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HomeMy WebLinkAbout018-1006-40-100 ~ po o m c C I y C O E O N -O x N CL p y E Y 0 0 c 7 O 0 0 C m c po 0 00 ° 0 0 0 c ° p 0 N C Z (n - 3 C . N LL c C ~ N U O f0 O)'O ~ co 00 j O f0 O O 3 M a' m Z N E C,) ; O ,t `O Z ~ y r) H ~ d co c C7 a) O Z d v r U Z d N ° to F- ~ cu z O E = c c~ co O N ~ N c U 0 Q Q O O © Z Z 0 ~ III ~ - y N i o N V Cl) N E - > CL N (6 m a r co 7 2 0 0 0 a c a) N Q O E F- F- F- 0 O TO 0- U) O O O ° •"`i m m m a d c I > 7 tq Q U) J U r rn rn 0 Z (O M a O co N ~ O O N co 00 0) O O m N !~CO 0- n Lo N p m N Q N O p ? 3 N C 0 T 0) O m~ C U C c ~..t_ Op 0 O O V Q• 0 C c a) N N 0 ff O co Q) L<? D -u- a ~I co N E 0 - W 3 • h byi' 0 0 2 1 m N 0 Z o (n CC +~-'k Q d d ' a w `~1 0 a O U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Randv & Sandi $ol 1 nm i ADDRESS 1838 110th Avenue Hammond WI 54015 SUBDIVISION / CSM LOT I SECTION___3_T__2N-R~_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N~ r Wed ~oas e 6a~ w gm r S a hr0' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center -r BENCHMARK: To o /4" Thin Wall Pipe El vation 100.0' ALTERNATE BM: Top of thin wall pipe Elevation 99.75 PTIC TAN / PUMP CHAMB / HOLDING TANK INFORMATION Manufacturer: Weeks Liquid Capacity: 1000/800 Setback from: Well House -if__ Other Pump: Manufacturer Mugs Model' ME40 Size Float seperation ~8 X Gallons/cycle: / Z Alarm Location :SOIL ABSORPTION SYSTEM Width: Length Number of tre -71- nches Distance & Direction to nearest prop. line: Setback from: well: 2D0 House -6 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: -Member 13, 1996 ~ . PLUMBER ON JOB: Pa„T C -T Stpinpr LICENSE NUMBER: 6780 INSPECTOR: 3/93:jt Wisconsin, Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Hyman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) sanitary Permit No.: GENERAL INFORMATION 268608 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: BOLLOM, RANDY & SANDY HAMMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: r r ~ TANK INFORMATION E VATION DATA A9600306 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. r Septic (~I Benchmark / / 61 Dosing r ~J71-& -go a r Aeration Bldg. Sewer d y, ' Holding St/ Ht Inlet ' TANK SETBACK INFORMATION St/ Ht Outlet 9S' ' Vent TANK TO P/ L WELL BLDG. AirIto ROAD Dt Inlet ' Air Ito - g Septic Jr _ NA Dt Bottom '1.7.5' Dosing NA Header/Man. ab; 95,5L Aeration NA Dist. Pipe ~3r Holding Bot. System 3 4'57-- PUMP/ SIPHON INFORMATION Final Grade Manufacturer c~ Demand Model Number 1~0 GPM TDH Lift '7 r Loss sy Mead TDf-gq,5--- Ft Forcemain Length, ~ r Dia.arr Dist. To Well o , SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O /XL j CHAMBER Model Number: System: ea t'C' "Vo 4 r /Op' ,v OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) Ix Hole Size x Hole Spacing Vent To Air Intake r Length Dia- Length yla Dia. Spacing Grr~ i //Z/ /I 9 " f SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sew xx Mulched Bed /Trench Center Air Bed /Trench Edges-~s r Topsoil t gal~es ❑ No 'Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND.3.29.17,W, SE, SW, 110TH AVE Plan revision required? ❑ Yes ❑ No Use other side for additional information. l SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , E tr.■~:e~r=■7 SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuilBuildiinWatengWater System-- 201 ri E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 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 revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S'96-02623 Property Owner Name Property Location & SmdV SE 1 /4 Sq 1/4,S 3 T 29 , N, R 17 W Property Owner's Mailing Address Lot Number Block Number 141 1-1i qtmq4 12 City, State Zip Code Phone Number Subdivision Name or CSM Number HAMU-d WI 54023 ( 715) 749-3228 II. TYPE OF BUILDING: (check one) [j State Owned Nearest Road Public 1 or 2 Family Dwelling - No- of bedrooms Town OF H3TnlZ d 110th AUErM III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo V f8 1006 ya/D~ 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 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 450 375 375 95-0 Feet Feet Ca VII. TANK in gaclt gallons Total # of Prefab. Site Fiber Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass App. New Existin strutted g Tanks Tanks Septic Tank %88~~ 1000 low 1 ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /9jT6VVddU00bM 800 800 1 Wee)ts FLI ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) P er's Signatur : (N Stamps) MP/fdeW No.: Business Phone Number: Patel C.J. Steiger 715 425-5544 Plumber's Address (Street, City, State, Zip Code). N8230 945th StL ; ltvisr FaUs, WI 54022 IX. COUNTY / DEPARTMENT USE ONLY ent Signa ture (No Stamp>b ❑ Disapproved S nitary Permit Fee (Includes Groundwater mik X Approved ❑ Owner Given Initial Surcharge Fee) (fT Adverse Determination dV X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-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 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 Dvvelling. Ill. 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, rt c )nnect on, 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 ' VII. Tank information Fill in the capacity of every new/or existing tank, list the total gallons num!,,er of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a// ._ptic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experiments, product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in lame, license number wi+:h appropr!a Drefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X_ County / Department Use Only. soE.,ific.a: s r.cr srnal!er P 1%,'_ x 1' . s ~s must be sul tied to r,anty. --he plans must ,':i dine tilrik(-,), septic - lak.s rurrip or siphon =s _ Irjcer.. arc 3 theJld:ng served; r i ont:cls; dosevolume; m t> _U nw _..v~,irec cross section i tcqu,rc.- b4 l~, to ~3 Tl, u ! 11'Ing .nforrnat60n. GROUNDWATER SURCHARGE 1983' )scOnsm Act 4 1 U Included the creak+on o C';rac'S)'or a number of •et;'_tiuted p!,3 it Whitt' can effect ero,indwater_ The monies c~ Jested through these surcharges are used for nonitoring -roundwater c.ontarr in, ti,: investigations and establishment o- standards_ - s SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations August 20, 1996 201 East Wasnington Avenue P. 0. Box 796' Madison WI 53707 STEINER PLUMBING N8230 945 ST RIVER FALLS WI 54022 RE: PLAN S96-02623 FEE RECEIVED: 180.00 BOLLOPI, RANDY / SAVOY E1 /2,SW,:-,29,17W TOWN OF HAMMOND COUNTY OF ST CROIX MOUND SYSTEM The Department nas reviewed the above-referenced submittal. Conditional approval is hereby granted for the syster;; 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 ootained, 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 Deparvaent'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 De obtained prior to installation. Inquiries shoul4 be ; dire, cted to roe at the number i i sted below. Please refer to the plan rlum6ee -shown above. Sincerely, James Quinlan Plan Reviewer Section of Private Sewage (608) 266-3937 SBDA-9928 (R. 10194) MOUND SYSTEM FOR Randy & Sandy Bollom 1419 Highway 12 Roberts. WI 54023 INDEX Page 1 of 7 ...........................Index Page 2 of 7 ...........................Calculations Page 3 of 7 ...........................Plot Plan Page 4 of 7 ...........................Lateral Layout Page 5 of 7 ...........................Cross Section Page 5 of 7. ..........................Plan View Page 6 of 7 ...........................Pump Chamber Page 7 of 7 ...........................Pump Curve Located in the SE a of the SW Seca 3 T 29 N, R 17 W, Town of Hammond , 'St Co3 "C~~ w n g Wisconsin." EOF INDUSTRY, LABO b HUMAN F-n 3 DIVISION F SAFET AND BUILDI, S Prepared by Paul C.J. Steiner Steiner Plumbing and Electric, Inc. SEE CORRESPONDENCE N8230 945th Street River Falls, Wisconsin 54022 S96-02623 Master Plumber: #6780 Date:-July 24, 1996 CALCULATIONS STEP 1: Absorption area: 150 gpd/bedroom X 3 = 450 gpd. Table 4: 450 + 1.2 = 375 square feet required. Use ft X ft bed Use 1 trenches, 4 ft wide X 94 ft long 2 laterals, each 46 ft long, manifold, spacing between laterals. STEP 2: Table 5: 11 "'diameter laterals, 4 " diameter holes at 48 " spacing between holes. STEP 3: Table 6: 12 holes/lateral, 15 gpm discharge rate per lateral. 15 gpm X 2 = 30 gpm total discharge. STEP 4: Table 7: " diam. manifold, inlet at of foot long manifold. STEP 5: Design dose volume is 150 gal/dose at a rate of 3 times per day. Min. dose volume must be at least 10 X distribution pipe volume. Table 10: 12 diam. pipe= .064 gal/ft X 100 = 6.40 X 10= 64 gal. STEP 6: Table 8: Dosing rate = 30 gpm. STEP 7: Table 9: Friction loss in 2 diam. force main, 40 long; 30 gpm= 1.54 in 100 feet. .ELEVATION DIFFERENCE 9.5 .FRICTION LOSS .62 HEAD 2.50 12.62 TDH page 2 of 7 STEINER PLUMB & ELEC INC 7154258818 P.02 P L O ,I' PLAN page 3 of 7 9 c r ~ .I sy5~~►~ The area 25 ft. below the downslope edge of the Soil Abaorption System must remain undisturbed. ~tl BM r>~ 1~v. 9~1•~G' j Ly of Th 5 (ae(~ well P1, /locos e G~rc~7 pr~'r twRy 3 94 r' GM #.I ~ ~ ~ ~ ~ t" )cu FDA 0' , //D A -me w f Page 5 Of ? CROSS SECTION Straw, Marsh Hay, Or Synthetic Coverinq~ Distribution Pipe Medium Sand H _ G Topsoil F stem Elev. 95.0' 3 1 b % Slope Bed Of 2 2 %z Force Main Plowed Aggregate From Pump Layer p 1.0' E t.Z~ Cross Section Of A Mound System Using .A Bed For The Absorption Area F -`81 G 1.0' A 4 Ft. H 1.5 PLAN VIEW B 94 Ft. I 18 Ft. J 8 Ft. K ' 10 ;2Ft. L 114 Ft. Force Main W 3o Ft. L 7- F Observation Pipe--.~ r A I.---------------------- -----------------------i Distribution Bed Of i - 2 ? Pipe Aggregate I Observation Pipe Plan View Of Mound Using A Bed For The Absorption Area PUMP CIIAH11ER CROSS SECTION AND SPECIFICATIONS Vent Cap NT Neatht:r Proof Approved Locking Junction Box Munhole Cover 4" C.I.--- 12" lain ; Vent Pipe Final 4" Min Grade ' ,_----~-j`~ 18" M i n Conduit 18" Min - - Inlet i ! Approved Joints w/ C.I. Pipe Approved Extending Joint w/ 3' Onto C.I. Pipe Solid Extending A Ground 3' Onto Solid Alarm Ground i B - On , C .Pump q off Concrete Block D SPECTFICATIONS TANK • P0111 Manufacturer: Weeks Manufacturer: Myers Tank Material:- Concrete Hod e1 IJun►tier: MEO Tank Sizc: 800 Gallons Switch' Type Float Total Dynamic stead: 12.62 Ft. CAPACITIES Pump Diucharl;e Rate: 30 GPM Total Daily Effluent: 450 Gallons A - 21-.3" or 362 Cnllons Number of Uoues: 3 Per Day B 2_ or 34.2 Gallons Dose Volume:' 158.2 Gallons C N „$s82 or _ .158.2 Callons Notes: 1. See pump curve for D - 12 " or _ 204 -Gallons additional performance Total Tank information. Capacity Required -„758.40 Gnllona 2. Pump and alarm are co be inatalled on ueparat,! circuit ALARH au die r ILIIR 16. 19 NAC . H n n u f n c t u r o r: layel Alarm Hode l I1umbe r : _ D Switch Type. Float page 6 of 7 PAGE 7 of 7 ME40 PERFORMANCE CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 12 40 35 10 N 30 W W 8 W W U- 25 Z Z 6 0 W 20 W S ia- 15 4 H ~ O 10 2 5 0 0 0 10 20 3 40 50 60 70 0 90 100 CAPACITY GALLONS PER MINUTE v 11 23333A275 e,, ,04_X /SE//i f 7-0 tf,t/ ~9,)/4LTO.v. ,ee • T~,s T 0/Pif orEpo,o T' OF- Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations age / of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 11 Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. 3 996 • APPLICANT INFORMATION - Please print all information. Reviews bye 4 ~r;, Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ~w V / 5"'Vpy /30Ao"t-1 Govt. Lot jZ 1/4 5o 1/4 s ~A 1T ~ 7 E (orwD Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# /V. /Z 101W7- o~ ~o aces City State Zip Code Phone Number Nearest Road Fo/3~T5 4V/S. 5yo 1 his )1 yy- J?2 ❑ city ; //4 )x l1 ,61-e , [ New Construction Use: tesidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ,l ❑ Public or commercial - Describe: Code derived daily flow T^10 gpd Recommended design loading rate bed, gpdfft2 trench, gpd/ft2 Absorption area required 3 7.5 bed, ft2 3-7S trench, ft 2 Maximum design loading rate bed, gpd/ff2 trench, gpd/ft2 Recommended Infiltration surface elevation(s) S~ P j r 3 ft (as referred to site plan benchmark) Additional design/site considerations Parent material SCS j - S/facAS Flood plain elevation, if applicable ft S = Suitable for system Conventionaall ~M,ouunnd In-Ground ~Pressssure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S io ~ U LJ 5❑ U ❑ S LJ U ❑ S P,--u [:1 S 0 u ❑ S Ehr SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 5- Ground 3 to ~!0 7 S I 2 C~ S/G SCL z.H, ip.L` ~r„ 7 / , elev. AGT/(/ 57 f lf- T' la Depth to limiting factor 1 _in. 5S5 Remarks: /vd7_ 7X, SYST'~ Boring # / 0-/0 io y~e 3/1- -l,, of e C S 2 f S ' - 2 O-/ 10Y/Q y/y f P f Ground elev. If e7 /41AF- X16~542A 147- 157 Depth to limiting fa r it/dT SU/'T UE,cJo In. Remarks: 5107- CST Name (Please Print) Signature Telephone No. 71 Pao,* 5-3 ?6 - e/ FS Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench / ,2-10 /o Vle 3/2_ 5-/,/ /-f'S h,e pie S Z 3 C~ Z (o ~C L !T S~~ /bv► Ground 3 17-b /D Yee -51 11 elev. Depth to limiting /4CT/ UE' ~T (!-4J ~ ,4 1(-~ -4 factor Remarks: s' TE- A-10 7- S U f'TA A.) `Co K° /ll d y-ul~ 7-Yt46 SYS"T , Boring # Si 1fS`jK ~,Q Z~ s / -/Z /o Y2 31G z- /1-10 ior/e s/ 1-Fs 0-5 s ; Lvl~ Ground -/j~d /0 r-c 'I, s J~ ✓ be ~P"-O / Cw elev. o ~,e y z~ sGL D •mw% 516, /O /pie 412-- ; Depth to limiting factor in. 5ss Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# D-/3 /ol~° 1fs6.C Ccd ! v , S 1 6,r 110" 8 2 3'1G 0 311K Ground S- l -7, 5Y'4 Y/& J /T s/J~ /k~ / • y , . S elev. c~ct' MeM S Depth to limiting factor 3 in. Remarks: S SS Boring # / 19-9 I-0 3 3 Ground elev. Depth to limiting factor 3 67 in Remarks: SBDW-8330 (R. 08/95) -7--~4 (,y ~ a ~n~►o8' ~Sv~ `V s ~ br o~9 ~ ' MNs o~ m m 3 ~ csi _ o say to T' Z ~ a v ~ o0 tA 0 31 Vl- a r~~ W w c Cn co R from 5-20=96. Mound system .A Addendum to complete soil testorepor_t t , to better facilitate area was enlarged, per owner, relocation of house. of SOIL AND SITE EVALUATION Wisconsin Department of Industry, accordance with s. ILHR 83.09, Wis. Labor and Human Relations in Uri' Division of Safety and Buildings County r b er not less than 81 /2 x 11 Inches in size. Plan must S t ' r o dt,' FL Attach complete site plan on pap point (BM direction and parcel LD. # include, but not limited to: vertical and horizontal reference po percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 l 10 0 Reviewed by D~ r APPLICANT INFORMATION SePleas e p ry PU~OSenP°a e~on.15 (1) (m))• maybe Personal information you p Property Location N,R 17 E (or) W Govt. Lot SE 1/4 SW 1/4,S 3 T29 Properly Owner Rand & Sand B01 10m Lot # Block# Subd. Name or CSM# Part of a 40 acre parcel Property Owners Mailing Address 1419 HWY. 12 Nearest Road Phone Number ❑ Village ® Town 110th Ave. City state zip code ❑ city Roberts Wi. 4022 (715)749-3228 H Addition to existing building ® New Construction Use: ® Residential / Number of bedrooms __3--- ❑ Replacement ❑ Public or commercial - Describe: 4 bed, gpd/~ • trench, gpd/W Recommended design loading rate d/ft2~_trench, gpd/e Absorption Code derived area daily flow required 7 9~bed ft27 `--trench, ft 2 Maximum design loading rate bed, gp „ ~ referred to site plan benchmark) design/site surface elevation(s) 95.26' with 1 2 X Additional Recommended Infiltration Use a lon narrow mound with 5 ' licable N/A ft :h t r- considerations Flood plain elevation, if app If 11 System in Fill Holding Tank Parent material In-Ground Pressure AT-Grade ❑ S] U Conventional Mound ❑ S ~ U C3 S ~ U ❑ S mil S = Suitable for system S ❑ U U = Unsuitable for system C3 S U SOIL DESCRIPTION REPORT ce Boundary Roots GPD/flz St - Bed Trench Dominant Color Mottles Texture Horizon Deem Qu. Sz. Cont. Color L t. 2 m s bk d g Boring # in Munsell cs 3f Q10' SL 2msbk mfr 1 -7 10Y1 1/6 SL lcgr mfr gs 1Vf .4 .5 2 1OYR 4/6 flf 7.5YR SL lcgr mfr as / .4 .5 Grounli 4 5 4 5/6 gl.SD~tt. - c2d mots 65 SCL M171 DePtt' 5YR 5/6 timitm9 factor Remarks: 3.% # 1 -9 _WYR 3/2 SIL 2m 3f 5 .6 2 11 -14 lOYR 4/4 SL 2m-qhk mfr- C.Q 1f 5 C' t 3 4-3 JOYR 4/6 SL lc r mfr. CS Ground 4 1-4 lOYR 5/6 ' elev. 92 .-n• 5Yr 5/6 Depth to limiting factor 31 In. Remarks: CST Name (Please Print) Signature Telephone No. Robert Ulbricht 715-386-8185 Address Date CST Number i a Ilk w k y ~ 1 L 'N~ fD w to ~s U,i a`e F-A \ o ~ v `V Vl o . N - cn o° a • a # r l> II (D e1 'd• ct w - to o 0 n C mb :y o -a N to " m r ct a y ~ o~ r1 w ~ n o IZ3 h W ~c~vc awe c 40 Ca P. \ e "an9 ~ mo STC - 10S SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Randol h & Sandra Bollom p ~3 e.rtS MAILING ADDRESS 1419 Highway ttmMond, WI 54023 PROPERTY ADDRESS 1338 110th Avenue; Hammond, WI 54023 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Hammond WI 54023 PROPERTY LOCATION SE 1/4, SW 1/4, Section 3 "1' 29 N-I2 17 W TOWN OF Hammond ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUMEL184, PAGE 271 , 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 forni, 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 Me, 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 sct by the Wisconsin DNR. Certification slating that your septic has been maintained must be completed and returt to the S Croix County Zoning Officer within 30 days of the three year ex ti da SIGNED: DMT. l St. Croix County Zoning Office Government Center 1101 Carmichael (toad lludson, 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 Randolph & Sandra Bollom Location of property SE 1/4 SW 1/4, Section 3 ,T 29 N-R 17 W Township Hammond Mailing address 1419 Highway 12; +IammendRG~e-rfS WI 54023 Address of site. i831 110th Avenue; Hammond, WI 54023 Subdivision name Lot no. Other homes on property? Yes No Previous owner of property John & Carolyn Dalton 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 1184 and Page Number 271 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. 545301 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 r f Applicant Co-Applicant Date of -S~-i nature Date of Signature - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7-1 1-1996 1 0 : 26AM MOM BX,, ST. CR.LJ 71 5 86 1 O61 F' t' ,J •ifEvic.i I =-`'Z_. BAX it F ,j'A i1..: ty°~'.:,,.q T}I:5 dwwrC RESERVCb cCR RFC6kC1NG DATA LAN -U N1 r Mr;*i' indiviouvi ♦,il 1[ rr Sc +c„~ ^t~. #.ds3 iii: ] g+i e e L t3M1 ~,\c T.Lti1; YZ`F_E$i: ,VER! nif~TLr7r ~I II ED ?:Jr CN G'ZHER ON•CO.SfiCIMER i ~E~~~71GClU Vrl"ly CT rKAeN :CTIGIT,, . GRU1X G! s; - V' 1 - 1Y~ ~+-a- G~ Tl-,Irnd -etwC:TI jhT---- l}J 1~1},... rid4 JUN 13 1996 r i 3 19 JQ6 „ yi 55 f Y entiG " nn D i o'.. t h ~.r yore) _.LVZLYL]L L-)1.Lv5x~r and 1 C1. T.:...11: PJ~ lip S 1- f r _ at Ll L_; JL1 1 ' Fe;gival 0 t e s - - - i"li'SIrr•iiFaSt-;r wrc t:_e r one or mort•1 r'~ ..,...~._l ✓ c='i ti .,t 11~- al} l 3 #2} 'QS to en;ivtl to S LI 't.e.Sel t 12POn the Frolyrot and full 1~.or, ,,,r:: } n--L OL Lhis contract b P,,Irchaser, the fmkwing propertytOgett er with t}-.e . .tn.ea arlpni•tensint interests (s13. called the "iI'rvperty") County;. stat,& l - - - Z~ fit L}rz? "„c L o~ tri,3 East [?P_:=-la,$.lY CSI rhev Si?il -hwe, L e-( uarte. of ,ecron ; , lownshiy ?'9 Kaxt e- 17 West, St. Croix County, tiJiSCOnsin. ~tR i79' 1 Q t h Aveniie ^ti. t i. l• CrE E, to l urrh~ g the t'rCl Erti. aS?u 'O 1 5.r ca Vender at 6ammond, Wisconsin 54015 zn the following; manne-r: i10 3'3-5 Q -QQ..---~------ a t e 'C '-tat}:it'_ of ttiiu t'ii;]iI' :CLw ' r.Li (1 „ xt]i:t i f 4D i](P1i . -0 - ce o ~ - -_r 115:'i ~~I.~{R1~i~I:40~"@~14Ei41~.^43.'.•.C`? a. T ~~a:l ~`~kkc..1,. L/I ffd Wi,.-sy k.~:~ !•X}{ii~ xg - ,E •YU vT.. lm,-%1w,,tgA)l;i MPC3? 4 :'+lt{+'.~stirx vt tlx;=' Y'x Ya,,:PM'.:d'JCA ,.-a 1n; ,I G ~)av ent ~ n!lIDfRCi^ tilt' y 199F-7 aI%;;,1 rttI u -n, for a period Cif 9 orit:C2 ~ wit1_ a irLua1 Pt' V'lrle'.lt of 311 of the then remaining a -.,,A tnterest due ar2N llvavabl.e o-i `,t before June 6, 2001. Monthl", t 1, itt undc-.r ti-as Land Co:.-2tr C't snail by base upon a twenty (20) gear r.Uat~ :SOfl. ` i e .interest rates be the prime rate, adiusted annually 4 if 3 ?i , vevs rv aaLe of t 2is ; and Contract. The initial IIIOnC111C~ payment ,)r till _t ; tit veai~ of this Laftd Cont'ract: shall be $113.02. tto,'facr+, i. rcr_ tt en. ne aatstandi]1C bah ance shall be paid ir. foil ._,n or hefn btr2 r re the s ; 1 (1 ?.,i. ' "T~ _ 1 1.6e. 221at52rl:=i' (latP _ -n5 C1 .1 7': t i=i _lll.. interest ,hall a eCt1' a mile :atr• of -Y~'_~_ 'l}e annum on the entire', ruin iyn I;. f it is :]i:i!, Cl_if2,que,iet ;ntfrna i and, luron acceleraziori or I7tliturlt; they emir: C~ L; s ui'S ? r, ir2ies; E:kC lsed oY V•endur„ agrers r, p-iv n-) iThly to Vendor wnounts sufficient to pay rt~isansblr nntili - 7.. L 1'i tic, ,nevial as:;.p.3=t--,ents. `ire and rt, wired insurance prenrnu2n9 ~7-hen clue. To the extent reCelvicefl h:- vel- c-, vi,y .,t a rei ; .t) y' r2t,'1A:c21t, to .rie,e ob1`:ga;tions when due :Such a2nounth received by the Vendor :for patnnent (:f ava insun-411,-~Y_. -xeil'l be tlepos''i.r; into az es^EC?'4' itir2d r trn.stee ueCoux;t, but shall not bear rote. 0 L.a re ztt, Interest on the t! a..kan. e ii t I.•' rats' ° if'•ed and al. 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