HomeMy WebLinkAbout002-1082-80-000 r ~
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER_ Saver v Bar" -S
ADDRESS o5e~ Z Y) e,
SUBDIVISION /'.CSMJ LOT
SECTION__2?2_T_~N-R /6 W, Town of Q /
4~ Lc.~ i rte.
ST. CROIX COUNTY, WISCONSIN
2LAN._VIEW.
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
-See- Xl-lac&d L,,--a
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
jr ,
I
'BENCHMARK: o T /~Z~~ P1~C ALTERNATE BM: o o w G Q Si 9 7. Z0 /~'f p r. /S o G o r 9'1- 9~
:SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:~wr-sf ?e Cas Liquid Capacity: 11401 166'0
Setback from: Well_ 8O• House Other
Pump: Manufacturer 60ul ;Model IVZo.3/14 Size 1
Float seperation Gallons/cycle:-./36
Alarm Location roo-n W,,24X
SOIL ABSORPTION SYSTEM
Width: :30 Length Number of trenches
Distance & Direction to nearest prop. line: 13 0 'f'o s GJ
Setback from: well: 1-50' House /'YO ' Other -3 5 s~G a
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: ~A/e /~NC~/So/►
LICENSE NUMBER: M?/CST Z2O9S3
INSPECTOR:
3/93:jt
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 289301
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: /
BARTS, BEVERLY BALDW1R b~ 2~
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: d P7
002-1082-80-000
jk_
TANK INFORMATION ELEVATION DATA 11_
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i
Septic & f"- Benchmark
Dosing ,_r 9f(9s~
Aeration , Bldg. Sewer
(~.csd r ,.~t>
Holding St/Ht Inlet 9 ~ig,77~
TANK SETBACK INFORMATION St/ Ht Outlet ~j, 3 S IFS SAS
TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet
Septic > Sd e_3 / 7 q w NA Dt Bottom a g~ $S~ f
Dosing NA a~J Man. 9 02
Aeratio NA Dist. Pipe6,550.2
Holding Bot. System .3/~ 1n3•o
PUMP/ SjP J-INFORMATION Final Grade
Manufacturer
Model Number GPM N e
TDH Lift Friction,,&, System TDH ~Ft
Loss Hea
Forcemain Length Q Dia.02/' Dist. To Well t
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS S DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN u acturer:
SETBACK CHAMB
INFORMATION Type O model Number:
System: 4011-3 >wq 7f OR UKU.
DISTRIBUTION SYSTEM
Header/Manifold ~j~ Distribution Pipe(s) , / „ x Hole Size / x Hole Spacing Vent To Air Intake 4,4 1 Length Diall 4- Length ~i0 Dia. Spacing ,
AV 'j(~; I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)' l
LOCATION: BALDWIN 33.29.16.484A,SW,NE 2352 ROSE LANE
fi-^ r`) ,Ga
)Ia
I P.l ~~l'. ~ ~ fa t tl W YY^ ~.1 iY'i :J L.f~~,!S L'-}
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
O ~ c•-t,,.Y CMG r~+'-rG}r;1 ,~eG~'-S`~.f ~ l ~+(~C~~' CL'D r~~ G7~~j'- , ~f~ = v~' ' r~
d ~
L~y
3-577 '(97,20)
DILH TRANSFER/RENEWAL PERMIT ~f A- COUNTY
R UNIFORM PERMIT #
(PLB 67-T) Z 9 93o
PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER:
PROPERTY LOCATION: CITY: VILLAGE:
Si.J Y. /(/`'4,S3.3,T N,R (or)
LOT NUMBER: BLOCK NU BER: SUBDIVISION NAME: NEAREST ROAD, LAKE OR LANDMARK:
PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO:
NAME: SIGNATURE: NAME:
id~ / , 001 " S ~ PHONE NUMBER:
u r _1DOle ~rr/~'SOh 68y-3,37
ADDRESS: PHONE NUMBER: ADDRESS:
_57 DIWs2'
I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this
property.
PLUMB 'S SIGNATURE: PREVIOUS PLUMBER'S NAME (IF CHANGED):
C G llI art of SC Lt. Iw Y
PLUMBER'S ADDRESS: PREVIOUS PLUMBER'S ADDRESS:
~7 U tlO JAG d
MP/MPRSW NUMBER: PHONE NUMBER: P MPRSW NUMBER:
) V'~ ~ PHONE NUMBER:
5 (7/5 -S32'
IGNAT RE OF GA N DATE PPR VED. DISTRIBUTION: Original -County
Copy - Bureau of Plumbing
Copy
DILHR-SBD-6399 (R. 5/82) - Owner
Copy - Plumber
Safety and Buildings Division
r~•~~r■rt SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code 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. t, ~i'
• See reverse side for instructions for completing this application State Sanitary Permit Num er
1 I
sion to previous application
The information you provide may be used by other government agency 4 p
y y y programs Check I i
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Pro y Owner Name Propert Location
pe r7- "1/4,~y 1/4, S 2,y T ;Z , N, R j6 E (or) W
Property Owner's.M (ling Address Lot Number Block Number
3 m ,tvix -e .5, *T
City, State Zip Code Phone Number Subdivision Name or CSM Number
/
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road
❑ To age
❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of kJJa~'
Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(sLa_ 3 0 8? 7 O
00A _l?
1 ❑ Apartment/ Condo 6o"A-icFx_ a' eva- /0f6- d
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. [g New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
_____System ___System______----- __TankOnly- Existing System _________ExistingSystem
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
13E] Seepage Pit 43E] Vault Privy
14E] System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
Y.26id i6d'"d U Feet?, Feet
VII. TANK Capacity gallons Total # Of Prefab. Site Fiber- Plastic Exper-
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank x E9 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber X ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature,,:~~(NoStamps _M MPRSWNo.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
d 7d PV e
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved nitary Permit Fee (Includes Groundwater ate Issued issuing Agent Signature (No Stamps)
Approved ❑ Owner Given Initial Surcharge Fee)
Py
Adverse Determination oC '7 hig
MZ L"
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Div, ion, Owner, Plumber
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. 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, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. 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 # 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 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.
VIII. Responsibility statement- Installing plumber is to 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 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; welly.; 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; 1=) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation 6f -surcharges ('ees) 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.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Commerce
Aprtt 25, 1997
2226 Rose Street
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S97-40251 FEE RECEIVED: 180.00
BARTS, BEVERLY
SW,NE,33,29,16W
TOWN OF BALDWIN COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincerely, ~ 11121
,moo rf► l`/~,
Dennis Sorenson
Wastewater Specialist Q' k 1997
Section of Private Sewage 5TH,.`
(608) 785-9336
ZONNOOFFOOE
/ C r '
9
SBD-7997 (R.11/96)
S97 49 2
Page 0
RECEIVED
MOUND SYSTEM
: .FOR APR 18 1997
A 3 BEDROOM RESIDENCE ',SAFETY & BLDGS. DIV.
LOCATED IN THE S~ 1/4 OF THEN 1/4 OF SECTION 33 T Zq N, R l~ W,
TOWN OF B f~~Dw t Jv , 51' CCu11X COUNTY, WISCONSIN.
INDEX
PAGE l '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
.PACE 5 of 6 PUMPING CHAMBER '
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
3Eu~~y 8R-R1'S
3 Lo t--. ST•
W 0_l~~ V L l.l~.{ 4v ~ S4
PREPARED BY
WEGEE;tER SO = L TESTING NO
. m
AND SCONS/
DES I (SM ST=RV I CE ~
ARTHUR L
URL
F.O. 301 74 421 K. 114I11 ST. _ • WEOE ER
RIVE! ft11S. MI 54022 ~g E{D.4WORT1,
ag~~ hp G
JOB NO. 7' y
PLOT PLAN
Page Z- of ~
Scale 1"= y p'
i
i
a-2 S97-40 ~_2 5 ~
B•3
ej r:
Z"PvQ F"I yo, OF
P S yPUC
c~ ka
J
~.S S max'
0
0
tv 01,tr
w t!1- L lb B E L.r''tT&T SO' F2.owl r-ia ux.p
n,-n-~.►zs
Vlv~ Y YT UErt Sr ZS,
PRIVATE SEWAGE SYSTEM
Conditionally
P IMML
N. p - KOVED
AP
NVION OF SAF AND
SEE CORRESPOND
NOTES:
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. { 2 required)
3. Install.4" observation pipes with approved caps. ( Z required)
4.-Septic tank to be1000t6S0 gallon capacity manufactured by
JAIC_
5. Bench Mark %*I - L1:. `oo.o' on, laP or-- bt^- l~yC j~lPe .
Pf~T~ar+R'R3 3M - LZ. m4_1o, (:*-j -MP or-- STM FoNiCQ- POsr.
6. Divert surface water around sys te-M to. prevent- at the uphill side.
Page 3.Of ~o
Approved Synthetic Covering
19sTM c 33 Distribution Pipe
Medium Sand _ J
Topsoil F Elev: qL. o
3 E p
e
l % Slope
Force Main Plowed
Trench of 2"-2 2" From Pump Layer
Aggregate
Undisturbed D L• b Ft.
Soil E 1 • Z Ft.
Cross Section Of A Mound System Using F 0, B Ft.
I Trench For The Absorption Area G 1•ts Ft.
A S Ft. H I. S Ft.
6 -IS Ft.
I 'NS Ft.
Linear Loading Rate= 6.3 GPD/LN FT
Design Loading Rate= O. 3 GPD/SQ FT J ~ Ft K 10 Ft. S97-40251
L °l S Ft.
osition of Force W ZS Ft.
L
J Fores,
B 3014 K -Mflin-
A---- -
W Distribution Trench Of 2 - 2 2
Pipe Aggregate
Observation P arub SEWAGE SY EM
ers
(Anchor securely)
Pipes Condition ly
API)ROVED
DIVISION OF SAFETx AND BUILDINGS
Mound Using 1 Trench For
SEE CORRESPONDENCE
Page Of
Perforated Pipe Detail
0
End View
Perforated
End Cap. PVC Pipe
I
Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q End Cap
f S9Y7-40 1
Q
* PVC Force Main
PRIVATE SEWAGE SYSTEM
Dis,naa,ion Conditionally
Pipe p DIED
Last Hole Should Be
Next To End d Cap
DIVISION OF SAFETY AND BUILDINGS
Distribution Pipe
E CORRESPO D010L Ft.
X 3 Inches
Y Inches
Hole Diameter Ily Inch
Lateral 1 y Inch(es)
Manifold - " Inches
Force-Main Inches
# of holes/pipe ~z
Invert Elevation of LateralsR6.5 Ft.
Place lst hole from tee with succeeding holes at 36" intervals..
Last hole to be next to the end cap.
Combination Sep"c;_Tank and 6
PUMP CHAMBER CROSS SECT10 AMD SPECIFICATIOMS ' PAGE 5 OF
J WEATHER PROOF
-VEIJT CAP
JUWCTIOU 80X ;
4'C.I. VENT PIPt APPROVED LOCKING
lO' FROM ODOR, MAWHOLE COVER iul'1H
wAR n~lWG LI48El.
41MDOW OR FRESH
AL_IUTAKE co~.lDulr
~ I `f• MIN.
~ I ~ 19• MNJ.
RI`
PROVIDE I
IWLET _AIRTIGHT SEA ~itty
~gFF~tS I VED .l01WTS
. PIPEP'C
APPROVE. JOIAIT A~
W/C.i. FIFEaR Tank construction I
shall comply with DIW I A B WINGS
ILHR 83.15 and 83.20
SEES RESPO DE CE
LLEV. $4. FY PUMPS O F
0 LCOUCILETE
DLOCK
!✓L.~U . 8 5l • O o
APPRwVc-
g€DDI~
KISER EXIT PERMUTED ONLY IF TANK MAWUFACTURCR HAS SUCH APPROVAL13#'
SPECIFICATIOLJS
SEPTIC f
TANK MANUFACTURER. ~'z S_r NUMBER OF DOSES: PER DAy
TAWK !AZE: 1000 6S0 GALLONS DOSE VOLUME t
S, --!Z. ~r1.Q,.,_Tm S`1131r 4S INCLUDINO 5ACKFLOW: 13~ GALLONS
ALARM MANUFACTURER:
MODEL NUMBER' I S5 l 11w CAPACITIES: A= "g INCHES OR 3 _ GALLOI,IS
SWITCH TYPE: ~~Z CuR~ 5= Z INCHES' OR - G(11.1_01,15
PUMP MANUFACTURER: ZOt~-~ 2- CO. C: S INCHES OR X3\0 GALLOWS
MODEL NUMBER: 98, D- VZ~ INCHES OR \,D GALLOWS
)"1 WR L( MOTE: PUMP AUD ALARM ARE TO 6i ~
SWITCH TYPE:
MINIMUM DISCHARGE RATE z8.0 GPM INSTALLED OW 5EPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AUO_1315TRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . 2-So FEET
100 FLFRICTiON FACTOR.. FEET
+ 100 FEET OF FORCE MAIN X F/ `61
TOTAL Oy1JAMIC HEAD = \S.7$ FEET
DIAMETER
Pump chamber •
JUTERNAI.. DIMEIJSIOM~ OF TAUK: LEAIGTH --,WIDTH --4L.IQUID DEPTH
BOTTOM AREA i---- 231= GAL/INCH
AS PER MANUFACTURER = 110 GAL/INCH
HEAD CAPACITY CURVE 3 7/8 6 1/4
0 MODEL "98" 4 5/8
a-
25-
3 5/8
= 6
15
J 4 4 3/16
F
~ 10
29.0$
2
5 1 1/2-11 1/2 NPT
0
70 80
U.S. GALLONS 10 20 30 40 50 7"
LITERS I
80 160 0
0 FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE
EFFLUENTANDDEWATERING
CAPACITY 12
HEAD UNITS/MIN
FEET METERS GALS LTRS
5 1.52 72 273
10 3.05 61 231
15 4.57 45 170 4 3/16
20 6.10 25 95
Lock VaNe 23' 1;.. +
SK1102
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single
supplied with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available
or without alarm switches. for variable level long cycle controls.
SELECTION GUIDE
Standard all models - Weiht 39 lbs. - H.P. 1. Integral float operated 2 pole mechanical switch, no external control required.
2. Single piggyback variable level float switch or double piggyback variable level,
98 Series Control Selection float switch. Refer to FM0477.
Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075.
M98 115 1 Auto 9.4 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, E-Pak.
N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4)
float system.
D98 230 1 Auto 4.7 1 or 1 & 7 - 6. Four (4) hole J-Pak, )unction box, for watertight connection or wired4n
E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10.0002.
7. Two (2) hole J-Pak, for watertight connection or splice.
CAUTION
ForirdomlNiononadditionalZoellerpnoductsreferbcatalogonCombinationSlarter,FM0514;Piggyback All installation of controls, protection devices and wiring should be done by a qualified
Variable Level Switches, FM0477;F_liictrrcalAllemaalor,FM0486;Mechanical Alternator, FM0495;Sump/ licensed electrician. All electrical and safety codes should be followed including
the most
Sewage Basins, FM0487; and Single Phase Simplex Pump ConboliAlalm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
ft1a T& P.O. BOX 16347
Loul%*, KY 40294347
~ SNP T0: 3649 Cane Pan Road
Lo *46, 040211-1961 ,~ufurrPiat~r Sim "
PUMP !O. (502) 77'0i7(OW 904
T
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUN I
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but roi
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P D. # Rory-gyp ! 6
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ED C c 1` 9S AT
PROPERTY OWNER: PROPERTY LOCATION S► C
Beverly Barts GOVT. LOT SW 1/4 NE v Tip ,
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME
320 E. Maple St. na na na
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ff OWN NE~M
dville. WT_ 94028 (715)698-2103 Baldwin Rc)-,t- Tn.
[ New Construction Use [x ] 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 ed, gpd/ft2_ _5_jrench, gpolft2
Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate .4 bed, gpd/ft2. -a -trench, gpd/ft2
Recommended infiltration surface elevation(s) 95.60 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based oncontour line of el. 94.60'
Parent material pitted glacial dirft Flood plain elevation, if applicable na ft
S =Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE mTm~SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ® U ® S E3 U 1:1 S ® U ❑ S i7 U ❑ S 1.21 U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1...'' 1 0-11 10 r4 3 none 1 2msbk mfr cs 2f .5 .6
2 11-27 10yr4/4 none scl 2msbk mfr gw if .4 .5
Ground 3 27-50 10yr3/4 2p7.5yr5/8 scl lcsbk mfr na na .2 .3
elev.
95.5 ft.
Depth to
limiting
factor
27"
Remarks:
Boring #
1 0-12 10 r4 3 none 1 2msbk mfr cs 2f .5 .6
2 2 12-24 10 r4 4 none scl 2msbk mfr if .4 .5
Ground 3 24-34 10 r4 6 none scl 2csbk mfr C1W na .4 .5
elev. 4 34-55 10 r5 6 none scl m na na na .2 .3
95.1.
Depth to
limiting
factor
+55"
Remarks:
CST Name:--Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 2 . Ave. Ne hmond WI 54017
Signature: Date: 11-19-96 CST Number: m02298
PROPERTY OWNER Beverly Barts SOIL DESCRIPTION REPORT Page 2•' of-3
PARCEL I.D.# ~C^ --2-^ ^I6
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
...3...... 1 0-13 10 r4 3 none 1 2msbk mf r cs 2f .5 .6
2 13-25 10 r4/4 none sicl 2msbk mfr 9w if .4 .5
Ground 3 25-38 10 r4 4 2 7.5 r5 8 sicl lcsbk mfr 9w na .2 .3
elev.
93.6 ft. 4 38-55 10 r4 6 2d7.5 r5 6 sl lcsbk mvfr na na .4 .5
Depth to
limiting
factor
25"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
.
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Beverly Barts 1554 200th Ave.
CSTM2298 Sw4NE4 S33-T29N-R16w New Richmond, WI 54017
MPRSW 3254 town of BAldwin (715) 246-6200
1
N
1"=40'
BM. = top of l t" pvc pipe C el. 100'
Alt. BM.= top of steel fence post C el. 104.10'
p~r°1~[1 d a o
Gary L. Steel
11-19-96
J
C
64•-0"
9'-6" 8'-4" 12'-6" 16'-4" 5'-3" 12'-1"
o MASTER UTILITY BATH
[ID 2
~►TH KITCHEN
❑ BEDROOM 3
F
('7 DD - - O
IL.fI'~l O ~E
"
O
ao
io
cli GREAT
ROOM
.T
MASTER DINING BEDROOM 2
io BEDROOM ROOM
I
- J
17'-4" 101-8" 18'-8" 12'-8"
007
(21t707Sq.
F~
Io
2,~ n f~,, Q ~i
f2e->,i cc cp
CLd,
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property.5 tj /4~/ 1/4, Section 3, TAq N-R / 6 W
Township n G Mai ing address
IN D~~
Address of site
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property
Total size of property 0-e- .t' 7
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? ;/Yes No
Volume 131 and Page Number ?S as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 5S 7 4:rP , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature o. Applicant Co-Applicant
q_da -ei7
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix ounty
OWNER/BUYER
G0,~"
MAILING ADDRESS 5-"
z,~,S 2
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE W o "'4L Vp LJ -7--
PROPERTY LOCATION S4✓ 1/4, ,U 1/4, Section 3.3 T__Zy_N-R_L,,/._W
TOWN OF ~s- ,L~ CJ ,•'N ST. CROIX COUNTY, WI
SUBDIVISION a c N Y, _V LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year- expiration date.
SIGNED: &zlk
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
F
• , 55'7680 PSTATE BAR OF FORM 5 - 1982
RESENTATIVE'S DEED
ERSONAL RPi
DOCUMENT NO. VOL 3233 PAcF5 / 5 _
REGISTER'S OFFIOE
Gerald C. Hegland ST. CROIX CTY., WI
ftao'd la Ramro
as Personal Representative of the estate of
Glenn R. Hegland APR 8 1997
qt 11:00 A. M
("Decedent"), ~s*tsL_ * IdAtt
for a valuable consideration conveys, without warranty, to iiepbter ut Desds
Beverly A. Barts, a single person,
Grantee,
the following described real estate in County, i THIS SPACE RESERVED FOR RECORDING DATA
State of Wisconsin (hereinafter called the "Property"): NAME AND RETURN ADDRESS
Et3#vta-~- t1e
T q 185450
002-1082-3 11
$ 09-11 - ' 00 -1 86- 0 '
PARCEL IDENTIFICATION NUMBER
All that real estate lying South of Railway right of way of the Chicago, St.
Paul, Minneapolis and Omaha Railroad Company in the W 1/2--of NE 1/4 of
Section 33, Township 29 North, Range 16 West, EXCEPTING therefrom a parcel
of land in said W 1/2 of NE 1/4 of Section 33 that lies south of that
certain highway running between Baldwin and Woodville, Wisconsin.
That part of the E 1/2 of NE 1/4 in Section 33, Township 29 North, Range 16
West, St. Croix County, Wisconsin, that lays South of the main line of the
Chicago, St. Paul, Minneapolis & Omaha Railway Company, and
All that part of the SW 1/4 of NW 1/4 of Section 34, Township 29 North,
Range 16 West, St. Croix County, Wisconsin that lays South of the main line
of the Chicago, St. Paul, Minneapolis & Omaha Railroad EXCEPT that part
conveyed in Vol. 1158511, Page 407, Doc. No. 353495.
That property located North of St. Croix County Highway BB located in the W
1/2 of SW 1/4 of Section 34, Township 29 North, Range 16 West, St. Croix
County, Wisconsin EXCEPT that part conveyed in Vol. 1158511, Page 407, Doc.
No. 353495.
Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately
prior to Decedentl; death, and all of the estate and interest in the Property which the Personal Representative has since acquired.
Dated this day of April 19 97.
904 (SEAL)
(SEAL)
• erald C.: He land
Personal Representative Personal Representative
6 L_67~j P e I LPL-1 CST~~
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
as.
St. Croix Countv
authenticated this day of .19- Persnnally came before me this day of
April -.19-9 , the above named
Gerald C_ Hag] and ~~><sonal representat:iv
Of the Estate Of G1608. R Regland
TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public
abhor
authorized by 9706.06, Wis. Slats.) State of Wisconsin me known to be the person who executed the foregoing
Diane M. Barrdfi
instrument nowled a the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Diane Barron
Hudson, WI 54016 Notary Public, St. -Croix County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date:
necessary.) Nov. 48th _X A9 1 -
Names of persons signing in any capacity should be typed or printed below their signatures.
STATE BAR OF WISCONSIN - Wisconsin Legal Blank Co., Inc.
PERSONAL REPRESENTATIVE'S DEED Form No. 5 - 1982 _ Milwaukee, WIS.