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AS BUILT SANITARY SYSTEM REPORT
OWNER n 1)r/ ~'f1 S~Yv
ADDRESS 4
SUBDIVISION / CSM# j,✓; LOT #
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
2
ST~,)en ~ fdu~3y Vek
4zc/
K +~li1~
Y
INDICATE NORTH iRROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
• r
BENCHMARK:
~GL•,-z- ° j l
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: J;';,:W,, ,s,, 7.e_j_ ~ Liquid Capacity: lead
Setback from: Well 56 House ;7,d Other
Pump: Manufacturer (f-sukAC Model#. Size
Float seperation Gallons/cycle:
Alarm Location
SOIL AB'sORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. liner Soy. li
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: Z,°
PLUMBER ON JOB: -
LICENSE NUMBER:
INSPECTOR:T
3/93 : jt
1'li
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
zSafety and Buildings Division Count tT . CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarlm"il.:
Personal information you provice may be used for secondary purposes [Privacy L r, s.15.04 (1)(m)].
MgMfteaml~AD & LISA [Afjfy_QjjiIlage ❑ Town of: State Plan ID No.:
CST BM Elev Insp. BM Elev.: BM Description: Parcel Ty2W-:1283-60-000
TANK INFORMATION ELEVATION DATA A9700229
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing ~Lrvt .6~h ai psi (a jdc~
Aera ' Bldg. Sewer
Holding St/ot Inlet
TANK SETBACK INFORMATION SCiCHi Outlet
TANK TO P/ L WELL BLDG. Airi to ROAD Dt Inlet
Ar Intake
/5-r~~ ys
Septic v NA Dt Bottom
Dosing NA +4 q
et*der/Man. ~ Z 1 9c' ;
Aeration NA Dist. Piped
Holdi Bot. System
ie' S `
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Loss System_.,_
TDH Ft
H c
Forcemain 1 Length . S ' Dia. ; Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I
-ACHM
SYSTEM TO P/ L BLDG WELL LAKE / STREAM LE u acturer:
SETBACK
INFORMATION Type O n ,tt i~;„ ,CH IT R Mo a Num er:
System: ry ,r_
DISTRIBUTION SYSTEM
Header/ Mani old 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.l--~ XS
LOCATION: HUDSON 20.29.19,NW,NE 443 VIRTUE ROAD LOT 116
"
~ Ir'. / ~'i'= C/~~~.~ •i of r ~-F: l~~ .R t"' ~~:4
C71 JJ.
Plan revision re46ired? ❑ Yes ❑ No
Use other side for additional information. FF1 IJ
SB -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION safety and lWater Systems Water Sn
Bureau o of f Building ystems
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 1/2 x 11 inches in size. j TC t
• See reverse side for instructions for completing this application State Sanitary Permit Number
,R k c7-, d7 110&
The information you provide may be used by other government agency programs ❑ 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
cE a 41,m .ULd ti4~~ 1i4, S~jd TaQ . N, R ll E (or)9
Property Owner's Mailing Address Lot Number Block Number
Y! / r~I la
City, State Zip Code Phone Number Subdivision Name or CSM Number
E"asT
~✓r S.9rlo ( > w; A, &e_
II. TYPE OF BUILDING: (check one) ❑ State Owned ~j ~ !t~ Nearest Road
❑ Public 04 1 or 2 Family Dwelling - No. of bedrooms ✓ ❑ Town OF U Y u-~-
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) I
1 E] Apartment/ Condo 0° (Y 1-2 ~3r~~~`~' 1 l 3
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor R creational 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. 5LNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting 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
1 11 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
15-0 d . Feet ~ l Feet
VII. TANK Ca
in galloacitns Total # of Prefab. Site Fiber- Ex er_
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks Jid e S2"
Septic Tank or Holding Tank X C' /,o t ❑ ❑ ❑ ❑ ❑ bag_ Lift Pump Tank /Siphon Chamber x r6v Sd l ❑ ❑ ❑ ❑ ❑
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 Signature: (No Stamps) P PRSW No.: Business Phone Number:
!/1:ccm SG rc l - - l
Plumber's JAddress (Street, City, State, Zip Code): /
IX. OUNTY /DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee 0ndudesGroundwater Date Issue Issuing gent Sign ture (No ps)
Surcharge fee)
Approved ❑ Owner Given Initial ~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) 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 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:
i. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
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; well!,; 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.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Commerce
2226 Ruse Street
ApItt 25, t99?
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S97-40253 FEE RECEIVED: 180.00
AMERSTRONG, TAD
NW,NE,20,29,19W
TOWN OF HUDSON 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,
Dennis Sorenson ~C' '
Wastewater Specialist
Section of Private Sewage
(608) 785-9336
_Ile
SBD-7997 (R.11/96)
Page of 6
F S r SSA r9 ;1 ,
MOUND SYSTEM / z.i
RECEIVED = -FOR
APR 2 2 1997 A 2 BEDROOM RESIDENCE ,
SAFETY & BLDGS. DIV.
LOCATED IN THE N"31/4 OF THE NLF 1/4 OF SECTION ZO , T 2-9, N, R 19 W,
TOWN OF Sp1J , S~"• CIZrJUC COUNTY, WISCONSIN.
CLol- l1~ - W~~Ww 21~~66sT 1~>
INDEX
PAGE l 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
TRH F3r•A _ -LtiS~ -Pr~.~ s`muN G
4 ql v j TLzvE cz-,~3.
PREPARED BY
WEGEE~ER SO I L TEST I NG
AND. ~y►~°~„~a~
DES I cam S~RV I CE r
F.O. 301 74 421 K. KAIK ST.
RIM FILLS. VI W22 ARTHun L
RER
A : WfGE
Isp
715-4L.r-0165 H LSgWORTH,
~iSIGNE4
~NNK
JOB NO. Of
PLOT PLAN Page Z of (a
i
Scale 1"= y0 '
' I
- I
W ~T Z-oM~.
wez,~ ~o QE ~~c~ of 4}-ovsF ~ _ _
o
~o
ZO Or
4 Zd' ,
40 OF a-1
rt • ~
P\3 C F-m
` i V
i J
~ bo +vOT eon ~R~T oR J
\J\IYUVL3 `TVkjS MUSK
Z / ~ GE 5 STEM
SO'i1P' 11Y
Of
Z~• B.Z PR` O
t
Cori
tlp~NGS
p 81!
pEE~
pf S
D~VISwN
Gt
S E ~R(tE z
cow y p IN
y
NOTES:
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install.4" observation pipes with approved caps. ( Z required)
4.-Septic tank to be ),0,0\516S 0 gallon capacity manufactured by
+n vtz, 'i ASH ~ -r
5. Bench Mark Rr 1- - \oo. o' ow) 1_jM N I" ~owe_R_ PyL-@ _
BM~Z_ ff1_g3-$S Mi sE- Lcm S~'hkE
6. Divert surface water around system to.prevent- .ponding at the uphill side.
Page 30f
Approved Synthetic Covering
19sTN► c 33 Distribution erg
Medium Sand ` 40 2 5
Topsoil F Elev.
D -
3 E
b
S % Slope .
(Force Main Plowed
Trench of k1,2"-2,1k,2" From Pump Layer
Aggregate
Undisturbed D Ft.
Soii E \-I S Ft.
Cross Section Of A Mound System Using F 0•8 Ft.
I Trench For The Absorption Area G N•~ Ft.
A S Ft. H S Ft.
B -IS Ft.
I S Ft.
Linear Loading Rate= t GPD/LN FT J 8 Ft.
Design Loading Rate= 0,3 GPD/SQ FT K 10 Ft.
L CIS Ft.
-A Position of Force Main W 2.2) Ft.
L
J force'
- B K Mein-
A 4- -
w 2
Distribution Trench Of 2 2
Pipe Aggregate
I
Observation Pe~rmanen~Et SEWAGE SYS M
(aach g es na
. r securely) J
R0)rED
AND BUILDINGSISION of SpFEiY
Mound Using I Trench For Abs(q?N~ion Ar" FNCE
SEE GORRESPON~
page ll Of
r
Perforated Pipe Detail
0
End View S97 -40 2 5 3
)Perforated
End Cap.) 0\cPVC Pipe
Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q End Cap
I
- I
/ SYSTEM
~ PRIVATE SEWAGE PVC Force Main Conditionally
AppptONJED
Distribution
AND BUILDINGS
Pipe DIVISION W SO
Last Hole Should Be l
Next To End Cap
ONDENCE
SI ORRESP
Distribution Pipe Layout P 3'Y 5 Ft.
X 3 0 Inches
y -jj -Inches
Hole Diameter ley Inch
Lateral 1 Inch(es)
Manifold Inches
Force-Main Z Inches
# of holes/pipe
Invert Elevation of Laterals q$•1 Ft.
x 414. + .ICS- ~-~i A~'r
t~lX 1,►'t iia . x Z = 32,71c Q~n1
Place 1st hole from tee with succeeding holes at -aQ"intervals.
Last hole to be next to the end cap.
i
Combination Sept!c;.Tank and
PISMP CHAMBER CROSS SECTIOIJ ARID SPECIFICATIONS PAGE 'S .OF 6
r
,j
EuT CAS WEATHER PIIOOF
-V
Jl1uCT101J 90X 4-
4'C.I. VENT PIPC % APPROVED LOCKING
10' FROM ODOR, MAWHOLE COVER 1N11H
:iIWDOW OR FKESN WA(ZN1uG L14gEC.
ALP,,IUTAKE ce~aDuii
to
PROVIDE I
. IIJ LE T 7 AIRTIGHT SEAL I I I ~
_ I III
84~~5 A I I I APPROVED JOINTS
APPROVED JOINT I W C I. PIPE-itPvf-
w/c.i. PIPCOR Tank construction I 6 ASA ST M
PRIVATE S~
shall comply with e I al
ILHR <,3.15 and 83.20 Coll
I I W
C
LLEV. P123 FT. U Pi But is
`~IVISI
D OLIXTE
gPONDE C
t_TL 1 8 9 00
3" APPRWEI
RISER EXIT PERMITTED OIJLy IF TAUK MALIUFACTURCK HAS SUCH APPROVAL BE00i
SPECIFICATIOI.IS
SEPTIC f
DOSE M lbH1L3S"I~R1J `mss- T gT-
TAWK MANUFACTURER: ►J MDEK OF DOSES: 3 -q PER DAU
TANK SIZC : 1300 6 S 0 &ALLOWS DOSE VOLUME I
S-S• zA_zCTRO S~[STr~2S IuCLUDII146 BACKFLOW: GALLONS
ALARM MANUFACTURER:
MODEL NUMBER' l~I ~w CAPACITIES: A= ►uCHE5 or. 3b~ GALLONS
SWITCH TUPE: ~I"I`~ZCrUR'~ B= Z MCHE00K G( LLOU5
PUMP MANUFACTURER' GOU ` 11 S r- IWCHES OR GALLONS
3a-~ ~o
MODEL WUM9ER: T D= I`N,CppNES OR X10 GALLOWS 67
w'l ~ZL'fJ~Z- `.,MOTE: PUMP AWD ALAIIM~AR TO 5E
PE:
INSTALLED OW SEPARATE CIRCUITS
IAII D, CHARGE RATE GP - '
8.21
VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD_DISTRIBUTIOU PIPC.. FEET
t MIuIMUM WETWORK SUPPLY PRESSURE . ; . . . . . . . 2.50 FEET
-f• FEET OF FORCE MAIM X A•b FYofxFRICTIOU FACTOR-. b' 64 FEET
TOTAL OyUAMIC HEAD = 1 4 -FEET
DIAMETER
Pump chamber
1WERWAL DIMEN6t0wJ OF TAIJK: LENGTH=.-;WIDTH - 4LIQUID DEPTH
BOTTOM AREA 231= GAL/INCH
AS PER MANUFACTURER = ~`l:O GAL/INCH
Goulds
Submersible
Effluent Pump
3871 EP04
EP05
097 .40
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,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas-
components. tic cover with integral handle
• Homes Motor: Available for automatic and and float switch attachment
• Farms
• manual operation. Automatic
• EP04 Single phase: 0.4 HP points.
Heavy duty sump 115 or 230 V, 60 Hz 1550 models include Mechanical
• Water transfer Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with
automatic reset. preset at the factory. rated oil and water resistant.
.
• EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower
SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing
Pump: EP04 built in overload with ■ EP04 Impeller: Thermo- construction.
• Solids handling capability: automatic reset. plastic Semi-open design
3/4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SA Canadian Standards Association
• Total heads: up to 24 feet. with three prong grounding
• Discharge size: l'/i' NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "For "AC".)
rotary/ceramic-stationary, three prong grounding plug improved performance.
BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged.
• Temperature: thermoplastic design provides
104°F (400C) continuous superior strength and
140°F (600C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10-
• Capable of running
dry without damage to s 30
components.
Pump: EP05 $ - - .
• Solids handling capability: 25
0
i ;
3/4" maxmum. 7-
W
• Capacities: up to 60 GPM. x s zo
• Total heads: up to 31 feet.
• Discharge size: 1'h' NPT. z 5-
• Mechanical seal: carbon- 0 15
rotary/ceramic-stationary, Q 4
BUNA-Nelastomers. o tt.~l
• Temperature: 3 10
104OF (400C) continuous
140°F (600C) intermittent. 2-
5
1
0- g
00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m'/h
CAPACITY
01995 Goulds Pumps, Inc. Effective May, 1995
83871
.1AVisconsin,Department of Industry, SOIL AND SITE EVALUATION
Lpbor and Human Relations Page of j
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 s
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
i2= 3--O
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
G /r Y' . /J) Y 4 'T ati. trG f/ Govt. Lot 1/4 1/4,S Td 'N,R1,j,1gd E (or)~
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
® New Construction Use: ❑ Residential / Number of bedrooms ✓1 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate y bed, gpd/ft2 , -5 trench, gpd/ft2
Absorption area required bed, ft2 -Z trench, ft2 Maximum design loading rate `Y bed, gpd/ft2 m/ trench, gpd/ft2
Recommended infiltration surface elevation(s) 7. ft (as referred to site plan benchmark)
Additional design/site considerations - (z,_
Parent material Flood plain elevation, if applicable All 1*1 ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank i
U = unsuitable for system ❑ S ®U ®S ❑ U ❑ S O U ❑ S U ❑ S 0 ❑ S W U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground
elev.
ft. I
Depth to - -
limiting
factor - - 1
in.
Remarks:
Boring #
0--12 'G .7j, I r1~ ✓ F
Ground
elev.
ft. _
Depth to - - - c
limiting
aQ. r jy J'
"in. Remarks:
i "ST Name (Please Print) ;inn< 1 it Telephone No.
_ - _ - ~:L . ----------LAS _ b" ,Si ( ~
Address Date CST Number
PFOPERYY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots GepIft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed • Trench
Ground f iE Y l~7 r 1
elev.
2y ft.
Depth to -
limiting
factor, - - -
Remarks:
Boring #
Ground
elev. - - - - - -
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Structure GPD/ft2
Texture Consistence Boundary Roots
in. Munsell C1u. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
-
Ground
elev.
_-ft.
Depth to
limiting
factor _ ~...._...1.._.__......
----in. Remarks:
Boring #
- -
Ground
elev.
ft. •
Depth to -
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
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STC- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWN JUBUYER Tcc N1 L ~`s c ~ m
MAnMG ADDUss q 1 y, f L -e, C~ u cal SG l~ 1 y
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE IA as0 Yl V--) 5U o I co
PROPERTY LOCATION 114, 19, Section a T.~ a -N'R_L a
TOWN OF ckc'o ST. CROIX COUNTY, WI
SUBDIVISION t LOT NUMBER ~l (Q
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 road 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: C d v w 1`
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 $4016 11/93
60 39Gd dd9r LS SZ:PT L66Z/i0/L0
aTC - 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 issuahde. 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 I Gl C~ r'1. Ci 1 i S G M _ ki- rVAG- D ~L
Location of property 1/4 l/4, Section aLI) 2 _N-R_Z IL _W
Townshi UIC~So _ Mailingaddress kAk-l3 Vit- u e- P-d
14 U Ck 5, c, 1-5 LA I LP
Address of site yLI V 1 i4 u e✓ Rd • VAucjSC~ r~ lD ( 5q o ( ~p -
Subdivision name la- x5r 7- Lot no.
Other homes on property? Yes ✓ No 1 ~1
Previous owner of property i ( 'Ped u r-e yx Km 1 c:,`~m r-+ 1 b~
Total size of property ( . 15'0 0. cr
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes ✓ No
Volume /a?-I/- and Page Number 16-7 as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICA'T'ION 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. and that I (we) presently'
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant I-Applicant
l-I -Cf9
Date of Signature Date of Signature
ze add vd9f, 1-5 eZ:vi l66i/Z0/!0
o ~U
4 STATE BAR OF WISCONSIN FORIM i - 1482
SS IS41 WARRANTY DEED
DOCUMENT NO.
II DELTA CONSTRUCTION, INC. , ST. CROiX CTy, WI
This Deed, made between fte[dkreuol+
a Wisconsin corporation, aka Delta Construction
i'. Company APR 3 1991
Grantor, 11:30 A. ~I and TAD M. ARMSTRONG and LISA M. ARMSTRONG, husband .
and wife as survivorship marital property
Roghmf of Deed..
Grantee,
j
II Witnesseth, That the said Grantor, for a valuable consideraor.
St • Croix THIS SPACE RESERVED FOR RECORDING DATA
u conveys to Grantee the following described real estate in
County, State of Wisconsin: NAME AND RETURN ADDRESS
Tad M. Armstrong
Lisa M. Armstrong
441 Virtue Road
I; Hudson, Wisconsin 54016
it
I~
PARCEL IDENTIFICATION NUMBER
n
Lot 116, Willow Ridge East II in the Town of Hudson, St. Croix County,
j! Wisconsin.
!I
~M§FER
i
FEE
I, is not
This homestead property.
(NIK (is not)
r
l Togethcr with all and singular the hereditaments and appurtenances themunto belonging,
And Delta Construction. Inc. _
warrants that the title is good, indefeasible in fee simple and free and c .ear vfencumbrances except None
~I
~i
and will warrant and defend the same.
Dated this day of -April - 19 97
DELTA CON TRU ON, INC.
(SEAL) (SEAL)
BY: Vi g 1 Fedorenko, President
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) ,,~~tHUEupl~~9 State of Wisconsin,
St. Croix
Count}
authenticated this day of • Personally came before me this / at " day of
• April
19 9 7 . the above named
%rl;~ • ~_~v` Virgil Fedorenko
j' TITLE: MEMBER STATE BAR OF ' ✓ISCOI`W**~ ~•tte(
(if not,
authorized by 8706 Ob, Wis. Stars.) is me known to be the person who executed the foregoing
inla nt and acknowledge.i ie sagte.
THISINSTRUMENT WAS DRAFTED BY