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Wisconfln Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
299063
Permit Holder's Name: ❑ Cit ❑ Village'Ej Town of: State Plan ID No.:
SITTLOW, DAN HAN~MOND
CST BM El v.: Insp. BM Elev.: BM Description: Parcel Tax No.:
018-1023-20-000
TANK INFORMATION ELEVATION DATA A9700385 /p
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Sd
/ Aeration— Bldg. Sewer
II o~l Hol St/~o Inlet 47,711
TANK SETBACK INFORMATION St/A Outlet
Vnto
TANKTO P/L WELL BLDG. Aulntake ROAD Dt Inlet
Septic NA Dt Bottom Y3 ~7
Dosing NA Header / Man.
Aeration - NA Dist. Pipe
Holding Bot. System 9Y.
PUMP / ORMATION Iz^ Final Grade -
Manufacturer De and 35~'; 79
Model Number p716 j
TDH Liftl Friction System GQ~ TDH 9 Ft
H
LOSS
l
Length ' Dia. Dist. To Well
FForcemain
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. uid Depth
DIMENSIONS DIMEN I
SYSTEM TO P/L BLDG WELL LAKE/STREAM LE HI Manuacturer:
SETBACK HAMBER
INFORMATION Typeo Sd model Number:
System: X14 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 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: HAMMOND 11.29.17.172B,SE,SW 1950 CTY RD E
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. I F
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
,i
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
I'
( Visconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Department of Commerce Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. ix
• See reverse side for instructions for completing this application State Sanitary Permit Number
99900
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 INF RMATION
Property Owner Name Property Location
1. SQ ti4 S,k)1i4, S T rQCI , N, R E (or)&
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE ILDING: (check one) ❑ State Owned ❑ it~ Nearest Road
❑ VII age /
Public 1 or 2 Family Dwelling - No_ of bedrooms ~ Town OF 4'7
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 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. [W Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------System ________System_____________TankOnly______________ Existing System Exlstln~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 R 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
~d _T ? S__ % 9G. Feeti 7P, 3 Feet
VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank ❑ ❑ ❑ C3 ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans-
Plumber's Name: (Print) Plumber's Sig~ nature: o Stam PRSW No.: Business Phone Number:
~
Plumber's A( dress (Street, City, State, Alp Code):
-5 -c d 14 _JZ ~.J e IS
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sao-itary Permit Fee (Includes Groundwater Late sue Issuing Agent Signature (No Stamps)
XA roved `4Surcharge fee)
pp ❑ Owner Given Initial ~ 7~, ~
Adverse Determination 7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: I/ V
SBD-6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may 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, 608-266-3151.
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 online 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; F) 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.
I
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Commerce
July 8, 1997 2226 Rose Street
La Crosse WI 54603
BILL SCHUMAKER
1070 SCOTT RD
HUDSON WI 54016
RE: PLAN S97-40768 FEE RECEIVED: 180.00
SITTLOW, DAN
SW,SW,11,29,19W
TOWN OF HAMMOND 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,
n
G and M. wim
Ian Reviewer
Section of Private Sewage
(608) 785-9348
SBD-7997 (R.11/96)
RESIDENTIAL MOUND DESIGN
INDEX AND TITLE SHEET S97--40768
Project Dan Sittlow
Owner Same
Address 1950 County road E
Baldwin, WI 54002
Legal Description SW 114 of SW 1/4, S 11 T 29,N,,R 19 W
Township Hammond County St Croix
Subdivision Name 6.6 Acres Lot No.
Parcel ID Number C < - /Z7,1 3 c`
RECEIVED
Plan ID Number > f~ yG JUG _ 7 1997
V .S.
,P. O.. iQtt y INDEX SHEET PAGE ONE Sal
CQn v~~ MOUND CALCULATIONS PAGE TWO
ROC ~~E MOUND DRAWINGS S
0, RES. DS. ALCS. & LATERALS PAGE FOUR
QQ~NZ ~
RE400 0 UMP TANK DRAWINGS PAGE FIVE
PUMP SPECIFICATIONS PAGE SIX
SITE PLAN PAGE SEVEN
Designer License Number 1~f~G
Signature Phone No. c ~Tr ~l:Z 1
Date 04/14/97
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate mod iflcation will result In disciplinary action under s. 145.10, YVis. Slats.
SSE)-10482-E (N.05198) Page 1 of 7
y
ji,
RESIDENTIAL MOUND DESIGN
Eight Bedroom Maximum
Complete Infomatlon in red framed boxes as necessary.
(y or n) n Is the s tem constructed over creviced bedrock?
Slope 3.5 %
Number of bedrooms 3
Wastewater flow rate 450 gLpd
Depth to limiting factor 26 cm
In situ soil infiltration rate (code) 20.4 L/m~
Contour line below the upslo a edge of absorption cell X86.8 ft 29.5 m
Use standard fill depths? I~.J OR Designer speed depth 0 in ~cm
Plow X In box to an standard depths (!Z 24 Ai4 lndudw) OR specW des/gn flit depth.
Center or end manifold G (c or e) Estimated hole space 3 ft Not a final calaa:don.
Lateral spacing 0 ft Minimum dose 10 times void volume
Use a o lateral spedng for tr8nches. Pump tank elevation 80.3 ft outside bottom.
Force main length -2-3-0- 1 ft Force main diameter 2 in
Force main actual dia. 2.087 in
SYSTEM SOLUTIONS Inch-pounds Metric Cell media "x" one only.
Estimated daily flow 450 gpd 1703 Lpd E]q Aggregate and pipe
Chamber and pipe
Absorption cell
Design load rate $ area 1.2 901fe 375.0 ft2 34.84 m2
Linear load rate 6.0 gpd/ft 74.4 Lpd/m
Design width (A) 6 ft 1.52 m
Cell length (B) 75.0 ft 22.88 m
Depth of cell (F) 9.7 in 24.6 cm
Sand filter
Upslope fill depth (D) 12.0 in 30.5 cm
Downslope fill depth (E) 14.1 in 35.8 cm
Basal area required (gpd/infiltration rate) 900 ft, 83.61 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 (I) 10.2 ft 3.11 m
Upslope toe length (J) 7.6 ft 2.32 m
Downslope toe length (1) 10.0 ft 3.05 m
Total mound length (L) 95.4 ft 29.08 Im
Total mound width (W) 22.6 ft 6.89 m
Project: Dan Sittlow
Plan I. D. Page 2 of 7
MOUND PLAN VIEW
observation pipes (typical)
J
W= 22.6ft A A= 5.0 ft 1.52m
6.89 m - B = 75 ft 22.86 m
g K J= 7.6 ft 2.32m
I 1 = 10.0 ft 3.05 m
K = 10.2 ft 3.1 m
L= 95.4 ft
29.1 m ~ typ. obs. pipe
A X B refers to absorption cell width and length (anchored securely)
J = upslope width
I = downslope width
K = end slope dimension X64 (150 mm)
MOUND CROSS SECTION
subsoil cap D = 12.0 in 30.5 cm
lateral topsoil G E = 14.1 in 35.8 cm
invert 98.3 ft F = 9.7 in 24.6 cm
elev. 29.96 m see note F G = 12.0 in 30.4 cm
D E ASTM C33 H= Min 45.6 cm
Sys. 97.8 ft sand Fill
elev. 29.81 m 96.8 contour 3.5 %
29.50 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
Aggregate
F = absorption cell depth as specified FqChamber
G = subsoil + topsoil depth at cell wall at right. H = subsoil + topsoil depth at cell center
Designer notes:
If aggregate is used, it is covered with code compliant material.
Permananent markers to be installed at end of each lateral required
4" observation pipes to be installed with approved caps required
Septic tank will be t, Ccc-~ gallon capacity
Manufactured by Midwestern Precast
Surface water to diverted to prevent ponding on uphill side of mound
Project: Dan Sittlow
Plan I. D. Page 3 of 7
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 5 ft 1.52 m
Length (B) 75.0 ft 22.86 m
Lateral specifications
Number laterals 2
Holes/lateral 12 holes
Lateral length 36.4 ft 11.1 m
Perforation dia. 0.25 in 6.4 mm
Lat. dis. rate 13.98 gpm 0.9 Us
Sys. dis. rate 27.96 gpm 1.8 Us
Hole spacing 38 in 96.5 cm
Lateral diameter Pipe diameter Design options Design choice
Designer must 1In/25 mm Place X In red
W" one choice 1 114IW32 mm x x box of chosen
from the options 1 1i2int40 mm x diameter.
provided. 2W50 mm x
3In/75 mm X
Manifold diameter Pipe diameter Design options Design choke
Designer must 1kV25 mm
W" one choice 1 1/4in/32 mm None required.
from the options 1 v2in/40 mm No choice necessary.
provided. 21W50 mm x
131W75 mm I
4in/100 mm
LATERAL DIAGRAM - CENTER CONNECTION
Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area.
P I end cap y
+E- x-, 1E xr2 T 2i Laterals & farce main of PVC SA 40
Last hole *Mtd twat to end cap (per COMM Table 64.305)
Moles Wiled on the bottom of the lateral.
equaAy spiced • . permanent end market
Inch-pounds Metric
Lateral length (P) 36.4 ft 11.09 m
Lateral spacing (S) 0 ft 0.00 m
Hole spacing (X) 38.0 in 96.5 cm
Hole diameter 0.25 in 6.35 mm
Lateral diameter 1.25 in 32 mm
Number of holes per pipe 12
Invert elevation of laterals 98.3 Jft 29.86 m
Project: Dan Sittlow
Plan I.D. Page 4 of 7
Total dynamic head
System head = 3.26 ft 0.99 m
Vertical lift = 16.90 ft 5.15 m Are laterals the highest point in the
Friction toss = 3.13 It 0.95 m system? Yes "x" here.
Total dynamic head = 23.28 ft 7.10 m If no, what is the highest elevation
Dose Volume downstream of pump? C~
Lateral void volume = 5.7 gal 21.6 L Force main drain
Minimum dose = 112.5 gal 425.9 L back to tank? ("x" one)
Drain back = 40.1 gal 151.8 L x Yes
Dose volume = 152.6 al 577.7 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
iT weather proof w/waming label and padlock
grade levels junction box grade levels
quick disconect
aRernate
4" vent pipe electric as per NEC 300 and rE- outlet
COMM 16.28 WAC location 18"(46 cm) min.
ff'wall of pump Lam--- approved
chamber or outlet
combination ~I joint
tank A 1/4" weep Grade levels
alarm on hole as pump tank mmhole - 4' min. above rnWW grade
pump on B necessary pump tank man. -100 mm mka above f nWW grade
nt- tY min. above flnlalaed grade
pump 81.4 ft C ve vent ■ 300 mm min. above fkalebed grant
oft' elev. 24.8 m
D
3 " (75 mm of bedding under tank and anchor tank as necessary_ 80.3 ft Pump tank elevation
24.5 m bottom of tank
Tank specifications: Midwestern Precast
Pump tank = 18.75 gaUin
Pump tank volume = 750 gal Capacities: Inches Gallons
A= 19.9 372.4
Pump manufacturer. Gould _ B = 2 37.5
Pump model number: EP 05 C = 8.1 152.6
D = 10 187.5
Project: Dan Sittlow
Plan I.D. Page 5 of 7
PA&F (o -2
y 1 ~ ~
l i
3871 EP04
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
• Capable of running lubrication and efficient strength, and durability.
following uses: dry without damage to heat transfer. m Motor Cover: Thermoplas-
• Effluent systems components. tic cover with integral handle
• Homes Motor: Available for automatic and and float switch attachment
• Farms manual operation. Automatic
• Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical Points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and s Power Cable: Severe duty
• Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant.
automatic reset. m Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, heavy duty ball bearing
115 V, 60 Hz, 1550 RPM, FEATURES
Pump: EP04 built in overload with construction.
®EP04 Impeller: Thermo-
plastic Semi-open design
Solids handling capability automatic reset. AGENCY LISTING
3/4", maximum. • Power card: 10 foot v!ith pump out vanes for
•.Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP- canadranstandards Association
• Total heads: up to 24 feet. with three prong grounding m EP05 Impeller: Thermo-
• Discharge size: 11/2" NPT. plug. Optional 20 foot plastic enclosed design for (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with end in "F" or "AC".)
rotary/ceramic-stationary, three prong grounding plug improved performance.
BUNA-N elastomers. (standard on EP05). u Casing and Base: Rugged
• Temperature: thermoplastic design provides
104°F (400C) continuous superior strength and
140°F (60°C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10 1 r!
• Capable of running
dry without damage to 9 30 - ~-5GPM
components.
I i 2.5 Fl'
e
Pump: EP05
• Solids handling capability: 0 7 2 - 1~.
W
3/4" maximum.
• Capacities: up to 60 GPM.
• Total heads: up to 31 feet. s 2°
• Discharge size: 1'/2° NPT. Z
• Mechanical seal: carbon-
rotary/ceramic-stationary, 4 151
BUNA-N elastomers. o I - EPOS,
• Temperature: 3 10~. - - - - -
104°F(40°C)continuous EP04
CN~
140°F (60°C) intermittent. 2
i
1
0 00 - 110 20 30 40 50 GPM
0 2 4 6 8 10 12 ml/h
L
CAPACITY
v 1995 Goulds Pumps, Inc. Effective May, 1995
83871
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PLOT PLAN Scale Page of
BM1= -':r~r `-'"T;~1.c. "":i~'_ ~a.s•l'" ~L~Jr~ ~(nv fgcl~
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of SI!"C(
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All elevations shown ore existing ground elevations unless noted differently.
Setbacks to meet or exceed the hollowing,
from absortion cell
5'- lot line; 10'- water service, unihabited slab; 15'- habited slab, swimming pool
25' below grade foundation, habitable building, public water main, astern, 50'- well, resovoir, high water mark
from septic tank
2'- lot or property line, 5'- All structures, swimming pools, 10'- underground water supply system or cistern
25'- well, high water mark
5L; P -I I L TAa~,
fTiT', f' W •-FA4v- -750 EAL- Mtj>w-`,rte ,Z~CA57
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page I of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
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 ST 4
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
Qle'
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner . Property Location
Govt. Lot SSW 1145f,J 1/4,S J~ T2 Q N,R Q E (or)o
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
/ fs-e ca w G,,,CJ-es
City State Zip Code Phone Number
❑ City El Village ® Town Nearest Road
❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow 41S'Q- gpd Recommended design loading rate S bed, gpd/ft2i~trench, gpd/ft2
Absorption area required gibed, ft2 trench, ft 2 Maximum design loading rate bed, gpd/f12_. /__trench, gpd/ft2
Recommended infiltration surface elevation(s) finnompmu, q'7, Fa ft (as referred to site plan benchmark)
Additional design/sites considerations cov ?08,0
Parent material a w2'a'- Ski _ 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 U ®S ❑ U ❑ S Z u ❑ S [R U ❑ S ® U ❑ S Z U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/112
Texture Consistence Boundary Roots
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench`
O -l Y l D R 3/2 e S/ .2 )n a6K C s .2 YN . S to
,2 14'-If 7, ~ A `I' .va SCE hi *bk
e e and 3 g-yY 71 SY~ C 2 Gt 7 S Rs C 4 3~ db k Jmf~l
S U
9~~a ft.
Depth to
limiting
factor
'7
in.
Remarks:
Boring #
l --1s -e- s~- Avbk C- s m ,s .r
a9- -2s of ad -2.f
Ground
elev.
i
Depth to -
limiting
factor
in. Remarks:
CST Name (Please Print) Signature Telephone No.
w H4 ScA u ¢ !I'e- 3/ a
Address Date CST Number
70 S d dcfals.~~___ ply/!p ; 2a 7 440
PROPER Y OWNER S~ 7 1 .oe./ SOIL DESCRIPTION REPORT
Page 2 of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots QPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
l -/Y l4 R s.a S ,l 1 In abk Al l R Z)w ► s ~
a !3~ /d y? c/ a yn a 6 K rn E l? G s/ `l
:
Ground 3 G F a d 1a d 1a Fs- ! F9 rni, rk c .T
le
Depth to
limiting
factor
••in.
Remarks:
Boring #
i
Ground
elev.
I
ft. '
i
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to -
limiting
factor
'n. Remarks:
Boring #
Ground
elev.
ft. '
Depth to -
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
1
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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.
r
owner of property 'Zy-- ` ,L ( 01C / a-k- J v TI~IU~
Location of property fZ4W1/4 1/4 , Section L, T=y N-R_1 7 W
Township Mailing address SO
a~ 6dO I j 4L--1z 6- vU 2--
Address of site ~3 A--tU,6-
Subdivision name Lot no.
other homes on property? Yes__->S,_No
Previous owner of property
Total size of property f , (o A, C- V- C- -S
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 )w.-No
Volume --71,2 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 in the office of the County Register of
Deeds as Document No. d "Z ?!p , 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.
F:
Signature of p icant Co-Applicant
/-7- See 7:7 ~P -71
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ct,~ a Qu, _vw . P T'1"l o~
MAILING ADDRESS 0
0.-
PROPERTY ADDRESS
(location/of/septic system) Please obtain from the Planning Dept.
CITY/STATE G d t.J r +J ~iC, 1= Jam' q O O cZ-
5,,,~ 3 ash ~ ~ Svw 4
PROPERTY LOCATION A -D 5c--114, 5 wl/4, Section T a_N-R 7 W
TOWN OF 4-t v- %-o t/~J ST. CROIX COUNTY, WI
SUBDIVISION 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:
DATE: 17- S M - c7J
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
;Z
r 430779
Boot 792 PA!!55?
Ifin hWk*M, lf&* kit 26th d, , 4/' August 19 87 , Frderal Lar4 Bank
of 3t- Pw4 a carponslbet, wtanized eudr: the taws , y the united Stags, wW .
a post ojke address of 375 Jaekmon St . ,
_ . ftult N,= -
I
Mel Danniel D. Sittlow Ara uAase Pats o0km address 4 Route 2, Baldwin, WI 54002
&W; Wisconsin part Y of the second.
OMEMM. Thar the said party of the f ra part. for and m consideration of the stun of FOUrtY BouC Tlfoi " ld rVUAN
.0
To k Paid by the said part--Y-- of she second part. Me receipt whereof is hereby acknowledged. does Grant, same. &q and. Co nvy &me the
said pi.X-_ of At second part. His - heirs. successors and assigns forever. the
f61/owdng described rrral es9Anrte, std in she CoMfy
of - St. Croix
and &we of Nise-~omin
. 1s-tale:
The east 305 feet of the south 946 feet of the SEh SWh,
Section 11, T29N, R17W.
subject to all existing easements and rights of way; also subject to all razes on said premises for the year 19..81:1- and foAowing years; atw subject
to all unpaid parts and instdlmenu of special assessments on said Premises which have fallen due, or will jilt due hereof ter.
TOGETHER with all and singular the heredhamaas and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right.
elide, interest, ck m or demand whatsoever. of the said parry of the first part. either in law or equity, either in possession or expectancy of, in and to
At above bargained premises, and their heredhamenu and appurtenances.
TO HAVE AND TO HOLD the said premises as above described, with the hereditanents and appurtenances unto the said part*-- of the w-
cand part. and to---Hi& heirs, successors and assigns FOREVER.
AND THE SAID party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said cart- of
SAW second part. His heirs. successors and assigns, that the above bargained premises, in the quiet and peaceable possession of the said
Pan,Y-.- of She second pat. LU heirs. successors and assigns, against all and every person or persons lawfully claiming the whole or
any pan thereof, by, through or under said party of the first pan, and now other, it will forever WARRANT and DEFEND.
1N WITNESS WHEREOF, the said parry of the first pan, has caused these presents to be executed in its corporare name by its duly authorized
linters, and ifs corporate seal to be hereunto affixed the day and year first above written.
An Presence of. THE FEDERAL LAND BANK OF S41NT PAUL
Paul Moe, Regional Manger of the
M~ taw
Federal Land Bank Association of Northwest Wisconsin
Acting as Attorney-in fact for the Federal Lad Bank of Saint Paid
BAN. X44
. Q
3
' TS2 tic 55 Wisoosin
Co+wr of . Croix
M Jbrrgolwg on adbwwkdjwd b4om ew on Almat 26. 1987
ar►
by Paul !lOe, Raviar ` 1 ~anig~c y/ Ae FS&W Imew Mat ?
M.r xr
Northwest Wisconsin r be fast an bdaq~ f 7bs F so* 9f ~ lO~•i4 Q~.
by oawwrslow eg&u 5-19-91
• ~i~7,1F~ { w
Cam* Sam
JEAN M. LARSgy
swe of ► WdTMV Pmo
ss. STATE Of WLvmjM
C WY aJ ►
Af fomgokq kwwnm was oiabww&dged b4m me on
am
by err of At PMA@ dm Cm* Anadodm A
w bmw of Jwd mrpww as
yrC-Wd%siox aw
Oar." $we
Droned ay.
Joan Larson
P.O. BOX 199
River Falls, a 54022
u
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