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HomeMy WebLinkAbout004-1054-95-000 o a~i °o M ° O s°~ M ao ° ° a a o 0 e L ch co O 0) CY) c V N X O N N LL c (a N. x in N C N N U - (D N 0 N t' I C ~ O C a) E T E O L h 'O N N ~ IO -0 -E CL a) c cc o 3 3a) ° c CD L) CD CO o m Z E E O a) a) L U N N N it N d 'O N d dQ T a) o N N O N.O ~ll O C-° 5) C C Z (03 °~c 5 Z -r- Ow 7 (6 N ~ V .y 7 <6 _ LL O w C C N J ~jLL 0 ap > p N N w C Q 20 3 Ems E Q o U Z O O O O Z £ a a j 4' a m N N ai a m c O o z ~c .U r O N N - m Z c o N F e- a) O z : m E° E ch 'a 0) a) co ° t~/ III CL i a) ° O • "IVA a) L C L C CL C O j O U Z 1- Z Z Z Z N ° W E a) E N N 5 i O d i O C 5i C N N d T Q) ~ N v i a) w O ~ c a a .a (D D a L E m N U) V) U) E 7E E o N H F~ ° (1) N H F- E `n O O O `n O O O ~ z O •rv ~CL CL a ~aaa CL o N o N p m co N 7- 7- > CA n W > ° O) N N w N .M a) ~2 O O _ O O L m N L co N a (O O d N N O d N a) ~ Q Q~ R7 N 'd N 'O M 3 w M 3 a~+ O " N C N N to 0) r C ~F+ O N N O 'O C E O O O O E U E U C O 4} O O °Lo' 3 > m Q o > ° Cl) E a c s a°y C o J c m a' 1 y E 0 _ u~ _ o L" ° co E N a`) o Z E c°p 0 N -00 F • Y> `t0 m~ E rn ,n y m o E w O N o E "rs =u y O N U F- CA M 2 F F- N O - Z fn t \ *k « G~ N V wa CD 7@ _o y a w `aY da • m .2 m a~ r`1~1 E v c c c A U a 0 U) U 0 V5 U 11 10 0(A0 3'00 d o ~ 0 ; °c g I " I ~ O cn co w 0 o o o 00 l o m (n o w `O 1 N o m 3 am o 0)3 3 ° m N3 ° ccoo~ CL o m u, o_ Z a y o c o r m r cp 0) 0 Cl CD CD CD o n rn S* (D "g O N C A 0 fD O. 3 n 3 o A~ IA fA 0 Cj G Lj C 41 D A a No 1 (n < D m oN rn m y N ca y (n d "o W W 3 00 _ I~ p ~I p _ a co CD 1 co ` 1 00 CD co cco = y 00 co C y K e cn 3 1 Z 0001 000 ° o o a t~l X00 3 c (a (A CO) co o- Q 3 -4 M o o m o• M 0 v 0 0) p w 0a1 'p L ~'1 Qy t01~ ~1 CD ~D lr f0 G O d w ~ I N 3 - 3 CD CD Q N Z 1 0 p D D o p z m 0 c c0i m y !r • a o Er s (D :L1 W N CD D M. c C N fD w CD 3 3 Z CD 1 cD C6 Z N N o n A z 0 1 = 1 W W 1 W T W m 00 CD a eo Z C C A G G co ;q 3 3 m Cn Z A v I N F i ~ m a c m o m o? Q CD 1 a 1 "ammaiu, n 1 o m M v CD 1 Co. o ° m~CLC o v, -U CD m u0i D~o°co a, CD N)O CD " y 0 N N n CD = y . OD 3 f aC CD w- a 1 ° 1`5 Na a z CD = 7 A v o. d, = o 1 CD 1 ..1 P CD 9) 25. 3 r1v'~ m o x~ o CD c) (a cz o o b CD m j 0 q N 1 o Q 1 0 p y N O ` O CD ^1 r AS BUILT SANITARY SYSTEM REPORT OWNERi P It1' c' / j 41 / TOWNSHIP ( SE i i W ADDRESS ST CROIX COUNTY, WISC INS FC SUBDIVISION pA LOT LOT S f PLAN VIEW Distances and dimensions to meet requirements of H63 THIN WITHIN 100 FEET OF SYSTEM 4:" 0 X: F Idiae othArrow -L 0 SC LE : i BENCHMARK: (Permanent reference Point) Describe: S'wear' v ~ lmv 4 e Elevation of vertical reference point: EL -106 Slope at site: J 9 SEPTIC TANK: Manufacturer: t~j A Liquid Capacity:r Number of rings on cover : Tank manhole cover elevation: , Tank' Inlet Elevation: Tank Outlet Elevation: q'5 5 PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number , Type of warning_ device HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover AS BUILT SANITARY SYSTEM REPORT r OWNER Ur.P.A tMm TOWNSHIP r SEC -R ADDRESS ST. CROIX COUNTY, WISCONS SUBDIVISION rAgn\ LOT LOT S 3p <1 1 tom. ~y6 PLAN VIEW Distances and dimensions to meet requirements of H63 EUTHING WITHIN 100 FEET OF SYSTEM b• S ORO" I NT I di -a Vot r ow SC L: - I --f~ b't 0.0 P A -r BENCHMARK: (Permanent reference Point) Describe:$gtK 00ot of )4o-SC Elevation of vertical reference point: /000' Slope at site: Q p SEPTIC. TANK: Manufacturer:MIDwE57' Z-Lo dC„ Liquid Capacity: 2000 GAL Number of rings on cover Tank manhole cover elevation: 1? 0 Tank Inlet Elevation: SO " Tank Outlet Elevation: S'J" PUMP CHAMBER Manufactur 6 Number of gallons Number of gal. pump set or a cycle gallons; total capacity o distribution lines gallon: size of pump head; gallon per minute horsepower ran name of pump and model number ; Type of warning device i HOLDING TANK: Manufacturer 4 _ Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Number o pits eet diameter feet liquid dent seenage nit in et nine-elevation a?. v REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM Sanitan.y Pe, mit State. Septic NAME ,&r"4,~Me Township - St. Choix County Location 64f SIF Sec ion Lo Sub ivi,6ion SEPTIC TANK Size_ l exl~sV gatton~s Numbet o6 compantmen.tl / Distance {nom: Wett Building 120 3.Eope ?ZZ Highwaten. PUMPING CHAMBER Size ga.2 ump Manu6dctuheh Mode. Numbers HOLDING TANK Size ga tons N mbe o CompaA.tme.n,t,,s Pumpet .Ea .m -tem D~.,stanee (nom: Weee_ Buitd4ng_, 120 .5tope. Highwatetc ABSORPTION IT Bed Tke.neh Distance/'"{nom: Wetk_- S~ Buitding f20 6tope Highwaten ABSORPTION SITE DIMENSIONS Width o6 tkeneh ~ 6,t Req uiked akea ff-2 d 6t Length o6 each tine yes (I t Depth o6 tcock below -tile (i in. Numbers. o{ tines Z Depth o6 koek ovek tile. Z-tin Totat tength o6 Unee ( .v 6t Depth o6 -tite below grcade 2-0 4 n. Di6tance between tin.e5---~_ 6t Stope o6 tke.nch in. pen. 100 At Totat abaoAption aJCea~C~ _6t Type o6 Coveh: ape on i5 aw PIT DIMENSIONS ~r Numbers o6 pit,6 GiLavet an.ound pith yeas no Outside diameters 6t Depth below inte.-t 6.t VV - , ~47, Totat ab6o&p,tion area Anea hequi,-Led t -67 PLB State and County State Permit # tak Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: ZA- ve r M C- -,rl A4 A k1i YSO A) Wl ( -S B. LOCATION: Section T N, R~~t W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township c C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms Z No. of Persons D. SEPTIC TANK CAPACITY 10 d U Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete X_ Poured-in-Place Steel Fiberglass Other (specify) New Installation X Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. 70 Width s Depth-5--~--Tile depth (top) No. of Trenches Seepage Bed: Length Width Depth Tile depth (top) No. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land_ /0 Distance from critical slope 10, WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certi ' Soil1 Tester, NAME e! © IJ C.S.T. # y~ and other information obtained from (owner/builder). 7 Plumber's Signat e M Phone < Plumber's Addres ` .3 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. 1 E i E 3 , • ~y s~ ~YvTe G lG K Q s. w ~Ta be r~ u 1-7- 3 I lbc a r~ l s v lr~a. ~ L J-~ S ~ vvz~.~Q Y. G~'cJ i V .;+FWM Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:! ~'%!LEN4, Section ;F- 4 T N,RLE-" W, Township @F Mlumic4xa4' ry to /s ~j <7- County Lot No. , Block No. _ u Iw. ame Owner's/Buyers Name: Mailing Address: 7 TYPE OF OCCUPANCY: Residence No. of Be rooms 2- L L EFFLUENT DISPOSAL SYSTEM: NEW _X REPLA MENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS +j~ PERCOLATION TESTS l r ;car SOIL MAP SHEET L' NAME OF SOIL MAP UNI e PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL QCEHO WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM INCHES THICKNESS IN INCHES HOLE AFTE INTERVAL MIN/IN BER SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P-1 See bore hole data ,Ye-Ni= 3 S P-2 30, -3 2 P- 3 '73 k !5 P-4 Install drainfield at 7,C 140 elevation. SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLCPf# Ad Y` TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B-1 72- yon E 7Z. 2, 3. - ! i ZC 3 . p .ter ° 7 F3 v, i' ~ n mss` .QS ' -r: B-2 72- ?2 2Z.7i 2. L-,4e-8 Cs R sd >E B-3 7Z I 7 7Z_ •-tl T /y-Cirla 1,4 9 j-3 1R- f- l dcr, B-4 7'~- Xy72_ TS 7 Z h n C _C'T fi=r B-5 77- 1 L © 7 it R . 1 v ~S -r B-6 7- ri 7Z :-12 L5 5 / y.: Sir/3 9& ri ~r -3! )2~ 7 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable are12S Indicate number of square feet of absorption area needed for building type and occupancy I aid rP- f ffGi f Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. SCALE 1" _ JL! _ O = BORE HOLES i = PERC HOLES A = EL•j fflR UF-- - Notes : ; _ ~ - - - I -Red flags at tae a holes 1; 2; & 3 indicate location of pf•imary disposal site. > > v 13A R 2Elevation yand horizontal reference _s ;ee ii~ point is ~jL //Sly! G ;~i S j T~ w P ON N r 3-Measurement for were ` obtained by pacing. a_L. Hc'iC l.~c..a...__i._...►~va.w t.. 1-'-.._~t , _~t~ ~.4 s / % c.~l_AR°~ f h~ T.~ r..... ST. CROI X COUNTY fflY/WISC0NSI N ,h Z O N I N G O F F I C E 796-2239 I AMTOND , WI 54015 April 13, 1981 Gordon N. Wing 3508 Nimitz Street Eau Claire, WI 54701 Dear Mr. Wing: We are returning the EH 115 for La Verne Timm, located at the SEk of SEk of Section 23, T28N-R15W, Cady Township, for the following reasons. l.. The name of the soil map unit, Onamia Antigo Chetek does not agree with what is represented in St. Croix County Soil Survey. 2. There is a conflict between the bottom of your per- colation hole elevation and the bore hole surface elevations, for the initial area. Onee .the, items have been corrected, we will again accept .them for review and filing. Should you have any,questions, please feel free to contact this office. Yours-'truly, J Thomas C. Nelson TCN:sl I Enclosure Section 43 ,TZfN,RZ? EAwj W, Township ap Muaicipalialy C/4 ~ y ' ,LnCATIQN:?C~'/+~%, Lot No. , Block No. County -SubdivisiWrName Owner's/Buyers Name: Mailing Address: S ' ,"L 7 TYPE OF OCCUPANCY: Residence No. of Be rooms v &FIetAL ~Z,2~~ IL `Z~ Helii f EFFLUENT DISPOSAL SYSTEM: NEWREPLA MENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS PERCOLATION TESTS `,OIL MAP SHEET o 1r NAME OF SOIL MAP UNIT PERCOLATION TESTS 1 EST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 3*' See bore hole data U Nr t_ 3 r S '~%f 11 If 2 k- 3 6- P__4 Pj If 11 Install drainfield at V.0 "elevation. SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COL Y' TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES , j>"C mac" B--1 YL o /Y E 7Z - M -40 1-3 7 Z 14 i> n Ci of 13-2 72- 11 ?2 2Z 732L -j-e, R C_ s 610-- ei-aws e e B-3 II 72 -,I r[ - 3 r Y ~3 M E r <r 13--5 7 2- z- o 7.2 t3 L e 4, PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable area. Indicate number of square feet of absorption area needed for building type and occupancy ffc iY Indicate scale or distances Give horizontal and vertical reference points. Indicate slope. SCALE 1" _ O BORE HOLES • = PERC HOLES 0 = EL. JOP RE F._ Notes: i P rc 1-Red flagt at Alt 1, r holes 1► 2j 6I3 Ind caie locat•ioh of P} im lry , - i ; ~%~Tr► r✓' _ I dlspbsal site r9:&A 2-Elevatio aid I or~zo tai r fe~en e ! ! " [ --~U ` I i 111 rr~Pe , ell l i . IAI )I point is r p ( q 'vwK • i i f i ~ 3-Measutem4ntlfQ s-etjh er i i o6 to l ned by pdc i 9. i f -G . L+ 1ff i ~ Aj~_ Hc• l r 4-Estim4te,~5"/+Y1 " fti, Dui table (r 4" soil arRa for ~eadh f rirlar.- 3V1A.. -1, rv3`l ; i c alter*naie dis 4os l Lt~. t - LI I t J N J lrn r` y D (r -V 1 r I ~ ~ ^s ET r c~ 1 Ift. Lilt ~ Tt_ C> F-7-. © m. I { I v n f`f ~l w , i 4 • • L STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER i ADDRESS a Z 3 ?a f 1~ SUBDIVISION / CSMJ LOT ~ SECTION-21_T Zg N-R 15' W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Ippp' Nh h~ s3' yy- f~ 76' 'A IN INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center ~r BENCHMARK: _lG 0. ~~4C~ s l <z-L ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / BOLDING TANK INFORMATION GJirs~r C' 10' "4 Manufacturer: yak` - 1 Liquid Capacity: Setback from: Well-/r House Other Pump: Manufacturer Ca d Modell V/) ~ Size Float seperation G>S'~ Gallons/cycle = 173 Alarm Location :SOIL ABSORPTION SYSTEM Width: Length_ /64~) Number of trenches / Distance & Direction to nearest prop. line: a~eY 6vo ~ Setback from: well: /OD~r' House /oo'¢_ 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: LICENSE NUMBER: ✓1~5 32~~! INSPECTOR: _-T, T, 3/93:jt Safety and Buildings Division AANITARY PERMIT APPLICATIA 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 9j- n ` V than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitar Permit Number W81600 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop rty O ner Name . Property Location 5g_1/4 5C 1/4,S a 3 T 7-8 , N, R (or)oProperty Owner's Mailing Address Lot Number Blocumber IW 3 A214 City, S/tat~R / Zip Code, Phone Number Subdivision Na a or CSM Number LcJ~ !1 ( ) II. TYPE F BUILDING: (check one) ❑ State Owned ity Nearest Road 1~ Public 1 or 2 Family Dwelling - No. of bedrooms Towan of 5f-" 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. K Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System ____System_----- _______TankOnly- 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 X Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 0-M .6 XIA ? 6 '5 Feet VF-e Feet VII. TANK Capacit ns Total # of Prefab. Site INFORMATION ingallo Gallons Tanks Manufacturer's Name PConcrete Con- Steel Fiberglass- Plastic ExpeAppr. New Existing strutted Tanks Tanks Septic Tank or Holding Tank /esoD Z l ✓ ~i ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber x ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plumber' Signature: (No St Rps) MP/MPRSWNO.: Business Phone Number: 7!:5r -7-72-..7, U Plumber' ddress (Street, City, State, Zip Code h IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved anitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) ❑-Owner Given Initial 1-1 Surcharge Fee) Approved Adverse Determination U / X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Dive ion, Owner, Plumt> r • INSTRUCTIONS • 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority- 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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, re-onnection, or repair. V. Type of system. Check appropriate box depending on system type. VI Absorption system information Provide all information requested for numbers through Vli. Tank. information. Fill in the capacity of every new/or existing tank, list the total gallons, n. n-i: ter of tanks and manufacturer's name, indicate prefab or site constructed and tank material- Complete for ill si_ ptic, pump/siphon and hoiding tanks for this system. Check experimental approval only if tanks receive,' experini nlai product approval from JILHR VIII. Responsibility statement Installing plumber is to fill in name, license number with aaprop ia'_F prefix (e.g. MP, etc.), address and ;phone number. Plumber must sign application form. IX. County / Depar°_ment Use Only. X. County / Depa-tment Use Only. ,,.,i.. o~ i li;_ati snot. srn i an R 1/2 X -.r -L'St btu SU l.d f . -'.inty he plans must Its 'vl-}lof_ ,)'an, '.r.'iCale or v'/ith l..)(!1' ~r1Slo iC3C +'li~',i if ! d mg riink(s), septlC p r si tilt .,li dl Sc?rV .~S? d::. siz nt1 info"I!aUOn- GROUNDWATER SURCHARGE 1 98:: `e «.~t 410 in- I!aded the creation cf surchargt,~1 ;:fees) for a number of r ated ri ti. which can efteO ci,ut.'nr!-,jva er- I !in=s+. ,,ciiarges are used fc,, monitoring groundwaie( cuniarn;riz u w !nvestirlatlons and eS s;:~r crrl` <ii StanCi3rC'' f S96940654 Gerald Glampe - Mound 596-40654 Location: SE 1/4, SE 1/4, Sec. 23, T 28 N, R 15 W Town: Cady County: St. Croix Date: June 26, 1996 Owner: Gerald Glampe Address: 96 CTHW PP Menomonie, WI 54751 Plumber: Roger Timm Signature: License # MPRS 3224 Attachments: 6748-Plan Review Application SBD 8330 page 1: cover Izecelve 2: calculations 3: plot plan JuN 2 ,51996 4: system cross section : plan view, tank lateral SgFEn& 6 BC~S, p~ 7: pump curve page 1 of 7 System Calculations • - One family residences bedrooms Loading rate ° gallons/sq ft per day Depth to ground water Z4 in Depth to bedrock ( 61 in Cross slope g % Force main length 10-0 ft of Z in Manifold/header length A ft of in Drainback 16.r gallons Lateral length @ `tT'O ft of Z in Lateral elevation ft (bottom of pipe) Lateral hole size in @ in ( S' 0 ft) spacing I o holes/lateral, holes total Lateral volume t5'~ g gallons Total lateral discharge rate Z3-~ gpm @ Zft head Elevation difference ft Friction loss ft @ gpm Total dynamic head •'R ~r ft Pump/sirT'on Z4r "S, gpm @ ft of head / Manufacturer Model # Dose volume « gallons Lift/siphon tank gallons septic tank S gallons Measuremenn _p off in RA)Uht~ a}aji ff lpnk bottom in ReCeP a cgallons NGS U11.D1 P He 0 s~ c ~pN page of r ~ RR~~~pNDENCE. SEE Co CA M 1 J I I d 3 0 -t q4c ' r iy fw / ~ „t # ~ f ltd 3 p co~ ' to ! q 3,0 ? d~ ~ 3 C4 i L N !p o - ~ r Li SeD 3 ~w C-2 (b $ t - w ~q • ® ~ I ZCJ A ~ ~ t co~l/ 46 Q Q t o S c,k S }-o+~~ Yv 4 S S d L V% cmo% V. 04L.\C, %a e~ ZSa 1~ ~ Cn't1a~o~~ ~"~pav ~wY 1~'v•~ ~sv. ~o ~opt~:1 b o.v~r►.. qd}-1 °t e 2, 1+ t 9v1 E SEWAGE SE`S r EM Conditionally PROVED AP "SION OF SAFETY AND BUILDINGS SEE CORRESPONDENCE ~O IZ.~1 I o, to I • o - ~I o, b Y.: `I L ST Q. `1 QrL b~►. l 0v .~:u.) 1 wT w J~+.X w+ urltM.t ~y:va,. ~o \~:.1^.'1► ~1r ~+~i 0S 4 1'' u G r►. !.Z O\p i v .L OM w i.1~ S o v. o T ~r o~~~ 1~ U t a,'t Qtr. wk. D~~~: ~ e "-j~'~•~ ~,.Zvett,~. ~.5.~ QU • vc- 1..~ • ~~4. h e1 ~ o.~. 1 at a~.JC co..► or ~01 l o•.. l:»e ~ ~v O •p S• o ~ J PRIVA~GE:WACE: SYSTEM Conditionally A oft NWL IJIJROsv'ffED- .,DIVISION OF SAFETY AND BUILDINGS SEE CORRESPONDENCE „ Aghk Q. r oA ~ovat VEWT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAJG JUAJCTIOAJ BOX MAWHOLE COVER rF7 I 25' FROM DOOR, ` Aa a V WIIJDOW OR FRESH ,Z I LAQrcL- AIR IAITAKE GRADE I 4„ Q.\w... alO I COWDUIT-- X111 PROVIDE I AIRTIGHT SEAL I I i I l~ 13 } I I v CrP►~-S. <L'BSLR-ylT I III APPROVED JCIWT: I I III W/C.I. PIPE ALARM EXTEWDIUG 3' ( ~ i I I ONTO SOLID SOIL U ~ I I O►J SYSTEM 64 I PRIVATE SEWAGE 14 PUMP - a.k av, ~ 4 • ~ Conditionally OFF D BLOCK Api PB'W- a- a Kcfv PAD" ov" o"DENCE C FtEsp I ' SE j c(.0 to, i j Alt* - t ; in, `.r i - Performance Data 32 Pump Characteristics Pump/Motor Unit Submersible Manual Models SW25M1 SW33Ml LL 2a Q 1/3 HP Automatic Models SW25A1 SW33A1 W _ _--1 F x Horsepower 1 /4 1 /3 " 16 1/4 HP Full Load Amps 8.0 10.0 Motor Type Shaded Pole (4 pole) a R.P.M. 1550 o a Phase 0 1 Voltage 115 Hertz 60 0 0 10 +.+F H- OI ld 20 30 40 50 60 CAPACITY-U.S. G.P.M. Operation Intermittent Temperature 120" F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Discharge Size 1-1/2" NPT Solids Handling 1/2" Dimensional Data 1. Unit Weight 30 lbs. y^' I rrrtsroas in inches Power Cord 18/3 SJTW 10' std. 3.1/2 5-7/8 ' j ompaneN dimensions may e - 4-1/2 W vary ±l/8 inch (20' optional) 0 3. Not for construction purpose ' 1-Y2 NPT unless certified 3-1/2 DISCHARGE Materials of Construction 4 Dimensions and weights are approximate 5 On/Off level adjustable Handle Steel 6. We reserve the right to 3.1/2 muke ievrAons to our lubricating Oil Dielectric Oil products and their Motor Housing Cost Iron specifuanons without notice Pump Casing Cost Iron I Shaft Steel Mechanical Seal Faces: Carbon/Cerondc Shaft Seal Seal Body: Anodized Steel _ Spring: Stainless Steel •.r 11 1,8 Bellows: Buno-N POMP - 9-1.2 Impeller Thermoplastic 10-1l8 Upper Bearing Bronze Sleeve Bearing DISCHARGE HEIGHT Lower Bearing Single Row Ball Bearing -7I 3 31/2 Strainer/Base Plastic PUMP OFF Fasteners Stainless Steel AURORA/HYDROMATIC Pumps, Inc. 1840 Baney Road, Ashland, Ohio 44805 OT (419) 289.3042 Vscorisin Department of Industry, I L AND SITE EVALUATION 4 Page 1 of 3 LaWr and Human Relations Division of Safety & Buildings IGmiISdOW L ~ith ILHR 83.05, WIS. A COU Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan m ' Iude g_k\'- not limited to vertical and horizontal reference point (BM), direction and % of slop V le or dimensioned, north arrow, and location and distance to nearest road., APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~a L;a VIEWE 04 DATE PROPERTY OWNER: PROPE TI0Ao,tAG Gerald Glampe GOVT. LO SE 3 T 28 N,R 15 ~O) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLO B R CSM # 96 CTHW PP CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Menomonie, WI 54751 ( 716 772-3252 ty'' 320th St. [x] New Construction Use ]a] Residential/ Number of bedrooms 4 [ ] Addition to existing building J~ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate .5 bed, gpd/ft2 .6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.5 ft (as referred to site plan benchmark) Additional design / site considerations install 5' x 100' rock bed mound on 94.5 as upslope edge of rock w/ 1' sand fill Parent material loess over till 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 for s stem ❑ S ®U OS ❑ U ❑ S ®U ❑ S ® U ❑ S U U ❑ S )ID 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 Tmrch 1 0-12 10YR 3/2 - sl 2 f sbk dsh cs 1f/m .5 .6 2 12-18 10YR 4/4 - sl 2 m sbk mvfr cs 1m .5 .6 Ground 3 18-24 7.5YR 4/4 - sl 2 m sbk mvfr cs if .5 .6 elev. 7.5YR 4/6 94.5 ft. 4 24-38 5YR 4/4 c2d scl 0 m mfi - - NP .2 41BYR 6/2 Depth to limiting factor 24' Remarks: Boring # 1 0-11 10YR 3/2 - sl 2 f sbk dsh cs 1f/m .5 .6 2 2 11-20 10YR 4/4 - sl 2 m sbk mvfr gs if .5 .6 '.w 3 20-29 7.5YR 4/4 - sl 2 m sbk mvfr s if .5 .6 Ground elev. 4 29-36 7.5YR 4/4 f2d 10YR 6/2 sl 2 m sbk mvfr cs - .5 .6 94.5 ft. 5 36-42 5YR 4/4 c2d 10YR 6/2 scl 0 m mfi - - NP .2 Depth to limiting factor 29„ Remarks: CST Name:-Please Print Henry F. Grote Phone: 715-665-2681 Address: PO Box 57, Knapp, WI 54749-0057 Signature: Date: CST Number: PROPERTY OWNER Gerald Glam a SOIL DESCRIPTION REPORT Page of,:,3 PARCEL I.D. # h Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 01 U 1 0-12 10YR 3/2 - sl 2 f sbk dsh cs 1f/m .5 .6 2 12-24 10YR 4/4 - sl 2 m sbk mvfr cs if .5 .6 Ground 3 24-34 7.5YR 4/4 f2d 10YR 612 sl 2 m sbk mfr cs if .5 .6 ev6 ft 4 34-41 5YR 4/4 c2d 10YR 6/2 scl 0 m mfi - - NP .2 Depth to limiting f1;Qr Remarks: Boring # 1 0-9 10YR 3/2 - sl 2 f sbk dsh cs 1f/m .5 .6 4 2 9-36 10YR 4/4 - is 1 m sbk mvfr gs if .7 .8 3 36-64 7.5YR 4/6 - s 0 sg dl - 1m .7 .8 Ground w/ occasional is inclusions elev. 94.5 ft. Depth to limiting factor Remarks: Boring # mottled @ 28' in scl below s similar to B-3 5 Ground elev. 90.5 ft. Depth to limiting factor 2811 Remarks: Boring # mottl d @ 32' in scl below s similar to B-3 6 Ground elev. 97.5 ft. Depth to limiting factor 32" 10 r► ~ 3 ~ I ( - m r► I r 3 J, Cf, 4 "4 f ry C7~ ~ ~ 1 o 1.-10 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Z4 Ver4 Lt - MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE /f-,)/ PROPERTY LOCATION 5CL 1/4, 1/4, Section -2 T N-R l W TOWN OF 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 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. 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 6 b.Q- '-9 / • Location of property -SC 1/4 S£ 1/4, Section a , T ?40 N-R 1,$ W Township Mailing address 7.4 Address of site Subdivision name Lot no. 9 other homes on property? Yes No Previous owner of property Total size of property Total size of parcel X11 t Arm Date parcel was created Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house) ? Yes _2~,, No Volume -390 and Page Number .65~ 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 th office of the County Register of Deeds as Document No. a((o wo- , 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 Date of Signature Date of Signature -no D"'d -t'., imu:,i I+nrm (STATIC' OF WISCONSIM PuhII hed by Eau Claire Gawk e. SPrtI jy 2'. i l t art•,)r'otm No. 11 _ Fi Made this clay of ':7Lr a1,,• D.. 19 Jr nvecrx a i part of th4e first part { „1 t Part of the second part. Zi: tite~i• tt1), 'That the said part i..; of the first part, for and in consideration of the Burn of ~ ~ u(J!rr valtiable corlsirl.erat .on Ponta to in hind paid by the said part 1.e s of the second part, the receipt whereof is hereby cor•fess.-d lr;t . given, granted, bargained, sold, remised, released and quitclaimed, and by these <<:. rlts r_u - Live, grant bargain, sell, remise, release and quitclaim unto the said part •.f the ~ :',rnd part, ctrud to heirs and assigns forever, the following, described real estate, .'•:a:: J .:t the County of State of Wisconsin, to-wit: ,i 7r.,rt er (S of j o! ~_.c(1 on T--I" to tCCtr•ic, :1;it, :d lu l,;T 10,11 :m,1 r( cordc,l in ire 1 u, , :It ~.c. oC „~~:trh oc' u((]s for ~f;, t7ro.ix CoUt.',,, Qhlf, tun (ncy he :t;cen !tl ~ J it y --i ab' I t1aT -,TWneY -to-ether with-all and singular the-appurtenances. and privileges thexcanto ^7 or in rtr,y•wise thereunto appertaining, and all the estate, right, title, interest ..and claim v , vcr of the said psrt of the first part, either in law or equity, either in possession or r,:i ~t;:ncy of, to the only proper use, benefit and behoof of the said part of the second part, j heirs and a,;signs forever. } M1)r;•coP, the said part, of the first part ha hereunto set hand:; an,f / this , day of t~ , A. D., 19 u Sr~;rred/ndSealelinPre.sgnceof L?1^ f d3 Seal) II (Se-11) ky County ~ f.. II PPr.;nn-rlly carne before tae, this day of :r•,~Lt; ii~r' A. D„ 19 ` I . sa, to-c..~e kn_)ic•n to be tFc- person who erecu#ed-the f~re;otng sti-zioe tt and cknowledged the same. ~~,i ICI ~'j