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HomeMy WebLinkAbout004-1042-70-000 0. 0 ~ o er 0 of M o~ Oq ICI O ~ ~ I O O N N v , i ~ I I LL a Q I' 3 M I v I ~ (n p Z ~ i' £ c I w co W a m F- U) c o i 0 2 I' w dz'al'' ~ o I NE-.-i ~ Z I E ~ m ! t It c I • N a •c o i Z Z Q ~ N w c c N N l6 E (9 N m: wa i ~ aM w m c N N d ~ O ~ I a N N N ~ •N i o a o. a m 2 . . ~ = a N 4j (o (D U1 J V z rn rn t►i z } cn co `l v ao rn a~ 0 a ON CD 00 N O E CO (O O :3 _ N U m Q } c C (D y N °o Cl) h e o a c E rn co 0) O Cd O Q O U O O 'V L Q~ O O O^ C p~ N C Q N ON N ~ a s*y p ~ O EtF N L a WF- O H N a N Li d0 j, ' C I~ d N a U N Z Z (n iii OO U Y N O _ O ~ I .r V a; (D a 3 u a CL 2 d • m c m 3 o con E c1 A a a ~ o U) ) ` Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY paper s st include, but Attach complete site plan on not less than 8 1/2 x ,t' ind Z746~qU not limited to vertical and horizontal reference point (BM),`dir13ction and % of-;lope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance( ,te nearest road. CCAI -/b y_Z~ _ 70 APPLICANT INFORMATION-PLEASE PRINT,-ALL INFORMATION- c REVIEWED BY DATE PROPERTY OWNERS Qr Lj, n L zPROPS LOCATION o ~ of GOVT LOS' 15r- 1/4 1/4,S /9 T N,R /S' E (o',Lv PROPERTY OWNER':S MAILING ADDRESS .f LOT # BLOCK # SUBD. NAME OR CSM # /10 p- ; (Ct CITY, STATE ZIP CODE PHON []PITY ❑VILLAGE WN NEAREST ROAD (7 16r ['i-illew Construction Use [residential / Number of bedrooms Addition to existing building j ] Replacement Public or commercial describe Code derived daily flow X SG gpd Recommended design loading rate s bed, gpd/ft2 trench, gpd/ft2 Absorption area required __Wl) '6bed, ft2 212_trench, ft2 Maximum dgsign loading rate bed, gpd/ft2_,~,_trench, gpd/ft2 9;tAC), Recommended infiltration surface elevation(s) 9~ ~l ft (as referred to site plan benchmark) Additional design/ site considerations Parent material 15, 'y-,11 Flood plain elevation, if applicable Ay ft S = Suitable for system CONVENTIIOONgt, MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL. HOLDING TANK U = Unsuitable fors stem ❑ S D O Ew- ❑ U ❑ S C~'l1 ❑ S B-IJ ❑ S au- ❑ S 8•H- SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtclary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 15 AL S Ground 3 5~ elev. ft. Depth to limiting factor Remarks: Boring # a r r4a I a - Jb ► F s_ -57 ~3 ?~-4o Io h U - vC tr VY1u~lr Ground ele ft. Depth to limiting factor 'fU'~ Remarks: CST Name:-Please Print Phone: C o -~•S~ 77.2 3-2:1 k Address: ' I = 5 .7,/, 1 Signature: Date: CST Number: i ~ ~ ...E ~ C cf ~.)Q'r v%~~ Litull PROPERTYOWNER ja` 5- SOIL DESCRIPTION REPORT Page 'of 3~. PARCEL LD. # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed Trench Bed re Boring # Horizon in. Munsell Gnu. Sz. Cont. Color Gr. Sz. Sh. i ~y IU ' / J S6y~ WtTr ~'Ll~l 1J~ Ground p, elev. \ - 1 S ft. h n v ~~1 S Cry Depth to limiting factor 4 14.6 U-) Remarks: Boring # ( cv I,J t v F f c r (U 7. SL le c) '412 i 5 2`+ I Cr J Ca Ground r 3 , elev. U /G Still ? 6 ft. Depth to limiting factor Remarks: Boring # -e (O 2 s~~ ~~u~Sd Ccw a:...,.,........ d ti S P r Ground 2 1-7-24, O elev. ft. Depth to limiting facto„ Remarks: - Boring # 4 r ` v .SLR Ground.. I G JL c r1 s- + ~t elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) t C A a i ~ I R E_ ~ - ~ c ~ r h ts~ n h~ k OB S OC o ~T rZA l C a I I i t G ~ ~ r Wisconsin Department of Industry, SOIL AND SITE EVALUATION R T Page/ of 3 Labor and Human Relations A q Division of Safety & Buildings in accord with ILHR 83.05, W' JR~VEJVED Attac h complete site plan on paper not less than 8 1/2 x 11 inches in si,~ ~ust,iVttinot limited to vertical and horizontal reference point (BM), direction and 00 81t~,pe, soole or . # dimensioned, north arrow, and location and distance to nearest road. 7p k BY DATE APPLICANT INFO RM ATI0 N- PLEA E PRINT S ALL INFORMATIO i PROPERTY OWNEPS 4, u )irt L f za// PROPERTY LOCATION A ;vl rs OVT.LOT' 1/4~. ,S T -2) N,R /S- E(o&1- PROPERTY OWNER':S MAILING ADDRESS LOT.# BLOCK # ME OR CSM # / 1 0 P7 0 O( J s~"rz•~~ IL_ CITY, STATE t ZIP CODE PHONE NUMBER [-]CITY ❑VILLAGE WN NEAREST ROAD t Vii ~0 5 o2b (7 /,5F C.7"/-f "IV 0 " }-Kew Construction Use [residential / Number of bedrooms _ [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow C gpd Recommended design loading rate . S bed, gpd/ft2---&-trench, gpd/ft2 Absorption area required ( _Aed, ft2 7 j 2 trench, ft2 Maximum design loading rate . r bed, gpd/ft2_(,_trench, gpd/ft2 Recommended infiltration surface elevation(s) 9~ S/,~ r ~ Yfi It (as referred to site plan benchmark) Additional design/ site considerations 2 5 x o -27,S -0 Parent material 5,/f war Flood plain elevation, if applicable ✓f1 ft S = Suitable for system CONVENTIIOONg~ MOUND 1 7 IN-GROUND PR SSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S L~ C1 ❑ U ❑ S ❑ S E J ❑ S Dij- ❑ S 9-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 V) A VA Ground c r t , S 6 elev. ft. Depth to limiting factor ' Remarks: Boring # Ground ~ ' 40 0 l1 y' v 5 c r I ~A u ~v I S ele . ft. Depth to limiting factor - 7 ` Q" Remarks: CST Name:-Please Print / Phone: \ 77. . ,r; J 9 Address Signature: Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page? Uf3j PARCEL I.D. Depth Dominant Color Mottles Texture Structure Consistence Bax>day Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>fi 73<>> r D 3~L r" LA-) Ground - s w, b r 3 elev. .5 M/51t. S ft r, n z Depth to limiting factor :3q" Fs 1a-Guy Remarks: Boring # I-S 15- --^A 1 C3 ~12 %L j Ground elev. ft. Depth to limiting factor Remarks: boo ~,r Boring # _ ' - C e. 2 ( > u S~ Vv~ r mow' , yr 9 P I I f ~ Ground elev. ft. Depth to limiting factor , Remarks: czf ~c - ice' Boring # F Ground elev. ft. Depth to limiting factor ---r Remarks: SBD-8330(R.05/92) { mss` F 713 C I vk T' T n R, I w 1 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS oa~- 16gA- 10 -mob SUBDIVISION / CSM# 1,7 • ZgoA LOT # SECTION T_N-R_4:~- W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S r 34 Cr,' \ N~ 0 a 5 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: r ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /~©a ^ boo Setback from: Well aJ House Other Pump: Manufacturer Model#~ZrL Size Float seperation 1 16 Gallons/cycle: 13-5- Alarm Location- 6T-1 SOIL ABSORPTION SYSTEM Width: % Length Number of trenches Distance & Direction to nearest prop. line: 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: PLUMBER ON JOB: v S-/ LICENSE NUMBER: /~c INSPECTOR: /ItA^- 3/93:jt i11 m onsln Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division ~ (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 262468 Permit Holder's Name: ❑ City ❑ Village] Town of: State Plan ID No.: Insp. BM Elev.::p BM Description: Parcel Tax No.o,/ / y~ fK X02 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION -_BS HI FS EL 6. Septic Benchmark 6.701 /G~• Dosing l lrY1 rn~2 %r ~d G~c✓' l~ Aeration - Bldg. Sewer 0 X00, Holding St/ Inlet 3 x'36 TANK SETBACK INFORMATION SbkOk Outlet gSS~ Verit TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet /l Air Septic ~166 gs' } NA Dt Bottom /o? 30' 9 Dosing # NA liaader_/ Man. Aeratio NA Dist. Pipe Bot. System Holdi T PUMP / StPFUM4FIFORMATION Final Grade Manufacturer Per On t Model Number (0 ,-0V P Loss mead riction r 1 System TDH9 ' Ft TDH LiftLJ~S' F Forcemain Length I Dia., " Dist. To Well >9S r SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S~ IMEN I LEACH[ SETBACK acturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION Type 0 O A NIT R Mode Nume r. System: n `."bISTRIBUTION SYSTEM ~ x Hole Size x Hole Spacing Vent To Air Intake Header /Manifold Distribution Pipe{s) ~ Length ~ Dia. a' 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 i ti COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CADY, 18.28.15W, SE, SE, CNOUNTY RD N , n Plan revision required? ❑ Yes 0-4-0 Use other side for additional information. /y o J" SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ti SANITARY PERMIT NUMBER: m E i Safety and Buildings Division v~i~'■'■R SANITARY PERMIT APPLICATION Bureau of Building Water System: 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 8112 x 11 inches in size. S G • See reverse side for instructions for completing this application a State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ eck t revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION ~o O O Property Owner Nam Property Location 0C, SEl/4 .5`C1/4, S T N, R /sE (orko Property Y r s aili Address Lot Number Block Number J, d. Ci , State Zip Code Phone Number Subdivision Name or CSM Number 245 It Nearest Road II. TYPE F BUILDING: (check one) ❑ State Owned y ❑ Village _ Public 1 or 2 Family Dwelling - No- of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 00y/oya-~o 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. rV New 2. E] Replacement 3. ❑ Replacement of 4_ E] Reconnection of 5. E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 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 41- Re uired(sq. ft.) Proposed (sq. ft.) (Gapda /sq. ft.) (Minc1,J ~ Elevation 7s -0 J , Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank 1,004- dd o ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber a061 - Dp ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er N m (Pri t) 2 Plumber' gnatur No St m ) MP/MPRS No.: Business Phone Number: Plumb dress (Syre~t~City, State, ~i~Code~ c~ Z4_e_Z:_' IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved SAfaitary Permit Fee (Includes Groundwater ate sue Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial lox Surcharge fee) 6 / /6; X, I. . Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit 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"purnper 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 3 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 isto fill in name, license numberwith 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 in~lude.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'1 15 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. STATE OF WISCONSIN ST. CROIX COUNTY MOUND SYSTEM COVER SHEET PAGE I OF 7 FOR: Greg Took PAGE 1. COVER SHEET PAGE 2. PLOT PLAN PAGE 3. PLAN VIEW-CROSS SECTION LOCATION: PAGE 4. DISTRIBUTION PIPE LAYOUT SE '/4 SE S18 PAGE 5. PUMPING CHAMBER T28 N,R 15 W PAGE 6. PUMP PERFORMANCE CURVE Cady Township PAGE 7. SOIL EVALUATION REPORT PRIVATE SEWAGE SYSTEM C'ond'itionally Materials as per 84.30-2-3, 83.20 (1) -(6) Bury as per 82.30-5-6-7 APPROO"VED"' Pitch as per 82.30-3 Tanks as per 83.15 (1) - (5) • Installed as per 83.23 DEPT. OF INDUSTRY, LABOR & HUMAN RELATIONS Friction loss as per table 9, 83.14 DIVICI OF SAFETY AND BUILDINGS SEE,COR a PONDENCE Plan #596-20064 Bradv Utgard MP0007456 S96-20064 re Co,'' I i ~~T-- ~~~yi j i ~P/ n s► S9G j- x;00 ,'S~ SE / Gr/ I I , ' v /B`T R I I 4 T~v a j ,I . : ' I To'ne O f Ga 1 - int VOT, I - r sde~ m, o ! C7 h I j I I v-y n i~erS. I , 1 I h~ ~ I I ~ ~ I I ; i ' j t I I I I( j i ~ I I I I i I~ i 1 + ~ I I i i I i l : ' I I- I I I I I NA)L-4- -T-o j cam, ► z. i j I t t ~ ~ e i i I I I ;1 I I , I . 1- ~ ~ ~ I -4 I I~ r ~..9J.- . he ark Z t below ~v r ~F Y I I 'or do y to must r z° i:~ ndi tt~► i - - '~Sotj Ab ms ~ I ~ i Page 3 of 2 . 1 Approved Synthetic Covering ~gYM c ~3 Distribution Pipe Medium Sarid H -G Topsoil oar, - F Elev. C-/% _J t D 3 E e 7 % Slope (Force Main Plowed Trench of z"-2h" From Pump Layer Aggregate (undisturbed D Ft. Soil E &2 7_ Ft. Cross Section Of A Mound System Using F Ft. I Trench For The Absorption Area G Ft. A Z/-_ Ft. H Ft. B 9''/ Ft. I A Ft. Linear Loading Rate= •l, GPD/LN FT J b~ l Ft. Design Loading Rate= GPD/SQ FT K 10.2 Z Ft. L~ ~.W Ft. Position of Force Main W , S Ft. L 77- J ~ 41 -4 K- A o _ w + Distribution Trench Of 2 - 2 2r Pipe Aggregate 1 Observation Permanent J Markers Pig.es Mound Using I Trench For Absorption Area rte, Page _ Of Perforated Pipe Detoll 0 End View Perforated End Cap) e_y' PVC Pipe 1 . ~~Zo voce Install permanent-marker at end of each lateral Holes Locoted On Bottom, Are Equany Spaced Q End Cop P ti PVC Force Main Oisirtoution Pipe Lost Hole Should 8e Next To End Cap Distribution Pipe. Layout , P _Ft. X 40' Inches Y y Inches J, Hole Diameter Inch Lateral_ Inch(es) Manifold Inches Force Main Inches It of holes/pipe /7- Invert Elevation of Laterals/00*440IFt. ~ intervals. Place 1st hole from tee with succeeding holes atVV Last hole to be next to the end cap. PUMP CHAM&ER CROSS SECTION AWOSPECIFICATIOAIS VCIJT CAP 4'C.I. VENT PIPC WCATHCK PROOF APPROVED LOCKIWI•. 77 JuUCTIOIJ BOX MAM WLC COVER v~ L5' FROM DOOR. Il~MIV. 1AI WINDOW OR FRCSH AIR INTAKE 1 GRADE I y' XIIJ. WHO 10' M111. COWOUIT 'PROVIDE I INLET AIRTIGHT SEAL I III 1 / 1 111 I ( I~I APPROVED JO' APPROVED JOINT A I Ili W/C.I. PIPE W/C.I. PIPE 1 ~m [XTEUOIur. I 1 ( ALARM OIJTO sotto It EXTENDIM(p 3' (=Jt'~C f n c:~~ - I 11 . OWTO SOLID &OIL B I r I ow c i LL CV iT. PUMP-A Off O Provide N Ott ETE BLOCK material under tank-in 3" (4~ ( AP R15CR EXIT PCRMITfED OWL I 'TAIJK MANUFACTURER HAS SUCH APPROVAL. gFpp W' SPECIFICATIOAIS SEPTIC E _ DOSE Jk 4-> IQ OonCr, /-2 NUMBER OF DOSES: PER DAS TANK MALIUFACTURC.R: - TAIJK 51ZE:-.APOA00 =GAL.LOWS DOSC VOLUME 135~y~ GALLo L~vc / /d"o- INCLUDING BACK/ LOW: AL~A_RM MANUFACTURER: L~ MODEL IJ.UMBCR: h y CAPACITIZS: Aa WCHESOf, 222 G^LL0 SWITCH TYPE: t/C d~ I/ - g = a INCHES OR -?3' 6 L-. GALLC 0, a INCHES OR I-L y GALLC PUMP MANUFACTURCR: MOD L NUMBER: 9 D= INCHES OR/~1 GALLC SWIT H T'JPE: H1~CV~Y MOTE: PUMP AND ALARM ARE TO BE INSTALLED OW SEPARATE CIRCUITS MINIM M DISCHARGE RATE O$ GPM VERTICAL DIFFER CE BETWEEN PUMP OFF AND DISTRIBUTIOAI PIPC.. 2L FEET 2.5 F LET + MIIJIMLIM WETWORK SUPPLY PRESSURE . . . . . . . 1y~ FEET OF CORCE MAIM X L.~ FYoFORICTION FACTOR.. .0 PEET TOTAL Dy1JAMIC HEAD FEET = Y9~ IWTERWAL. DIMEWSIONS OF TANK: LEWGTH 1L -.WIDTH -;LIQUID DEPTH gIGNE D: LICEWSE IJUMOER: DATE:-- HEAD/CAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 18514185 should not be subjected to less than 30 feet TDH, TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE to ~ u66 t;J w 3ER11s _-~1 - -111 --gt-1JL- X11 +NI 1 -!1JMjJL- t t 1 _11sv+1 t 1 t , 1 u to F7. r. GM. Lft GM. L16. GM. LN GM. In GM. I" CM. L!6 GM. lIS GA Lh% G41. L60. GM. LW& GM. Lim GM. 1.q. GM. L67. GM. LM 140-- ~ 1.07 113 @ 21 1N U p7 fl 211 11 112 N 214 IN N1 11 127 IT 271 N 220 III 6117 M 1n 41 171 42 +0 IAI ql M 21 17 _34 111 11 121 /1 100 N 211 IN 271 11 211 91 111 N 221 101 101 111 m u I?$ !L--M 114 PA 13 + 11 1" IS 12Z N 1J II~F 102 SIT ul 41 7 1351-- - - M 1.11 It 1 2 It IS 11 IS 110 12 221 N 1N 11 221 N 127 11 221 120 111 IN NO is 111 40 t12 - It 7A1 - - 1 11 12 111 N IN N 111 11 U2 N_ 211 121 011 112 IN U ql 70 I.t4 _ 12 101 N 101 /1 2N N 221 N 3" 11 221 121 10 121 y+ 01 171 40 ,tto 20 IU W 174 41 172 N M1 71 212 II M 101 217 114 N1 41 111 38 0 161421 N 22 121 61 111 N 1H N 221 N 101 1N 171 41 171 tl It 41 141 M 116 61 221 11 !11 I1 12 41 111 - f0 2L14 21 111 II IS u 1a 11 IN 71 2N a 171 36 191 'o- ItA 14 11 A 111 21 106 N 104 45 ITS 1 1 5- W ltA1 22 111 2 1 11 140 46 ITS 100 20.01 _ I N 2, fl 00 1N 34 Vito a;o - 7 21 1 21 )o f14 110 116 26.11 _ - 20 n 105 uo-?tu - - ,o >a 32 l«IVMN. !14' 21' 11.11' it 40' N' U. P 12' 11Y 1P 117 tir 100 30 I- 95- 28 9--- 0 - - - 186, 76 4186 115 - - - - 165, 74 80- 4165 IS, 75-- - n 22-- INS 70- - L 65 D } 60--163, 4163 18 - 63 189, ~ r d 55- 4189 0 50- 14 45- 12-- 40- 140,' 188, 35- 4140 - 4188 10 30- 137, 185, 8 25 139 4185 6 20- 15- 4- 10 2 5 43 4 5 1 161, 57,59 98 4161 0 U.S. GALLONS 10 20 0 40 50 60 70 80 90 100 110 120 0 140 150 160 1 LITERS 80 160 240 320 400 480 560 640 0 , 08 ~~~FLOW PER MINUTE OM__ Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page % of Ls+bov and Human Relations D1Gision 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 ' c e, `°s -q Nn include, but not limited to vertical and horizontal reference point (BMiftFectdn and of sfbe Is or PARCEL I.D. # dimensioned, north arrow, and location and distance to, , garest road-, CICY 4/- 70 REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT A~. IINFORMATION PROPERTY OWNERS 4r t.Ji n ,L t Ze// - RI PER LO ATION e( std I~ , es 'a GOVT. L gTZJ r 1/4 Sy;- 1/4,S /S T N,R /S" E (o&', PROPERTY OWNER':S MAILINGADDRESS L LOT # CK # SUBD. NAME OR CSM # /10 1. CITY, STATE ZIP CODE PHONE N ERf - VILLAGE WN NEAREST ROAD 17tI~,e Ul 5'y 0 2 f3 (7/ 67 f9~ BSc C•7 /-f /U-~(% [ -I-Kew Construction Use [residential / Number of bedrooms 7 [ ] Addition to existing building ( ] Replacement [ ] Public or commercial describe Code derived daily flow G ,ggp~dd d Recommended design loading rate s bed, gpd/ft2~_trench, gpd/ft2 Absorption area required ~4Eed, ft2.Sh trench, ft2 Maximum dtsign loading rate . ~ bed, gpd/ft2__~trench, gpd/ft2 Recommended infiltration surface elevation(s) 99 ~ o L: ft (as referred to site plan benchmark) Additional design / site considerations l~ S x Z 7 7° Parent material S,/~ wPr Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL, MOUND IN-GROUND PRUsSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ❑ S L~ U mz" ❑ U ❑ S 0'0 ❑ S ~J ❑ S C~t~ ❑ S 91d- SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o-y C'S e Ground - 5~ elev. ft. Depth to limiting factor Remarks: Boring # ` 1c) --1 O (O k 3 - 5' I u s h~ 0, LJ 1 5 Ground ele ft. Depth to limiting fact-, Remarks: CST Name: Please Print Phone: 272 - _3_27 9 If 'C y -1 Address:,/~~ r Signature: Date: CST Number: !3 rv%1r L,tzeh PROPERTYOWNER Un,lA Ma-lk,Qs--- SOIL DESCRIPTION REPORT Paged of 3 PARCEL I.D. # GPD/ft Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots Bed ed ITMrer>cfi Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 2-3~ 10V Ground c5 s w, 6 r,, r ; . u e? elev. eft. - PL T h o r V S C 1- r E Depth to limiting factor s ,3q Remarks: Boring # F 3 S- ~ O % S 2 I w` Cw w J 6J-j Ground elev. ft. 10 . "k r Vh Depth to limiting factor Remarks: Boring # auk s6k vh r ~w ,J~ ' © ~ - ~ ~ s ~ l rr. S~oY Lv~c~ r ~ I v Ground elev. ft. Depth to limiting factor Lo Remarks: Boring # i c)wL S LL --i L) s Vil. 3 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ` 4'd Prf G- r ~CP3 / / h r Q v - ti T R~ ~ r i A p ~ A k 00 'i 1 b ' ~ i i r ~ 3 ,1 D T W ~ n Q _ (N STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER f t° fi C~ MAHJ NG ADDRESS !c l~ l: e r~ I-~ cam . c~ ~~cj ut i S'~orS Ile PROPERTY ADDRESS C~u•Ii~/ .~o~~/ IVAI (location of septic system) Please obtain from the Planning Dept. CITY/STATE WGa od uh //,C_ (.tom --r- 5 `lod e' PROPERTY LOCATION St 1/4, S4F 1/4, Section- /P T_2-L-N-R W TOWN OF G 14 U ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP ,VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verif;~ing 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 dat . SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property C Pexi eook Location of property 5C 1/41/4, Section /9 N-RAW Township C Ap i Mailing address 1,7h 9[- tv-\ Of- Address of site /Yl✓ Subdivision name Lot no. Other homes on property? Yes X No Previous owner of property DkVL'.),,-N C. L j ze-l~ Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , 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. gn ur of Applican Co-Applicant ~ - Clio ~2 Date of Signature Date of Signature it 54513' ;i State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED 'i DOCUMENT NO. V~-I.1183PAGE531 I -j, REGISTER'S OFFICE iI ST. CROIX CW., WI Darwin C. Litzell and Lloyd E. Mathiesen Redtifad - _ ! JUN 11 1996 at 9:30 A. M ii conveys and warrants to Gregory S. Koch and Tv`aw ` LrJi~o{i. Conn.-'Le M. Koch, husband and wife Register of Deeds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St . Cr OlX A_ County, State of Wisconsin: i! 004-1042-70 ~ (Parcel Identification Number) i i Southeast Quarter of Southeast Quarter (SE4 of SE4), of Section II Eighteen (18), Township Twenty-Eight North (T28N), Range Fifteen West (R15W), St. Croix County, Wisconsin EXCEPT West Twenty-five ii (25) acres thereof ~I i AtR This 1S not homestead property. :Nil (is not) II Exception to warranties: Easements and restrictions of record. Dated this - day of ~y- 19 96 . ~I ✓r,.. _ ..l al~~ (SEAL) I - C' (SEAL) 91--4 * Darwin C. Litzell Lloyd E. Mathiesen (SEAL) (SEAL) I~ i~ i AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) SS. St. Croix ~i County. -/0- authenticated this day of t4 norm gyn., k.47- w o Yt :c a., -f I v • , DOCUMENT NO. WARRANTY DEED THIS SRACC RESERVED ►OR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982_ 504729 r.ECIST&ETS OFFICE . Richard J. Studt, tenant in common with 'tec~dtorRzco.d w . ~ unaivided 3/4 interest and Judith A. Gerten, r, . tenant ..in__ common.... . with u.nd.ivided.. ..interest........ AUG 3 3 1993 , conveya and warrants to Darwi.n._C. Llt2e11 and Llo ~ .0 30 ~ 8 ~ • E.,-..sta.thy,esen.,.-.a5...te n.an.ttl-.commo_ti. Rer1s'a ,r l)eeda _ L • RETURN TO F ' I S. . the following described real estate in S•t-_...Cr-OlX_------------- County, n, State of Wisconsin: ~r Tax Parcel No: { Southeast Quarter of Southeast Quarter (SE4 of SE4) of Section Eighteen (18), Township Twenty-eight (28) North, Range Fifteen (15) West except the West Twenty-five (W 25) ~ acres thereof. FIA~tSF ~ I FEZ A A. f This iS nOt homestead property. Nw(is not) `.1 Exception to warranties: Easements and restrictions of record. k Dated this .........3..0._........... day of 93 (SEAL) SEAL) Richard J. S dt (SEAL) (SEAL) ~i Judith A. Gerten . AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF VAMRX. 3t& MINN OTA r t ss. County. authenticated this day of..... _ 19 rsonally came before me this V... day of J 19.91. the above named ,Richa.-d J_. Studt_-and.•Judith Gerten TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized b y $ 706.06. Wis. Stats.) to we known to bet ersons........... who executed the feregoi stru and pekr. wl - THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack - s .r- ..~~-y~~/~~~ -5-~3''f3 S~- S~ ~~_93 s ~ _ S~ ~ a~ „~.r.~~,-