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AS BUILT SANITARY SYSTEM REPORT 4
OWNER
ADDRESS gC3 Q ' S
~ 16
L.-,. o-ZG
4SUBDIVISION / CSM# tul4 LOT iU A
SECTION- ~T~N-R OW, Town of
ST. CROIX COUNTY, WISCONSIN
P IEW
SHO EVERYTHING WITHIN 100 FEET OF SYSTEM V
ZaJ
r
3 Si
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a~
,8 -
INDICATE NORTH ARROW
Provide setback an elev information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r
1
BENCHMARK: lit C~~~ (Mtte~~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ,
/drC) Liquid Capacity: Xo~~ -74
r
Setback from: Well $•S House Other
Pump: Manufacturer e_n ~ Model# (ir-763fl Size
Float seperation //e.Z Gallons/cycle: 7
Alarm Location 6n1 -jq, c3s2.
-:SOIL ABSORPTION SYSTEM
Width: S Length 7-5 Number of trenches
Distance & Direction to nearest prop. line: Aj fA cv
Setback from: well House C s Other -
ELEVATIONS
Building Sewer ST Inlet: ST outlets s~
PC inlet 93-3,;),TC bottom v9 a Pump Off 6~
Header/Manifold Bottom of system Id7l
Existing Grade Final grade
DATE OF INSTALLATION: 7 - / \
PLUMBER ON JOB:
LICENSE NUMBER: Te;-a%
INSPECTOR: 1.,..
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) Sanitary Permit No.:
`GENERAL INFORMATION 262395
Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.:
BOUCHER, ELROY HAMMOND
CST BM /E1llev.:~ Insp. BM 1Elev.: BM Description: /J/ Parcel Tax No.:
Ul/ x!01 l GU ,CCU ~~,~n P 5 / (G---
TANK INFORMATION ELEVATION DATA V/7hV-
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark . 3v 07 160,
Dosing 0,4 rv(, 3.05 D/, Ov-'
Aer Ion Bldg. Sewer
Holding St/*1 Inlet /d /5 93•g~
S~
TANK SETBACK INFORMATION St/}fir' Outlet 31
~
TANK TO P/ L WELL BLDG. Ventto Air Intake ROAD Dt Inlet
Septic r q g ( Al "-),4 NA Dt Bottom
Dosing 7 j SS S NA Header / Man.
Aeration- NA Dist. Pipe a' /O?1,~~
Holding Bot. System 3 99,70
PUMP / SFORMATION Final Grade
Manufacturer 8e"m0 iM r
Model Number Lc~EC~ //L S _pewlrd
TDH Lift Friction c8System2~ TDHj3,8SrFt
Loss H /
Forcemain LengthA~S Dia. Dist. To Well ~/11~
SOIL ABSORPTION SYSTEM
I BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. i th
DIMENSIONS s 75 DIMEN I
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING
INFORMATION TypeO CHA Mo el Number:
System:/ &,6d,Mnd,
ti DISTRIBUTION SYSTEM
L . -NeZ "anifold Distribution Pipe(s) / i x Holeize~r x Hole Spacing Vent To Air intake
~ Length D Length Dia. Spacing T
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: HAMMOND. 21. 29.~W, NE, /RF, 901.'H AVE
97
99
M,97 ~l 1e~
U
Plan revision required? ❑ Yes ❑ No /
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signa re AC e ~rNo.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
SANITARY PERMIT APPLICATION
ve~~■rfa In accord with ILHR 83.05, Wis. Adm. Code COUNTY
S}1 Crv I
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than "q& o2 39,1,
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
N 9 Y4 WE I S T 14N, R W
PROPERTY OWNER'S AILING ADDRESS LOT # BLOCK #
tk MA A)
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISI N N ME OR CSM NUMBER
vil" PrIa % -4- (ja t oa
331
I TT A) ~ P1
II. TYPE OF BUILDING: (Check one) r_1 State Owned O VILLAGE NEAREST ROAD y fi
slt
El C~
Public ~1 1 or 2 Fam. Dwelling-#of bedrooms - PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) L~
l.J l U ~
10 Apt/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 in line A. Check line B if applicable)
A) 1. ❑ New 2. K 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 # 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 El Seepage Trench 22 ~In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 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
5o REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) > ELEVATION
~L 5 3 7.5,6 _5 / 161 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New ii-sting Gallons Tanks Concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank fOZfil~ e r
Lift Pump Tank/Si hon Chamber, ( p h,
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
PI ber's Name ' Plumb is Signature: (N Stamp /MPRSW No.: Business Phone Number:
Plumber's Address (Street, City State, Zip Code):
L09 _ S-t-^ c,f2.. R? •Q w3 K~ ~h W~ p
IX. COUNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued uing Agent n re (No Stamps)
g.~ Surcharge Fee) j
XApproved ❑ Owner Given Initial
12 -1
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(11.08/93) 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 the 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 (BBD 6399) to be t
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 & 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 in 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 in ##1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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
i
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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
Wiscorrsff"e hmentofIndustry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division
Labor and Human Relations Bureau of Building Water Systems
REVIEW APPLICATION
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1st Street 2226 Rose Street 201 E. Washington Ave. 1053kE. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188
Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606
Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614
Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633
INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office
where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference.
1. APPOINTMENT INFORMATION -if ou have scheduled an appointment, fill in the information requested below to save time:
Appo tment Date Review ame Plan Identification Number
QA I qS I gn ss 313 ~ -7
2. PROJECT INFORMATION If this review is a revision or extension to your existing
plan identification number, provide that number here:
Project Name
❑ City ❑ Village ~ Town Of: County
Project Location
GOVT. LOT 1/4 Ajr- 1/4,S Q) T N ,R or W 01 ti ST
3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type 1 (include new and existing tanks)
Up To 1,500 gallon septic tank $110.00
A At-Grade 1,501-2,500 gallon septic tank $120.00
H Holding Tank 2,501 - 5,000 gallon septic tank $160.00
M Kn Mound 5,001 - 9,000 gallon septic tank $200.00
N Non-Pressurized In-Ground (Conventional) 9,001-15,000 gallon septictank $300.00
P ❑ Pressurized in-Ground Over 15,000 gallon septic tank $ 500.00
` O Other: U To 1,000 gallon dose chamber $ 70.00 74
1,001 - 2,000 gallon dose chamber $ 80.00
Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00
4,001 - 8,000 gallon dose chamber $120.00
D Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00
P ❑ Public Building Over 12,000 gallon dose chamber $160.00
S ❑ State-Owned Building U To 5,000 gallon holding tank $ 60.00
5,001 -10,000 gallon holding tank $100.00
Code Derived Daily Flow 1 gpd Over 10,000 gallon holding tank $150.00
Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00
Revisions To Approved Plan 2 $ 60.00
Petition For Variance: Setback $100.00
Petition For Variance Site Evaluation $225.00
Plumbing $22 MO 1116..
Revision 5.....3
'Rip
❑ Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00
(other than a proposed subdivision)
❑ Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00
Subtotal:
Priority Review: Enter same amount as Subtotal:
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ~b
5. SUBMITTING PARTY INFORMATION
Telephone No. (include area code & extension) Cp any Name Contact Person
( -l /5) a S 1 c9 w e vs C c v ` l f C h c<~ U',
No. & Street Address Or P.O. Box Cit, Town or Villa e, State, Zip Code
1 Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers.
2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals.
NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually.
SBD-6748 (R. 03/93) OVER
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa g Labor and Human Relations g of
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S t C ra \ X
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
a p LkG % Q y GOVT. LOT AJ C- 1/4 1/4,S,-a/ To? 9 N,R -jpor) W
PROPERTY OW R':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
f ' -5 • • N 14 N A., 7J ,a,
CITY, STAT ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD
r r ! 5i(ot 015) oZ -337
[ ] New Construction Use[ ] Residential / Number of bedrooms Addition to existing building
XReplacement [ ] Public or commercial describe
Code derived daily flow ~4Z gpd Recommended design loading rate _L_~Y_bed, gpd/ft2 ..5 trench, gpd/ft2
Absorption area required -37S bed, ft2 37S trench, ft2 Maximum design loading rate , Y-bed, gpd/ft2 1-5 trench, gpd/ft2
Recommended infiltration surface elevation(s) Q/ o a ~o ft (as referred to site plan benchmark)
Additional design / site considerations MLitt oir 7d A, a~ to :t )
Parent material f ' Flood plain elevation, if applicable n~/A ft
S = Suitable for system CONVENT 0 AL UND IN-GROUND RESSURE AT-GRADE SYSTEM IN ILL HOLDINGTT~A4NK
U=Unsuitable fors stem I ~ A I _I El S U S❑ U ❑ S U ❑ S )N U ❑ S U ❑ S ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. ShConsistence Boundary Roots Bed Trertch
.
/0 ~eR '4j AL m .56k, trif
IN
!s 3if /d sJ d rn Shk ,s
S oari'
Ground
elev. 9f- -Yv /o e S C 5 $ S / o'? m .56k m~S J $ ,
.
ft.
Depth to
limiting
act
L I
Remarks:
Boring #
D- L or.Q- l S k t-n r O 3 y iS
/ NDrw S 0M t r C ~7
4,9 - Ground
elev.
ft.
Depth to
limiting
fac Cb =0 i5 ~
Remarks:
CST Name:-Please Print r T Phone:
a J d C.v' 2 r-.5 ~1 - ':V309 -yr/3t5
Address: x
w .s a
Signature- Date- CST Number:
~`-a9-~s s
PROPERTYOWNER G/ hD y C&Ltcker SOIL DESCRIPTION REPORT Page a of 3.
PARCEL I.D. #
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
bn k + W
Ground 3 30-U
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:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
C _34
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WORKSHEET - MOUND SYSTEM DESIGN
PROBLEM:
Design a mound system for a mac asr~ -
The site characteristics are:
Depth to groundwater or bedrock. ~.34 in.
Landslope
P¢ ,
Percolation rate .~.5_ m
Distance from dose chamber to distribution system a30 _ ft.
Elevation difference between Dump and distribution system , 9 ft.
Step 1. WASTEWATER LOAD 5v '5~57> gal
Step 2. SIZE 'THE ABSORPTION AREA
A Area required = 4-50 -i "L
sq. ft.
B) Bed or trench length (B) = 54-~r= 75 7.s ft.
C) Bed or trench width (A) ft.
D) Trench spacing (C) E d
Wastewa `er load .24 (?al/ft2/day B a , ft.
tr~•i~e+~i sue"
Step 3. MOUND HEIGHT
A) Fill depth' (D) a ft.
B) Fill depth (E) - D + 6 slope (Aj-fP) ~ l• ~ : ft.
0 / X s~ - a5
C) Bed or trench depth (F) a , 83 , 8.3 fit.
D) Cap and topsoil depth (G) _ ft.
E) Cap and topsoil depth'(H) r 1,5 ft.
T. j
-Canuo
- ,lj 6 cam. ch.•~ v~ ~ O l D
h6~J '
Step 4. MOUND LENGTH
A) End slope (K) ' CD + E~+ F + H x3 ft
./6- /y
2
B) Total mound 1 e tai L = B + 2 --;a 95• Z-~
7s aC~ 95,13
Step S. MOUND WIDTH
Al) Upslope correction factor
A2) Upslope width (J) ^(D + F + G) (3) (factor) _ ft, s-1• C
C/-f •d'3t1~h 3x i9~ $13
B1) Downslope correction factor = # 3 c>
B2) Downslope width (I) _ (E + F + G)(3)(factor) _t l
C/Iasf, k3KA03
Cl) Total mound width (W) for bed = J + A + I f~2-s t-
+
C2) Total mound width (W) for trenches =
+ + no. nches 1) (c) + A + I_~
Step 6. BASAL AREA
A) Infiltrative capacity of natural soil .rs., gal./ft2/day
r
B) Basal area required = wastewater flow
natural soil infiltrative capacity = 94~ sq. ft.
Cl) Basal area available for bed for sloping sites =
B x (A + I) sq. ft.
C2) Bas are avail le for trench for sloping sites ~f S
B + A q. ft.
gaa,s
7-5 X ~3, '
C3) Basal area available for trench or bed for level
SitSBXW= sq. ft.
S i (.1
License c:u~ MLS~3_
S95-31387
Step 7. DISTRIBUTION SYSTEM
1A) SIZE DISTRIBUTION SYSTEM
1) Hole size = in.
2) Hole spacing in.
3) Distribution pipe length 2 10
4) Distribution pipe diameter in.
5) Spacing between distribution pipes in.
6) Distance from sidewall to distribution pipe =0 in.
7B) DISTRIBUTION PIPE DISCHARGE RATE
1) Number of holes per pipe = << s .1~
2) Flow per pipe 2-7 = GPM
7C) SIZE MANIFOLD A I/L'<~
2) Manifold length ft.
3) Number of distribution lines =
4) Manifold diameter = in.
7D) SIZE FORCE MAIN
1) Minimum dosing rate GPM
2) Force main diameter in.
l
3) Friction loss ft.
7E) TOTAL, DYNAMIC HEAD
1) Vertical lift = 9 ft.
2) Friction loss = / L:67 ft.
3) System head 2.5 ft. 0~.5 ft.
4 Total dynamic head ft.
~icersc: ~,S'(o 3
Sc 31387
7F) PUMP SELECTION
1) Pump selected will discharge r1_ GPM at ft.
total dynamic head.
2) Pump model and manufacturer
W -,G'0 311J-
7G) f
DOSE VOLUME
1) 10 times void volume of distribution lines = S, gal./cycle
iDX~ C o IQ X-7q~ 6&,a8
2) Daily wastewater volume 4 doses/24 hrs. _ PAS gal./cycle
`1SO a, 5
3) Minimum dose volume = gal./cycle
oZ ytd ww. b kX 13 82. s ~ c /112-
7H) DOSE CHAMBER
1) Minimum capacity required = gal.
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Straw, Marsh Hay, Or
Synthetic Covering
f~_Si7a1 3 Distribution Pipe
m Sand '
Tops - "
Slope
Bed Of 2M- 2 12 Force Main Plowed
Aggregate Layer
Ft.
Cross Section Of A Mound System Using E - Ft'
A 'Bed For The Absorption Area F Ft.
G / Ft.
A A_ Ft. H Ft. B Ft.
Signed:
License Number: IS 06 ~3 K D,/ Ft.
Date: Vol 9 L Ft.
Jr~ Ft z
Alternate Position I Ft. 1
of /
Force Main W Ft.
.L
Observation Pipe
g K
PA Force Main
w
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A
Distribution. Bed Of 2y- 2 i
Pipe Aggregate
1
Observation Pipe l Permanent Markers
5-31387
Plan View Of Mound Using A Bed For The Absorption Are
Y
Perforated Pipe Detall
End View
)Perforated
End Cop( PVC Pipt
Holes Located On Bottom,
W a``o of
c Are Equally Spaced
t
C~F 'Y
\ n5 r;bwfro'?
Lau Hole SAo`uTd Be
Neat To End Cop /
Distribution Pipe Layout P et'
R~r
S N b
X c Inches
Y Inches
Signed: - Hole Diameter r/ Inch
Lateral " 1~ IncM s)
License Uumber: I$~3 atn -"2 y
Date: C`L2 - ~S Force Main 3 Incho.;
# of holes/pips ' C 1
Invert Elevation of Laterals Ft.
red
ss 3 1t 8
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PAGE OFD
' PUMP_CHAMBER CR055 SECTION AND SPECIFICATIOQS
VENT GAP
I 't"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
ZS' FROM ODOR, JUNCTION BOX MANHOLE COVER
WINDOW OR FRCSH 12"MIU.
AIR INTAKE I
GRADE I
I
I 'i" MIIJ.
"/IIN, CONDUIT L-- \ 16 Alm.
10
11~
J ..F; '1' PROVIDE I
AIRTIGHT SEAL I I ~ I
I I I
APPROVED JOINT A I III APPROVED JOIAI
• W/C.I. PIPE. I III w/C.I. PIPE
CXTCNDIAIC. 3'
ONTO S01.10 SG':. - I II ALARM EXTENDING 3'
B I I ONTO SOLID SO;
I I
c I i ON
•I I
I
1 PUMP----
OFF -
0
COIJCRETE DLOCK
RISER EXIT PERMITTED ONLY IF TAI,IK MAMUFACTURER HAS SUCH APPROVAL
SPECIFICATIOUS
SEPTIC AND
DOSE TAAIK$ MAIJUFACTURER: WAA0 -
~ NUMBER OF DOSES:- - PER pAy
TANK GIZC: _Z-S 1 GALLONS DOSE VOLUME z.j
ALARM MANUFACTURER: stem INCLUO!!!-- ;,;,L FLOC ::L-' iI GALLONS
MODEL NUM6ER: CAPACITIES: A= INCHES OR ' ~ALLOuS
SWITCII TYPE: ~p a,7~ B = ~2 IMCHES OR 50 7
PUMP MANUFACTURER: - O tale,5 GALLONS
//-1 S C=INCHES OR ~oh GALLONS
MODEL AIUMBCR:
SWITCH TYPE: O--9 INCHESOR ~ -3 GALLONS
NOTE: PUMP ANp ALARM ARE TO BE
In
PUMP DISCHARGE RATE; INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE D 4JCCN PUMP OFF AMD DI5TRIBUT101`I PIPE.. / FEET
f MINIMUM NETWORK SUPPLY PRESSURE ,
J 2.5 FEET
1 -ALL= FEET OF FORCE MAIN X F otr.FRICTIOU FACf00.S FEET 4
s
531
TOTAL DYNAMIC. HEAD Z. FE 9 -
INTERNAL.. RIMEWSIGNC OF TAIJK: lt)r1,}~'T{ ~ ~ j LIQUID DEPT 1-I
SIGNED:
LICEIJSE ►JUMt3ER: 1~6-3 pATE:
-117-
VF'} a s
GOtlIDS SUBMERSIBLE
SEWAGE. AND EFFLUENT PUMPS
Fti,y~Afi
i r EP0311 LLST DISC.
i .1 =V P0311 142 EP0311 1/3 HP 115 V Effluent PUTV 1/2" solids 256.80 172.10
4},, : , a .T~n s , Submersible
MODEL EP0311
r` h- Effluent Pump
METERS SIZE 3/e" SOLIDS
5EFT
ti
: , 20
\ 41,~.r T_
Fi`L a" 4 ;
10 '
2 p
t 1i
5
' i Z1
o pp 4 8 12 18 20 24 28 32 ss GPM 40
- - ' '
p1 2.5 5.0 7.S m'/h
CAPACITY
Performance
k Y Curve 3885
t+crEtls FEET • ~
•o MODEL 3885 wk .
{ n 6o SIZE 3/4" Solid
ti
t ao
d~ ~ eo
...r2 < ~ wEOtn....
16 70
r EOSM .
b
to 30 wx
70 WEOX
,1 a~+ 410 0o FF:R
C 10 - -
to 20 z no 60 60 To ro •o too 110 110 01,111
t
10 CAPACITY 20
+1' ' LISP DISC.
0XI'V E03111, 142 WE0311L 1/3 HP 115 V Law H 3/4' solids k91.55 329.35
, 1z =ZWF.0311M 142 WE0311M 1/3 HP 115 V Mod H 3/4" solids 491 .55 329.35 '
>sl`i , w,7 ooup1ao51in 142 WE05i'1H .'I/2 HP 115 V High H 3/4" solids 104.25 47.1.85
d%IK~ a
GOMIE07M 142 WE0712H 3/4 HP 230 V High H3. 3/4" solids 843.65. 555.25
C' *****sEE FazcwING PAGE FCR PmFC *wM AND &,B=r1c&TIONS.
PAGE 07u
p4T'E 10/88 DEPT 30
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
At\
OWNER/BUYER. V
MAILING ADDRESS ~ Lo' S
n
-`5-~r-
PROPERTY ADDRESS I -7c
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE ~cs 1~ t~o~ n : SAC C)
PROPERTY LOCATION I~ 1/4, NIC_ 1/4, Section T- -N-R_W ,
TOWN OF H cam Mn r, , ° ST. CROIX COUNTY, WI
LOT NUMBER N
SUBDIVISION
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
A
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. A
Owner of property:
Location of property N 1/ NI 1/4, Section ~,T~9•N-R 1 '7 W
H
Township jAa v,,, 4.0 AA_ Mailing address Qp ~4, v (_ol~
Address of site JIN ,,,n o must C)
Subdivision name 1-N R Lot no. (A
Other homes on property? Yes__X_No
Previous owner of property
Total size of property
Total size of parcel
Date parcel was created
Are all borners and lot lines identifiable? yes No.
Is this pry perty being. develop Mpr ('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 o the County Register of
Deeds as, Document No. 5 ,:~_qV nd 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 Ap icant Co-Applicant
Date of Signature Date of Signature
A t
TtF00RDING Q~ORMATION
OCUh ENr NO. WARRANTY DEED
L
Von Z1n~PA,F~~~ REGISTER'S OFFICE
2 88 ST. CROIX CO., WI
Reed for Record
THIS DEED, made between Belveidera Boucher, a single person. Grams,. and Bettj Lou DEC 2 +Y 1994
Manning, LaDonna M. Johnson, Elroy J. Boucher, Grantee, t 8:30 i► A. M
WrrNESSETH, That the said Grantor, for a valuable concideratiom coneys to the Grantees
bLr undivided 1/4 interest in the following described real estate in SL Croix Canty. State of Wisconsin'
North 200 feet of the East 373 feet of the Northeast Quarter (NE 1/4) of the Northeast Quarter GYE - ..,..1
1/4) of Section Twentyone (21). Township Twenty: nine (29) North. Range Seventeem (17) West, except
that part heretofore conveyed for highway purposes. RETUR V TO Battles Norman,
New Richmond, WI
L
Tat Parcel Na:
This is homestead property. T
Together with alt and singular the hereditament& and appurtenances the eusso belonging; and Grantor warrants that the title is good, indefeasible in fee simple
and free and clear of encumbrances except:
Easements, highways, utility rights and reservatioms of record, and will warrant and defend the same.
Dated this r, j ye
o ` -
Y
FEE
7't (SEAL)
ACKNOtVTF~GEMFNT
• Belveidera Hotrc~Y STATE OF WISCONSIN )
(SEAL) ) aL
ST. CROIX COUNTY )
• Personally came before me this Beelveidera Boucher day of
19~ the above named
AIlTHENT[CA'IION
Signature(s) of ' ra Boucher to me known to be the peraon_ who
Behy-t
executed the foregoing instrument and acknowledged the same.
/2day 19
authentkaja&
• Thomas R. Schumacher I.D. *101498!_ Notary ~blle' minty, y.
T1 TLE MEMBER STATE BAR OF WISCONSIN
(if nk
authorized by } 706.06, Wis. Stats) My Commission is permanent. (If not, state expiration date:.
THIS INSTRUMENT WAS DRAFTED BY:
BAKKE NORMAN, S.C.
NEW RICHMOND, WISCONSIN
'Names of persons signing in any capacity should be typed or printed below
their signatures
i