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HomeMy WebLinkAbout042-1097-40-000 r' STC - 104 AS BUILT SANITARY SYSTEM REPORT ~ Et 19-377 CUUNN OWNER ZUNINGOFFICE ADDRESS SUBDIVISION / CSM# LOT # SECTION-Z,~T~N-RAW 1 Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW F EVERYTHING WITHIN 100 FEET OF S~ EM _ T-, CA tx" -j I'd 7 ~i ✓ 1;01~ IL 4 l~Jf t 4- %b it 0 INDICATE NORTH ARROW ,f Provide setback and e~Iev tion information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK:,8, ` , ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~ (2svttAat4 Liquid DO city: Setback from: Well-l 4ouse' ~/2GOthe ' / 0 Q Other Pump: Manufacturer z o 1 ~h _Model # Size Float seperation Gallons/cycle: 2 Alarm Location I SOIL ABSORPTION SYSTEM Width: Length. j S"41 - Number of trenches Distance & Direction to nearest prop, line:_ ,G Setback from: well: /3'1 'House / 7' Other ELEVATIONS Building Sewer y3 ST Inlet: ?9.44 / ST outlet: PC inlet S PC bottom 7 7. y J Pump Off Header/Manifold Bottom of system / Q Existing Grade Final grade_ /O ,06 ° DATE OF INSTALLATION: 40 D ac- 7 PLUMBER ON JOB: -1~ LICENSE NUMBER: Q,3, S-ir INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labo"r and Human Relations INSPECTION REPORT ST . CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284236 ❑ City ❑ Village Town of: State Plan ID No.: Permit Holder's Name: WARREN SORLIE BRUCE parcel Tax No.: CST BM Elev.: Insp. BM Elev.: , BM Description: 042-°1097-40 0000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 12Oo Benchmark 13• W" /,oo 60 Septic P~-'~G, K~ Alf, Dosing ~CekS ooo bAET~ OS27 Aeratio Bldg. Sewer /.S 9 $'2 Y3 Inlet ~j/:S3 9 3• g2- Holdi TANK SETBACK INFORMATION Outlet -71 91 62- ventto ROAD Dt Inlet 9 9S' ~g TANK TO P / L WELL BLDG. Air Intake d f foC~ 1 < <5 2 2 ~ NA Dt Botto 011,53 /yob -7 Septic 35 II I l 1 R ( NA -Man. Dosing NA Dist. Pipe Aeration Bot. System H Ing PUMP /3 INFORMATION tti+ok p . Final Grade Manufacturer Demand 1 91-53 <3 " I ' y~ GPM /490 Model Number TDH Lift2,c Lriction SYStem2 TDH 2,9 t Forcemain Length Dia. Dist. To well S SOIL ABSORPTION SYSTEM No. Of Pits Inside Liquid Depth B / TRENCH width I Length, No. Of Trenches P MEN 1 N 2,b 1~ DIMEN I Manufacturer: P/L BLDG WELL LAKE/STREAM L G SETBACK SYSTEM TO MBER um er: INFORMATION Type O e f/G l~L1 j q-7' 137 ' OR UNIT System: DISTRIBUTION SYSTEM x HoleSize x HoleSpacing Vent ToAirlntz?ke Header I Magna old Distribution Pipe(s)I ri r 1 /y 5 7L Length 1 Dia- Length Dia Spacing I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only xx Depth Of , r xx seeded/ Sodded x Mulched Depth Over + Depth over ryrr Yes ❑ No E - f Bed/ Trench Edges I Z 1Topsoil ~~Yl Yes ❑ No Bed /Trench Center COMMENTS: (Include code discrepancies, persons present, etc.) (LOCATION: WARREN 34.29 18 539C.SE.SE 130TH S~REET l2 °I-ate Pla~r~vlsion required? ❑ Yes lo 7 s Use other side for additional information- Inspector' Signature ert SBD-6710 (R 05/91) Date ) Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ! than 8 1/2 x 11 inches in size. it Number • See reverse side for instructions for completing this application State Sanitary Permt 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)1. State Plan I.Q. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Own Name Property Location - 1/4 1/4, 5 j T -2'7 , N, R f E (or¢,W~ Property Owner's Mailin Address Lot Number f Block N mb / ~ City, S to Zip Code Phone Number Subdivision Name or CSM Number ❑ Gty ]Near7estRoad II. TYPE OF UILDING: (check one) ❑ State Owned ❑ Village Public 1 or 2 Famil Dwellin - No. of bedrooms own OF v ' Ill. 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 [1 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: (Vplacement only one box on line A. Check box on line B, if applicable) A) 1, ❑ New 2. 3. ❑ Replacement of 4. ❑ Reconnection of 5- ❑ Repair of an System System ____TankOnly Existing System _________ExlstingSystem 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 410 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 (000 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) / Elevation ` .Say 7a 10q.10Feet 106,45-Feet VII. TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper_ INFORMATION New Existin Gallons Tanks Concrete strutted glass App Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank /Siphon Chamber 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 Stamps MP , P W No.: Business Phone Number: Plumber's A ress (Street, City, State, Zip Cade IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) Surcharge Fee) [Approved ❑ Owner Given Initial pzj Adverse Determination J X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO-6398 (R 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings oivi ion, Owner, Plumber - INSTRUCTIONS t 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. 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 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. SAFE'rY & BUILDINGS DIVISION State of Wisconsin I)epartmentof Industry, I.aborand Human Relations July 1, 1996 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S96-02270 FEE RECEIVED: 180.00 SORLIE, BRUCE SE,SE,34,29,18W TOWN OF WARREN 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 ILHR 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 ILHR 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. Sinc ly, Q, Ise Page Plan Reviewe Section of Private Sewage ORIGINAL (608) 266-2889 SRUA-9666 (R. 05/95) tt , 1 4 ULBRICHT & ASSOCIATES Reg. Designers of Engineering Systems 655 O'Neil Road • Hudson, WI 54016 715-386-8185 • Private Sewage Consultants PROJECT INDEX DILHR Plan I .D. # S96-02270 Date July 2, 1996 Owner Bruce Sorlie Phone 715-749-3795 Address 618 130th St . Roberts, Wis . 54023 Legal Description Tax Parcel # 042-1097-40-000. 27 acres. CSM 351514, Vol . 1 , Pg. 64 . SE 1/4; SE 1/4, Sec. 34, T29N, R18W Town of Warren County C St. Croix C .S .T. Robert Ulbricht CSTM2482 Installer Local Authority/ Supervision St. Croix County Zoning Dept . PROJECT DESCRIPTION Replacement system for an existing 4 bedroom home. The existing system is ponding above ground, and is sited in seasonally saturated soils . The soils are slowly permiable in the upper 12" ( platey horizons with load acceptance rates of . 3 GPD/ft2 ) . A long narrow mound system , trench type, is proposed. Soils were seasonally saturated at 22" as evidenced by mottling. The site meets the A+4" rule, and the mound will require a minimum of 14" of sand fill . A new code compliant 1200 gal . precast septic tank shall be installed. It is highly recommended that a Zabel filter be installed in the outlet , to provide ,;or the highest possible pretreatment and clarification oArEAPfluent . This will enhance the life of the system. L All old treatment `tam%s •• ' bandoned properly ro erlY per ILHR 83 .03 ( 2 ) . 4, + ,,„ � a S96 - 02270 �Q 00WWWWWnip,��� Pg.1 PLOT PLAN VIEWS OC `' $CONS ���'•,�. Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS g *f ROBERT W. ;y` r ULBRICHT -_ Pg.3 PIPE LATERAL LAYOUT Irmo HUDSONA1 Pg.4 DOSING CHAMBER CROSS SECTION -4 .6 ''••••••..••.• Pg.5 PUMP PERFORMANCE SPECS ,'�����''►'�rmmuG� "������``` This design for installation is based entirely on measurements, elevations, landscape conditions The accuracy (51opes etc. ) and soil suitabilityMili of his specs, as reported, shall remain thepsoledresponsibility�B of the CSTM. Any use of this POWTS design by any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the sorkmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet/frozen soils) by any such parties or persons. . 1 IN Ilk o vl I W r ti � � �. 3 I I o 0 k 11 I N N i o ' 1 • �, N � ,H I o ti N II II 11 I I Q(p o I T_ II II :I 11 I N, 1 I 1 I 0 ti , 1 a „ ----- _ - H ' ! 1 1 k k 1 p 11 I PM (") + 1I o f \� bi I > 70 I Ma E ? '� • 0 o --- I U' -h • o z 71 . i I irr i1 ......c,. y (1 ° 11 -r < X 't 111 \'‘ %\t‘ j cnz ri 11 N IA 0 W 596 - 02270 b C • v, II n ➢ o ... ...i n 7zl— \I 4. '�---- 1. --- NI 11 Sri o Z 1 v� b -j o 1 w r c• N N t 1 � ;� 4. � � I o N o 11 I ab N N 't o c\ 1 1 I N ; 1 r p O • o I I Z N iI N- II II II II I I 7— I1 '601 11 11 >< `I (-I 11 11 I ' I Q I /,) W I I I iT tI sc 11I fi 11 I n r I o •1i 7 1t 0 1 '....—/ m > m '= I rtr � y ao kli Z o � Z 0 mk It 1, 0 0 0 X /_.-K. - X -X X . i I ic s9s o 2 2 7 0 W • c W It II v. [Tr N In n (--- 1 •Z ftl - ' E' Z.. „5._______ . ill / 1/4, -1....is' i'r"N --1 I I yN b ), 1,3 U€R 1-- © F ' /2 17TE R A I S /6 4 6° • T°P aF /2 IArekAIs i° 7.5-- • To P o f R oc k. /d 73 s y s rEI EiLukri oA,, /Gy/D Straw, Marsh Hay, Or Synthetic Covering Medium Sand Distribution Pipe ,,...fir+ Topsoil !!��m s —_1 i E D �MIFDRN / 1(3 % Slope Trench Ofi.- 2 i2 Force Main Plowed ' Aggregate Layer /02 • 90 (Undisturbed 0 I• 2- Ft. (I y") Soil E I. Co Ft. ( I") Cross Section Of A Mound System Using 2 F •85 Ft. SE PAT - Trenches For The Absorption Area G 1• O Ft. A 1/ Ft. H / - Ft. B 63 Ft. C G Fk . K // Ft. L /54/ Ft. J 7 Ft. c� Positiorf of Force Main W ZCo Ft: S 96 - ® 2 2 7 0 il* — L11 J • I _ B _ _ 41 K 0,1 • 1.\\ c._ ____ _ __Ili 1-. I \ W Observation Pipes , Distribution Trench Of 2~- 2 w Pipe Aggregate if Mound Using - Trenches For Absorption Area ( 5EPEe/1-/- Ti?EN cffE5 ) _ PER FbR ATeD P i Pe be-rtNi L. ���;���e 1 Fb R TRe N C t� '.S �ERh� ‘ A ,\ 9 ST b pv6 L ,� E- 0 Li O" .� \ l D eo° bs ` 5o ,pp--�c,. ' \a______._____--- NN't GM To --- \_st,\ \ \ f 0?61- 0,,o.‘6P . �n,E s � @ -p (pi\- r TC�TA L v v� unE OF C ! F r a a x 1-0IE- � �rAN� t� / iudt VC)/D Ud/at€EE FoR 375- ,cT_ LATEPhL " J z i,.. M AN TWO " Z- i' 2 °F PUG Foie66- fri/f/a) (p 2- F0RCE 1`1AO u 2 ,i tas # 4o/Es p p E / 7 y i iNc N ES 1.13uER r E I E uATt o o Y5 ' L"--r to/NLs /6g, 60 S96 - 0 2270 I)ISTPiT3uTIo,. DI'Sat- SUE RetTE- FoR EAc-GA. I ATE/26L \IAA_ 0 TI 5 Ti .,27 /y: ey . , _gt/444,.,0 .25 n/A) . I/L-40 TaTA-L D'S 7R/ /3uT/0,v D i'SGGi 44/6-6" kr4T T fO 39 7� � rwo,�� t.. . 3 0T S -- PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE 1 of 5 r.r-VENT CAP 4 C.I. VENT PIPE 1 `— APPROVED LOCKING I WEATHER PROOF JUNCTION BOX MANHOLE COVER. 25 FROM DOOR, - to/ajAR,UIJ(-- 41/3E/ WINDOW OR FRESH I2"MIU. 1 AIR INTAKE I VADt Gr/E 1/47/On/ GRADE I [HR_ 9I 'MINJ. ���� 4. _ l..� I .... • `err I 3 d I CONDUIT � —� L_ A 3• c\-\� frv4n n/v 1 — 'F \ „-i p go.Q PROVIDE 1 - p y —--- ,V y� INLET —_ AIRTIGHT SEAL I I 1 5117E 1� ' APPROVED JOINTS APPROVED JOINT A 111 ,(Alf I I 1 W/C.I. PIPE W C.I. PIPE I F� ��U 1 I ALARM EXTENDING 3' ONT SOLID SOIL B / �0 I(� ONTO SOLID SOIL I 1 b� (0 ) I OM / s b ELEV. FT. 1 I PUMP-� --J741> 1 OFF 05 �(f if 4A��Kull if—A.) ` I t( BLOCK--►{ Fit X-- RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFICATIOMS DOSE GUE-ek-C Cd',vGt-e f-C . TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TANK SIZE : /cTV V /gyp GALLONS DOSE VOLUME 6y2 ALARM MANUFACTURER: Uv 4`/f'`M CO` • INCLUDING BACKFLOW: �/Z GALLONS MODEL NUMBER: 7,• O.L. - / CAPACITIES: A= 20 INCHES OR yO GALLONS SWITCH TYPE: M�/QGUR y F/047 B= Z INCHES OR 7v GALLONS PUMP MANUFACTURER: /��[ 1`5 O ' C=/d' INCHES OR 2/2- GALLONS MODEL NUMBER: kilt- Ar40 /61 Yy i/Q D= /74/ INCHES OR 37 g GALLONS SWITCH TYPE:PlJY6/46K /11 wR✓ f%''47' NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE /a GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..�7 V FEET fiAfrol�L SPECS . � + MINIMUM NETWORK SUPPLY PRESSURE g2.55 FEET 6ACGt I �I 01 �k P ` { _ 375- FEET OF FORCE MAIM X Z•6Z FT�0U.FRICTION FACTOR.. /• o FEET t- 2 0 ., �rJrls ?IS-, = TOTAL DYNAMIC HEAD = 3 9 7° FEET Roui p gr CO INTERNAL. DIMENSIONS OF TANK: LENGTH/ ;WIDTH ;LIQUID DEPTH 896 - 0 2270 P , 5 oF 5 + P HEAD/ 115 - CAPACITY � :: :: LIT CURVE . . . 30 100 85 28 90 28 -85 'MI 1 i EFFLUENT 24 -80 " 1 MODEL and 75 MODEL 189 .. DEWATERING = 22 70 ,65 ,� �� 111 U 20 -85" ` I ' I18 -60 ,55 18 , MODEL 50 N I" ., 1r MODEL 14 45 ; 188 12 -40-35 10 30 �� 137MODEL,139 MODEL i: , 185 SEWAGE and 8 25 Mil/ DEWATERING 6 -20 I MODEL MODEL .4 161 15 4 •7 ' , 10- W { 2 MODEL ,' • .11I ■ F 5- 53,55, I:u 57,59 0 I GALLONS 10 20 30 40 50 60 70 80 90 100 110 80 1 24 75 ■■■■ • LITERS 0 80 6. 40010 240 320 4 22 'o :MNMNM FLOW PER MINUTE 20 65 1•EEE 18 _60_ EEM ,. ' MODEL— . ',, 295 W 55 S 16 ., U SO ` in i IIIII 3 14 MODEL ..1 12 - 0- 4 • • 1 . Q 35 MODEL F- 10 293 -� I i O 8 25•'OMEN MODEL_`� 2 4 E` - [_ jr s ® 2 2,7 U _,'U MODEL _' I ■ 6 -20- �_ _`+ 282 _ - - 4 1015 I MODEL ��\ ZUELLERin. 2 5 ■ 267,268 o • , 3280 Old Millers Lane GALLONS 10 20 30 40 50 601 70 80 190 100 110 120 '130 140 150 160 170 180 190 P.O. Box 16347 I I . } } I I I Louisville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 (502) 778-2731 ' • FLOW PER MINUTE • HIGH HEAD "161""16,7 ""1651 "185"-"188"-"189" Series (1/4HP) (% HP) (1 HP) (1 HP) (11/2 HP) (2 HP) • Automatic or Non-Automatic. SERIES ,,. +u ss 1es +a +n • 'h IA.P.,115V,230V,200-208V,1 Ph.Or 3 Ph., 41 51 c.+,O. a41 1,,, a.l 11., 1151 11,5 041 11,4 041 11. •. ' / I 460V,3 Ph. „ 1 57 IM 401 61 231 61 nl 155 567 155 567 /^! • 1 H.P., 1'/x H.P.,2 H.P.,230V,200 208V, 1 Ph. 05 37e e1 ", 61 "' 4e 560 151 sn SI 91 Jae 60 127 fQ 227 142 531 145 S49 • or 3 Ph.,460V,3 Ph. 20 510 62 3,0 59 223 60 227 ,S9 515 140 530 25 752 74 240 57 2,5 59 227 126 464 133 503 SC 1225 • Passes 3/4"solids(sphere). 10 914 65 246 55 206 59 270 90 350 121 458 121 461 • 11/2" NPT discharge standard. '° 12,9 48"' 46 29 55 206 75 '°, 105 397 "' "' 50 IS 24 21 90 13 125 51 191 59 219 90 III 100 319 • Float operated,submersible(NEMA 6)2 pole 56 IR 29 15 67 41 16, 16 116 I1 269 65 372 70 21 14 10 114 1a 36 51 193 70 265 ' • mechanical switch. M 2436 14 51 29 106 54 204 • • Automatic reset thermal overload 27 43 2 a 37 146 ,30 10 44 21 79 protection, 1 Ph.only. s Jx 06 , 39 — • Durable cast iron construction. ,xs v4wr 56 66 87 73 91' 115' • 2"or 3"flange available. • 20 ft. UL listed neoprene cord and plug. • Canadian Standards Non-Automatic ()listed al Assoc.Approval available Model Pictured WARNING: Model 185 should not be subjected to less than NOTE. No UL listing for 20-208V/1 Ph.pumps. 30 feet TDH. Mercury float switches ere available for non-automatic models. tt . 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 8 1/2 x 11 inches in size. Plan must County include,but not limited to: vertical and horizontal reference point(BM),direction and S% G"0/*)( percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.# aye- /c 7-17/0 -04 ° 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)). I . Property Owner Property Location / /3R c -- S4R L/E- Govt.Lot 5 1/4 5E 1/4,S 37 T 2? ,N,R /g E(or)C9 Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# I S 13o te- sr. PART ©` z7 '4c ves City State Zip Code Phone Number gNearest Road Rof3ERTs i w (. i syo Z3 1 (-7/S )7yf .377 ❑ City ❑ V aAkfe Town I /30 - 5T-. r❑ New Construction Use: esidential/Number of bedrooms - / Addition to existing building ED-rieNeplacement ❑Public or commercial-Describe: /{//� NOT Pf 'A1/T7` 2 Code derived daily flow (nOo gpd Recommended design loading rate N/fi bed,gpd/ft2 '33 trench,gpd/ft2 Absorption area required COe bed,ft2 .'OCR trench,ft2 Maximum design loading rate N� bed,gpd/ft2 ' trench,gpd/ft2 Recommended infiltration surface elevation(s) - '2a- p . 3 ft(as referred to site plan benchmark) Additional design/site considerations 5/ TE iPE CiiRES' /Vo ODD) A4E4/"s A-4 y" /ev/E-. Parent material SCS 68 _ U/VS4Ty . S.//Cy CE,ArrF-v%-s 40 Flood plain elevation,if applicable '74 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system [1] S 0-i f EllL❑ U S +�f u ❑ S [jiU ❑ s El-tr ❑ S ❑-t SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz.Cont.Color Gr.Sz.Sh. Bed , Trench /• I o io /o ye 3/3 /s /.wt fR d 5 c .S' 3-r ."7 .5 2- /0-4 /o 0 3/3 3/ /fsh/4' , i,,., f/e C& 2 U f- , iV : • - Ground 3 /f X /0 yR 3/7 S// 2f s hid /h,_r/2 a co /U f . 5 : .C. elev. /0 2-yo ft. Lf )4-36 10 YR `//G 7 s`);--A 5/4, 5 C - I f 5-he Alf R C 5 . z : . 3 s 36-Y6 Ioy2 4/ z p ci. /IGJ5'h>v 4-fP--- . — . Z ' .3 Depth to — 5 w' S1' ' limiting , factor 7lp in. . $S5 . Remarks: Boring # / y / o- 2 3/G 3 /osln /fsh/ . d5 C 5 2 f . '7 : .5- 2 ' 2- V-/6. /b yg 3l`/ /D/ii if5he ,wr fie c S 2_+ . q : . 5 /6/e y - ae 3 /6-3o JoyR W6 — / y�,4�FGe&�,y Scz- /fsh,� '2 a- 5 , 2- : • 3 Ground 2-yb /o yR �/2- Ai.. 2. e CL . 2 f S h f I- . ' S elev. ,oi .yo ft. sy2 5/6, . Depth to ORIGINAL limiting - factor 30 in. Remarks: CST Name (Please Print) Signature Telephone No. Ror3eRr 211-3RiCGAT �,� 7/5-- 3960-91J35 Address Date CST Number Ce- I2.- '6,, csrAfzy82- Ulbricht&Assoc es Private Sewage Consultants 655 O'Neil Rd. Hudson,Wis. 54016 k 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Z 3 Page of PARCEL I.D.# d Y~ - /d f -7 000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 o-S to vie 3 /3 /014A, 2,w she s Cs 3uf . s L Z 42- /0 V 313 1 lk4- R CGV 3 f- V . 3 elev. nd -2 / 0 i2 t/E~ E S ~T <7 /Jk /tM lJie C S 04 -ft. i- /a R 2 c L 9~ys SRS/G Depth to limiting factor 2-2 in. t%:5.5. Remarks: Boring # Ground elev. h. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD fit in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground) ! elev. ft. Depth to limiting factor m. Remarks: SBDW-8330 (R. 08/95) K w rC. 3 1' i o '4 4. 0 o CO N N N r o a I • o o ie m ? Q(a01 ;< 0 _ - • • I., b, N. Q w /--1 N J ul 3 v, m � 01 y ys 0 a -- -"r--- -t-- \:‘ ''',,i\ ''' o El III � z A 0 a 0 r e w • kP D :z n w It I ft PI 4 C tn• S.I\ ln -+ TZ. .)_____........... Il otIl i ° o , W E 1 rr , W r ~ ~ ~ ~ N • ~ o o y ~ 3 `9 a 1 ~ o m 0 o Q w N J ~s m o v w o~ ~z m n~ 0 0 0 r w D oil 6 °1 C; - 10i" 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_ E % E m t- 4 Location of property 5E 1/4 L 1/4, Section -7~ c( , T-N-R~ W© Township 4Va ka, g W Mailingaddress ~l$ 1-3cs-9 ~f- Address of site Subdivision name Lot no. Other homes on property? Yes ,'--No Previous owner of property 'W14I.-L / Total size of property 9'Z 64 4-501 Total size of parcel a-9~~ ~cJ~al Date parcel was created / 98y Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes !/No Volume Z59 and Page Number 'f 'Y 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. 32,S-9 7-A/ , 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-Applicant //)//171 D to of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER~ f' c 5 a> h~ Lr- MAILING ADDRESS PROPERTY ADDRESS &j F_j'_t_5 (location of septic system) Please obtain from the Planning Dept. CITY/STATE 9,& ~ r)- t5 l yz- PROPERTY LOCATION 5' 1/4, 1/4, Section 3'Y T N-R_J$ TOWN OF W !j N ST. CROIX COUNTY, WI SUBDIVISION /T LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. ~J SIGNED: DATE: l/ 9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 RfSEPVED /ON REffRDUO OA~~ rJ. y ,-.S SPArt WARRMTY DEED DOCUMENT NO. STATE BAR OF WISCONSIN FORM Z_"" 395374 695%E247 _ RBG45TERS OFFICE lund ST. CRO(X CO., WIS. Hoglund,.and•.Deborah•_L.,,Hoq„ Rx'd, for Record this 28th husband and wife as joint..tenantsr day of AuR a D. 19 84 j of io • A , M. f' conveys and warrants to $rllce__M.._-Sorlie__ and--..-_•- 1 l~al.l y-..d Sort-ie.,...husband._.and._wi.Ke---------- RETURN TO - E St. Croix i ! the following described real estate in ~ State of Wisconsin: Tax Parcel No - f i Part of the Southeast Quarter (SE's) of Section 34, Township 29 North, Range 18 West, described as follows: coasmmcing at the Southeast corned of said Section 34; thence proceed North 88047' Wesintlofgbehinningh if line of said Sect'_on 34 a distance of 60 feet to po' g for a parcel to be described; thence proceed North 3°02' East a distance! ~ of 222 feet to right of way post; thence pwoceed South 86058' East a thence proceed North 3°29' j distance of 27 feet to a right of way post; ; East parallel to centerline of town road a distance of 757.5 feet; thence proceed North 86039' Wes.`_'a distance of 766.80 feet; thence I proceed North 2°18' East a distance of 33:_70 feet; thence proceed South. 87015' West a distance of 286 feet; thence proceed South 0018' East a distance of 301.50 feet; thence proceed Swath 83006' West a distance of 720.60 feet to northerly right of way of I-94; thence proceed South 53°28' East along said northerly right of way line of 1-94 a distance of 1593.3 feet; thence proceed South 88°47' East a distance of 386.8 feet to point of beginning. Said parcel containing 26.92 acres more or less.! i! !I TRANSFER i This ......1s homestead property. L*[~+ (is) (is not) Exception to warra..ties: Subject to easements, reservations and restrictions of record. Sr 19....8.~t day of Aug_v$ Dated this Y/4& ------(SEAL) P• t- H_OtG4LUD (SE AL) - ---(SEAL) F.AL) DE OR" L. HOrL1,ND. AUTHENTICATION ACKNOWLEDGMENT Or aXl9-M D-kWLTA Signature (a) as. SS .County. authenticated this .-day of--------------------------119 Personally came before me this -•~l------ day of A& lst , 19 84 the above named Alan P. Hoglund.and - y TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - authorized by $ 706.06, Wis. Stets.) to me Lmoam In be the person -5=..... , wllb exec e ferego®C anfdrument and acknow I th a!4i6.-