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HomeMy WebLinkAbout030-1006-80-000 ST. CROIX COUNTY ZONING DEPARTME]I" f AS BUILT SANITARY REPORT Owner d e e e - Property Address City /State Legal Description: - Lot j Block Subdivision/CSM # ,z t /a 4Ld V 4, Sec. , T N -RAW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Al, al) e s 4- w Size ST/PC / Setback from: House Well PAL Pump manufacturer 1 z, /d Model Alarm location t� s (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: , 4g�d Width 32 Length Number of Trenches Setback from: House Well PAL �_ Vent to fresh air intake 2��= ELEVATIONS Description of benchmark Elevation _iae, Description of alternate benchmark ,O� tr'o,w o ,, Elevation f9'. y4 Building Sewer ST/HT Inlet 9?�7. ST Outlet PC Inlet PC Bottom 1/' 16 ' Header/Manifold 6 S Top of ST/PC Manhole Cover 7 °Z Distribution Lines () 977- ° 3 () ( ) Bottom of System Final Grade () () ( ) Date of installation 3 /,� - /�9 Permit number 9, State plan number 4 / Plumber's signature ��;�.�� -��� icense number Date Inspector Complete plot plan Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM count • INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar PermitNo.: Personal information you provice may be used for secondary purposes [Privacy Lay, s.15.04 (1)(m)]. � 2 4 6 6 7 A ftHolcjg s plame: 1;i11!' 6 t 3hl) Town of: State Plan ID No.: CST BM Elev.: 1V Insp. BM ElTB M Description::5 SE Parcel T o. �ge a - ylQe" � "b- 1oo6 -80 -0.00 TANK INFORMATION ELEVATION DATA A9800557 0- 1 j `l. Z. - 7� TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. rtcu,Pr LOCO Benchm loci Rosin � �o �� l 3,7� � • Aeration Bldg. Sewer Holding St /Ht Inlet r {� 7 9' TANK SETBACK INFORMATION St/ Ht Outlet TAN TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl eptic � � c� S 7 j v ti NA Dt Bottom /d,a /�/� 87� E ing `� " /r S� NA Header /Man. 77 Dos NA Dist. Pipe lci,• b Holding Bot. System �d SAS 9 - 7_ PUMP/ SIPHON INFORMATION 30 P& �.)c Final Grade Manufacturer C�6ld Demand 5�,�►n��1,.� Model Number _ Z C PM pv �)IA J lo/ /ate TDH Lift` Lriction3q Systema� TDHI71 Ft Forcemain Length33 a Dia. F a" Dist. To Well -t- �r I SOIL ABSORPTION SYSTEM J- G1 BED / TRENCH Width Length q 7 ( No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM I N DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA ING Manufacturer: INFORMATION Type O _, � , CHAM M el Num ov ti /J;9 OR UNIT DISTRIBUTI SYSTEM Header /Manifold a Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length / pia_ Length Dia. ), acing 8 ti SOIL COVE x Pressure Syst 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 E] Yes ❑ No [ E01 Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 2 .29.19.27G,Sfn1,SW 1119 COUNTY ROAD A F ;1 ke � V 1� �� Plan revision required? �] Yes 3 Use other side for additional information. Zp�� SBD -6710 (R.3/97) Date Inspector's Signature Cert. No Safety and Buildings Division NV% iconsin S ANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. , • See reverse side for instructions for completing this application state sanitary Permit Number Personal information you provide may be used for secondary purposes �Q [Privacy Law, s. 15.04 (1) (m)J. ❑ Check if revision t previous ap location State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATI N Prop y Owner Name Property Location 114 57/Q 1/4, S ;Z T ;2 41 , N, R� E (or) (6 Property Owner s Mailing dress Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUMMING: (check one) ❑ State Owned ❑ ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms I] Town OF d III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ,T (J — /� d G 571 — Cc d 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 E] Campground 7 E] 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 ❑ S stem 2. ZReplacement 3 E] Replacement of 4 Q Reconnection of 5_ E] Repair of an ------ _ y__ .......... _ S yst em ____ _________ Tank Only ______________ Exi sting System Exist System B) E] 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 (,Mound 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.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 27S 97 ' ` -Feet Feet VII. TANK Capacity n gallons Total # of Manufacturer's Name Site Fiber Gallons Tanks INFORMATION i Prefab. Plastic Exper. New Existin Concrete Con- Steel glass App. Tanks Tanks strutted eptic Tank r- F+ehdiTrgfiank 60(0 G1 �$'7`!✓.I� E] 1:1 ❑ 1:1 ❑ ft Pump Tan nber 66 / es rek,,J EL I ❑ ❑ 1 ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signa e, tu : (No Stamps) r PRSW No.: Business Phone Number: n °2'7 ! 'ir ' 2 - Pl umber's Address (Street, City, State, Zip Code): = IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit F e (Includes Groundwater ate iss Issuing A nt Si g nature (No Stamps) XApproved El Given Initial �( da Surcharge Fee) Adverse Determination VO I A V �( C� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1 W5 *i sconsin Tommy G. Thompson, Governor Department of Commerce Philip Edw. Albert, Acting Secretary October 14, 1998 CUST ID No.267341 ATTN.• POIPTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 h 1 ! , 9 1 CARMICHAEL RD RIVER FALLS WI 54022 ! -� ON WI 54016 RE: CONDITIONAL APPROVAL \� f, APPROVAL EXPIRES: 10/14/2000 (,.�MP 1J Identification Numbers i OCT Tr-Ansaction ID No. 181260 T98 )Sj$4 ID No. 161645 SITE: ST cR Oix pease refer to both identification numbers,' CCXJ �''✓ above in all correspondence with the Site ID: 161645 ! (�NIlVG OFFICE St.Croix County, Town of Saint Joseph �'' . a en . SWI /4, SWI /4, S2, T29N, R19W Dan Beer FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 429488 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/05/1998 FEE REQUIRED $ 180.00 fer M. Swim FEE RECEIVED $ 180.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon Fri, 7:15 AM - 4:00 PM jswim a commerce. state. wi.us i Page 1 of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION 2 , T l N, R 19 W, TOWN OF sT_ __s COUNTY, WISCONSIN. I NDEX - Q,c� PA GE 1 'of 6 TITLE SHEET S gFFTy ` `" PAGE 2 of 6 PLOT PLAN - PAGE 3 of 6 PLAN VIEW -CROSS SECTION: PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR _ 74 _ c()i�d 1111 eov►,,`M �� '` a`' � ��:� `' � ,ERCE of ca�� �o► s PREPARED BY WEGEE�E� �p = L TEST I RlG AND . DES = G[4 >ER�1 I CE Ito ��� \SC ®•�V1^/ F.O. BOX 74 421 K. KAIK ST_ ,�. ti RIVE? FALLS. KI 54022 W 715 -44 -0165 ARTHUR L D . ., p R = •975 P 1 : ELLSWORTH, IG�� r) Fi JOB NO.' PLOT PLAN Scale page Z of �o 1 "= y p' 2 a 5 3 h d� ��Stvit Z S pnL y y PV Q- '? I� I I N v ' r M n 5,1 t:L a b - KIIJ s � 6z , V, `1 b - I L6T L I �--1, ail. S Ey- l4mf J G _M71k -S To Y1 s eeo NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (__E_ required) 3. Install 4" observation pipes with approved caps. ( Z required), 4. Septic tank to be ` bso gallon capacity manufactured by w'l lI�W S 1 GV C� ` s-- , L /'1l 0 - 5. Bench Marker gMk{ (_ — tuo. o' 0 N (JNAL IKJ b" wowo P23 r QwItA'Z �- w(� ,p' or.I t w CHI el.usTf� 6. Divert surface water around mound to prevent ponding at the uphill side. Page 30f c Approved Synthetic Covering r C.33 Distribution Pipe Medium Sand Topsoil a — I E J' D Elev. q S 3 b Z % Slope Bed Of 2"— 2 %2 Force Main Plowed Aggregate From Pump Layer D -o Ft. Cross Section Of A Mound System Using E N36 Ft. A Bed For The Absorption Area F 0 •`� Ft. G N.o Ft. A F-S Ft. H � -S Ft. Linear Loading Rate= C . GPD /LN FT B Ft. Design Loading Rate= O.� .GPD /SQ FT j 11 Ft. J Ft. K Ft. -ems L b1 Ft. _..F-or-e -44&ir _ W - 17- Ft . L Observation Pipe B K i -------------- - - - - -- --------------------- A J I _ _ F w t - - -- Force Main Distribution \., Of %«— 2 %M °t�Pos i Pipe 2 I Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View. Of Mound Using A Bed For The Absorption Area Page 30f Perforated Pipe Detail 0 End View Perforated End Cap. ° �` PVC Pipe Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced V S PVC Force Main P PVC Manifold Pipe * '2 Oistri ution Pipe Lost Hole Should Be i Next To End Cap End Cap P Z Z Ft. Distribution Pipe_ Layout S L_ Ft. X YR Inches Y —q_ Inches Hole Diameter IV Inch Lateral Inches) Manifold Z Inches Force ' Main Z Inches # of holes /pipe L Invert Elevation of Laterals g8.o Ft. �,x1 -k1= —) - UZx V_ Z$ -6? GUS•'1 Place 1st hole U from center of manifold with succeeding holes at u $ intervals. Last hole to be next to the end cap. - Combination Sept;ic-Tank and • PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE S OF -VEIJT CAP WEATHER PROOF JUIJCTIOIJ BOX 4"C.I. VENT PIPC APPROVED LOCKING lO' FROM DOOR, MANHOLE COVER rvrM 'dINDOW OR FRESH wARIJ1W` LI4gEt.. AtR IMTAKE S cor�Dutr tj 6 MPry i ,L_ `1, - d{ 6 S j • CORN - I ` "MIU. Fn-7 `_ _ .� le•MIU. PROVIDE I INLET AIRTIGHT SEAL I I I 3laFF��S APPROVED JOIMT A I I' ( APPROVED JOIIJT: PIPEOX Tank construction W /�' P shall comply with ALARM ILHR 1;3.15 and 33.20 � I oIJ C I I CLEV. o __� PUMP OFF D COIJCRETC BLOCK - RISER EXIT PERMITTED OIJLy IF TAAJK MAIJUFACTURC R HAS SUCH APPROVAL BEDDINQ. 1 86D� I N4 SEPTIC f SPECIFICATIOfJS DOSE TA M KIJ MANUFACTURER: w'1 \Dk1�5T��V P NUMBER OF DOSES: 3 ' 3 � PER OAy TAWK SIZC: 1 652 GALLONS DOSE VOLUME z ALARM MANUFACTURER: S'S• k`LL S`'1 S`R6I S INCL DACKFLOW: ��� GALLONS MODEL DUMBER: ' " 3 t tw CAPACITIES: A= \b INCHES OR GALLOIJS SWITCH TYPE: �iZ °Un2'� $ = Z INCHES OR 3 y G( LLOUS PUMP hIAMUFACTURCR' C: \O IIJCHES OR x`10 GA LLO N S MODEL N UMBER: 3$ ��Oy 8 �,3� D w IAICHES OR GALLONS SWITCH TYPE: T 5L fJOTE: PUMP AUO ALARM ARE TO bC MINIMUM DISCKARGE RATE Z �' •O� GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AU PIPE.. fit' 33 FEET + MINIMUM NETWORK SUPPLY PRESSURE , ; , . • .. . • , • 2 5 O FEET t ZZS FEET OF FORCE MAIN X `' b F �orr. FRICTIO N FAtTOR_. 1 FEET TOTAL DyWAMIG HEAD = 1`�-Z9 FEET Pump chamber DIAMETER _ IIJTERAIAL. OIMEI.ISIOIJ� OF TANK: LENGTH _ ;WIDTH ;LIQU10 DEPTH BOTTOM AREA — - 231= GAL /INCH AS PER MANUFACTURER = t1: ' GAL /INCH • .. • Goulds ��s 6 or— Submersible Effluent Pump EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Motor: Available for automatic and •Farms • EPO4 Single phase: 0.4 HP manual operation. Automatic a ntsoat switch attachment • Heavy duty sump g p models include Mechanical p o ints . • Water transfer RP , 230 V, v Hz 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. SPECIFICATIONS • EP05 Single phase: 0.5 , FEATURES ■Bearings: Upper and lower heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. g Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design 3 14' maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Co. Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: 1 NPT. plug. Optional 20 foot ■ Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic stic enclosed design for end in 7" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 r components. _ — - - -► 5. Pump: EP05 8 • Solids handling capability: 0 25 ; %" maximum. • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. g j • Discharge size: 1 1 /2' NPT. a - — -- __ - -_ _ _ _ _ - ___ - -- -_ - - -. _ - - - -- —� - • Mechanical seal: carbon- 0 5 15 j rotary/ceramic - stationary, BUNA -N elastomers. 0 4 - - - -- -- -- - - - - - - -- EQOS Temperature: I 3 10 i 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 - - -- ` - -- - - -- - -- -- - - _ EPO4 -- - - ! - -- - 5 1 i 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divisir*$Qf Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direefidn and S r n r percent slope, scale or dimensions, north arrow, and location and distanq� to'nearest roa APPLICANT INFORMATION - Please print all inform-16 Q ­ Reviewe.by Date Personal information you provide may be used for secondary purposes (Privacy l aw , s. 15.04 o m i '± Property Owner Prop` sdifon 2 ►� 1 Gp>f ��,( i /4,S i� TN,R , E(or Property Owner's Mailing Address tot # Block #, �Su . Name or CSM# City State Zip Code Phone Number El City - Village ® Town Nearest Road C4y R ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building 14 Replacement ❑ Public or commercial - Describe: Code derived daily flow �4 5 n gpd Recommended design loading rate • 5 bed, gpd /fi - 4 _0 trench, gpd /ft Absorption area required - L Q_ bed, ft trench, ft Maximum design loading rat _ bed, d /ft gp _ Cc gpd /ft Recommended infiltration surface elevation(s) 97,210 ft (as referred to site plan benchmark) Additional design /site considerations Co niQc s r e.1 t? U ?( z [) Parent material Q la ck, 1 11 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 El [ u s ❑ U ❑ S EA u ❑ S 15L U ❑ S U ❑ S [] U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 5 k rn;r C 1 4 ......:...... Z ►C ID. r 2.) S I I rra rn ,- Ground Gro J Gro ZO� Z r 3 2 - -- —, S� I �r – S i 2m(AtK -fi C — Depth to D - IQ r 3 ) q 7 r g I 31 Y1�1 Mil -t 1 Iv N y limiting g -5� Z •5 (0'e, 1 SS13(Z (Ylf't factor min. Remarks: Boring # r3 1 5 rymlok 2 Z G -ZI �0 211 51 oaabL CO-Cr- C-5 5jT 3 21 -25 l U y 31 2 1 L m r C — le Ground 4 �J -3 Ib r 3 ( 3 5 2 4ab elev. 5 �G. 5,11 — 5 3 0 ft. 5 33 -39 r a y C 2P r 4 m v i — IV ,�, Lo 39- 2.5, Depth to i L S — N limiting factor 33—in. Remarks: CST Name (Please Print) Signature Telephone No. a 7i /� Address Date CST Number �5�. Sc� wl s �- 9 -2- _ a S� r til u SyS�ew� e(eU• q?.ZD 1 1460's L sok. V Orywell (1 a r'aq e- ( cv' i•'�'11 Wisconsin Department of corm e " SOIL AND SITE EVALUATION Division of Safety and Buildings Page of ntneau of Integrated Servicos in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — - - -- - -- - Parcel I. D. # 0 3o- i l o (., -Q( APPLICANT INFORMATION - Please print all information. Reviewed by Date - Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location _ Pr 1) O�V1 Bnov' Govt. Lot ls� 114 SW1 /4,S T ,N,R / 9 E (or) W operty Owner's Mailiin�g�Adddress Lot # Block# Subd. Name or CSM# City State Jfpjod, Phone Number ❑ C ❑ Village [ Town Nearest Road 1 ( )vim S3 ❑ New Construction Use: [Residential / Number of bedrooms 7 3 Addition to existing building �] Replacement ❑ Public or commercial - Describe: Code derived daily flow _ gpd Recommended design loading rate bed, gpd/ft trench, gpde 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 nsi Parent material � 1 l a�JGt_ [�( �eo� rc, 1Z—• Fk>od plain elevation, if applicable �'f ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S U3 U CK S ❑ U ❑ S ® U ❑ S ® U ❑ $ .lU ❑ S ' Q U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 . . Cont. in. Munsell Qu Sz Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots cc Bed , Trench TOM 2 g 20 5L r Ground 3 C elev. J Depth to a . 156 , tP 7S v limiting 6 510 factor in. Remarks: G('eV LS �j� — A Yn I V('Lve I (� > f ✓LOS G GG� p Tc- fo e— r atA c,—+— r C&&; & W; �AM 16 f +� f? " -�w �Ge 1� S0 L2 i l "71xq �d A I-4- C Wiscora Department of Commerce SOIL AND SITE EVALUATION " Division`of Safety and Buildings Page 1 of 'Bureau of Integrated Services in accordance with s. ILHR 83..09, Wis. Adm. Cooe G t r. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ounty include, but not limited to: vertical and horizontal reference point (BM), direction and ' percent slope, scale or dimensions, north arrow, atiRn a . d dunce to nearest road. parcel I.D. # APPLICANT INFORMATION - P/ rintaANnf mation..\ y � r i � f - Reviewed by Date Personal information you provide may be used f r �e ndary F!4Ubv cy Law, s. 15,b4 (1) (m)). Property Owner 7 r' 4 Property Location 7 4�t�c l� Govt. Lot 5(�J 1 /4,SC41 /4,S T . ,N,R E (or) Property Owners Mailing Address `° ..�, Lot # Block# I Subd. Name or CSM# 7.ONING 0FF'GE City State Zip Code a Number 5y O) )� \ \ 1:1 City ❑ Village Town Nearest Road 1 1�4 New Construction Use: 6XResidential / Number of bedrooms _-3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 456 gpd Recommended design loading rate !,bed, gpd/ft . t0 trench, gpd/ft Absorption area required you bed, ft 79 trench, ft 2 Maximum design loading rate a bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) 17./0 ft (as referred to site plan benchmark) Additional design /site considerations 0-0 r1-10v r' d &. Parent material — 6 - f -A 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 1 ❑ S [K U IE S ❑ U ❑ S U u [X s❑ U ❑ S OX U ❑ S [1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots `i5 Bed i Trench SL m c S to 2 15A r 2-5/7 Ground 3 S L 1 M r CS lip — 5 L (� elev. r -- �ft - �r LS -- _S Depth to limiting f t r �in. I ' Remarks: Cr-e V15Qd filmC f - 14one, M4 AR Boring # 0- tU r 2 1 S L 2 Z -I ?• r2.5 SL l rL 3 1$ -4 7.5 1jr ' 2 l.. NAAL Ground 9.3 5l c( r G rro n Q. md* CS Depth to limiting factor 4 in. Remarks: iYt' V1:50 ( S err , C 43" CST Name (Please Print) Signature 0 110 " Telephone No. ( -11 ` 2 00 Address Date CST Number 4 40$ Cad y -t -q P IK 0!r-Uo9LWi.5w-� K / 4 ?4tj . , Sec- -io Leg -OZ M!Lti. Maid n (je Yalder- �• #j CVA+o r- t1 v. q !o. fio N c4V iu n e�rjf+'R � Scpi� D�rWe I' . 6 f �3 C d r rr\ M ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number 3 0 /646 -8`d dd'o LEGAL DESCRIPTION Property Locatio _ I /,, y4, Sec, I- Tg_f N- R _j'V_ W, Town of SfiJ�so . Subdivision _ 6 Lot # Certified Survey Map # Volume , Page # Warranty Deed # `l �� 7 Volume 7 D , Page # ;z S Spec house ❑yes ono Lot lines identifiable .T yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of property described 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. * * * * ** i ** 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