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HomeMy WebLinkAbout042-1075-90-100 Wiscbnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 4bor fet and Human Relations Sa Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284249 Permit Holder's Name: ❑ City ❑ Village AKI Town o : State Plan ID No.: PECHUMAN JORDAN WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 160, CIS 042-1075-09-080 TANK INFORMATION ELEVATION DATA; TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark .c?S6 /Jv.60' Dosing r i -75.0 t 3.U~ /O 9, ~-/y( Aera i Bldg. Sewer Wet CL - Holding St/ . Inlet TAN BACK INFORMATION St/ Outlet ROAD Dt Inlet TANKTO P/L WELL BLDG. Air Ina Septic ~U NA Dt Bottom 9~ S , l0 3 Dosing 3/' 3/ ' NA Hem Man. Aeration NA Dist. Pipe Holdi Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft oss Forcemain Length Dia. II ff Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA Manu ac SETBACK INFORMATION Type O CHA Mo e System: UNIT 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 xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN.27.29.18W SE SE 70TH AVE UE ~cutQ C~( L r - Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: F 60, 10-2. 7 DILHR SANITARY PERMIT APPLICATION COUNTY 17 In accord with ILHR 83.05, Wis. Adm. Code Sr ~ STATE SANITARY R" # -Attach complete plans (to the county copy only) for the system, on paper not less than QoQ11_fL 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S - At 00 PROPERTY OWNER PROPERTY LOCATION CD V-% f` P0 u- hN CL h, 5t- Y4 S1 ' S T TBLOCK N, R ~r) W PROPERTY OWNER'S MAILING ADDRESS LOT # # A13 too . sT / C,~. CI STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0 r JOB 5 0a~ -3q1 G 7 Q9 II. TYPE OF BUILDING: (Check one) 11 State Owned ❑ VILLAGE: NEARESYROAD ~.btr f h Q u• 2_ OF: ❑ Public P~1 or 2 Fam. Dwelling4 of bedrooms3 PARCEL AX NUMB III. BUILDING USE: (If building type is public, check all that apply) - b b~ 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. F;-jl New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 9 Mound 30 El Specify Type 41 ❑ Holding Tank 12 El Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY Q. 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) 1&', - ELEVATION 375A N Feet 16 77,_T Feet CAPACITY VII. TANK in alions Total #of Prefab. Site'--c7 Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 4bD / LA_&_~ F1 I Lift Pump Tank/Si hon Chamber 75-6-1 F - 1 =EE 1 4 0 Ll I D 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/ (No 8jamps) MP/MPRSW No.: Business Phone Number: \a~v; n ow ,tz~s t SG 17 IS S1 Plumber's Address (Street, City, State, Zip Code): ,W 0 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Iss Ing Agent Signature (No Stamps) Surcharge Fee) Approved El Owner Given Initial n Adverse Determination / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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.. i .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 .4 Buildings Division, 608-266-3$15. To be complete and accurate this sanitary permit application must include: 1. Property owner'g name and mailing address. Provide the legal description and parcel tax number(s) of where thesystem is to be installed: II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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 rnains/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) s©If test data on a.115 form; and F) ,11 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11188) Wisco.15in !lee rtment of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems - Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 La Crosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone (715) 634-4804 - Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax(414)548-8614 Fax (715) 634-5150 Fax (608) 267-0592 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have qu ic~o j vhr~ in f4rr icf o/~' submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. s7 @~ -1 jj 1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewer Name Plan Identification Number !1 9 ler- r% yD0 ' 2. PROJEC INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Project Name - dr!d a, G ❑ City Village Town Of: County Lk. M Project Location C Y O ~X GOVT. LOT 1/4 56 1/4,5 T oZ N ,R r W War re fir. 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 A ❑ At Grade 1,501 - 2,500 gallon septic tank $120.00 H ❑ Holding Tank 2,501 - 5,000 gallon septic tank $160.00 M Mound 5,001 - 9,000 gallon septic tank $200.00 N ❑ Non-Pressurized In-Ground (conventional) 9.001 -15,000 gallon septic tank $300.00 Over 15,000 gallon septic tank $ 500.00 P ❑ Pressurized In-Ground O ❑ Other: Up To 1,000 gallon dose chamber $ 70.00 1,001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00 . 4,001 - 8,000 gallon dose chamber $120.00 D Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 P ❑ Public Building Over 12,000 gallon dose chamber $160.00 S ❑ State-Owned Building Up To 5,000 gallon holding tank $ 60.00 r 5,001 -10,000 gallon holding tank $100.00 Code Derived Daily Flow - gpd Over 10,000 gallon holding tank $150.00 ........~4 .Q0~A ❑ Check If Replacing Existing System Experimental System (additional one time fee) $300 Revisions To Approved Plan 2 $ 60~C .....T. f~`V Petition For Variance: Setback $100.00 ~U ❑ Site Evaluation $ 225.00 Petition For Variance Plumbing $225.00 Revision $ 75.00 Groundwater Monitoring - Per Site $ 60.00 ❑ Groundwater Monitoring (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 Subtotal: Priority Review: Enter same amount as Subtotal: _ MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: g Q 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Cna any Name Contact Person ( ?/5) -S/ 3 S w e,rs F-A u'Ut 014 .x/, c , `u n o w Q. v,= No. & Street Address Or P.Q,Box n ` City, own or Village, State, Zip Code l 96 1 £~S R (M6v,,, S101 1 Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. The information you provide maybe used by other government agency programs [Privacy Law, s. 15.04 (1) (m)j. SBDW-6748 (R. 09/94) OVER d C\Y\ v` Y",0.Y L j ' 12bb Qx~s ~ .5 y v ~ RECE~ QED WORKSHEET-- MOUND SYSTEM DESIGN FEB ~ Q 199 SAFETY & B~DDS. DI V. PROBLEM: r Design a mound system for a The site characteristics are: Depth to groundwater or bedrock in. L,:. !slope Percolation rate - µ - Distance from dose chamber to distribution system /00 ft. Elevation difference between sump and distribution system ft. Step 1. WASTEWATER LOAD gal Step 2. SIZE 'T'HE ABSORPTION AREA SO /1 373 sq. ft. A) Area required = 75 B) Brad or trench length (E) =S 3 75 7-5 ft. C) Bed or trench width (A) m , ft. D) Trench spacing (C) g Wastewa -Pr load .24 (3al/ft:2/day B f tre iE ei s Step 3. MOUND HEIGHT A) Fill depth (D) a ft. B) Fill depth (E) = D + slope ft. - 1 +Csxs C) Bed or trench depth (F) D) Cap and topsoil depth (G) _ ft. E) Cap and topsoil depth (H) _ ~5 ft. i4in'.C. -~o rc~ q ~e u rna Y. RECEIVECQQ~~---.~ l~ F E B 1 0 1997 Step 4. MOUND LENGTH SAWY & BLDGS. DIV. A) End slope (K) D + E / + F + H x 3 ~d ft. i a.~~~,83t1,5~X3~=/0.365 B) Total mound len`gt (L) = B + 2(K) ft. 75-I Step 5. MOUND WIDTH Al) Upslope correction factor = , $75 875 A2) Upslope width (J) D + F + G)(3)(factor) = 7.. ft. 1 04.3 A,,~75<. B1) Downslope correction factor B2) Downslope width (I) _ (E + F + G)(3)(factor) _ ./68 ft. C,Z+,83+)x 3 x ►,r~ / 90 Cl) Total mc+und width (W) for bed = J + A + I 7,x{3+5 + to =a33 ` C2) Total mound width (W) for trenches = J + + (no. trenches -1)(c) + A + I ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil = • S gal./ft2/4ay B) Basal area required = wastewater flow natural soil infiltrative capacity = sq. ft. ,q-56 ,S 900 Cl) Basal area available for bed for sloping sites = B x (A + I) _ ft. 75X(5+X0,9) = //qa,s C2) Bas are avail le for trench for sloping sites = B W-- ~J+AJ sq. ft. C3) Basal area available for trench or bed for level nv ices = B x W = sq. ft. Lic r,~c c:t~:....L5.G-3- D a RECEIVED FEB 1 0 1997 Step 7. DISTRIBUTION SYSTEM SAFETY & BLDGS. DIV. 1A) SIZE DISTRIBUTION SYSTEM 1) Hole site = in. 2) Hole spacing in. 3) Distribution pipe length 4) Distribution pipe diameter = Ali, in. 5) Spacing between distribution pipes = o in. 6) Distance from sidewall to distribution pipe N:3,Q in. 1B) DISTRIBUTION PIPE DISCHARGE RATE 35 ft. 1) Number of holes per pipe = _-LL 2) Flow per pipe 7 GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length e a ft. 3) Number of distribution lines = c~. 4) Manifold diameter .3 in. 1D) SIZE FORCE MAIN 1) Minimum dosing rate = GPM 2) Force main diameter = -3 in. 3) Friction loss = i a ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = _ ~02 ft. 2) Friction loss = z afft. 3) System head 2.5 ft. rift. ( 4) Total dynamic head ft. 1~icc~-rc: IS (o3 Tore, ~~c~c~h-►a+~ RECEIVED i FEB 10 1997 7F) PUMP SELECTION SAFETY & BLDGS. DIV. 1) Pump selected will discharge S GPM at ft. total dynamic head. 2) Pump model and manufacturer 3885 0zo 3IIL 1G) DOSE VOLUME 1) 10 times void volume of distribution lines gal./cycle 16,K [ C r 692 X, 76b) 2) Daily wastewater volume : 4 doses/24 hrs. gal./cycle ~LSo yI - //2,S 3) Minimum dose volume - , 60 gal./cycle iao 3 ~+yo f, .,,3(.£f - 369 7H) DOSE CHAMBER 1) Minimum capacity required = 7-50 gal. Licunsc Dato:_.!~~~~ 9.7__-- I 110 P~ aVNI- cs, - R~bEIVED _ :Too t- d4 Y,' P2 Sr 5- 5e. op7 JaQ/- Iv FEB 1 U 1997 C;z W, f -45144-. LZ 6^t4-1 SAFE I; Y BLUGS. DIV. 8 -91 ad :40 0 'ey /D71 d g4f /fit s X 7~C , q Ito io"Oy i w~; ; ~e4, P~NOENG SEE CSR i I i i i ~ I i i i0b I 955 90 7 , „ a - Page 6 Of) 5 y oa-3 RECEIVED _ Straw, Marsh Hay, , Or FEB 1 0 1997 Synthetic Covering SAFETY ...A5~ vl 4L C3-b Distribution Pipe & B~QGS. DIV. - ' Medium Sand j % fl G Tops % Slope Bed Of 2r- 2 %2 Force Main Plowed Aggregate - layer D _ I Ft. Cross Section Of A Mound System Using E a5 Ft. -A zBed For The Absorption ATea F Ft. G / Ft. A 5 Ft. N Ft. Signed: g 75 Ft. License Number: l~ 3 K /oA Ft. Date: C,? 7 L 5,S Ft. y3 Ft. Alternate Position 16,7 Ft. of Force Main W 3 Ft. 7- F Observation Pipe--- K -I - - - ~ I i Al la-- - `Force Main I i W - Distribution. \.,,Bed Of Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area cl\ L'L VYN dv . a(~ RECEIVEDPaZ. RD~ew~ks ~ W~ S~o~3 FEB 10 199 ge 7 SAFETY & BLDGS. DIV. Perforated Pipe Detail n End View )POrforoled End Cop PVC Pipe oi,o ice Holes Located On Bottom, Are Equally Spaced _ PAL r c j r - Al Last Hole Should Be Next To End Cop . Distribution Pipe Layout P 35 Ft. R !2 A Sig X _a2cVj Inches y 9*9 Inches Signed: 6c 2,~ Hole Diameter 1/4 Inch Lateral License dumber: - 15 ~ Manifold " 3 Inche:; Date: Force Main Indio,; # of holes/pipe Invert Elevation of Laterals /092 Ft. j a I pagevof loo o r cn n ( 0 ~ Lju G 'O I ~O - P I ~IO~cS' `9U~ vt` SIG - ~2 I 7 g n a D rt ~ 0 rt a o I 9 M a n e _ H L - d n a Cr a 0 , x t 0 rt rr Ij I; ~a ~r i I~ n ~a :.a • PAG[ 7 Of= PUMP CHAMBER CROSS SEeT1014 XUD*' SPECIFICATIOIJS' RECEIVED FEB 10 1997 - 4"C.Z. VENT VC IJT GAP SHFlr I Y & BLDGS. DIV. ~IPC WCATHER PROOF APPROVED LOGKIIJI: JUUCTION box J~lAMMLE COVER ~ L3, FROM DOOR. WINOOW OR FRCSH IL0141U. AIR INTAKE GRADC I 'I' MIN. i _ 10' MI1J. C0IJOUIT Ie'nlu. . 11~ IAJLE T 'PROVIDE AIRTIGHT SEAL APPROVED JOINT A i I I APPROVED JOINTS W/C.Z. PIPE I III W/C.I. PIPE EXTENDING 3' i 111 ALARM EXTEW0116 3' OWTO SOLID SOIL a ONTO SOLID SOIL 10 I I ow C .1 CLEV. 7O~ FT __j PUMP OFF 0 CONCRETE BLOCK 3" APPAWC, • RISER CXIT PERMIITCD ONLY IF TANK MANUFACTURCR HAS SUCH APPROVAL SEPTIC 6 SPCGIFICATIOKJS DOSE - TAMK MANUFACTURER:- NUMBER OF DOSES: PER DAy TANK 51ZC: 750 %GALLOWS DOSE VOLUME c- 5 4t,, _ INCLUDING, BACKFLOW: /So s .T 1r I e ht GALL ONS IN, ALARM MODCL MANUFACTUNUMISRCR: CR: Ll CAPACITIES: Asa 35 INCHES 09 5 GALLONS SWITCH TYPE: n'~Q g= INCMESOR - LLGALLOAJS._ PUMP MANUFACTURCR: INCHES OR / GALLON5 MODEL NUMBER: 3 St57 W re 10,311k _Y Z D a 9 INCHES OR JIM GALLONS SWITCH TYPE: - f/o a'-I NOTE_ PUMP AND ALARM ARE TO bC MINIMUM DISCHARGE RATE" ~GPM/~5 INSTALLED OM SEPARATE CIRCUITS, VERTICAL DIFFCREMCC DETWCCN PUMP.OFF AUO DISTRI/BUTION PIPC.. 12 FEET ~7,95 + MILJIKUM NETWORK SUPPLY PRES;URE , , 2•5 FEET 0 T,/ ♦ L~ FEET OF FORCE MAIN X F/DOFtFRICTIOIJ FACTOR.. ~ 0. FEET - _ TOTAL OJIJkMIC. HEAD = FEET 10. ~ INTERNAL DIMLWSIOWS~OF TANK: L g~ -,;LIQUID DEPTH. 'lk D S SUBMERSIBLE a 3 JVT yo~ FL PdMPS ~ RECEIVED GOUL r r ,a SEWAGE AND EF FEB 10 1997 1 SAFETY & BLDGS. DIV. hl EP0311 L= DISC. _ QOUPEP0311 142 EP0311 1/3 HP 115 V Effluent PWP 1/2" solids 256.80 172.10 Submersible ' MODEL EP0311 Effluent Pump SIZE Ye" SOLIDS METERS FEET Q < 25 Y 5 y •~r 20 , 4a- ~ ~ 1~t iS 4 O 0 00 4 8 12 18 20 24 26 32 36 40 GPM 25 -50 7.5 m'/h 0 CAPACITY :G Performance 3885 Curve wETE,I, FEET 90 MODEL 3885 a „ SIZE 3/4" Solids 20 F YVE07M.... so _ 'vr b EQSM 10 30 WE _ WEOA 20 i ~ - 10 0 00 ' 10 20 JO AO 60 EO 70 80 ib 100 110 120 OPU 10 20 30iwY11 CAPACITY LLST DISC. C3Jt1PNE031U. 142 WfA311L 1/3 HP 115 V Low H 3/4' solids 491.55 329.35 C3pl74FA311M 142 WE0311M 1/3 HP 115 V Mod H 3/4" solids 491.55 329.35 1r;' 3/4" solids 1704-251471 .85 OJLWE0511H 142 WE0511H 1/2 HP 115 V High H 3/4" solids 843.65 555.25 1 GOUPWE0712H 142 WE0712F1 3/4 HP 230 V High Hd. e*►*+S EE PDI.LAWING PACE FCIt PFilFtFiMAl7CE APID gppCIFICATIO[1S. nkm 10/~ DMI 30 PAGE 07u Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA dimensioned, north arrow, and location and distance to nearest road. di APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION /RY Wr9a )A PROPERTY OWNER: GOP LRTY LOCATION4 4,S N OT 2 ~1d;Fi'18 r) WW Jordan Pechuman SE 27 29 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUB E OR 213 W Elm St. na na cs d' CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [ 5TOW WOOF Roberts WI. 54023 (7151 749-3919 Warren [x] New Construction Use :c ] Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2 Absorption area required 375 bed, ft2 375 trey m ft? Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 10$ . > It (as referred to site plan benchmark) Additional design/ site considerations system el. based on contour line of el. 107.70'' Parent material pitted Glacial dirft Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ®U CtS ❑ U ❑ S ®U ❑ S ® U ❑ S 5 ❑ S ® 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 0-13 10yr3/3 none 1 2msbk mfr cs if .5 .6 2 13-26 7.5yr4/4 none scl 2csbk mfr 9w if .4 .5 Ground 3 26-35 5 r4 6 none S1 lcsbk mfr C1W na .4 .5 elev. 107.9ft. 4 35-55 5 r7 6 c20.5 r5 8 Sand tone Resi umm n n Depth to limiting factor 35" Remarks: Boring # 1 0-15 10 r3 3 none 1 2msbk mfr cs if .5 .6 MEMO 2 2 15-27 10 r4/4 none scl 2csbk mfr if .4 .5 Ground 3 27-35 5 r4/4 none sl lcsbk mfr crw na .4 .5 elev. 4 37-50 5 r4/4 2 2.5 r4/8 si lcsbk mfr na na .4 .5 108. (R, Depth to limiting factor 35" L F Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave., New ch nd WI 54017 Signature: Date: 11-20-96 CST Number: m02298 PROPERTY OWNER Jordan Pechuman SOIL DESCRIPTION REPORT Page 2 of - 3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourx* Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench <....3.....< 0-14 10 r3 3 none 1 2msbk mfr cs if .5 .6 2 14-30 10 r4 4 none sicl lcsbk mfr if .2 .3 Ground 3 30-39 7.5yr4/4 none s1 lcsbk mfr gw na .4 .5 elev. 106.Oft. 4 39-52 7.5yr4/4 c2p7.5yr5/8 scl lcsbk mfr na na .2 .3 Depth to limiting factor 39" 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) STEEL'S SOIL SERVICE Gary L. Steel Jordan Pechum 1554 200th Ave. CSTM2298 SE4SE4 S27-T29N-x18W New Richmond, WI 54017 MPRSW 3254 town of Warren (715) 246-6200 t N 1"=40' BM.= top of 11-2" pvc pipe C el. 100, N r Y~ n Alt. BM.= nail in Pine tree C el. 105.20' P ILJ ,)A PSI 0 1A~t- e4t' . Gary L. Steel 11-20-96 Q. ~"We 555017 CERTIFIED SURVEY MAP Located in Part of the Southeast Quarter of the Southeast Quarter and Part of the Southwest Quarter of the Southeast Quarter all in Section 27, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. -----SOUTH 114 CORNER Prepared for and at the request of: I SEC. 27-29-18 Jordan Pechuman i \ (FND 2" IRON PIPE) CAA 213 Elm ~ Ro berts, WI 54023 (Y GOWNER: --------LANDS Earl F. Pechuman 1310 County Trunk Highway TTt Roberts, WI 54023 Drafted Dy. Kristi A. Eylandt s6 N 00'38'07" E v l County Section Corner Monument I , --'281.95t- of Record 24¢.95' r ND Iron wei aem nimum4,of 1 13 Pipeou dsgpe 9 i ; 33.00'. i ii '~♦I ~4yZ*srit a linear foot. O Set 1/2" x 24" Iron Rerod i I I (i EAST LINE OF THE SW I I i I It 114 OF SE 114 OF i 70TAL AREA: 1 I l i i i i SECTION 27 435,595 SO. FT. I 1 i i 10.00 ACRES - I - - - ' i- - AREA EXCLUDING R.D.W.: v 1 3 1I' O1 33 I WEST LINE OF THE _SE 376,397 SO. FT. I Z I 114 OF SE 114 OF 8.64 ACRES I O SECTION 27 rt r- 000 mW I I ~I 7.v LO m n > I I/ I ~0 U) m DOD I I COD (1) O'D N M M X oo I I o C m n ~ I I I j I1 I 01 0 ~~9~ c ao ao fD- mOm N I' I i JQN3 wr ► ~ I zI =to 02M i CI /1EENH. ) (JI Deeds M -.0 3° f o v m IC O 1 IoD I40LO') j CD IC r0 ~ C p'IXCrO o to o Z IZ C I~ I' CR S O o y O M O M I~ M 1 UI N I I IZ7 o a..' ~ lui I a; O ' cn I~ T I~ v- o. rn to S 0 I° > CD I I°% I ' I N 0`1 Im m o y M z j O O 1 I* I ° m n I 0 15- co "v N rn IZ W y I I \i I+ ID U7 (f) -1 ' CA I `z I Icn o 3 CL a (7) Z C N I I~ I N ° Ig S 0-0 !''D I I r a 0 I° I. o~ mZ \ I I i I rt m , II 1 o• or• _ '0*1 f) ED 0.0 N rt rn I J (D I n (D v S D Q I vraj (n ort rz) C)0 p 1 I I O~ 5-C o --I c 0? t\ I I : p I I EAST 114 CORNER E I ; n I I SEC. 27-29-18 - D z \ I I I I ► I (ALUMINUM MONUMENT) O I I I I I I ~ EAST LINE OF 200 200 \ I ' (I w i i THE SE 114 0 \\.I li gnn'.R'n7"w o i i CERTIFIED SURVEY MAP Located in Part of the Southeast Quarter of the Southeast Quarter and Part of the Southwest Quarter of the Southeast Quarter all in Section 27, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. SURVEYOR'S CERTIFICATE, I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, hereby certify that by the direction of Earl F. Pechuman, 1 have surveyed, divided and mapped a part of the Southeast Quarter of the Southeast Quarter and a part of the Southwest Quarter of the Southeast Quarter all in Section 27, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin described as follows: Beginning at the Southeast Corner of said Section 27; thence, on an assumed bearing along the south line of the Southeast Quarter of said Section 27, North 89 degrees 52 minutes 56 seconds West a distance of 1545.00 feet; thence North 00 degrees 38 minutes 07 seconds East a distance of 281.95 feet; thence South 89 degrees 52 minutes 56 seconds East a distance of 1545.00 feet to the east line of the Southeast Quarter of said Section 27; thence, along last said east line, South 00 degrees 38 minutes 07 seconds West a distance of 281.95 feet to the point of beginning. Containing 435,595 square feet (10.00 acres). Subject to right-of-way for existing 70th Avenue (a Town Road) along the most southerly line and 130th Street (a Town Road) along the most easterly line of above described property and also subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Warren in surveying and mapping the same. /ZZ/ 6 R nald F. nson Reg. No. 2145 Date A & E Land Surveying Telephone # (715) 246-433.9 P. U. Box 325 New Richmond, WI 54017 G~ O RONALD f ~ ~V~°v w~Zdn~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT II 1 St Croix County OVPNER/BUYER ~l D ~ciar 'i" -C C)\%krAa n MAILING ADDRESS a l 3 w h, S-r_ PROPERTY ADDRESS C ~1` tS b s 5 (location of sep 'c system) Please obtain from the Planning Dept. CITY/STATEwS 54 0a3 PROPERTY LOCATION 1/4, S IE-1 1/4, Section Q,: , T_QL9_N-RL_W TOWN OF V'0(Xr1P eh ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE )IOT 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 systoms agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certi3ication form, signed by the owner and by a mater plumber, jouneyman 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 s by the Wisconsin- DNR. Certification stating that your septic has been maintained ust be complet d returned to the St. Croix County Zoning Officer within 30 days of the three ye ex ' tion date. SIGNED: DATE: z 1 - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 1.1/93 S T C - loo r 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 l o ,.V% -P,~~~ r- Location of propertys 1/4 1/4, Section Q-_7, T alN-R 19 W Township \~9c~,c~ .eve Mailing address l3 W. El,h S~t' O W~ Sy o.%3 Address of site O S w-r SIL 0~.3 Subdivision name (7Sn'l _ 3,, 9 Lot no. Other homes on property? Yes No Previous owner of property F Po a Total size of property /D Total size of parcel /D 4 C. vref,s Date parcel was created Are all corners and lot lines id ntifiable? K Yes No Is this property being developed for ("spec house) ? Yes /~C' No volume l,;LQ D- and Page Number 3 75 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. 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. ALL, VL) n04DA&=-2 )ignature of Aplicant C -Applicant A r h'7 Date o Signa ure Date f'Signature VOL 1_ c `3 5 555449 STATE BAR OF WISCONSIN FORM 3 - 1982 QUIT CLAIM DEED jj DOCUMENT NO. ii Earl F. Pechuman and LeNcre Pechunan, 6T. CROIX his W e film for PAM4 quit-claims to Jordan L. Pechuman and Vicki Lynn FEB 10 1997 Pechuman, husband and wife, holding as it 10:30 A. survivorship marital property q . ~l.~. -9 1441 , Roptatx d o..c~ the follow°ng described real estate in St. Croix County, State of Wi:xonsin: THIb SPACE RESERVED FOR RECORUING DATA NAME AND RETURN ADDRESS Thomas A. McCormack Baldwin, WI 54002 042-1075-090, -80 PARCEL IOEHTIFICATION NUMBER I Part of the Southeast Quarter of the Southeast Quarter (SE% of SEk) and Part of the Southwest Quarter of the Southeast Quarter (Sidle of Seh) all Section Twenty-Seven (27), Township Twenty-Nine North (T29N), Range Eighteen West (R18W), Town of Warren, St_ Croix County, Wisconsin. More particularly described as Lot One (1) of Certified Survey Maps filed January 30, 1997, in Volume 11 of Certified Survey Maps, at Page 3209 as Document No. 555017 Office of the Register of Deeds for St. Croix County, Wisconsin. gFEE EXEAIVt This is not homestead property l~x (is rot) ` Dated this day If b •~'1 19.97 (SEAL) (SEAL) Earl Pech an_ (SEAL) C (SEAL) LeNore Pechuman i AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature (s) St. Croix Cowtgt authenticated this day of , 19 Personally cow before me this day of B ~ ' 1i 19 7 , the above named Ear.i F. Pechuman' and LeNore Pechuman TITLE: MEMBER STATE BAR OF WISCONSIN 1 (if not, ' authorized by 1706.06, Wis. Stats.) w mw known to be who ted the foregoing Amoumettt and THIS INSTPUMENT WAS DRAFTED BY