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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER C~ty,A
ADDRESS ~r'e.r
Z-) ~l
SUBDIVISION / CSM# LOT #
SECTION__2Z T~ N-R / W, Town of Z:7~ yrs./y
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
41
H v
I{'~ - V
`V
~I
~ 9v
INDICATE NORTH RROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: x~ S'
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ~2j,~/~~, s7`~Iii✓ Liquid Capacity: 12,-fd
Setback from: Well ~G f- House .2,,f Other
Pump: Manufacturer See f+2e'v /Mod ,l Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length / Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: Housed 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:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
' (ATTACH TO PERMIT) 5anitaryPermit No.:
GENERAL INFORMATION 268604
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
ERICKSON, CARL CYLON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
09 -
TANK INFORMATION ELEVATION DATA A9600302 ;ELEV.
TYPE MANUFACTURER CAPACITY STATION BS HI FS Septic Z Benchmark Gl~
7, 7S
Dosing r/ (DA'L+1 , Q 11+1, ' 90'
Aer tion Bldg. Sewer ,asp 7
Ing St/ Inlet
TANK SETBACK INFORMATION St/ I K Outlet 9,17' vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air O - l
-77 .2 /
Septic NA Dt Bottom
Dosing NA Hsu=-/ Man. ?9, 7V
,~lo Aeration NA Dist. Pipe
/ , Holding Bot. System 3,g/S!~
PUMP/ UPYWNFORMATION Final Grade
*VO
Manufacturer Demand
Model Number GPM
TDH Lift '((0 Friction Systems T D H 2,SIFt
Forcemain Length 3 Dia. mead
Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Lengt / No. Of Trenches No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMEN I
LEACHI acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type Of y)zw- C BER Mode Number:
System: yKVtxKj OR UNIT
DISTRIBUTION SYSTEM
177~ / Manifold Distribution Pipe(s) Holee x Hole Spacing Vent To Air Intake
-9 Dia. Length Dia. 1 Spacing J5
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: CYLON.27.31.16W, NE, SW, 240TH
~ ~ c ~,1 cam ~,C- CdLre~ ~ ~LZ11.
f
Plan revision required? ❑ Yes No
Use other side for additional information. 191 `
a - r
5--- FJYT/ SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
L
Safety and Buildings Division
Bureau of Building Water Systems
Agi SANITARY PERMIT APPLICATION 201 E.WashingtonAve.
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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Numl~er
'r k The information you provide may be used by other government agency programs ❑ Check ifrewsio ato preoo s application
(Privacy Law, s. 15.04 (1) (l State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
v4 ~1/4,S T / ,N,R~GE(or
Property Owner's Mailing Address Lot Number Block Number
4' -1Yd7h e,-
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPIE OF BUILDING: (check one) ❑ State Owned ❑ city T rest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms Town of C_° 7/~1
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Numbe (s)
1 ❑ Apartment/ Condo 066 106 b 30
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. [gNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
4~7Q 16-,66 S r /a • Feet 1AM,, Feet TANK Capacity
VII. INFORMATION in gallons Total # of Prefab. Site Fiber- Exper_
Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks pp~~
Septic Tank or Holding Tank / r yr/ CSL ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber /Qd U ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite s age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No tamps) MP PRSW No.: Business Phone Number:
a _?~2 7!~ - 38G a
Plumber's Address (Street, City, State, Zip Code):
Its GJ,'
IX. COUNTY / DEPARTMENT USE ONLY
El Disapproved sanitary Permit Fee (includes Groundwater 1, Date Issued Is i g Agent Signat a (No Stamps)
Approved E] Owner Given Initial i
sit
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety 8 Ruilifingi Division, Owner, Plumber
INSTRUCTIONS
t
1 . A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe 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-
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
August 5, 1996 2226 Rose Street
La Crosse 9 6 0 ,
1
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74
ST rR-re
RIVER FALLS WI 54022 COU
wN
a 1()Ms4GOFFICE
RE: PLAN S96-40859 FEE RECEIVE fI
ER.ICKSON, CARL
NE,SE,27,31,16W
TOWN OF CYLON 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.
Sincerely,
Dennis orenson
Wastewater Specialist
Section of Private Sewage
(608) 785-9336
SBDA-7997 (R. 10/94)
9~r6
1
• ~ 9 4 0 ~ ~Page of 6
MOUND SYSTEM "CEIVEC
FOR
A L4_ BEDROOM RESIDENCE J U L 3 1 1996
SAFETY & gLM. DIV.
LOCATED IN THE 1/4 OF THE SE 1/4 OF SECTION 1_7,T3) N, R16 W,
TOWN OF Gk LON , T- G\ZIJiX COUNTY, WISCONSIN.
INDEX
PAGE l 'of 6 TITLE SHEET
PAGE :2 of 6 PLOT PLAN
.PAGE 3 of 6 PLAN VIEW-CROSS SECTION :
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
C. ►~2 l.. 1~1vb 'C~,~ Sftr~N~, ~.L.CkSO N
~ y b zoo `rw sr2~r
~Cl~ ~PcR-~ , 111 S ~ pp`7
IRPARED BY
WEGEE;tEF? SO I L TEST I htG
AND. ®640
I3ES I (stm SEEN I CE
F.R. BOI 74 421 K. 1SAIK ST_
RIV9. FALLS. MI 54022 1 °q
715-4125. -0165 ARTMr, L.
WE'"EHER L ~r
Z D355P
E.L5WJRTN.
1 YJ13.
r Q
'S 1 G I3
~eoaetos
_ Zs-`t b
JOB NO.
PLOT PLAN
6
-Page - Z- of
Scale 1"= yd'
RS stiOL r
pP UNe > 3S P\ e, c ~L
0"
@ Q~
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Le"T -is' F-ao" a
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be t'UOO gallon-capacity manufactured by
~-l ~Ow~`Rs;ul ~ ~13~'1-3T . ~v~►P `[o aE `odo r ft-,- M tbweSTLJ~N k .
5. Bench mark ttV_U. V00• ' ou 1NPnL y' Praov 61Z&11,j 1!V .S1.D@
of= 411lbtfl. R?~_pcR -W-0-S. C s wuE FI-NiR L_Q,"_V0"
6. Divert surface water around mound to prevent ponding at the uphill side.
-page 3 Of b
Approved Synthetic Covering
Flrs-rm C.33 Distribution Pipe
Medium Sand
Topsoil F Elev.
3 E D
b
3 % Slope
Bed Of 2- 2 %2 Force Main Plowed
Aggregate From Pump Layer
pFtIVATE SEWAGE SYSTEM
Conditionally o \:0 Ft.
Cross Section Of A Mound System Using E N AS Ft.
APPIRONJED A Bed For The Absorption Area F o-8 Ft.
gU1lDINGS
DIVISION Of SAIETY D G l • o Ft.
A 6 Ft. H l- S Ft.
i ear r, I GPD/LN FT B V_ Ft.
e= p, . GPD/SQ FT I Z Ft.
J 8 Ft.
1o Ft~96-4®85
Z 4. Ft.
- ere --Ma;-n t
L
on Pipe
A I 01
W
Force Main
Distribution Bed Of %M- 2
2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchbr securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page !-1 Of
Perforated Pipe Detoi!
0
End View
)Perforated
End Cap. d~O~e PVC Pipe
Install permanent-marker
-4a;at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
P
PVC
Manifold Pipe
Distr ution
Pi e
Last Hole Should Be I
Next To End Cap
End Cap V
S96 ~
- P 34- 6 Ft .
Distribution Pipe- Layout
S Ft.
X 50 Inches
Y SO Inches
Pt<.,s,jxfE SEWjkGE SYSTEM Hole Diameter 1y Inch
Lateral Inch(es)
Coll Itionally Manifold "
Z Inches
Force-Main " Z Inches
'D
AND BUILDINGS # of holes/pipe, lQ '
IV~~JON Of
nvert Elevation of Laterals 99.V0 Ft.
SPONDENCE Lp x 1 = l t.~ y< 4 ; LL 6, $ GPM
SL_ CORRE
~l
Place lst hole ZS from center of manifold with succeeding holes
at SO4intervals. Last hole to be next to the end cap.
r' • - PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS ' PAGE S_ OF 1,
VEWT CAP
4*C.L VENT PIPE
WEATHER PROOF APPROVED LOCKING MANHOLE
10 -FROM DOOR, JUNCTtOAf BOX COVER WITH WARNING LABEL
WINDOW OR FRESH Irmo.
AIR INTAKE 1
GRgDE
yr MIIJ.
_ 18' MIIJ.
GOUDUIT
18"MIAI.
lh
INLET PROVIDE
AIRTIGHT SEAL I 1 i'
• I 1
APPROVED JOINT A Tank construction shall comply 1 APPROYEDJOIWTS
with ILHR 83.15 and ILHR 83.20 1 111
R p► SWAGE SYSTEM i I I ALARM
cot dinonally
1 ON
--CLEV gs.oo FT
PUMP-1
ROVED I
WIUMS OFF
COWCRETE 6LpLK
05`
NDENC
RISER EXIT PERMITTED ONLY _ IF TAWK MANUFACTURER HAS SUCH APPROVAL 3ApPRoVl:p
. 8E001N4
DOSE SPEC- IFICATIOKJS
TANK MAAJUFACTURCR: vZcw
NUMBER OF DOSES. 3' Z PER OAy
TAAIK SIZE: ~y GALLONS DOSE VOLUME r
ALARM . MALIl~FAtTiJR>r.R: S-~•-~1Z4 SL(S~'L11~ $ INCLUDING BACKFLOW: GALLONS
MODEL 1JUM8ER:
I Nw CAPACITIES: A= S 1 IZII,IC}I OR 1-) O 3 GALL,OUS
3WITCN TyPC: ~~~CU~-~'Y B = Z IIAMCNES OR S Z 6(~LLOUS
PUMP MANUFACTURER: ZqELL~ CA C a I ES OR Z ay GALLONS
' MODEL NUMBER: X63
D = -s-INCHES OR GALLONS •
SWITCH TYPE: NOTE: PUMP AWD ALARM ARE TO 6 51
MIWIMUM DISCHARGE RATE L4 6 • S GpM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEU PUMP OFF AUO_DISTRIBUTION PIPE.. FEET
f MINIMUM NETWORK SUPPLY PRE~S/SURE _ 2.50 FEET
+ 2 $ S FEET OF FORCE MAIN X. t 7 Fo FEFRICTwu FACTOR. L\ •
FEET
TOTAL 0SUAM1C. HEAD -FEET
DIAMETER
H
IUTERLIAL DIMEIJSIOMJ OF TAWK: LENCYTH ;WIDTH ;LIQUID DEPTH
BOTTOM AREA - - 231= _ GAL/INCH
AS PER MANUFACTURER = .....Z 0- GAL/INCH
4
r
-rt~
~ r
• - - - _ E 6 of ~
rorALE FiuENrAropnl«
HEAD CAPACITY CURVE
W 161,163 AND 165 SERIES SERIES 161 163 155
FT. lk Gat Ltr Gal Ltr Gal Ltr
5 132 106 401 61 231 61 231
28 90 10 3.05 100 378 61 231 61 231
15 4.57 91 344 60 227 60 227
20 6.10 82 310 59 223 60 227
24 80 25 7.62 74 280 57 216 59 223
30 9.14 65 246 55 206 58 220
70 165 40 12.19 46 174 46 172 55 206
20
163 50 1524 21 80 33 125 51 191
60 J829 15 57 43 161
~ 60
70 2124 30 114
16 80 24.38 14 53
90 27.43
O
100 30.48
40 1 LOCK VALVE 56' 66' 87'
F 12
0
30
8 Z .y0
20
4 10 161 4 7/32 8 3/4
46. r6 1/2
0 1
U.S. GALLONS 10 20 30 40 50 60 70 80 90 1o0 110 1
LITERS
0 80 160 240 320 400 4 7/32
FLOW PER MINUTE _
6 11/32
Standard all models - Welgh(77 lbs. - 20 ft. cord -14 H.P.
161 MODELS Control Selection Listings
1
Model VOUs-Pa Mode Amps Simplex Duplex CSA UL 1 1/2- -71 112 NPI
M161 115 1 Auto 15.5 1 or1 b9 y y I 2- - 11 1/2 NPT (OR)
3" -8NPT
N161 115 1 Non 15.5 2or2&8 3or5&6 Y Y
D161 230 1 Auto 7.0 1 or 1& 9 Y Y I
E161 230 1 Non 7.0 2or2&8 3or5&6 Y Y co:
F161 230 3 Non 4.0 2&4 3&4or5&6 Y Y I
H161 200-208 1 Auto 8.2 1&9 Y N
' 1161 200-208 1 Nan 8.2 2&8 3 or 5& 6 Y N I
J161 200-208 3 Non 5.2 2&4 3& 4 or 5& 6 Y Y
G161 460 3 Non 2.0 2&4 3&4or5&6 Y Y 18 9/16 I 1
Standard all models - Weight 77 HIS. - 20 IL cord - Yz H.P.
163 MODELS Control Selection Listings
Model V011114% Made Amps Simplex Duplex CSA UL 6
M163 115 1 Auto 14.0 1 or 1& 9 Y y 1
N163 115 1 Non 14.0 2or2&8 3or5&6 Y Y
D163 230 1 Auto 7.0 ---Tor 1 -&9 Y Y 40 E163 230 1 Non 7.0 2or2&8 3or5&6 Y Y S 9
F163 230 3 Non 4.0 2&4 3b40r5&6 Y Y a!
' H163 200-208 1 Auto 82 1&9 Y N
• 1163 200-208 1 Non 8.2 2&8 3 or 5 &6 Y AN SELECTION GUIDE
• J163 200-206 3 Non 5.2 2 & 4 3 & 4 or 5 & 6 Y 1. Integral float operated mechani al switch, no external control required.
G163 460 3 Non 2.0 2 & 4 3 & 4 or 5 & 6 Y 2. Single piggyback mercury float switch or double piggyback mercury, floatswftdt.
Refer t0 FMO477.
Sgn11ard all models - Weight 7716L - 20 IL cold -1 H.P. 3. Mechanical alternator "M-Pak" 10-0072 or 10--75.
165 MODELS Control Selection Lk" s 4. Combination starter. Refer to FMO514. ,
Model VeMe-PIl Mode Amps Sloop lmt Duplex CSA UL 5. See FMO712, for correct model of Electrical Aitemator, "E-Pak".
D165 230 1 Auto 9.8 1 or 1 &9 Y Y 6. Mercury sensor float switch 10-0225 used as a control aft ator, with "E-Pak"
aftemater ' 3 Or 4 float system.
E165 230 1 Non 9.8 2 or 2& 8 3 or 5 b 6 Y Y
7. SIMPLEX CONTROL BOX 10-0050,115/23OV, I Ph. max.2HP use one(1) single
F165 230 3 Non 6.6 2&4 3 & 4 or 5 & 6 Y Y piggyback wide angle mercury float switch OR two (2) 10-0225 mercury sensor
• H165 200-208 1 Auto 10.7 1&9 Y N floats for level control.
• 1165 200-208 1 Non 10.7 2&8 3 or 5 &6 Y N 8. Four (4) hole "J-Pak",)unction box, for watertightconnection or wired-in simplex
J165 200-208 3 Non 7.0 2&4 3 &4 or 5 &6 Y Y or duplex operation.
• G165 460 3 Non 3.3 2 &4 3 &4 or 5 & 6 Y Y 9. Two (2) hole "J-Pak", Junction box, for watertight connection or splice.
• RA165 575 3 Non 3.0 2&4 3& 4 or 5& 6 Y N *No Mokled Plug
CAUTION
ForintomodimionadditioalZoellerproductsreWtoestalogonCombiationStarter,FIM14, ANlndallaWaelcoanak.prolecdcadedce:aadwidpabeMbadmbyagealMWN=md
PigOybadcL%-YSwdchegFW477.EkkcWAlta-W.R 04W;MwMmmMANenWorR"5: ekddda. AN eMebkal and aa" coda saoeM be followed ladeft Nw awel roaal
Agmh PacloOe, F10513; SumwSewage Basins, RAMP; and Snaplax Control Box, FW732 Naflowal Elesgic Cabe (NEC) wed the Oaepiloul SMaly wed Rolle Ad (0811A).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
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
ICOUN Y
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimen sioned, north arrow, and location and distance to nearest road. , ,.%~APPLICANT
INFORMATION-PLEASE PRINT ALL INFORMATION Alp.
ED `°;f"-
I, "Y
PROPERTY OWNER: PROPERTY LOCATION zy." ` X-so GOVT. LOT 1/4T~l~u
PRO PER T OWNER: AILING A Rf SS LOT # BLOCK # SUBD. R NTY
l f 0FFICE
'3 75-
r~-_N 9v/ CITY, STA E _ 21 CODE PHONE NUMBER
WOWN / OR .
apt / ~
r$ New Construction Use [A Residential / Number of bedrooms 5~ [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 4L2 gpd Recommended design loading rate / bed, gpd/ft2Z, ;2- trench, gpd/ft2
Absorption area required _I~Ad bed, ft2 trench, 111:2 Maximum design loading rate e. 27 bed, gpd/ft2 / -2 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97,1 ft (as referred to site plan benchmark)
Additional design /site consider
Parent material Flood plain elevation, if applicable ft
S =Suitable for system vE 10 AL M ND 0 RESSURE AT RADE SYSTEM IN ILL HOLDING ANK
U=Unsuitable fors stem S U 2. 1 S❑ U S S❑ U E] S E] S U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bouxlay Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
Ground oe r (i SC j
AIA NNIAVIA1
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Depth to
limiting
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23
Remarks:
Boring # 1.5 &1 0
r At iix,
/nom
/ ✓
Ground ,A/
5!94 y
I .Graft. Fy A4 jt+:. JA
Depth to
limiting
facl.%
Remarks: i
CST Name: Please Print cJ tr` Phone:
Address:
Signature: ` 13-ate:' ✓ CST Number:
C PROPERTY OWNER SOIL DESCRIPTION REPORT Page _of-
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
'_::_ris`s B
5
-52
Ground P i~
/ ft.
Vv; ~V- w y0l, 06 1A Aa (vik
Depth to
limiting
fact[, `
Remarks:
Boring #
krt
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
r Soil Test Plot Plan
Project Name Carl Erickson Byron Bird Jr.
Address 375 Krattley Lane
Hudson Wi 54016 C #3479
Lot Subdivision Date 5/25/96
NE 1 /4 SE 1/4S27 T 31 N/1316 W TownshipCylon
Boring O Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft.Nail in Poplar Tree
System Elevation 97.9 * H R P Same as Benchmark
04
Bedroom
wilding
Site
60'
B-2 DOI
5' 3%
Slope
60'
Mound 100'
Area
200' 60' 30'
B-3 B-1 B.M.
150'
290' Property Line
7
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County /
ONVNERMUYER ,2
MJULING ADDRESS 9 Z/
./7 P
PROPERTY ADDRESS CA ry\ e-
e
(location of septic system) Please obtain from the Planning Dept.
crrY/STATE
PROPERTY LOCATION 114, .5-cO 1/4, Section
TOWN OF ST. CROiIX COUNTY, WI
SUBDIVISION LOT NUM33EA~
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NrtTM ER
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 ilicensed 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 rtplacement of a failing system, which was in operation prior to July 1, 1978, St. Croix County
accepted this program in August of 1960, 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 matcr 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
purriping.(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, heroin, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the . Croix
County Zoning Officer within 30 days of the thres y iration date,
SIGNED:
DATE; /
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 54016 11/93
r• ,
9TC-100
This applioation forte 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, (epee
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.
~►r~w~~~w~Aww~ ~~-..~w-r/~~wwryw w.w~~~rl/f.7-w w. r ~r 4 ~r r ~w w-.~//w~/~ w w+r-w ~ w ~ ~ ~ rvr~.~ww
Omer o! property
Loo~stion of property_Zi 1/4„ 5't.%) 1/4, section A-7 ,T.3 LN-R=w
1{c5 s j
Township Ca 0 Mailing address -19l-
cro 7
Address of site 96~C2i 1flcj) d .,,~Ir
subdivision nue / Lot no.
Other homes on property? Yes-~No
fre'vious owner of property y4 -1 11-2
_
Total size of property i -7 l e ~ A
Total sire of parcel ~ -1 .
Data parcel was created
Are all corners and lot lines identifiable? . X' Yee No
Is this property being developed for (spec house) ? -4.Yes
vol~mo _ and Paqe NUfter as recorded with the Register
at Deeds. ,doe 1
w~wwwwwNwww~~~w.r..~~~www-__w____--r-w---w--------------
INCLUDE WITH TW6 APPLICATIOU Tn POLLOWINOt
A WARRANTY DEED which includes a DOCUMNT NUMBER, VOLUME AND PAGE
NVMBRA AND THZ SEAL OF THL 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
reterences to a Certified survey Map, the Certified Survey map
shall also be required.
MVIRTY OWURR CEkTIVICATYON
I NO certify that all statements on this form are true to the
best of my (our) knowledge that i (we) am tare) 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 On easement, to run the abovs described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds us Document No.
signatu Appl cant Cc-Applicant
J
Dad of gnature gate of S ghatuxe
i.
546605 STATE BAR OF WISCONSIN-FORM 2 - 1982
WARRANTY DE D
DOCUMENT NO. Y01 Q U Pw
REGISTER'S OFFICE
~ T. CROIX CTY., WI
Bernice M. Albert, Ilene M. Simon, Mary C. S RoddbtReWd
Wright, an William J. Hennessy, a one-
fourth interest each as tenants in common JUL 10 1996
conveys and warrants to 7755r1 P . Erickson a n Rosanne at 9.30 AM
L. Erickson, husband an wi e, of ing as -y~ 0,4k,
survivorship marital property Register of Deeds
II THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURNADPRES$ ~
th e~ciitowiiigdestril3ed-reatstat Cou"nty,
JL I~
State of Wisconsin: ~y1
006-1060-30/006-1060-70
PARCEL IDENTIFICATION NUMBER
East Half of Southeast Quarter (E1j of SE4) of Section Twenty-seven
11 (27), Township Thirty-one (31) North, Range Sixteen (16) West
EXCEPT Part to William J. and Jo-Ann Marie Hennessy in Vol. 11492",
page 411.
~i
~I
TRANSFER
This is not homestead property.
>P;X (is not)
Exception to warranties: Easements and restrictions of record.
A.D., 19 96
Dated this day of v
(SEAL) (SEAL)
Bernice M. Alb rt Ilene M. Simon
(SEAL) LOA a (SEAL)
Ma . C. Wright William J. Hennessy
AUTHENTICATION ACKNOWLEDGMENT
State of Wisconsin, - -
Signature(s) ' , rX
st . Croix
authenticated this day of , 19 Personally came before me this id(* 6,f