HomeMy WebLinkAbout040-1084-80-150 (2)STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
[Ail
-P
SUBDIVI S ION CSM # C'S N\ LJO S /0
SECTION -Z T N-R W Town of
SIN
ST. CROIX CO N Y, WTSC
Provide setback and elevation information on reve-t,--se of this form.
Provide 2 dimensions to center of septic tank manhole cover -
op
q
BENCHMARK: //I
I ��g leo
6
1,5 - *4'e
OM C70
ALTERNATE BM:
r5 60
4JLJ7.
SEPTIC TANK / PUMP CHAMBER HOLDING TANK INFORMATION
Manuf acturer: 6U�5-6K<-"' 57 Liquid CaDacitv: jYO�D
Setback from: Well /U/q-' House Other
Pump: Manuf acturer Model # tL) (4 V-5S J- z e
Float seperation Gallons/cycle:___-, / 2— (c=2
Alarm Location J4-��-/Vze/vr 6e.
�SOIL ABSORPTION SYSTEM
Width: Length n Numberoftrenches
Distance & Direction to nearest prop. lineo
Setback f rom: wel 1: A House Other
ELEVATIONS
Building Sewer ST Inlet; ST outlet
PC inlet PC bottom Pump Off
4-OP P106-
Header/Manifold Bottom of system
Existing Grade
DATE OF INSTALLATION:
PLUMBER ON JOB: JAI
LICENSE NUMBER:
INSPECTOR:
3/93 : jt
Final grade
LOCATION: TOWN OF TROY 21.28.19.334A50 SW SE Lot 4 To
Wisconsin Department of industry, PRIVATE SEWAtE SYSTEM
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division (ATTACHTO PERMIT)
GENERAL INf ORMATION
Permit Holder 0 s Name: E] city [I village EkTown of:
I Troy
LAPERRY, JAMES
CST BIVI Elev.: Insp. BM Elev.: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER
CAPACITY
Septi c
Dosi ng
Aeration
Holding
TANK SETBACK INFORMATION
TANKTO P / L WELL BLDG
ventto ROAD
Air Intake
r
Septic
NA
Dosi ng
NA
Aeration
NA
Holding
PUMP / SIPHON INFORMATION
Manufacturer
Demand
Model Number
GPM
Friction 5ystem, TDH 0
TDH Lift IL , 1 0, Li Ft
mead
Loss-
Forcemain Length/00 Dlaj)l
i — I
Dist. To Well ..�, f-///
Lounty*
.qT
Sanitary Permit No-:
I q
State Plan ID No.:
Parcel Tax No.:
040-1 0R4_Jqn_
A9300121
STATION
BS LHI FS
ELEV.
Benchmark
Bldg- Sewer
2,9"
St / Ht Inlet
St / Ht Outlet
Dt Inlet
S� 5-
Dt Bottom
Header / Man.
Dist- Pipe
Bot. System
Final Grade
SOIL ABSORPTION SYSTEM
BED/TRENCH
Width Length
No- Of Trenches
PIT
its
No, Of P, al
'de Di
:ns 11:d e.,D i a.
Liquid Depth
DIMENSIONS
DIMENSIONS
LEACHING
Manufacturer:
SETBACK
SYSTEM TO
P/L
BLDG WELL
LAKE/STREAM
CHAMBER
Model Number:
INFORMATION
TypeO
AIJ
OR UNIT
L
System
DISTRIBUTION SYSTEM
x Hole Size x Hole Spacing Vent To Air Intake
Header/Manifold
D'str'but'on P
I ipe(s)
J0
l Length Dia-
Length
Dia- Spacing
, - --- x Pressure Systems Only
SOIL COVER
xx Mound
Or At -Grade Systems Only
_FE1
I Depth Over
Depth Over
xx Depth Of
. I
xx Seeded / Sodd'e&
-;r/Y e s r-1 N o
FL
xx Mulched
x Mu
0�,`Yes ENo
" y e
Bed /Trench Center Bed /Trench Edges I I up'5ul
COMMENTS: (Include code discrepancies, persons present, etc.)
LO-gATION: TOWN OF TROY 2lo28.19.334A50, SW SE, Lot 4 TownsValley Road
Plan revision required? E] Yes No
Use other side for additional information. 11 - -1) - L_
SBD-6710(R 05/91) Date inspector's signature Cert- N
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
M2
r 0;7 t 7017 W= � = = � SANITARY PFRMIT APPLM.ATION
LiUm"M In accord with ILHR 83.05, Wis. Adm. Code
rux"."PA
COUNTY
_�_ C
f�? (� 0
STATE SANITARY PERMIT #
—Attach co'mpleteAplans (to the county copy only) for the system, on paper not less than
81/2x 11 ipches, in size.
if revision to previous application
—See reverse side for instructions for completing this application.
STATE PLAN I.D. NUM�IER
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION.
�Z ca-_)
PROPERTY OWNER
PROPERTY LOCATION A4_1%
7Y9
LA P(��RIZZ
5 S49 S ZA T N, R E
PROPER OWNER'S MAILING ADDRESS
LOT #
BLOCK #
S 3? 3 / 3 5rt-
I
1/0
CITY, STA1 t:
W6LFAQ-5 1j(
ZIP C(5DE
51�(dZz
PHONE NUMILER
'0" / Z
SUBDIVISIFN NAME OR CSM NUMBE
0,
r,:L1W L..,. 9
TYPE OF BUILDING: (Check one) CITY 4:�� V NEAREST ROAD
State Owned VILLAGE
TOWN OF
1:1 Public Y4or 2 Fam. Dwelling—#
of bedrooms 7— PARCELTAX N14ULB.ER(S)
111111. BUILDINGUSE: (if building type is public, check all, that apply)
1 0 Apt/Condo
2 El Assembly Hall 6 El Medical Facility/Nursing Home 10 El Outdoor Recreational Facility
3 El Campground 7 El Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining
4 El Church/School 8 El MobileHomePark 12 El Service Station/Car Wash
5 1:1 Hotel/Motel 9 F-1 Off ice/Factory 13 ElOther: Specify
IV. TYPEOFPERMIT: (Check only one in line A. Check line B if applicable)
A) 1. RNew 2.E] Replacement 3. F� Replacement of 4. El Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) El A Sanitary Permit was previously issued. Permit# Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non -Pressurized Distribution Pressurized Distribution Experimental Other
11 El seepage Bed 21 1^11 Mound 30 El Specify Type 41 0 Holding Tank
12 0 Seepage Trench 22 In -Ground 42 El Pit Privy
13 El Seepage Pit Pressure 43 El Vault Privy
14 El System -In -Fill
V A
1. ABSORPTION SYSTEM INFORMATION:
'6
1 A L
1 G
.GALLONSPERDAY 2.ABSORP.AREA 3.ABSORP.AREA 4.LOADINGRATE 5.PERC.RATE 6-SYSTEMELEV. 7.FINALGRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
CTO
eet I /(//j5"Feet
V V11. T� CAPACITY I
11. TANK in gallons Total # of Prefab. site Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App.
Tanks Tanks structed
Septic Tank or Holding Tank
I .z4m
...a"
I
T er.,�
(L
Ld
a
F —1
F
Lift PumETank/Siphon Chamber
-V-601
Vill. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
31 0
Plumbpr's Name (Print): Plumber's Signa ure: (No Stamps) MP/M@"SV No.: Business Phone Number:
Aj CC-C�,N _?Z2___1 VOW-
Plurfib4r's Address (Street, City, State, Zip Code):
IX. C5'UNTY/DEPARTMENT USE ONLY
Approved
F_� Disapproved
owner Given initial
Sanitary Permit Fee (Includes Groundwater
Surcharge Fee)
Date Issued
Issuing Agen Sig ure (No Stamps)
Adverse Determination
.��26
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1 A sanitary permit is valid for two (2) years.
2. Your sanitary permit may tie renewed before the expiration date, and at the t4nie ()f renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisiomis to ihis permit must be approved by -the permit issuing authoritty.
4. Changes in owner -ship. or Riumber requires a Sanitary Permit TransfeoRe�-,�ewall Form (SBD 639091 to be,
submitted to the county pri8r to installation.
5. Onsite sewage systernii§ mtMt be property 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 llo.cal code administrator ol- the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
L Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in 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.
VL Absorption system information. Provide all information requested in #1-7.
VIL Tank information. Fill in the capacity of every new and/or existing tank, list, the total gallons., number of
tanks and manufacturer's narne. Indicate prefab or site constructed and taank material. Cornplete for all
septic, pump/siphon and holding tanks for this systern. Check experimentall approval only if tanks received
experimental product approval from DILHR.
Vill. Responsibility statement. Installing plumber is to fill in name, license number- w1th 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 81/2 x 11 linches mijs� be sub.-nitted to counly. The
Wans must inclUde the fc1fliolrviling: A) plot plan, drawn 14.", s-.'cale .:)r with ,Compllete location of
ri CA S. e 4 e, �, F e
011ding tank(s), septic. tard "s" or- other ireat!nenttanks; M"i-cl- s, wa.t��-, service
- - , #I ",fa
L n, i,
stream.Q. and la.kes pur*np or siphon lanks; dictributi S� 5r,0 systerr"'S, e rr _nt
ta, �,nij v4-Ar+c-a.
-areas, a -id the location of lhe, b1i"di
point.,
dos,��, vo!wne; e0e.vaf',_;, d�fferemces- f r i 0 n
C.) complete speClificallons for purrips and controls-
absorptic�-n sy� fea-,
Performance c-urve; Pump model arid puMp mtanuflactu�ef-, D) cn,-)ss set7;t*,--n �-�J the s,
required by the county; E) soill test data on a 115 f9rm; and F) ali sizing Information.
GROUNDWATER SURCHARGE
11983 '0v`;Sconsin ACA 410 incluc-led ",he creation of -,unchia 1-ges (fe-,es) foi nuw1-.:,r
regulated practictr�-.,s which can effect groundwaten.
The through the -se surelvarges are. ucstilz-,d fof- rnonitoring i
I . groui-dwater,
Water 4-�ontaminafion invest--igations and establishment of startdards.
S B D-6398 (R. 11/88)
SAFETY & BUILDINGS DIVISION
A State of Wi1sconsin
Department of Industry, Labor and Human Relations
Western Regional Offiro
PRIVATE SEWAGE PLAN APPROVAL t_%
??26 Rose Street
LaCrosse, Wisconsin 54603
WEGERER SOIL TESTING & DESIGN
PO BOX 74
RIVER FALLS wT 540?--2-
RE: Plan Number: S93-40440
" I
Gallons Per Dav* 6 0 0
Proiect. Name: LA PERRE; JAMES
U
Town of TROY
Date Approved-, june 71 1993
IV A:,
Date Received: Mllay. 26, 19-93
Location: SW;SE;91;28;19.w
Countv: ST CROIX
W
The plumbing plans and specifications for this proJe_(_t have been reviewed for
�� r- W - code requirement-st This approval is based on Cha.nt.pr
compliance with applicable
145, Wisconsin Statute-S and the Wisconsin Administrativ- -ode, The plans are
compliance wit.1-1-
stamped 'conditionally approved'. This approval is contingent. upon
tipulat the plans. All items tbat. are noted must be corrected
any s w ions shown on llagp, townshin or county shall be obtained
All permits required by the city; vi A, X, %0
V V n 'h1e for this i-nstal !at. 1011
sed plumber responsi -7
prior to construction. The Hice A: at. the
shall keen one set. of plans with the department's approval stamP
.V, V X, A: inspector when
construction sitef The installer shall n A:
otify the appropriate -
inspections can be made#
A:'
This approval will expire two v,,P-Rrq- from the date approved or if a sanit-ary
A: C 0
it. will expire the day the initial sanitary permit, expires4
permit. iq obtained; X'
.0
The Section of Private Sewage has reviewed these plans for private sew -age system code
%0
X,
wef -i -i rements
requirements oniv, These plans have not. been revie,--i for the code reni
set. forth in section TLHR 8? for general plumbing or jil chapters 50-64 of the
Wisconsin Administrative codet
This approval is for t.be following components onlv&
- NEW MOUND
q this approval may be made by calling (608) 785-9348q,
inquiries concernin4-j K so %#
Sincerely,
W '0
6(G7,. RARD M-1. _,<SWIM
Section of Private Sewage
Division of Safetv -and Buildings
pppo39/0009n/55
cc-, Private Sewage Consultant
S H D .6423 (R - 0 1/9 1)
rl
Page of
MOUND SYSTEM
: FOR
A L/ BEDROOM RESIDENCE
S t_� 3,4 () 4,4 o
LOCATED IN THE S\A3 1/4 OF THE S Q.' 1/4 OF SECTION -2,1 r TVa N R 19 W.,
TOWN OF r "ST. CULX COUNTY, WISCONSIN.
r 7Z I Z)
S j P
L4 0 F C, 1Z.A!7LGl -b tM , It j - .
INDEX
PAGE
1
*of
6
TITLE SHEET
PAGE
2
of
6
PLOT PLAN
PAGE
3
of
6
PLAN VIEW -CROSS SECTION
PAGE
4
of
6
DISTRIBUTION PIPE LAYOUT
PAU
5
of
6
PWIN G CHAMBER
PA GE
6
of
6
PUMP PERFORMANCE CURVE
PREPA RED FOR
Im
lmilmM
E_= CS I-E F;Z FEE F=;Z E3 C3 1E L_ _lF F_= !:-:; -IF 1 1`4 CS
AtO
n E-= !E; X C-3 P.4 !E3 YEE F;Z W X f,' FEE
P. 0. BOX 74 421 K. MAIK ST.
RIVER FALLS. VI 54022
7 15 -4 '2x-0 1 t51
vw�
4&V69
I'll 16too
ps
APTHUR L. Till
W �7
r=
tan
some
06,3
I G
ve
0
3,0162seq. -
s - 02, 9 —
a
40
T-) T C) FP TD T. n T\1
Scale 1"= -:?)0'
STU"'
sew
nally
to
I A If
A7
C- IE7
Page of
t-A. -40-A Ar 0 4 4 o
Oka
L-j iZL C0%-ML:TR
NOTES \--WNN-Tb NT Lj�AST 2. S
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. required)
4. Septic tank to be Zc�Q gallon capacity manufactured by
�A �� LAJ (P�;Jr- 3 0
5. Bench mark S�Z--G�
6. Divert surface water around mound to prevent ponding at the uphill side.
Approved SynthetIc covering
Medium Sand
Page Of
S 4
Distribution Pipe
Topsoil
H
F
E I
E.
D
.. ........ . . . . . . . . . . .
SEWAGE % Slope
Plowed
-�ional Bed Of 2 Force
Moin
Aggregate
From
Pump
Layer
.0
Ft.
"MAMINS
LABOR I i I'M
Of lum"
DIVISic Of Cross Section Of A Mound System
Using
E N,
F
Ft
Ft
Bed For The
Absorption Area
G
Ft
Go
A
Ft.
H 5
Ft.
B �>I
Ft.
L3-near Loading Rate q, -5 GPD/LN FT
Design Loading Rate= o- -1 GPD/SQ FT
j�
Ft.
j �6
Ft.
K 10
Ft.
L 5
Ft.
Ft.
L
<:Z�
Observation Pipe--,,,\
0
A
Force M pin
W
i
Pion View Of Mound Using A Bed For The Absorption Area
End CaP
(9
Perforated Pipe Detcil
0
End View
perforated
PVC Pipe
z
Lost Hole Should
N-1 To End Ca
End Cap "')
Distribution Pipe Layout
PRIVATE SEWA(3it m w 1
Con ditio
nally
290wh Rooms&
WIM
APriiOVED
W OWSTRY, LABOR & HU 11 IMAMoj
DM OF SAFETY AND U LOW$
F F
Page '-) Of (0
4 () 4- 4 0
Install permanent -marker
at end of each lateral
Ic W1
C4 OCGIeu Un bottom,
Are Equally SPaced
P a0_ Ft.
S Ft.
X Ll 3 Inches
y V 13 Inches
Hole Diameter
Inch
Lateral
Inch(es)
Manifold
Inches
Force Main
_L
Inches
# of holes/pipe
8
Invert Elevation of Laterals clq.S Ft.
Place lst hole .2,� from center of manifold with succeeding holes
a t qS W intervals. Last hole to be next to the end cap.
PUMP CHAMBER CK055 SECTIOM AMD SPICIFICATIOMS PAGE OF
4`c.j.,.VLUT PIPC
10 1 FROM DOOR,,
WIMI)OW OR FRE:5H
AIR, iMTAKE
V E: ki T C A P
WEATHEK FK00Fr
JULICTIOW BOX
1 130 #A I I I
&RADC
now
C0QDUIT,Z
A
4 YI 4 0
APPROVED LOCKING MANHOLE
COVER WITH WARNING LABEL
4 0 MIM.
00� VFW dom
SYSTEM PROVIDE
L_ F T AIRTIGHT SEAL
APPROVED -JOINTS
APPROVED J010 A Tank construction shall comply
with ILHR 83.15 and ILHR 83.20
with approved 111 ALARM
pipe extending
3 feet onto OF INDUSTRY, LABOR & HUNIM RELATION$
solid soil. N OF SAF AND §01UNU ow
Both sides of
tank.
1>
LLF.V. 81. 10 F T. --ONO
PUMP—,'.. __j OFF
CokICF,�_T[ 5LOCK
3 APPROvE i
KISEK EXIT PERM11TED OWLI IF TANK MAMUFACTUFLr�-K HAS SUCH APPROVAL.
SPE-C-IFICATIOMS
DOSE IAJ E-Ely= S MUMBER OF DOSES: __�PEFL DAU
TA E.K
MAMUFACTUR9R,
TAWK �51ZE: C6c>0 DOSE VOLUME
-y \�� INCLUDMIG 15ACKFL-OW;
ALARM P%"UFACTUFLER: GALL011 5
MODEL WUtABCP.-- CAPACITIES: A= IMCHE5 OR
5WITCH 8 = -INCHES OK G�LLOLJ 5
PUMP PkAMU FACTURE R*. C a .1kICHE5 OR GALLOUS
MODEL MUMBEIU10 Dw -INCHES OR GALLOUS
*1 ��Lc_u MOTE* PUMP AMD ALAFLM ARE TO DE
5WITC14 TIJPE*e INSTALLED OW 5EpxRATS: CIRCUITS
MIMIMUM DISCHARrjE RATE 2'1- Li Y__ GFOA
VLRTIC&L DIFFER.EkICE DETWEEM PUMP OFF A&ID..015TRIBUT101i PIPE k6-za FEET
I
+ miuitAUM WETWORK SUPPL�I PRE�SUKE: 0 db SCL FLLT
+ FEET OF FORCE MAIM X Y10() FtFRICTIOU FACTOR FEET
TOTAL OtJUAMIL HLAD FLET
DIAMETER
ILITERkIAL. DIMLWSIOM� OF TAWK: LEM&TH �;WIDTH .....,LIQUID E)LPTH
BOTTOM AREA 231=' �.GAL/ INCH
AS PER MANUFACTURER - GAL/INCH
MECHANICAL FLOAT SWITCH
Mercury -free, 90* angle operation
POWER, SWITCH CORDS
Quick -connect, watertight
fittings
FUMPAND
MOTOR SHAFT
416 stainless steel
01
.,J0. 1/2-HP PSC MOTOR
1750 rpm built-in
overload protection
UPPER SLEEVE,
LOWER BALL BEARINGS
Take radial loads,
absorb upthrust
ROTARY SHA17 SEAL
06
L11 Nsl Q W�
a M Carbon. ceramic faces
. ON
TWO -VANE,
SEMI -OPEN IMPELLER
Most efficient pumping
CASTIRONVOLUT
Passes 2' dia. solids
(Q
WHV5
1/2 HP Residential
and Co=ercial Sewage Pump
DIMENSIONS
C
t),
5ff to 6w TETHER LENGTH
ON
VT OFF
7
1 7'
5 7/8
PERFORMANCE CURVE
44
40
36
tu
U2 32
z
a 28
4
W
x 24
43 _j
1<
1— 20
0
16
12
a
4
0
CAPACITY LITERS PER MINUTE
0 100 200 300 400 5W 600 700
14
13
12
cc
LU
10
LLJ
2
z
Uj
7
6
0
4
3
2
1
20 40 60 80 100 120 140 160 180
CAPACITY GALLOkS PER MINUTE
I L1 \4
K3200 9 / 91
Printed in USA
F. E. Myers, A Pentair Company
1101 Myers Parkway
Ashland, Ohio 44805-1923
419/289-1144
FAX- 419/289-6658,,TLX.- 98-7443
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
western Regional office
PRIVATE SEWAGE PLAN APPRUAL C.-P
2226 Rose Street
LaCrosse; Wisconsin 54603
SO T L TEST 1 NCT & DESIGN
PO BO X `74
RIVEF, FALLS wi 540??
7
Date Approved: june
RE: Plan Number*# S93-40440 K' X' av 26. 1993
Date Receivpd: [Ni-
Gallons Per Day4
Proiect. Name- IV T, A PERRE jAMES Locationa, SW;SE;21;?g;lgw
County: ST CROIX
Town of TROY W
j1d sperif ications for this proiect have been reviewed for
The plumbing plans, a
;�j K'
compliance with applicable code requirements. This approval is based on Chanter
- 17 As
145, Wisconsin Statiltes and the Wisconsin Administrative Gode. The plans are
s'ta-mped '(7onditionally approved', This approval is contingent upon compliance wit,h--
V 17 A: — — — — — — A:' -V %-,P - K- C
any stinulations -shown on the plans. All items that are not.ed Must I-)P- corrected.
V _Ar V inqhin or coi.inty sball be o 1) t a i n e c-i-
All permits required by t he city. villa,9_.P_ t0v - - 1. A,?
A7 - -A V %0 J# n qible for this installation
nri(--)r to construction, The licensed plumber resp n.--
-)1ans with the department's approval stamp at. the
qhall keep one et, of T t-,he appropriate inspert.or when
construct i cin s i te The installer shall not.ifv
inspections can be made.
oval. will expire t.wo years from the date approved or if -71 �._'-anit,ary
This appr 17 V_ K K -)ireq-.
.V A: tbe H,-iv the initial sranitary permit. exi
permit. obtained; it. will expire
The Section of Private Sewa-ge ha-q- reviewed these plans for private sewave system, code
0 Pnt.q-
.he ccxie requirem-
requirements on-1ye These plans have not been reviewed for t
leneral plumbing or in Chapters 50-64 of the
set. forth in Sect -ion ILHR 82 for
Wisconsin Administrative code.
annroval is for the following component-s only:
Th i s 'Vc - C - V "
- NEW MOUND
innijiries cnnrerninq this approval may be ma -de by callin.Ll- (6np) 78. -348i,
_A K to V � I
R-incerely,
6G, ,ARD M_ SWIM
Section of Private Sewage
Division of Safety and Buildings
PPP039,/0009n/5-5-
cc: Private Sewage Consult -ant
S H D -6423 (R. 0 1/9 1)
i
Page of t>
MOUND SYSTEM
F Oft 0 3 4 () 4,4
A q BEDROOM RESIDENCE
LOCATED IN THE S�43 1/4 OF THE S t� 1/4 OF SECTION I , TZEN N, R ) q W If
TOWN OF -ST. C,�ZALX COUNTYr WISCONSIN.
Z'
L/ lzlt�r.LO�Lbtm JAJ -UO'L IE�� OF S YT)
Maim,
PAGE
1*of
6
TITLE SHEET
PAGE
2
of
6
PLOT PLAN
PAGE
3
of
6
PLAN VIEW -CROSS SECTION.
IPA CIE
4
of
6
DISTRIBUTION PIPE LAYOUT
PAGE
5
of
6
PUMPING CHAMBER
PA GE
6
of
6
PUMP PERFORMANCE CURVE
Lk-pe1z,
1\3 <6 ,I :s i -sr
F -t\ LLS UJ I -S4 6 2, Z-
W I=- IS E: F:Z a F;Z �� C3 3E L_ -V F_= !E; -T- I " C3
AND
P.G. BOX 74 421 K. KAIK ST.
RIVER FALLS- Ml 54022
715-402_'�AWJ:
OVA
11 14
ARTHUR L.
4b
4w
40 E-L L SA 0 .9 T H,
toy
I G
s
JOB NO - '13 -'�3 E)
(07
11 = -.� C)
scale I
T
'as S*j�T�
SEW )k ,
1P Fil,14 if me, 0 ally
0 n 4.1011
WaKO't.1
&
M ddz- %>W44...4
Of$,
L-z�T- L L �J 1Z
ej
f---ea,�j C-
Page of
. 1�
4
0340
K3 %Te� L-j ITL�. -Sol f=;jwM
NOTES PiT L��ST Z S; F-Azt�"
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( required)
3. Install 4" observation pipes with approved caps. ( -L- required)
4. Septic tank to be gallon capacity manufactured by
)A Aj
5. Bench Mark S
6. Divert surface water around mound to prevent pondinq at the uphill side.
Approved Synthetic Covering
Medium Sand
Topsoil
Page s Of
4 4- 4
Distribution Pipe
G
�i'WAGE $i4blr
L
% Slope
I-Onal B e d 0 f
2 Force Moin
Aggregate
From Pump
6 liwux RSAMNS
DLK. of ig,)USTRy, LABOR B jLvXGS
Of SAFETY AN
Diviswo Cross Section Of
A Mound System Using
Bed For The Absorption Area
SEE. 00 DENCE
A Ft.
Linear Loading Rate- q, S GPD/LN FT
B Ft.
Design Loading Rate- 0- -1 GPD/SQ FT
I Ft-
J 16 Ft.
K 10 Ft.
L 53 Ft.
W q QL_ Ft.
76
Observation P i p e
A
W
Plowed
Layer
D Ft
E Ft.
F c:� Ft.
G Ft.
H 5 Ft.
III \,Fnr-ce M-6in
Plan View Of Mound Using A Bed For The Absorption Area
Page '-) Of (0
Perforated Pipe Detoll
(0
4
4 o
,on S
3
End Cap
0
End Cap __")
all permanent -marker
nd of each lateral
Holes Located On Bottom,
Are Equally Spaced
P 3 0 Ft.
Distribution Pipe Layout S 14 Ft.
X 113 Inchp__t;
PRIVATE SEWAQ1 mm-
WWWWW
y Ll 8
1 nches
Conditionally
Hole Oiameter
Inch
Lateral
Inch(es)
APPRUVED
Manifold
-2--
Inches
OF WNSTRY, LABOR a IjU 11 RRA7M',
Force Main
_L
Inches
DIVI OF SAFETY AND U LMGS
#o-f holes/pipe
SEE
Invert Elevation of Laterals
Ft.
NDENCE
Place Ist hole �Z-Ll from center of manifold with succeeding holes
a t q2� intervals. Last hole to be next to the end cap.
4
PUMP CHAMBER CK055 SICTIOM AMD SPECIFICATIOKJS PAGE 0 F
40C.1. VIKIT'TIPC
10 FROM DOOKs
WIMDOW OR FRE:5H
AIR INTAKE
115"Aw.
IMLET
APPROVED JOIN'T
with approved
pipe extending
3 feet onto
solid soil.
Both sides of
tank. FT
f- L E: V.
.,_.,—VE:k1T CAP
WCATHEK PKO01r
goo=
JU&ICTIOM BOX
&RADE
00
COUDUIT--Z
() 1, 4 0
APPROVED LOCKING MANHOLE
COVER WITH WARNING LABEL
PROVIDE
AiRTIGHT S[AL
ly
Tank _c&n,st_ ;x-,�
sha-111 comply
11 8'3"- ilnnd ILHR 83.20
wit
I ALMM
E PFTT. 0 P.4,01USTRY, LASCR HUNIAM REtAyIONS
1>
I ON OF SAFr".-"j AN1) d' iLL "1 8
om
CE
PUMP OFF
ED
COMCF(ETL 5LOCK
4 0 ADJ.
150
APPROVED JOINTS
%
KISER EXIT PLRMIITLD OkJL!J IF TANK MAMUFACTURF&-P, HAS SUCH APPROVAL 3 10 APPRCWF- I
0 1 aEoo I NQ
SPE C, I F I C AT I OM S
DOSE
TAW�j MAIJUFACTURCR 5.
: -1A oeb=- MUMBER OF 00SES:
TAWK 5IZL: �GALLOLJS DOSE
YOLLIME
ALARM M,"UFACTUKER: N-�QC�j� S%7r3j-L-_aj S INCLUDIN(a
8ACKFL-0W,*, CPA'LLONS
momL WUIABr.R*. CAPACITIES:
A=. MA -IjjCHL5 09 GALLOIJ3
SWITCH T:JPK&
-IWCHES OK 2"4
PUMP "MUFACTUP.10t:
C; IQCHE5 OR "LLOWS
MODEL MUM15EX",
1) - IMC HES OR GALLOMS
5WITCH TtJPE: MOTE:
PUAP AMD ALARM ARE TO bL
MIMIMUM DISCHARGE RATE -7. Lj Y GPM
IN5TALLED OW 5EPP%RATE CIRCUITS
VLF%TIC&L DIFFEKENCE 5ETWILEw PUMP OFF AUD.01STRIBUTIOW PIPE..
FEET
+ MIUIMUM WETWORK SUPPLJ PP%E$5uFL[ 0 a 0
2--5c) FLLT
+ 63-FEET OF FORCE MAIM X FACTOR,
FEE:T
TOTALD9WAMIC HLAD —
-FEET
DIAMETER
WTER�IAL DIMLkIStOM OF TAWK: LEkIGTH -.;WIDTH
OEPTH
BOTTOM AREA 231--
9 .-6V GAL/INCH
AS PER MANUFACTURER
GAL/INCH
0
UNIOU01.1
7�
7- r7:-7
71 F- 777-
r,,7
77
-7 ?"'17
L- ja;7
7� r--
L4 t-
77-
SEPTIC TANK MAINTENANCE AGREEMENT
Ste Croix County
OiqNER/BUYER__._,/ es
Let
ADDRESS:
FIRE Not 44; 7, yr
LOCATION:. t:�UJ 1/4, SEC* 7,1
TOWN OF: �_Wr
STo'CROIX COUNTY
SUBDIVISION: 0 ------ -
LOT NOe
Improper use and maintenance
0 Of Your septic
in its Premature failure to handle wastes. system could result
consists Of Pumping out the sept'c Proper Tnai ntenance
sooner, if needed, by a 1' 1 tank every three years or
icensed 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 to
helP.with the cost of the replacement of a failing system
I
Was in Operation prior to July it 1978, which
th1s Program in August of 1980 St Croix COuntY accepted
I With the requirement that owners
of all new systems agree to keep their
maintained, sYsteM properly
The property Owner agrees to submit to the St. Cro '
ZOning a certification form, signed by the owner and 1X County
Plumberr journe)�man . Plumberf restricted Plumber o by a master
Pumper verify, r a li
ing that (1) the on -site wastewater disposal icensed
is in Props�-n_r operating ' system
Pumping I condition and (2) after inspection and
1- ('f necessary), the septic tank I's less than 1/3 full of
sludge and scum. Certi I
ficat-ion from will be sent approximately
30 days prior to three year expiration.
IIWEI the undersigned have read th . e above requirements and agree
to maintain the private sewage disposal system -in accordance with
the standards set forthr herej"Ln/ as set by the
Certification form must be Wisconsin DNR.
Croix county completed and returned to the st,
Zoning Officer within .30 days of
exPiration date. the three year
X
SIGNED:
DATE:
7q73'
St. Croix county Zoning Office
911 4th St,
Hudson, WI 54016
S T C - 100
Th ,
's aPPlicc-ItiOn form is to be completed in full
the 0;,0ncr(,q alld signed by
w i Of the Property being developed, Any inadcquacies
11 only restIlt ,
developmellt 11, delays of the Permit issuance. Should this
)louse N be intended for resale by owner/contractor,(s ec
if th0t, fa second form should be
the property i,,. retained and completed when
, sold and submitted to
OPPropriate deed recording. this Office with
the
----------
Owner of property
Location
of property_Ll�/4 Section T.
TownsIlip LN R W
]'[ailing address
Address of site I- A) I?
Subd*v*
ISion name, 11 'Oh
no
_101
Other homes on property? N o
Previous Owner oE property A A R FF-,Aj /14 $q14 V /JJRiA4W
Total size of parcel
Date Parcel was created r
4) 7'
Are _Z_
all corners nd lot lines ident'
:113 th's PrOPGrtY being developed Ifiable? --Y.,Yes No
for (Spec house)? ye
Volume d page Numbe _� S -, X, N 0
Of as recorded.With the Register
--------------
-----------------------
114CLUDE WITH THIS APPLICATION THE FOLLOWItIG:
A IYAMWITY DL,-ED wilich includes a I)OCURENT 14UHDEJR,, VOLUME 2UID A
C C 17 t SEAL Or. THE
,3,21nif sur"Yi if availabl Ion
yo of tile rev,ew,ng e- -would be helpful In addit, a
P ,
reforences to a cartif,ed P rocess. so as to avoid
Shall Sur If the deed descriptin
also be required. vGY HaP, the Certified Survey Map
PROPKHTY OWNE.R CERTIFICATIou
ccrtify t1lat aj�j statements on this form are true
c)f ny (our) knowledge th to the
Prc)PertY deScribed in t1liat (we) Om the owner(s) E
'4arvantY deed recorded ' t S information form, by Virtue of o a
'Auh e of f- i c a
DOcument 110, f f i Of the county Register of
own the
Proposed s* t.
1. .0 f or the sewn and t1lat (we) presently
obtainecl c1r, C"-Isement I to run the ge disposal syst" Or I (we)
tile cOnst,ruction of saicl Sys above described property,
recorde for
tl2m, and the same 11ar, been duly
le Off ice of County
No. q/��l Register
--------- Of deeds as Document
0
voll
Signature of �_I_ �ic a nt��
C 0 - a p p I-rc—a —nt-----
__7
Date- of—
Signa Urre
gna u_ —at—e _c—)f S i g n -t—u �re
DOCUMENT NO.
WARRANTY DEED 'rH)S SPACE RESERVED FOR RECORDING DA-rA
,:STATE BAR OF WISCONSIN FORM 2-19821i
4 8 1
VOL 9 473 REGISTER'S OFFICE
Country Oaks, a Wisconsin Partnership by Laurence W.
...... .......... I .. � - ---------------------- -----------------
Murphy__and Norwood A* Ecklund ST. CROIX Co., W1
----------- I., ------ -----------------
------------------------------ Rec"d for Record
--------------------- --------
--- -- -----------
------------------- ........ ---- --------- ----- - - ---- ----------- JUN 18 1992
conveys and Aarrants to Amip�q__Pl. _LaPerre._,qjqd Ann Marie - LaPerre,
------ -- ----
.-hus-band-and.wife--as--survivorship-marital--'Dr ert 8:40 A. M
-- ------------ ------------- ----------------------- -- --------
--------------------
-- ----------- ------ ----------------- -- --- --- --------- - - -------- -----------------------
------------------ ------ ------------- ------- -- --------------------------- --------------
- ---------------------------- ___ -- ---------- --------------- - - -- ..............
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . . . . . . . . . . . . . - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------- -
the following described real estate in _... ----- ---- S Q,ix
State of Wisconsin: �Qr - ------------- ....County,
49%
U
gisfer of Deeds
RETURN TO
Tax Parcel No: -----------
Part of SE 1/4 of Section 21-28-19 described as follows: Lot 4 of Certified
Survey Map filed January 9, 1991 in Vol. '1811, page 2312. TOGETHER WITH a 66
foot private roadway as shown on said Certified Survey Map.
6, C/�
1�5Y
is not
This - -- ------------ homestead property.
(T-A (is not)
Exception to warranties:
easements., restrictions and rights of way of record, if any.
Dated tills ---- -- ---------------- day of June 92
19
County Oaks.-
------- — -------------- ------ (SEAL) -By: (SEAL�
------------- ------ - -- -------------- ___ --------------- ur nce W. Murphy
...... ----..(SEAL) By:,
Y:, A L)
---------- ----- ----------------- ----- ------------- ------- Norwood A. Ecklund
AUTHENTICATION
Signature (s)
--------------------------------------------------------------------------------
authenticated this -------- day of --------------------------- 19 ------
--------------------------------------------------------------------------------
------------------------------------------------------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If notp ----------------------------------
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Joseph D. Boles - Attorney at Law
----------------------------------------- ---------------------
River Falls, WI 54022
- - - - --- - - - - - -------------------------------------------------------
(Signatures may be authenticated or acknowledged. Both
are not necessary.)
ACKNOWLEDGMENT
STATE OF WISCONSIN
Ss.
-------- ------ ------ County.
Personally came before me this _ ------------ �Ialay of
------ Ju-n-e ----------------------------- 19-9-2-___ the above named
--------------------------------------------------------------------------------
Laurence W. Mur h
------- ------------------ P--y
Norwood A. Ecklund
oil. �� ----------------------------------
0 ------------ --------- 1. ------- -------- -- ----
N '%N A .. 1:.
to me known to 4e'tbj 1A,90h, who executed the
foregoing
gp le all)
------ --- .......
Notary Public 'i %F
X. -------- County, Wis.
My Commissioii� 11�ppr rult state expilration.
--*ass
date: ------- r %V,-> - C
li-A-11st - -_ -, 19--t.2
#of,, I '
of 04411110th%%
*Names of Persons signing in any CQVILrItY should be typed or i)rinted helow thoir signatureq.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Lpgal Blank Co Inc
FORM No. 2 — 1982 MilwaLikee, Wisconsin
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of
Labor sand Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach,compiete site plan on paper not less than 8 1/2 x 11 inches in size. Plarimust 1 e but 7, C- R,(.�
not lirrilted,,to �7ertical and horizontal reference point (13M), direction and % of slo ale or ARCEL D. #
k
dimertsioned, north arrow, and location and distance to nearest road. q0 IQ
APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATI' R DATE
P PROPERTY OWNER- PROPERTY LOCA 10
R P
5 L R en VT. LO 1/4,S T
IN R 9 E (or)
E
"W)
PROPERTY OWNER'-S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR OSM #
S
C S
ITY, STATE ZIP CODE PHONE NUMBER DCITY OVILLAGE UOWN NEAREST ROAD
U i�FZ Ft� �-� S I I^j )i -S q r *L low
,� e. (-)� -) !J > 5�- I -S
F
New Construction Use Residential / Number of bedrooms L I AdditiQn to.existi building , 0 4
Replacement Public or commercial describe bvy a4tld
Code derived daily flow gpd Recommended design loading rate 1—bed, gpd/ft2 c!� - �� trench, g d/ft2
A bsor pti o n area req u i red 14 Qs b ed, ft2 trench, 01 ft2 Maximum design loading rate -S _bed, gpd/ft2 (Y. 6_trench, gpd/ft2
Recommended infiltration surface elevation(s) 9 q, (3 ft (as referred to site plan benchmark)
Additional design / site considerations tlt�%,j �� / 'i?) ' y- 3 QL�b 14-11 xj S F) k%jN�� i7-7 k. L
'f applicable
Parent material Flood plain elevation, I I A ft
S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE I SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system I El S [9 U [X S El U I EIS MU EIS NU DS ZU El S ETU
Ground
elev.
q?_. 6 ft.
Depth to
limiting
factor
Ground
elev.
C) �3' ft.
Depth to
limiting
factor
7 --1
SOIL DESCRIPTION REPORT
!Horizonl
Depth
in.
Dominant Color
Munsell
Motfles
Qu. Sz. Cont. Color
Textu re
Structure
Gr. Sz. Sh.
Consistence
Bourrbry
Roots
GPD/ft2
Bed
ITench
L K)
Q) \-t
!s
L
1 10 -3 1
2- �k
C- S
I
'�Z-50
LIVL VJV
"(s, I
G
L, L "�'331ue
11) t:�I-y 31
PyNC-k7-C'1
�?I""Lr )C4� L
L kS-1P-S
Ij A
0 L 01 V
Remarks:
0-vz
S)
S
-2
-2 tai
Z-)-3-3
VL 5
Lq
3 L4 -7
te L/ I V
r". -p
(4
02-0 11-4
$NJ S
Q F Y-1 1� 5 S Q ("%'W
S C
rz' TZcyj)'V to 1,%.
Remarks:
'FST Name --Please Print Arthur L. Wegerer Phone- 7 15 -4 2 5 -0 16 5
� "dress: WI 54022
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,
)ignature-
Date. CST Number.
M00576
PROPERTY OWNER
SOIL DESCRIPTION REPORT
Page
of
PARCEL I.D. #
3 L4 (3
Boring #
Horizon Depth
Dominant Color
Mottes
Texture
Structure
Consistence Bounciay
R "ots,
0
2
GPD/ft2
i n.
Munsell
Qu. Sz. Cont. Color
Gr. Sz. Sh.
Btd
iTmnch
...................
............
3 6
Ground
'yn
elev.
OX-) -I ft.
-.3 %-y k
Depth to
j %r
Ll �B
limiting
factor
Remarks:
Boring #
M I
.................
Ground
elev.
r E I VE
f t.
4
Depth to
limiting
S T C FA"' 0 Xx c4j
factor
DDLRA' ri
KN
Remar
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
...........
...........
...........
Ground
elev,
Depth to
limiting
factor
Remarks:
SBID-8330(R-05/92)
PLOT PLAN
Page "?z of
SCALE 1 lo
Idwill, j,jjj,yW11jj,wIwIIII'�
C4
Cj K*AJ
-1�> 'wk
97
m0*0v0,h tT-
VJTLX% I
SIVr
elo
IoQr---
i
16't Ff O%J E
Gv*%3AJZ I ry
S b
s t:!,T
wut�j:j
%4W
I
"J IrL L %M Ta 'E WT k��49k$T- -S&
f�-r Lj�A ST 2. S r Flz,u m z
7 4 25'-- 01 6.s M00576
Date Signed Telephone No. CST #
CST Signature
04119/2005 11:50 AM
Parcel#: 040-1083-80-000 PAGE 1 OF I
Alt. Parcel #: 21.28-19.328C 040 - TOWN OF TROY
ST. CROIX COUNTY, WISCONSIN
Current X
�%,*ea?ion Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address:
GARY A & MARLENE C DUCLOS
237 TOWNSVALLEY RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special
Type Dist # Description
SC 4893 SCH D OF RIVER FALLS
Sp 0100 CHIP VALLEY VOTECH
Legal Description: Acres:
SEC 21 T28N R19W PT NE SW THAT PART OF
NE SW KNOW AS PART OF LOT 4 OF CSM V
4/1157 INCLUDES P332C, P333A, P334A &
P335
Notes:
Owner(s): * = Current owner
* DUCLOS, GARY A & MARLENE C
Property Address(es): * = Primary
1.500 Plat: N/A -NOT AVAILABLE
Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
21-28N-1 9W
Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1213/131 WD
07/23/1997 766/151
- Bill #: Fair Market Value: Assessed with:
2004 SUMMARY 26789 Use Value Assessment
Valuations: Last Changed: 07/20/2004
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 30.320 4,700 0 4,700 NO
Totals for 2004: General Property 30.320 41700 0 41700
Woodland 0.000 0 0
Totals for 2003: General Property 30.320 5,000 0 5,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials: Category Amount
User Special Code
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel#: 040-1084-40-000
04/19/2005 11:49 AM
Alt. Parcel #: 21-28.19.332C PAGE I OF I
Current X 040 - TOWN OF TROY
ST. CROIX COUNTY, WISCONSIN
CreaVion Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
T A
CIA UU1 u5s:
GARY A & MARLENE C DUCLOS
237 TOWNSVALLEY RD
RIVER FALLS WI 54022
Districts: SC = School SP = Special
Type Dist # Description
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
L-uwdi uescription: Acres:
SEC 21 T28N R1 9W PT NE SE THAT PART OF
NE SE ALSO KNOWN AS PART OF LOT 4 OF CSM
V 4/1157 ASSESS WITH P328C
Owner(s): *'= Current Owner
* DUCLOS, GARY A & MARLENE C
Property Address(es): Primary
0.000 Plat: N/A -NOT AVAILABLE
B 10
lock/Condo Bldg:
Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
21-28N-19W
Notes:
Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1213/131 WD
07/23/1997 766/151
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations:
Description Class Acres Land Improve Last Changed:
Total State Reason
Totals for 2004:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2003:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code
Category
Amount
Total Special Assessments Special Charges Delinquent Charges
0.00 0.00 0.00