HomeMy WebLinkAbout022-1089-50-200
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STC 104. I$
AS BUILT.SANITARY SYSTEM REPORT h
VEP
OWNER OCT 9
'~F33 sr~,~ UC1997
Sl t-~ ADDRESS
SUBDIVISION / CSM# LOT # N/~
SECTION 30 T Z 1! N-R W, Town of ~~~✓G!~/~~~'C~
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
T aT.rL - ~
OFF '4L/-5
S". z o
%0 Z,fGi icTjo,> Gas S
fD -fo/. 2 0/--
1.
O
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
7-,
ALTERNATE BM: ! ClC ewet elylp- 4S W~ - ~l~p • ~y
17-0 S~tx
SEPTTC- TA/N'K / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: l~~P Liquid Capacity:
OAl l
U pO Setback from: Well House 15 Other
Pump: Manufacturer 204516 Model# fs Size
Float seperation ~ Gallons/cycle:
Alarm Location 510 l ~
/ m 0 U-Aj
OIL ABSORPTION SYSTEM
Width: S Length d Number of trenches
:Distance & Direction to nearest prop. line: ~7,NS T-
Setback from: well: House 7 f50 Other
ELEVATIONS ,
Building Sewer 113.1o ST Inlet: /!A• 57 ST outlet: 30
4 PC inlet `0 PC bottom 161'OP Pump Off l r
.2 f
Header/Manifold 6D7 L10 Bottom of system 106-7-5
Existing Grade 10 5'1 5 Final grade
DATE OF INSTALLATION: d G~ • l 2 a oh d - Z Z C Rte! r~
;PLUMBER ON JOB: V d? Q~ I~ ~L~/t / •C ~l
LICENSE NUMBER: / /Aif ~3 0 l
INSPECTOR:
3/93:jt
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n
1 00
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UN
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8 0 3199 2 Y;_ 1 -7 1997
tv-A v 1 b
ST. CROIX COUNTY
5664,36 L Cco SURVEYOR'S RECORD
C~ 2
CERTIFIED SURVEY MAP
LOCATED IN THE SW 1/4 OF THE SE 1/4, SECTION 30, T28N, R18W, TOWN OF KINNICKINNIC, ST.
CROIX CO., WISCONSIN
OT BEARINGS ARE PREPARED FOR: RANDY CUDD
REFERENCED TO THE SOUTH
LINE OF THE SE 1/4.
(ASSUMED BEARING).
~I
NORTH QUARTER CORNER
SECTION 30 - FOUND
COUNTY MONUMENT PNPLATTE•D„LANDS
Opp,
i
68.30,
~ w / , g 8. E .646.
~ ~ w N73 I
' z w
N HIGHWAY SETBACK L I N
p c ° 66' y
of C'pp 1 N I O
O
N
° :z
Iw C el N :z
~ C. S. M. VOL. 8 0r. N :D
: PAGE 2277 ? rn :m
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as
:
p~ : FENCE .554.9I _l m - CA
N :O 26' I N78° 23I I N E LOT
870, 314 SQ. FT. rA
OR 19.98 ACRES ~ Z4
o X (848,834 SO. FT.
o ro OR 19.49 ACRES EXC. RIC
wA (T73, 86T SQ. FT.
(it
OR 17.77 ACRES EXC. RiW
AND EASEMENT 66.01
1320.34'
n` 1234.33' - -
g -
S89042' 00" W 1320.34' S89° 42' 00' W
SOUTH LINE OF THE SE 1 i4
SOUTH QUARTER CORNER UNPLATTED LANDS SOUTHEAST CORNER
SECTION 30 - FOUND SECTION 30 - FOUND
COUNTY MONUMENT COUNTY MONUMENT
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0 00
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OINNINOINNIN d0 NMOl - ZZO 86Lb'8 L'8Z'0E laoJed 'HIV
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Aise'f$hsin Department of Industry, PRIVATE SEWAGE SYSTEM County: yZS = 9
Labor a uman Relations
Safety and nd Buildings Division INSPECTION REPORT ST. CROIXc/1o5' O - ~e
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 289343
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
LARSON, SARA KINNICKINNIC
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /U ;
022-1089-50-000
,e0-f"/,CS / 3-3x7
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION B HI FS ELEV.
Septic .Sof° yt ~~Sz~, Benchmark eo
Dosing
Aerati Bldg. Sewer ql gL.' 3 '
Holding St/ W Inlet 5,36 //a. 57
TANK SETBACK INFORMATION St/ Fj14 Outlet
TANK TO P/ L WELL BLDG. Aenttake ROAD Dt Inlet .3
Septic NA Dt Bottom
Dosing NA / Man.
1
Aeratiorr- NA Dist. Pi
Holdin Bot. Sys - ' ,~•F~~/
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand JQ
Model Number GPM
TDH Lift Friction System TDH Ft
oss Head
Forcemain Length Dia. Dist. Towels
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia.
DIMENSIONS DI MINSID N
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAS
INFORMATION Type O CHAMBf Mode Number:
OR UNIT
System:
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: KINNICKINNIC 30.28.18.P479,SW,SE 929 QUARRY ROAD
4, 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:
I
I
I
I
i
I
I
^P,^ Safety and Buildings Division
e:~•~nr• 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, G~v' X
than 81/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
a~ 9 3~3
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)I- State PI.an I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 5'77- o/S3 ro,
Property Owner Name Propert Location 2,,
S,VA J. LA 9O~ ,5w 1/4r' 1/4, S 30 T2_9 'N, R JOE (orl~2
Prop rtyQwner's Mailing Address Lot Number Block Number
f o / -;1 • CURD AVE- ,r,/,q
City' State Z C de Phone Number Subdivision Name or CSM Number Q s? dti vf)~
,e, vtce >i*/S 41/- r 2.Zr ( 7(s) J12S •Zf1 ANT of 2_-~ 44S
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
Ano,
Public [or 2 Family Dwelling - No. of bedrooms Vowngof
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ~j
1 ❑ Apartment/ Condo f9 'Z
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 _ ew 2 ❑ Replacement 3. Replacement of 4. E] Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 found 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 6x 1'57'1,u Cr- ¢ R,N4 r I7 43 ❑ Vault Privy
14 ❑ System-In-Fill e_- 1n9 0- V l~
VI. ABSORPTION SYSTEM INFORMATION: ZS-
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
(P DO Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) /O(o 7s Elevation
Soo $0 O /.2- - T > Feet Feet
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank 200 1200 W ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 6yfl ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) PI mber's S gnature: (No Stamps) /MPRSW No.: Business Phone Number:
lzor3 g1e7' Z>%G/a2iG~T" 330 7 7/i 8G ' "S_
Plumber's Address (Street, City, State, Zip Code):
& SS o /v - l j9So-,) ~S
IX. COUNTY / DEPARTMENT USE ONLY
Fee) Fee) water ate Issue Issuing Age It Sign ture c, amps
❑ Disapproved San t ry Permit Fee (Includes Groundwater
Approved ❑ Owner Given Initial Adverse Determination~anj ~~~<!7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Ruildi rigs Dim.ion, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by 'a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed-
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7-
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber into 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; r) 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
201 E. Washington Avenue
P.O. Box 7969
Pisconsin Madison, Wisconsin 53707
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
May 22, 1997 201 East Washington Avenue
P. 0. Box 7969
Madison WI 53707
ULBRICHT & ASSOCIATES
ROBERT ULBRICHT
655 O'NEILL ROAD
HUDSON WI 54016
RE: PLAN S97-01536 FEE RECEIVED: 180.00
CUDD, RANDY / LARSON, DAVID
SW,SE,30,28,18W
TOWN OF KINNICKINNICK 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 pla number sho above.
i
Sinc e
Peter E. Pagel f
Plan Reviewer
Section of Private Sewage ORTINAL
(608) 266-2889 3083R/ 1
SBD-5524 (R.07/96)
ULBRICHT_ & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX
DILHR Plan I.D. # 597-01536 Date May 23, 1997
SELLER/OWNERS: Sara S. Larson & David Larson Phone 715-425-9102
BUYERS: Cudd's Mobile Court, Inc.
Address Randall P. Cudd & Yvonne R. Cudd
105 No. Cudd Ave. River Falls, Wis. 54022
Legal Description Tax. Parcel # 022-1089-50 Part of 29 acres.
Town of 1/4, SE 1/4, Sec.30, T28N, R18W County
-------I~~..nn-i-ck.i. nxi.~c------- ~ St. Croix
C.S.T. Robert Ulbricht CSTM 2482 Installer
Local Authority/ Supervision
St. Croix County Zoning Dept.
PROJECT DESCRIPTION
New development. A four bedroom sized home is being moved
onto the site by house movers. Estitiated daily wasteload -
600 gals.
Soils are fairly permiable in the upper hozizons, but
seasonaLLY saturated at 25" with permiability restrictions
(fine sandy soils banded with weakly cemented bands of SL).
Design loading rates are .4/ .5 GPD/ft2.
Proposed: a long narrow mound system using 12" sand fill.
CxS 5.,
se\N pwigVe
conditto
4
OA b H~ 1~~
oil Ulbricht & Associates
~~GE prh ats sewage Consultants
665 Rd.
54018
irE coRR~sp0 MAY , 1997 HucudO'Neil
S son, Wis.
SAFE IY ~ti. OS uIv.
Pg.l PLOT PLAN VIEWS -S -75 ~
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS
Pg,3 PIPE LATERAL LAYOUT
Pg.4 DOSING CHAMBER CROSS SECTION S97-0153 6
Pg.5 PUMP PERFORMANCE SPECS
a.~ W
r
. woo
20 d
xr, 1 c
a
A d
\ 0 ° °m
0 ~ \ ~ vim- \ ~ a 'J ~
\ \ mod'
Q J
~ o
nr~
zoo 5
Pposs SeC'T'0V of MOUAJD wi rt-4 BBD
peo ~F ro
1 A59Qc-SATE-
•DISTRi(3uT%okj
G , rti~ cka Fs s pip
OF r°P 5o(L s`1srEM
E IEVA 1-io~
i
i Fop M T•o E
r Rh-TiO-- Mao• • • 8 ~9
SAND
1 Fb JN
1 u k)
R
d % SIoPE FORCE'
~ 6'tEVATAoa uNVER.
Rep /0.x-.7:
.17 /-0 Fr• - Et_EVArio►J S
E, INVERT- OF IATERA(S /07.25
~ • ~Z F T • 57
-
• Top of R oCk !p 7.
G ~ a FT•
-I Fr, TOP °F _ IATERAIS 7. X0
FLAW VIEW vF MOUAJD LO r A 13ED
<✓vPcz MAiAJ A ~ FT.
I I f3 /00 F r
K /z Fr
FTI* - 4 - I T L. / 2'~ ~r
w 1 ---j • 1 FT
F r
3 0
°b w
Fr
I
Bee of To 1
Pur CADncn yn
V O/O t1dq%tiE X09 36- Fr o F Z PUC FoRei_ m A W
/ PIA CE /4s r Ao/E Perloraled Pipe Detail
&c ,Pi'6A r fee UAIVME
r-- vAcuii 1'oN 0
End View `
)Perforcled
End Cop ``o~\ ~I PVC Pipe
~a
Holes Located On Bottom.
Are Equally Spaced
-fob
\\\V~ PVC Force Main
P ~ ~•g3 mss.
Distribution
Pipe
Lost Hole Should Be
Nsxl To End Cap
End Cap Distribution Pipe Layout P y8 Ft.
I
• a.
X yY Inches
Y ti Inches
Hole Diameter Inch
Lateral Inch(es)
Manifold " r Inches
Force Main " Inches
# of holes/pipe /3
/,07 2 5
Invert Elevation of Laterals Ft.
-D 1*5 TRi13L) Vi 0&.-I 3)tScHR RGE RITE FOR E'Ac 14
t,aTER RL, o z~ z/ MI'A
1 1
PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS p,41E OF S_
VENT CAP
4"C.I. VENT PIPE APPROVED LOCKING
WEATHER, PROOF MAIJHOLE COVER
JUNCTION BOX
25 FROM DOOR W/ 4 ,4,f 11NCf IA13EI
, 12"MIN. -
WINDOW OR FRESH
AIR INTAKE
& („tTICAl GRADE ( 14LPAIIJ.
I
~ I ~ 18" MIN,
~d7 O COIJDUIT
~IEv~n ow ~ ~h
PROVIDE i
~b IIULET
1J AIRTIGHT SEAL I III
: r,7
y l pG I I I i APPROVED JOINTS
APPROVED JOINT A IN ~K I II W/C.I. PIPE
/C.I. PIPE tA ( I
LARM EXTENDING 3'
aXTENDING 3' '00 10 ONTO SOLID SOIL
ONTO SOLID SOIL B O0. I I
d / I ON
3Q I
c t
r~ 0
I- LEV.I~1 FT. 1 PUMP --J OFF
I 1
D I•'
N K .gt D01~ 6- I BLOCK
~cc tE v!1 f id,J
RISILR EXIT PERMITTED OIJL9 IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPECIFI'CA//!!TIOUS
DOSE WMBER OF DOSES: PER DAH
TAMKS MANUFACTURER: =Op
TANK SIZE: /0~ GALLONS DOSE VOLUME /o
-,GU.r~2. INCLUDING BACKFLOW: GALLONS
ALARM MANUFACTURER:
MODEL HUMBER: V CAPACITIES: A= INCHES OR yT GALLONS
SWITCH TYPE: /41or'Iewifty P/O*7 B = p2 INCHES OR GALLOWS
PUMP MANUFACTURER: G = d ' Z INCHES OR q0 GALLONS
MODEL NUMBER: T2' ~ypp D= INCHES OR I - GALLONS
SWITCH TYPE: P, Y,,Q ,ku< "~nG 7/o.,,+T_NOTE: PUMP AMD ALARM ARE TO BE
3.5 GPM INSTALLED ON SEPARATE 7C~IRCUITS.
MINIMUM DISCHARGE RATE ki SrECS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..S~ FEET -I'AN
MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET tcA6(A- P ttt
I FEET OF FORCE MAIN X y'y5 F/ooFT.FRICT1oN FACTOR..' /y FEET (~V~IS is
TOTAL 09VJAMIL HEAD = g =--L- FEET
r 3p~. ,
INTERAIAL DIME.IJSIONS OF TANK: LENGTH 1d ;WIDTH ;LIQUID DEPTH
HEAD CAPACITY CURVE 3 7 / e
i j/4
0
MODEL "88" 4 5/4
e
25
w ~ 9 I
3 5/6
6
20 -i
15
0 + +
1 3,
43/14
B
10
2 ` 1 I/2-I1 1/2 NPT
3
0
U.S. GALLONS 10 20 30 40 50
;LITERS 60 70 60
60 160 240
0 FLOW PER MINUTE
TOTAL DYNALW NEAWLOw Pali ptralTL
9MU NT AN0 01WATEIYNG '
CAPACI7Y
JIM •
UNITS/MIN 12
FEET METERS QALS L 1`145 v
a .1.52 72 278
10 3•05 at 271 A
15 x.57 45 170
20 11.10 25 95
• 3 5/16
Lock ValYe «J'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
s Electrical alternators, for duplex systems, are available and
supplied with an alarm. Mercury float switches are available for controlling single and
#..Mechanical alternators, for duplex systems, are available with or e Double h Ise aback mercury float switches are available for
without alarm swltche$. p 99Y
variable level long cycle controls.
Standard all models • Weight 38 lbs. - Vh H.P. 1• NltepralMoat operated 2 SELECTION OIUIOE
1. Single pole rrwhanlcai switch, no external control required.
98 Series Control Selec- tlc piggyback nwrcury hoar switch or double p7flY~k mercury, Ilow
Model V Ile-ph Mode • switch. Refer to FM0477.
Slm lex _ Du bx & Machu" alternatw 10.0072 or 10-0073.
M" 1 5 1 uto• 9.0 1 a 1 t - 4. Sea FM0712, for OOrrec) maclel of Eleculcal Akernator, "E-Pak".
Non
3. Mercury sensor float switch 10.0223 wed a{ s oonuol activator peclly
094 230 1 Auto 4.'1 1 or 1 i 7 duplex (0) w (4) Ibat system
SITE-# 2 = 13 o rroM of /3 /vF-yc-
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations e I
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County
A
Include, but not limited to: vertical and horizontal reference point (BM), direction and -5-77 j,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - t
Parcel I.D. APPLICANT INFORMATION - Please print all Information. Reviewed b -
Personal Information you provide may be used for secondary by
purposes (Privacy Law, s. 15.04 (1) (m)). X opF/r~r
Property Owner
Property Location
Govt. Lot W 1 /4 SE 1/4,S 30 T 2S
Property Owner's Mailing Address Lot lock# Subd. Name or CSM#
9$f /;5FiPN /?v• !4 lpvr of goo Mlt
City State Zip Code Phone Number [Er Nearest Road
f/voS,0~ !vi• 5'gpmo ('715 ) 3&- 81&7 ❑ City❑ Villa a LI Town Qv gRRY
L!'J New Construction Use: E!I esidential / Number of bedrooms 3 - Addition to existing building
❑ Replacement ❑ Public or commerbtal - Describe:
Code derived daily flow & 00 gpd Recommended design loading rate • 7 bed, gpdnt2 'trench, gpd/112
Absorption area required SOD bed, ft2 5'0 0 trench, ft2 Maximum design loading rate _bed, d/fl2
9P trench, gpd/tt2
Recommended infiltration surface elevation(s) StIm 3 D It (as referred to s)te plan benchmark)
Additional design/site considerations S / TE f7-AX 49- FO/Q At-041W,0 7Y~0,0- $1157-•
Parent material SG! /I/i(,g('/ U R/ Ac, C
Flood plain elevation, If applicable ft
S = Suitable for system Conventional ,M~o ind P
;;;11 -Ground,Prres~sure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S Ga'G 19'S El U ❑ S Li U ❑ s g< ❑ g [s-~ ❑ s [~.1f'
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles T Structure GPD/ft2
In. Munsell qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary , Roofir._
Bed , Trench
10/I My 3/ LS *1 dS Cs z : 7 'g
_/0 VP %/60 OF
Ground
elev. d
10 15 ft. yl? ~Y16
Depth to ~ANR>
limiting
3 IV factor O • s • J Tp / ,V
LJh In. CGS c TES GG /7
Remarks: STS
Boring #
a /o R /1/ 5 SL 2 sti S t✓ 3f- .5'
G
L7g z /0 3 SL CS :..57
3 - ~L- 26 She
114
Ground d JC IIE~i / ~5-
elev. /
X03
5L / ~R vf~'
ET --F2
Depth to S9: K
s
limiting /*/Z L&
factor
2In. Remarks:
CST Name (Please Print) V0eEQT A Q t Signature Telephone No.
l~ R • ~.~t-t' his= ,38&- gi8.s-
Address
Date CST Number
PROPERTY O~pt11E T~ SOIL DESCRIPTION REPORT
/ Page Z of
PARCEL I.D.# ~OD 4&e v 6w wqd- 14cl- lp4ae
Boring # Horizon Depth Dominant Color Mottles Structure 2
In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots
Gr. Sz. Sh. Bed , Trench
o- 10yR SL 2,M s~ S CS 3 s
.54
Ground /Q ~G 2 N C S
165-lift.
Z--2i 3141 elev. Depth to l~ V
limiting MY V14( 01 JACe ~ W-1 , / PD. ~
factor
In.
Remarks: S. w 'F f ~rO7~S
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottles Structure
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots G D/
Bed ;Trench
Boring #
s
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
}t.
Depth to
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
r
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S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER s GS~~
ADDRESS FIRE NUMBER
CITY/STATE_ ZIP
PROPERTY LOCkTION:y4r.)1/4,' 1/4, SECTION-2L, T_ R, W
TOWN OF ygw •✓V~~C St. Croix County,
SUBDIVISION N , 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 a 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 matter 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 Co. Zoning officer within
30 days of the three year expiration date.
SIGNED: r~
DATE : S// !3 6 Iq l
St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016
S T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property GSaA~)
Location of property 67&! 1/4 S1'- 1/4, Section T N-R W
Township Mailing address /G/ ~•.~4e ~Gr-2--
4~/. 5-44 2--~Z---
Address of site 410,1~rp/2 r Ad
Subdivision name Lot no.
other homes on property? Yes P---- No
Previous owner of property
Total size of property .Z-eF
Total size of parcel ~Z.,~ ,r¢Gtj S
Date parcel was created
Are all corners and lot lines identifiable? 1,- Yes No
Is this property being developed for (spec house)? Yes' ~No
Volume //4 7--and Page Number 2- 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 th office of the County Register of
Deeds as Document No. S 2 ? 13 / and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature o Applicant Do Applicant
Date of Signature Date of Signature
DOCUMENT NO. STATE BAR OF WISCONSIN FORK 8-Uft TMa "es ssam- yen VALCONOWIS DATA
at" CWM DEED
di.iaf;a i kit's
David 0. Larson . « -
Y 4'
goiirekinw to 813k....... _
..ti...,,.*„
..•..M a. ...,.....w .j ; --F R.
.s....' • ..«...M «.Y...~, • -
ass~twkwies dMerg" reiu estate it SLT.. ~ o f~bosl0ri ~.tu ; c~
Stss• of WfaeansinI S 4 YO~t ti „ w 4
A,
[ a 4 «41 _
f. _ax R~ r
tierptj;~ '
Sae attachtd shut for legal deiscr
:rp
(6110 dii4 Siven, Pursuant t@
A+:"mac ` .~k ~ • a°'~"'
a Jr~ h
a
_ A
a
Ila
..'w+i, $.".R•1,7A.a..+r...s.a.-.-c...«.At...rwYV+.++t-:}..a.r... ..a....•.Mryf1F~ ~ ~F4•~mr ':i`S
L J
TMs, UMBER STATS BAR OF *18CONSIIF
.
s . •etLss ei IqR ~ ~
y
" # 706.Ois his. SleAs.T.
y
.
s►tr~ iissr [ r WAa DRA"m w
The South Ralf of southeast Quarter (s 1/2 of SE 1/4) or $ftOttee ' ~
Thirty (30), except pare" Auarlb" as; Cownaing an 11orft Ii r a _
thereot 1229.0 feet hest of Rarth ast cosnsr°. tbereote-
S34 7on 94.0 feet otAterlihr o!' a TOM Roal an¢ Tact
Dsgi=ingt t Si4-7y0g 272.3; lath # 1175 22*2 MW 4-37* "a.2 feed, Mete or lasso to the v -mat"" 042 k
Tom Moodi thence westerly, oan saw oohtetline to p ► 1~ -
>Nginniag A", except dot I of rtilied Swr"v map in YalmNt t
Corti may INgpw paeie 22770 as doaumaltt nwAmm 44200T'
L Crai cam ;Wister c* ome t ottim on, October • Ii
located in tbo owtbwst to of the Southeast Quarter.
- ~ 30,. T~avnship aE 1Ao~rtil.F. Wit. td Most, T~ at 1ti~iWtiaei~.~ z
11u4 eacept the sow t Qasrtm of the soutbooet - (sit
at SE. 1/0 o! Soatie Tl tr... `r 10wa hlp
gal-
1Mote#i€~ _ Face r l gbbm a Was emompOC pal ia14 ~ -
t~oasndng: On, Morta 11ao lams.s Eeet I at as'
corer thesaof, th.nce 014 74W 111.51 foot to oastesliae of a
Roa~ and Place- of D~ljlaning j thencei $14 37#2 372,1 feetfL
1175 23111", feett t mme Mt. * 273.1 feeto, more ow ImW*. t y
couterline, of sate. Tom mad* tarn" Smaterly an said coutowl"tVMt.4
4
ft WO Of ftgiWAUV. An U* 111 Ra t " but Qoa~ ~Z
of 10 2l4 of Saotiou Thirty-' Oil#?tj 1 213 7ltetnsbi..
k.
(90) mortki Ran", Rigbted (
-
_Ji
.
.
~ .
VVIsconsin Department of Industry, SOIL AND SITE EVALUATION 3
Labor and Human Relations
Division of Safety and Buildings in accordance with S. ILHR 83.09, Wis.
wR~PENT o rrl v ~4v~ !~i-~PSov .
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 '5_77
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # s J +
APPLICANT INFORMATION - Please print all information. Reviewed by G
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
C=
Property Owner Property Location
Govt. Lot 5W 1/4 SE 1/4,S 30 T 2
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
f9f FE,PN ,2V • PV-r OF goo A(Ats / a-~33
City State Zip Code Phone Number Nearest Road
ffUpS°~ Sao/6 c ~lS 38(a• Sw~ ❑ City ❑ Villa e ErTown Qv,4RRY
2 'New Construction Use: Eg'lesidential / Number of bedrooms 3' il Addition to existing building
❑ Replacement ❑ Public or commerbial - Describe: l/
Code derived daily flow to 06 gpd Recommended design loading rate ' I bed, gpd/ft2 trench, gpd/ft2
Absorption area required X00 bed, ft2 5 00 trench, ft2
2 Maximum design loading rate • S bed, gpd/ft? ' ~ trench, gpd/112
Recommended Infiltration surface elevation(s) Stem 3 ft (as referred to site plan benchmark)
Additional design/site considerations 5_9t_ ti0 ~S & W .
p
Parent material -SGJ~' /Vi(y(~%,U R% ~•G~~ Flood plain elevation, if applicable Nl* ft
S = Suitable for system Conventional Mound in-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S IK ❑ S P-U El s Ls_f U' ❑ S gK ❑ S [s}~" ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure
g Texture Consistence Boundary Roots GPD/ft2
i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
/ o-ia ioYX 313 5i/, 2"W'%d e Asti Gs 3 f . s . ~
13 Z 110-4? /oyX 7/3 s// 2.6ie dX1 cs L f . S.
Ground • 2.5 /OYX & -f. S YIQ ~G L 70s~k ~~'I e5 /a f .2-: .3
elev.
-rj~ .att. s- /o `L 2 S N N
Depth to OE'l0 ET> ,ed~I G/~! $~D
limiting S ~/r~ REV /dJ D~l~~•l/~ ~ ~ ~ ,
factor
I?-- In.
;
JOSS Remarks:
Boring #
0-7 X00 z/z. v%L 2,4„ sh d54 cs 3 f . S
Z Z ' l /O 3/2- 511- 2` s b& ds4 CS ail-' • S ; • <o
21 3 io YYe 2 /W /7C
. s . G
Ground Y_: 5 A Y9 , l0 7•5 Y/e M( CL .i►, -5
elev.
SG •J- -n S s - io X s A.4 IL c L Sole Lv ;,v
Depth to
limiting f'1P.4 ~1ru - /,t.9 L GE- j~ /O -.1611
factor
24_in. Remarks:
CST Name (Please Print) ~i)D~QT •ULdRSignature Telephone No.
ll~~ 1~ I -7/37- 38& - ails-
5-Address Date CST Numhar
PROPERTY,QiII►fvR__ /Mt-Vie SOIL DESCRIPTION REPORT page Z~ of
PARCEL I.D.# ear D/-- le-) -4"5' O 46'-416P Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Mft2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3 / o-g A0 3/3 511- ?_,Wfhk _d SA C5 3 f . S ; . C,,
L Si )f5h,< d Z f . 57'.6
41A J. a Ground 3 Z O L Z 4"-
elev. 1W -
¢G oo~
f 51 4IL-ft.
Depth to
limiting
factor
,
in.
~Sf Remarks:
Boring #
Ground
elev.
n.
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.
tt. '
Depth to
limiting ;
factor
in. Remarks:
Boring #
Ground
elev.
tt.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
13 GV f Gi.vE
/ I `PRo/~os~v ~
I ~Tv~1 E S ~TE~
Sd yS~srEo
~o,v r~v,~ ~ • -vim.
L-3 9(~.ZS
\3.o \ 9o
~o
sc,4cE 38
sv~SEST~I~ sysi
5,4,QV -rdl ~t -7, 7S
Zvi God vAjei a,,(ec
411: S-S~Z7
-F~~-
~ oRN ER
wc~ati ~
r '
0 ~
V
G
e pC~ p 3199 T - 7 1997
~•~~EENH.wa~
Gco~~ ST. CROIX COUNTY
566436 L SURVEYOR'S RECORD
CERTIFIED SURVEY MAP
LOCATED IN THE SW 1/4 OF THE SE 1/4, SECTION 30, T28N, R18W, TOWN OF KINNICKINNIC, ST.
CROIX CO., WISCONSIN
OT BEARINGS ARE PREPARED FOR: RANDY CUDD
REFERENCED TO THE SOUTH
LINE OF THE SE 1/4.
(ASSUMED BEARING)
NORTH QUARTER CORNER w
SECTION 30 - FOUND UNPLATTED„LANDS
COUNTY MONUMENT
I Qv aRR~• ' ~ _
i 68.30'
646, gg'
I mow/ i N73° 62 3
w •I i z
Zi $ HIGHWAY SETBACK L IN
O 66 N
OI~ ~ N I O
Wp1 W p rn O ° •Z
NIA 50 C. S. M. VOL. 8 o f NI :n
;n PAGE 2277 :m
:n N I z a+ ml lo y :v
~rn co D
I '
Z
w ~v
<
: :-:o FENCE 854-91
n
N78 ° 23' 11 E LOT I m
:.1 I 870, 314 SQ. FT.
" OR 19.98 ACRES ~ -4
z x (848,834 SQ. FT.
OR 19.49 ACRES EXC. R/W)
° ro ( 773, 867 SQ. FT.
~ OR 17.77 ACRES EXC. R1W
w co AND EASEMENT 66.01 1320.34'
1254.33'
S89° 42' 00" W 132o.34' S89° 42' 00" W
SOUTH L 1 NE- OF THE SE 114
SOUTH QUARTER CORNER UNPLATTED LANDS SOUTHEAST CORNER
SECTION 30 - FOUND SECTION 30 - FOUND
COUNTY MONUMENT COUNTY MONUMENT
_.m®09010QO~~~a`