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HomeMy WebLinkAbout022-1070-30-000 r 0 CO) 0 1 'a 0 `+1 co 3 W U) x Z m Z o w ! T N C 0 CD I 0 �, o o w ca � CD CL L C: qTS 7 N OD _N hr CD CI O ' N CD N W of x O _ V cn 1 0 0 T', CD O d O p CD C) 7 VI A H C 7 O r7 Q d m m o na tr. D a < h m «n y w a CR CD I W N 3 r o 0 L £s!, w C o C 0 000 N o c N I 3 a m v o Z 0 0 0 E '. N ° a 'O O O n N 1 e A' m N �rl CL ` �1 I 0 Z o ° y 0 0 N Da 0 �` Z N N O O CD O N �{ • A N CD ? P c =r m � w m 0 ° a 3 0) Z CD 0 � Z_ ° U) g o {' a C Z N C w M co a 3 z O R . Z eo 3 Z a CD I a I p c o a CD z to o I I Z9 i A I � � a I � a I ° o v A o D A 41, CD Wisconsin Department of Industry SOIL AND SITE ,E V A L U A, ON R L T Page of 3 Labor and Human Relations _ Division of Safety 8 Buildings in accord with 4LHA 83.05; mss. At{m: C od j � COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inc+ size. Plan mustani ludo, b not limited to vertical and horizontal reference point (BM), directio(tand %of stop a,ot PARCEL I.D. dimensioned, north arrow, and location and distance to nearest ro APPLICANT INFORMATION- PLEASE PRINT ALL INFOR O ''` -< ' °< REVIEWED BY DATE MAL PROPERTY OWNER: GEO, /�i:vD rRV5 T % PROPERTY LOCATION BEN E /t-i AIL2 7X LIS TLcE GOVT. LOT,VU1 1 /4IVA) 1/4,S 7S 1Q ,N,R E (or1i PROPERTY OWNER':S MAILING - ADDRESS LOT # BLOCK # SUBD. NAME OR //9,? //9,? w. 5 wrFT - S % 4o it� M # �°�,PIE /, j CITY, STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE Pr6WN NEAREST ROAD 5T /- TEA' 5601P2_ (5 [ 'New Construction Use [ Residential / Number of bedrooms y [) Addition to existing building [ [ Replacement [ [ Public or commercial describe Code derived daily flow 6000 gpd Recommended design loading rate 7 bed, gpd/ft2 .? trench, gpol(t Absorption area required 500 bed, ft2 50a trench, ft ximum desin loading rate '7 bed, gpd$ ,L trench, gpd/ft Recommended infiltration surface elevation(s) S-� 3 /b/ D ) ' It (as referred to site plan benchmark) Additional design / site considerations s!TE Sv SyS TEAS Parent material x5 92- 110136. 1 5 Flood s plain evat' n, if applicable �� ft v cult uo - o v S = Suitable for system CONVENTIONA M IN- GROUND rURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S a ❑ U E3 Ld U [Is p•U ❑ S av ❑ S G-Lt - SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtfty/ Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 13, rend y,e y/ — s Mk- 3.,,, s' f y - ZS /Oyu 1s / sdi� (s es z f , Ground - 5 -31- l/le -4 U 7�S ©, S . G�S�i 5 s . G elev. f� f9� - y� /o yf? S/y s' R �� fs �, s EM�vr — N Depth to limiting factor Remarks: Boring # �ay,P y 13 �s /�, sd,� �s s 31 , 1 2 Z l� /- /01'� she -. o ­y S � Ground 3 /o l I� elev. o . SO /D ► //� G ai),�v � f s �� s � N N 9r ft „ -7S ye / - Depth to Aj : N :: limiting factor „ 9!!Ik rh i lk I A 30 Remarks: CST Name: — Please Print o I u LQ t C �.r Phone: 71.17- 3 F� _ F dress: D 1 1V,1 1 - /,6 CS 7 a-4/0 L Signature: Date: _ !� CST Number: R5� ?&9 NoTt . Before local zoning permits can be granted THIS PROJECT WILL CDvvi 7-1 0ti1 — 14,orfL4-1 ( PLAN APP s' 1 SOvfit /y REQUIRE APPROVAL LEVEL ,$,f Tv,P t 7 z 0 S�4 ,Q a U�- ROVAL. Plans will need to be submitted D t p E;e lv 1 /c- C��lE•v Tip by a , q ualifie d designer '/i;u E,e9 S,1 �vL�S '�/SE /a �� Si�,'O per LL.H.R. 83.08 (2) / /� i;v rl o vv p — Lvv� � NrIP�oW , d�� 4 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2- of 3 PARCEL I.D. # 10 14 � S Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh, Consistence Bourxisty Roots Bed Tmr& 3. I o /o R y a s / <57 � IV y I/. Ground s YA D , S C v ti ti elev. ft. i Depth to limiting factor, �✓�' Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor I Remarks: Boring # I 13 Ground' elev. fL Depth to limiting factor Remarks: Boring # r` f Ground --- — elev. ft Depth to limiting factor Remarks: COM 0110wo ACIAIM ti - �"•.�:i �' ^�� tai y:.. &)C67 25'Od y0 /gGr/S Z i iJ �d w N 1 N tit n it I N v, C4\ Qy 0 Z � Z � o w N 4 I M i 01 Q �' t • 4 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner 1 //4� �/ • �� Address I V,? City /State %�/•G l/ Gv� . jam' Syo Z z-- V Legal Description: Lot Block # �� GAS' '/. L Sec. 2S , T W N -R /� W, Town of �:y�i' PIN # o22- ' 107 '30 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: 'ho 4-0E1-G To �.¢TE Cy /E•SX 1 O - 1 Size ST/PC ty� Tank manufacturer Setback from: House Pump manufacturer ZO Model U • c Alarm location i (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Li `+ sr f '9c, Meter location C-0 Alarm location SOIL ABSORPTION SYSTEM: / T �R �dVs Type of system. Width 3 Length Number of Trenches 3 Setback from: House_ Well P/L /oa Vent to fresh air intake 20 ' ELEVATIONS �tG T�sT�s �.� �� 41 4 Z oti PLO T �' /,�,� Description of benchmark Elevation Description of alternate benchmark 136770-11 6�e of 2jL/?X 47 WA)"- Elevation /D<o- 7 3 Building Sewer ST/Wr Inlet ��' /7 ST Outlet fS S D PC Inlet f 5 4' DiPo� Soy- PC Bottom Header/Manifold �� ' Top of ST/M Manhole Cover 1 05 : l7 () l0 S• - 3 D () 3 ., sS�.P,S� Distribution Lines () � �d .S• yS r. q Bottom �oSystem (i) fO s • z 5' () ��7 • 7� () lO� Z S' � /1G� Final Grade 7 TS () /0 7. 2 ,5 - 3. ' 1 �n y� d Date of installation / / Permit number 3b0 State plan number �- Plumber's signature P*d License number 2 *3 7-5 Date e/ / 7/ Inspector R od (� OR IGINAL Complete plot plan � J J - t 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 e • INDICATE NORTH ARROW w/ ' cou,L, IN id c 5T 15 3Q Q� 0 lo t PS � 4 �lt 1 r i I � I I , I I I a cs to l I ` v � l- ,ol l f I 1 �o moct I /O Y• �s /o S o r- SCOW& 7 �- /V 40 7� D� 106o, ACE & A ssooUtOS Ulbrkht O Ne Rd• COtiWill>�fll� Hudson YrbF.� s 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.: Pe rsonal info rm a tion ou rovice maybe used for secondary 307648 l y p y ry purposes [Privacy La s.15. (1)(m)j. Pgrt ssie , WALTER & TERESA ❑�� C n of: State Plan ID No.: ! SST BM Elev.: Insp. BM Elev.: _ BM Description: Parcel Tltcnl -1070- 30-000 Ijo %-1& /O,a 44 e l7LG TANK INFORMATION [ 7 7J� ELEVATION DATA A9800037 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. eptic [ 1 9 y - IZS Benchm r 3i 7 61 lol� osing G� 8 C� lf. �' ,2� e Aeration Bldg. Sewer Holding t Inlet /a•S& 1(, C/ TANK SETBACK INFORMATION t/ Outlet �''5 cJS.V7 TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet 22 Air ��' �'� ��• 7� Septic ,-ao tV ti 11 NA Dt Bottom 4 O* q 249 S Dosing �� t � NA Header/ Man. 113. 7• o ll F OG .a► Aeration NA Dist. Pipe 1 '7• C. � : s, a Holding Bot. System T1 '.'� r y:u PUMP/ SIPHON INFORMATION 31 zipivi. Ax Final Grade Manufacturer Demand -.d �b '� Model Number g�j X GPM TDH Lift c 3. Friction �• System,^. TDH ;n3f t Forcemain Length.f o I Dia. Fi 4 _;�_ I Dist. To Well SOIL ABSORPTION SYSTEM BED / N H Width Le 1 y No Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM EN SIMS ' 4N 69 DIMENSION SYSTEM T P / L •BE'R'G' WELL LAKE / STREAM Manufacturer: SETBACK CHAMBER INFORMATION Ty �� h'/1 um er: Sy e DISTRIBUTION SYSTEM �u z- �- t.r aMe+� Header/Manifold roP $ Distributjo e g th Dia. L � t Pip) x Hole Size x Hole Spacing Vent To Air In take 7 Length f �a � 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 25. 8.18.3 0,NW,NW 1408 EVERGREEN DRIVE �a OAA - nP k,jj - �dLo e� 1 4 i f�(l Plan revision required? ❑ Yes `21 No �� f Use other side for additional information. l SBD -6710 (R.3/97) Date Inspector's ignature ert. No ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: i, * Safety and Buildings Division S ANITARY ITARY PERMIT APPLICATION 2 E . Wa shington Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County 6/40/t V than 8 1/2 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 revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan l,p. umber 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N N Property Owner Name Property Location U L7'"�7�' • AWi4 �&V i4, S Z, S T 2� , N, R E (or)(0 Property Owner's Mailing Address 7O � Lot Number N � � Block Number City, State Zip Code Phone Subdivisi n Name or CSM Number U ? �l 1. PE F B ILDING: (check one) ❑ State Owned J !t . Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ___j _ Q T.Twn of �� 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment! Condo A5. Oil?. I9.390 02-2. - /0 7h• 30 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 S ❑ 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.w 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 ❑ Se page Bed 21 E] Mound 30 [] Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 E] Seepage Pit � 43 � � G E] Vault Privy 14 E] System-In-Fill ��� /b S.O - f - VI. ABSORPTION SYSTEM INFORMATION: /04/• S4 -- /a 7. S' 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.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) lQy Elevation �P lib ��b Feet /O 7-0 Feet Ca acit VII. TANK in allo s Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete st acted Steel glass Plastic App Tanksl Tanks Septic Tank erHr 1 1200 J 100 ❑ ❑ ❑ ❑ ❑ Lift Pump Tanker /.045 o ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) /MPRSW No.: Business Phone Number: �o >�r 2Zlbi t z2-1�3 �s ws • 3 SG -AJ Plumber's Address (Street, City, State, Zip Code): ��.� leep . ����� ��. J r+ �D IX. COUNTY / DEPARTMENT USE ONLY �c 71 pp ❑ E] Disapproved Given Initial Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuing Age t Signature (No Stamps) 5 T 1 A roved �i� Surcharge Fee) X U O / Z Adverse Determination lkin X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: B (FLI t W DISTRIBUTION: Original to County. One copy To: Safety & Buidrngs DiNsiat. Owner, PMrrber 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 pf 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 I rxaailingadclless. 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 tan!cs and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX.- County/ Department Use Only. X. -County / Department Use Only. Complete'plans and specifications not smaller than 8 1/2 x 11 inches must.be submitted 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; t) soil test data on a 15 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- c r LBRICHT & 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. # � Date O/ 44t A l, 7 Owner &)A[ � 7 " &-j A - Phone '7 1 S ' y26 � Address 11 177 lela, t .s /;9- �9 30 F lel?� ? S Legal Description �0 /f4eS • fj22- /t�7Q. p 41,W Nw -�CC • z. S T 2 2 t.9 w Town of C County 5 T• G/eOt K C.S.T. R, 1(4 X(�� Zt Installer Rp/S WIA6(. <;�-41 Local Authority/ Supervision 2-7- 3"7 5' ST PROJECT DESCRIPTION �- - h - ��O 0 964 el 4��4 S7��&-Lltr- -- . r (�; a 3 !P Re-rZ - roe 7Vz9 at-es Gv.e i� 3 /. 9 . q n If P P • 3 -7;P E aV S (0 3' / 4 tt C1> 3 Pg .1 PLOT PLAN VIEWS C3) 3 Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS r P9 -4 RTPF 1:AT-E OU ��•3 DOSING CHAMBER CROSS SECTION PUMP PERFORMANCE SPECS This design for installation is based entirely on measurements, e lanci� cape conditions (slo e 'I accuracy (slopes etc.) and soil suitabilit elevations by CS7H of the csTm. of his specs, as reported, shall remain thepsoledrespo sibs ponsibility Any use of this POWTS design ty any licensed plumber, or. any related unlicensed parties or persons (excavaters, laborers) Shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumt-er 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. x 06W x 3 z C)6 to .� cp r d a o d t0 X t 1 .. l oq o C3, o CSIN O �J- o D • b -oa cn r ` QrQ az y c 101A1. 1,L Iff I /�t - -- C _ 14 to r p 5 CRo "S SEC Tloj o T�'E"�vGls Z�S /Av ( pROV A1- 3 1- F s! •� I /wkotp� 14507 PER p1-DM AaOVE -GROOND Ap1EASl .CODE AEE ZANKS & SySSEM AS1M PIPING (FR qp PVG .MEETING . MuS �5 �R p2 g5 S� AND ARDS' U,v ir/spEc T /ov p 1�, iff 18 Pp I l e L g.- 2 ' of C ,9 1 1, Iff F /iv /Sh`ED N - -- TiE'EA.) C1 T 1 vi�L � 4 rit D 7 &tom � s y�T�•� G OGV E 7 6k t .ma PER PLUMBING PRODUCT APR116VAL. CODES, ALL ABOVE- GROUND PVC PIPING (FRO SCT 40 PVC MUST BE MEETING ASTM D1785 OR 02665 STANDARDS. I f PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS -VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIMG N j JUNCTION BOX MANHOLE COVER ?_5' FROM DOOR 12 "/111J. 1, /.4v,4,(p /,O(l1AAf� WIIJDOW OR FRESH AIR INTAKE f /�A pr AcV /O n/ GRADE > _ I 4" MIAJ. IfZo CONDUIT L -- _- i IB" ____ -__ �IEU�rn o�v \ x'3.0 11l =____ INLET PROVIDE AIRTIGHT SEAL n I , APPROVED JOINT A 5 K I ( I APPROVED JOIIJTS 1J /C.I. PIPE IN I h � . v I III W /C.I. PIPE EXTENDING 3' .00� i i i ALARM EXTEMDIIJG 3' O ONTO SOLD 501E IJTO . SOLID SOIL. B '1 � 3 � i I QQ qD I I 0" ELEV. FT. 1 __J PUMP � OFF 'usE 3 D,Q D ' y �lO�PE CF 3 SAN k ��Opl� 6- I .BLOCK Sitvl� /r v!1 f i0 AJ loffm9/N RISER EXIT pERMITTED OtJL4 IF TANK MANUFACTURER HAS' SUCH APPROVAL SEPTIC E SPEC.IFIC DOSE �,(� (' � TANKS MANUFACTURER: -`� IJLIMBER OF DOSES: PER DAy TANK SIZE: GALLONS DOSE VOLU .Lf ALARM MANUFACTURER: IMCLUDIMG BACKFLOW: S GALLOMS ' MODEL DUMBER: Vu L' / CAPACITIES: A= I � INCNES OR . GALLOWS SWITCH TYPE: �e F` 0 B= 2 IWCHES OR 5,b CALLOUS PUMP MANUFACTURER: ` C= -7 IWCHES OR 11 CALLOUS MODEL NUMBER: _ D= 1 IAICHES OR 31 5 GALLONS SWITCH TYPE: Pi�t� M.>Q- f � MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE _ GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. /( e FEET - rAok SPE CS I � MII IIMUM METWORK SUPPLY PRESSS1UR�E/. . . . . . . . . . . FEET EACGI, -F ! �L=_ FEET OF FORCE M X 110 F /ooFr. FRICTIOU FACTOR.. �' S FEET t S 2 s `� = TOTAL D91JAMIC HEAD = �� FEET Yd ts. EN Q � �� INTERNAL DIME.WSIONS OF TANK: LENGTH ;WIDTH `� - ;LIQUID DEPTH ' ivLrT TO IS T PA doX /0 7. 0 • TO 7'�L G% �l MBI DO /6,0 PER PL�ING PRODUCT OND p�fL ABOVE GRO ,CODES, All TANKS & "ST NG ASI PIPING (FROM MVIS3 ov SCH.5DST NDA E D - D17B5 OR D266 Y li p e qj HEAD CAPACITY CU RVE 3 7/e 11 0 MODEL "9H" s/e Z 1 /8 15 4 16 10 2 1 1/2 -11 1/2 NPT —� s 0 U.S. G&ANS 10 ZO JO 40 50 LITERS 60 70 e0 e0 160 240 0 FLOW PER MINUTE TOTAL DYNA4x; NEWLOW Pill 1141unt EFFLUENT AND DEWATIFANO ' HEAD CAPAC17Y 12 UNITS/MIN • , `V FEET METERS GALS LTRS 5 1.52 it 213 10 .od e1 17 4 + 16 1.5Y 45 1�0 Ev 6 t0 25 95 3 5/16 sl w 2a' ---- -1 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical altemsiors, for duplex systems, are available and • Mercury float switches are available for controlllrtg single and supplied with an alarm. three hase *; Mechanical alternators, for duplex sVslems, are available with or • Double piggyback mercury float switches are without alarm stvitcheg. available for variable level long cycle controls. t Standard SELECTION DUIDE ail mode - WOlpht 39 ib�, - 1 /s N.P. 1. '"� Operat 2 a. m pech,T11c,1.wNch, no external conira r f6 series - 2. Single piggyback mercury NOM switch Of double ' equked. Conlrol j ection switch. Rotor to FM0477. Pigyback mstetlry, 6oa1 Model Vpbe -Ph Mode _At E* Sim lax M96 'is Du lox 9 Mechanical e8errtsta 10-0072 or t0-007s t ulo S,0 1 a li 1 — 4. Us FM0712, for 00(1661 model of Electrical AI16malor, "E—Pak". S. Mole" seraot tim switch 10-0226 026 0 pied N a eorNrol aedvalor 29 1 O 4.R 1 o(1 R 7 _ duplex t9) or (4) float system. p Y ES6 290 t Non 4.5 :2 Ol 6 4 a or 41� 6 S f ern lq hple "J Pak (unetloli box, for 18ita111efy tionnec11on or 1Air6r1•Im aim rplix or duplex operation, 10-0002. 7. t 7. Two''M Role °J•Pak ", lo( walemlgt11 0ortrle.__...x spBw, For MMfd `40on on addleooW ioeEei products "fir to Cat a on o4se: uch Barter, FM0511; AN 1 ... l of eodrole, plot CAUTION ecdon lose and wk PIppYQ':k Met" Bwitellee, F140477; Etsekkal Axornala, fM01e6; Mucharlket Axernatp, �' irrs ebeuki M done ►tr • Nwle. FM0405; Alarm Package, FMO517; eumNBeaeW (teems, FMO"?.. and Rimplex Conbol Iced Neeneed eledrklem AN eleotrkd end wady **&a sheul4 be loaeead blelurl ' fMo732. soK Me we am" reeed Ndlead EIeelde Code E Health Ad (OSHA} IN E) aM Nfe Cwvpego" solely end RESERVE POWEPED DESIGN For'unusuat conditions a reserve safety factor Ia dngineered into the design of o,iery Zoeller pump. `. MAN IQ P -0.80K 16347 lodsvillf.0 40 ?56.0317 Manufacturers o8.. , 0 ZZM ' �� NIP Ilk 3 80 Otr Millen lane N IOU/ 1t.. KY 10,.16 (502 )178•2731 ;e ItAY j502) 711.3624 +aw. „ Wisconsin Department of Industry SOIL AND,, EVALUATION Labor qnd Human Relations - Page ! of 3 .Division of Safety and Buildings in accor *ith i . - ,R BS,09, W is. Attach complete site plan on paper not less than 8 1/2 x 11 lnStSesar(size. , County C , Include, but not limited to: vertical and horizontal reference poM(BM), dirdcttb 577 percent slope, scale or dimensions, north arrow, and locatiorf end distcr to raPalestr�oad reel I.D. # f APPLICANT INFORMATION - Please print all ey,"ed b Date _ Personat information you provide may be used for secondary purposes (Pl'va'cy L/ —� Property O w n e r // ? �j' . Prop Lc it i / / S l/ j Gavt��Lf a 1/4 W &1 /4,S S T 2 ,N,R E (or V(0 Property Owner's Mail* n Address Lot # ; � Y6 Subd. Name or CSM# 77 ill -G�, Si1J� 3 0 .44e5 City State Zip Code Phone Number ,�,� Nearest Road fS C1/ SyD iz ( 715 )y1G • 1611 ❑ cit ❑v ina e�N Town New Construction Use: ffResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: ��� �440 J"' �Q,BCO.y�ErN�7� Code derived daily ow / 50 Y gpd Recommended design loading rate bed, pd/ft trench, /ft 2 l 2 �� 9 9Pd Absorption area required Nf� bed; ft trench,•ft �o M aximum design loading rate bed; gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) -SQL 3 ft (as referred to site plan benchmark). Additional design /site considerations �•S�"��.v �!�� Parent material .SCS 7�Z '��1J�,�/}�d L�'��� -s'¢ yf�s Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [�] S El C�'S� ❑ U [ S ❑ U Rl ❑ U I ❑ S E -g ❑ S SOI DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots Bed , Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Q 0 -3 e0 %C 3!L L s ��,,, ,e �QS CS f . 7: . y 100 4” Ground ..3 a -&e /b YIe Sl ,�l L S /,4. /i? �� G 41 . 7 elev Depth to limiting factor 7 in. Remarks: Boring # 2 • /0 Gd vte — L• S / GAS C S /f . ' • B :,. _ ... /d Y,4e S L Ground y /O 3 177 le �e , e lev. /o ft. Depth to limiting fact > fact Remarks: CST Name (Please Print) Signature Telephone No. T 2lG13�'iG4 7 7/,s7. 3 S G • 8/9 .S Address Ulbricht 8 Associa ate G CST Number gnsultants -7 655 O'Neil Rd. Hudson, Wis. 54016 N om , �.fllSi7'F— SyST 4r�L/ C or- 4 td . p�� • / ° �6�ivs SOIL DESCRIPTION REPORT PROPERTY OWNER Page 2— "� of i PARCEL I.D.ff d 40 4 4t f Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Wnsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 / a s io ./� to vx l y f s 4.4 W.S 0r 1 74 Ground C4 elev. /0216-ft. �� w S — — • S • � Depth to limiting factor .l —Pin. Remarks: Boring # �ifN GCs C,$' 2� . � ' � Ws es 1 W 4�r 1QY1V1* Z-5 e4) Ground elev. f "11 Depth to limiting fact r ,j'in. Remarks: Horizon Depth Dominant Color Mottles Structure Gp / in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed . Trench Bong # O. 5 /d ,31j_ LS �,," /� S G'S .2 ' !gee 1- ZY Ground 4 Il Depth to limiting factor in. Remarks: Boring # i Ground elev. n. Depth to limiting factor ' Remarks: SBDW -8330 (R•. 0/95) W � zz u' U ;1 0 61 v ov a 4 a Q o �� C l d d n a w a� ir I .J W Mrs ~� 1 (� 1 � � .- _- ..__._�... tai► t4 w Fq o a d - � ti o D • o Z 0 P� ti PL•'4.v T�9 Tio�v — �9�i°�°o x ��f 67 A°O�P , STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERMUYER �' 7 4t- CS MAILING ADDRESS `y 7 �� V ,f iD 3 0 " ' /f�• . PROPERTY ADDRESS 1 V 2 j(Q Ir' Q P 1^ (location of septic system) Plege obtain from the Planning Dept. CITY /STATE I V I S Y© Z Z_ PROPERTY LOCATION 1/4, ti 4) 1/4, Section 2s T 2 v N -R / W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION / LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, Journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County n Zoning Officer within 30 days of the three year expiration date. y g Y Y P / SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r 6 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ----------------------------------------------------------- - - - - -- - Owner of property 10 Location of property A1ZtJ 1/4 NLt /4, Section 2S , T L4 N -R L� W Township! Mailing address Address of site 1 yo 7'7v'zl ' fZ S Yo Subdivision name N Lot no. Other homes on property? Yes ' -�No > - Previous owner of property — �-t-a• �� 7;e&j Total size of property /K0 Ae' Total size of parcel L/p A4.1 S Date parcel was created /`^ Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds. ----------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. -S(O C-Z� 4 (1p), _ , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly rec ded in the office of the County Register of Deeds as Do ment No. igna�i�f Appli cant Co -Appl' an /,- ; Date/6f ate f Signature p4te of Signature / o O ° 1. 4 + SVTE BAR OF WISCONSIN FORM 16- 1962 • SGG248 TRUSTEE'S DEED DOCUMENT NO. *1267 ma5M REGISTER'S OFFICE � Gene R. K ind ST. CR M WI x _ as Truaa of I OCT 0 2 1997 Gladys R. Kind Family Trust 9.20 AM of 1111114101111111 for a valuable consideration commys withwt warramy to Walter L. Perkins and Teresa Haas Perkins, yg Aueba nd ,rife, as S _a /k /a Tere A liana Perki nd as su vivqrshi marital property n*S SPAM NESERVED FOR 11EC01110114 DATA t HAM AND NEtrxar aooMU > Grantee. P P the foibwft desctimbed teal estate in St Croix CMM)t r Sate cf Wisconsinc LaL C , C' ss - t l � t The NWk of the NWk of Section 25, Township X 28, Range 18. �j1'b 022 - 1070 -30 I twncR gEttltFrC,Ta9tm ttuttsstt i This deed is given in satisfaction of that Land Contract dated 9- 14 -94, recorded 10- 14 -94, in Vol. 10991 Page 200, as Doc. No. 522494, Register of Deeds" office, St. Croix County/ Wisconsin. 1 Y f M Dated this day of September ' GLAD S R. KIND FAMILY TRUST a (SEAL) (SEAL) Gene R. Kind Trustee Trust, >:a AUTHENTICATION ACKNOWLEDGMENT Sigature(,$) State of Wisconsin, ss. St. Croix authenticated this day of , 19 Person&j came bef�,v me this day of -A , 19 . the stave named no R. Kind TITLE: MEMBER STATE BAR OF WISCONSIN # - (if not, r — authorized by $706.06, Wis. Stars.) be the person who executed the foregoing tP iyrd acknowkd the same. THIS INSTRUMENT WAS DRAFTED BY �n[ ,• C. L. Gaylord, Attorney R iver Falls, WI 54022 p, Ii S _ e)( courny,wts (Signatures may be authenticated or acknowledged. Both are not M7 sion is permam (I( no( , state ecpir. ti te: necessary.) �O _, 19 • Names of persons sipina in any capacity should by Typed or printed below their siyeanrm LIM AI STATE DAR OF 1a7SCCIWN Wecarna Le¢t Rat Co Inc. r '? TNU;IFE'S DFFD Form No- 16 -n9t2 a��• ° mom r