HomeMy WebLinkAbout040-1230-60-000
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ST. CROIX COUNTY ZONING DEPARTMENT
`r' Ekr
AS BUILT SANITARY REPORT "
f J
Owner .l e f
Address /3o o ~,r~alusf~.s 7-
City/State c~o1Gn;FF
1
Legal Description:
Lot 71 Block Subdivision/CSM # 110o v e y a - el-d
~ s% Sec. tG , TAN-RAW, Town of PIN # Z3~O -
ljo..~.19, ll3(0
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer Size ST/PC o / o~d d Setback from: House Well P/L
Pump manufacturer P u 1,1 6 Model 420'Y
Alarm location A-"a e- -e-
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: h46,-,v cA Width 3;z Length 8' S Number of Trenches 1
Setback from: House as--o` Well a so PAL Gaf' Vent to fresh air intake 1.4 4,
-
ELEVATIONS:
Description of benchmark So h, a -i S Elevation 977•4~
Description of alternate benchmark Elevation
Building Sewer /,16,7. 6 j ST/HT Inlet /d oa'' S ST Outlet /00.9 • 2 6- PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover /6d S' • l
Distribution Lines 9 j $ ( )
Bottom of System ( ) ° ' ( ) L. Dl ( )
Final Grade ( ) ~D ( )
Date of installation y //C98 Permit number 307 d 2 State plan number 97-a 6 9~ y
Plumber's signature License number aa79rr', Date
Inspector
Complete plot plan or
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN ~m s
t3' y~
Jado s
4.
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i
JOdd pG I,
L
INDICATE NORTH ARROW
470
„Misconsiq Department of Commerce PRIVATE SEWAGE SYSTEM County:
~sc~i~
Safety and [3uildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitaryftll
Personal information you provice may be used for secondary purposes [Privacy La j s.15.04 (1)(m)].
P Ider'~ Nam 4 Village ❑ Town of: State Plan ID No.:
~ga. Jl:F `
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T4JW-1230_60-000
g7.7•!0 0177- G C ST'.5 13M 4116 1
TANK INFORMATION ELEVATION DATA A9700-524
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
e ti ; cP w r'c Ca (Zvz) Benchmark 'p CfW 4177• L
IR 15
Dosing 1c~r~x'-S'~ fYcng"~ 0C) C>
Aeration Bldg. Sewer
Holding St/ Ht Inlet p/l J 1D~L.
TANK SETBACK INFORMATION St/Ht Outlet /DOa.,;L
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
e L/O NA Dt Bottom C r LD • °177
i
Dosing alp p ~O NA Header/ Man.
Aeration NA Dist. Pipe '71137 31Z C1T1.65-
sys~
Holding Bot. System q-J5o 0.07 90*4
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer 0v 1 D and P`~ g88 3• qa'y .7
Model Number 'ITC L - 3, -7 q$~.~j7 (;94-7
TDH Lift_ , Friction System2'S TDH lQ:?IFt 0'1~ 3 Cpl l e?7*.7
` loll Sgp ~oor~
Forcemain Length 35 Dia. ;>"l Dist. To Well Slp~
SOIL ABSORPTION SYSTEM
TRENCH Width ( Length No. Of Trenches PIT No. Of Inside Dia. Li id Depth
DIMENSIONS DIMENSIONS
LE HING Manu 7:~~
SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM
INFORMATION Type o CHA R M er:
94-0 OR UNIT
System: MpJ"G ~d
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing -Vero Air Intake
Length L Dia. Length 3D- Dia. _C_ Spacing 1q- I ftpf a v0f
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center k_- I~ Bed /Trench Edges Topsoil Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) qo f 9~r3 `.4jCoAcV-
s•$s 6'o a93
LOCATION: TROY 16.28.1q-NE: qW 342 S O LINE ROAD .
Sc )eir g~
L~ S+ o ~f ~F -b IK (~•1-~ - ~y8-~,
3,) P. -t4 vjao da r pM o r 4,o -kw o ,ro ~ ~ 'br-fw~ kt;it ~ PI ~ C 4e W
Plan revision required? ❑ Yes No F 4 /
Use other side for additional information. ~~p 0'Ll
___J J
CA~
SBD-6710 (R.3/97) Date Inspector's Signature ert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
7_ -
SANITARY PERMIT APPLICATION 201E and Buildings Division
~~$COns~n •
Department of Commerce 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 8 112 x 11 inches in size. _57 tV•o
• See reverse side for instructions for completing this application State Sanitary Permit Number
&07coO7
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy taw, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 97AO
Property Owner Name Property Location
1,4"dle -c- ' o 1/4s~tj 1/4, S la, T 4_ , N, R/Q E (or)~#_
Property Owner's Mailing Address Lot Number Block Number
1-36 Q
City, State Zip Code T(P hone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned Cl !tl (age Nearest Road
p Vi
Public 1 or 2 Family Dwelling - No_ of bedrooms own OF J`'a A ; ,v-
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 4~0- l2 3 d--C d
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
S ❑ Hotel /Motel 9 ❑ Office/ Factory 13 Q Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable)
A) 1. M New 2. ❑ Replacement 3. ❑ Replacement of 4_ Q 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 21A] 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) I Elevation
6a0 "O S'~D y r 64-1- ff Feet 90"y-6- Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- Ex er.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel elastic p
New Existin strutted glass App.
Tanks Tanks
Septic Tank or Holding Tank K Z-200 / , rd a e9 r'e.* d ® El ❑ ❑ 11 ❑
Lift Pump Tank /Siphon Chamber X QO / 1 feY,v ~ 1:1 ❑ 1 1:1
VIII. RESPONSIBILITY STATEMENT
[,the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signatur N Stamps) /MPRSW No.: Business Phone Number:
` %a 6c a A, V7~ y ~
Plumber's Address (Street, City, State, Zip Code):
l ? D w a7' 9o..rJ L(a t' 0
IX. COUNTY / DEPARTMENT USE ONLY
Q Disapproved iG itary Permit Fee (Includes Groundwater Date Issued Issuing A ent Sign to
pp ❑ Owner Given Initial co, S rcharge Fee)
fOVed
Adverse Determination f3CJ G~
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 11/96) DISTRIBUTION: Original to County. One copy To: Safety 6 Buildings Division, Owner, Plumber
_I
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2_ Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3151.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. 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 81/2 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.
r
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
N visconsin La Crosse, WI 54603
Department of Commerce Tommy G. Thompson, Governor
04-Dec-97 William J. McCoshen, Secretary
Wegerer Soil Testing & Desig JEFF WINES
421 N Main St
PO Box 74
River Falls WI 54022
JEFF WINES Plan ID 9720994
NE,SW,16,28,19W
Municipality of TROY inspector: Leroy G. Jansky
County of St Croix (715) 726-2544
Private Sewage plans including the following element(s):
MOUND 600 GPI
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for
compliance with all code requirements.
This plan action is subject to the conditions listed on the following page(s).
A copy of the approved plans, specifications and this letter shall be on-site during construction and open
to inspection by authorized representatives of the Department. All permits required by the state or local
municipality shall be obtained prior to commencement of construction/installation/operation.
This project is under the supervision of a state inspector. As inspection concerns arise feel free to
contact the state inspector at the number listed. The inspector for this project is listed above.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when
making an inquiry or submitting additional information.
Sincerely,
rard M. Swim
POWTS Plan Reviewer
(608) 785-9348 I .L~, L
r. DEc o 1997 ,
ST CROIX
COUNTY r'
Z NdINGOFFIGF /
.4 i,
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
LaCrosse, Wisconsin 54603
isconsin
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
Page 2
97
- A Sanitary Permit must be obtained from the County where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats, prior to installation.
- Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
SBD-5524-E (R.07/96) File Ref:
e
Page of 6
MOUND SYSTEM
FOR
A Y BEDROOM RESIDENCE
LOCATED IN THE K E-1/4 OF THE Sbu 1/4 OF SECTION b ,T2$ N, R _1L W,
TOWN OF , S~ C ~Fjlx COUNTY, WISCONSIN.
LET "Z L o F ~~ov S'"dQ LI'T4 ptm1'v0tj,
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
PA GE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
~"'PF RlvD ~l-4E1L.'P~ t~lNEzS
c/O ~~s~ti..~f w1oT02 ~.El6t~-T
~3vo ~ ti,Ov 5TI~! try ST•
-vnsorv , w~ s q Z)16 RECE /FD
NOV 2 6 1997
SAFETY.
PREFAIM BY
WEGE~EF? SOI L TEST = r,4 C-3
;3 ®®e~!!!'~@~~OB~, ~
IDES I cam s~~v z 4--I=- C` ~ 40
P.O. BOI 74 421 K. KAIK ST.'
ARTHI!A L. •
RI11EF. FkIS. KI 54022 0 ~ v+=u.aEa
P.O.\A/ C 715-4225AIZ ty eLLSO-TH,
Yr ,.V f&► 5.
Conditionally z
APPROVED ~ ~ti
DEPARTMENT OF COMMERCE
ISIO Of SAFETY D BUILDINGS - `Ly - a 7
*EE CORR PONUENCE
JOB NO. 9-7-M6
PLOT PLAN
Page Z of b
Scale l 5 C)
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14 B~ at 1
1 ~
Z~s'oF t4°aUe 5`1~ 11
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y'•pVC ~I~~fL~l AJ F'LLN• zvor-7-
5' co~,eR v~n~~ri 9 3 eve F M 1 1 4
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LoT 1.1
52.5.0.9
IAJ ELL 'Tt Q k (It-r L~'tt 5T FIX41" Mi)U" fpv0 - - -
NOTES:
-1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. (_V_ required)
3. Install 4" observation pipes with approved caps. ( 2 required)
4.-Septic tank to be 12c~p gallon capacity manufactured by
KW-- - ~P `tfl~z YO 13E M L L-h/ eoTeu.Aj (S m- `1-"
5. Bench Mark 7YaM *I - as Cox~cQ gt pF ez.~ ~ ~Ox
8►''1*Z- -.at1~70' ON "2.~L 1 YU pLtO~ Wr C%VwtE~R
6. Divert surface water around system to. prevent.ponding at the uphill side.
6
Page I .Of
Approved Synthetic Covering
lps,7" c 33 Distribution Pipe
Medium Sand
Topsoil
-J F Elev. q a3.0
3 E p
b
S % Slope
Bed Of 2- 2 %2 (Force Main Plowed
Aggregate From Pump Layer
D 1.0 Ft.
Cross Section Of A Mound System Using E Ft.
F o•~ Ft.
A Bed For The Absorption Area
G Ft.
A 8 Ft. H s Ft.
Linear Loading Rate= 9.5 GPD/LN FT B Ft.
Design Loading Rate= 0.4.GPD/SQ FT j l`o Ft.
J 6 Ft.
K \ 1 Ft.
A+te,A*te-Position 05 Ft.
of
Force Main W 3 -1- Ft.
L
Observation Pipe
8 K
A I - - -
(o ----------------------•I Fer-e-Ma n
Distribution \,,Bed Of 2"- 2
Pipe Aggregate
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page U Of
Perforated Pipe Detoil
0
End View
)Perforated
End Copt PVC Pipe
~\e>
ass Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
P
PVC
Manifold Pipe
* PVC Force Main
Oistn ution
Pipe
Last Hole Should Be
Next To End Cop
End Cop
P 30 Ft.
Distribution Pipe Layout
S Ft .
X Y b Inches
Y V b Inches
Hole Diameter ICY Inch
Lateral 1 Inch(es)
Manifold z Inches
Force Main Z Inches
# of holes/pipe 8
Invert Elevation of Laterals 9 V-S Ft.
%X l . "I '3"3~ yc y ; 37 "4 V GPer
Place 1st hole Z4" from center of manifold with succeeding holes
at 41' intervals. Last hole to be next to the end cap.
I
PUMP CHAMBER CROSS SECTIOW AMO SPECIFICATIOMS ' PAGE S OF to
VEWT CAP
'i"C. I. VENT PIPC
WEATHER PROOF APPROVED LOCKING MANHOLE
-ff r : 110 'FROM DOOR, JUAICTIOIJ BOX COVER WITH WARNING LABEL
WIMDOW OR FRESH It'MtU. I
AIR MTAKE I
GRADE
aL qS3 MIIJ.
COWDUIT
18'MIN.\
PROVIDE (
IAILET r AIRTIGHT SEAL I III ~ /
III v
APPROVED JOINT A Tank construction shall comply I III APPROVED JOINTS
with ILHR 83.15 and ILHR 83.20 I III
I I I ALARM
8 I II
I I
i I ON
C I i
I
-CLEV.Ol-~FT PUMP-----
~ OFF
D
) S- DO / COUCKETE 5LOCK
3" AVPRuver
RISER EXIT PERMITTED ONLY IF TAWK MAIJIJFACTLIRER HAS SUCH APPROVAL gEDpIµG
SPEGIFICATICIMS
005E
TANK MA>.IUFACTUKCR: IJUMDER OF DOSES: PER OAy
TAWK 5IZE: 1~OG GALLOWS DOSE VOLUME r
S S• 2-jSTD" IS IWCLUDIN& DACKFLOW: $Z GALLOWS
ALARM MAIJUFACTURGR:
MODEL wumuR: CAPACITIES: A= "I IZ IMC14E5 OP. GALLONS
SWITCH TUPC: ER Y 5= Z IIJCHES OR S Z G, ~LLOW5
PUMP MANUFACTURER: 6p lr LflS ca 7 IMCHE5 OR ~(6 Z GALLOWS
MODEL WUMBEK*. 34311 ~~04 D= \-L INCHES OR 3~Z GALLOWS
SWITCH TYPE: Y - MOTE: PUMP AMD ALARM ARE TO DE
M1IJIMUM DISCHARGE RATE 3-), y INSTALLED ON SEPARATE CIRCUITS
_GPM
VERTICAL DIFFERENCE BETWEEM PUMP OFF AW0,.015TRIbUTIOW PIPE.. D'SO FEET
+ MINIMUM WETWORK SUPPLY PRESSURE , , . . , . 2.50 FEET
+ Z S FEET OF FORCE MAIM X-1~3110OFxFRICTIOU FACTOR._ 0.69 FEET
TOTAL OtIUAMIC HEAD FEET
DIAMETER
38 tIZ:%`
IMTERWAL, DIMEIJSio.kl i OF TAWK: LEN6TH - ;WIDTH ; LIQUID DEPTH
BOTTOM AREA - 231= GAL/INCH
AS PER MANUFACTURER = Z;6.O GAL/INCH
Goulds -?NC-Z 6 6
Submersible
Effluent Pump
3871 EP04
- EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas-
• Homes components. Available for automatic and tic cover with integral handle
• Farms Motor: and float switch attachment
• • EP04 Single phase: 0.4 HP, manual operation. Automatic
Heavy duty sump 115 or 23V, 60 0.4 0 models include Mechanical points.
• Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering 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 construction.
■ EP04 Impeller: Thermo-
s Solids handling capability: automatic reset. plastic Semi-open design AGENCY LISTING
3/4" maximum. • Power cord: 10 foot with pump out vanes for
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Canadian Standards Association
• Total heads: up to 24 feet. with three prong grounding _
• Discharge size: I V NPT. plug. Optional 20 foot ■ stic Impeller: Thermo- (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F or "AC.)
rotary/ceramic-stationary, three prong grounding plug improved performance.
BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
1040F (400C) continuous superior strength and
140°F (60°C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10-
• Capable of running -
dry without damage to s 30 sG
components.
Pump: EP05 s _ _ - -i- - - 25 Fr
• Solids handling capability: c 25 -
maximum. W ' - - - - - - ~ -
• Capacities: up to 60 GPM. s 20
• Total heads: up to 31 feet. 0
• Discharge size: 1%" NPT.
z 5-
• Mechanical seal: carbon- c 1 s
rotary/ceramic-stationary, I
4
BUNA-N elastomers. - - - EPOS=___
• Temperature: ° 3 10 ~b' b9
104°F (400C) continuous
140°F (600C) intermittent. 2 ---T-- - -
5
1
f 0 00 10 20 30 40 50 GPM
-L L
0 2 4 6 8 10 12 m3/h
CAPACITY
®1995 Goulds Pumps, Inc.
Effective May, 1995
83871
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05 VV '5kd )e?~" COUNTY
Atta
ch complete site plan on paper not less than 8 1/2 x11 inches in size. Plart~swelST' not limited to vertical and horizontal reference point (BM), direction and % of ~tae PARCEL
LD. #
dimensioned, north arrow, and location and distance to nearest toad. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE
PROPERTY OWNER: PROW~TY~lqA, 1, (ON tC
C. M • B`"1 E ~ 17~1J>`1 \ S S C L ' Z,. ~ 4 1/4,S~ T N,R 19 E ( w
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCS a>~. BD. NAME OR CSM #
t_ov LI*N .Sf Y1 OK3 L IV ft b l n oN
CITY, STATE ZIP CODE PHONE NUMBER [~CIT'F {]VILLAGE MOWN NEAREST ROAD
Rl.VffT . F>~u s,w1 s oZZ. (715) cIZS- B ► 6 L( SOO Lu~E Ro►rD
p(] New Construction Use. pq Residential / Number of bedrooms 4 [ ] AddttiQrt to existing building
Replacement Public or commercial describe
Code derived daily flow bOD gpd Recommended design loading rate C, • bed, gpd/ftt2 trench. gpd/ft2
Absorption area required SOD bed, ft2 SOO trench, ft2 Ma)dmum design baling rate C~ • S bed, gpd/ft2 0 - b trench, WW
Recommended infiltration surface elevation(s) °L a3.O' It (as referred to site plan benchmark)
Additional design/ site considerations a,L"ItINM" Ek) b *1'IN% Jb a' x 63' 8lep. MIN J. \ ` OF SftNO F~ LL..
Parent material S t L~ S ls-4b1 wt &vT o v M ' rI L t, Flood plain elevation, if applicable N •A - ft
S = Suitable for system CONVENTIONAL MOUND IN4MJND PRESSURE AT-GRADE SYSTM IN FILL HOLDING TANK
U = Unsuitable for stem ❑ S ®U IRS O U ❑ S ICU ❑ S ®U ❑ S ®U ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisterice Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
[3 o-ZY to t tz ztZ - si 1 Z `F3bIt cS - o•S GA
Z -eq-u3 Lo`2R y/3 Z'fsbk b.S o-6
Ground ~7 S Oft S/g S1 elev.
~~'lft. 3 Coti Jv5 \~OCk. U~ ~ `1RYl ~S
Depth to
limiting
factor
Remarks:
Boring #
o-~~ Zo~.~31z - s>:1 zFgbk cS o.s 0.6
3z, Z l~-Z6 1uK 2 2. _ s i ! Z Sl~k wt'~~• c - 0.5 ` b.(,
3 i6-36 ll~`1rz Y 13 - g t 1 3 Q 3 bh rn 'P~ e S o• S o. b
Ground
~~ft. 36-s9 ~).sLfe S/P. sick \wtsbk W) -
Depth lo
limiting
factor
36 `r
Remarks:
T Name:-Please Print Arthur L. W e e r e r Phone. 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: 1- 3 CST Number:
q y-302---7I 3_9S M00576
PROPERTY OWNER 'a4 t~17 sCwjt_TZ SOIL DESCRIPTION REPORT Page Z of. 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
r~ l o-tl VS-M 3Lz sil Z Sb vv1 H Cw - 0.5 0.
n 4i•.nJ
>`Z \1-1Z 1oytL 3~y SI Z Sbk w, `PI• cw 0,.5 0.
Ground 3 Zz-31 -S YR CIl b - 51 -1 Z s bar vh h S - n• 4 o S
elev.
q~`~Sft. 4 31-61 ~,Sytz 31 ~~~SyR Slg 3 t7 1^a `~i i
Depth to Cwj% !v S C 5
limiting i
factor
3l''
Remarks:
Boring # '
b-~ S 1~`l(Z 31 i - S11 Z GPs ~ h w~-~~- C$ O .S i O. L
Z t s Zo to tz S t y - s l l Z a 1012 x~- c s - o. S i o. t.
h
3 zo 3o do -t [Z 316 - s 1 c Z s bk wi dL g - o • o ,S
Ground
-
elev. O 3 t~ ~i tZ 3/` -~L-i - iS 'i R sib C k 1 %vt s b k v►1`FI 0-S
-L.-q ft.
cl
Depth to S 38= ZZ 10 `1 R Y1L ! i ~S ~~'''t k1v`~1- - i"
limiting w S S 1 3! t7 w ir- L_ e-wl Law b 3 1.
factor
30" }
Remarks:
Boring # i
I
%pe~1,
i w K•v'
i
i
.Ground
elev. I
ft.
I
Depth to
limiting {
factor
I
Remarks:
Boring # ii
I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
SCALE 1"= y0 '
LoT 1.0
1 -
41 lZ x.1.981 y 0,0 "j' u N
~.4 I
1 twtZ►u ty~
hY
~`RSp„ ~ ~ T,I o,v t'' ~ 0..u 1ti P lPt
- - 37.
"2S~
It%a,9 - OZ
~ 2 on ~ oT ~ 1STUSZQ,
last i I
coh.Pvtc~-
5 1 Ttt'lS 141"
SSA ~ `
1
6.3 a
1 O
ti.. °1815 ~ " 11
_ ~o v~~►Tb ~kSOK~T
q8 L 9
t ~'rov.2 ~1.. gBZ,o'
61G.0Iq auTbr-► of O~
•°183.0
NOTE: House to be at least 25' from mound.
Well to be at least 50' from mound.
For 3 bedroom home, install mound with a 61X63' bed.
9Y-313 2--7I
1-30-qS (715 ) 425-0165 M00576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3
Labor and Human Relations
Dtvision of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST- CAZ01 X
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
C. M. @11E f'►MJ ~~u 1 S S Q-ItQ L Z 66W. E6lF fN Z 1/4 S W 1/4,S It T Z8 N,R 19 E( W
PROPERTY OWNER'.S MAILING ADDRESS LOT If BLOCK # SUED. NAME OR CSM #
'i lO m • m Art m % T". -7 1 - G L-OU f?1Z S" W (4'VPt b117t1N
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
CUs eVL.L.S,w1 S bLZ t71S) ~IZS- 8161 7rym Soo LuUt~- Rupp
pq New ConsWction Use. M Residential / Number of bedrooms L) [ 1 AddftiQrt Io existing building
[ 1 Replacement [ 1 Public or commercial describe
Code derived daily flow bOD gpd Recommended design loading rate •'4 bed, gpd t2 trench, t
Absorption area required SM bed, g2 Soo trench, g2 Maximum design batfing rate o • S bed, gpolft2 0 . b trer>ch, gpoll(t22
Recommended infiltration surface elevation(s) °L a3.0' it (as referred t'D site plan benchmark)
Ati~tiottal design / site consideratifrts ~.k~>'AN'It"I D "INUM w/ 8'x.(.3' B~ . M IP0 . ~ r o!= Sf1N0 F't Cf. -
Parentmaterial St~,~ S Eft wI e" r ov era_ 1r% Lt_ Flood plain elevation, if appfic'able N J\ . ft
S = Suitable for system 00NV9M0NAL MOUND rl-GRO M PRESSURE AT-GRADE S%IrrM IN FILL HOLDING TANK
U = Unsuitable for system ❑ S ®U 19S U ❑ S oU S ®U ❑ S ®U ❑ S klU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure Corisistance GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Co nt Color Texture Gr. Sz. Sh. Bounty Rood Bed Tench
13 o-Z~ lo`LR ZLZ Sl 1 bIiz vwiIi,- cS 0.6
2 zy-u3 tio`12 V/3 S)) Z ~5bk Y4 qt- as b•s o• 6
Ground 3 ~3-t.b S`~R 3l ~7 S 4VL S/9 S1 C`'h ~+•F1-.ri`~; - - -
elev.
X179.1 It
Coti W 5 \_Z)u Q,6 01 `1 R Y! ! s
Deo to
limiting
factor
y 3`t
Remarks:
Boring #
SO Z Fgbk cS _ e•S 0.6
Z Z 11-zb 1wi tL -LlZ - S l 1 I 310h VA Tl, 0 _ o•S u.(,
3 zC-36 1o~ttz Y 13 - s 1 3 Q a l~h YK''I^ d S _ o. S o. d
elev. c( 36-s9 ,.Stilt y /6 ~L stce s!~ sick \wt sbk v~'~i - -
9.
Depth to
limiting
factor
36'r
Remarks:
CST Name.--Please Print Pine'
Arthur L. We erer 715-425-0165
eRerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date- l _ 3 0 _ CST Number:
q~(-3oZ-~I ~)S M00576
PROPERTY OWNER 'a4 tf- 3Ct*U~-TZ- SOIL DESCRIPTION REPORT Page L of 2S
PARCEL I.D. # y
Depth Dominant Color Mottles Texture Structure Consistence Boa -dart' Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
o S o. L
w st 1 b
n~ o-tl ~o`~a 3LZ
Vo_tc 3/y si ( Z Sbk w, `Flr cw - o•S o.
•~z z ~
Ground 3 ZZ-31-SYR c!!(, - Sic. Z sbk 1M ~S - ~•y o S
elev.
gP`~.Sft. 4 31-61 "-•,S`!vL 3/ ~Li `iR V& S L-~,vw\ yn 1 - I
Depth to w g C
limiting
factor ~Remarks:
Boring #
~ o-~ 5 ~o~-t.a. 3! Z - s,~ 1 L `~a b h w►'~~- c S o .S o.l
y awb s ZA t o `i tz 3 t s I) Z a b~c Wt - c S - o. S o. L
3 ZO 30 t O `-i [R 3! 6 S l C. Z'~ S blot 1yt S 0• O. S
Ground
C1 elev. ft. 0 3 to ~t 31C -i.s Lev. s18 C 1Nfl$bk
Depth to S 38 ~Z 10 `f 2 Y!L ► r ~S O~ w1 v-~• - -
limiting
factor atN w S S y O w L l I
II
Remarks:
Boring #
p•sn't g
7<a
-Ground
elev.
ft. If
Depth to
limiting
factor
Remarks:
Boring #
r N
R•:.3
Ground
elev.
ft.
Depth to
limiting
(actor
Remarks:
SBD-8330(8.05/92)
X . PLOT PLAN Page 3 of 3
SCALE I"=
'
LoT 1.10
417. l2 LL q81 y c'Q "W"► u N
va•Y I
~'hs~ TI o~v t" EAU tr.~ P lpt
L%T 11
- - 3z ZS. 1►t1.g19 - ~ DZ
i I
~ t Z •on ~ oT ~ lS~u tz.6
5°~0 11 1 ; otZ eorlpnc~-
1 asp ~1 1"Tt'lS 14R1~
t ~
es~ 1 0
8.3
"-L 9v15 ~ _ 11 \
'l LtTb em'94e rr
tTLg8L 9
oti z" SRAM pi vie.
NOTE: House to be at least 25' from mound.
Well to be at least 50' from mound.
For 3 bedroom home, install mound with a 6'X63' bed.
d• 9 y-30 2-~ I
1-30-4S (715 ) 42.5-0165 M00576
CST Signature Date Signed Telephone No. CST #
f
r, STC-105
E k SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ,(JeS ,
MAILING ADDRESS l3O 4 T .57 -e, 1
PROPERTY ADDRESS A41 A444"
+
i{ (location of septic system) Please obtain from the Planning Dept.
CITY/STATE
t PROPERTY LOCATION 1/49 S~ 1/4, Section 16 T a c~ N-R W
TOWN OF ~Yo ST. CROIX COUNTY, WI
Y,
SUBDIVISION J/ &,q y LOT NUMBER 7l
a 4t,,
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
f ,
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
E; as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly, maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: l l l '3 All
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
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 J-C FF ~d. `Ve5
Location of property~1/4 -O'A) 1/4, Section /6 , T N-R_W
Township ~ilv ✓ Mailingaddress 13d0 ~.tl~lcS~y,`cc /
r
Address of site X
Subdivision name XD 42 -6 y sa 'a Lot no. 17/
Other homes on property? Yes___,e_No
Previous owner of property
Total size of property v? not,
cS
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 V_No
Volume i F and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. `f13 , 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.
Sig t e of Applicant Co-Applicant
a 13 /CI-7 l 13 ~`11
Date of Signature Date of Signature
t 569633 Yk =/fdrTY D1
1/6
Document Number:
REGIS i = R'S OFF ;(-,E
ST. CR0i', W!
_ A
Return Address:
' -je ~ ~jJytp~, DEC 9 1997
Re Isfer of Deeds
Parcel I.D. Number (PIN): 040-1230-60 `
.A
x,
` This Deed, made between C. M. Bye, WmEwidually; Dennis R. & Sandra C. Schultz Revocable Trust, Dennis t
R. Schultz & Sandra C. Schultz, Trustees, both with ftA power of sale or encurrbrancing, Grantor, and Jeffrey W. Wines
and Sheila J. Wines, husband and wife, as survivorship marital property, Grantee,
Witnesseth, That the said Grantor, far a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of VWisconsin:
Lot 71, Glover Station 4th Addition the Town of Troy, St. Croix County, Wisconsin.
This is not homestead property.
a
Together with all and singular the hereditaments and appurtenances thereunto belonging:
And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
r* easements and restrictions of record and will warrant and defend the same.
Dated this day of November, 1997_ _
L~,1 v ~ r
. Dennis R. Schultz
C. M. Bye 0?(~~G.-✓
' Sandra C. Schultz
ACKNOWLEDGMENT TRANSFER '
,
' STATE OF WISCONSIN 1 $70
1 ss.
ST. CROIX COUNTY 1
t
Personally came before me this dary of November, 1997, the above named C. M. Bye, Dennis R.
Schultz and Sandra C. Schultz, to me known to be the persons who executed the foregoing instrument and acknowledge
the same.
YOtaRy ~blic
SE Crohi.LgJ"ilty, Wisconsin Y
THIS INSTRUMENT DRAFTED BY: r
Steven B. Goff
+ Bye, Goff & Rohde, Ltd. All,
8 L' C
,
PO Box 167 _
t River Falls, WI 54022 - 5
SBG\Schultz\Warranty Deed - Wines ~1
FAX
ST. CROIX COUNTY ZONING OFFICE
1101 Carmichael Road
Hudson, M 54016
(715) 3864680
DATE:
TO: Fax Number. UJ 1
Name: 1 -7
FROM: Fax Number. 3864686
,OG~ -
Name:
Number of Pages Including Cover Sheep
IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE
CONTACT:
NAME:
TELEPHONE NUMBER: g - klb o
ST. CROIX COUNTY
ti WISCONSIN
ZONING OFFICE
n x x u u x„x _ ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
May 26, 1998
Jeff Wines
1300 Industrial Street
Hudson, WI 54016
RE: Septic Inspection for Jeff Wines located at 342 Soo Line Road, Lot 71 of Glover Station,
Town of Troy, St. Croix County, Wisconsin
Dear Mr. Wines:
A septic inspection of the above referenced property was conducted on May 15, 1998. This
property is located in the NEY of the SW1/4 of Section 16, T28N-R19W, Lot 71 of Glover Station,
Town of Troy, St. Croix County, Wisconsin. At the time of the inspection, this septic system was
found to be code compliant for a four (4) bedroom home.
If you have any questions regarding this, please contact our office at (715) 386-4680.
Sincerely,
oz t IC-0-
Rod Eslinger
Assistant Zoning Administrator
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