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ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner K tlk
Address 4.3 Q12 5: & 57;
City/State AA,0X V6 17
Legal Description:
Lot Block Subdivision/CSM #
OC~
'A _,%d '/4 _&g Sec. 3V, T 3/N-RAW, Town of PIN # hn6 -_i879-66 -0
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer JYwJAuAo4t Size ST/PC I Qabl J# 60Setback from: House Well P/L _IjL
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
l
Type of system: &4.r~ Width Length Number of Trenches
Setback from: House 1, Well P/L Vent to fresh air intake
ELEVATIONS:
Description of benchmark Elevation
Description of alternate benchmark Elevation
Building Sewer 0 , ST/HT Inlet ST Outlet _7,. _ PC Inlet / V, 73
PC Bottom 7 Header/Manifold O / Top of STJPC Manhole Cover
Distribution Lines
r
Bottom of System ( ) { }
Final Grade ( } ( } ( )
Date of installation / / Permit number State plan number
Plumber's signature t License number _8A ?VS-4 Date / J
Inspector
Complete plot plan R
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
37 ~
i
i_-
INDICATE NORTH ARROW
Wisconsin D,gpartment of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
aureau of Integrated Services ifya e with s. ILHR 83.09, Wis. Adm. Code
,
,
Attach complete site plan on paper not less ~n~~f~Ye x 11 ' ches 0t Ian must County
include, but notlimited to: vertical and ho ' refer ifM),l~ife n and
percent slope, scale or dimensions, north rr and I istancla.to dearest road. Parcel I.D. #
APPLICANT INFORMATION - r e (rf~rit ad info Q ~ 'M, 006 - /0 7g- ad t
/1 t/OM, Reviewed by Date
Personal information you provide may be used r ndary pukacy Law, < . (t) (m))•
Property Owner K, f Property Location ~9 <9
Govt. Lot 3~/ 1!•; Nr.- 1/4,S,?'Y T 3 / N,R LG E (or)(@
Property Owner's Mailing Address 5 Lot # Block# Subd. Name or CSM#
/gG3 .235-' sr Id / G
City Lrc,~ State Zip Code Phone Number El .
City El Village ®Town Nearest Rog
/X
wT s11007 cats- )vog- cygfq C La o?3s .57, _j
.2 Y k- '77 Yt
❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building
® Replacement ❑ Public or commercial - Describe:
Code derived daily flow ~00_ gpd Recommended design loading rate 4_bed, gpd/ft2 2 trench, gpd/ft2
Absorption area required oo bed, ft2 00 trench, ft2 2
_ Maximum design loading rate '2- bed, gpd/fl2 trench, gpolft2
Recommended infiltration surface elevation(s) ___,__ft (as referred to site plan benchmark)
Additional design/site consi rations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U= unsuitable for system ❑ S E U ® S0 U ❑ s ®u ❑ s 0 u ❑ s 0 u ❑ S K] I
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
- R.~.s- - s,/_ vFs rhaF Q
Ground y ~.S y~y 1~'S1'~3~ S:L l~S,~~fC I~,FlP
elev.
X!!~.~ft.
Depth to
limiting
r
in.
Remarks:
Boring #
3 3> > SYRy~ t~ F.~ ~ 3yy ~ Fsd~l rhFi?
Ground
elev.
Depth to
limiting
fagtor
17 in. Remarks:
CST Name (Please Print) Signature Telephone No.
ehn ~~s .?6fi- GG37
Address Date CST Number
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page T of
PARCEL I.D.# %
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
9 l -I3 IP~r V_-~ S•~ awser
13'.?o S/ CL .?h, U Y a W a
Ground 3 ).sYjfWV FM S _ S~`c ade ~ ~ -
elleyl
/033--ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
Ground
elev.
ft.
Depth to
limiting
factor
'n. Remarks:
Boring #
L
Ground
elev.
ft. ,
Depth to
limiting
factor
in. Remarks:
SBD-8330 (R. 07/96)
3Yo 4
5 yu ~yS 3YT31Mf14w
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Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
INSPECTION REPORT ST. CROIX
Safety and~uildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary289321
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
KLOSOWSKI, KURTIS CYLON
CST BM Elev.: Insp. BM Elev.: BM Description: / Parcel Tax No.:
. G Ali. l c~ 006-1078-60-000
TANK INFORMATION ELEVATION DATA 3 Ste' ","_-74.
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 25-an, Benchmark
Dosin t'""~'
'7 OX g 5~ > s!67
Aerati Bldg. Sewer OS '
H St/ Inlet
TANK SETBACK INFORMATION St/ Alt Outlet
Vent
TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet
Septic NA Dt Bottom 7s
Dosing NA Header/Man.
Aeration NA Dist. Pipe
Holding- Bot. System
PUMP /hIPOWNFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System
e a~ TDH Ft
Loss Dia. F~ Dist. To Well
Forcemai n Length
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length r , r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LE NG Manu ac
SETBACK
INFORMATION Type Of n CHAMBER tuber:
System: OR U.
DISTRIBUTION SYSTEM
.k4ee rolanifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _ L Dia. C;- Length Dia. Spacing b 3011
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.)
LOCATION: CYLON 34.31.16.5~2B,SW,NE 1863 235TH STREET , sc/7
I \I y ~ }e" ►4 e~L-G, L<~~, .x._% .fir t
7r o/!/,~JQj~321
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:
SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildiinWater Systems
ngWater 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. ~k
• 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
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Pro ertyOwnerNam Prope*rtY Location
1 05 1 g((~I/4 K G 1/4, S T N, R 1(0E (or
Property Owner's Mailingpddress Lot Number Block Number
City, State Zip Code Phone umber SubdivisiorL Name or CSM Number
1:5),94169140 t4
II. PE F BUILDING: (check one) ❑ State Owned ❑ !ty Nearest Road
❑
Village ` A .
Public 1 or 2 Family Dwellin - No. of bedrooms Town OF
~j 0,Q
) an
III. BUILDING E: (If building type is public, check all that apply) Parcel Tax Numbe ) p
1 ❑ Apartment/ Condo 0(~)(D - I (~1 0 " IWO
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. P Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
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
Re wired (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) Elevation
b 15 oo /V/14 Feet "-'Feet
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ~p~ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber -16O 5 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite age system shown on the attached plans.
Plumber's Name: (Print) Plum is Sign ure: (N St MP/ PRSW No.: Business Phone Number:
I 1 0. at, 11
- - 99
1V d I Z17
Plumber's ress (S et, City, State, Zip Co e): '
Z
IX. C UNTY /DEPARTMENT USE ONLY
❑ Disapproved Sani ary Permit Fee (includes Groundwater ate Issued Issuing A ent Sig !ure (No 5
*Approved E] Owner Given initial
Adverse Determination ~0/(~ Surcharge Fee)
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & RuilJings Division, 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 nevv 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 bya licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage systems 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; 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.
N
RESIDENTIAL MOUND DESIGN
INDEX AND TITLE SHEET
Project ~YBTEM
Owner ,12A
"Ad:&W
Address g 3 S 7-4 S
VED
Arr
Sys
DEPT. OF INDUS?, * M ~Tt
Imm
DIVISION OF Legal Description sw 1 IVZ--1 S.3 y T 31 yR i w
SEE R&M
Township _ County S-11 Cc.,t~
Subdivision Name Lot No. -
Parcel ID Number oo& - /0)?- LO - 00 0
Plan ID Number
INDEX SHEET PAGE ONE
MOUND CALCULATIONS PAGE TWO
MOUND DRAWINGS PAGE THREE
PRES. DIST. CALCS. & LATERALS PAGE FOUR
PUMP TANK DRAWINGS PAGE FIVE
PUMP SPECIFICATIONS PAGE SIX
SITE PLAN PAGE SEVEN
Designer License Number 75~SL
Signature Phone No. 0247. C G 1 7
Date 41- 279.7
R~EIVE
Notice: Tampering with this rile by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s.145.10, Wis. Slats. MAY
1 1997
tMS. OI
SBD-10462-E (N.05/96) Page 1 of 7 SAFEYVC 8
V.
C -20176
lip
~~jggg 4
RESIDENTIAL MOUND DESIGN
Eight Bedroom Maximum
Complete information in red framed boxes as necessary.
(y or n) n Is the s tem constructed over creviced bedrock?
Slope 3 %
Number of bedrooms 4
Wastewater flow rate bE 00 Uinl 2271 Lpd
Depth to limiting factor 50.8 cm
In situ soil infiltration rate (code) gpd 16.3 Llm2
Contour line below the upslope edge of absorption cell 103 ft x31.39 m
Use standard fill depths? n OR Designer speed depth 16 in 40.6 cm
Place X In box to use standard depths (12, 24, At4 indwave) OR specify design tilt depth.
Center or end manifold c (c ore) Estimated hole space 2.5 ft Not a final calculation.
Lateral spacing 5 ft Minimum dose 10 times void volume
Use a Q lateral spacing for trenches. Pump tank elevation 94 ft outside bottom.
Force main length 85 ft Force main diameter 2 in
Force main actual dia. 2.067 in
SYSTEM SOLUTIONS Inch-pounds Metric Cell media "x" one only.
Estimated daily flow 600 gpd 2271 Lpd x Aggregate and pipe
Chamber and pipe
Absorption cell
Design load rate & area 1.2 gpdm 500.0 ft2 46.45 m2
Linear load rate 12.0 gpd/ft 148.8 Lpd/m
Design width (A) 10 ft 3.05 m
Cell length (B) 50.0 ft 15.24 m
Depth of cell (F) 9.7 in 24.6 cm
Sand filter
Upslope fill depth (D) Zft? in 40.6 cm
Downslope fill depth (E) in 49.8 cm
Basal area required (gpd/infiltration rate) 139.35 m2
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.4 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 11.4 ft 3.47 m
Upslope toe length (J) 8.6 ft 2.62 m
Downslope toe length (1) 20.0 ft 6.10 m Includes basal adjustment
Total mound length (L) 72.8 ft 22.19 m
Total mound width (W) 38.6 ft 11.77 m
Project:
Plan I.D. Page 2 of 7
MOUND PLAN VIEW
observation pipes (typical)
T J
W_ 38.eft 10 A A= 10.0 ft 3.05m
11.81M B50 ft 15.24 m
g K J8.6ft 2.62m
1= 20.0 ft 6.1m
K= 11.4 ft 3.5 m
FF- L = 72.8 ft
22.2 m typ. obs. pipe
A X B refers to absorption cell width and length (anchored securely)
J = upslope width
1= downslope width
K = end slope dimension 18 6" (150 mm)
T
MOUND CROSS SECTION
subsoil cap D = 16.0 in 40.6 cm
lateral topsoil G H E = 19.6 in 49.8 cm
invert 104.8 ft F = 9.7 in 24.6 cm
elev. 31.94 m see note LF G = 12.0 in 30.4 cm
H = 18.0 in 45.6 cm
D E ASTM C33
Sand Fill
Sys. 104.3 ft
elev. 31.79 m 103.0 ft contour 3 %
31.39 m slope
Note: Absorption cell media will
D = upslope fill depth plowed layer consist of aggregate and pipe
E = downslope fill depth or leaching chambers and pipe
F = absorption cell depth as specified Aggregate
G = subsoil + topsoil depth at cell wall at right. MChamber
H = subsoil + topsoil depth at cell center
Designer notes:
If aggregate is used it is covered with code compliant material.
Project:
Plan I. D. Page 3 of 7
PRESSURE DISTRIBUTION CALCULATION:
Absorption cell Inch-pounds Metric
Width (A) 10 ft 3.05 m
Length (B) 50.0 ft 15.24 m
Lateral specifications
Number laterals 4
Holes/lateral 10 holes
Lateral length 23.8 ft 7.3 m
Perforation dia. 0.25 in 6.4 mn
Lat. dis. rate 11.65 gpm 0.7 Us
Sys. dis. rate 46.60 gpm 2.9 Us
Hole spacing 30 in 76.2 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1in/25 mm X p/a
`Xw one choice 1 1/4in132 mm x x bo.
from the options 1 1/2in/40 mm x dia
provided. 2in/50 mm x
3in/75 mm x
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in/25 mm
W" one choice 1 1 /4in/32 mm Pla
from the options 1 win/40 mm x bo;
provided. 2in/50 mm x X dia
3in/75 mm x
4in/100 mm x
LATERAL DIAGRAM - CENTER CONNECTII
Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagran
Force main connection 4ia too or cross to manifold a t any point
Laterals are identical typi Cal
P end cap
I~ X-- 1+a12 sf14; Laterals & force main of PVC Sch +0
Last hale drilled ne4t to end cap (per COMM Table 84.30-5)
Holes drilled on the bottom of the lateral, ~ . permar *nt end marker
equally spaced
Inch-pounds Metric
Lateral length (P) 23.8 ft 7.25 m
Lateral spacing (S) 5 ft 1.52 m
Hole spacing (X) 30.0 in 76.2 cm
Hole diameter 0.25 in 6.35 mn
Lateral diameter 1.25 in 32 mrt
Number of holes per pipe 10
Invert elevation of laterals 104.8 Ift 31.84 m
Project:
Plan I. D. Page 4 of
Total dynamic head
System head = 3.25 ft 0.99 m
Vertical lift = 9.80 ft 2.99 m Are laterals the highest point in the
Friction loss = 2.98 ft 0.91 m system? Yes W here. C~
Total dynamic head = 16.03 4.89 m If no, what is the highest elevation
Dose Volume downstream of pump?
Lateral void volume = 7.4 gal 28.0 L Force main drain
Minimum dose = 150.0 gal 567.8 L back to tank? ("x" one)
Drain back = 14.8 gal 56.0 L x Yes
Dose volume = 164.8 al 623.8 L No
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per COMM 83.20(3) WAC.
approved manhole cover
weather proof w/waming label and padlock
grade levels junction box
quick disconect grade levels
alternate
4" vent pipe electric as per NEC 300 and -EE- outlet
COMM 16.28 WAC location 18" (46 cm) min.
TAwaulof pump approved
chamber or outlet
combination joint
tank A 1/4" weep Grade levels
alarm on We as pump tank manhole -C min. above finished grade
pump on B neceaaary pump tank mom. =100 mm min above finished grade
vent = 12' min. above finished grade
pump 95.0 ft C vein = 300 mm min. above finished graft
off elev. 29.0 m
D
91
3 " 5 mm of bedding under tank and anchor tank as necessary 94.0 ft Pump tank elevation
28.7 m bottom of tank
Tank specifications: rHUFFCIUT Pu
mp tank &1 14 9aUn
Pump tank volume = 750 gal Capacities: Inches Gallons
A~ 426:.2 Pump manufacturer: OELLER B = 2 3" 3 q,q
Pump model number: I C =Xem 1*0 164.8
Project:
Plan I.D. Page 5 of 7
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Wkv*i )sin Safety of Commerce UJ TION
- t5lvittior7of S Safety and Buildings SOIL AND SITE EVAL
`BE rdau of integrated Services in accordance with s. ILHR 83.89, W Adm. Code Page of
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ,
Include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Plans* print all Information. G + ~O 7 d - tl
Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. is.o4 (1) (m)).
Property Owner -
Property Location '
Govt. Lot V., AJI:' 1/4,S Y T 3 / N,R /6 E (or)®
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
/8'G3 ,23sM s; ~ d ~
City State Zip Code Phone Number ❑ City ❑ lage ® Town NeareERoad
.
z
4 07 (7/s' )P • 94py ~ i
.2v&- nW
❑ New Construction Use: ❑ Residential / Number of bedrooms Addition ) existing building
® Replacement ❑ Public or commercial - Describe:
Code derived daily flow - gid Recommended design k ding rate f - bad, gpdfl 2 l'L trench, gpd*
Absorption area required Oo bed, ft2 c9o trench, ft2 Maximum design k din rate Z 2
9 _bed, 9P~ trench, 9PdM2
Recommended infiltration surface elevation(s) (as referred to site plan benchmark)
Additional design/site oonsi rations
Parent material Flog I plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ s 491.1 NS ❑ u ❑ s ,®u ❑ s u ❑ s M u El s Z u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Stru ure GPD/ft2
in. Munsell Qu. Sz. Cont. Color Texture Gr. S Sh. Consistence Boundary Roots
Bed Trench
TIC
Ground
elev.
k1~1 it.
Depth to
limiting
c~qr in.
7 Remarks:
Boring # 0/0 ?,Jwzl;A
3 37 ) sYI? / f f51 if 3/Y fs /~if'I?
Ground
elev.
Depth to
limiting
f
in. Remarks:
CST Name (Please Print) Signature Telephone No.
'eA i 7iS .?Y` 4C37
Address W ^ Date CST Number
3 %Z yd S 7- rft,,l S oc / --,)"7
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F -,PRGhERTYOWNM SOIL DESCRIPTION REPOT T page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture E vcture
lww~ In. Munsell Ou. Sz. Cont. Color Correistence 7M2
a sz. sh. 131-210 ~4rr 0 Ground r-3 0. ~Sy~PSI/S/ f.1F SC
k~Ole
ft. ,
Depth to
limiting
factor
.'LO In. 1EE I
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottles St cture
In. Munsell Ou. Sz. Cont. Color Texture Gr. ;z. Sh. Consistence Boundary Roots
Boring # Bed ; Trench
Ground
elev.
-t t.
Depth to
limiting
factor
in. Remarks:
Boring #
13
Ground
elev. '
ft. ,
Depth to
limiting
factor
in' Remarks:
SBD•8330 (R. 07/98)
r Pay
cs~-~, 30;4
Sw y y S 3 v T31 WX w'
4~y lw, Tw/
s
/03 0 ~
moo'
i
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X
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4 13/16 7 7/16
W w HEAD CAPACITY CURVE MODELS 137/139 L 6 1/8
4 MODELS 137/139 Ft. Meters Gal. Ltrs. 0
5 1.52 93 352 0 4 13/16
a 2510 3.05 79 299 _
° 15 4.57 64 242 0 o i
6 20
20 6.10 36 136 0 1 1/2" - 11 1/2 NPT
a 25 7.62 8 30
° 15-
4-- 137,139 30 9.14
0 10- Lock Valve: 26 ft.
z
5
I
13
0
U.S. GALLONS 10 20 30 40 50 60 70 9o 90 100 110
LITERS 90 160 240 320 400 I 4
0 FLOW PER MINUTE Sx373
009921
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Three phase pumps are available in 200/208V, 230V or 460V. • Variable level control switches are available for controlling single and three
• Electrical alternators, for duplex systems, are available and supplied with phase systems.
an alarm. • Double piggyback variable level float switches are available for variable
• Mechanical alternators, for duplex systems, are available with or without level long cycle controls.
alarm switches, • Over 130°F. (540C.) special quotation required.
• Combination starters are available for 3 phase pumps. • Refer to FM0806 for 2000 F. applications.
• Control alarm systems are available for 1 phase pumps.
137 Series - 47 lbs. 139 Series - 51 lbs. SELECTION GUIDE
Single Seal Control Selection Listings 1. Integral float operated 2 pole mechanical switch, no external control required.
Model Volts-Ph Mode Amps Simplex Duplex CSA UL 2. Single piggyback variable level float switch or double piggyback variable level
M137/139 115 1 Auto 10.7 1 or 1& 8 - Y Y
N1371139 115 1 Non 10.7 2 or -2 & 7 3 or 5 & 6 Y Y float switch. Refer to FM0447.
BN137 115 1 Auto 10.7 - Y Y 3. Mechanical alternator M-Pak 10-0072 or 10-0075. Refer to FM0495
D137/139 230 1 Auto 5.8 1 or 1 & 8 Y Y 4. Combination Starter. Refer to FM0514.
E137/139 230 1 Non 5.8 2 or 2& 7 3 or 5& 6 Y Y
H137/139 200.208 1 Auto 6.2 1 & a - Y N 5. See FM0712 for correct model of Electrical Alternator E-Pak.
1137/139 200.208 1 Non 6.2 2&7 3 or 5 & 6 Y N 6. Variable level control switch 10-0225 used as a control activator, specify duplex
J137/139 200.208 3 Non 2.6 2&4 3&4 or 5&6 Y Y (3) or (4) float system.
Ft 37/139 230 3 Non 2.6 2&4 3&4 or 5&6 Y Y
G137 460 3 Non 1.4 2&4 3&4 or 5&6 N N 7. Four(4) hole J-Pak, junction box, for watertight connection for hardwired simplex
G139 460 3 Non 1.4 2&4 3&4 or 5&6 N N operation, 10.0002.
No molded plug ''Single piggyback switch included. 8. Two (2) hole J-Pak, for Watertight hardwired Pconnection or splice, 10-0003.
Pumps must be operated in upright position.
CAUTION
Three phase units require a control switch to operate an external magnetic or combination starter. All installation of controls, protection devices and wiring should be done
by
For information on additional Zoeller products refer to catalog on Combination starter, FM0514; a qualified licensed electrician. All electrical and safety codes should be
Piggyback Variable Level Float Switches, FMO477:Electrical Alternator, FMO486;Mechanical Altema- followed including the most recent National Electric Code (NEC) and the
tor, FM0495; Alarm Package, FM0732; and Sump/Sewage Basins, FM0487. 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.
MAIL TO, P.O. BOX 16347
Louisville, KY 40256-0347 Manufacturers of..
Z SHIP TO: 3649 Cane Run Road
Louisville, KY 40211-1961 rLWIrY14!/ANF9 SNCE /9.79
® DUMP ~0 (502) 778-2731.1(800) 928-PUMP
FAX(502)774-3624
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• 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 _Lur
Location of property S 1L/ 1/4 Ali 1/4, Section T_JLN-RW
Township Mailing address f dp &
Address of site/b'l 3
~-~3,> .,at r p r
Subdivision name IvyNr Lot no.
Other homes on property? Yes r~ No
Previous owner of property
Total size of property f.a?;' ~~r,r t
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yl Yes No
Is this property being developed for (spec house)? Yes __j/ No
Volume - q70 and Page Number 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 i the of -ice of the County Register of
Deeds as Document No.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.
~ P-Aeef~_
Signat re of Applicant Co-Applicant
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ~~~r r s r' or✓.~o vas/ s I
MAILING ADDRESS -2 r- rf
PROPERTY ADDRESS / to . 3 S' f P
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE r 1, rn v r~~
PROPERTY LOCATION 51,1J 1/4, )V E 1/4, Section T 3 N-R Z4 _W
TOWN OF C71e n/ ST. CROIX COUNTY, WI
SUBDIVISION Aj c - LOT NUMBER
CERTIFIEDSURVEY 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 ex 'ration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
it _ DOCUMFNT NO.
WARRANTr PEED THIS i1'ACS R[it"to IOR RLCDRo, NO DATA '
t I STATE BAR OF WISCONSIN FORM e - t>=
- - _v^~ • 41D REGISTER'S QFR;E
AVCO FINANCIAL SERVICES, INC., SECAI~
A Wfecon'sin Co'rpo-ration, formerly USA Financial Services ` Wd1w !imw
ii
Sr 1392
conveys and warrviad to Kuti8 L. _KlOSC ,ski, And Christine A. I d 8:30 A. M
K10flowaki. husband.and.yi.fe, as marital. i
at.Irvivarahip..,~perty ow Rd D" I
:
i ~
i
the following described real estate in _St_..Croj~c- . - ~
State of Wisconsin: County,
! -
Tax Pa-. a No:...
A parcel of land described as follows: Starting at the
Northwest corner of SW , Sec. 34-T3,y-iit1611, thence South
along the centerline of the Township Road a distance of 258
feet to the point of beginning, thence Fast 290 feet, thence iI
South 58 feet, thence East 105 feet, thence south 100 feet,
thence West 395 feet to the centerline of the Township Road,
thence North 158 feet to the point of beginning.
~'RANb'f'E$
Q Aft
.I
.I
I I~
II
~I II
This .----.19--nOt......... homestead property.
Odt (is not) a
I~
Exception to warranties: Existing, hig1ways, ewmnents and ri&.ts of way of
record.
Dated this --19th t
day of
19.9
~VFO FIN,4aCI~L SERVICES,INC. ;
- --(SEAL) scoresln rporation
(SEAL)
~ Scott N. Grasmick
1.1-1- ......(SEAL)
(SEAL)
~i
ALTHRUTICATIOAi
ACSNOWLBDGa[ENT
Signature(s) STATE OF WISCONSIN 1
i
St. Croy
authenticated this ----•-••-•-----•----Colmty.
dally ot it P>asmaaUy came before ;1-9-
th' : t
11,t-Y of
.abvii
>pabed•.
IS
a Ct..
A- Yiscons n or
-
TITLE: MR31"It STATE ME OF WISCONSIN `
s
(If" -
authorised by 70606. Wis. 3tabJ i O
-
to use hxewna to be the person
THIf INSTRUMENT WAS for Ina nt nd ,ow.~ c -
DRAP"D MY l/ - _
I ..._.+'~CQr~y.d_ J~_ Estreen ~
i