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HomeMy WebLinkAbout036-1065-80-000 ST. CROIX COUNTY ZONING DEPART 0. AS BUILT SANITARY REPORT r' /•:'? Owner c� ` " , D Address City /State vs e.v SS ' .� le'''a 5 1999 u } - -' ST CROIX COUNTY Legal Description' 20 NINGOFF1 CE Lot N ) Block Subdivision/CSM # '/4 jL&' /4 A"W Sec4 . T 31N -RAW, Town of Q,n�o,� — / (.as ' SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer wo , I Size ST/PC I &5 Setbac from: House �( 'Well N r1 PAL� �s Pump manufacturers_ Model _ Gad O 3 11 L F{� Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width a3 Length I D) 1 Number of Trenches a Setback from: House 1— Well nom! _ P/L 2 a Vent to fresh air intake alz/& ELEVATIONS Description of benchmark c ,p Elevation Description of alternate benchmark Elevation Building Sewer / ST/HT Inlet 9 - 5� ST Outlet _ PC Inlet PC Bottom 9,71j, 8" Header/Manifold /o � Top of ST/PC Manhole Cover / 1 5-, 97 Distribution Lines O 10 3, y Bottom of System () / 7 Final Grade () _/D - �g, Date of installation 5 //i if Permit number 30T (o f 7 State plan number 9 �(,Qcg I Plumber's signature License number Date - Inspector ZM 8 t.w U FZ— Complete plot plan i Wisconsin Department of Commerce Count y PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT S'4 • Gv'o, r GENtRAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], -_7 41 1 7 Permit Holder's Name: ❑ Cityy [] Villa a g Town of: State Plan ID No.: CST BM Elev.: Insp. BM Rev.: BM Description: Parcel Tax No.: 6b lu ,� 2" PVL c o -°J o� - 9U - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tff,, C,/ ZS-o Bench r 103- /07-05— /pd Dosing rn1-jo 75M� BM 51 6'1$ 106 1 od Aeration Bldg. Sewer g �, ;G ,,� Holding St/ Ht Inlet 16105 9.47 99 • 5"8 TANK SETBACK INFORMATION St /Ht Outlet /d ,p ID•ad 48 q TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic r 2 7 NA Dt Bottom ,P .D J�1 4 7 4.8 Dosing NA Header/ Man. JD ; Z• 1 D3 >� Aeration Dist. Pipe 1(2r 6 Z (p3. : 3 7 Holding Bot. System 105715-, ? 1 � PUMP/ SIPHON INFORMATION Final Grade Manufacturer ov Demand ± afA* loq y. 78 `O d /,Z7 Model Number �? ujs C� 3i Z `d .O 3. 10 S 1 41 , TDH Lift4?5*7 Lriction� System DH t S ( p l d Forcemain Length 111,011' Dia. Dist.ToWell SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .r I O I — I DIMENSION SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM LEACHIN Manufacturer: INFORMATION Typeo , Mod ber: Systemm" t (�' ( � `� CHAMBE OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distributio x Hole Size x Hole Spacing Vent To Air Intake Length Dia. LengtfT[� Dia. , i/ 2. Spacing I / ,� (b" (�� 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 12 - Bed/ Trench Edges Topsoil Yes ❑ No ❑ Yes A-No COMMENTS: ( code discrepancies, persons present, etc.) t (psZ? ir} T.P DC 4vo�dafj b SL- 1 W4,iA:0W " 3) ,X-4 c4i4 iron oz Wcl_�j 4 M-9 f n a ( s11z�16 Plan revisi � on required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date spector's Sygnature ert N 1 r NV f Safety and Buildings Division i scons i n SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83 -05, Wis. Ad m. 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 8 1/2 x 11 inches in size. $1* G r"a t Y • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 1&,'Q 2 ,2G/ ?V_A1 NI - Z State Plan LanN mber I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Zd 01 Pro erty Ow ne Name Property Location K * JL sue. W v4Aj !� 1i4, S a$ T 31 • N, R / f(or) W Mai Property Owner s ling Address Lot Number Block Numb 2 23.2 11 .n w Ci , State Zip Code Phone Number Subdivision Name or CSM Number v �) 4020 . TY E F BUILDING: (check one) E] State Owned !t� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 5 qvN is r �` AGO Ott,. 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo - !' ©36 _ 1O . .. 86 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_ ❑ Replacement 3, ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an XSystem ________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 KMound 30 [ 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. 1 7. Final Grade Required (sq. ft.) Proposed (sq_ ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Qp 00 10 /D.1. Feet 1 61, 2,. Feet VII. TANK in Capacity g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank 50 a r j ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 730 1z ❑ ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri J Plumber's S�at : ( N Stamps) r/MPRSW No.: Business Phone Number: t uJ�1ts 1.50.3 715 ­2 Plumber's A( dress (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE O NLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Q'+ (4 Approved ❑ Owner Given Initial p Surcharge Fee) G Adverse Determination �DO l� f � t2• X. CONDITIONS OF APPROVAL/ REASONS F R DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber - PRIVATE SEWAGE SYSTEM Department of Commerce Safety and Buildings Division REVIEW APPLICATION Bureau of Integrated Services Hayward Office LaCrosse Office Madison Office Shawano Office Waukesha Office 209 W. 1 st St. 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay St. 401 Pilot Court, Ste. C Rt 8, Box 8072 La Crosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, W153188 Hayward, WI 54843 - Phone (608) 785 -9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548 -8606 Phone (715) 6344804 Fax (608) 785 -9330 Phone (608) 266 -3151 Phone (715) 524 -3626 Fax (414) 548 -8614 Fax (715)634 -5150 Fax (608) 267 -9566 Fax (715) 524 -3633 INSTRUCTIONS To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plansMformation. Your submittal must be received at least two working days prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what Information to �. nEl LRtNT VERY U CLEARLY. A sample of a completed form is on the reverse side for your reference. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. 9 Q v 1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the information requested below to save time: Appoi ent Date Review r Name �4 11 Plan Identification Number Q 00 I 2. PROJECT INFORMATION If this review is a revi ion or extension to your existing plan identification number, rovide that number here: Pr 'ect P'ame ` County V l A Q v-- S ❑ City ❑ Village Town of: Project Location $T • C r v % X GOVT. LOT iN (,3 114 Nt j 1 /4,S d8 T 3 ( N,R E (or) W 1 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (include new and existing tanks) A ❑ At -Grade Up To 1,500 gallon septic tank ... ............................... ..$110.00...................... H ❑ Holding Tank 1,501 2,500 gallon septic tank .......... ...........................$120 M ; Mound 2,501- 5,000 gallon septic tank .... ............................... ..$160.00...................... N ❑ Non - Pressurized In- Ground (Conventional) 5,001 - 9,000 gallon septic tank .... ............................... ..$200.00...................... P Pressurized in- Ground 9,001 - 15,000 gallon septic tank .... ............................... ..$300.00...................... O ❑Other. Over 15,000 gallon septic tank .... ............................... ..$500.00...................... Up To 1,000 gallon dose chamber . ..............................$ 70.00...................... 710 Building Type (check one): 1,001 - 2,000 gallon dose chamber . ..............................$ 80.00...................... D Dwelling, 1 or 2 Family 2,001 - 4,000 gallon dose chamber ............................. ..$100.00...................... P ❑ Public Building 4 001 8,000 gallon dose chamber .... IR�l..tV. ...................... S ❑ State -Owned Building 8,001 - 12,000 gallon dose chamber ............................... 40.00...................... Over 12,000 gallon dose chamber... .. .ig}60.00 ...................... Up To 5,000 holdi to jAp ......� ............ 60.00...................... Code Derived Daily Flow gpd 5,001 -10,000 gallon holding tank ....................2L.Wa .... .$1100 Over 10,000 gallon holding tank . ............................... ..$150.00...................... ❑ Check if Replacing Existing System Experimental System (additional one time fee) .............. ..$300.00...................... Revisions to Approved Plan ........... ..............................$ 60.00...................... Petitions for Variance: Setback .. ............................... ..$100.00...................... ❑ Petition for Variance Site Evaluation ....................... ..$225.00...................... Plumbing ... ............................... $225.00...................... . Revision ..... ..............................$ 75.00:..:..:............... ❑ Groundwater Monitoring Groundwater Monitoring - Per Site .... ..............................$ 60.00...................... other than a proposed subdivision ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring ..........$ 60.00 ...................... Subtotal: ................. Priority Review: Enter same amount as Subtotal: ................... MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ............. Re 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) pany Name C CM�act rs on GXL-u0 adr, X K C tit r W r . No. & Street Address or P.O. Box City, Town or Villa State Zip Code 8s Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose ch bers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. OVER ----- SBD -6748 (R. 07/96) ,JAN -06 -1996 09:10 P.03 `7 tS d 8 V 17 - 3 ! �, 7 i PAGEIAOF_ MOUND SYSTEM FOR A- BEDROOM RESIDENCE LOCATED IN THE&W_1 /40F THENWI /40F ECTIONPS,T3N,Rj TOWN OF Crp OTTY, WISCONSIN. INDEX i I I PAGE 1A OF 9 TITHE SHEET PAGE 1 OF 9 WO SHEET PAGE 2 OF 9 WO SHEET PAIGE 3 OF 9 WORT{ SHEET PAGE 4 OF 9 WORD SHEET PAGE 5 OF 9 PLOW PLAN PAGE 6 OF 9 PLAITVIEW CROSS SECTION PAGE 7 OF 9 DIs#iBUTION PIPE LAYOUT PAGE 8 OF 9 PUMF CHAMBER PAGE 9 OF 9 PUW PERFORMANCE CURVE I PREPARED FOR QkVID 4 AGC -N 5R, PREPARED BY POWERS EXCAVATING INC. Caj.A� M PRSw 1563 1969 185th AVE NEW RICHMOND, WISC 54017 P.O•WT•S• 715- 246 -5135 Conditionally APPROVED DEPARTMENT COMMU LDiNGS ViSt F .� I SEE CORR ONDENCE Of ID 0, 4cl c ` a k. v i-tAo Ac>.e- 3/ WORKSHEET - MOUND SYSTEM DESIGN;;�� 4'f ° ' x ' ;� SY, G.•e D7 o -' PROBLEM: Design a mound stem for a rnb rh �' 9 Y �• Y�-UP> The site characteristics are: • Depth to groundwater or bedrock. 39' in. Landslope 3,,5% d 2 Percolation rate Distance from dose chamber to distribution system 80 ft. Elevation difference between sump and distribution system ft. << Step 1. WASTNATER LOAD • gal.*. Step 2. SIZE THE ABSORPTION AREA } s.. : s� A) Area required (�QQ � /, a .....,._._ s. 9 . ft. B) Bed or trench length (B) a ,. C) Bed or trench width (A) 5 . _.5 ft. +« �'.. r r r 1 i a` x {D) firetrch spacing(C` rib ? .: r.. i '" las&ater load .24 gal /ft /day B ft. trenc e�i s Step 3. MOUND HEIGHT N A) Fill depth (D) s 39 ft. B) Fill depth (E) a D + 6 slope (A)+P) �! ,... ft. C) Bed or trench depth (F) , 3 ft: D) Cap:and topsoil -depth (G) ft. ,. EY Cap and topsoil depth (H) ft. i gn License N a :.;•.;_ j'S- J(a3__ _._ 5".2fi TY) - 7 L0 Ras Utdo m a S-S/3 S Step 4. MOUND LENGTH C& A) End slope (K) _ KD + E l + F + H x 3 ft. J B) Total mound le t (L) - 6 + 2(K) Step 5. MOUND WIDTH Al) Upslope correction factor = Y's A2) Upslope width (J) = D + F + 3)(factor)_ = l (� ft. 81) Downslope correction factor 1 I, 1 82) Downslope width (I) _ -(E + F + G)(3)(factor) ft,. (�.z �Yq+1)X3 x / if Cl) Total mound width (W) for bed s J + A + I _�3 _ft. �. b �• S f / - 13 � C2) Total mound width (W) for trenches = 1,/• J + g + (no. trenches -1)(c) + A + I Step 6. BASAL AREA A) Infiltrative capacity of natural soil S g.0. /ft2 /day. B) Basal area re uired = wastewater flow natural soil infil rative. capacity = /o?Oa sq. ft. Cl) Basal area available for bed for sloping sites = B x (A + I) _ sq.• ft. C2) BBas W are J a+ail le for trench for sloping sites = AM) sq, ft. A-b � l aq6 C3) Basal area available or trench or bed for level _ sites _ B x W = ___ sq, ft. SiGn : -. -- License Ku: Date Z2 3�.. 73/ -��� .,.Step 7. DISTRIBUTION SYSTEM s "tan 1A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing = - in. 3) Distribution pipe length = ,[ in. 4) Distribution pipe diameter = f� in. 5) Spacing between distribution pipes = O in. 6) Distance from sidewall to distribution pipe • .36 in. 7B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes per pipe 2) Flow per pipe 9 2D GPM i 7C) SIZE MANIFOLD 1) Manifold is X central/ end 2) Manifold length = 3"4 D ft, 3) Number of distribution lines = 4) Manifold diameter = 3 in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate =_ y GPM 2) Force main diameter =. 3 in. 3) Friction loss = S� 3y0 /QO' �y� • 6-S ft. 7E) TOTAL, DYNAMIC HEAD 1) Vertical lift = r" 2) Friction loss ft. 3) System head 2.5 ft. ft. 4) Total dynamic head Sign:_ p_ Licenge :_ Date:_.___ / Z-- - Dq. d -l-Qi F, O f ." 7F) PUMP SELECTION 1) Pump selected will discharge GPM at ft. total dynamic head. 2) Pump model and manufacturer -_-- F -- If L _ ----- 7G) DOSE VOLUME 1) 10 times void volume of distribution lines gal. /cycle 2) Daily wastewater volume : 4 doses /24 hrs. gal. /cycle 3) Minimum dose volume = 46 gal. /cycle 7H) DOSE CHAMBER 1 b- 1) Minimum capacity required = �jl� 2 gal. Si' n: P ., � _ License ::u •_ 7s _ Date �- �- 4 _ Ti I I - -�_ Aj - �� I li I _ i _ a 7 i r I � r i i I ' _ I Daukd � Pa H o� v y\ S � �'- Of S-S / /3 Straw, Marsh Hay, Or S�a.r► Synthetic Covering SfQroix A5 C'h3 Distribution Pipe Medium Sand s T _ G Topsoll- Y % Slope Bed Of ? — 2 %2 Force Main Plowed Aggregate Layer 0 _L Ft. Cross Section Of A Mound System Using. E /. 2 Ft. ' For The Absorption Area F . ,$3 Ft. G l Ft. A .Sr Ft. H h S' Ft. d: B Joy Ft. se Number: I S K /b, Ft. 7 L 1,26.L Ft. 7. Ft. of Position I /D, Ft. Force Main W ,._ Ft. .L Observation Pipe—, I Distribution. Bed Of i M — 2 ' 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area s:•.. �8 T3/-/7 UD Perforated Pipe Detail l! End view Perforolsd End Cop PVC Pipe Notes Located On Bottom, Are Equally Spaced h � P ,. E r � nrS rib Lott Hol• Sl+o Be .. _ .. . _ '! , i,•. Next To End Cop Dittrib.ution Pipe layout P Ft. R S X 36 Inches Y 3 Inches Signed: Hole Diameter _ Inch — V Lateral " / %z , Inch( s) License Number: -- Manifold " Inches Date: I o Z —Al/ '-9 7 Force Main .3 Inciw; N of holes /pipe / 7 Invert Elevation of Laterals p,!. Ft. SEPTIC TANK 6 PUMP CAAMB£ CROSS SECTION AND SPECIFICATIONS • _ - • . apt �.. • }"lq� t � AIf R k w►u SS�IX '4" CI VENT PIPE 12" MIN. ABOVE GRADE S WATHER PROOF' >_ 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" CI RISER W/ PADLOCK 6 7 6 MIN. WARNING LABEL ABOVE GRADE —�.� 4" MIN. 18" IN. 6" MAX. INLET ` WATER TIGHT SEALS GAS- —�— TIGHT: , 4„ �� A SEAL 1 APPROVED CI PIPE BAFFLE _}_ ALM JOINTS W/ CI 3' ONTO B PIPE 3' ONTO SOLID f i , ON SOLID SOIL SOIL PUMP OFF ELEV. FT. 0]e �I RISER EXIT D PERMITTED ONLY IF.TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS dft SEPTIC / DOSE TANK MANUFACTURER: i4 "a NUMBER'DOSES PER DAY: TANK SIZES SEPTIC' /,;?SO GAL. DOSE VOLUME INCLUDING DOSE � _ GAL. FLOWBACK: /ga GAL. ALARM MANUFACTURER: T E /��f�,c 5.. �f•+. CAPACITIES: A = D, INCHES = S.2•y GAL. . MODEL NUMBER: ,r 4 4 SWITCH TYPE: ribcd B = 2 INCHES = GAL. PUMP MANUFACTURER: C = 4 •2 INCHES = l�G_ GAL. MODEL NUMBER: P SWITCH TYPE: ��,�• D = 6 INCHES = GAL. REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . .%. 2.5 FEET + 90 FEET FORCEMAIN X 41 FT /100 FT. FRICTION FACTOR , ,G FEET T.OTAL DYNAMIC HEAD = _�r FEET I INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH S/ off . /y 7�,0•l v++ SIGNED: LICENSE NUMBER: /5g_? DATE: /e2 - ,31 -9� 1/88 w • GOULDS SUBMERSIBLE FFLUENT PUMPS SEWAGE AND E Aa EP0311 LIST DI gn , OaMEP0311 142 EPO311 1/] Itp 115 V EEflucnt Ftttp 1 /2" solids 256.80 17 s , � ,� ,:Submersible , k� ; `� MODEL EP0311 Efflu Pura METERS FEET SIZE W SOLIDS C6 i.} r 25 UL tit S P 10 p. ' _ _ 5Fc, c, 2 ro 0 0 0 • e 12 16 20 24 25 32 36 40 GPM 0 2.5 5.0 7.5 CAPACITY - f ' • N saw .Perionnance =qtr_ Curve MDR 3W5 a ., { tt k• :s so - — - — SIZE 1 /4" Solids to 210 80 wtom -- i so so to 30 — wto� +' e » 30 eo so to 0o a too too 120 arm e ..�.. ».. _ ...._.. 10 70 J 30 WA, " ti•� . % ':. CAPACITY LIST DISC. 0WPh'E03111. 142 WW311L 1/3 1tP 115 V Low H 3%4 solids 91.55 329.35 _ r. OXIIIA•E0311M 142 WE0311M 1/3 IIP solids 491.55 329.3S `' "��� "`r °•'iS''' ' �' 00Ln'so"1111 142 wE051`1H 1/2 SIP 115 V Itigh H 3%4" .oblidn 704.25 0115 �+!' i.�•. s e Ti U7t1 7071211 142 NE07121i 3/4 IT 230. V 111gh Ili. 3/4" aolids A43.65 565.25 . ti• t r s: •.►.• FaA4WIM P FM FF2iFCttMM7CE AND SPDCIFICATIOt13. ':' ;' "? •' D= 10 /as D= 30 PAGE D7u ,Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor arxy Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 1 s in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point irp , iQnand. % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dist e artist -foad. 036- 1065 -80 APPLICANT INFORMATION PLEASE ��` A VL ��MATIQ�I R VIEW BY ] TE 97 PROPERTY OWNER: _PROPERTY LOCATION � l . Oi f VT. LOT 1/4 1/4,S T N,R r W David L. Hagen Sr. - �� 7 NW NW 28 31 17 � ) PROPERTY OWNER':S MAILING ADDRESS 2838 Lakeview Ave. sT UNN # BLOCK # SUED. NAME OR CSM# a na CITY, STATE ZIP CODE ON CITY ❑VILLAGE MOWN NEAREST ROAD Roseville, MN. 55113 ( '483- -429 Stanton 200th. Ave. APO [xj New Construction Use Residential / Num 4 [ ] Addition to existing building ( ] Replacement [ j Public or commercial describe Code derived daily flo ® gpd Recommended design loading rate • 4 bed, gpd /ft • trench, gpd /ft Absorption area required 500 bed, ft2 500 trench, ft Maximum design loading rate • bed, gpd /ft2 - 5 trench, gpd /ft Recommended infiltration surface elevation(s) 102.70 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 101.70 Parent material glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL IN- GROUND PRESSURE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S N U &S ❑ U EIS N U N S ❑ U [IS N U ❑ S NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench .................. ................. .................. ................. .................. 1 1 - 10yr3 /3 none sil 2msbk mfr gw 2f .5 .6 ................. 2 10 -16 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 16 -37 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 elev. 4 37 -60 5yr4/4 none scl lmsbk mfr na na .2 :.3 10 ft. Depth to limiting factor +6n,, __T Remarks: Boring # 1 0 -9 10yr3 /3 none sil 2msbk mfr gw 2f .5 � .6 2 2 9 -18 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 18 -39 7.5yr4/4 none sl 2mgr mfr gw na .5 .6 Ground elev. 4 39 -72 5yr4/4 c2d 7.5yr5/6 scl M na na na np 1 .2 10 ft. Depth to limiting factor 39" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 -6200 Address: 1554 200th. AA1, New Ri and 5401 Signature: Date: 12 -1 -97 CST Number: m02298 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 David L. Hagen Sr. New Richmond, W1 54017 MPRSW 3254 NW4NW4 S28- T31N -R17W town of Stanton (715) 246 -6200 N 1 " =40' BM.= top of 21 pvc pipe C el. 100' Alt. BM.= top of steel fence post @ el. 109.95' ��� 'l �1uC�• 2� fL 4 4z- 70' 'I p -1 Gary L. Steel. 12 -1 -97 S 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 Dpv t 4 L, Poi -IE N Location of property Nw 1/0 1/4, Section T �� N -R W Township h '5t1&*1Ta U Mailing address yiu Address of site - " O a 400 A014Z= , tiv (ZcuA 1-iO Subdivision name C-:�NA Lot no. Other homes on property? Yes No Previous owner of property T Total size of property �'( Xc- ± Total size of parcel �J1 A�C' ± Date parcel was created 1Z-- IZ- °I1 Are all corners and lot lines identifiable? x Yes No Is this property being developed for ( spec house) ? Yes X No Volume 11�b'L and Page Number 2 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. 51x9 - 1 - 1Cb , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above descried property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deed as Document No. Signature of Appl ant Co- Appiica:� / -;R-9'y STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ��A�/ i D t_. , OP� vt ie W MAILING ADDRESS 2 r� lfAwe�Yi 441c: t 5c_ . E mN �' I /G ?7� PROPERTY ADDRESS Xx.X 4 1 00 TIV (location of septic system) - Please obtain from the Planning Dept. CITY /STATE 0.6w Zt 'k'o 1� _ PROPERTY LOCATION �IiW 1/4, 9W 1/4, Section �`� T N -R 1 W TOWN OF �'t-! ST. CROIX COUNTY, WI SUBDMSION LOT NUMBER CERTIFIED SURVEY MAP 44 1 40 , VOLUME - 1 , PAGE '10 , 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 scum. I /We, the undersigned have read the above requirements and azr = to maintain the private sewage disposal system in accordance with the standards set forth, herein. _s set by the Wisconsin DNR. Certification stating that your septic has been maintained must be come:: ::d and returned to the St. Croix County Zoning Officer within 30 days of the three ye expiration / da::. SIGNED: DATE: i _ g - St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016