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HomeMy WebLinkAbout020-1337-50-000 (2)St. Croix County Planninor and Zo��ingDetail Sanitary Information Computer #: 020-1337-50-000 Sub/Plat: Grass Range Section: 14 Parcel #: 14-29-19.1791 Lot: 5 TNIRNG: T29N R19W Municipality: Hudson, Town of CSM: 114 1/4: NW 1/4 NE 1/4 Owner: Bast, Kernon J. & Donalda J. Speer- 988 Drover Trail Hudson, WI 54016 State Permit: 338806 Issued: 03/11/1999 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 06/25/1999 POWTS Detail: Trench - Seepage Bedrooms: 4 WI Fund: No POWTS Pretreatment: NA N otes Issuer/inspector As Built Plumber Rod Eslinger Yes Fogerty, Dave Kevin Grabau Signed Off. Yes Maintenance Scheduled Pump Date Pumped 6/24/2002 AloitdaY, July, 25, 2011 a1.3:15: 31 PM Pali e 1 of 1 Other Requirements Additional Notes Money Owed for sale in 2011 - no pumping records $0.00 1200 gal. Weeks septic tank to 800 gal. dose tank to 2 trenches 5' x 72' & 5' x 79' with "T" header between - see as -built for location Notification Notification 04/20/2006 X COUNTY ZO AS BUILT SAN�,Tj Owner 41 Property Address City/State Legal Description: Lot :57 Block Subdivision/eS*" (/ V4 , ez, E 1/4, See./ , T2f N-RAW, Town of IN # eP .2- 0 — 222 2 — J SEPTIC TANK - DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC Setback from: House 33 Well P/L Pump manufacturer tw4Model FAD Alarm location �3��/T (HOLDING KS ONLY) Setbacks: Sice row Meter location Alarm locatioi���� Vent ta-ks�rr i��intake Water Line SOIL ABSORPTION SYSTEM: 2,, --"7r-7e&-)V C(-lam--s Type of system: Z4;v Width S Length ' 714? /72 Number of Trenches 2- Setback from: House ->Le2�2 Well a &:2 P/L Z Ventt-o*/ fresh air intake 1-11:0 z4dxv ELEVATIONS: Description of benchmark 7a? eor-- o n2, G ty,E-,g- r,-.--,004 44— Elevation LL Description of alternate benchmark De4 #2'' Elevation C/ Building Sewer ST/HT Inlet j�,.2o— f-4 — -.2 ST Outlet 0 PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines () � ?- 4: r, ? — () �� � ( ) ,*,� T Bottom of System ( ) R e ( ) � 7. 1� ( ) Final Grade lelf 0 /0 4 iz ( ) Date of installation � Permit/6mber tvl . state plan number Plumber's signatureA -0 License number Inspector .--? >- lz;�q Date Complete plot plan or NOTICE: Plea e- ovide thelSo 6wing: • Rian ViT, -"s etch sho everything within 100 feet of the system. • Twoldrizon'tal reference porn1s to center of septic tank manhole cover. • Show alternate benchmark, if applicable. INDICATE NORTH ARROW w a . NOTICE: Plea' a ©vide the *?howin • g -?M S t SK .: +. • an vie ` . s etch sho everything within 100 feet of the system. r 1Y • Twa ht�rizontal reference s to center of septic tank manhole cover. - -- p P • Show alternate benchmark, if applicable. PLAN VIEW Z' r WC) scAcr INDICATE NORTH ARROW SY� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s. 15.04 Permit Holder's Name- [I City D Village IN Town of: BAST, KERNON HUDSON CST BM Elev.:- Insp. BM Elev.- BM Description: Z&V / TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG- vent to Air Intake ROAD Septic �—' > 70 31 10 NA Dosing NA Aeration NA Holding _,� I - &1 9.4 If SOIL ABSORPTION SYSTEM ELEVATION DATA County: Sanitary Permit No ST. CRC 338806 State Plan ID No - Parcel Tax No.- 020-1337-50-000 PitijuUU10 j STATION BS HI FS ELEV_ Benchmark Bldg. Sewer Z_ ig Ht Inlet Ht Outlet e) Dt Inlet �3 Dt Bottom Header / Man. spy lee-P7- Dist. Pipe 77 �� Bot. System 1# jZ Final Grade were, .3 /0Z lev on � trot av, 44 4 17 or e.4 -70(_ Z ED/TRENCH Width Length No. Of Trenches PIT No Of Pits inside Dia. Liquid Depth DlM,ENSIONS--- 7,2 cl I DIMENS1 SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION CHAMBER OR UNIT Type Of 0 / Model Number: System: C104 6( 12, > /41*0 30 DISTRIBUTION SYSTEM Header / Manifold Distribution x Hole Size x Hole Spacing Vent To Air Intake Length J-0 D i -a 0 Length 75_f_ ' Dia Spacing _ Ajr-41 . 410 134o 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 e I W -. g No - 11 1 0— # J . F 0 ys- COMMENTS: (Include code discrepancies, persons present, etc.) I /4-r-j 7 - Z 3 LOCATION: HUDSON 14.29.19 NW,NE 9088 DROVER TRAIL -LU; �s ITMIGE-T 32-o ed > ����' Plan revision required? E] Yes 0 No Use other side for additional information- SBD-6710 (R.3/97) Date Inspector's Signature Cert No 1 -0 41 ' Safety and Buildings division • SANITARY PERMIT APPLICATION 201 W. Washington Avenue isconsin P Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Ad Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. State Sanitary Permit Number • See reverse side for instructions for completing this application Personal information you provide may be used for secondary purposes Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)j. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location �►�-- o t 14 1 /4, S Z T , N, R (o�& Property Owner's Mailing Address Lot Dumber Block Number !EV 4e 4afiow- %X C City, State WZip Code Phone Number Subdivision Name or�'rfdM 7T 5er ,&dam h��"4 i277157 ,�►� - ___ 11. TYPE OF UILDIN+G: (check one) ❑ State Owned ® City Nearest Road Public 1 or 2 Family Dwellin - No. of bedrooms ❑ Village Town OFAWAPYCOCIA&wort III. BUILDING[ USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 [] Apartment/Condo ""' ""` Ito 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 0 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 0 ❑ 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 __ /Z System -------- System Tank OnlyExisting System Existing System B) j6 A Sanitary Permit was previously issued. Permit Number jup Date Issued Z rj? V. TYPE +OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 V1 Seepage Trench 22 ❑ In -Ground Pressure , At 42 ❑ Pit Privy 13 ❑ Seepage Pit JI&� 43 ❑ Vault Privy 14 ❑ System -In -Fill G-- VI. ABSORPTION SYSTEM INFORMATION: 1. gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) Elevation 1 7rO , ,�' Feet Feet VII. TANK Capacity INFORMATION in gallons Total Gallons # of Tanks M,anufacturer's Name Prefab. Concrete Con Steel Fiber- glass Plastic Exper. APP. New Existin Tanks Tanks strutted Septic Tank or zwe A 94V 0 El Lift Pump Tank ❑ El El El 1:1 Vill. RESPONSIBILITY ATEMENT 1, the undersigned, assume responsibility for installation of th/orsite sewage system shown on the attached plans. Plumber's Warne: (Print) Plumber's Signature: (No Stam ) N4Q=PRSW No.. Business Phone Number: V •Ir umber's Address (Street, City, State, Zi Code): L&.1—Ir 107t, ', a 4<-;LZ7 IX. COUNTY'/ DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A nt Signature (No Stamps) pproved [-]Owner Given Initial Surcharge Fee) 0 Ctl> Adverse Determination l X. CONDITIONS OF APPROVAL I REASONS FOR DISAPPROVAL: SBD- 6398 (R.11J97) DISTRIBUTION: original to County, One copy To: Safety & Buildings Division, Owner, Plumber f INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-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. 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 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. V1. Absorption system information. Provide all information requested for numbers 1 through 7. V11. - 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 D1LHR. Vill. Responsibility statement. Installing, plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. PlutOervustsign application form. IX. County / Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 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; Q 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. �- /j &,gl,te-,417— �ae rAf- Z-07- 49;1VT e---- loo::Iw 140 IP171 P� �--ee 17e:5�- � O;r W .5- -5-c,ofz 47 OP = Aye 110 41 err, 0/ 00 _ r ./` PUl`-"\P CHAl�1 R CR0c5 SEC'10tJ 0JG SP CI��C� rIO �.,� E .� VE QT CAP `i C.I. \/[ OJT PIPE WEATHERPROOF APPROVED LOCKINJG ^'1 DOOR, JUUCTIDQ BOX MAnJHO�E COVET R o �i WJJDOW OR FRESH IZ"M1IJ AIR I>JTAKE GRADE4zte , t� COQDUIT I � N rkJLET I ELEV FT i PROVIDE � AIRTIGHT SEAL *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL ALARM 0 tJ PUMP OFF C O UC R'ET+E BLOCK RISER EXIT PERMI-TTED OAJLy IF TAI..IK MAAIUFACTURER HAS SUCH APPROVAL SEPTIC E 5PCC.IFICATIOKJS DOSE _ TAUKS MAkJUFACTURER: /`""'' �J BER OF DOSES: PER DAB TAIJK SlzE : ----y - _ GALLOIUS DOSE VOLUME ALARM MAUUFACTURr.R: ,r IMCLUD)MG I5ACKFL0W: e _ GALLONS MODEL DUMBER: /� CAPACITIES: A = 17 ..� s� � GALLO lu+CNES DR '�>�!S SWITCH TyPtE: �� C I B -- FICHES OR G�,LLO►JS ti PUMP /' AIQUFAC.TURER: � WCHES OR GALLOQ5 MODEL JLlMBER: D = IKICHES OR 2 GALL©�JS 51r,11'17CN TAPE; lc6zC416CIC4 C �1 ATE: PUMP AMD ,ALARM ARE TO DE MIMIMUM DISCHARGE RATE... ,GPM INSTALLED OU 5EPARATE CIRCUITS VERTICAL DIFFERZKICE BETWEEAJ PUMP OFF Ault] DISTRIBUTIOM PIPE.. FEET �'r �,- + 1" IMIMLIM ►JCTWORK SUPPL.j PRESSURE . . . , . . . . -- -- FEET + D FEET OF FORCE MAIM X � FYl FRICTI0kJ FACTOR, �•/ o F� OR . FEET TOTAL D�WXMIC- HEAD FEET IUTERMAL, DIMEWSIC)M& OF TAUK: LEU&THL� ,WIDTH • L.I UID �Q DEPTH SIGHED: R r../� '1) Cf LICENSE h!UtABrE -� 7 R,. tiATE. GOULDS Pump Specifications 1/3HP Up to 40 GPM Discharge size V/4" N PT Solids: Ya 11 maximum Motor Single phase: 115V Materials of Construction Brass/thermoplastic Features and Benefits *Top suction eliminates impeller clogging. e Corrosion resistant construction. *Float actuated switch. METERS FEET MODEL DVPO 25 7- 3 5- 15 4 d 3- 10 2- 5 I- 0-0— 1. 0 5 10 15 20 25 30 35 40 U.S,GPM 0 2 4 6 8 10 m3ft CAPACITY MODEL: 3871 [mot MM MMM EON Pump Specifications Features and Benefits 4 /io and 112 HP 9 EP04 impeller- semi -open design Up to 60 GPM with pump out vanes to protect Maximum head to 32 mechanical seal. Discharge size 1 112" NPT e EP05 impeller - enclosed design Solids- 1/4 11 maximum for improved performance. 9 Rugged glass -tilled thermoplastic Motor All motors feature ball casing and base design provides superior strength and corrosion bearing construction. Single phase: 11 5V resistance. Materials of Construction e Cast iron motor housing for efficient heat transfer, strength, Cast iron and durability. Thermoplastic Stainless steel *Corrosion resistant threaded stainless steel shaft. *Available for automatic and manual operation. e CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. Wiv:on'sin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and 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 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL # dimensioned, north arrow, and location and distance to nearest road. e9 In---* / 3.,? *7 APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION R IEW BY JIM DATE o. PROPERTY OWNER: PROPERTY LOCATION U I (-,,,6�j/,p1(,�' '4Z GOVT. LOT T N, R E (qjf�V I.A. 4661111S./ PROPERTY OWNER'.-S MAI ING ADDRESS LOT # BLOCK # SUBD. NAME %."R e5kir# PA RCEL COUNTY T Y EL I.D.I-D - # R I W _ / 7' E BY CITY, STATE ZIP CODE PHONE NUMBER ❑[:]CITY E]VILLAGE OTOWN NEAREST ROAD Z( 2 z nv� New Construction Usej Residential / Number of bedrooms Addition to existing building Replacement Public or commercial describe Code derived daily flow -_ 4kO gpd Recommended design loading rate bed, gpd/ft2 .-trench, gpd/ft2 Absorption area required /5-7 bed, ft2 2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) I o gr,�y4 P�c_ -ft (as referred to site plan benchmark) P7 -if I — Additional design / site considerations .3 Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND N- ROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S o U S El U El S 0S .21S El U PS EILI U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Munsell Motdes Qu.'Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 - T - BedTr -in. 5L 2A Z 14-1 .5 z4E .3 .27- 19 VA; C 13 X IS6:j Remarks: '5 Z- 7. 6Z Remarks: ST Name -.—Please Print E-7 1Z Phone: ddress- ;ignat CST Number- 'PROPERTY OWNER_ SOIL DESCRIPTION REPORT Page .2 of PARCEL I.D.# 49.ZO -7 ---§Y.) Boring # .............. .. 3 ... ........... Za Y Ground elev. 104 -��q ft. Depth to limiting factor f Z . Depth to limiting factor > goy Depth to limiting factor Ground elev. f t. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottes, Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed ITrer& L 011-A 2— .5— — ,fir l- L .5 W—tz- 701> Remarks: 0* Ll 3 -sL- z o4Ae gotElz IRS-. .04 w F 17 74 Remarks: dry IF > 3 - . N 5 ee2; nf 4- 7. Sa .3 Cv it L. 04 L— 17 lop 47 71 > Remarks: wx P�ex Remarks: SBD-8330(R.05/92) .3 DAVE FOQERTY PLUMbINt uc ensod Pork Tester & plumbL r #3233 #3289 FoMrty Heights Road ROSE -WISCONSIN 540423 Phone 749-3656 7- 12AI %off' tlay0000001 00, Z07 cc/tx,��� 7X 4r-Ac14 / A 7/5c z?00' *j ,lJc CTiS� lo.�/S% T visco Department of Commerce SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code I I Safety and Buildings Division 201 E. Washington Ave. P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. cmazc • 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 it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION I Property Owner Name 4u Property Location A1411 /4 1141S4 I E (or )jT:) a T .29 IN Property Owner's ailin Address Lot Number Block Number 49 ljt City, State Zip Code Ph"one Number Subdivision Name or SAA Nam44)-w I 'Wozze,00--i I ---- 11 TYPE OF BUILDING: (check one) [:] State Owned 0 it C Nearest RoadE] Public 1 or 2 Family Dwelling - No. of bedrooms Village ElTown OF t:z 1 4 A f _,Ina 111. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) v4. z-9. tq. n9l 1 E] Apartment/ Condo A.20 — Z �P7 2 Assembly Hall 6 [j Medical Facility/ Nursing Home 10 F] Outdoor Recreational Facility 3 ❑ Campground 7 El Merchandise: Sales/ Repairs 11 Ej Restaurant/ Bar/ Dining 4 F] Church / School 8 El Mobile Home Park 12 E] Service Station / Car Wash 5 F] Hotel / Motel 9 n Office/ Factory N1 3 Cl Other: specify IV. TYPE OF PERMIT: (Check only one box on 11 Check box on line a able) Check I ' A) 1 New 2. E] Replacement ❑ R lacerrient Reconnection of 5- [:] Repair of an System System Ta k Onl Existing System Existing System ) B) ❑ A Sanitary Permit was previously Issue Per it iur!p Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized I ion Experimental Other 11 'Seepage Bed 21 [:] Moun 30 0 Specify Type 41 [] Holding Tank 12 E] Seepage Trench 22 E] In-Gro nd Pressure 42 E] Pit Privy 13 0 Seepage Pit r A? 43 E] Vault Privy 14 E] System-In-Fi I I► VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation - 9 Sir I- Y Feet l IELQ Feet VII. TANK Capacity Mao= INFORMATION in gallons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete S ite Con- Steel Fiber- glass Plastic Exper. App. New Ex I stl ng Tanks I strutted Sep I Tan k -Tanks 4/ 47,o�.,X El El El El 1:1 '` TT5 �Pump Tank rr r /-Z,2V- 11 T Vill. RESPONSIBILITY STATEMENTS 4r-pr .rr,*rjV/t., :;r POW AAC.-C-PCA. 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. .4 Plumber's Name: (Print) Plumber's Signature: (No St I'fps) MPRSW No.. BusineZssoonmeW Number: C2t1. Y—0i1r . - ovPih 7..- Plumber's Address (Street, City, State, Zip400" L&)O Al6f42r& _11�4yo_JL_ IX. COMWY/ DEPARTMENT USE ONLY ID Disapproved Sanitary Permit Fee (Includes Groundwater Date Issuel Issuing A_�e nt Signature (No Stamps) Approved F] Owner Given Initial - 0�n� Surcharge Fee) /� 11 T2 0 1 I Adverse Determination /C / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: V SBD-6398 (R. 11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumt>er INSTRUCTIONS r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-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 i s to be i nsta I I ed . il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling_ III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on lief V. Type of system. Check appropriate bo`tc VI. Absorption system information. Provide l 11I Vill. tank replacement, reconnection, or repair. ,mbers 1 through 7. Tank information. Fill in the capacity of every?t'e r is ng bank, lift. the total gallons, number of tanks and manufacturer's name, indicate prefab or site const e d to k mpterial. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental ap I only t nks received experimental product approval from DILHR. .' Responsibility statement. Installing plumber is to fill in name, licerif 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 1/2 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. RTY PLUMBING DAVE FoGE- - Licensed Park Tester 328&9 Piu"**' #3233 # Fogerty Heights Road 4 ROBERTS.W'S0f4sm 540 (, Phone 749. 36 97 /CE,FvP* A r// 0/f4f Z-,o7- 5-r"w kc 2-4nrl , F PUP`\P CHAMEtR CROISS SCC`, iio .j c �.�.9G �PECiI~ ICE rt0k_,c, --- v E Q T C A P y" C.I. VE'JT PIPE WEATHERPROOF APPROVED LOC.KlNJC, - �0."'1 DOOR, Ju>�C�rlo� Box MA�JHOL E COVE F �s Wl,JDOW OR FRESH IZI�"IIU. AIR tM7AKE GRADEI W... I � C0KJ1)UlT__// 18 PROVIDE � AIRTIGHT SEAL �II � I I ALARM *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL i PUMP � .� OFF CONCRETE 15LOCK RISER EXIT PERM17fED OIJLy IF TAIJK MAuIlFACTURE.R HAS SUCH APPROVAL SEPTIC E S PE C. I F I'CATI DUS DOSE TAMKS MAMUFACTUR I-K - �JUMBER OF DOSES: PER DAB TAI`1K 5(ZE : GALL OMS DOSE VOLUME ALARM MA1,lUFACTURIER: `�" L J IMCLUD)MG 6ACKFLOW: . GALLONS MODEL uMER : CAPACITIES: A=..r....WCNEs OR d G L A Lous SWITCH TYPE: rz ' - IMCHES OR GALL0u5 PUMP I"1AMUFACTURER: C == !uC - 5 HES OR I GALLOu MODEL lUUMgER: LU PA .7 D 1niCHES OR �.�GALL(JUS 5W17C H TAPE: % W. AgoMOTE*- PUMP AMD ,ALARM ARE TO bE h"111kiIMLII'''ti, DISCHARGE RA-rE GPM INSTALLED 01�! SEPARJ�ITE CIRCUITS VERTICAL DIFFERENCE BETWEEN.! PUMP OFF AND DISTR1BUTIOM PIPE.. 4.1- FEET + MIIUIMUM K1ETWORK SUPPL'tJ PRESSURE . 0 , , , a FEET -+ jFE E T 0 F FORC E MAI M X_;n � F/ FRICT IOU FACT OK-.�T aR_. FEET TOTAL. 0'3 iJ A M I +C. HEAD /' - ? FEE T IUTERMAI, DIMEWSti0Ns OF TAUK: LF- I&TH � ;'WIDTH .;LIQUID DEPTH 5_3 5IG ICE D:_'12 c .,,'►a�'I `—) LICENSE' NUMBER— na,-�-• T Performance Submersible E-ffiuer'n. . FOGERTY PLUMING Pumps Cu�eS & PERK TESTING,BINC. P.O. Box 130 ROBERTS, WI 54023 METERS FEET 30- 100 - ---- --- SERIES: 3885 SIZE: 3/4' SOLIDS RPM: VARIES 80 5GPM .......... ... 5 FT ------- LU 20- ........ 4. ...... ...... 0 z _4 40 - 0 . ....... ... ..... 10- 20t 0- _j 0 0 0 2 L 120 140 160U.S. GPM 40 60 80 100 0 0 MI/h 10 20 FLOW RATE 0 N GOLD LDS PUMPS, INC. WATER TECHNOLOGIES GROUP SENECA FALLS NEW YDW 13148 METERS FEET 120 -3885 SERIES. SIZE: 3/4" SOLIDS 35- RPM: 3450 110 5GPM 30- 100---- 5 FF 90, w 25 80- 70. < 20- z 60 t .. . ....... 15- -50 . ........ . ........... 0 ... ... .. . ..... . ... . .. ........ . . ... ...... ...... ........ ....... . 4- 10 30 . .......... ........ ........ . ...... 20 .... . .... ..... ....... ... . . 5- ...... ...................... . .... .... • ... . ..... ........ 10 0- 0 0___'_10 20 90 100 110 120 U.S. GPM 30 40 50 60 70 80 w 01 20 30 ml/h CAPACITY F fledive July. 19113 t"t. 1993 Gourds Pump I. 111c, SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINI'Ll') IN () S A. G36853-150 W. S' 77� Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page i. of Labor arO 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 11 inches in size. Plan must include, but Crniy- OU 'T not limited to vertical and horizontal reference point (BIVI), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 020-1020-90 0 APPLICANT INFO R MATION-PL EASE PRINT ALL INFORMATION FREVIEWED BY DATE PROPERTY ROPERTY OWNER- PROPERTY LOCATION Kernnn Bast GOVT, LOT Nw 1/4 NE 1/415 12T 29 N,R 19 �(or)W PROPERTY OWNER'-S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # OP 948 LaBarge- Rd.,, 5 na Grass CITY, Ra -e Addn, S ITYSTATE ZIP CODE PHONE NUMBER E]CITY E]VILLAGE OTOWN NEAREST ROAD Hud,cign, WT. 54016 (7A 386-1771i 1judson, McCulcheon Rd. New Construction Use [A Residential / Number of bedrooms 3 Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate 4,7 bed, g pd/ft2 8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate 7 _bed, gpd/ft2 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.85 ft (as referred to site plan benchmark) Additional design / site considerations alt. site system el. = 101.61 & 100.20, Parent material outwash Flood plain elevation, if applicable na ft = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK S U = Unsuitable for system [N S El U wmd� IN S El U [X S El U ER S El U [2 S, 0 U El S EiU Ground elev. 105-'45_ ft. Depth to limiting factor +8011 Boring # .................. ................ ........... ................ 2 .................. ................. ...... I ........... ............ ­... '11-111 .......... ................. Ground elev, 105,3 ft. Depth to limiting factor +8411 SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Motes Qu. Sz. Cont. Color Texture Structure ctu re Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed 7mrich 1 0-14 10yr3/3 none 2mar mvf r CTW 9f .5 -6 2 14-80 7..5yr4 4 none Cos OSQ M1 na na., 7 a8 Remarks: 1 0-11 10yr4Z3 none 9msbk mf r as E .5 -i 06 2 11-25 10 r4 6 none S1 JCSbk_­-.i­--.­.--mf --0S-g-'­­' 3 25-50 7.5yr4/6 none M R 4 50-84 7.5yr4/4 nQne nsg M1 -7 7 70 RE 11WI 9. 1 -T Remarks: CST Name: --Please Print Gary Steel Phone: 715-246-6206' Address: 1554 200th.,6v ,yl 54017 ...e., New Richmopd, Signature: Date: NT'.Nurfiber: '*nW248 62 5-1-97 PROPEMOWNERKerncm Rasp _ SOIL DESCRIPTION REPORT PARCEL I.D.# 020-1020-90 Page of- i Boring # 3 Ground elev. 105,1 ft. Depth to limiting factor +8211 Boring # :L: 4 Ground elev. 103.2 ft. Depth to limiting factor �Qn II Boring # 5 Ground elev. 103.5 ft. Depth to limiting factor +3011 Boring # Ground elev. ft. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots G P D/ft 2 Bed Trer& 1 0-15 10 r3 3 none sl 2msbk mvfr cs 2f .5 .6 2 15-34 10 r4/4 none sil lcsbk mfr gw if .4 ,5 — na na .7 .8 3 Remarks: if na . 4 .5 .7: .8 2 2 — 8 10 r4 4 none sit lcsbk mf r — cos 0SQ ml na Remarks: .4 .5 e sil lcsbk mfr 9w if A. .5 na na .7 .8 Remarks: Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Kernon Bast CSTM2298 NW4NE4 S12-T29N-R19W MPRSW-3254 town of HudSon lot #5-Grass Range Addn. N 111=401 BM.= top of NW lot stake @ el. 100, Alt. BM.= top of steel post @ el. 106.901 p M C�� ' I ta' 15 � 13' z3' ��6 I � pz� kGi' /4J' o' 6PO \v Or �, k ��a ti Q� Gary L. Steel 5-1-97 1554 200th Ave. New Richmond, W1 54017 (715) 246-6200 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner4krm __1L7,5X4e5A7 ;Or Mailing Address zzl_ Property Address ��& ' (Verification required from Planning Department for new construction)-- City/State e--� _5_Yc7-- �7 -- /� Parcel Identification Number LEGAL DESCRIPTION Property Location 1/4 T_,.;?-N-R_ NN12 Town of -Z7?- Subdivision Lot # Certifled Survey Map P Volume Page # Warranty Deed # f__ 2 :2V S7' Volume Page # Spec house El yes 110 SYSTEM MAINTENANCE Lot lines identifiable,JA yes El no Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/wet the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 days f the three year e pirat*on date. SIGNATURE OF AICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described ove,,�y virtue of a warranty deed recorded in Register of Deeds Office. SIGNA'FURE OF ACANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds off -ice a copy of the certified survey map if reference is made in the warranty deed 40 rY UMENT NO. 4. WAJ"M SWO a us Or wi -0now bf am 2 2m kt_ Novo$ I `Olt 5%!7�ft wo �Wlm ON—O' sad 40 owed ..... TWiV SPACI "It"90 P*% "CORDiNG DAYA GICE ST CRC C 9 1, VIF11 Reed Sw R;* %W iUN 5 1995 .0 6.0 .461A 0, Mvv -*VAM -40 &"*# 0*0 wo tvw # &Z r 4.0 0 d( '.. � �. '. . i * - ` . U: , _1_11 - so* 4 op 0"tj • COP . do W* 0.10 1 71 - COP., raPon -W "Mai0, 1pon a p op 4 a W­W%4�w -0-1. too O!W.10� eav Re I -*-'Cro Ix w w C120-m I OIS-40 .1 4 .,t 4r. d -90 film Pk"d No ip part ]a MAP 4r 6 7:. .--jar- S.1610149n . 9-liells zxcxpT por to a W1 J*Y in Vol 9 S77 W, SN southerly. i I no of, said lands, x 0*6 494t, r 4 A. .1 I� . 0 twit for tb* .."S Mal t beoa�__rt. IDA" a ab 419'9 tj lee- IdEW lip* _c_ It Ir IL AI 4W KI NO4028'02"E 128.39` L I S44026' 38"E 72.84' MI SIO026' 15"E 77.28' � - IVD N 1/4 COR SEC. 14 MAQ004123riE 31, NORTH I INF OF THE NEI/4 a 3 285.08' A���Wom�j 2.02 ACRES 87,99I SO. FT. 1.53 AC. EXC . ESMT, 66,486 SQ. FT. w O 0 0 U) r N 8 9°0 4' 3 2" E 1989.41' NE COR. SEC. 14 FL 0.5' WEST OF LOT COR. co �I C, N � 0 •� U 0 0� U �4 �4 0 M 4-4 U � o 0 0 � t1 � Q b 'ri 0 '�.-�w r 0_ 0 V � 0 p .-. 'm w 0 V � �.0 �4 � rd 04U w � 44