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HomeMy WebLinkAbout008-1089-30-000 -0 0 v p ts> iri 0.p ~ I ~ I CD ~ I V a I ~i a a~'i 3 I v z a_0i c _ w U. -o c O U Q C i 3 co z ~ o L Z y IL m co U) c O Z 7 U W y U) F- ~ a I o Q Q ~ w I Z Z - N z I N C 7 O O CN V) L f6 0 y G1 CL m LO N d ' ? 2 O 0 0 a .0 O N U) (n c E > N _7 2 4. 0 0 0 N Z O IV R m m m a m a o y rn rn acoi to J U x rn rn } '0 00 r- \ a) O U N Cn O O ~ ~ N N CL O Q > 0 ~r O O O ~ ~ N C C 3 C C O ~.a O m N C. 00 7 O N N N N J p p cl CL 0. c V w N N N E E m a) N N L" r~ U t M ~ o N F- co v • > o N Co a~ 00 a E E cti O M W N O N In 0 ~ I .nor i', a= •m a • ~ a. m m y I E c c 3 c A U OL. O N U i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _j A IM e S PlG wPt h ADDRESSO ? 7 S°y q rj, rL 84 SUBDIVISION / CSM# LOT # SECTION ' T N-R /G W, Town of ,r6 a 4 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. . w BENCHMARK: )mat t V ALTERNATE BM: r`p d ~9S s h'~ WAj1 4T L SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~~d est~~ rt Liquid Capacity:,)00 > - 45-10 Setback from: Well House 17% Other Pump: Manufacturer It 2 Model# 3 Size Float seperation Gallons/cycle: Ig 3 Alarm Location ex X <-t l3co f SOIL ABSORPTION SYSTEM Width: Length 1 Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House sly / Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system GAS' Existing Grade Final grade Y , V DATE OF INSTALLATIOJ4: V ^'2 PLUMBER ON JOB: LICENSE NUMBER:./ ~ G L GJ~ INSPECTOR: 3/93:jt Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM County: tabor Human Relations INSPECTION REPORT ST. CROIX Safety fety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar284325 49 Permit Holder's Name: ❑ Cit ❑ Villa a Town of: State Plan ID No.: MERTH, JAMES/MERTH, DARREN E2 GALE CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel Tax No.. &1d~ 008-1089-30-000 TANK INFORMATION ELEVATION DATA A9700093 to a711~' (a~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~i 7 Benchmark O U3~ f. Dosing bi r_ wn S~ r Un^ 134,X1.2 n a / Aera ' Bldg. Sewer Holding St/Ht Inlet 7 Z,2' T SETBACK INFORMATION St/Ht Outlet TANK TO P/ L WELL BLDG. [Vent take ROAD Dt Inlet Septic 1 7f NA Dt Bottom 07 Dosing c15 / NA Header / Man. 7' F7 Aeratio NA Dist. Pipe 2 Z ~ ' Holding Bot. System 3s3 96, So PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 0-1 S me Model Number GPM TDH Lift,70S I Lrictior~ , System~_,,) TDH /~,Ot Forcemain Length,6}'. Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IMEN LuMa SET BACK SYSTEM TO P / L BLDG WELL LAKE /STREAM fa er: INFORMATION TypeO CHAMBER Model Num er:' System: OR UNIT, DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over TD.,epth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center d /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 0,7D re, 0.~%3' LOCATION: )~AU GALhE 31.. 22/8.16.472B, SE, SE BALDWWIN c;, C,~ 4.1,) C7 YlF-~ r2~ . t . c ' a„ , n sue, t 8p 4 3 ~ ;C e-C /i~ q~Z t ~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: Safety and Buildings Division 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 sl~ than 81/2 x 11 inches in size. ct to - • See reverse side for instructions for completing this application State Sanitary Per it Number ' The information you provide may be used by other government agency programs El Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location lv!e - /04rr•e*1 /naet ,56 1/4 S,6- 1/4,S _?I T .2Y ,N,R IG Aor) W Property Owner's Mailing Address Lot Number Block Number C State. Zip Code Phone Number Subdivision Name or CSM Number I a" . r 4/ tS -qov 2 ( ) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it( age Nearest Road ❑ l f ❑ Public Erl'or2 Family Dwellin g 3 Vi - No. of bedrooms Town of Gr,e-G StC~o.'y It~oud III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 F1 Apartment/ Condo 00? - 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 _ ,A New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an -----System --------System Tank OnlyExisting System Existing System 8) ❑ 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 L/5 Requiird (sq. ft.) Pro~o~(sq. ft.) (Gals/day/sq. ft.) (Min./inch) 10e S~ Elevation l 3 t S + ( ! + Feet `iP f-, S' Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic ANew Existin strutted g pp Tanks Tanks Septic Tank or Holding Tank /boo L I ~ )11 tG k. E t`~~vl ❑ ❑ ❑ 1:1 ❑ Lift Pump Tank /Siphon Chamber f/ 6 S V Lk E] I Ell El I 0_ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibilit for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum rs Signat e: Stamps) RSW No.: Business Phone Number: Plumber's Address (Street, Ci y, State, Zip Code), 4-0 6 (t/, /4 - 6G C/ 1/ G l(c° W+' S S~~CG `t=. r IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fe (Includes Groundwater ate Issue Issuing ent Signature (No amps AA/pproved R Owner Given Initial V,/Iurcharge Fee) I Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: -)-6398 (R. 05194) DISTRIBUTION: original to count y, One copy To: Safety & Buildings Divi.ion, Owner, Plumber 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, 608-266-3815- 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 a/l 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. Np"~90 SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin April 9, 1997 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 WEBSTER PLUMBING & ELECTRIC N3659 CTH C ELLSWORTH WI 54011 RE: PLAN S97-00632 FEE RECEIVED: 180.00 MERTH, JAMES SE, SE, 31, 28,16W TOWN OF EAU GALLE 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 lan ;nUmbe r s wn above. Si e ly, , PeterE. Page Plan Reviewer" Section of Private Sewage (608) 266-2889 1602R/ 1 SBD-5524 (H. 03M) Mound Plan for JAMES IVERTH N8754 450th (present address) Baldwin, Wisconsin 54002 State Plan ID * S97-00632 Tax Parcel * 008-1089-30 Located in the SE 1/4 of SE 1/4 section 31 T 28 N R 16 W Township of Eau Gale St. Croix County Page 1 Title r" Ci A,r° Page 2 Plot showing 5 acre parcel Page 3 Small area plot° Page 4 Cross section / plan views F Page 5 Distribution pipe detail Page 6 Septic tank / pump specification Page 7 Pump curve Page 8 Worksheet 's /BRUa Vqq N RECEIM APR 8 - 1997 SAFETY i BLUGS. 131V S97-00632 rll V r DRY RUN WATER RUN ~ rr~?D4T (at commencing at the SE corner of section 31 T 28 M P 16 W n0P '~0 S acre parcc( 412,5 feet E - W 528 feet N - fi woo dj WELL TO BR > 50 FEET FROM SYSTEM ~0C~Ns - State Plan I, D, a * # S97 - 00658 i i Tax # 008-1089-30 Soi( Boring and p(ot for mound for James Merth N8754 450th Batdwin Wisconsin 684-3584 lerce -C. roixc oa Ver-tide Bench Pa 3aF' Top of fence ~ r~► C~199~ P e posts with ribloons P 100-1 to td I'D R) e n CO F 1 /~y Wqutstltrnr,; SD A fT) ai.swo SWO i nnH WISCONSIN f AIF C.J -~1 0 4 1 Page I Of 8 t Straw, Marsh Hay, 'p~ _ Synthetic Covering' q(~,3 i~ Distribution Pi e Medium Sand Y ` 6" Topsoil H a G _ J t F ' 3 E " D r Slope R rLEN Bed Of -2 1~ 1 :a 1195 = 2 2 Force Main Plowed _ WORTH Aggregate `~scONSiN; ` Layer Air •.(611 Below Pipe) 1,0 Ft., Cross Section Of A Mound System Using E '~y Ft. y A Bed For The Absorption Area F 0.1 Ft. G 1.0 Ft. Signed:. A Ft. 'H_ Ft. F` B Ft. License Number: K 10 .S Ft. Date: ~✓'I 6_ L Ft. b J 8 Ft. I Ft. r y: Force Main W jr7 Ft. L t Observation Pipe yy ~o ---------------------~I -~,Disf ribution Bed Of i 2 i Pipe Aggregate Observation Pipe Permanent Markers r Plan View Of Mound Using A Bed For The Absorption Area t. j Page 5 Of 8 Distribution Pipe Detail For A Four Lateral Network 'Cap t Force Main P ~a ~G, jc~-rA PVC Distribution Pipe P Holes'Equally Spaced PVC Manifold Pipe On Bottom S ~X X J_ X 2 * Last Hole Should Be Next To End . Cap rY'' _ 23,r VO Ft• 3' s . ~vtd S_jFt e X Inches Y ~Z Inches Signed: Hole Diameter Inch License Number:h.,~'' 1i9 ' Lateral Diameter ' i- Inch(es) Date: IMNf"Manifold Diameter Inches N S co Force Main Diameter -2, Inches 7 s /Holes Per Pipe i Invert Elevation Of Laterals 17,0 Ft. } ~4 BSI G~~' o~ Page_fL_Of~ COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" 9 VCVent Pipe with ,Approved Locking Manhole Cover Approved Cap, +251 With Warning Label Attached From Buildings Warning Label Weatherproof Approved Junction Box Vent Cap 12 Mi n i mum Final; Grade 611 M t Minimum 6 Maximum ' 4 a PyC . ' 18" Minimum Insp. Pipe r k8I-C, ~ ovt Pw~P O f YlYltlpp/ ~ \a~ al~r t °4-may I ~ n" s - a ' ' A r K7sco MR Alarm On 6 C *APPROVED Off Q" JOINTS WITH APPROVED PIPE D 3' ONTO SOLID SOIL Conc. Block S 3, /S 3" of Beddinq Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: ~ Per Day Gallons Per Day/ Doses: II Gallons Tank Manufacturer: r1t► Dire- Volume of Backflow:..... Tank Size-Septic/Pump• ` Total Dose Volume:..••,•••= i3 Gallons Alarm Manufacturer: Ga 1 ons _L Gall ons Aodel Number: Switch Type: bCv MtrCVV-V Capacities: A~inches or 3 Of ?ump Manufacturer: Gallons M .DIV. + B inches or '.3z. Model Number: inches or Ions Minimum Discharge ate: gam,. a 3 + D inches or y Gallo Total.....= es or 6 n Gallons lertical Difference Between Pump Off and Distribution Pipe: 13 F , Minimum Required Supply Pressure:eet 1#0 Feet of Force Main x ~J_Friction. Factor/100•Feet: + ~.J Feet 2 Inch Diameter Force. Main t Total Dynamic Head:...=16.6 Feet Internal Tank Dimensions: Length WidthjLb Liquid Depth Signature License Number p'~ 5`0 Date ro l 1f Pa- 7 0Fg ME S ° eves 1/3 through 1-1/2 HP Effluent Pumps Performance Curve CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 400 450 100 90 2e eo MF/S 24 70 Q aC w MF/p W U- 60 O 2O z z Z W 50 MFRS _ 16 w H 40 M~SQ 16 O 12 O 30 20 MF33 e 10 4 I 0 0 1020 30 40 50 60 70 60 90 100 110 120 1,30 0 a~awurvrn►rurp,,1/1~ CAPACITY GALLONS PER MINUTE D-~ ~y 7 4 Parkway Ashland 419/289-1184 FAX 419/289-6658 T lex 98-7443 Ohio 44805-1923 K3327 8%92 Printed in U.S.A. tr, ~ aM tIONAL. WORKSHtET 6" ep~ Pd B l , g B o 1. MOUND SYS 1 Etr 1• Wastewater Lnad• T111A Daily Flow a It. IN-GKOUNO P".SSURE SYSTEM-Conhnued- Use s. ILIIR 83.15 fat' 10. l•Of(eMaln: Adm. Code and PROVIDE A DETAILED MmOnlum Dosing Rate a .22..& LIS I '0F SIZING ON PLANS. Diameter = ,t 2. Depth to Limiting Factor = 11. Total Qynamit Head: 3• Landslope = 2° 3 f t System head = 4. 'Distance from Dose Chamber to !G Vetttcal Lift = 2.5 70 r?.o.. Distribution System = friction loss S. Elevation Difference Between ft. TDII Pump and Distribution System ■ J3 ft 12, Pump Selection: r 6. Absorption Area Sizing: ' Pump will discharge at least 2 2 rS Area Required a at L• gpm ~7s -~_ft. total dynamic head, , t Bed or Trench Length (8) a 4 I' jee P ft ' Pump model and manufaceureft t. v Bed or Trench Width (A) ■ ft.* Trench Spacing (C) ft. 13, Dose volume: 7, Mound Height: ft' 10 Times Void Vko."me of Fill Depth (D) _ ~a Q Distribution Lines Fill Depth Downslope (E) ■ ft. g;. ft. Daily Wastewater + Bed or Trench Depth (F) ■ O, 4 Doses In 24 hrs. ■ Cap and Topsoil Depth (G) ft' Backffow g° .1 3 Cap and Topsoil Depth (H) - ft' Minimum Dose = ? g" 6. Mound Length: ft, 14, Dose Chamber: O gj, End Slope (K) _ 1 O Volume = Total Mound Length (L) _ s ft ' ga 9. Mound Width: 'ms's fl 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM Upslope Correction Factor ■ OAT, - I. Wastewater Load, Total Daily Flow a Upslope Width (1) a U ga Downslope Correction Factor =L tt se s. ZLHR 83.15 Adm. Code and PROVIDE DETAILED ft. Wis. Downslope Width (I) • LIST OF SIZING ON PLANS. Total Mound Width (W) . 2. Required Septic Tank Capacity ■ 10. Basal Area: sg'• fl 3. Percolation Rate a ga' Infiltrative Capaclty of 4. Absorption Area Siting: tni' Natural soil = 0.5- Refer tO Table 2 in ch. ILHR 83 Basal Area Required a W yD0 114.ft,/day and PROVIDE A DETAILED LIST OF Basal Area Available ■ 912 '4' h' SIZING ON PLANS. ' 11. If Standard Tables from Chapter sq. ft' Required Area are used, Indicate TabILHR le 83 Length = sq. 12. For the Distribution Network, Use Numbers 5•14 in Section It. Width = ft. Number of Trenches = ft. 11. IN-GROUND PRESSURE SYSTEM Trench Spacing a I• Depth to Limiting Factor S. Distribution System: ft. 2. Landslope ■ ft. Lateral Length ■ 3. Percolation Rate a % Number of Laterals = It' 4. Proposed System Elevation ■ min./In. Lateral Spacing = 5. Wastewater Load, Total Daily Flow: ft. Distance from Sidewall to Pips ■ in. Use s. ILHR 83. 15 (3) (c) , Wis. Sal' System Elevation a In, Adm. Code and PROVIDE A DETAILED ft. LIST OF SIZING ON 'PLANS. IV. SYSTEM-IN-FILL Required Septic Tank Capacity ■ Fill in All Items from Section Ill 6. Absorption Area Siting: Wf Percolation Rate ■ V. SEPTIC TANK Area Required - - min./in. L Capacity System Length a sq. ft. 2. Manufacturer: ff gal. System' Width = ft. 3. Show Site Constructed Tank Details 7. Distribution Pipe Siting: ft. on plan Hole siit VI. DOSING TANK Hu1c Spacing = in 6 2 14th 1. Capacity L.ttcrrl LengtA hiw 2 ~ s 2. M.lnufacturcr: P gal. Lrlrtrl Siir 11• .1, Pump ManufacturerJQ. 1..urtrl lpasinK in. 4. Pump Madcl: OisLutcr hnml lidrW•rll In I'ipc i11 S• Operrhme Hcrd= A, Ui~tnbultutt Pipe Di%Lh,l1 its. ham... It. JK Krlr: b. I low Rate. Number of Itulrs 1'rt 1'iltr Sl,~~s IPtO 7• Sho33itc CO struclcd Tank Details on?Ians pm. I luw Put Pilot : M069 F--- 069 tv/j( J0Pny7- - M.InilnldSiAng: L gilt", VII. 1101.DING LANK lytn (~enlet or entl) ~QitilTPif/- 1. Capacity = Length = 2. Malltllal lurer: at. Diameter = •4 I f. 3. Shnw SitrConstrut.ted Tank Details o 1#4 in. ans -SHOW ALL INFORMATION ON PLANS- OIt.HR sBO.61'61 fR,03fa2) • 8 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 YY1 e. 4_ Location of property__,~E l/4 _SE 1/4, Section 3 I T Z$ N-R W Township ) l Mailing address Address of situ?/~ ` e 34 P_ w.T O©Z Subdivision name Lot no. _ Other homes on property? Yes X No Previous owner of property ~O.r'-N eS Total size of property 0'C, _5 Total size of parcel ~ o~v'eS Date parcel was created S ~b P,.r Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes X No Volume 123 y and Page Number S__/9 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. I (we) certify that RallR statements on CERTIFICATION this form best of my (our) knowledge that I are true to the (we) m property described in this information form, by owner virtue oof ha warranty deed recorded in the office of the County Register of Deeds as Document No. S" 8 3 7,~_ , and that I (we) own the proposed site for the sewage disposal system orr Ie(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. S-E8376-- Signature of//Applicant Co-Applicant Zs - 77 Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1)U rrL v'\ J P1,e_v" 4- h MAILING ADDRESS N PROPERTY ADDRESS '2 ei( /i'e e c S C ec, r ~t a 4 (location of septic system) Please obtain from the Planning Dept. CITY/STATE _ 1 ( G1 w i r\ W T PROPERTY LOCATION 5 1/4, S 1/4, Section 3 T Z g N-R_!Y~W TOWN OF / a V (o ST. CROIX COUNTY, WI SUBDIVISION AJo - LOT NUMBER CERTIFIEDSURVEYMAP , VOLUME IL1 PAGE g, LOTNUMBER 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: 'J~ DATE: 7 ?_57 - 7Z St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 a8~~ STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED DOCUMENT NO. _ VOL 1234 PacE51$ REGISTER'S OFF! "T This Deed, made between ST, CROIX CTY., WI Wd la Mum APR 2 4 1991 ~/nL~ Ln and Grantor, 9:00 A. M y~ Register of Deed$ J tr ar e 7 T Grantee Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in THIS SPACE RESERVED FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN ADDRESS P A G o nl c- c~I rn e S ,f7 ~ r► Tai b 7- Tq 7-A -0 7-4 4 00 9- /6 F? PARCEL IDENTIFICATION NUMBER 31) This homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this 7-A F qq day of _ ! L .19-19-Z (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, IS s. 0. r v X County. authenriratori rhie a _r _ HEAD/CAPACITY CURVE EFFLUENT SL DEWATERING TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE w 3-55 10 SERIES 43 48 57.59 98 137-139 14014140 16114161 16314163 16514165 18514185 18614186 18814188 18914189 191 ' 1 42 135 IT, M. Gal. IAA Gal UM Gal. LirS Gal. Ura'. Gal Ltn'. Gal Urs' GaL LIM : Gal Lfrs Gal UUrs, Gal. Luc Gal. L3Cf.:. Gal. Ur'f:.'. Gal. Urt, Gal. Ltr% 40 5 1,52 16.5 62 28 1051 43 163 72 273'. 93 352 94 3561 100 379 61 231 61 '.231 58 220 145 549:9145 549:'. 45 170 f. 130 10 3.05. 13.2 LO_ 23 87. 34 1291 61 2311 79 299 90 341 93 352. 60.5 220 60.5 .229 58 2201 140 530 140 530.'. 45 470 38-125- 15 4.57 8.9 34 15 57 19 72 ' 45 170 64 242. 83 314 85 322 60 227 60 5 1229 58 220 135 511'. 1 35 51111 45 170 ' 120 20 6,10 2.5 9 3 11 : 25 98 11 36 136- 73 276.'. 78.5 297 59 123 60 227 58 220'.'. 128 484." 130 4945 45 170 35 t9t 25 11262 : 8 301'. 63 23Li 70 255 57 216 59 223 58 220'.122 46211125 473<. 45 170% 175 30 : 914 : 53 201 61.5233.'. 55 206 58 220 85 322 58 120 116 43911120 484 45 170 34 110 40 12.19 30 11445 170. 46 172 55 .'206 70 265 58 2201 103 3921:109 413. 45 1701'. 32105 50 15.Z4 20 76 33 .125 50 189 51 193 58 220 90 34f 7. 97 367 r. 45 170 60 18,24 15 57 39 1148 32 121. 58 22071 26985 322'.'. 45 170'. 100 30 70 21.34 22.5 165 9 34L 52 197' 51 193'.'. 69 261:4 45 1701' 95- 28- 80 24.36 10 138 45 170'. 28 1061: 51 19345 70` 90 90 27,43 30.5 1151'. 2 8 34 129 45 170 S 186, 26 g5 4186 100 30:48 16 60 ` 17 64 40 151 110 32.00 4 15'.'. 30 114: 2480 165, 120 36.58 4165 20 78 75 130 32,621 1 10 38 2 22 70 lock Valve 21.4 21' 19.25' 226' 46' 56' 66' 86.5' 73' 114' 91' 110' 137- 20- 65 WARNING: Model 185/4185 should notbe subjected to 18 60 I ess than 30 feet TDH. :611 63 1t~9,89 NOTE: For Head Capacity on Model 112, Industrial 16 55 column-explosion proofpump,seeFM0219. 50 14 45 009922 12 40 4 , 88, 35 414D 416 10- ,30- 137, 185, B 25 139 4185 6 20 v 4 0 5- 2 43 4 161, 57,59 98 4161 0 U.S. GALLONS 10 20 3D 40 50 60 70 80 90 100 110 120 130 140 150 160 LITERS 80 160 240 320 40D 480 560 640 0 FLOW PER MINUTE WARNING: Model 293/4293 should not be subjected to less than 15 feet TDH. SEWAGE & DEWATERING TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SERIES 2621264 266 267 268 27014270 282/4282 28414284 29214292 29314293 29414294 295/4295 40614405 75 FT. M, Gal 1-trs: Gal L1rs. Gal Lbs Gal. LM Gal Lirs Gal LOS Gal.. L". Gal LVs, Gal. Ll- Gal. LIM, Gal. Ltra Gal. LIr4:.~ 22 70 5 11,521 90 341 128 494: 128 484 128 484 132 $00 130 492 180681 133 $03 196 742 214:.810 361 1366 10 3`.05 60 227 89 037 89 337 89 11337 101_1!2 1 95 360: 1581588 116 439 .1:181 68$ 1991753 326 1234 20- 5- 15 4.57 225 85. 50 959 50 -089. 50189 77 241 63 238 135'.811 100 378 118 4471165 625 184'.696 28410T5. 18 0 20 6.16 10 38. 10 38: 10 38 56 212 33 125 106 401 83 332 108 4" 150 568: 168'.836 241 912.' 55 25 7.62 29 110 5 19 76 ?286 66 250 96 363 136 615 154 x663 197 7455. 16 30 .114 43 183 46 174 82 319. 121 458 140 $30 134 807 g 50 40 12.19 48 '.182'. 94 J55: 115 .439 14 45 50 1514 _ 58 220 89 832 i 12 40 60 18.29 13 49 59 223 35 70 21-14 26 : 87 10 Lock Valve: 18' 21.5' 21.5' 21.5' 29' 26' 35' 39' 50' 62' 75' 37.5' ° 3D T--7-7 I 293 8 , 25 4293 2824282 270, 6 20 4270 5 4 11 292, 10 26 4292 2 767,26 5 262,264 2847294 295.5 42a4 4294 295 44056 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300 310 320 330 340 350 360 370 380 390 400 410 LITERS 0 80 160 240 320 400 480 560 640 720 800 880 960 1040 t120 1200 128D 1360 1440 1520 FLOW PER MINUTE 009904 DOUBLE SEAL PUMPS (4000 SERIES ONLY) DOUBLE SEAL PUMPS WITH MOISTURE SENSORS (1) Pumps with moisture sensors have a separate 18 SOW-A 2 conductor sensor cord in addition to the power cord and the control cord on XE models. (2) Sensor cord conductors are connected to sensor probes in the lower seal cavity. The conductor wires are terminated in the control panel for activating an indicator light when moisture is present in the lower seal cavity. (3) When the moisture indicator light is activated, the lower seal has allowed leakage of water into the lower oil filled seal cavity. The pump should be serviced as soon as possible to avoid damage to the motor and bearings. (4) Oil in the motor housing and lower seal cavity must be changed when pump is serviced. If oil from the motor housing contains water or other contamination, both seals should be replaced during maintenance. Always replace with new factory recommended oil and service parts. All repairs must be made by Zoeller Authorized Service Stations. DOUBLE SEAL PUMPS WITHOUT MOISTURE SENSORS (1) Double seal pumps offer extra protection from damage caused by seal failure. Pumps are frequently installed without sensor probes. (2) Pumps without sensor probes should be serviced on a periodic preventative maintenance schedule. (3) Oil in the motor housing and lower seal cavity must be changed when pump is serviced. If oil from the motor housing contains water or other contamination, both seals should be replaced during maintenance. Always replace with new factory recommended oil and service parts. All repairs must be made by Zoeller Authorized Service Stations. SERVICE CHECK LIST WARNING: ELECTRICAL PRECAUTIONS- Before servicing a pump, always shut off the main power breaker and then unplug the pump - making sure you are not standing in water and wearing insulated protective sole shoes. Under flooded conditions, contact your local electric company or a qualified licensed electrician for disconnecting electrical service prior to pump removal. WARNING: Submersible pumps contain oils which becomes pressurized and hot under operating conditions - allow 2% hours after disconnecting before atfemp rng service. CONDITION COMMON CAUSES A. Pump will not start or run. Check fuse, low voltage, overload open, open or incorrect wiring, open switch, impeller or seal bound mechanically, defective capacitor or relay when used, motor or wiring shorted. Float assembly held down. Switch defective, damaged, or out of adjustment. B. Motor overheats and trips overload or blows fuse. Incorrect voltage, negative head (discharge open lower than normal) impeller or seal bound mechanically, defective capacitor or relay, motor shorted. C. Pump starts and stops too often. Float tight on rod, check valve stuck or none installed in long distance line, overload open, level switch(s) defective, sump pit too small. D. Pump will not shut off. Debris under float assembly, float or float rod bound by pit sides orother, switch defective, damaged or out of adjustment. E. Pump operates but delivers little or no water. Check strainer housing, discharge pipe, or if check valve is used vent hole must be open. Discharge head exceeds pump capacity. Low or incorrect voltage. Incorrect motor rotation. Capacitor defective. Incoming water containing air or causing air to enter pump. F. Drop in head and/or capacity after a period of use. Increased pipe friction, clogged line or check valve. Abrasive material and adverse chemicals could possibly deteriorate impeller and pump housing. Check line. Remove base and inspect. G. Pump seal sensor remains "on". Lower seal oil cavity contains moisture. Service pump and replace lower seal and oil in seal cavity. If moisture is present in motor housing, the upper seal and oil must be replaced. If the above check list does not uncover the problem, consult the factory - Do not attempt to service or otherwise disassemble pump. Service must be by Zoeller Authorized Service Stations. Wisconsin WWUpprtment of Indus W~nsinp Bela' ns SOIL AND SITE EVALUATION REPORT Pa Division f ty RUR"A Page of ® i n accord with ILHR 83.05, Wis. Adm. Code COUNTY Attac fete s' iat-fe, ' p plan oq~;er n s than 8 1/2 x 11 inches in size. Plan must include, but T ~ ~`O t not Ii to v I and' zontal r6' nce point (BM), direction and % of slope, scale or PARCEL I.D. # dimed coned, north 9rT locatjb d distance to nearest road. 1 . 2~ • 6 '47 Z ~ TT APPL~r~"T INF JE SE PRINT ALL INFORMATION REVIEWED BY 1 OD~_l o7-3O DATE PROPER r°^ PROPERTY LOCATION Oki t`' e tr'~• 1 GOVT. LOT 5 1/4 5 /4,SzT l-I PROPERTY OWNER':S MAILING ADDRESS ✓ N.R C (or LOT # BLOCK # SUBD. NAME OR GSM # CITY, ST T!~ ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE LNi h W 6t n h S'~CC2 (7i ~ ~ ~ El~.v MOWN N AREST ROAD A New Construction Use Residential/ Number of bedrooms .3 or Ll If, Wf l Addition to existing building j ] Replacement Public or commercial describe Code derived daily flow N 00 d gpd Recommended design loading rate bed, ft2 9P~ trench, gpd/ft2 Absorption area require37f" bed, ft2 trench, ft2 Maximum design loading rate 2 bed, gpd/ft trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations ~oun~ p r j . Parent material 1-0 05-e$ Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND ❑ U IPRESSURE AT- S D U SYSTEM FILL HOLDIN TANK U =Unsuitable fors stem ❑ S V1 sa-S ❑S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure in. Munsell Qu. Sz. Cont. Color Consistence Iftrifty Roots GPD/ft ~ o _6 Bed Trench 715yoz 3- o, S' 2 D.-.G Ground ~ 2'33 2 0 ~5 D- 6 ~f elev. 75-,8 it, vo `f p ft. 9 ~3 I )0%/ 1~ Pt c ` f 4,6 r Q d SY 6 6 s, 12 ask e, s~~ d .s 0,6 IDep to 7,5 YR 511 G factorg Jr6~ -8 2 t` R c p,5 6 Y R 6 618 M all( _ 0 6 Remarks: Boring # i Q 2 G-!2 ro rR 5/y l 1 2 bk 3 !2 a R JCL e s 2 O, s.d,6 Ground S 2 ` elev. 15--q- ft. Depth to 36-`~ to YR q 6 Fw►~ 5YRG 6 s~'I L 5 0", , l r^ 0,6 at tr factor 41-0 7,y YR 5-16 j R06 a k 6 621 10 rK UY tmd 7,, Wlg I ` Itri f Remarks: CST Name:-Please Print Phone: Address: Signature: Date CST Number: l l C577j? I Io t PROPERTY OWNER Yi%Q SOIL DESCRIPTION REPORT Pgge,? of PARCEL I.D. # Depth Dominant Color Mottles Structure G P D/ft Texture Consistence Boundary Roots Bed Trench Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ".'..y. 2 m-29 10 YR I 2 F a~~t m c s 2►~ p,r p,6 Ground 3 2~'3b I a S► T'Q~ rt C I 0, S 0 elev. E('i ft. 3~ 16 YR q ~6 f,; 5 t R F q~ In r c, s l 0,5- 5" T YR 5IC KF Y 16 r-, aL ~ - S Orb Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor -LL Remarks: Boring # Ground elev. ft. Depth to limiting factor - LL Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) } ' i f lrrr - - - DRY RUB! WATER RUN i j.r~tD FH t ti,vy~ r! I PE J' . f~~ +1t f~ im.3 r Fr r~ i l rr r' c. cornmencinq at the r`r v SE r d , • f~ ; r;,11 i ,y~° r_-,:. ~t~: r-, SrCtlc.n ! `8 fed R 16 W =r L- it Feei vv } 1 ~-j 5 acre pcz ;nom e l P ED WELL TO BR 50 FEET FROM SYSTEM T { = St_"t.- Flr_._n I, Il: +j r j - 00632 r' 1 L to f 1 ECrt''t-tL~ and ptot f 0r 'mound -For James Mer--tin N8754 450th i 684-3584 ifi=rrt e Fr.o!x ;~oa V e r t r F ef y .z - T trL- fence 1 0 99,81 IIJI r c, t,.Y'Y rfj~ l'l J~M1? _Lv I fr: s ,i 77 !E ~ J }.-may _ ~ 1 s--, s ts} i < <r' ~ r_-7 rT F7 -7~ i f ~ r;r i I t rTj I r,T)