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HomeMy WebLinkAbout042-1045-50-100 c n 3 4 m CD a 0 Z O N C N 01 to O O N V A• 00 CL fD L n CD 0 to 0* 7 (D Q N ~ 7 O N N C- j 77 ~ CD N Cll O O n CD C~ N 7 7 a O p O CD ~ w ? i O o m Ur, to a OD N N co 7 N O j CD a { O O < ? C Z! fCD o co co 0 nrto V~ m 3 ° a M N i c < Z ~y~~ • o N c co co N p a y 00 o 3 m O W al 7 M w Ch D N I O CL d' Z 3 0 2 Z ~O D D o i O 0 m a !V (AD • c w o 3 0Z CD CA ~ A Z to ~ m A Z o 0 N) W I ►ZT1 V a z O :i z E2 3 m I,I p! N A C i W (D ;r D cM~~ 3 c n CL (D d o' 7 N p~ N C CID 3 x°~N 0 a m O x 03 a yy p 0 7 0 Al O~ 3 N3 m,0ate, a v 3 , u e ;Ol m a-C w' O C p A I w 0.1 = D. fD W j y 8A Z N N O O z et a I w a 6'0 O I N o n la o °o Parcel 042-1045-50-100 10/03/2005 09:21 AM PAGE 1 OF 2 Alt. Parcel 17.29.18.258D 042 - TOWN OF WARREN Current -1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner KEVIN G & BRENDA BLOOM O -BLOOM, KEVIN G & BRENDA 1049 100TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1049 100TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 16.230 Plat: N/A-NOT AVAILABLE SEC 17 T29N R18W PT NW NE BEING LOT 1 Block/Condo Bldg: CSM 11/3207 2.673AC & INC COM N1/4 COR; TH S 88'E 257.OOFT TO POB; TH S 88'E Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 72.74FT' TH S 00'W 1331.71 FT; TH N 89' 17-29N-18W NW NE W 329.85FT; TH S 89'W 300.02 FT; TH N 00' E 880.69FT; TH N 00' E 1.16FT; TH S more... Notes: Parcel History: Date Doc # Vol/Page Type 06/08/2000 624481 1517/439 WD 04/24/1997 1235/005 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.630 40,500 262,000 302,500 NO AGRICULTURAL G4 13.600 2,400 0 2,400 NO Totals for 2005: General Property 16.230 42,900 262,000 304,900 Woodland 0.000 0 0 Totals for 2004: General Property 16.230 42,900 262,000 304,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 v AS BUILT SANITARY SYSTEM REPORT OWNER .1-57/ 3 , t ADDRESS_ 4-gq SUBDIVISION / CSM# LOT SECTION / 7 T :21 N-R~g? W, Town of f d y~ e~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEE OF /S STEM s C. A" f ^F ~-"T ( o r G G o`m-p C7 ~d ~Y iJ lc .S' -t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM' SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: _Z22: Liquid Capacity: Setback from: Well House y'D Other Pump: Manufacturer Y 4 Z ,e,,- Model#~ Size i ~ Float seperation it Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Lengthr~ ~ Number of trenches J Distance & Direction to nearest prop, line: Xl ' 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: 7~ j 9/• PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt wisconsiA Department of Industry, PRIVATE SEWAGE SYSTEM County: *Laborf ant'Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284345 Permit Ho der's Name: ❑ City ❑ Village Town of: State Plan ID No.: BLOOM, KEVIN G. WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: y 042-1045-50-100 OD TANK INFORMATION ELEVATION DATA 970 11 29 -/G =3v TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J ' Benchmark ~ ~ ~ Dosing -U /D8 ~9 Aeration Bldg. Sewer ;v0' 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 S !,5 Dosing NA Header/Man. Aeration NA Dist. Pipe Holding Bot. System /O/ 6 -3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number 5_3 GPM TDH Lift (,,~3 Friction ~.,_q System,_cr, TDH Ft oss Forcemain Length Dia. H Dist. To Well , SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length 1/ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 97 DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM CHAMBER INFORMATION Type O /kZG,~ Moe Number: i OR UNIT System: ,q~:v~k~ 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 --F [6BeedlTrench pth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN.17.29.18,NE,NE 1049 100TH AVENUE LOT 1 Plan revision required? ❑ Yes [ff/No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH F SANITARY PERMIT NUMBER: G 5~ b 1-_ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System! 201 E. Washington Ave. In accord with ILHR B3.05, 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. 67e u^,. C K, • See reverse side for instructions for completing this application State Sanita~ry Permit Number F4 3L4 S 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 Property Owner Name Property Location ife v k m M W45- 1/4 1/4,5 f1 T ~ N,R IfE(or Property Owner's Mailing Address Lot Number Block Number / 6 _?C.' P, ~ke ad 0 J Cl-/- 111, 7 J City, State Zip Code Phone Number Subdivision Name or CSM Number ~ C ( ) 9 a'' ~rl l 324 ~ II. TYPE F BUILDING: (check one). ❑ State Owned city Nearest Road ❑ Village / yJ Public 1 or 2 Family Dwelling - No. of bedrooms _ Town OF oZ)) Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 6 `.1 X - / e `r S-67cj -/,a fl 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3: ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an ___~ystem --------System Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 S 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 ~6 7 7 G j Feet d, j Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks manufacturer's Name Concrete Con- Steel glass Plastic App- New Existin structed Tanks Tanks Septic Tank or Holding Tank QU f%✓e.5'~C~.f/ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber t t ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: Ile- J, ~ E` m S Giu 1AW 4141~ 0727 d 21--5-3f'G 3l~ I Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ss ss g Agent Signature (No tamps) proved ❑ Surcharge Fee) Owner Given Initial a'0 ~ 7d7 No tamps Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: i SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUC=TIONS ` 1- A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority- 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 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 13 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. f Safety and Buildings Division Bureau of Building Water Systems E; SANITARY PERMIT APPLICATION 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. T Cam 'r n • See reverse side for instructions for completing this application State Sanitary Permit Number a Sy3~s The information you provide maybe used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (1 State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ea"'t) eaaN'► p 1/4 4g- 1/4,S f 7 T ¢ ,N,R/FE(or4 Property Owner's Mailing Address Lot Number Block Number !e r r~~o d y`3 City, State Zip Code Phone Number Subdivision Name or CSIVI Number s G ~G t ) GS/~ 5 S' ~i vlNearest II. TYPE OF BUILDING: (check one) State Owned [j City Road Village ❑ Public 10 1 or 2 Family Dwelling - No. of bedrooms - 4-Town OF 1,44ovme llye7"d v,-, III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an Lk New System Tank Only Existing System _________Existing System- B) ❑ A Sanitary Permit was previously issued- Permit Number Date-Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® 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 37s, 276 , 3 .Al a- lOrl J Feet d O Feet VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank G~eJ 7 5Ti~ v,✓ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber o ~i SQ f xJ 19S riC Vi/ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP MPRSW No.: BPe Number: G"3 -are- sla mber's Address (Street, City, State, Zip Code): Plu 4,0 7 a C a 77- R, 01 -4Z- W_ s-Y Gd S IX. COUNTY D ARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (No Stamps) c arge ee ❑ Approve ❑ Owner even nltla Adverse Determination X. C NDITIO S OF APPROVAL/ REASONS FOR DIS ROVAL: 5 D-6398 (K. OS/94) DISTRIBUTIO Original to County, One copy To: Safety a Bui dings Division, Owner, Plumber INSTRUCTIONS 1 . A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Bpildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E' soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ' I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce r April 1'f, 1997 ^226 Rose Street La Cposse. WT T i 54603 WEGEREfi SOIL 'T ES'T i XG '321. 1i lAI STREE-1 PO BOX 7I} RIVER FALLS WI 51022 RE: PLAN S97-40227 FEE RZ E-L QED: 180.00 r.,!? T 9.. I> DUt1, i1i.Y W,NE,17,29,13 TOWN Or WARREN COUNTY OF ST CR.OIX M0U'D SYSTEM The Department has reviewed the above-referenced submittai. 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 AumInistrative Golfe, alma is contingent upon compliance with any stipulations shown on tiie plans. This system has not been rev Ieweu for the code i`cquiremeIlts set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will rxplVe tiv ~ t_:a.r5 fr'oni file approval date, or if a sanitary permit. is obtaiiic'd, piaii approti"a1 i.i i-j expire on the clay the ilii~.la1 sci.nl.tarj perl:llt _ pi<.ti l Tife -i.1::~'ll.l:.IllililDer responsible rfor this installation shall keep oiie scat, of plalis with t.tie Dupai'tment's stamp of cLjJpi'vvll.i 2Lt the C i. i ti l- 1(}II tii L+'. 11 1115 .diiei' Shot!! no liw he appropi, ate lilsliecl.or when inspeci-ions car) 7.ie ruadle.. All- pri`iiiits- 7`el1tii3t( Dy 01F' Cr iliage, to++li5 shat be vbt.F7 ne.d prior to r 111 .:.'3 i,_C;. i~_ U.1f` l. i•eii i,ci we C11, la+.' ;illU Jt'i. 1' C.c li iDC'loii•, ?Lease refer. to tale pla3l IlUm"Der si3ui~n l?`, e. L tic 1y , 4r1. e r._i i'JIM. a r,; l to ' 1'i2A.i1 R!-\ lt'. in'E'.1 ' ~ 'i"2~ Section of Private Sewzte Cz1 " t Mo 00 "I'l SBD-7997 (R.11/96) 97r "~lFiipge I of 6 MOUND SYSTEM, FOR F A BEDROOM RESIDENCE 'R 1 11997 rr 8 B[OGs DIV. LOCATED IN THE MI-31/4 OF THE ~3G~ 1/4 OF SECTION k- T 21 N, R tB W, TOWN OF tA) fpm\-Z~~ , ST. Clot a COUNTY, WISCONSIN . INDEX PAGE I'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 163 Tzuvs.,J0o0 J'i'PT B }v~So~, wl Syol.~ PREPARED BY W~[REFZ E3 C3 2 L TEST I U4 C-3 ~eN~A► AND. sc o )v o~ TICA E 2 cam s1-=FZV ICE • ` ~ g • r , y.. V Q. 1@174 421 VAIK ST. r ARTHUR L. si,~ ® • WEGEHER ii = 0.915 R fills. NI 54022 ELLSVIOATH, 715,525-016; $ s. g~t, r, oo d 4~ I G l; per' p1 O~O~~GE ~~0lvOtittq 4 JOB NO. ~~-a y PLOT PLAN Page Z of E, yp ' j r Scale 1"= m 0 r p j 'Do hxiT c~►.~h'zl' oR o i- J "o lSlvti2a `Ri'1 S R'R ~q ? viol S j wr h ~ tl41 ~i,ggs • •rL S ~H11u. 07 W ' N L& IW -GL. IrjQ.S P S of %CY" of tbL-s 60 00 30 of EL LQ ~ m r✓) 2 J 3 BDW~1 1~ovsle s ZS7•oo' weL. - 1v 8F W CZIBT So F W" "ovwp Pn\.& VP T Leks1 Z S' FWCTAC - sWpE StiD F .o!~- ~novk,0 r~PNt $E ~~L~ ~ 8~.~ rlovt~~ _:J ti`s- - - NOTES: •1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install.4" observation pipes with approved caps. ( 2 required) 4.-Septic tank to be MIO ASO gallon capctcity manufactured by f--N k ~ 1~'Q-er fi lr, ),v c . • 1. 5 . Bench Mark 1. 100 O t" SUP O F 31 U "e ,py lT PCRk-~ WITH 1kXy g`Tf'rhW_ w/ ~,tt-6 6tn1 6 6. Divert surface water around system to. prevent, ponding at the uphill side. i Page 317f b Approved Synthetic. Covering 1~sT*~ C 33 Distribution Pipe Medium Sand _ • Topsoil G F Eled. \ \.5 D - 3 E e j~ % Slope (Force Main Plowed Trench of -,2"-2,-,2" From Pump Layer Aggregate Undisturbed D 1.0 Ft. Soil E l.Zy Ft. Cross Section Of A Mound System Using F c•~ Ft. I Trench For The Absorption Area G 1-'o Ft. A Ft. H I- S Ft. B 1) Ft. I VL Ft. Linear Loading Rate= y.8 GPD/LN FT J -7 Ft. Design Loading Rate= 0.3 GPD/SQ FT K 10 Ft. L 11 Ft. osition of Force Main W Z 3 Ft. L J ~ K Main-- 7: E A-- - - - - - - - - W Distribution Trench Of Pipe Aggregate i J Observation Permanent Pipes Markers (Anchor securely) Mound Using I Trench For Absorption Area Page Of _(o Perforated Pipe Detail 0 End Via- PVC End Cop.) cd~6~e PVC Pipe arse Install permanerit'marker at end of each lateral Holes Located On Bottom. Are Equally Spaced Q End Cop Q ~'t * ~ PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cop I i Distribution Pipe Layout P 6 Ft. X q8 Inches Y "18 Inches Hole Diameter J1Y Inch Lateral Inch(es) Manifold Inches Force-Main " Z Inches # of holes/pipe t"z- Invert Elevation of Laterals 10 Z.O t. VL k V. 1-1 = 114, 0q 1- Z = Z $ . C GPM Place lst hole Zgrfrom tee with succeeding holes at 484 intervals.. Last hole to be next to the end cap. Combination Septic-,Tank and • PUMP CHAIABER CROSS SECTIOU AIJD SPECIFICATIOUS' PAGE S OF -VEAJT cAr WEATHER PROOF JuIJCTIOIJ DOX 4"C.I. VENT PIPE APPROVED LOCKINF. .x,10' FROM DOOR, MAWHOLE COVER OJI'M ~ wAttIJ1A1G 411JDOW OR FRESH LAOEL. AJK IWTAKE cwatw~r C ~ I "t" MIW. EIL I Oz- I K I i IC• /'11u. 18"MIAI. 11~ _ PROVIDE i IAILE T _ T AIRTIbHT SEAL I III ~ 1 I III SA~~S A I III APPROVED JOIrJTS APPROVED JOIWT I I I W/C.I. PIPE4tP'C W/C.I. PIPEaR Tank construction I I I ALARM shall comply with - I I I ILHR 83.15 and 33.20 e I 1 I OIJ C I E. LEV. RS-92 FT• __J PUMP OFF r D COAICRETE Lz qS ,oo BLOCK 3" APP'RavED RISER EXIT PERMITTED OWLy IF TAUK fAAWUFACTUR6R HAS SUCH APPROVAL gEDpl SPECIFICATIOAIS SEPTIC f TAS►JK MALIUFACTURE;R: 1'II~k/t`~1 1J A~ sT NUMBER OF DOSES: 3.86 PER DAU xzo~ 650 GALLONS DOSE VOLUME r TANK `rIZC S S ~L~T `Z4 S'-LVE S INCLUDIU& 5ACKFLOW: 1 GALLONS ALARM (KAUUFACTURER. MODEL IJUM6ER: CAPACITIES: A= IIJCHES OK 30 GALLONS SWITCH TJPC: B= Z IUCHES"OR G(►LLOWS PUMP MANUFACTURER: Zotrl,l,elt- CO. C= 7 INCHES OR GALLOWS MODEL 1JUMBER: SA D- INCHES OR ~ GALLONS SWITCH TYPE: I~ CURS( WOTE: PUMP ARID ALARM ARE`To OE6 MIIJIMUM DISCHARGE RATE_ GPM INSTALLED OW 5EPARATC CIRCUITS - VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AUD_DISTRIbUTIOU PIPE.. 6-08 FEET 2.50 FEET + MINIMUM NETWORK SUPPLY PRESSURE.:.. ♦ FEET OF FORCE MAIN X I' FY100FEFKICTIOU FACTOR__ 02-y FEET TOTAL DtJUAMIC HEAD = e ' $Z FEET • DIAMETER - N Pump chamber IIITERIJAL. DIMEIJ610LIt Of TAAJK: LENGTH e-.WIDTH ...--r; LIQUID DEPTH - - GAL/INCH BOTTOM AREA s 231'= AS PER MANUFACTURER GAL/INCA 3 15/16-6 5/32G~ ~f= 6 "U HEAD CAPACITY CURVE --I + s/e "53 - 57" - "55 - 59" SERIES 1 1/2 -11 1/2 NPT 25 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE 3 15/16 EFFLUENT AND DEWATERING 6 50SERIES - - f 6 Ft. Meters Goi. Lt's. 4 1 x 15 S 1.52 43 163 U I I . + 10 3.05 34 129 r ~ 15 1.57 19 72 ~O 10 e.g Z Loeb VoNe: 19.25' I I 2 5 B 10 1/16 0 10 20 30 40 50 1 3 3/32 U.S. GALLONS LITERS 80 160 0 FLAW PER MINUTE aKw sKxoc i I i CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Available with special cord lengths of • Variable level long cycle systems available. 15', 25', 35' and 50'. • Alarm systems available. • Duplex systems available. SELECTION GUIDE Standard cord lei - automatic 9 ft 1. Integral float operated mechanical switch, n0 wdemal control required. Standard cord lencrth - non-automatic 15 ft. 2. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to 1`1010447. MS 5 and 5715 Series Control lection 3. Mechanical aftemator V-Pak* 10-0072 or 10-0075. Model Volts Ph Mode Amos I Sim x Duplex 4. See FMO712 for correct model of Electrical Aftemator, E-PalL M53155 & M57159 115 1 Auto 110 1 or l a 7 - 5. Variable level control switch 10-0225 used as a control activator, with E-Pak (3) or a (4) float system- D53155 & D57J59 230 1 Ago 4.0 1 7 - 6. Four (4) hole J-Pak, junction boot, for watertight connection or wired-in simplex or 2 E53155 & E57F9 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 PAP operation. PM 10-0002. 53 Series - WL 22 lbs. 57 Series - WL 27 lbs. 7. Two (2) hole J-Pak, junction box for watertight connection or splice, 55 Series - WL 24 lbs. 59 Series - WL 30lbs. PM 10.0003. i CAUTION For adomlabon on ad31ional Zoeller p oduGs refer lo catalog on Combilation starter, FM0514; AN installation of controls, protection devices and hiring should be done by a qualified Piggyback Variable Level Float Switdles. FM0477; Electrical Ahernahor, FM0486; Mechwzal licensed electrician. All electrical and safety codes should be followed including the most Allema6x, FMO495; Sump/Sewagegasm FM0467;andSm*PhaseSimplexPwMCor"Alarm recent National Electric Code (NEC( and the Occupational Safety and Health Act (OSHA). systems, FMO732 RESERVE POWERED DESIGN For unusual eandilions a reserve safety factor is engineered into the design of every Zoeller pump. WlM TO. P.O. BOX 16347 4W AF A&MINIftw, Loui;%*. KY 40256-W7 116m ck mrs al. . LO SHIP TO- 3649 Cam Ihn Road Louisvik KY 40211-1961 ZWWT ANM PL//I~1P !0 (x)778-2731.1 (80g928-P1/&IP FAK(502) 774,W4 scor+si Department of Industry, SOIL AND SITE E V A L U AT I O Page of Labor and Human Relations Division of'Safety 8 Buildings in accord with ILHR 83.05, Wi Od14VE R Attach co lete site Ian on a er not less than 8 1/2 x 11 inches in size. Pla t includ~ p P p # ndt limited to vertical and horizontal reference point (BM), direction and % of scal~V dimensioned, north arrow, and location and distance to nearest road. 1 4 fAPPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ST CROtx BY DATE OOUNTY PROPERTY OWNER: PR !/,t A,' /71 Lb© GOVT. T N,R s7 E (ortv PROPERTY OWNER':S MAILING ADDRESS LOT # B ME OR CSM # ~wf wM~qp '41c # -7 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE mfOWN NEAREST ROAD New Construction Use[/] Residential /Number of bedrooms ,3 [ J Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow IZS-0 gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) /1lakW4 ft (as referred to site plan benchmark) Additional design / site considerations Parent material /~CjZ 'r F- jr 1-7- L o~ rrt Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S U S❑ U ❑ S O U ❑ S O U ❑ S U ❑ S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounc6y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench d -1a 2 rL 'Z /of X 2 S / S 6 2 ,OX ^ezlt c S z 3 Ground 30 - fed S- Y L. r,5X 'W vf2 _ s elev. ft. Depth to limiting factor > Remarks: Boring # i z 1.2-,z 7. S-'1y t C 3rr rhFr e- -C r , a, O Ground 3 lo- G 3 - S L As. elev. o - Y S G S /Sx YF O Depth to limiting factor may" Remarks: cur TC.) 'rRt*A" .L CST Name:-Please Print Phone: / !-~2 T f 7 9 `36sG Address: 30 v Zo ~ sy~-3 Signature: / r--` Date: CST Number: PROPERTYOWNER K~v~'~ d~Oollb( SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed french 3 I m- ~0 2 = r ~ t F .S- ~v4 Ground 7. 3--- S m s,~ L , elev. y ft. 3s-y .z • S- L S s e" L f~S . 8 Depth to h► P _ S ~ ~ lo- S 3 s. o. D limiting factor yy „ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) DAVE FOMTY PLUMMNG Licensed Perk Tester & Pluff*er 113233 93289 Foggerty Hei~~►is Road FEtvCE J~~- ROBER'fS. WISCONSIN 54023 Phone 749-3636 i ~ uT N.~ ~estc~ , ~L I j /l~'t!Z'iC1 LOOM -/s f i E x i i d 90 bo' d== 73 x--- _ _ V /z7- 2 'd i s s'cs4L~ / " = ~°o I 1 Y x sr~i~kE Ire, E o. i 9 -z-- ------h-___--__---~------ -tom SOB ~ ~►/~~~.._._.__W_~_.-. ~.~___~_..s.,m. W,_..e.~~..._____---~ - s ~ FILED JAN 2 9 1997 ► KATHLEEN H. WALSH 10 . Repfs teroCo. J SL Croix t0e,W! eds I CERTIFIED ~'VEY MAP GEORGE AND MARY BLOOM Part of the Northwest 1/4 of the Northeast 1/4 of Section 17, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. • Indicates 1" iron pipe found. oInd_i~c_ates 1" iron pipe weighing 1.13 lbs/lin. ft. set. UNPL A TIED LANDS NE COR. SEC. 17, T29N, R18W, / COUNTY SURVEYOR'S MON./ N LINE NE ' 114 N//4 COR. SEC. 17, T 29N, 589•//'2!"E 263/:36' R / B W, / COUN T Y SURVEYOR'S MON.I /87,27' 'If Q M 25 BO' V E' a 2374. 56 OUT / LOT 1 N CX~T o 732 SO. FT. N 10.017 AC.) ti W 4 Z yf ~ ♦ h V~ J BOO K llNE~-~_ \ ROB AN 29.gI Z m o~ i z z ~W ~I Q ~ a QI 2 J a O 1. Q Co„ptaru~ ^ m LO / / N Y ?ortir~g and I h o ~ ~ 3 F'arx.s Comsnittc~ " e I M a 2.673 ACRES O ~ W ~ h O ~ / /6, 420' SO. F T, Q h I y ~ 1, -,Ot recorded I 3 2. 355 ACRE S EXC. ROAD R. 0. {Y. v 2 w,.,:-.in 30 days OR V~ /02, .?91 $O. FT. ~ N ~I ..;jtryioval date ~ o Q W •yi:rt~val shall bZ o m o ~ h c' N 89•//' 21 "W 237.00' P.37' Y C 0 Q, UNPLATTED LANDS $ N to Dated: 12-6-1996 0 •LAJ"NC,E••v y ? m This instrument drafted by Laurence z m W "i PINY m W`.'. Murphy ~$~~7713 T 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 &C U,',y Location of property AL4 1/4 ,d,0 1/4, Section 1 7 T ag N-R / W Township_ /_j V►^ .0 ~ Mailing address lG3G ,o,~ti c✓~~~ 3 t~ d.5- w= tile el 6 Address of siteO'Q ~ 1,p 7% Ja-t- i o 64V7-s I-xi Subdivision name _G s m S ' S~ ~IBr 41W ~ 3,1~? Lot no. / _ Other homes on property? Yes_,k No Previous owner of property .L '&A'0.0 Total size of property 4r -7 .1-L CP, V's Total size of parcel Date parcel was created f 2 197 Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes p( No Volume 35*- and Page Number 606- 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. S6 e'l xt , 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. Lf X5-ilnature of Applicant Co-Applicant L Z~j -97 Dat of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER r •l~ ~~6 ~Y1 MAILING ADDRESS m y9 too AP:e- PROPERTY ADDRESS • " - " s 7- ( location of septic system) Please obtain from the Planning Dept. CITY/STATE r- ;~S PROPERTY LOCATION V4d 1/4, 1/4, Section 1 7 T 9 N-R J W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP63*4 4Yr , VOLUME l l , PAGE 30 6 ? , LOT NUMBER l 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 iratton date. SIGNED: - DATA: L St. Croix County Zoning Office Government Center 1101 Carmichael Road I Judson, %V1 54016 t 03 ~ lam' • 1. L 558421 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. VOL 235 PAU005 REGISTER'S OFFICE George P. Bloom and Mary C. Bloom, husband and wife, ST CROIX CTY., WI r fi6dd Ax FWca~ ~ APR 2 4. 1991 conveys and warrants to Kevin G. Bloom, a single person, 12'30 P. M -Ka1-l-i....,. # IdA h Register of Deeds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN DDRESS Geor Vla TSl o a m the following described real estate in St. Croix County, f °J State of Wisconsin: t Z Z 1 ' ~ two bar -hs ~ w i 5'~ 0 23 PARCEL IDENTIFICATION NUMBER Part of NW1/4 of NW1/4 of Sec. 17-T29N-R18W, Town of Warren, St. Croix County, Wisconsin, described as follows: Lot 1 and Outlot 1 of Certified Survey Map recorded Janaury 29, 1997, in Vol. 11, Page 3207. # F~P This is not homestead property. XX (is not) I Exception to warranties: Easements, restrictions and rights-of-way, of record, if any. Dated this day of April A.D 9 9,7 (SEAL) (SEAL) George P. Bloom (SEAL) i c (SEAL) . Mary C. loom AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix ss. County. mir~ionrirornrl rhic a. -17 N i 30'-0" X 13'-0" LIVING/DINING ROOM I U i i r `V c° I 2/8 F ENCH DOOR ~ I N N' 12'-0" X 11'-8" N OFFICE 3/0 BF N U C24 i 13/0 WITH O I 4" X 6' W I } ! ! i i 12'-6' 2,-4 7'-8" ' 44'-0" - FIRST FL( 4- i