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HomeMy WebLinkAbout006-1078-10-000 m C) Q ~ I O I 4 N o x a N c Co 0 ti O C N rn I m c ca o~i c rn D V O E 0 ~8 0 O E 0 C) 0> ICI C ~ O y 30~~ I 3 N "OU C- N N O N 7 Q U 'O Z 3 Q ~ 'O C C 7 f6 a C 7 y C O O LL O O O V 0 (D C O E N E Q O C co 8 1 O N Q V N E w o Z z m W ! (L M F- z N CD C Z N O Z ~ N C C E i N N C f6 O a) Y (~i N O O O O • 1N`l V t fY6 c3 N C O ►i j O u . cli Z Z o Z o N j Z N '1 ~ I 0 M, -0 i y 06 T co 2 24 a) O J N Nr j j E O o o a wail a a a in J U E 01) a) Z w .O o 0 ~~l N O O O N N 0 O O a z L m c a l!') I~ 5 ii (n a) .2) 2 1 N Q 0 d (V ~ 7 a0 0) 0 G p a c E y O O O N I~ O p C N C C C a O N N N O y 00 p co Fc III m N a) CD y 5, ~n w p E rn N^ Z -o o N N O U 0 -C, . N p E try,, M~ OO d' J O M U Co N O z • 1V N r \ ~ ~ III E d I V ~ d ~ `m a a ~ CL CL 0) c rr~~ 2 c S c R U a 2 0 U) U A ell STC - 104 AS BUILT SANITARY SYSTEM REPORT ~r!C> OWNER ADDRESS SUBDIVISION / CSM# LO # r- SECTION_T3 /N-R_W, Town of Gp.t~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHI G WITHIN 100 ©FEET OF SYSTEM ' 6 G ~ A& P~C Al- ~i - our ~ ► i9~/ ~ Q © tie) y ~Z' INDICATE NORTH ARROW i Provide setback and el vation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 RECEIVED 6 C L t Z j '`~i9U _ BENCHMARK: 7Z Sr ORG : Zotq!NG OFFICE ALTERNATE BM: `SEPTIC TANK / PUMP CHAMBER / HOP/DING TANK INFORMATION Manufacturer: Capacity: /Qcpa ~i - t Setback from: Well House 120 ~ Other l Pump: Manufacturer -~d6iGe-iz Model#i~ Size Float seperation Gallons/cyclei Alarm Location :SOIL ABSORPTION SYSTEM Width: Length O NS- Sf Number of trenches DkJ Distance & Direction to nearest prop. line: S 1, /.S" Setback from: wel1:~d4 House r Other ELEVATIONS /3.16 ' Building Sewer / ST Inlet. ST outlet PC inlet_ PC bottom 17, Pump Off Header/Manifold 1-0 Bottom of system Existing Grade Final grade DATE OF. INSTALLATION: -J PLUMBER ON JOB: , G LICENSE NUMBER: An ~ (O 2 ~ ~jt~lG//ys INSPECTOR: 3/93:jt Wisconsin Depertmentof industry, PRIVATE SEWAGE SYSTEM County: Laborpan~tHuman Relations, ~ INSPECTION REPORT Safety and Buildings Division ST CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 26239 Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: X Parcel Tax No.: A9600204 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ' Dosing 2 -39 Aeration Bldg. Sewer Holding St/Ht Inlet 13r6 TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P / L WELL BLDG. A irl to ntake ROAD Dt Inlet 13, 7 Air l Septic NA Dt Bottom - O Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer il~lu Demand Model Number ~f ?J '7 GPM Friction Syestem TDH Ft TDH Lift I Loss 1 -1 Forcemain Length z, Dia. I0 4 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Mode Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes El No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CYIAN.34.31.16W NE NE 240TH ST 1-7 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' Ste, s SANITARY PERMIT NUMBER: I SANITARY PERMIT APPLICATION Bureau o oand ff Buil safety uildiinnggWaterl5ystem! 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 Count than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application state sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if evisidfFI -ev pr~ion [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prope.! y~tr Name property Lo ation c 1/4 t 1/4, S T 3 , N, R E (0( OW PropertyOwn~ Mailing Address Lot Number Block Numbe_ City tate Zip Code Phone Number Subdivision Name or CSM Number gJS ( ) II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ~t~ Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ VII age 4 Town OF OJL,~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number s) 1❑ Apartment/ Condo Q 1/ v 770 -/0 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. 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 21gfMound 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 -3 C} r~- re C~ Dt~. 7 Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber- Ex er. Gallons Tanks Manufacturer's Name Con- Steel Plastic p New Existin Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank /add e-d J ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber (0 /0 r GC ILJd~ ❑ ❑ ❑ ❑ 11 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plum er's ame: (Print) Plumber's gnature: (No Stamps) P PRSW No.: Business Phone Number: le, v 1 Z/ Plum is Address (Street, City, St e, Zip Code): tt / S 5 2d1146/ ~O v c~c~~LC t.~J~ syo Z S° IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nary Permit Fee (Includes Groundwater Date Issue Issuin tamps) ~Approvecl ❑ 4 D Surcharge Fee) Owner Given Initial c7tj ~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS 1- A sanitary permit is valid for two (2) years. 2- Your sanitary permit may be rer-rewed 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. Tankinformation. 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. Vlrisooa<.;. u aman gel Relattioionsnduwy, SOIL AND SITE EVALUATION REPORT Page 1 of 3 atyor and Nu _ Divisiom of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY . Attach complete site plan on paper not less than &V2 a 11 St Croix inches i1`lsi`6 plan must include, but not limited to vertical and horizontal reference 9oint*0f~fj, direction and. _14 .slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and diotance to, nearest road. 006-1078-10 APPLICANT INFORMATION-PLEASEP RINT ALL INFORMATION"_ REVIEWED BY DATE l.... rc PROPERTY OWNER: ! . PA PERTY LOCATION Marie Hennessy Estate .,G . LOT NE 1/4 NE -1/4,S 34 T 31 ,N,R 16 *or) W PROPERTY OWNER':S MAILING ADDRESS T # BLOCK # SUBD. NAME OR CSM # 3236 Hy. #170 na na na CITY, STATE ZIP CODE PFfON fyUMBE ' ' i ❑CITY (]VILLAGE MOWN NEAREST ROAD Glenwood City, WI. 54013 (7l5) - Cylon St. Hy. #64 [ ] New Construction Use [ xJ Residential / Number of bedrooms 2 (J Addition to existing building jx}cReplacement ( ] Public or commercial describe Code derived daily flow 300 gpd Recommended design loading rate • 4 bed, gpd/ft2 -5 trench, 9Pdlft2 Absorption area required 250 bed, ft2 250 trench, 11:2 Maximum design loading rate • 4 bed, gpd/ft2 -5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 100.43 It (as referred to site plan benchmark) Additional design / site considerations ssytem area based on contour line of el. 98.76' Parent material alacial drift Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I❑ S 1!~[U ® S O U O S 13U ❑ S ®U ❑ S ®U 0S ;911.1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botir>ary Roots GPD/ft I in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer& Pwo 1 0-11 10yr3/2 none 1 2msbk mfr 9w 2f .5 .6 1 >Y>t 2 11-22 10yr4/4 none sicl 2msbk mfr yw if .4 .5 Ground 3 22-34 7.5yr4/4 none scl lmsbk mfr gw na .2 .3 elev. 4 34-80 7.5yr4/4 c2p 7.5yr5/8 scl lmsbk mfr na na .2 .3 99.56ft. Depth to limiting factor 34" Remarks: Boring # 1 0-11 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 2 " 2 11-30 10yr4/4 none scl 2msbk mfr gw if .4 .5 3 30-55 7.5yr4/4 c2p 7.5ry5/8 scl lfsbk mfr na na .2 .3 Ground elev. 99.56ft• Depth to limiting factor 30" Remarks: CST Name:-Please Print Gary L. Steel Phone: 715-246-6200 Address 1554 200th. Ave., New Richmond WI. 5401 10-30-95 cstm 02298 Signature: Date: CST Number: PROPERTYOWNER M. Hennessey, estate SOIL DESCRIPTION REPORT Pwjq._J,~of 3 PARCELIM4 006-1078-10 ' Boring # Horizon Depth Dominant Color Mottles ( Texture Structure Consistence Boundary Roots G PD/ft in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed (Trench -10 10 r3/3 none 1 2msbk mfr gw 2f .5 !.6 3 2 110-16 10yr4/2 none scl 2msbk mfr gw if .4 j.5 3 16-30 10yr4/3 c2p 7.5yr5/8 scl 2msbk mfr gw if .4 ! .5 Ground elev. 4 30-50 7.5yr4/4 c2p 7.5ry5/8 scl lfsbk mfr na na .2 .3 98.31 ft. Depth to limiting factor 16" Remarks: Boring # Ground elev. f t. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground 1 elev. ft. Depth to limiting factor Remarks: SBD-6330(R.05192) STEEL'S SOIL SERVICE Gary L. Steel Marie Hennessey, estate 1554 200th Ave. CSTM2298 NE4NE4 S34-T31N-R16W New Richmond, WI 54017 MPRSW 3254 town of Cylon (715) 246-6200 1"=40' BM.= top of 1" steel pipe by se lot corner C el. 100' Alt. BM.= top of wooden corner post @ el. 104.00' 12 /lo p r Z' nyl Alf- t Gary L. Steel 10-30-95 ( SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations June 28, 1996 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 GUSTUM PLUMBING N13450 937 ST NEW AUBURN WI 54757 RE: PLAN S96-01851 FEE RECEIVED: 180.00 HENNESSY, MARIE NE,NE,34,31 l 6W 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, David Russell, P.E. Plan/Plat Reviewer Section of Private Sewage (608) 267-3605 SUDA-6926 (R. 10/84) Ay * ? 0 f M R SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations June 28, 1996 201 East Washington Avenue P. 0. Box 7969 Oadison WI 5370? GUSTUM PLUMBING N13450 937 ST V NEW AUBURN WI 54757 RE: PLAN 596-01851 FEE .RECEMED: 180.00 HENNESSY, 10A'RIE NE,NE,34,31,16W TOWN OF CYLON. COUNTY Gr ST CROIX MOUND. SY'STEN! f The Department has reviewed the above-referenced submi'-,al. Conditional approval is'ilereby granted for the system plan submittal. All noted items music be ,corrected. The review and approval of the system is based on chapter 145,'!Wisconsin Statutes, and chapters ILHR iii ana 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 50-54, Wisconsin Administrative Cade. This plan submittal approvai 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 perr:sit expires. The 1 i censeo, plumber responsible for this installation shall keep one set of plans with the DeparUaent's stamp of approval at Vie construction site. The installer shall notify the appropriate inspector wnen'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, JJ ~r David Russell, P.E. Plan/Plat Reviewer Section of Private Sewage (608) 267-3605 SODA-6926 (R.10/94) ; ~ A/~' '1 F S3 y r3l flAl , err/ t~j Toil of Cl/Oro I t 3 a3,w 70 Card i ye Ile a { p A/, 3r ~r'oss ,Sc~7iorJ av7d /~l ~j ic&4/ I, I ~ I f r ►'l~ 1 ';0~~~, y a:~,d _ Poi, . C. i ' l I ~ I I I/ !j hAi►~bt/ 4rdt3 fC 17+'! ~r~d .~~tG/rt`. [gTioris I -TVA 1 AGO. s I I j I ( 1 1 1 1 ORj~tb $EW nd jooially t 1 O v afuroNs ,LABOR H os Q / 5 tY, t~ pF' ItJ~ Q' yv1S►YN of SAF Z !f"' I RVIFSPON s co 1201 ~JUN 2 6 1996 I f 1 ~ ! j SIG~E~ I f 1 ! ~ ~ 1 SAFETV DV. i VVV 0185 f 7'y 06tto i 1`3- . _IllJc;w gib#~ •,Sv71'7 i / ~~a'~'~"G l7?y/rlcSSc~/ LSt tc. ~~T Alw, /Uf NF S 3 y raw ,e/4 - T wn of Y/617, S+. CO.$ Cou^~ 3G h~wy !70 ~ F ~ SS/ol3 w04 Ci 4,1 Gy _Z~e~- ~/1O~/~p°I ~~Q ToP o~ /N SI~cC~p/~4t- ~i1 S6~J~ Cprlttl -r.p 0--- L✓Cbdt.-! Co ra,er1QO,S*- J61/ _ /D y 1 .Z ~c~lvOrr/ cc / vp, l ~orint~. S J f6- W 16 oq c,,/ S4r~i'c Q / 'tf b to Ga / ~v h~o Corw r, o -14n `iC o o3Y PvG_ 7, 36 ,has; b A d %j (,fQ ►y~'p~ r / 41'e1 ~~iw l~lavnd 4 €YS~i~ RECEIVED JUN 2 61996 C4,4.,, r i~ 9S.si' GcrCC 1144, SAFETY & BLI)CS DIV, cU'-140b4 r aoF~ ,~~M S 96o,o1 851 ` Page -3 Of S' Cross Section Of A Mound Using A Trench For The Absorption Area y Medium Sand Fill F - 6" Topsoil 3 E D -T T's L- Trench Of 2h" Aggregate, Plowed Layer 6" Below Pipe, Covered With D_ Ft. Straw, Marsh Hay Or Synthetic Fabric E l 92- Ft. r, = Ft. F - Ft. H Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe Permanent Markers Observation Pipe A o W - B K \Trench Of k" - N" Aggregate I L A ~7t. 1 12- Ft. K 12, Ft. W Ft. B 6y S- Ft. J 9. 6 Ft. L 81,36 Ft. License 6 ~oZy/96 Signed: g Plumber: IJ /Z&/ Date. RECEIVED JUN 2 6 1996 SAFETY b BLDGS. DIV. li 5 Page y,Of .5- Distribution Pipe Detail For Two Lateral Network Holes Loca%..d On Bottom Are Equally Spaced PVC Force Main End Cap 'Y ' X X PVC Distribution Pipe It, P P X ► * Last Hole Should Be Next To End Cap .r ~.i P 31.E Ft. Hole Diameter Inch X 36 Inches Lateral Diameter Inch(es) Y = Inches Force Main Diameter aZ Inches # Of Holes/Pipe ~z Invert Elevation Of Laterals d Ft. i,t 11 Signed: License Number: Q/2o~ Date: S-13~ /ti PERFORMANCE MODELS BARNES PUMP TOTAL HEAD NET. tl. -AAA 11111 Is so 1, ]lilt T- 12 ro • a0 "ECEIVED • 20 JUN 2 61996 ' I r% IAFEIV SL90S DIV. , PER MIN- 1 EP MIN. 10 ~s 30 61 Y!7 70 110 •s, S96 01 8 51 ► Page L Of S SEPTIC TANK 6'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI.V-ENT PIPE 12" MIN. ABOVE GRADE 8 WEATHERPROOF 25" FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ FINISHED GRADE PADLOCK 6 4" CI RISER WARNING LABEL 4" MIN. 1~1 7 18" IN. 6" MAX. INLET I' WATER TIGHT SEALS GAS- ~ TIGHTi VAPPROVED A SEAL JOINTS WITH APPROVED ALM APPROVED PIPE PIPE 3' B ' ON 3' ONTO ONTO SOLID C ' SOLID SOIL SOIL C I ' PUMP OFF ELEV. /,WFT. - - OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE p TANK MANUFACTURER : 1,04,6d- NUMBER DOSES PER DAY : .2- TANK SIZES: SEPTIC 006 GAL. DOSE VOLUME INCLUDING DOSE 6_ro GAL. F LOWBACK: 00 GAL. ALARM MANUFACTURER: 5~5E/ec ~ro CAPACITIES: A = INCHES = 3 7~1 GAL. MODEL NUMBER: SWITCH TYPE: l~1rrcvr✓ RECEIVED B = 2 INCHES = 3y GAL. PUMP MANUFACTURER: ,Qa~nts JUN 2 6 1996 C = INCHES = 17o GAL. MODEL NUMBER : SE ve/ SWITCH TYPE: Me,,,, SAFETY & SLOGS. DIVD = 4 _ INCHES = 68 GAL. REQUIRED DISCHARGE RATE dlr Og GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . /O FEET + MINIMUM NETWORK SUPPLY PRESSURE . 2.5 FEET + VS' FEET FORCEMAIN X /,ry FT/100 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD -2. FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER Nh" LIQUID Tf~ 3g SIGNED: LICENSE NUMBER: O/ZoJ DATE: -/~~Iy6 /AA S06-01851 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER ce MAILING ADDRESS PROPERTY ADDRESS /U /lIC S -7_3 l Ay 2 l rZt~ (location of septic system) Please obtain, frjom the Planning Dept. CITY/STATE /G/ l? C't_ r OAS 6 Lj I S PROPERTY LOCATION 1/4, A) ~F 1/4, Section T__3j_N-R~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 ed to the St. Croix County Zoning Officer within 30 days of the three year expiration date. /1) SIGNED: i v 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 Y' r Location of property L 1/41/4, SectionT_,~N-R_W Township 1, Mailing address Address of site r Subdivision name Lot no. Other homes on property? Yes No Previous owner of property &7 , &,,z- ~r~~rJL~dy Total size of property 4* -A- Total size of parcel / 4-- tea, 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. _~3 79 y7- , 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. S},gn~tu~ Appl 'cant Co-Applicant Date of Signature Date of Signature y • DOCUMENT NO. STATE BAR OF WISCONSIN FORM 5° 19821 THIS SPACE RESLRYEO rOR RECOROING o4r. s ' PERSONAL REPRESENTAME S DEED 5,1707 2" - - a,- illiam J. Hennessy = •t...~..,;~i . as Personal Representative of e-ate of • _ _ DEC 2 0 1995 Marie G Hennessy_,..... a/k/a Mary G. Henne__~', 3. a/k/a Marie G. Henneseey, aIk/a i arie 10:30 A. rj } Hennessey,. k/a a................. arie Hennessey 7 0 ~•~ld.a'-~. for a valuable consideration conveys without warrant , to tcf r;cs JaX S. Beckman and Brenda S. eckman • ? - husband and wife, -__'~t~r RETURN j the following described real estate is S t • Cr01 X Co-anty, / ~D'•~✓Il ~I°!Ar'p'1 j State of Wisconsin (hereinafter called the "Property") Tax Parcel No- NE1/4 of NE1/4 of Section 34-31-16 EXC= T commencing at the Northeast corner of said Section 34; thence N90000'00"W, 173.00 feet to the point of beginning; thence S0103511011E, 400.00 feet; thence N90000100"W, 544.5 feet; thence N01035'10"W to the centerline of State Trunk Highway R64' and the North line of said ' NE1/4, 400.00 feet; ::hence S90000100"=•, 544.5 feet to the point of beginning. I TRAP = E- ;k a Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the , Personal Representative has since acquired. Dated this 15 December 95 r day of 19--------- i r ii Y ----(SEAL) (SEAL) William J. Hennessy - - ' 'j Personal Representative Personal Representkti,_ AUTHENTICATION ACKNOWLEDGMENT r.. II Signature(s) .....William J. Hennessy STATE OF WISCONSIN i- ss. - County. authenticated W- this..__....day of. December 1995 Personally came before me this day of 1WS/.tt(IC1 - 19 -the above named . Kristina 0 land - TITLE: MEMBER STATE BAR 0>< WISCONSIN . i authorized by § 706.06, Wis. States) to me t-A-n to be the person who executed the fork instrument and acknowledge the same. 1 I THIS INSTRUMENT WAS DRAFTED BY Kristina 0$land