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HomeMy WebLinkAbout040-1144-80-200 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law. a 15 Aa (1)(rn)) Permit Holders Name- City Village Township William L. Tilton revocable trust I TOWN OF TROY TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dial. Dist. to Well Z IL AI1JUli I IUN 5Y51 tM ELEVATION DATA STATION BS HI FS ELEV. Benchmark All BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Disl. Pipe Bot System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System Model Number UNIT UIJ I r%IDU I IVIV J TJ 1 CM Header/Manifold 10istribution x Hole Size x Hole Spacing Vent to Air Intake PIPe(s) Length Dia Length Dia Spacing SOIL COVER . Drxau vn cv..nm. n..w - AI M. A._r-A Depth Over Depth Over xx Depth of xx SeededrSodded xx Mulched BedfTrench Center BedfTrench Edges Topsail yes No Yes No COMMENTS: (Include code discrepencies. persons present, etc) Location: 278 W GROVE RD 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Inspection #1 Inspection #2 Plan revision Required? Yes ] No Use other side for additional information. SBD-6710 (R.3197) J Date InsepctoYs Signature Cart. No. S" -- n Itary Permit Application ST. CROIx COU WISCONSIN (j with Chapter st. Croix County Sanitary Ordinance COMMUNITY DEVELOPMENT DEPARTMENT ST C v rml i orm p may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road S. L5.04(1I—A, Hudson, W1 54016-7(715)3t36 4680 Fax (715)245�250 yi plete for the a out ro 11 incites in sae. Si rl ❑ Chalkif revision to previous raigm 7t I. A - Plow* Prim all Information cation: Property Owner Name �%- 114, Sec N, R E (o Bill Tilton Ipplication Property Owner's Mailing Address 278 Westgrove Rd C Z�$ uJ Qzo v tr RD C ! Number Block Number 1'ot � City, State FOC41de Phone berbdivision E 1612-867-7473 Name or CSM Number / P�� CJ 3ype Hudson Wisconsin 7 r ng: ec one Pa' � )City ❑ Village drTown of P W 1 or 2 Family Dwelling - No. of Bedrooms', 5-&gAf&*A4.9 ❑ Public/Commercial (describe use): Nearest R- ❑ state-owned 11 D Type11. y one x online x online applicable)Parcel ax um r(s) 2.0 Reconnection 3[] Non -plumbing 4 ❑ Rejuvenation A �O -(� 1� Repair N Sanitation } l Y l 61 34`1 ``5 Permit Number q L1 / q G Date Issul/a3 hil jj State Sanitary Permit was previously issued IV. Type of POW T System: (Check all that apply) Non presskrized In ground ❑ Mound 2 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Pit Filter ❑ Drip Line O Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑Other ❑ At -grade ❑ Aerobic Treatment Unlit ❑ Recirculating t V. Dispersal Area Infortrtatbn: Final Grade (bin.linch) N 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. Synattachedd /evation N Required Proposed (Gals. dayfsQ.ft.) s `� C� 0 3 7 V1. Tank In pasty in Totalcurer e Plastic New Existing Tanks Concrete stru ted Tanks Tanks ❑ ❑❑ N ❑ ❑ s vll fieaponsibilltyStatement 1, the undersigned. assume responsibility for repair/reconnectiorJrejuvenatiorJirstallatwn of non -plumbing for the POWTS showplans. Alicense is not required for terrelift repair a the irstallat n of non -plumbing sanitation system. MP Busirt Plan r (prntt) Plan Sig to Pkimbe Address reet. City. State, Zi Codei� ^ Vllt. County use Only b asappt,.ed IF Sa Permit Fee -� /Date Issued I Agent S ure No stamps) 1'y2DLZ Approved Initial Adverse 7 Dete action Ix. Cato W3T`1 s� �r tt�—i� Q�w Nrte C tt'a"" Septic tank, effluent filter and dispers?! c ; I 99q. must be serviced I maintained as per �gre k, management plan provided by plumbo,. 001, L All setback requirements must be maimai red �) CALL w; l.. .• ivk �^""" ^' as r applicable code I ordinances. 5.) ("VSr r .... t� r- - �a� S 0i 5 �+►�n ova e�tg %l Csr �[ a+.-+Naut�Rr e sW�-it ram- w V PROPERTY INFORMATION MS WG_ COMMONS,, / SONNENTAG CONSUL. UL O.EALA. RNER / - 1 TM LNNE ` / PFi1fEL. FL:)A y / �- / i 1� 616 TOWER AD. 9ETRAcrcS 41 / / HVDSON. WI 54M RDAs w"_ (\ b1� ,/ / • ) / PH. 651S34-M = FEET SIDE wwPOQOM2DNTLN) =FW ���0' b o Ow"c1q UPC" PROPCe[D pdt * 1 ETRXI'L 'pNE e1* dPq� r i♦1 J� 1 F£MA NAVOMIa Y mo (� •?! • /`� 6Qj ) I MYMMA FILL' RENAREMENT' m r / mi aWILIR MN DP,mD FEM FLOOR• ew0 qQ oic .. IM W. CROM OOULRY FUDOOPL.AIN , F' ^ GARAGE / / � yE�MKIINII'TMtJO.t Rz r 1 (eee.D 3) / ORnwcE FOR MORE NFasuTION 1 Jpp Ion.aM.a r, Pc �, Fe" TwcNr&BULETNtom �p 1 / °Y / / DOYT.bTiI=tx sF, WSOVIw ADNTONPLNDODPR00FM �)y / i P00.GGIMIVM R. OPTIONS. 'TROPLE DATA FROM YMOOIOTON OOUNTYAND R. CROIX COUNTY F.Ls RhNC A 080" A FIDOOFUN ELEVATION 1 UCIURE ON PILRN J / �� LUINc RXWMY LOP61 TNMI ma % (FLOOR ELEV. 9 .e) DETE•MOINAT A VWTLAIILY // �• i -•cy� ���f OETERYNE 2O&TL MAOO MOLIFOMf - VJ aF M](1N]OATDYPRAOOEIIVAT1Vfi ,LIMITM� �e� cMTaF]dO]IATE Cbl10Mt WIM/WETLANCF/DICFE � NDNO TNO / ` '^6 l ' X IPOT OEYAMI EBOTION OFTHE a CRONRNEII / ` EX. •r PUMP mow. i X' TANK q-OPADED Ih •I,m0W EaFT. / SEPD / Ai.ORAOE FOOTPRM •1,T70IN 6aFT. WN KCAarmM•;D- 2)m ROOFLWE •LNO It) SQ f DECK $fAR6, GTYdAX.00(p EQFT. xsluP\ 1 / J I \\ r� Ira aoasmwy nun WE %VWIID � 1 WELL 1 OLAmDATan�a. , I>t• � ' I / Fau N ALLI, "� 1 I / Foam aN TM® ISRI A bee t �- I �� \ ♦ ,''1 I nKm THE ieoL " MEam IttlDDIES *ALY L FIW Ps1MWl CI TPRINT TO RE D& I\ / aoomPF e ati e ci FLOODPROOFED (RAISED) I /willm / alA aA1WD nm QtVIIw LINE 3Y MDE Npt6S GRESS EASEMENT. PAGE 4'1iS. DOG. j597784— ///� a VOL 1403. PACE 4661, DOC. fW7786 / 7 // // SOUTH,UNE Dv . LOT z SEC. 12, T26NL' R2OW T . C 8T. CROIX COUNTY CDD • � w�� o�,.o a�l�aa A� OL-01-k SS�� PROPERTY INFORMATION EXISTING CONDITIONS., 1, / SONNFNfAG 0� y R�ivER�iar YER or rn�ILLIOLrruL //�� y i ' PROPMUME uC. PAFKEL•PItl AOEI �(11 P "ime M6 TOWER IP. $ NUDSOf1. YASWB SETBACKRCMD WA e'\'M' \/ • �� I PH. 661-m-m O iRPE BOO FEET �O/�b SEPBQq tLFCN PROPOSED FEFf ((�� Q ,' n e O p`I � � m � ow I arRucruRE St7 �Qo� eye o`ti / � ♦il _ I\1 �VV I M, MAL ELEV. O iPt„P9l 5e2 1 •AulAFtltl i MA A VDSSOATUY QL20�RECLWMME� Ono O ,? / i �V�N OI L fTR1f-MwASLO :AEawm sko///ed` J GARAGE ,i I 7EEsr. OT 00LXYFLOODP1AN awpn:. ". oROPw+CEPa tale P�alrATo1 - / �' / I Imt-oFl lc�r,ALAmt �BAA TEOMCALRUM iOM ° / / aovr.ImswaoNaraR. p � - iuDPt Townwnov. a. opnow M]aRIDIYL FlO0aP1100Flq / r amoouwrt:w av RCFL , 00V P A aTT.CA wASEaTax / TUR ELNA / COISRY NOR. CIIOa(oOILRV FLI `� 1 , UCTURE ON PION / i� mTa1G c 0HTLyUInmrwm@KAN =vATw FLOOR ELEV-E97.9) i i '— QuaF1TLv LOVYBI T111N cL20. ( NOTE -TIE OIQI KN Pq RAND LT .? OEIETtYLE 2MrJM 0ACO WWATBOLE R wOS Itw7CN1lNO lACOIwE11VATNE PIIpOEOuIE (Al11Rw (riffs MFRNQ)FOTsaw 6A / L I�SpB 1 .1 ' SPOT aray" UPON FWOR0.001C FAGTM ALOW TN! O SECry TlEa. CgMRNBl / ♦ .T EX- aaPcs ma PUMP EDI�srNOSPa1GTIAE O TANK •ryg /. / ORgNALrmrPnFar .1IM s¢FT. SEPTI �ORAOE rd ATOlAtM.t.=,]70 W LQFT. ENAIE FOOTPRM•T.SFO W60.FT. / m � / CECK IE RIm W lOFT. O Imo,/ 1' f / CEO[ ETAPq, G1WN.1t WO W sCFf. O // � • V \ � ) i� / � � S SAM R1E WpML OI1 '^, 9' N.mw : / I ; \ uTm uP011W. suFRer ,4 ,4 • � / I,WL.nE.anmMo O I , X. AOQIYIAL sT. aaDl 1 WELL \\ I >S+ I Flo°AaPORAATTm"AT0i Foam am nm sm A uWAlEame�� � A CP aOl -�'' +f ,1 �♦ wAIdY MO ST. CL OOW1Y TA ene O GI TPRINT TO BE 06 I♦ „ / ®K. Tw —e �• ry bb —1 „ , � ♦ FLOGOPROOFEO (RAISED) TMTL WA amroR / ; I ♦ �� /T // FnTaoPax uF an N _ I / 33' N1DE INGtMA E% EASEMENT. L. 1403, PACE 9E 455, DOG. j597784 VOL 14M PACE 441. DOC. f777 PR TY UNE SOUTN,UNE GF . LOT 2. SEC. 12 T2; R20W / 0 / o b amFmrnae File #: ST. CR NTY SANITARY SYSTEM Office Use Only ""0 OWNERSHIP/ADDRESS FORM Creoted 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Prol2eM Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addre City/State/Zip Phone Number (required) 6 /a — 91, 62 7y ;73 Email Address Parcel Identification Number (found on the property tax bill) M NEW SYSTEM: LEGAL DESCRIPTION Property Location t/4 , t/4 , Sec. 11, T,2EN Rol W, Town of Subdivision Plat: Lot # �. Certified Survey Map # le -I y / 5% Volume 7 Page # O� O a 3. Warranty Deed # / t :2 LSl� (before 2006)Volume Page # Number of bedrooms Spec house 0 yes Xno Lot lines identifiablekyes O no New Property Address ( to Initials) (Verifica ion of new address I Zd� zz (Date) OFFICE USE ONLY from Community Development Department for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-42SO Fax cdd@sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov UMMAw A1.0 EXSTING CONDITIONS A1.1 NEW FOUNDATION Al FOUNDATION AND FOOTING DETAILS A1.3 EbSTING FLOOR PLAN At.! PROPOSED FLOOR PLAN Ik A20 ROOF PLAN A3.1 EAST ELEVATION A3.2 SOUTH ELEVATION t AM WEST ELEVATION A3.4 NORTH ELEVATION A1.0 DOSING POST FOOTIGO, f a M, Aucried DQSTIK FOU 11 1411GII I 10GARAM P9,11, LA DOOR FURAGE� /I& GARAGE DOOR uw am. was acawtaor.r�eary rwamR�. �osr..m vsccrmwerso+.m oscrvo�wwwa•r iM1�•IN �4 91 FOOTING DETAIL WITH GARAGE DOOR FOOTING DETAIL GARAGE FOOTING DETAIL URDAN EXISTING FLOOR PLAN'' URBAN I iM f�I�ML � I I I I I I --------------- r-__ -- I 1 I I I 1 --------------------- I 1 I 1 L- -- -----1 I I I I wales Iw I i I I I I I I I I I I I I I I I � I I I I I 1 L__----- ------ ---_-J EXISTING ROOF PLAN PROPOSED ROOF PLAN 4ILV,•IZ IB'•lw O PROPOSEDFLOOR PLAN Y16_ • rsr URw^H I .Ills .Ills milli mills m, Ill III Ill milli .Ills \Ill 111111111,111161 milli mdn ■Ilu milli mills milli ml II1a11111 mills mills mills mills mills milli m11111 .1....... ,..... ..... ..... ..... .i .uu •nu 11111m1mm.1.11."1m...m.. u. uu•van .nu. gym. nut `.1111 Dille .IIILm1111 ■IIII mill `qll mills 11111111 I" mills mall 111 4mmills ills m11 ■U11 ■ 1.-I...—... p11..-- ls •1"111111 ._..._ _ iun�tw 11-�ili� 11 .IIIm.1111 mil- l...ills ai111J' EXISTING SOUTH ELEVATION S 16' . 7'-W PROPOSED SOUTH ELEVATION L 5ne•.r.C' UNMAN EXISTING WEST ELEVATION � 3ns•rw' PROPOSED WEST ELEVATION 2 3nr.1w EXISTING NORTH ELEVATION T PROPOSED NORTH ELEVATION 2 anet- r-o• URMAN n Wisconsin Department of Commerce Safety and Buildings Division GENERAL INFORMATION PRIVATE S� INSPECTION REPOR (ATTACH TO PERMIT) Personal information you provlce may be usea for secondary purposes [Privacy Lew s.15.04 (1)(m)]. PerrQjtltp Nam�ILL C1tjt_ ❑OVilage Town of: T B1MIIElev.:� Insp. BM Elev.: BM Description: TROY �D.Or e �' Sta►t DO reary rwrrnDuwTrnws a c IArrnu nw TYPE MANUFACTURER CAPACITY Septic ���,� lb5o Dosing Nil 1 imp Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto Air Intake ROAD Septic >(ap' ,Z I NA Dosing f170r 7SZt 0231 NA Aeration NA Holding PUMP / SIPHON INFORMATION SOIL ABSORPTION SYSTEM Sanitary Permit NO.: �A. 7 344645 J340-1144-80-0 a0!.4 --- vn / STATION BS HI FS ELEV. Benchmark 'I, o t Ilya, d . ast Bldg. Sewer St/Ht Inlet St/Ht Outlet .o} 3- Dt Inlet /s• �� q2. S Dt Bottom �q, (�� 3 / Header / Man. ? I e • t 7r Dist. Pipe Bot. System 110,6-47- . Final Gradeou BED/TRENCH DIMENSIONS width f Lent . No. ches No. Of Nts InsideDia. Liquid Depth SYSTEM TO PJL BLDGWELL tt LEACHING Manua rer: SETBACK CHAMBERINFORMATION Type 1 r re um rS stem: r (co >1M >,cfsOR UNIT O , DISTRIBUTION SYSTEM / f� L " q. a -� /4- Hea er / M ni o 11 Distribution Pipe s x Hole Size x Hoe Spacing Vent To Air Intake Lengt�f. ,. Dia Length ' Dia. 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 X I* COMMENTS: (Include code discrepancies, persons present, etc.) r, LOCATION: TROY 12.28.20.575A 278 WEST GROVE ROAD sZ � O 3il.a r �:.-'�' �I, ww �� • 5sv,e,� a� � �" �;,� e,.t,..,-. q....�.� �'�= ,.r f . © S•.kIL.� t1.Iri�e,aQ., �� `'P°`e°:-� e°�-to`T3�o� U"^� d -�Q Plan revision required? ❑ Yes J 2>7-4c No ��� Use other side for additional informs on. 05- 77- 00 L`__I_�J K SBD-6710(R.3/07) Date inspector's Signature Cert No ' Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue 1*1s ns/n P o Box 7302 Department of Commerce In accord with ILHR 83.05, Wis, Adm. Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on p than 8 112 x 1 1 inches in size. ^� - • See reverse side for instructions for completing this application 9%tttejsanita Permit Number ��� Personal information you provide may be used for secondary urposes cp p(eOk it `lo previous application (Privacy Law, s. 1 S.04(1)(m)L Ja1�/' �C `ST ate Planl.D. umber (FLEA I APPLICATION PRI T INF 9 ProDertyOwner Name 1A j R bon ' 14. S a g, N, R a (__))kjo W Property Owner'sM ilin Address Lot -'--"� �2, Block Number / 57` i s I City, State Zip Code Phone Number Subdivision ameorCSMNumber _ a BUILDING:11. TYPE OF (check one) ❑ State Owned Public 1 or 2 FamilyDwellingNo. of bedrooms o ity ❑ age 7 toTown of Nearest Road Gam_ III. BUILDINGUSE: (If building type is public. check all that apply) Parcel TaxNumber(s) j2.Zv.s-n. S-tsA 1 ❑ Apartment/Condo V0 - - 000 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 online B, if applicable) A) 1. ❑ New 2_ K Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S_ ❑ 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 1 1 ❑ 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 3 0 r— S' VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation ! S % '0 .1 Feet ^— Feet VII. TANK U cat alallo INFORMATION in g z Total Gallons of Tanks Manufacturer's Name Prefab Concrete Site con- Steel Fiber- glaze Plastic Exper App New Existin strutted Tanks Tan k Septic Tank or Holding Tank a Wdhw I ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Si hon Chamber lopol0OD / ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum 's Nam (Pant) Plum be ' ignatu e: (No Sta s) /MPRSW No.: Business Phone Number: .00L�s � a Plum r' Address Street.Gty.3 Codep" O C_ IX. COUNTY f DEPARTMENT USE ONLY [:]4pproved ❑Disapproved ❑OwnerGivenInitial Sanitary Permit Fee I1n0"oc'GrOii".1V sw<Mrgereei ssue Poo? I t5 natwe(No Stamps) �(Adverse ��44 Determination /� X. CONDITIONS OF APPROVAL / REASONS FOIt DISAPPROVAL, (� �oL�t.IMb►•► r d►.ua#'�, �MtOxe+prt� t� . �� btwatl SBD-6398 (R.11197) asrneunma: 0d9i ,rtoco,,nry,o0oropyTo: Witty asotwngtntrelan fl n ,Number 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. Changesin ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (5BD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete 8 of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber isto 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 8 112 x 11 inches must be submitted to 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; E) soil test data on a 115 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. y�. ✓io. yo , Ex;se,-T - � . � 5D� Qppnq. /otat,•ey, 6uri[d r1 I.'g4e. appro'. /*C&Con of �iL4rrlCd LtCC. tint nwng.(,_ +1 ilLon i9s C44A "arR st St. At,C, Jfn. ss)os � if 70 � fll�+i:on N _5cafc: l : 40, j "O V L- i4 j,l 6-3 ■ tl 1�/ole.Elea=9G. Sa; Gov i . At z, Scc_ i1,T z8rt•, Q. zo �v; T. 0.07roK, SE- Croix a,., wl. 4,% 5 fo" 18" ......'1� r - 4" Cl VENT PIPE 12" MIN. ABOVE GRADE t ! 25' FROM DOOR, MINDc)w OR FRESH AIR INTAKE FINISHED GRADE Y• CI RISER 6" MIN. ABOVE GRADEP) IN.`1 6" MAX. CA WEATHER PROOF JUNCTION BOX WITH CONDUIT APPROVED MANHOLE l W/ PADLOC WARNING 1 4" HI? INLET ` �' � .�• / � r' if WATER TIGHT SEALS y`p AA S. ; k" TIGHT - CI PIPE BAFFLE A SEAL 3' ONTO _.L_ a IAPPROVED SOLID . 0 B LM JOINTS M/ PIPE 3' 0 SOIL C SOLID SOI PUMP OFF EL1:V . FT. � r ' OFF ** RISER D PERMITTED IF TANK MANUFA C TU ; 3" APPROVED BEDDING UNDER TANK �OHAS PPRO' SPECIFICATIONS CONCRETE P IEPTIC / DOSE - TANK MANUFACTURER: NUMBER DOSES PER DAY: WANK SIZES: SEPTIC /Io SU GAL. DOSE DOSE VOLUME INCLUDING Oa GAL. FLOWBACK: O7, GAL. ALARM MANUFACTURER: CAPACITIES: A = �iINCHCS MODEL NUMBER: _cyj SWITCH TYPE: B ? INCHES o, ys�, P PUMP MANUFACTURE -�— MODEL NtlHBER: 0 C �LIYINCHLS c O% SWITCH TYPE: REQUIRED DISCHARGE RATE D INCHES GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION . + MINIMUM NETWORK SUPPLY PRESSURE PIPE O FEET FORCEMAIN X.. . `p FT/100FFRICTION FACTOR.. %— FEET TOTAL DYNAMIC HEAD --� FEET INTERNAL DIMENSIONS 01' PUMP TANK: LENGTH I� / rr —� FEET ' a �i WIDTH �- DIAMETER LIQUID DEPTH ,IGNED: LICENSE NUMBER: FMO A►PUCATIM Specifically designed for the following uses: • Ettluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP0/ • Solids handling capability: '/: ma)omum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • Discharge size: 11/2' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104•F(40°C)continuous 140'F (6D°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. I": EP05 • Solids handling Capability: '/i maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge sizeI W NPT. • Mechanical seal: carbon rotary/ceramic-stationary, BUNA•N elastomers. • Temperature: 1040F (40°C) continuous 140•F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0 5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord:10 foot standard length, 16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET 10 9 30 B c 25 a i 0 0 J 20 Goulds Submersible Effluent Pump '' Cis 3871 EP04 E P05 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and Preset at the factory. FEATURES ■ EP541mpaller. Thermo- plastic Semi -open design with pump out vanes for mechanical seal protection. • EPOS Impeller: Thermo- plastic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. W Motor Housing: Cast Iron for efficient heat transfer, strength, and durability. ■ Motor Caaer. Thermoplas- tic cover with integral handle and float switch attachment points. a Powe► Cable: Severe duty rated oil and water resistant. ■ Bearings: Upper and lower heavy duty ball bearing construction. "Env LISTI111S 41 cau I naunfer Awowbo11 (CSA listed model numbers end in "F" or "AC" ) giros z 1 5 1 0 00 10 20 30 40 so GPM 0 2 4 6 e 1D 12 W711, A 1995 Gouws Pumps CAPACrTY EffeCj v 16uy. 1995 B3871 #4 . �Nmcatein DeparMwt of Commem SOIL AND SITE EVALUATION Division of So" and Buildings In a=rd with Comm 83.05, Wis. Adm. Code Attach complete site plat on paper not less than 8% x 11 inches in um, glen must Include, but not Imrled to: vertical and txxmaM91 drectuon ad peroart slope, scale or dimensions, oath =ds1 10 nearest road. APPLICANT INFORMATION - PerwrW inronnaaon You Wwbe may be weed Lew. s.5.04 (1) (m)). Property MAY i Fq"LaaBon William L. Owdes Miip Addle- — -1 2 IN 1/4 S 8bdc 0 Subd. Nana or CSl Page I. d 3 AC.& sad t Site Evaluation 040-114440400 _ 1A - Ly i1 12 T 28 N,R 20 W 195 Chatsworth Strrxt k i I NA I cam Vol. -1rg, Ztus Cyr Sw Cky ❑ VNP ®Town Nsersst Rao Saint Paul MN 5 -22 - IM TMY West Grove Road ENew Construction Use: ®Resider 5 ®Additlon to existing budding Replacement [] Public or commercial describe Code Derived daily flow 750 gpd Recommended design bading rats .7 bed, gpdW .8 tranch, gpdMF urea required 1071 bed,11= 937 kertch, fP Maximum design loading rate .7 bad, gpd/ff 8 Uerxfi, gpdM Recommended infiltration surface elevation(s) 101.00' ft (as referred to she plan benchmark) Additional design I site oonsideratlons huUH t mches using high `pv.lry infiltrators. D0B1e8 required io reach system location. Parent material Outwasb s & gr. Flood plain elevation, 'd NA ft S-Suft" for sysw Conventional7)SF]IJ ound In -Ground Pressure AT -Grade System In Fill ! Holding Tank &Unsuitable for spslem IDS � U ® S U U S ') U Ci S® U Li S �: U Boring# 1 Ground dw 105.001t Depth to limiting tailor >10T i� Ground elev 105.82 ft Depth lo limiting factor >115• Depth Dominant Color i Mollies in. Hansel ()u. Sz Cant Color Toldin SIv(hlre Conssten Gr. Sz. Sh. Boundary Roots —'PM r— gad Trench 1 0-5 IOYR3/2 None 51 1fgr muff cs 2f Im OA 0.5 2 5-14 I0YR4f2 None sl lmsbk mvfr a 2llhm OA 0.5 3 14-39 IOYR4/4 None 8 0 ag ml gs lfkm 0.7 0.8 4 3948 7.5YR4/6 None a 0 sg ml gs if 0.7 0.8 5 68-109 10YR5/4 None s 0 sg ml - - 0.1 0.8 1 0.6 10YR3/2 NOW sl 1fgr mvfr a 24lm 0.4 0.5 2 6-20 10YR4/2 Now sl lmabk mvfr cs 2fdtm 0.4 0.5 3 20-39 IOYR4/4 Now s 0 sg ml ga IMin 0.7 0.9 4 39-0 7.5YR4/6 Nara a 0sg ml ga if 0.7 ) 0.8 5 68-115 10YR3/4 Nail s 0 sg ml - - 0.7 0.8 q3 .ti3 Rerr aft: --- - -- - 'ST Name (Plem Print) Telephone No. James K.T6ompeon 715-248-7767 r((dmey A.C.E. SoB & Sine Evakpildlis Date CST Number Rat# 340 Paulson Lake lane, 0ao * WI 34020 5/14/99 3602 1031 M. P4OkM OWUM rn�Wdhmm L. _ _ SOIL DESCRIPTION REPORT FTQ3iPap 2 of 3 'PARCEL LDJ 040-114440 O n.C.E. Sol R I Ewhiii� 3 Ground elev 103.87 ft Depth to Hmiting factor >98. Grour elev Depth limitin factor Ground elev Depth to limiting factor Hortam D11plh in. Dominant C06 Mottles Texture! Structure sislence BoundaryRoots Munsel a. Sz Conk Color Gr. Sz. Sh. GPDM' Bed Trench 1 0-5 10YR3/2 None sI Ifgr mvfir cs 2C Im 0.4 0.5 0.4 0.5 2 5-17 10YR4/2 Now sl Imsbk mvlti a 2fltm 3 17-25 10YR4/4 Now s 0 sg ml gs 1f1tm 0.7 0.8 4 25-53 7-SYR4/6 Now s 0 sg ml gs If 0.7 0.8 5 53-98 10YRS/4 None s 0 sg ml - - 0.7 0.8 D RernwKL P of •,lio. yo' EXl3f;n� _ K-4pi braried�as /:ht. apprdy. /*c&i;on of bwrled etee. lint OuriLr: gat Tlton i9s�t.�,s-K• Sf• PaCA wr„• ssrcts } oF3 ■ .5,;rM6.rw+;eh N IAI� 7dr,(Y �1 9Y.. SO; C 4. o caf: e�ov'L /O't 21 Sec.1Z,-rzR/I., Q. to cJ, Tn. e:'Toi', L X>/ �700� C vner/Bu•r(:. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM L L. l��v /t) A i tiling A• I Tess /V / f d'e S 1-V-' b-v -P� Z z z v Pi operty A d tress (Verification required from Planning Department for new construction) C ty/State 9'6Jrj Parcel Identification Number =LO- Il yy" 8p . P! operty L o. cation , _ '/., '/., Sec. . 1 a T�Z)a_N-R 2 W, Town of St bdivision .. Lot # _ ( srtitieti Survey Mal► # ry `A 1615 Volume �? , Page # `� -1�0 , Volume 1 a , Page # arraofiy Iheed # ___. �9� o - Sl •ec hots*.- '7 yes I no Lot lines identifiable t� yes O no §' ,ST 1M P'-1AUM .. M Inp koer use and mainterianceof your septic system could result in its premature failure to handle wastes. Proper it sintenance c, isists of p.Lc rping out th- septic tank every three years or sooner, if needed by a licensed pumper. Wbat you put inic the system cai t aftbct fb r i unction of t`w septic tank as a treatment stage in the waste disposal system. Tic 1' a:iperty owtr;r agrees to submit to St. Croix Zoning Department a certification forte, signed by the ow•itr and by a tr . sterplmtrl ei , journeym aplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewatcrdi4pe.aal system is a proper i 7u rating condition and/or (2) after inspection and pumping (if necessary), the septic tame is less than 1/3 fu; of sludge. V •e, the ura t,iigned have read the above requirements and agree to maintain the private sewage disposal system with lr: standards st C •irt. asset by tun Deportment of Commerce sod the Department of Natural Resources, State of Wiacousio. (%tWiicatioz It; ' r:sep tic ptic system hasbeen maintained must be completed and returned to the St. Croix County ZoninS' Of t u within 30 dr : t itt+ x year expi atiot d e. a0/ 5 9 S 3NATUR V APPLIC 4NT DATE .C! JYNEk x Le.RTMCATION I = i certify that !IlAtatements on this form are true to the best of my (our) knowledge. I (we) am (are) the : wner(s) of it • d: ecnbed •e, by v' a of a warranty deed recorded in Register of Deeds Office. S 3NA R : ?F APPLIC 4NT DATE •' r••• Anl mformation tat is mis-represented may result in the sanitary permit being revoked by the Zoning Departrro it. •"•" •' lnelu& %Mich this application: a stamped warranty deed from the Register of Deeds office a copy of the certified stmvey nup if reference is made in the warranty deed ST, CROIX COUNTY No.sTc �tMl3ru-33K SANITARYPERMIT OWNER PLUMBER 1 •.. a # �� TOWN OF 1�e 2�cj SEC AND/OR LOT w7-zoi3 LOCATED T 1,a N;R Za W I BLOCK :ANISIS SUBDIVISION REPAIR ❑ REdbNNECTION NON -PLUMBING ❑ SANITATION REJUVENATION ❑ the purpose of the sanitary permit Is to allow repair, reconnection, nation, or Installation of non -plumbing sanitation as described In the allon for permit. The approval of the santlary permit Is based on regulations In force on date of Issue. The sanitary permit Is valid for 2 years from original dale of Issuance and be renewed for similar periods thereafter. Application for renewal shall be r through the county and shall comply with regulations In effect at the Changed regulations will not Impair the validity of a sanitary permit until time of renewal. Renewal of the sanitary permit will be based on regulations In force at time renewal Is sought Changed regulations may Impede renewal. The sanitary permit Is transferable. A sanitary permit transfer shall be ied from the St. Croix County Zoning Department. If you wish to renew the permit, or transfer ownership of the permit, j contact the St Croix County Zoning Department_ AUTHORIZED ISSUING OFFICER - DATE THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE TWO Y RS FRC&MRIGINALPATE OF ISSUANCE OST IN LAIN V1 W VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION A. vv-, jr Ov 40. PROPERTY INFORMATION ZONED: TOWN OF TROY - AG -RESIDENTIAL OVERLAY: RIVERWAY PARCEL • 9 (t) ACRES SETBACKS ROAD WA ^M' cr REAR 25 FEET SIDE 23 FEET BLUFFLINE 401100 FEET OHWM (680.0 1912 DATUM) 200 FEET J 'DEPENDING UPON PROPOSED STRUCTURE ,O FLOODPLAIN �Q• REGIONAL FLOOD ELEV. -FEMA NAVDBB DATUM 692.0 FILL REQUIREMENT' 8930 FIRST FLOOR* 694.0 CRAWL 3PACFJBSMT' 892.0 ((v^ 'SEE ST. CROIX COUNTY FLOOOPLAIN ORDINANCE FOR MORE INFORMATION. l "FEMA TECHNICAL BULLETIN 10-01 l SPECIFIES ADDITIONAL FLOODPROOFING OPTIONS. vO / —PROFILE DATA FROM WASHINGTON COUNTY AND ST. CROIX COUNTY F.I.S. IDENTIFY A FLOODPLAIN ELEVATION SLIGHTLY LOWER THAN 692.0. NOTE - THE DNR HAS PREVIOUSLY DETERMINED THAT A WETLAND BOUNDARY OF OW 3 (1912 DATUM) 19 A CONSERVATIVE LIMIT OF WETLAND POTENTIAL BASED / UPON HYDROLOGIC FACTORS ALONG THIS SECTION OF THE ST. CROIX RIVER. / EXISTING STRUCTURE / l ORIGINAL FOOTPRINT •1,000 (t) SO.FT. • AT -GRADE FOOTPRINT •1,730 W SO. FT. ` J ENTIRE FOOTPRINT •2,370 (t) SO.FTROOF. DECK ST I2,850 T S LK = DECK STAIRS, CATWALK =470 (t) SO.FT. / Q � J o EXISTING CONDITIONS 1 PROPERTY LINE E82 // 6xti GARAGE / / 1 (689.0 t) 1 C�1 NG EL VA D �J 1 TRUCTURE ON PILINGS (FLOOR ELEV.=697.6) • � 684 O LuLu Q A�Y c �i . W 33' WIDE INGRESS/EGRESS EASEMENT, ` CID VOL. 1403, PAGE 461, DOC. #597786 0 S'� •� 89] AA �/ 1 4 clf i is EX. PUMP TANK ) / e / zy i• I / OR GINAL FOOTPRINT TO BE FLOODPROOFED (RAISED) 1 1403, PAGE 455, DOC. #597784 TY LINE SOUTH LINE OF GOV. LOT 2, SEC. 12, T28N, R20W SONNEWAG CONSULTING, LLC. 616 TOWER RD. HUDSON, WI 54016 PH.651-334-3332 101 E STH Sr. - SVITE 02220 ST. PAVL, MN SS1D1 PROPERTY i7T906STGROVERD. LOT 1 -GSM VOL 7, PG. 2023, GOVT. LOT 2. SECTION 12, T26N, 1120W, TOWN OF TROY, ST. CROiXCOVNTY, WI EXISTING PROPERTY LINE Ij5b CONTOUR INTERMEDIATE CONTOUR X SPOT ELEVATION = SLOPES >12R EXISTING SITE CONDITIONS BASED UPON 2004 SURVEY COMPLETED BY OGDEI ENGINEERING. CRIRCIAL ITEMS VE RE VERIFIED AND ADDITIONAL ST. CROIX COUNTY UDAR DATA WAS INCORPORATED. ORIGINAL TREE INVENTORY IS NOT ALL INCLUSIVE AS IT WAS FOCUSED ON TREES WITH A DIAMETER > 40 AND NRTH A VISUAL IMPACT AS SEER FROM THE RIVER. ARE ON I DERIVED / DRAV / CHEC / DATE DWG a \ oil Obi O Ory / RFF 9 REVIS'' / DMF REVIE L_ ) --_iv._ I i 0 / 40 90 Fyt EX. CONDITIONS SHEET NO. 3OF6