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HomeMy WebLinkAbout034-1022-90-000 n N p n+ f c °' O m > > 0" 3 W (D 0 Z Z, o w O ° (D 'D O A O p O C ' i O (D N (O N A (O 41 -4 (D "' (D N N Q N (T N O (D p. ^S l (O Vl N O a:s C CD n '--I N O 3 0. 0 °W F ° v 7 (A O O O p O d m C A !v (D W a c o o N N � a O O � O L (p l� CD m(0 n r W (o 00 � � rr Q o � N N (n 'D Z O O O = c (A N fR D N N O S c V O o C> o O O O � M d 'O fn �1 A !ti CL z N z .. ZZ� 0 0 1 1 D D o c w O I CD a �• CD c I z � -' —1 co O_ D A Z n rti A n A z O N O 0' O zz —1 (D (D CL z O A I F a A a I n � o' N T C Z (D z Q) o a a I I it A N O O v � A b w (D O O O d y I ti �1 DEC -15 -1995 14:17 ATK 612 639 3656 P.02 D EPART M E NT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDING; INDUSTRY, LABOR AND PERCOLATION TESTS 115 OX 7 HUMAN RELATIONS � � P.O. P -O, 60X 796 & (H63.090) & Chapter 145.045) MADISON, WI 53701 LOC RMO /� TOWN IP/ilR}p�N OT NO.. BLK- NQ: SUBDI V N NAME: lio �' �f A/ O / 1 ?1 04d rior) w l�� I / Li COUN[Y M R'S NAME: AILING ADDRESS: us E T NO. BEDRMS : COMMER iAl DES RIPTION: r DATES OQSERVATIONS MADE IMF! enet' D New OReplace • 90 , /90 RATING: S- Site suitable for system U- Site unsuitable for system ONV NTI NAL: MOUNp IN GROUNaPfi .p LL G NK: RECOMMENDE SSYSTEM:(optional) os�tt sou oSmu 0S.M1 os OLDIN TA If Percolation Tests are NOT required DESIGN RATE: under s /���Q If any portion of the tested area is in the F1oorlpla iit,_i n dicate F l oo dp l ain el ev at ion: PROFILE DESCRIPTIONS — BORING EP TAL H TO GROUNDWATER L WIT - INCHES CHA ACT R OF SOIL. THICKNE TEXTURE, SS, COLOR, AND DEPTH h0.1M9ER DEPTH IN, EI- EVATION RSE V D HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) % - Ly 7 E mv& � 9S 8- C tiET >iG 3040 B- 3 e- PERCOLATION TESTS TEST DEPT N H'. WATER IN HQLE TESTTiME DROP IN WATER L V RATE MINUTES UMBER NCHE IS AFTVISWEI -LING INTERVAL -MIN. p R p PER INCH 1 �: F 1 P. l t6 vzk P. P_ PLOT PLAN. Show locations of percolation tests, sail borings and the dimensions of sLitable soil areas, Indicate scale or distances. Describe what are the hori• zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, SYSTEM ELEVATION FAF- -.j Air S..... _ `�P If �pf . h ... I........ i _ _ _.._ _ r —T—� —� T . t !E•.� l i +off _��� i L ° ` - ft - Rl - wJ7'�C 9,0 403 1, the undersigned, hereby certify that the sail tests reported an this form were madt; by me in accord with the procedures end methods specified In the Wiscon-11 Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME jorl &FA V. CMWA 13A TESTS WERE COMPLETED ON: ADD 2 T1 N 121 UI rICATIONMqER: PHON (optional).' 16 2i6S- GNATURE. VIS714111BUTION: Original and one copy to Local Authority. Property Owner and Soil Tester, DILHR-SBO8395 (R. 02182) — OVER — TOTAL P.02 ST. CROIX COUNTY WISCONSIN move i ZONING OFFICE 1 „ /, , ■ r ■ - ST. CROIX COUNTY GOVERNMENT CENTER -� ► - 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 i January 2, 1996 Mr. Tim Mahoney 925 rustic Rd. #3 Glenwood City, WI 54013 Dear Mr. Mahoney: An onsite soil investigation of your property, located in the NE�SE;, S.10, T.29N. R.15W., Town of Springfield, St. Croix County, WI., was conducted on April 24, 1990 with the assistance of Don Cormican, CST# 3646. My notes indicate that the property was in the name of Ray Mahoney at that time. This onsite revealed suitable soil for onsite sewage disposal to a depth of 25" while meeting the requirements of the A + 4" rule. This site should be suitable for new construction utilizing a mound septic system. Our office does not have the original soil test completed by Mr. Cormican. Accordingly, a new soil evaluation will be necessary prior to the issuance of permits for this property. Should you have any questions, please feel free to contact me at this office. Q nceely, 7 M s K. Thompson Assistant Zoning Administrator cc: file DEC - 15 -1995 14:17 ATK 612 639 3656 P.01 • URIC. /ice / MAIL STATION: PHONE NUMBER: � (o Z16 96 { ;. . j � .... FAX NUMBER: a� Y FROM: PHONE NUMBER: 617 - 6,3g- 3 (o NUMBER OF PAGES (EXCLUDING LEAD SHEET): COMMENTS: cQm".^ -aA;. !Z/i51, e"I r _ -7,4- 1 1 f � /.e 046, • ST. CROIX COUNTY TONING DEI'ART 9 AS BUILT SANITARY RE PORT ,p Owner /`� RcIvE a Address City /State / v, �e�.., J'� OCT ii:: X - ! � L Description: ZQ N L.nJ INGOFFIM' t Block -- subdivision/CSM # '�` °`} t Ir JJ t 5; SeC. T N -RAW, Town of S �rd PIN # o SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION: Tank manufacturer l�'� /naive `t_ (` Size ST/PC/ Pump manufacturer 4' Model ��, Setback from: House Well -!�LjP /L > /po i Alarm location (HOLDING TANKS ONLY) Setbacks: Service roa Vent to fre Meter location ater Line Alarm 1 ion SOIL ABSORPTION SYSTEM; Type of system: thi O� Width L / Setback from: douse ' Well Number of Trenches -� P /oo Vent to fresh air intake 7 j ELEVATIONS: Description of benchmark Description of alternate benchmark '4 bd �Ld '� �� Elevation Elevation Building Sewer ST/HT Inlet ST Outlet � - �9 PC Inlet - --- -- PC Bottom _a,�� Header/Manifold - ,f` Top of ST/PC Manhole Cover F- �1 Distribution Lines (!) , , �' - Bottom of System (1) Final Grade ( Date of installation X01 / 9 - yPermit number ,2 - State plan number Plumber's signature License number Date Inspector Complete plot plan w Wisconsin'Department of Commerce ,,Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) sanitar p [Privacy i Personal information you provice may be used for secondary Purposes La s.15.0 1 1 �� Permit Holder's Name: ()( mil• %E ROBE RT ❑SPRINGFaIE Town of: State Plan ID No.: BM Elev.; Insp. BM Elleev.: B Iat G Parcel _h ':1022 -90 -000 TANK IN ORMATION ELEVATION DATA A9800380 TYPE MANUFACTURER CAPACITY STATION BS HI TFS ELEV. JPF 7��O1 *Benh 4 �,Og 3.�3 ItTI9 � �4 l� TANK SETBACK INFORMATION - 3 _-V TANK TO P/ L WELL BLDG. vent to D Dt Inlet Air Intake Septic NA Dt Botto DK l fvn � r r I Z a NA Header / Man. It T- 5,Z Ae NA Dist. Pipe Hog Bot. System PUMP/ SIPHON INFORMATION �8 8� Final Grade Manufacturer o�� Dem�nd B� Z x$;33 Model Number as GPM GPM J! vv� Friction •S� 3 �3,oS TDH Lift S ,, Systema A L FFl TDH Ft t i`b lv 1. I G Forcemain Len th r ` 5-(. g �.p Dia. � " Dist. To Well X010 r SOIL ABS PTION SYSTEM Width � Lengt h� r No. Of renches PIT No. Of Pits �Inide Dia. L�id pth DI MEN I N 5 DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type o CHAMBER System: > I(A) (g r � r OR UNIT Model Number: DISTRIBUTIO SYSTEM Header / Man Distribution Pipes) q �� � if x Hole Size x Hole Spacing Vent To Air Intake Length Dia Z Length _1�2_ Dia. � Spacing I a I 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 P El Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) A 3.11 3.4Z 9�.? Z LOCATION: SPRINGFIELD 10.29.15.158,NW,SE 1036 RUSTIC ROAD #3 W 1A Lx— ctt � ' 4t, _ � c t _ �/ •� �/ _� ) o — S ` 9 °� �' > 1/ f.,� -- P N o . n r evision required ❑ Yes — /6 `�� 1` � � Use other side for additional information. ) 0 SBD -6710 (R.3/97) Date Inspector's Signature Cert. SANITARY PERMIT APPLICATIO Safety and Buildings Division V iconsin 201 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application G State Sanitar Permit Number Personal information you provide may be used for seconda IPrivaC Law, s. 5.04 1 m ry purposes y 1 O ( )) / / 9 �1 /. _ -{� ❑ Check if revision to previous application V9& k�(, S17 3 IgOad State Plan I.D. Number I. APPLICATI N INFORMATION -PLEASE PRINT ALL INFORMATION /7 Prope Owner Name Property Location �• w 1 S t i4, S �0 T c,2 r N� R ��- W Property Owner's Mailing Address Lot Number Block Number IMW City, State ° Z� e `hqn�) umber Subdivision Name or CSM Number II. YP F B ILDING: (checkohel ❑ State Owned ❑ It Public 1 or 2 Family Dwelling - No. of bedrooms ❑ vil lage Nearest Road p Town OF III BUILDING USE (If building type is public, ch SP / eck all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo `©- 9 . 15 • X58 D Yel — le ;2 -2 — �� 3 ❑Campground 2 C] Assembly Hall 6 E] Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 7 ❑ Merchandise: Sales/ Repairs 11 Q Restaurant /Bar /Dining 4 Q Church/ School 8 ❑ Mobile Home Park 5 ❑Hotel/ Motel 12 El Service Station /Car Wash 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. X New 2. ❑ Replacement S stem 3. ❑Replacement of q ❑Reconnection of S. Q Repair of an ------ -Y -!em -- - - - - -- System -------------- Tank Only-------- - - - - -- Existing System Existing System ❑ A Sanitary Permit was previously issued. Permit Number B) - - - - -------- -y - - -- Date e Issue V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 X1 Mound 30 12 E] Seepage Trench [1 Specify Type 41 Q Holding Tank 22 E] In- Ground Pressure 42 El Pit Privy 13 E] Seepage Pit 14 ❑ System -In -Fill 43 ❑ Vault Privy 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 60 © Re uired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 090, -5 _ VII. TANK Capacity D Feet O Feet INFORMATION in gallons Total # of Site Gallons Tanks Manufacturer's Name Prefab. New is Con- Fiber- plastic Aper. Concrete strutted Steel glass App_ Tanks Tanks Septic Tank r Holding Tank GO f d 1 e ® 0 ❑ Lift Pump Tank iphon Chamber 1:1 n VIII• NSIBILITY STATEMENT I 1 ❑ ❑ I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( Stamps) M p E N O.: Business Phone Number: Plumber's Addres (Street, City, State,.Zip Code): ccr o , .t IX. COUNTY / DEPARTMENT USE ONLY C] Disapproved Sanitary Pe r mit Fee (includes Groundwater ate slue Approved y Issui A ent Si nature (No Stam s) []Owner Given In G Surcharge Fee) f: p Adverse Determination 0 O /� U 8 /V g$ 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 15837 USH 63 I sconsI HAYWARD WI 54843 -8107 Department of Commerce Tommy G Thompson, Governor William J. McCoshen, Secretary August 11, 1998 CUST ID No.222234 GALE W SMITH 3228 HWY 170 GLENWOOD CITY WI 54013 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 08/11/2000 Identficatiori Nurni�eus Transaction ID No. 117259 SITE: Site ID No 16566 Site ID: 16566 Please refer to bath ldentlfieatic�a numbers; ST CROIX County, Town of SPRINGFIELD above, in:all correspondence with the °agency..3 NWl /4, SE1 /4, S10, 729N, R15W ROBERT KEIL RES MOUND FOR: Description: NEW MOUND Object Type: POWT System Regulated Object ID No.: 36626 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. This plan approval is for a 600gpd mound. The following conditions shall be met during construction or installation and prior to occupancy or use: • This plan action is subject to designer comments on the plan • Correspondence Note: • Maintain well setbacks per Comm. 83.15(4) & 83.10(1). • The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope P • Per Comm. 83.23(3)(b)2, the area 25 feet below the downslope edge of the soil absorption system must remain Con undisturbed. • Install dose pump per manufacturer recommendation (Re: "D" dimension — 4 inches). APF of the a P s p DEPA TM A copy a s ecifications and this letter shall be on -site during construction and open to DIV90701, 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. SEE C!JF Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. S4;es DATE RECEIVED 07/13/1998 T REVIEWER FEE REQUIRED $ 0.00 nI FEE RECEIVED $ 180.00 (715)634-3026, M - F 7:45 AM TO 4:30 PM REFUND DUE $ 180.00 TBRAUN @COMMERCE.STATE. WI.US /Ab 4 AC4! 47 gle -Iry a,5 Jt� 4_1 Hi Tz Q -�- I - - -►—' • - - -- - - - -! - I _ -�_ � -�dis a �d +- + - -• i i I � I I I — , J pi pe L I H - - -- - — - -- -- �- - _I� I •W.T.S -- i ttinQ EO COM ERC ESPONDEN I - -- - - - -.. I - I jk-4:1 �,Nt, INk Ilk I _ Page °? Of Strow, Marsh Nay, Or Synthetic Covering Distribution Pipe Medium Sand cv , Topsoil _ 3• E d % -Slop Bed Of 2— 2 %Z ( Force Moin Flowed Aggregate From [lump L.oycr D /, o Cross Section Of A Mound Systern Using A Bed for The Absorption Artc F�� G ' 9 �z�YiGU A S Ft . li Sr /. J • Si 6 le e Fr. License N umber: I p,. 1 FL. Date: �� /p qif J 4 Ft. K Z& / Fr L 4? Nor. f L d ORScrvaf o' n Pipe !3 K A -7 � Force Main W ° 1 From Pump �Distribulion Bed Of �— 2 iM Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorplion Area Page Of. Perforated-Pipe Detail CP End View peR FOR '�, z pV4 P"P 4 psi ' '1. Force iiain PVC i Holes located on bottom of force main are equally spaced End cap `— Last hole should be next to end cap Distrihutation pipe la out C/ J P Ft. Invert Elevation of Laterals , j Ft R Inches S _Inches S igned s X�Inche s License t �. �„ (� ! rInches Dates —l �' Hole Diameter Inches Lateral 11 Inches Manifold It .Inches Force Main It Inches # of holes pipe. ��'' y . Re V /,s e Page Of COMBINATION SEPTIC TANK /PUMP CHAMBER (No Scale) 4" CI Vent Pipe with Approved Locking Manhole Cover Approved Cap, +251 With Warning Label Attached From Buildings Warning Label Weatherproof Approved _ Junction Box Vent Cap T 12" Minimum Final Grade -,,, 6" Minimum 4" Minimum _ 6" Maximum ; 18" Minimum 4" C.I. ' Quick Insp. Pipe Disconnect 1/4" Weep Baffles Hole � A 4 � Alarm 1 On B C *APPROVED , Off JOINTS WITH Qr APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL i 3" of Bedding Under Tank—/ , I Note: Pump and Alarm Are On Separate Circui P c its Number of Doses: Per Day Gallons Per Day / o Doses: 1,5 Gallons Tank Manufacturer: Volume of Backflow: ....... + yl5'Gallons ' / v� Cf i'N �°�� Gf9 Total Dose Volume:— ume :........ = g , rGal 1 ons Tank Size - Septic/ © r - � Gallons Alarm Manufacturer: s 7 _ c /-g o Model Number: Capacities: A inches or Switch Type: + B �.� S'3 Gallons Pump Manufacturer: d inches or Gallons Model Number: + C inches or ° + D inches or Gallons Minimum Discharge ate: � q, Total ..... _ _ inches or�Gallons Vertical Difference Between Pump Off and Distribution Piper ,p Feet Minimum Required Supply Feet of Force Main x Pressure:............ ,�© /,6 Friction Factor /100�Feet:'�+ eet Inch Diameter Force Main �eet Total Dynamic Head:... XZIOFeet Internal Tank Dimensions: Length �-- � 9 Width r Liquid d Depth 3e o?lq ,41 / lNd Signature ^ License Number o?.?.? ? , ?k , Date� � �� PUMP CHAMBER CROSS SECTION AuD SPECIE pAOe or -� : - ICA1'IONS ' VCI\JT CAP 4 "C.I. VENT PIPE ' WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUIUCTIO" Box W'1000W OR FRESH 11 u. f MANHOLE COVER A-IR IuTAKE GRADE I 7T MIA1, 18 "MIN, C0U CD) UIT PROVIDE AIRTIGHT StAL I ", 4 P PRO VE D FIFE JOINT A I I \\ '•��, C.I. IF I EXTENDIAJL. 3' I III APPRDVED C� JTO SOLID SOIL, - I I II w /GI. PIFE ALARM EXTENDIUC. ONTO SOLID c A CLEV. O� �-� FT. + I I Cki I I p ump -- -- p - [� y ' OFF COK3CRETE BLOCK RISER EXIT FERN i1TED GI�Ly I /f SX / TA►JK M AIJUFACTURER Hqg SUCH APPROVAL �L'd uN�IB,�? SEPrIc f /0?CCt °- eee .fL eeA41G DOSE SP ECIFICATIONS rA/V/r - =A_uKS MAUUFACTURE R : 11 etc= s f ER/V TAIJK SIZE G WMBER OF DOSES: ALARM MAAlUF GALLOIJS DOSE VOLUME PER DA-4 - s r� INCLUDING BACKFtow: MODEL AIUM6ER' Q LV GALlOr g SWITCH TYPE: M e/p _ CAPACITIES; A= '� ►L IWCNES OR PUMP MA NUFACTURER: _ G► GALLOk;1 �L! L a/ g'- —Z _IWCHES OR GALLO► -'S MODEL NUMBER: _Jc 00 c !� C ' '` IQCHES OR S WITCH TYPE GAILOI'� -. -f/Ja ,[� �'� D " -- INC HES OR MINIMUM DISCHARgE RATC o E: GALLOKIS LL,_ PUMP AWO ALARM ARE TO BE VERTICAL DIFFERENCE OETWEEU PUMP OFF Aup pISTR UTION ptp �� I �� NST �� AIIEO ON SEPARATE CIRCUITS + MIuIMUM NETWORK SUPPL!j • PRE65URE "�"�'� FEET + � FEET OF FORCE MAIN i l/� 6 0 ' 0 . i � � F iooFtFRItTION fAtTOR. FEET TOTAL OyNAMiC HEAD a 1 -n� , INTERNgt, DIMEIJSIOAIL OF TA FEET AIK: LENGTH ----- ;WIDTH —2 . • DEPTH � LtgUtD LICEMSE &IUMBER: Z 2,3 _ gp WESTSURNE SUPPLY INC. ' 12 DUSTRIAL RD. ON, WI 54016 Goulds Submersible Effluent Pump WIMP 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series Specifically designed for the stainless steel. Fully submerged in high following uses: grade turbine oil for g • Motor Housing. Cast iron • Effluent systems • dry without dama to lubrication and efficient for efficient heat transfer, • Homes components. g heat transfer. strength, and durability. • Farms Motor: ■ Motor Cover. Thermoplas- Heavy duty sum Available for automatic and tic cover with integral handle P • EPO4 Single phase: 0.4 HP, manual operation, Automatic 115 or 23 and float switch attachment • Water transfer 0 V, 60 Hz, 1550 models include Mechanical • Dewaterin9 RPM, built in overload with Points. Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, IN Pump: EPO4 115 V, 60 tiz, 1550 RPM, FEATURES Bearings: Upper and lower • Solids handling capabilit autotmaticreset with Impeller: Thermo- heavy duty ball bearing 3/4" maximum. y' ■ EPO4 construction. • Capacities: up to 55 GPM. • Power cord: 10 foot Plastic Semi -open design • Total heads: up to 24 feet. stan prong 1 6 /3 SJTg with pump out Protection. AGENCY LISTING with • Discharge size: 1'; NPr mechanical seal cip • Mechanical seal: carbon- ength , 116/3 S TW w tl� P ast enc osledrdesie m o rotary , r (CSA steel Ca nadia n Standards Association -N t ionary, elasomer three prong grounding plug improved performance. model numbers BUNA - elastomers. end in "F" or °qC °,) • Temperature: (standard on EP05). ■ Casing and Base: Rugged 104" F (40,,C) continuous thermoplastic design provides 1401(60q intermittent. superior strength and • Fasteners: 300 series corrosion resistance. stainless steel. METERS FEET • Capable of running 10 I dry without damage to — _ components. 9 30 + I Pump: EP05 8 I : I— - ,-- SGPM--- i- - - - - -I • Solids handling capability: o �� l �J 3/" maximum. a z _ i t-•2.s .. -- FT . • Capacities: up to 60 GPM, z '" i - -- - - -_ S2 6 20 • Total heads: up to 31 feet. I i y • Discharge size: 1 %z" t NPT. • Mechanical seal: carbon- 9F s rot ary/ceramic- stationary, ° 15 i I — BUNA -N elastomers. q i - - -- • Temperature: o 104 °F (40 °C) continuous 9 10 EP03' -. 140'F (60 °C) intermittent. - - -- !_ _ t 0 °� -- ' ° 40 so ° 2 q c�;t,5 GPM 6 8 10 l� 1995 Goulds Pumps, Inc. CAPACITY 12 nt'/h Effective May, 1995 0116- Wisconsin Department of Commerce SOIL AND SITE EVALUATION .Division of Safety and Buildings Bureau of Integrated Services in accordance with s. ILHR _83.09, Wis. Adm. Code Page of .� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size ¢fllri must include, but not limited to: vertical and horizontal reference point (Bt�A) CI o� ` and tCOUnty percent slope, scale or dimensions, north arrow, and location and .distarfce to nrps `� � �+ Pardel I. D. # APPLICANT INFORMATION - Please print aii info{n; tiow °Cfa `r Y Personal information you provide may be used for secondary eview y Date Purposes (PrivocyJAW, S. 15.Wl) " IX Property Owner + t Govt. Lot 1/4 s� S f T / W Property Owner's Mailing Address 1/4, 9 N ,,R 3 i' tOt#' B1 u V 5 Sbd. Name or CSM# City to Zip Code Phone Number A � (�`�) ❑City ❑ Village 9 ®Tow Nearest Road New Construction Use: 14 Residential / Number of bedrooms T Addition to existing building El Replacement El Public or commercial - Describe: Code derived daily flow O p gpd Recommended design loading rate bed, d/ft Absorption area required •---- bed, ft2 Q � 2 9P trench, gpd/ft trench, ft Maximum design loading rate bed, d/ft Recommended infiltration surface elevation(s) / Oi �'� gP trench, gpd/ft It (as referred to site plan benchmark) Additional design /site considerations Parent material rare �j 6 1 A L 7' L L Flood plain elevation, if applicable )VA ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade U = Unsuitable for system EIS ®U ®S ❑ U System in Fill Holding :;* ❑s 0U ❑s ®u [Is ®u ❑s u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles in. Munsell Texture Structure Consistence Boundary Roots GPD /ft Qu. Sz. Cont. Color C i Gr. Sz. Sh. Bed , Trench �R i C'. ob Ground 3 2 S � M � C' a� , •� elev. ` j J r 9 "ft. s �� s Depth to limiting factor Mkjn. Remarks: /doll. �,,i f l�/Q q / Boring # 2 C k 1 6 4 Ground elev. ft. Depth to limiting faptor ZZ- 1n. Remarks: CST Name (Please Print) Signature 01 � � Telephone No. Address Date CST Number 10 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT OWNERSHIP CERTIFICATION FORM Owner/Buyer a t o e e Mailing Address o 2 Property Address [ o c< (Verification required from 3 Planni Department for new construction) ����� /1�"v City/State / �� -- Pa=l Identification Number d LEGAL DESCRIPTION Property Location Alk ,, _ ' / Sec. R Subdivision W, Town of --` Certified Survey Map # Lot # Volume Page # Warranty Deed # --- 13 $s�p Volume 1 S7 Page # Spec house O Yes fly no Lot lines identifiable O yes Q no Sy S'TEIK. r'L4IlVMN'ANCE mea dnm tenameof Consists of �draaltiaits tank Y'ourseptic can affect function of M Septic °s 50 M4 if needod a lice se to � e - Ps'OI &Vow Septic tank as. a � is &C Waste Pumper: What you put ifto the system The property owns agrees to submit to St: Croix Zoning Dqmh ismp �l �Phberor a Iieensed ag a oat<ficxtloa form, signed by the owner and try a &C on_sit6 and/or (2) after inspection and P°mPi (if n � .tncis Tess ew �, "e Id have mad the above sludge set forth, hcr+ein, - as set by ffie Department o and the D to th pa� system with the standards Commerce dad the loa Your the x "M has been, maintained mast be completed � rivaL sewge d4o r Of Nat Res tot �' She of Wisconsin.. Certification 19�M expiratio n data. (�oixCormty Zoning Office within 30 OF APPLICANT OWNER. CERTIFICATION DATE I (we) certify that all statements on this form are true to the best of m Y (our) knowl the Party described above, R y virtue of a deed recorded in It I (WO) am (an the owner(s) of Register of Deeds Office. SIGNATURE OF APPI;I /3 / Y� « « « « «« DATE Include with Any information that is mis- c+eMsented may t+�1t is the sanitary it being revoked b the «« this application: a stamped warranty e Zoning Department. tY deed from the Register of Deeds office a spy of the certified survey map if reference is made in the warranty deed 2 y a JI-4 1" - S t t r •' i:,; r r�,- i i iv (h ' " v � 1 01 x Wo_V tt:V �. t' � 1 •.� }� � •F�,; Ir '�tif♦MKI •' � W � t' Y f e.:.•� 1 � ..•� .. 1 �" �� .y k (. -4 r W .+ Z'.fy 'k' 'ka d.,�''1'K •+ "• r 1'``h (. i !� {' ytx �►' ` 2 1t+" r �. . }}`F •i �..• '•� A tc .X fah t..,, Do ji lL'IWD� rr 1 ^_ ,IB � 1 'sll�eP luudeniq s• (SnloB aoj UM049 uoRBnele "'f U 00"14 )13 d d f 1 um e�p �o/pue uBld �oo� o� �ele� eseeld 'jeumoeuXoy ;." 843 �(q POHIPow t ueeq eney �(ew ewoy peydoiBoloyd enoge eyl j&( oj OI x i l �. o s £L Z WMM -3 LON 3noev I