HomeMy WebLinkAbout034-1015-80-000
STC - 10 4
AS BUILT SANITARY SYSTEM REPORT
OWNER HO r✓rr q
ADDRESS 0'2 G 2 c S t
n h., d S SW 4l to l
SUBDIVISION / CSM#q LOT #
SECTION T I N-R W, Town of Yn ? 4,
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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V X4e,
X600
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INDICATE _ . NO.KTH_ ARROW .
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
Y
BENCHMARK: ~Ge o r r G,~ S c l C
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: /Y1, p~G,~cStG~ t7 Liquid Capacity:
Setback from: Well )7U House J 3 Other
Pump: Manufacturer,?,.
e /t Model# Size
Float seperation C/ Gallons/cycle: 153
Alarm Location .r~ 13o yC l~ y f" a t°t
SOIL ABSORPTION SYSTEM
Width: Lj Length 1_j -Number of trenches 2
Distance & Direction to nearest prop. line: /yu
Setback from: well: a House 1'30 ' Other
ELEVATIONS
Ile
Building Sewer j-~,
ST Inlet: ST outlet:
PC inlet PC bottom ~ Pump Off qL9
Header/Manifold Bottom of system U4,
Existing Grade Final grade J 2-,
DATE OF INSTALLATION: 7
PLUMBER ON JOB:
LICENSE NUMBER: MOO 6G c G
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor andHuman Reis INSPECTION REPORT ST. CROIX
Safety and Buildings Div Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 289359
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
GRAHAM, HOWARD SPRINGFIELD
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
034-1015-80-000
TANK INFORMATION ELEVATION DATA A9700174
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark a, OS JdL, C✓_),
Dosing
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto _ Air ROAD Dt Inlet
Intake'
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
Loss Head
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of CHAMBER Model Number:
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
34< ,
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
1 Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
l~ Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SPRINGFIELD 07.29.15.1,09,NE,SE 1026 280TH ST,.,,
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 , ab
than 8112 x 11 inches in size. _04- d
• See reverse side for instructions for completing this application State Sanitary Permit Number
3S
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
P9p rt y Owner Name rope?,L Location
r (fo i✓ d a A h 4 lY~-t/4 1/4, S? T 2 N, R E (or) W
Property Owner's MaiIin~ Address Lot Number Block Number
162.(o 2 PG c-
Cit,y, State Zip Code Phone Number Subdivision Name or CSM Number
G/en k/o v C( 6I~ 4-41,013 1514f?2PZ2
II. TYPE F BUILD G: (check one) ❑ State Owned ❑ Clty Nearest Road
E] Public or2 Family Dwelling - No. of bedrooms W rowan OF -S,p
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. to Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5, ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Jl 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
t l 3-24, 3?(e loo, ? Feet 102.? Feet
VII. TANK Ca
Exper
in galloacits Total # of Pretab. Site Fiber- Plastic
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
T nks Tanks
Septic Tank or Holding Tank 1060 t lam" ot K/ 25"6 C r ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber S'U 1 L t ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility r install o of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Signa Stamps) PRSW No.: Business Phone Number:
e -t c,
J - S r
Plumber's Address ( treet, Cit ate, Zip Code):
~Z G ti, ~ G c.. ~ l? L-J6 G ~ V -Z. ~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitar Permit Fee pncludesGroundwater ate Issued Issuing Agent Signature (No Stampsf
Approved ❑ Surcharge Fee)
Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SHD-6398 (R. 05/94) DISTRIBUTION: Original to County. 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 all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks;distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater:
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
' I SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations p it
May 30, 1996 2226 Rose Str..
La Crosse W 4603Rf CEIVEO
co j to N 4 X056
sr c~o;x
WEGERER SOIL TESTING COUPr ,
421 N MAIN STREET ZONt
PO BOX 74 9
RIVER FALLS WI 54022 l5
RE: PLAN S96-40472 FEE RECEIVED: 180.00
GRAHAM, HOWARD
NE,SE,7,29,15W
TOWN OF SPRINGFIELD 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 ILHR 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 ILHR 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
Wastewater Specialist.
Section of Private Sewage
(608) 785-9336
SUDA-7887(8. 10/84)
' l
Page of 6
MOUND SYSTEM S96-40472
FOR
A 3 BEDROOM RESIDENCE
LOCATED IN THE N~ 1/4 OF THE SE 1/4 OF SECTION -7 ,T19 N, R IS W,
TOWN OF Sp~1N G F=t E'L)~ ! fir, C,\Z-olX COUNTY, WISCONSIN.
INDEX
PAGE !'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
ows~2b Gtz~~+~~ RECEIV
-Z.a0 `nn- sr. ED
6 L QN W36b e-ttY, i 01 su X13 MAY 2 3 1996
SAFV y RLMS. Div.
PPRE'PAIM BY
W EC E E::ZEFR SQ I TEST I N C
Fl3
~~~eC~sea6cA ~i
DES = Gtr! S~RV = CE ••~r •..•..•.,`~t
All
F.O. BOX 74 421 N. MIK ST.
RIV9. FA-LS. VI 54022 ApTNIR FL{
ar weer.!:
- Y
715-52`.x-016 i _ ~i G sW F:o PT,.
wfs
l
®**4,d MA4S I ~d ;
G
S-[S
JOB NO. 01 - Z l~ 3
PLOT PLAN Page Z- of b
Scale 1"= L-Jo '
S90-40472
~/N ` 'N b~\3\v ~PRc'T' oR J
•~0~. 8.3
~SSof z.`PvC
~ g
^ S
L-L q~ 3 CL98 s l0 of alt V-UC
NA-% SF 300 ~ 9
moo= -ww~ X96®40.
A ti`Z R~~ 19'l..L. mac.\sT)nlG S_ _ .n
ftsfT~o>v ~m ftS PER czt5 E'.
Ve _
- - ~ N
1~.'M - ~L~, lOu.v' o►v ~4o~D \'~'C°"~~o~,~ ~s. .~I y ;~1J
nally
Conditio
APPROVED
p~ 0110 SAFETY AND BUILDINGS
t,
C O RRESPONDFN OF~-
~E:-
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. i required)
4. Septic tank to be 10oo16SO gallon capacity manufactured by
t-q l flbJ ez-x 1 Q ~1-6-s-r
5. Bench Mark S kna "oyg
6. Divert surface water around mound to prevent ponding at the uphill side.
page 3 Of b
Approved Synthetic Covering
V-)STm C 3 3 Distribution Pipe
Medium Sand
H -G
Topsoil F Elev. 1 7
.
D
u
E
3
Z Slope Trench Of 2~- 2-1 Force Main Plowed
From Pump Layer
Aggregate
Undisturbed D Z. Ft.
Soil E ?•4q Ft.
Cross Section Of A Mound System Using F 0.8 Ft.
2 Trenches For The Absorption Area G \ .o Ft.
A 9 Ft. H V5 Ft.
B u-7 Ft.
C 18 Ft.
Linear Loading Rate= Y.'78 GPD/LN FT Ft.
Design Loading Rate=o.-Z.,6 GPD/SQ FT J > > Ft. S
K 1q_ Ft. + 4
72
L '1S Ft.
W L4 7 Ft.
L
K
A - - -
Observation Permanent _
D Pipes ~-Markers - - ~S
(Anchor securely) Force p~pOSt`tE
- ~ Main
Distribution \ Trench Of 2 - 2 2
A gYS~ Pipe Aggregate
SE
flat
--77
~N
ORRESpUNU Mound Using 2 Trenches For Absorption Area
SEA
Page _Lj_ Of.
Perforated Pipe Detail
0
End View
)Perforated
PVC Pipe Install permanent -marker
End Cap.) Z~0"
at end of each lateral
(DHoles Located On Bottom,
Are Equally Spaced
S
PVC Force Main
Q
PVC
Manifold Pipe
896
Distri ution ~ ~j
Pipe `
2
Last Hole Should Be I
Next To End Cap `
End Cap /J
P Z Z Ft.
Distribution Pipe Layout S Ft.
SYSTEM X V8 Inches
PajVATE SEWAGE Y L18 Inches
ondit'Orially Hole Diameter 11Y Inch
E® Lateral t' _1 Inches
AN y Manifold " z Inches
ND BUILDINGS
DIVISION OF SAFES A Force Main " Z Inches
# of holes/pipe 6
&iCENCE
SEEIGO~ESP Invert Elevation of Laterals lb\.L Ft.
Place 1st hole Z4 from center of manifold with succeeding holes
at 4£3' intervals. Last hole to be next to the end cap.
Combination Septic: Tank and
• PUMP CHAMBER CROSS SECTIOW AND SPECIFICATIONS' PAGE S OF
VENT CAP WEATHER PROOF
JUNCTION 50K
4'C.I. VENT PIPC APPROVED LOCKIPJG
~!.10' FROM DOOR. MANHOLE COVER wt'M
'+iINDOW OR FRESH ? wRRt..)IUG LaeEl•.
AL IJJTAKE E a T
r
11 tj I
~ I 'f~ MIU.
JJ3"MIW.~AG S~
`PROVIDE I
~u AIRTIGHT SEAL I III
• _ - ~ I III V
~q~f `Cs A I I I APPROVED JOIIJTS
APP N I III W/C.I. PIPE4PI)c
w c • R'!" E Tank ction
I I II ALARM
10VIK4 ,FWnply with ( I(
Lys 83.15 and 83.20 d ( r
t 1 otJ
5E G° C I
ao.~s I
LLCY. - FT PUMP-,'
OFF
D CONCRETE 9
9LOLK y ,d
EL X33 -Ul>
3" APPQoVE i
RISER EXIT PERMITFED OWLy IF TAUK MAUUFACTURIF-R HAS SUCH APPROVAL. I SEDDINQ
SPEC.IFICATICWS
SEPTIC f
DOSE
^K MANUFACTURER: M IOW Zl~1 PAST W WIDER OF DOSES: 3 S3 PER DAU
TAWK :,IZE : vua% / 6Sc7 GALLOWS DOSE VOLUME t
S :y. SLIS~rnS INCLUDING 5ACKFLOW: N IS GALLOtJS
ALARM MAULJFACTURJ:.R:
MODEL 1JUMBER'• '-Ol CAPACITIES: A= INCNES OK 3DIO GALLOIJg
SWITCH TYPE' +-I izv-N R Y 5= Z INCHES"OR G~LLOIJS
PUMP MAUUFACTURER: ZOELL.M ~10 • - C- 9 INCHES OR "33 CALLOUS
MODEL NUMBER: Cl`8 D- INCHES OR S7's GALLOWS
P'\ CU\Z-`( NOTE: PUMP AND ALARM ARE TO 5E 6
SWITCH TYPE:
28.08 INSTALLED ON 5EPARATE CIRCUITS
MINIMUM DISCHARGE RATE GPf~
VERTICAL DIFFERENCE DETWEEIJ PUMP Off AUD..D15TRIBUTIOU PIPE.. 10.y.S FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . • 2'52 FEET
+ \SS FEET OF FORCE MAIN X L. - FYoFLFKICTIOU FACTOR. `'S2 FEET
TOTAL DyWAMIC HEAD = \S.\{S FEET
Pump chamber DIAMETER
IAlTERNAL OIMLWS101J~ OF TAWK: LENGTH ;WIDTH - -iLIQUID DEPTH
BOTTOM AREA - 231= GAL/INCH
AS PER MANUFACTURER \`1.O GAL/INCH
s
~
. ,L~
,a
~
,Y
.,y. ~ ..6'~,.
, ~~~'Y
PAGE OF 6
• N -
HEAD CAPACITY CURVE 3 7/8 6 1/4 -
~ MODEL "98" 4 5/8
30
-1
8 6 I
255-
3 5/8
6 20 • j +
U_ p
15 4 3/16
o
4
0
~ 10
1 1/2-11 1/2 NPT
2
5
0
U.S. GALLONS 10 20 30 40 50 60 70 81.
LITERS 80 160 240 bu
a
0 FLOW PER MINUTE
TOTAL DYNAMIC HEADIFL.OW PER MINUTE
EFFLUENT AND DEWATERING
CAPACITY 12
HEAD UNITS/MIN
FEET METERS GALS LTRS
5 1.52 72 273
10 3.05 61 231
15 4.57 45 170 _ 3 5/16
9
20 6.10 25 95
Lock Valve 23'
CONSULT FACTORY`FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
• Mechanical atemators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required-
Standard all models - Weight 39 lbs. -1/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float
98 Series Control Selection switch. Refer to FM0477.
Model volts-ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075.
M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator. "E-Pak".
N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify
duplex (3) or (4) float system.
D98 230 1 Auto 4.5 1 or 1 & 7 - 6. Four (4) hole "J-Pak", junction box for watertight connection or wired-in Sim-
E96 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 Alex or duplex operation, 10-0002.
7. Two (2) hole "J-Pak for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by
a quali-
Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical Alternator, fied licensed electrician. All electrical and safety codes should be followed includ-
'FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FMO487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FM0732. Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
AWL To. P.O. BOX 16W7
Z La isW9, KY 40258-0347 Manufacturers of .
L O SHIP 71D: 3280 Old Millers Lan,
OE~~f~ O. Louirn7le, KY 10218 QUAL/7Y PUMPS ~iYCE /9a~9
p (502) 778.2731 • 1(800) 928-PUMP
PAY I'M% 77A-AR7d
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
Labor qnd Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Ad,
. ~'COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. PI Lido tx>t' Ste` lX
not limited to vertical and horizontal reference pant (B", direction and % o sole or • 4M„ L I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO R D BY DATE
cr~
RGl'ERTY OWNER: OPERTY UICATION f
114 SE 1 ?f ~ T Z,c[ .N.R ~ S E (acw)
PROPERTY OWNEFr.S MAIUNG ADDRESS SUBD,. NKfrt R CSM #
CITY STATE ZIP CODE PHONE NUMBER IN EAREST ROAD
~t e3woa~) cjTN'm s~lo~ 3 (-)IS7 64U0- Z.4S3 f ~ Zoo `nF sT.
[ ] New Construction Use pCJ Residential I Number of bedrooms 3 [ J Addkn to existing building
P4 Replacement [ ] Public or commercial describe
Code derived daily flow WS O gpd Recommended design loading rate 1 bed, gpd/ft2 0 -U trench. gpd/ft2
Absorption area required ZZ S bed, 42 Y) S trench, ft2 Maximum design loading rate o- z bed, gpd/ft2 0.3 trench, gpolft2
Recommended infiltration surface elevation(s) kOO.'7 ft (as referred to site plan benchmark)
Additional design / site considerations 1 ~pvy~ wlZ ~~j aft-S a ",C ti 4'X-4 7. LW C , `I-'Lnj . Z' (3j:- FiLL
Parent material S L0N ao Cam- 5 ` 'T► ~l Flood plariRlevation, if applicable N • IN - ft
S = Suitable for system cONvefnoN& MOUND IN-GROUND PRESSURE 7 AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for stem ❑ S Q U ®S ❑ U ❑ S IOU ❑ S ®U ❑ S O U ❑ S C U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bandary RootsGPD/ft-
j
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch
0-6 tio-lP_ z. L z s i I Z Wi a S -L w-% o.s o. 6
Z 6-16 10`tR s13 - S1~ ~~Sbk `M'~1- c-S 1 o.Z o.3
Ground 3 ! 6 - Z2 s ,Z 3 / y - S ~°-S bh v fit- C S ) w% (3, q e • 5
elev. c ~•S `t 2 s/g
~a.s fL y zv~9 s `ilZ 3 l y I rt 61
Depth b
limiting
factor wt S
2 Z"
Remarks:
Boring #
DA ~0`'IR ~-(Z - 5t1 Z'F~1- v~`F1 a,S Zn~ o.S °.b
Z Z b-i3 t b4R S 13 - s i t 1 inn s~k W1 ~l- ~S ° Z 0 3 r
Slb
3 i3 So Sti2 3~y ~Z$ ~rz 6/3 s 1 0~, y~`f~ - -
Ground
elev.
~4 3 fIt
Depth b
limiting
factor
~
Remarks:
CST Natte:-Please Print Phone.
Arthur L. We erer 715-425-0165
M gerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
e
Signaler ` 10 3 Date: S_ L _ CST Number: M00576 s
PROPERTY OWNER SOIL DESCRIPTION REPORT .Z 3
Page - of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary. 'Roots` 'BPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
o-~ lO't~2 zCz
oLS 7,
Z 6-IV
w11 R s t3 - s, ► 1 sb~ N't,% a-s lw, o `Z o.3
c -7 .s`tRS/e
Ground 3 1~/-31 't.S'i(Z 3~y g ~pY~ f,13 s l oW\ v"..'~ _
elev.
O$.0 ft.
Depth to i
limiting
factor
Remarks:
Boring #
E3
Ground
elev.
ft
Depth to
limiting
factor
i
Remarks!;
Boring #
Ground
elev.
ft. `
Depth to
limiting
factor
Remarks:
Boring #
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SRn-8330(R 05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= 1.10 '
01Z
~ ` ~~g1vR-f3 `C~-LS I~b~'A ~
Cam, b
cx-
> 13.3
3 C1 38 S
3
L'1vv3E 3UV'* ~'9
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q6-l03
(715 ) 4 .5-D1 fi5 1400576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pie of 3
Labor and Human Relators
Vwision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
UNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S~` lX
rPARCELLD.#
not limited to vertical and horizontal reference point (Bfi~, direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
p W f°~ 2D G~ [ x'1 NF 114 SE 1/4,S 7 T Zq NR 1 S E (orcw)
PROPERTY OWNER':S MAILING ADDRESS LOT ft BLOCK r SUBD. NAME OR CSM If
CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE C TOWN NEAREST ROAD
r;t_~Nw~o~> ~-~'t,wl 54ot 3 0157 64~- 2.453 s~2w ~ F-L~-D 'z ~o `rat sT.
[ ] New Construction Use pC] Residential / Number of bedrooms 3 [ J Adclikn to existing building
l~ Replacement [ ] Public or commercial describe
Code derived daily flow y S O gpd Recommended design loading rat bed, gpolft2 0-U trench, gpd/ft2
Absorption area required 3Z S bed, 112 3-LS french, ft2 Maximum design loading rat -13-'L bed, gpd/9 0.3 trench, gpdlft2
Recornmended infiltration surface elevation(s) k0.-7 ft (as referred to site plan benchmark)
Addilionaldesign /sheconsiderations w/ZTY-W OftS.) Mti 4 A-4-)' LWC. 1-'1lnt. Z' OF Sft►-~D FILL
Parent material S LO-f 0j M- S ' Ch U Flood plain elevation, if appfiCable N • q - ft
S =Suitable for system (AM/ENIfO k MOUND IN-GROUND PRESSURE AT-GRADE SWFEM IN FILL HOLDING TANK
U= Unsuitable for system ❑ S E] U ®S ❑ U [IS R]U ❑ S EIU ❑ S ® U ❑ S IJd U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring# Horizon Texture Consistence Botchy Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerrh
0-6 Sri -L>Z Z t z s i i Z h ► a S Z~, o.s 6.
Y I
.2 6-16 lo`tR s13 sil ~~sbk ~t~i~ cS 1>n o•Z °-3
Ground 3 f 6.22 • S ~t ti S ly - S e S bk 1 q ° S
elev. c -)•s It R- S/g
`ia.S t y 2Z ~q S `t2 3 /Y 4 1O R 61 S 1 O~, wt'~I. - -
Depth b
limiting
factor ~r ►.9 wt n s fh'f'
Remarks:
Boring#
DA ~o~c~ zlZ - st1 Z~~~ w~► a-s 2wt o.s
Z a.Z 0.3
Z 6 Z3 Lo`1R S13 - Si 1 VrA Z~V \W\
CZ ,_g~(Z slg
3 2 3 50 S `1 R 31Y ;i ► p ` ttt_ 613 s l cs-' -Y'i - - -
Grourd
elev.
93it
Depth b
limiting
factor
Z 3+
Remarks:
CST6ne:-Please Print Arthur L. We erer Pine 715-425-0165
erer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
103 Date: CSTNumber: f
M00576
PROPERTY OWNER y%_L-6 "Y1 SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. 0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary- Roots`,.: )/ft
In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
3 O l~`t~2 Z[Z S Z ` 9w w. Q,S Z+,~
Z 6-L _
U0 1-1. R S~ 3
C ~•S`1RS/(3
Ground 3 l~/-31 ~I•S y fZ 3/y $ ~o~~z c, l3 s 1 0
elev.
U$oft.
Depth to
limiting
factor
Remarks:
Boring #
" i
I i
Ground
elev.
ft.
Depth to ` i
limiting j
i factor l
i
Remarksf?
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
i
Remarks:
Boring #
Ground
elev.
ft.
Depth to v.
limiting
factor
Remarks:
SRn-AIMR 05/921
PLOT PLAN Page 3 of 3
SCALE 1"= L`D '
\3`Nt13 tt►.s i'rrzA
a
8.3
.loo ? "s \ /y~
3 a CZ48S
C"i
ti
Zhu gE 300'*
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y
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fn
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0 V
W 1 _ ffLL-~,, loo. p' OQ `TAWSH ooh i)-T SOUR I
Ceti d - X16 0 3
S -l8 6 (715 ) 425-016s M00576
CST Signature Date Signed Telephone No. CST #
STC-10S
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNEWBUYER 1 rid Gee yj l-1 AA
MAILING ADDRESS /V z S' 3
PROPERTY ADDRESS SA M e-
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE je n w~ u c✓ e L' l'J` S
PROPERTY LOCATION N/ 114, 1/4, Section T N-R S W
TOWN OF <P9 1'e- ! C ST. CROIX COUNTY, WI
SUBDIVISION LOT NUM13ER
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.
UWe, 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 m st be completed and returned to the St. Cro"~
County Zoning Officer within 30 days of the three ear e ira d e
SIGNED:
DATE.
St. Croix County Zoning Office
Government Center
1101 Cann ichacl Road
Hudson. WI 54016
• (14%25:197 FRI 10:17 FAX T15 396 45SO ~i I;KA ~.RJ
gTC 300
signed by the
This appl,cat on form is to be completedn Any inadequacies will
owner(s) of the property being developed- Should this
(spec
only result in delays of the permit issuance.
develapmeiit be intended for resale by owner/contractor eted hen
house)* then a second form should tbretained and c cal wi h wthe
the property is sold and subm ed to this appropriate deed recording
Owner of
property )40 "1 41?
T 2 N-R r7 W
ction
Location of property 4 ~'L--_1/4, se 2 '2 s~
Township Mailing address v
Address of Site S4"' C Lot no
subdivision name
11 Na
other homes.on property. ~Xes _ rC4 4
Previous owner of property m"'~ G" -
Total size of property 4lv q e 2
Total size of parcel
Date parcel was created yes No
Are all corners and lot lines identifiable? identifiable? --Yes
Is this property being developed for (spec house)? -,Yes t/No
3 L1 7 as recorded with the Register
volume and Page Number
of Deeds. _
INCLUDE WITB THIS AppLICATIoN RNVM ER, FOLLOWING: VOI,UME AND PAGE
A WAFJU0TY DEED which includes a DOC In addition, a
NUMBER AND; THE SEAL OF THE REGISTER OF DEEDS. t?on
certified survey, if available, would if hthefudeed descrip old
delays of the reviewing process ey Map
references to a certified Survey Map, the Certified Surv
shall also,be required.
PROPERTY OWNER CERTIFICATION
the
I (We) certify that all statements on this form e are rue to the
best of ray. (our) knowledge that I (we) an (are) by Her(s) of of a
the ntormCtion form, by Register of
property described in this;
warranty deed recorded n and that I (we) presentlY
Reeds as C3ocument No disposal ~ system or x (we)
own the. proposed site for the sewage for the
obtained an easement, to run the above described property,
construction of said system, amd t same hDse eenadulUore riled in NO,
th of 1 e of the county Register
Co-hppl icant
Signature of Applicant
Date, of Signature
17ate of Signature
w
r?~ . PACE ~
DOMMENT NO. WAMMAX" DEED THIS SPACIC R9SSRVM FOR ■CCOMMIM DO TA
I•a!Y eel
471313 REGISTER"' OFFICE
dap -9 7:11A A. D, 19-.91., ST. CROW CO.,
AL
TM MENrUn Made this..3
R-1c d for, Record
"'eeII_ husband JUL lid 1991,7
ES... of-the first of 12: 10r F.
ryj 3gamm
V
r a~1. .a ~D~e~c........_..__._..r ~ and ~~"swofusbawife oedr
- - -
as joint eeaaoas, parties of the second part,
Witnesseth, That the said art.ies of the hot part, for and in consideration
RETURN to
of the sum of._._l1nE_t1 0111..l1nliar- a-A othpr-goAd..atld._:_.._.._...
«.._tla] uahla_.rnnsideraLitan
to- shed`-... in hand paid by the said parties of the second part, the receipt
whereof is hereby confessed and ackaowled~o leaH4-_ given, grimed, bargained, sold, remised, released, aliened,
conveyed and confirmed, and by these presenes ia~_.- give, grant, bargain, sell, remise, release, alien, convey and
confirm unto the said parties of the second poor. im joint tenancy, the survivor of them, his or her heirs and assigns
forever, the following described real estate sated in the county of...__~L._.~CQ~.X...
_ and State of Wisconsin, to-wit:
East one-half (Eli) of Southeast one-fourth (SE14) and East one-half (Eh)
of Northwest one-fourth (Nigh) of Southeast one-fourth (SEh) of Section
seven (7), Township number testy-nine (29) North, of Range number
fifteen (15) West, except one (1) square acre in Southeast (SE) corner
of Southeast one-fourth (SEA) of Southeast one-fourth (SEA) of Section
seven (7), Township number tumty-nine (29) North, of Range number
fifteen (15) West, in the County of St. Croix and State of Wisconsin
,u (IF -VECUMARX ealWn-CITE :,ESCRIPTION ON REVERED 61M)
Together with all and singular the hemilitaments and appurtenances thereunto belonging cr in any wise
appertaining; and all the estate, right, tit1- iiterest, claim or demand whatsoever, of the said partie5_--. of the.
first pact, either in law or equity, either in pamession or expectancy of, in and to the above bargained premises, and
their hereditunents and appurtenances.
To Have and to Hold the said premises as above described with the hereditaments and appurtenances, untd•;
the said parties of the second part, as joint t enianas;, and to the survivor of them, is or her heirs and assi s FOREVER:
And the said Edmund F. Grahm and Betty Max Graham, husband and wife
_ - -parties..of the- first part -
for.. themsel ves,Lthei r - hoe, estecutors and administrators, do.......... covenant, grant, bargain, and
agree to and with the said parties of the second put, the survivor of them, his or her heirs and assigns, that at the
time of the ensealing and delivery of chest poesents heY_ a1 well seized of the premises above -
described, as of a good,. sure, perfect, absoirre and indefeasible estate of inheritance in the law, in fee simple, as
that the same are free and clear from all rnr-lumbrances whatever .
. -
and that the above bargained premises in the quiet and peaceable possession of the said parties of the second part,
the survivor of them, his or her heirs and assz~as, against all and every person or persons lawfully claiming the whole
or any part thereof, they-.-- will fammer WARRANT AND DEFEND.
In Witness W~treof, the said part_A!S of a first part hs.VP...... hereunto set ..,tht:.ir..... hand.S... a15d `
seal.-S. this.... 3AAE........... day of ~ A. D., 19-.9a.....
( SEAT:),
SIGNED AND BEADED IN FRS\-E:E MCW
BY;... i r~rk->Q..~ .....~is.- (SEAS.)
By;. =am itt (SEAL)
met
(SEAL)
-_f
S to of *2"K*K Mi nnese"
...._~..~lmSQY_.._
Personally came before me, thi% day of-.-_............................................ A. D., 19.91.....
the above named ...---.Edmund-_ F._Graiti■_and_.Betty_May Graham,.--.
husbaM amd wi fe.)
to me known to be the Dersons- who wed the foreeoinr ment an cknk-w.'Odrad,: the saKe.