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HomeMy WebLinkAbout040-1080-20-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT Rem 0 OWNER co ORD? emu' ADDRESS_ ? ~Z ®xY4A. Z" . w ~lol 38 /1 ~ s LONINu Owc' y; SUBDIVISION / CSM#-VAt LOT SECTION -"-Z6 T 2(YN-R_2t_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF ~YS M I ~ -7L r /PIC Lam. acfu~Y 0 . • r a~ P y I/ 1y' R~ 6 T INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. s.T, rM l~f i~ s:T. ~u/~~ BENCHMARK: 0/ ALTERNATE BM• :GEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: e-~cr Liquid Capacity: / p4D Setback from: Well House Other * 3 8?-r Pump: Manufacturer_ 4,u (o Model# ~yEO3L Size Float seperation F" Gallons/cycle: Alarm Location 4 fF~I'e is OC-74~~ 4f h- 33 SOIL, SORPTION SYSTEM Width: Length 76"' Number of trenches o_~ J ~~wll D sta. ce ^irection to nearest prop. line: Setback from: well : ,l/,J1" House_ Other ELEVATIONS Building Sewer h/.7 ST Inlet:/a2, y1 ST outlet: 1,92.27' PC inlet fp PC bottom & , ; Pump Off Header/Manifold_/o, Bottom of system ZD9, -?I ~o~• Existing Grade Final grade DATE OF INSTALLATION: D 1 F~ PLUMBER ON JOB: LICENSE NUMBER: .2.z~~ INSPECTOR: 3/93:jt t Wisconsin Qepartment of Commerce PRIVATE SEWAGE SYSTEM Count SAfey and Buildings Division INSPECTION REPORT bT • CROIX iff GENERAL INFORMATION (ATTACH TO PERMIT) SanitarX~v4v G Personal Information you provice may be used for secondary purposes [Privacy S-15.04 (1)(m)), Z 7 Permit Holder's Name: f1i„❑ Village Town of: State Plan ID No.: SIMENSON, SCOTT 'I Y S M ev.: Insp. BM Elev.: BM Description: arcelbidtlQ.1080-20-000 G~ , 0~ /G.1, G) So- e a-,, ( P(--~ 0 03 TANK INFORMATION ELEVATION DATA A9700217 7115197 - G TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s ~n e , Gov, Benchmark ti Dosi4:s 6111, Aeration_ Bldg. Sewer H ng M St/ Inlet 02, 33~ TANK SETBACK INFORMATION St/,0K Outlet 53' I~ TANK TO P/ L WELL BLDG. Ventto Intake ROAD Dt Inlet 13,79 Septic ® ,~,f( NA Dt Bottom 7, Dosing NA Header / Man. 3. y a~ Aeratio NA Dist. Pipe 3 / Ho! ' g Bot. System 10,73' PUMP /-SIPN INFORMATION Final Grade Manufacturer Demand ~6P o ! s..~ : / el, 19 Model Number GPM TDH Lift Friction System TDH Ft 7~ Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Li Depth DIMENSIONS DIMENSIONS LEACHIN Ma urer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O CHAMBE Mo eIN um er: System: m ownd OR UNY DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 1 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 El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 20.28.19.313,NW,SW 248 CARLSON LANE -4 Y 1I t ~ r i~~ Q' / f\I £.C./ C~ c! -LO C . "Plan revision required? G3 es ❑ No Use other side for additional information. IT I Ll SBR-671 0 (R.3/97 Gt_ ~_„-,F,_- Inspector's Signature Cert . No. 0M/ ~ t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: u' Safety and Buildings Division rrt~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 than 8 1/2 x 11 inches in size. IVY. 6 • See reverse side for instructions for completing this application State Sanitary Permit Number --~V 4/Da~ The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. . State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION SQ -~d7 Property Owner Name Property Location r•,yC 1/4 W 1/4, S Tip , N, R E or -.Fop 47L 2,0 Property Owner's Mailing Address Lot Number Block Number 2t t City, State Zip Code Phone Number Subdivision Name or CSM Number 1QN cam! ( > S II. TYPE BUILDING: (check one) ❑ State Owned ❑ !tyy Nearest Road ❑ Village ~ls Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town of r~o L III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number 1 ❑ Apartment/ Condo O O • J10 ,2c 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. [Z New 2. ❑ 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 210 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 `f.S'V .373-- 3jS , L Feet Feet VII. TANK Capacity in gallons Total # of Prefab. site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass Plastic App New Existing strutted g Tanks Tanks Septic Tank or Holding Tank r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY ATEMENT I, the undersigned, assume responsibility for installation oft nsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No St ps PRSW No.: Business Phone Number: e--. ~ M 1, 14 umber s Address (Street, City tate, Zi ode): IX_ COUNTY/ UNTY/ EPARTME TUSEONLY01 ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Age t Signatu No Sta s *pproved ❑ Owner Given initial ~1 S hargefee) -Ile Adverse Determination ~11 C% X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system isto 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. . ~r v /`l H~ G it X h f ~3 yo s~c2€s p lrlr afG~ aslant q . SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations June 23, 1997 15837 USH 63 Route 8, Box 8072 Hayward WI 54843 FOGERTY PLUMBING BOX 130 ROBERTS WI 54023 RE: PLAN S97-20587 FEE RECEIVED: 180.00 SIMENSON, SCOTT NW,SW,20,28,19W TOWN OF TROY COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and. chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincer ly, homas L. Bfaun Plan Reviewer (715) 634-3026 7:00 - 4:30 3777R/ 1 SHDA-6928 (x.10/94) 655 O'Neil Road • Hudson, WI 54016 Reg. Designers?t Engineering Syste;- • 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I .D. I/ S97-20587 Date June 23, 1997 Owner Scott Simenson Phone 715-381-1295 Address 722 Fox Tree Lane, No. Hudson, Wis. 54016 Legal Description A 9.47 Acre parcel . Tax # 040-1080-20. NW 1/4, SW 1/4, Sect. 20, T28 N, R19W Town of Troy County St. Croix C.S .T. David Fogerty CSTM 3233 Installer Local Authority/ Supervision St . Croix County Zoning Dept. PROJECT DESCRIPTION New construction. For a proposed 3 bedroom home. Estimated daily wasteflow: 450 gals. Per soil report , soils are permiable in the upper 12" ( . 5 GPD/ft2 ) but underlain with dolomite ( fractured limestone) at 27" • 10. 11..41!' .i I,7L / ,1 e,.Li �.+ /� D i L1[//Sc L uw.AJt. A long narrow mound system using 24" sand fill is proposed. SCpNs4r - . ROeERT W. uLsnICHT \ 01160 HUDSON,WI ° 4SIGCS molinuntakoor Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS P•O.W. .B. Pg.3 PIPE LATERAL LAYOUT COndigkiallY Pg.4 DOSING CHAMBER CROSS SECTION APPROVED DEPARTMENT OF COMM Pg.5 PUMP PERFORMANCE SPECS 77:77177,77101 SEE COR S71 PONDENCE This design for installation is based entirely on measurements, elevations, landscape conditions (slopes etc. ) and soil suitabilit Theaccuracy of his specs, as re y provided by CSTM of the CSTM. Forted, shall remain the sole responsibility Any use of this POWTS design by any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet/frozen soils) by any such parties or persons. S97 - 20587 ,Vp . Lot G fevu_2 L ,( A x , IL 'if k /e00 (J- /0A1 -( .5 r �iPopas� �E// ,e,rc T /\ 0 "'/ se�LL " =4/0 3 / /3 E PipM /5 A • = /3,4efriax P/'rs y f Ho o \ - \ oA';oEw4 y CST S 8,, -- Tor of .y "- / ivoo p Pos r w/ /3ie2 i \/' 170 X r /69c3 - — - i_ __ _ 133 I 5To ICI 1 II I I I ►I 1191 ---,..:_ /00 0 s-S. P,e&-(4-ST- 1 I AU.y, e- a.._ /. ' o I I l 9S 8 I I i1 3 I lot a " /6c s . �o De area 15 It, below the downslope edge of th _ _ _ _ 1 .,f.c&--. yq,,(,, loll IIkoOioe Spill ma i moil mishit ii______ _ 3z C s7'. WA///WA-1 e,,,ti Tot,/C 4/A-/E- 1-� /0 f - /0 7, 70 p 2 f5 CROSS SECT I0 OF MOOD D ' W i r ti 13ED 1Eo eF % '' ro I ' Ayges-SATE- D1 ST Ri(3OTt o,V G• , Tkic.kp.sc-ss PIPIN �- sysrEA of roP soft_ IEvArloa Uui Fo9M ToE ►r /09.. 70 1u ,p N " t-I'&) E I . . r j r oG<< 1 . it I I Rh?�0 ,I MEI,. • `E . • �33 . ,i ' SAND , • • 1 //��� /// plowt° ToPSoi �— --_____`_ ri woiFd M R c 7o SIopE F°RcE lt>ATtot,) UNDER MAW REP /O 7. 70 ' ) 2 .° Fr. — ELEvArIoo s ` it E 2 . z5 Fr. • J vE,Rr of /2. IAT€Rn ( S /70• 20 F FT. • TopOF Rock //O..6- G /. � FT. i „ / H TO FT, ' Top OF �_Z IATERAIS //D• 3z/ 1 I PLAN VIEIAJ OF MooAiD - uoini BED GE/vT ic'1'L r�. FoRcE MAi>U A •C. FT. 1.- L -- -- . 1 B 160 Fr 1 K / FT I' - B .I T L /� Fr _o_ I- \ a /e w '' _ _ - - -- - - - -j' 1 FT K _,1 a - i I / 8 Fr O VI Z w 33 L Fr vs J Bev of Y2 �, 2 PVC- (Appel:. Tb �!y" o(35RVATto� 99RE5ATE P pEs PERMAo .AjT MARKERS REG ViREC) (3ASAL hReit ` -mill toh5rEFIo(4.2 y3i9 .6r0 _ sc,IL 10-rorcAT)5E . 7 6dt. FT, PRoposEp BAtsA-1 AiRei‘ = (3 )( ( A + z /70' Csp. FT. /;h J Q"i a Vow �v/qM rKw .3c F r o f 2 PVC FOPce MA/Ai .:75_ catiS - • 7)/ACE /ts r 40/E Perforated Pipe Detail ZyRi6tir f,e 1//11i' i6 v/Icv4r"oAv 0 End View Perforated End Cop) / ; �jl PVC Pipe 1 .{� Jai,o)`o^ce W p`e Holes Located On Bottom, Are Equally Spaced '2''' '-> . PVC Force Moin P Distribution Pipe lost Hole Should Be Neal To End Cop End Cap Distribution Pipe Layout P 36' Ft.. .i . fd,;4--z-- UD/t $4-, - of X 3(e Inches Y ' -::4InchesAA€ rio oe it &_115Y Hole Diameter I/ Inch Lateral " Ali_ _ Inch(es) Manifold " — Inches Force Main " 2- Incf.es # of holes/pipe i3 Z° Invert Elevation of Laterals ��� Ft. • D% 5TEZi6UI- O,, 1),1SC -{A RvE RATE FoR E-Atc F} • LATER AL 1 pkr- OTiS 27 /y .• 2-1 . 1-4-ep-if/J . TOT A1— -Di STR113urfo� DScHARG E RATE FOR k3e Two RK. 30. y2.---- _ a ,,,, g) a . 5 •Mi 'ifMVO hit >E A D • PUMP CHAMBER CROSS SECTION AMP SPECIFICATIONS — P4,IE I of 5 f �r✓ VENT CAP 4' C.I. VENT PIPE APPROVED LOCKING WEATHER PROOF JUNCTION BOX MAIJHOLE COVER 25' FROM DOOR, T- L✓/CU4iF Utv(i �>'14E/ WINDOW OR FRESH 12"MI►J. I FIR INTAKE I •icApr i/E till/On/ GRADE I Li"MILL 4/4 i I ..r, YI/O. a 1 ,/ CONDUIT \ s - _X _ h V \,k ' r. leVIri °v 1 \ ----- _ /o7 PROVIDE I c -� — —a INLET —1- 5 AIRTIGHT SEAL I III 'pE III APPROVED JOINTS APPROVED JOINT A IN �a�� III W/C.=. PIPE W/C.T. PIPE , rJ��U/O I I EXTENDING 3' EXTENDING 3' I ALARM OIJTO SOLID SOIL OEITO SOLID SOIL U 7' I ( lD B 1/ I/ 0, 3' ) I 3q1 IboN C I F LEV. FT. / PUMP-� OFF /-(,,, 31_,OP/A)3 �A�1 I. 1?)( (' BLOC H 1 7/1•0/'� X RISER EXIT PERMITTED OIJL`J IF TANK MALUFACTURER HAS SUCH APPROVAL SEPTIC E y� SPECIFICATIONS C DOSE /CS /Ct (D-CJG Q LUMBER OF DOSES: PER DAy TAIJKS MANUFACTURER: TAMK SIZE : /0�� GALLONS DOSE VOLUME (/ 5 � . FI-0CTRo INCLUDING BACKFLOW: /�� GALLONS ALARM MANUFACTURER: MODEL NUMBER: CAPACITIES:/v/ � CAPACITIES: A. 11,7I►JCHES OR 3� GALLONS /'-1 E f (0J P y F/o, 7— SWITCH TYPE: g= INCHES OR C/ GALLONS /� PUMP MANUFACTURER: G 0 L-DS C= ` INCHES OR /5 GALLONS 388 5' P16 v3 I- D= /� Q�z INCHES OR �/ l- GALLONS MODEL NUMBER: G/ pp SWITCH TYPE: P155Vt�+c MEQCUPI� F1DAr NOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE 3C✓' GPM SP[GS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE 2.5 FEET EAG(.1,. t 0i- � fJ itt -f- _35 FEET OF FORCE MAIN X 2 ' °5 F/ FRICTION FACTOR.. ' 70 FEET t40n f S Z5, Cow . Woo it. ((,, t 14/ = TOTAL DYNAMIC HEAD = J'/d FEET /0 ~ 86, LIQUID DEPTH 39 ' INTERMAL DI MENSIONS of TANK: LENGTH ;WIDTH Q Submersible " Effluent Pumps . I 3885 Vi , • 1 AVAILABLE CERTIFICATIONS ER LISTED SUBMERSIBLE PUMP to Pt CLASS I AND 11 DIV.2 AND CLASS III DIV.1 AND 2 ETI TESTING LABORATORIES,INC_ ;y, ,.� CORTLAND,NEW YORK 13045 G1086131480 4 CANADIAN STANDARD ASSOCIATION sp PERFORMANCE RATINGS(gallons per minute) MODELS WE0511H WE0511HH Series HP Volts Phase Max.Amp. RPM Solids WI.(lbs.) Series WE0512H WE0712H WE1012H WE1512H WE0512HH WE1512HH WE0311L 115 9.4 No. WE0311L WE0311M WE0532H WE0732H WE1032H WE1532H WE0532HH WE1532HH WE0312L 230 q.7 WE03121. WE0312M WE0534H WE0734H WE1034H WE1534H WE0534HH WE1534HH /3 1750 56 HP /3 1/2 /2 %4 1 1/ %2 1% WE0311 M 115 9.4 RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0312M 230 1 4.7 5 100 70 80 90 106 — 60 — WE0511H 115 13.0 I10 80 65 76 87 102 112 56 84 WE0512H 230 6.5 15 60 57 72 84 100 108 53 82 WE0532H 208/230 3.4 a 20 36 45 65 79 95 105 48 77 WE0534H �2 460 3 1.7 60 25 25 59 74 91 100 45 75 WE0511HH 115 13.0 3 30 50 67 85 96 40 72 WE0512HH 230 1 6.5 35 40 61 79 92 35 70 WE0532HH 208/230 3.3 ra 40 26 52 72 86 30 67 WE0534HH 460 3 1.65 ,/4„ 45 10 43 64 80 25 64 WE0712H 230 1 10.0 50 30 54 73 18 60 WE0732H 3/4208/230 3 5.4 3500 I 55 17 42 65 12 58 WE0734H 460 2.7 60 6 30 54 3 54 WE1012H 230 1 12.5 70 0 ilu5 16 40 51 WE1032H 1 208J230 7.0 =.1 70 5 26 47 WE1034H 460 3 3.5 75 14 43 WE1512H 230 1 15.0 80 4 40 WE1532H 208/230 9.2 `j 90 33 WE1534H 460 3 4.6 100 24 WE1512HH 1/2 230 1 15.0 80 110 15 WE1532HH 208/230 9.2 120 5 WE1534HH 460 3 4.6 metal parts, BONA-N elastomers. METERS FEET • Temperature: 160°F(71°C) 90 maximum. MODEL 3885 • Fasteners:300 series 25— 80 SIZE 3/4"Solids stainless steel. • Capable of running dry 70 wE,sH without damage to 20— WE10H components. 0 60 --O.- 5GPM w WE07H 5FT Motor: _ • Single phase:'A HP, 115 or Q 15— 5° 230 V, 60 Hz, 1750 RPM; o wEosH V2 HP, 115 V,60 Hz, ao 3500 RPM; '/2 HP through 10- !_.wEo3M 11/2 HP,230 V,60 Hz, 30. 3500 RPM. 20` WE031. Built-in overload with 5- automatic reset,class B insulation. 10 • Three phase: '/2 HP through o_ o' 1 Y2 HP,208/230 V, 460 V, 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 60 Hz, 3500 RPM. i I i • Class B insulation, overload 0 10 20 30 m3J1, protection must be provided CAPACITY in starter unit. 11 8 Wisconsin Qepartment of Industry, SOIL AND SITE E V A L U A E P O R T Page #Labor aril Human Relations 9 of 3 rvision of Safety 8 Buildings in accord with ILHR 8 *i COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches i ~ie:/Plan n th` bu not limited to vertical and horizontal reference point (BM), direction n~i'% of slope, sc~Il~l PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro d:- ,f) APPLICANT INFORMATION-PLEASE PRINT ALL INFOR T`ION STC DqQ? REVIEWED BY DATE X PROPERTY OWNER: a CATIO Sf SZ-~~ P'L V TO ~'S~ 1/4,S T y N,R /;r E (oc~ 1v - PROPERTY OWNER':S MAILING ADDRESS I C~ UBD. NAME OR CSM # 7 z le LA io ACS CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ErOWN NEAREST ROAD New Construction Use Residential / Number of bedrooms T [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow '02~ gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 X trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) /0 7.7 ' ft (as referred to site plan benchmark) Additional design / site considerations 1 u7wo Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system El S ZU B S El U 1:1 S e[ U ❑ S B U S❑ U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench / o S 3 JrL L i!/ S Z 2 Ground Z r_ s _rAe A21 z s elev. left. -7 _ z - LSI37t - - v 0 Depth to limiting factor -Z Remarks: Z~ Boring # Z_ F -S /YI 49 , t -Vy IF Ground 3 o s sL 3c s~X GS / - elev. /DZ ft. L S Iyr R e 5 y S Depth to ' - yg - 6 7. - s 8 S a c s B/~ F s . a limiting factot Remarks: #,114 # 09. c1 CST Name: lease Print !7 , Phone: 7 - 36s-6 Address: a 30 0 cv~ 2~1 Signature: Date: CST Number: 6 s 1~s3 PROPERTYOWNER AP741- rfiiysodl SOIL DESCRIPTION REPORT Page of 3 PARCELI.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench •44 L•v su'-'-}}'•-Lti ~r: 9 S rL /yt L ~ Z 2- 7 Ground 3 / -3 7•S - SL /mss CS o elev. _ !p 7, 7L ft. S .'r - -TAY, s L c Ay S S Depth to S 9-~6 LS BR , D limiting factorS9 Remarks: Boring # d L G//~ 2 S E Ground elev. ✓S 4 p) Z o w4 L e w ft. Depth to 7 limiting L p c Se factor Remarks: Boring # x. Ground elev. ft. Depth to limiting factor Remarks: Boring # n4':~ Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) fi otY~Rgg023 ROSE ml phone 749-3656 ,Jcs1~j~ i~s+oarcri wEs~ ~F p1G~ I #1 N v /80v 5 Y~ ,4cc~r d /3r+, ~ %oj' aF Y T wvoeG~n ~os'f' . 6i rq/~1 v uSC /~9" HrNe /G~ D ` ffs< ~r©Hf s~+kes i /07 7 s~ ?tv /ie ES w ~Hl C ~Z /(~ijt ~rb~lr 7~ N C in IIVP i GNOMON a 8 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„~~ Location of property /x_1/4 zz,, ) 1/4, Section .Zd , T _:!?,P N-R__Zf W Township I, Mailing address -712 ; i ac j rrc avt o Address of site ,v Subdivision name Lot no. other homes on property? / Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created /?y'-->- Are all corners and lot lines identifiable? _j-,--::Yes No Is this property being developed for (spec house) ? Yes -IZNo Volume _ 7 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. N7~ 79 7 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. H 79 ?97 nature f Ap ant Co-Applicant Date of Signature Date of Siqnature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER r~lc. tasd~'t MAILING ADDRESS 712 ~fi ~c L y . /U • ~cPl~sc. Wes- ,t/~ PROPERTY ADDRESS 5~ Cin L.~ (location of septic system) Please obtam from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, -s W 1/4, Section T c5P,, 0 N-R W TOWN OF ( 0 l ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP VOLUME PAGE LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can .affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ex i ate. SIG DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 j F, E RESCRVED FOR RECDRC ING DATA t ocuMENT NO WARRANTY DEED aTATE BAR"nF WIS NS[N ( L-1982 it 4'79' 93 l °a~t REGISTER'S OFFICE VOL - ST. CR(`IX CO., WI Recd for Record Richard A. Karlson and Carol Z- Karlson, FEB27199, husband and wife . _ at A/K/A Richard. Karlson A/K/A Carol Karlson 8'30 A. Scott E. Simenson- and Linda conveNs and warrants to Register of Deeds A. Simenson, husband and Wife- S. 4 ~ lu J!. 4.~►- ~ i,i ~J~tt~_Z St-- the foll.,wing described real estate :n Croi-x. cou rty. state of Wisconsin: Tax Parcel No- see attached le-al !lescrintion J E a/k/a Carol Karlson a/k/a Richard Karlson r:~! AUTHENTICATION AC';N(I W LEDGMENT i F in Alk/"a Ril-hard Ka rI )Ti ind Carol harlson i NW% of Sw~ of :section 20 8 ' X37 214 TOGETHER WITH and SUBJECT To a 66' wide strip of land*..for ingress and egress purposes lonated in the NW4 of the SEk, the,NEk of the Swk, the SEC of the SWI, the SWk of the SWk and in the.NWk of the Swk of Section 20-28-19, Township of Troy, St. Croix County, Wisconsin, more fully described as foljows: Commencing at the Wh corner of said section 20 thence S88 4038"E along the East-West Quarter Section Line a distance of 3379.82.'; thence. SO 4615311W 17.5C'; thence Southwester .'y 15".34 along the centerline of-Carlson Lane, alao being the arc o& a '100.00' radius' curve concave so8theasterly whose. long chord. bears S46°16'32".W 140.201; thence S1 46111"W 436.75' to,the :point of beginning of- the centerline of said 66' wide easement,bejng 33' on'.either.side.~en0 at right angles to the following describe4 centerline;, thence N87 49'06"W 617.37'; thence Southwesterly 311.42' along tie arc of a 270:00!' radius curve concave sogtheasterly whose long cLord bears S59°08'19"W 294.441; thence S26 0514611W 509.31'; thence southwesterly 322.811., along the arc of a 381.47' radius curve concave Northwesterly whose'-long chord bears 558 57105"W 305.41'; thence IM 1 1 i 3 I "W 723..80' to the end of said centerline, thereby t4_1n211wwit,; F'E` E.PIED FP011 - - i+2: 1~.1 11 5 o p a 1