prrurr r of uuil�t "�� Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS This design for installation is based entirely on measurements, elevations, landscape conditions (slopes etc.) and soil suitability provided by CSTM The accuracy of his specs, as reported, shall remain the sole responsibility of the CSTM. Any use of this POWTS.-d ty any licensed plumber, or any S9' ' 2 related unlicensed parties or persons (excavaters, laborers) R D EC shall not be construed as an assumption of responsibility by the designer for the Rorkmanship, construction, placement, substitution or selection of any components not specified, or N any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. �1�� T � m -^ T I' -n tD —4 >. m mr \ o e r D� b x z c z Z \ o it n wZ -+ aD C wO R1 I m i -Grp i 00 w ,� C C r, -- E of o i - _ o v •n n -o CA C=l cn =mT c 4= c cq cl go: CM in CA cn SA a ! a � � of � �• ego (� � � (� � �. O O � _b (A C!1 � 1� pl 2 of s CROSS ' S EGTIOAJ OF M ouAjD wi rti 13 ED OEo - F IV ro •DiSTRiBUT%o 1 1` AygQc-SATE' G, rktckaFSS pip sysreo op T ap SOi L e IE r io►J 9 y so 00i FORM To E• it► ►► N ,j E T- �t p owEO TopSoc N1 b u FO RM % S PE FORCE t= lEt�llTt0►.� (�uOEfZ MAW M UM O it O�/EAI 7 Al O U'V D � / / Fr. OUN� --- ELEVAT'IO/J 5 E /. 9 Ft. INVF-RT' o f ZI IATERMS 9�d F • So FT IT 5. 3o •Top of R oc>� G /-0 FT. , „ ' H �'J T. Top o F � IATERAIS F PLA VI EW vF MOU-�JD - wi rte T3E FoRct_ MAiAJ A S F -'. 8 O Fr 13 L Fr w I ---------- --- - -- - - -j! 1 - ----- T k -'I a T 18 F w r w 30 m FT l Bev of PVC- cAppeD To I—" 0135ERVATIO0 A 93pF5ATE pipes 1 PERP'IAO EoT MARKERS REG2uiRED BASAL. INReA - 'D �hsrE'F� = ys� 5 LTD SCI L. 101 I'rRATIOE . S C APAci T sa. FT. PRopoSEb BASM AReA = B x /{ t Z C V01 1 1 1 4( , ,C rOl/ 2 5 F r of Z Pu G FORc MAW / jcf /A6 r Perforated Pipe Detall u�,e G ti r Fo,� 1/i1l �J�tE VA v 4 i �'o,v 0 End V16M ) Perforoled _,/ End Cap e PVC Pipe 1 . r e Holes Located On Bottom. Are Equally Spaced x P *\ PVC Force Main P Dislribulion Pipe Losl Hole Should Be Next To End Cap End Cop Distribution Pipe Layout P 3$,Z } i T V O/ U L4 � Of= 34 >31:� Inches ?AY Inches 'Jy p Hole Diameter Inch Lateral �_ Inch(es) Manifold ,, Inches Force Main Z IncF.es # of holes /pipe /y Invert Elevation of Laterals p Ft. - Dt' 5 TR il3UT"tp k� 3 3)%ScHA RGE RATE FvR E E4 LATERAL t PAY OTi.S Z-7 j� . 3 8 1_ � � � M i nj . TO TAL — - DiS7R<<3uT"f0A_N 'D%GC VJARG E RArE FoR 1JleTWOP 3 z, 7(1 _ � M i ► J � � � Ott �,v''H V M PUMP CHAMBER CROSS SECTIOM AND SPECIFICATIONS Mv I of 5 - -- �__.- --------- -VEIJT CAP 4" C.I. VEMT PIPE WEATHER PROOF APPROVED LOCKIMG > JUNICTIOU BOX MANHOLE COVER 25 FROM DOOR, 1. WI to/4v, A0W6, 1 A 136 IJDOW OR FRESH 12 "MI U. .. AIR IUTAKE q1/' 0 - �E t"l 1 /0'4 GRADE 5rd I y "MIND. i COIJDUIT s.p �� __________ �IEU•1n \��\ IULE T PROVIDE r AIRTI&HT SEAL I L nG I II 10. APPROVED JOI A I Ny I V K I II I A PPROVED JOINTS \JiC.I. FIPE I" �r fUM I III W /C.I. PIPE EXTEIJDINIG 3' 60� Q I II ALARM EXTENDING 3 ONTO SOLID SOIL B D ,• y r I I ( ONTO SOLID SOIL ( 33 3) I I 1 8$ -(9 3 q o" c CLEV. FT. — 1 r PUMP I. I y OFF p �1 �,r coh)c- II 4 � l VA (i0 �l I " IPAvjda S -. ng Y R IStR EXIT PERMITTED OULIJ IF TAUK MANUFACTURl "FiyRS &W4kf OVAL. SEPTIC f SPEC,IFICATIOUS DOSE TAM IE� Co,yGll TAIJKS MAIJUFACTURE CIIEE IJ UMBER OF DOSES: PER DAH TAUK SIZE: C/d0 G GALLOWS DOSE VOLUME S Q ALARM MAAIUFACTURER: S uu 61'ac-� (Z o 11 IMCLUDIUG BACKFLOW: I I v _ GALLONS MODEL "UMBER: 1 - tfU �f_AAJk A'I ly•C* 3 CAPACITIES: A= INCHES OR GALLONS SWITCH TYPE: _ M� R GV RY F 0 . T a = Z INCHES OR GALLOAIS PUMP MAAIUFACTURER: 5. B I P C = INCHES OR � � CALLO MODEL NIUMBER: E O�'' M Y3 L R �� 4 _ 0= INCHES OR GALLOIJS SWITCH TYPE: pI5SyQRGk ME(RCVRy FI D hT NOTE: PUMP ARID ALARM ARE TO BE MIMIMUM DISCHARGE RATE io GPm INSTALLED OM SEPARATE CIRCUITS & VERTICAL DIFFEREMCE BETWEEN PUMP OFF AND DISTRIBUTION( PIPE.. �_ FEET �AA.)V SPtC 4- MIUIMUM AIETWORK SUPPLY PRESSURE , • . • 2.5 FEET EACGA_ - 2-5 FEET OF FORCE MAIM X 2'GZ FT,/ 5 loo FT.FRICTIONI FACTOR.. ' FEET t4 S 2- 0- s o — q yl) �S• — TOTAL DyAIAMIC HEAD = ' 55 / FEEL J Re W �7 3 q " IUTERUAL DIME"SIOUS OF A N — - TAUK: LEU&TH ;WIDT;WouID DEPTH PER PLUMBING PRODUCT APPROVAL ALL NON - CONFORMING (CODES, All ABOVE- GROUND PVC TREATMENT TANKS SHALL PIPING (FROM TANKS & SYSTEM AREAS) BE ABANDONED PROPERLY MUST BE SCH.40 PVC MEETING ASTM FOR ILHR 83.03(2). D1785 OR D2665 STANDARDS. Wisconsin Department of Industry SOIL AND SITE E V A L U AT I f ` Page L of J Labor arvO Human Relations t7ivision of Safety 8 Buildings in accord with ILHR 83.05, Wi C I COUN i Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan incl�I��uY CEL ©l not limited to vertical and horizontal reference point (BM), direction and % of sl ale or tt � dimensioned, north arrow, and location and distance to nearest road. ST CRax APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION�� REVI Y DATE 1CxdMfG OF � PROPERTY OWNER: PROPER GOVT. LOTS _ 4,S /S T ?, ,N,R 1 E (o® PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 S-0 _ CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [SOWN NEAREST ROAD [ ] New Construction Use [/] Residential / Number of bedrooms _3 [ ] Addition to existing building kj Replacement [ ] Public or commercial describe Code derived daily flow 0.SV gpd Recommended design loading rate bed, gpd /ft trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations /1 y mkt -9, — zivT, Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0 0 [ZS ❑U I ❑S ❑U ❑S ❑U ❑S OU ❑S JO U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxtdary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends (O C 2 D Ground ,3 Z3 7. S — 5' c , 1 - : 57-6f M L elev. �EtAt- -.7 7. s- — �s o SG /h L GS — -a Depth to limiting factor Remarks: Boring # © ^/ /a z s L / 114 FR {4i n :....:........; > Ground 3 33- o - elev. * 6f ft. Depth to limiting factor 33" Remarks: - - E /�' . T, A �ti�STrME, CST Name:— Please Print Fo 6L'E_ ! Phone: 7 _ 4/ 5, A ddress: o O v f3 77 o-a Signature: Date: CST Number: / . 14rZ60 s 3 PROPERTYOWNER P-OWiYo SOIL DESCRIPTION REPORT Page ?of � . PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bojxlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ,t3<: 3 L 3f/ L 3 M F.Z' C-5 /,f s Ground elev. Depth to limiting factor 36 Remarks:- Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # { M Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) h to im �1 C 0 Sze f i i w � N N V 1 3 � i i I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Bitper /( L/.� Foyyf pG7Z Mailing Address /mod Property Address s w �' (Verification required from Planning Department for new construction) City/State _Ae(ACEVAf�X) Parcel Identification Number — (J::� LEGAL DESCRIPTION Property Location ZC %., � '/,, Sec. /S . T it,' N -R W, Town of _ ICd'� Ar t 1 C'wA44-1-- Subdivision Lot # Certified Survey Map # Volume age # Warranty Deed # ?7 7F Volume .QD( . Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE 1mpr0Per use and maintenance of your septic systemcould 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 is the waste disposal system, 17ue property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a =sW P h " ber -J ou "`y man Phm`be4 restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic- t 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 drat your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 f the e . tion te. SIGNAL AP LI DATE O VVMR CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of described abo e, by a of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLtCX4 DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATE BAR OF WISCONSIN—FORM I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA kEGISTERS OFFICE THIS DEED, made between /a Bertha K— Smith. , ST. CROIX Co., WIS Rec'd fOr Record this Grantor day Of--AU91)JQTt,---A.D. 197-3 and —Ger ,a14_A,Emho-1tz--- at - - - -- : A. M Grantee, Witnesseth, That the said Grantor for a valuable consideration —Twenty-7-S-i-X— - Reostpr o f Depd Thousand < 26 0 conveys to Grantee the following described real estate i _Croix--___ County, RETURN TO State of Wisconsin: That certain parcel of land or tract of real tate located in the North One-half of Section 15, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County,.- --------- — -------- Wisconsin, more f ul ly de scribed as f ollows : Commencing at the eastr K ft quarter corner of said Section 15, thence go S88 W along the This is - -_— homestead propert south line of said North 2 of Section 15 a distance of 2653.20 feet to the point-of-beginnin of the parcel to be herein conveyed; thence continue S88 W along said south line of the North k of Section 15 a distance of 246.50 feet; thence N 00 E a distance of 880.50 feet; thence N88 ° 21' E a distance of 416.10 feet; thence S 00 W a distance of 288.00 feet; t hence S88 W a ditance of 169.60 feet; thence S 00 adistance of 592.50 feet to the point-of-beginning, the above described parcel containing 6.10 acres, more or less, including that portion presently used for public roadway, together with an easement 33 feet wide along and adjacent on the east side of the boundary line in the above described parcell, being the last call bearing S 00 W a distance of 592.50 feet in length. (This deed is given in partial satisfaction of a certain land contract by the part�eS dated August 1, 1973.) To with all and sin the hereditaments and appurtenances thereunto belon or in an wise appertaining; FEE I And---D4ha--Smith a/k/a Bertha_K, Smith, a widow, warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances excepting any liens-- encum-brance-a. eated-or--suffexe.d-to-be--created-.-by--the actions-or-defaults.-of --the - pasties __ of the second part. and will warrant and defend the same. I ' w R f � Submersible Effluent Pumps 3885 AVAILABLE CERTIFICATIONS ETA LISTED SUBMERSIBLE PUMP ' CLASS I AND 11 DIV. 2 AND CLASS III DIV 1 AND 2 ETL TESTING LABORATORIES, INC. CORTLAND, NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION slt PERFORMANCE RATINGS (gallons per minute) MODELS weo511H WE0511HH Series HP Volts Phase Max. Amp. RPM Solids VA. (lbs.) Series WE 5 1 11H WE0712M WE1012H WE1512H WED512HH WE1512HH WE0311L 115 9.4 N0. WE0311L WED311M WE0532H WED732H WE1032H WE1532H WE0532HH WE1532HH WE0312L 230 4.7 WED312L WE0312M WE0534H WED734H WE1034H WE1534H WE0534HH WE1534HH 1750 56 WE0311M /' 115 9.4 '/2 % 1 1 Y '/z 1' /z 1 RPM 1750 1750 3500 3500 3500 3500 3500 3500 W WE0510511H 115 13.0 230 4.7 5 100 70 80 90 106 — 60 — 10 80 65 76 87 102 112 56 84 WE05 2 230 6.5 WE0532H 2081230 3.4 1 5 60 57 72 84 100 108 53 82 3 WE0534H 460 1 . 7 60 20 36 45 65 79 95 105 48 77 WE0511HH /z 115 13.0 1 25 59 74 91 100 45 75 1 WE0512HH 230 6.5 3 0 50 67 85 96 40 72 WE6532HH 208/230 3.3 5 3 5 40 61 79 92 35 70 3 . WE0534HH 460 1.65 , /.. t0 26 52 72 86 30 67 - 45 10 43 64 80 25 64 WE0712H 230 1 10.0 WE0732H '/ 208/230 5.4 3500 0 50 30 54 73 18 60 3 • WE0734H 460 2.7 70 : 1 55 17 42 65 12 58 WE1012H 230 1 12.5 60 6 30 54 3 54 WE1032H 1 208/230 7.0 16 40 51 " - 7 0 5 26 47 WE1034H 460 3 3.5 14 43 WE1512H 230 1 15.0 WE1532H 208/230 9.2 8 0 4 40 WE1534H 460 3 4.6 80 _ 75 d 1 00 24 WE1512HH 1 /z __230 1 15.0 11 WE1 332HH 208/230 9.2 t2 5 WE15 460 3 4.6 metal parts, BUNA -N elaStomerS. METERS FEET • Temperature: 160° F (71 C) 90 maximum. - MODEL 3885 ' • Fasteners: 300 series 25 60 SIZE 3 /4 " Solids j stainless steel. • Capable of running dry 70 i ... WE1 '. without damage to 20- wE1 components. 60. —' 5GPM _ . _ ... v I 1 i Motor' Lu WEO sFT • Single phase: /3 HP,115 or a 15 50 i 230 V, 60 Hz, 1750 RPM; o WP H. i I I i '/2 HP, 115 V, 60 Hz, ~ 40 3500 RPM; /2 HP through 10 ? 1'/2 HP,230 V, 60 Hz, 30 � I 3500 RPM. 20 ...wn ._ I ,..... - r. Built - in overload with automatic reset, class B 5- 1 o I — -- __. insulation. i i f • Three phase: '' HP through o o . ..._ 1'/2 HP 208/230 V , 460 V, 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 60 Hz, 3500 RPM. I 1 I Class B insulation, overload 0 10 CAPACITY 20 30 m /h protection must be provided in starter unit. 8 " Y „ z ...fit . _- • n 9 � �_,_ /_ �f � ti y� -