HomeMy WebLinkAbout040-1239-90-000
CE
STC 104 AS BUILT SANITARY SYSTEM REPORT
OWNER G ADDRESS ~ SUBDIVISION / CSM# r'GG vC-~~ ~S ( LOT #
SECTION .2 T N-R W, Town of ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERY HIN WITHIN 100 FEET OF SYSTEM
a
v~
7, C,
1.2 e
~a
0 `
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: rg~'.S'e- 7` T`me
ALTERNATE BM: Xe y
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:- A2,2,J-t Liquid Capacity: Z,2Go
pl-" 77(T d
Setback from: Well House ~y Other
Pump: Manufacturer__,-'~0,5'/~,;~/d Model# Size 3
Float seperation 7 Gallons/cycle: 1 ':-z-
Alarm Location 20 a _,V C--'
SOIL ABSORPTION SYSTEM
Width: `3 l Length Number of trenches /
Distance & Direction to nearest prop. line: 3_D'
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: e5i7
PLUMBER ON JOB:
LICENSE NUMBER:
~/f'
INSPECTOR: a~
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and L4uman Relations INSPECTION REPORT ST. CROIX
S3ilety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No_: GENERAL INFORMATION 284344
Permit Holder's Name: ❑ City ❑ Village own o : State Plan ID No.:
VITALE, DOMENIC TROY
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax
/w ~ 0400-
-1239-90-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air 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 mead
Forcemain Length Dia. Dist. TO well
SOIL ABSORPTION SYSTEM
BED/TRENCH ;WidthYS Lengt h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
SOS -
I N
DIMEN I N DIMEN
LEACHING Manu acturer:
SETBACK TEM TO P / L BLDG WELL LAKE / STREAM CHAMBER
Mo a Number:
INFORMATION pe O OR UNIT
System:
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded =Ye
Bed /Trench Edges Topsoil E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Cur Qy a~Q~_
LOCATION: TROY.21.28.19,SE,SE 583 CNTRY OAKS CIRCLEI40T 16
00, 2
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. LLLJ F
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH t
SANITARY PERMIT NUMBER:
Y
1
W" ar ^ 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
than 8 112 x 11 inches in size. 1,1k. /
• See reverse side for instructions for completing this application State Sanitary Permit Number
84344-
The information you provide may be used by other government agency programs ❑ CtiecK frrevision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
G 1 /4 e 1/4, $ a j Ta f' , N, R/!? E (Or)
Property Owner's Mailing Address Lot Number , Block Number
'P.;./ ~r
City, State Zip Code Phone Number Subdivision Name or CSM Number
. TYPE F WILDING: (check one) ❑ State Owned ❑ citlyy Nearest Road
E] Public 1 or 2 Family Dwelling - No. of bedrooms El Towage OF tr . Co~Tr j 0,t-X'
ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 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
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. K_New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 K 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) c~ Elevation
0 Ccc) O Feet ?'s y Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ,r , ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1:1 El
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: ( oStamps) MP/ PRSW No.' Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing Agen r o Stamps)
Approved F1 Owner Given Initial Surcharge tee) / j. fl
GtZ; .[C f/I
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counl y, One copy To: Safety & Ruildings 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, 608-266-3815.
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-
11. 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 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot phan, 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 establisA-men-t of standards.
i
• SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Commerce
April 24, 1997 2226 Rose Street
La Crosse WI 54603
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
RE: PLAN S97-40273 FEE RECEIVED: 180.00
VITALE, DOMENIC
SE,SE,21,28,19W
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.
Sincerel
and M. Swi ° RECEIVED
Plan Reviewer
Section of Private Sewage Q' OR 2 S 'T (608) 785-9348 0 v~~
zCnvli OFM
,.C
SBD-7997 (R.11/96)
Page of b
RECEIVED ,
MOUND SYSTEM s
APR 2 21997 = FOR
SAFETY & BLDGS. DIV. A BEDROOM RESIDENCE
LOCATED IN THE SE 1/4 OF THE SE. 1/4 OF SECTION Z 1 , T ZS N, R l9 W,
TOWN OF -yA7Ml f S-'r' CxLeb( COUNTY, WISCONSIN.
INDEX
PAGE 1'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
~l6~IU~ bQ.
\S6611
F~ P L-C V`C, W~ N S S l 2-~
PREPARED BY
WEGEE~EF~ SOIL TESTING
AND .
z~1~s = CN s~i~v I cE ' •SCO~►~
P.O. BOX 74 421 K. KAIK ST. '
RIM.. FALLS. KI 54022 j ARTHUR 1.
r, ,C7 715-425-0165 we 7'R
WORTK
F"~ ~ ~rF1'3 a.., l.. r►_ ~~tp~b ~,V~U 117 1`
t, eu
ILI
0
SSE cO~ JOB NO. `7 ' 7
PLOT PLAN Page Zof (6
i
Scale 1"= 4cj'
~r
4op~~ ?o
Cov►s~-~ p
L~ ~S sr~z
rv~g
_w~u-'rte=~~ ~ ~.~eT so'_. ~,►o~
t~'r Ll~c sT Z S FI-Mki Tom`,-S •
S•3
t; r- 11 P, Q C F.
-G ~S ~ t~OV SF
►o of
8.2 q"PV C
-1
i
~ o~slvv~ Tt~1. S Pry-~~y.
9
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. ( t required)
4.-Septic tank to be \ZAO gallon capacity manufactured by
't'~tDW ~►ZQ 3T4 live. 1,-Lp-lP `T*,.%,k 1-0 3e wt~Dw looO G+t1- -TAU" L.
5. Bench Mark ?A+~ 1- tL o. 0' o" aPae_-Gi= 29k ~ xaCU -
T,aM 4 L F_r- 44.Zp ay ~ p 01= TL" wM C3oY-
6. Divert surface water around sys tem to. prevent- ponding at the uphill side.
I
-Page 3. Of b
Approved Synthetic Covering
rrs-r" C.33 Distribution Pipe
Medium Sand
Topsoil H - s= G
3 E D
hb
9 % Slope
Bed Of 2- 2 Force Main Plowed
Aggregate From Pump Layer
D 1.0 Ft.
Cross Section Of A Mound System Using E Ft.
F o.8 Ft.
A Bed For The Absorption Area
G t.0 Ft.
A 8 Ft. H V. S Ft.
Linear Loading Rate= q S GPD/LN FT B 63 Ft.
Design Loading Rate=D•y GPD/SQ FT j Z6 Ft.
J -7 Ft.
K Ft.
e Pasttton- L $S Ft.
Of-
Femme-A4_ W 3 1 Ft.
L
Observation Pipe
01
A I - - -
W ~o Force Main
Distribution \,,,Bed Of 2M- ?
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page of
Perforated Pipe Detoll
0
End View
Perforated
End Cop.) v~6e PVC Pipe Install permanent-marker
i Ja~~ s~ao~ at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
PVC
Manifold Pipe
Distribution
Pi e
Last Hole Should Be I
Neat To End Cap
End Cap
P 30 Ft.
Distribution Pipe Layout S L] Ft.
X L_ Inches
Y Inches
Hole Diameter )1Y Inch
Lateral ) Inch(es)
Manifold Z Inches
Force Main " Inches
# of holes/pipe
Invert Elevation of Laterals 9-1-9 Ft.
t,
Place 1st hole Z~ from center of manifold with succeeding holes
at 4$" intervals. Last hole to be next to the end cap.
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE - OF 6
VENT CAP
y"C.L VENT PIPE 7 WEATHER PROOF
APPROVED LOCKING MANHOLE
10' FROM DOOR. JUWCTIOIJ 80X K COVER WITH WARNING LABEL
wimDOW OR FRESH Iz'Mitl. I
AIR INTAKE I
GRADE
4a, go* F a .4 Pi L 1.
~ ~ Ie•Mlu.
COWDUIT--
18"MIN.
PROVIDE I
IAILET 7 AIRTIGHT SEAL I III
I II v
APPROVED JOINT/ A Tank construction shall comply I ICI APPROYEO.1o1ruTS
with ILHR 83.15 and ILHR 83.20 i .-III ALMA
6 'I II
I I
I I ON
C I
- - 83.0 o I
CLIV fT. PUMP-~
~ OFF
• O
z!'L $ Z CONCRETE CLOCK
3" APPROVED
RISER EXIT PERMITTED OWLI IF TANK MANUFACTURER HAS SUCH APPROVAL. UDDIN161
SPECIFICATIOAIS
DOSE . ~H~bw>J PsT 3. b Z
TAr`IK MA~JUFACTURCR. NUMBER OF DOSES: PER OAy
TANK 51ZE: lZoo GALLOWS DOSE VOLUME t
S. 2 • -LeC D s~ST S INCLUDING DACKIFLOW: 18Z"
AaARl+1 MAtJtlFACTURER.• GALLONS
MODEL IJUMBCR: IOL 1~ CAPACITIES: A= ~7 INCHES OR . GALLOIJ3
SWITCH TyPE: Z'
INCHES OR 4(►LLOLI5
PUMP MANUFACTURER: C~OI~L pS C- 7 I1JCHE5 OR 18 Z CALLOUS
MODEL NUMDER: 3a~ L - E'O Da NZ INCHES OR 31Z' GALLOWS
SWITCH TyPE:
NOTE: PUMP AMD ALARM AR TOO bC ,
MIIJIMUM DISCHARGE RATE 3`)- GpM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEEU PUMP OFF AUO_OISTRIBUTIOU PIPE- 14-20 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE • . • 2.50 FEET
+ LOO FEET OF FORCE MAIN X 1~I F~0 FL FRICTION FACTOR._ I•~~ FEET
10
TOTAL 0SUAMiC HEAD = FEET
DIAMETER -
INTERNAL. DIMEWSIOMf OF TANK: LENGTH ;WIDTH - LIQUID DEPTH 38 ~Z
BOTTOM AREA - - 231= GAL/INCH
AS PER MANUFACTURER = Z6.0 GAL/INCH
Goulds °r
Submersible
Effluent Pump
f
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 manual operation. Automatic and float switch attachment
• EP04 Single phase: 0.4 HP points.
• Heavy duly sump , models include Mechanical
115 or 230 V, 60 Hz, 1550 ■ Power Cable: Severe duty
• Water transfer RPM, built in overload with Float Switch assembled and
• Dewatering preset at the factory. rated oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing
115 V, 60 Hz, 1550 RPM, construction.
Pump: EP04 built in overload with ■ EP04 Impeller: Thermo-
• Solids handling capability: automatic reset. plastic Semi-open design
3/4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. sp• canadianSwridardsAsmWon
• Total heads: up to 24 feet. with three prong grounding 0 EP05 Impeller: Thermo-
• Discharge size: 11h' NPT. plug. Optional 20 foot (GSA 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 (600C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10-
• Capable of running j
dry without damage to s 30
components.
Pump: EP05 $ ; - j
• Solids handling capability: c 7 25 ! i
maximum. a I
• Capacities: up to 60 GPM. = i -Z 0-%A
• Total heads: up to 31 feet. E s 20 I
• Discharge size: 11h" NPT. Z 5
• Mechanical seal: carbon- }
rotary/ceramic-stationary, Q 4 15
BUNA-N elastomers. o
• Temperature: 3 10
104°F (40°C) continuous
140°F (600C) intermittent. 2
5 ,
1
0 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m~/h
CAPACITY
O 1995 Goulds Pumps, Inc. Effe*m May, 1995
83871
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of l
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. #
pqo 0039 - q~
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner , Property Location
Gc Govt. Lot S 1/4~! 1/4,S / T f N,R E (o&
P/Jr perty/Owner's Mailing Address Loot If Block# Subdd.. NName or CSM#
City State Zip Code Phone Number ❑ City ❑ Village fV Town Nearest Road
, l-e- Ua`/e 1' oa~1'' Ga S^~~
New Construction Use: Residential / Number of bedrooms Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow SOD gpd Recommended design loading rate 1 S- bed, gpd/ft2 , 6 trench, gpd/ft2
Absorption area required 04 bed, ft2 trench, ft 2 Maximum design loading rate ^_T- bed, gpd/ft2 , (:;~_trench, gpd/ft2
Recommended infiltration surface elevation(s) _ ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material % i` cy S",Y7- a dy`1s+ e,n1rT Flood plain elevation, if applicable ft
S Suitable for system Conventional Mound In G--T
round Pressure AT Grade System in Fill Holding Tank
U = Unsuitable for system El S 1Z U RS El U El S 2 U ❑ S U ❑ S [k U ❑ S NU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color ^Gr. Sz. Sh. Bed , Trench.
I/ C7 S"/ r d2 f 5'
Ground -3 ~3S 0 1 SIR y/ GEC. lm6blr b, F /F
elev.
Depth to
limiting
factor - 21" in.
Remarks:
Boring #
,~2 r2 D30 /6 .3 - si / 2hi5,6/J C S
3 a~ . t 4y - }~~i ~/G 5 G S /L tw
Ground y ~T Y2' " ~.v Qc~Jle 1^~~Q : arse 5
olev.
v
1051
Depth to - j
limiting l
f ctor \
O in. Remarks:
CST Name (Please Print) Signature Alo~-{
x ~5' -386' 1
Address
Date CST Number
~d e~ w ya~G y/7/ r7 g;2 7 990
PROPERTY OWNER _ ~ SOIL DESCRIPTION REPORT
t Page of 3
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
in. Munsell Cu. Sz. Cont. Color Texture Consistence Boundary Roots
Gr. Sz. Sh. Bed Trench
5 2 6'5s'b /f
02 Q-ad m 1,r,7 ~ z In Y
Ground o-SiG lit y G S:'~ a~1sb~ G s ~S G
elev.
9 eft. 4~ yb' /o ~'!G c %F S A 7/G 5c 4 l h~ 5g61-'
C ~
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to - -
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
~er~7 ,gym l
lc ~
,da5d: J
~/Y~~O~pow~rPit..d C,(~ IJ l~o~ Or
Bm~ rpa~~awBY yak ~d ~
J
h
v
U
RS
~ ~~op®sed "
~ Nowsc ~
e/
ti
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d
3
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S T C - loo
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
douse), then a second form should be retained and completed when
11
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property ffAT-"e,y%-;P I pa-r'k~'%,C, P, L~
Location of property_ 1/4 1/4, Section ,T N-R- W
Township mailing address 1.;-6
Address of site
Subdivision name Lot no. 1
other homes on property? Yes 1/ No
Previous owner of property
Total size of property
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 c---No
Volume LAlt- 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.
rROPERTY 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. e' , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co -!A[ip I i c a n t
I1nt o of flinnnt-11 -0 f girinat-iirp
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER MAILING ADDRESS _/S (o yt 4 z L/ o, Oil-41 Mae 5,61 l
PROPERTY ADDRESS _ 6'8 3 c o w'✓ 7V e- 0 1. -e-
(location of septic syst m) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION -'~T 1/4, 1/4, Section "Z , T Z °c 1V-R
'SOWN OF 'ro - ST. CRrJIL COUN'T'Y, V'1I
SUBDIVISION fir, L, ,j of Ak-5 LOT NUM13ER I_
CERTIFIEDSURVEY MRP &405 , 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 replncement 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.
Tlie 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 st b c m ted and returned to the St. Croix
County Zoning Officer within 30 days of the three year e. it i C.
SIGNED:
DATE: 27
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11193
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554508 STATE BAR OF WISCONSIN FC -W 2 - 1140482
WARRANTY DEED
DOCUMENT NO.
Ray Galep, Robert L. Mackey, Laurence ~ ChC;; Co., VA
Murphy and Norwood Ec klund a as Racd ~aeoot0
aartnershiD property, JAN 15 1997
conveys and warrants to Dompn i c R V i a 1 n and t rt _ 1l 11:30 A.
Vi to ps husband ^nd wi fp, ac ..t4t.._, *k U•.c_;.
cnrvivorship maritsl rj p prey- Huyyt,t~tL,--ft
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TMs APACE RE3EW40 FOR RECORONG DATA
NAME ANDr TU1M19s -
the following described real estate in S t Cro lx County,
State of f Wisconsin:
PA:.CEL tOF"M CAnON NLOAMR
Lot 16, First Addition to Country Oaks in the Town of
Troy, St. Croix County, Wisconsin.
I SEER
This This is not
XxiXXX (b not) homestead property
Exception towarranties: Easements, restrictions and rights-of-way of
record, if any.
Dated this day of January 97
A.D., 19
(SEAL) (SEAL)
L urence Murphy Norwood Ecklund
(SEAL)
(SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Laurence Murphy, State of Wisconsin.
Norwood Ecklund ss.
authenticated this L
4*1 minty.
_day of- January , 19 9 7 k,,or„Ih, came bekwe „te this day of
, 19 , the above named
• Kristina OgLand
TITLE: MEMBER STATE BAR OF WISCONSIN
(Ir not,
authorized by 1706.06, Wis. Stan.) tr sine known to be the person who executed the foregoing
I lMrm nt And y6--4..tr t1..
535
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 81/2 x 11 Inches In size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and `x+201, t~
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD. IV
APPLICANT INFORMATION - Please print all Information. Reviewed
b~-
,Vate f ,
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
C7FFiCE
L 1f W,,U 6-5:- ~V/~ / RT'vaR Govt. Lot SE 1 /4 SF 1 /4, ~ T ~ N ~ E (orX
Property Owner's Mailing Address Lot ti Block# Subd. Name or CS
Gv 9302- Sao Th 14mE:7• llo : 4P,9,' 0V - y oh cis
City State Zip Code Phone Number 930 ,Town Road
RIVER- FADS W 1, .Sqo Ix (1/5 ) /f%' - 9o32 [:1 City ❑ Village Town Co vNTR O,,e!5' Ci
,PC/
NIP NOT p",y /r-,SV
New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑Public or commercial -Describe: N1jP NbT ,P~~pyyFwD
yso-
Code derived daily flow to Oo gpd Recommended design loading rate ' S bed, gpd/f~ ' G trench, gpd/ft2
Absorption area required SOO bed, ft2 trench, ft2 S G
Maximum design loading rate bed, gpd/it2 -trench, gpd/112
Recommended infiltration surface elevations 3
~ It (as referred to site plan benchmark)
Additional design/site co ations A-0 ~"uD i1. rt S i VP TI
Parent material ~ BL Ow ~S ~Tii{(~ O. 5,-f-7- st 1•YE'.vT Flood plain elevation, H applicable N tt
S = Suitable for system Conventional Mound In-Ground Pressur AT Grade~ System in Fill Holding Tank
U = Unsuitable for system ❑ S [0,-U 0S El
U El S ❑ S -U ❑ g 04 ❑ S [U
SOIL DESCRIPTION REPORT
Boring # FHorlzon Depth Dominant Color Mottles Structure Consistence Boundary Roots GPD/112
In. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh.
Bed Trench
0-8 /0 312 S./ 2- f 5h& .►M >c s , S , G.
-17 io 3/3 S.'. 2fsL~ 4Mjo s S.G
If-
Ground 3 17 -4~ 10 J/ ~J O Q
elev.
yf, eft. Es o vE a/o tiro
Depth to -
limiting
fac or
in.
Remarks:
Boring #
I - ioy,Q 311- Sam/ ~ f 6~ s , S . ~
2- Z '-10 /o y 3/3 .511 2,S4e 1xt, yCX eS /f .5
; • G
loy
3 31o( 5/-/ 2-4whe Y2
Ground /D Y V/&
, ~I SGL d //h N N
elev.
7o ft. NOVA ~,/2-
Depth to
limiting
factor SS S
3-5--in. Remarks:
CST Name (Please Print) RoGeR T- 2-1 L R Signature Telephone No.
R 1C 147- 7/5-306-6? 1~35
Address Data cCT Nermhar
c. Ak
PROPERTY OWNER SOIL DESCRIPTION REPORT T
Page 2 of
PARCEL I.D.# LO T I Ce _ CO u.aT p r 4AKS
Boring # Horizon Depth Dominant Color Mottles Structure 2
In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots
Gr. Sz. Sh. Bed Trench
2 f soot *,6e Is A" j-ft
z /o' 3 3 Si Z f'S~II~ n„ A C5 /f , S .
Ground
elev. 3 TA O 31 l w. 6 ~r~, f ~ kJ S , r t~
. ft. - / . f I
5C L o, At,-FR - - N
Depth to -F f
I Z
limiting if
fa
for ,
- In.
JeS5 Remarks:
Boring #
Ground
elev.
fl.
Depth to
limiting
factor
._in.
Remarks:
Horizon Depth Dominant Color Mottles Structure
In. Munseli Qu. Sz. Cont. Color Texture Consistence Boundary Roots PD/112
Gr. Sz. Sh. Bed Trench
Boring #
Ground
elev. -
tt.
Depth to
limiting
factor
in.
Remarks:
Boring #
Ground
elev.
tt.
Depth to
limiting
factor
in.
Remarks:
SBDW-8330 (R. 08/95)
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ULBRICHT & ASSOCIATES CO.
655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
SPECIAL NOTES TO THE BUYERS/ BUILDERS, REGARDING SEPTIC SYSTEMS
AND SOIL TESTING ON LOTS #8 THROUGH 20 IN COUNTRY OAKS.
All of the lots evaluated will require mound type septic
systems. With only a few exceptions, the soils across the
1st Addition to Country Oaks had very fine weak textured silt
loam in the upper 12" of topsoil (a soil loading rate of .3
GPD/ft2). These low soil loading rates will require larger
trench type mound systems by design codes. Trenches can be no
wider than 48". It is suggested, to the installer, if a 4 bedrm.
home is proposed, some test areas provided may not be lonig
enough for a single 41x125' trench, in which case a wider mound
utilizing two tenches 41x 63" may be more suitable.
CAUTION: since all of the soil test sites are very heavily
wooded, extra careful planning and site preparation is required.
Great care will need to be taken in removing trees and brush
without disturbing the fine delicate silt loam topsoil. If the
site is carelessly disturbed, the Zoning Dept. will reject the
site and require costly new testing and designing! Do not allow
anyone to drive across or compact or distuyb the topsoil. Consult
with the Zoning Dept. Inspectors, a qualified plumber, or designer
for advice on how to properly prepare the site for mound system
construction.
The owners/developers have provided a complete approved
soil test area, registered with the zoning office as required
by subdivision ordinances. It is difficult to imagine today
where a future buyer prefers to build upon a lot. Common sense
is used to select a site at this point. If the buyer intends to
utilize the test area, careful planning between the oxner and
septic plumber (or designer) is very important. Careful planning
with qualified designers/ installers is critical. THe final
actual size and shape and location of the septic system is
dependent on the size and type of home proposed. Test areas
large enough for a 3-4 bedroom home has been provided, but a
larger home may require new or additional soil testing. The
septic system can not be shifted outside of the recorded test
area.
pg. 4 of 4.