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HomeMy WebLinkAbout018-1070-10-000 -0 C> 0 Q° 3 0 3 0 d 0 w. p e» :r > y C O O I C N ~O L_ EO CQ cu N 3 Ew O w I N I'' ~ I u0- j U C N 'Q CL 'N U N Y N 00-, v U jN O 4 O E N C U O+ a O N N z~ C C z N C 7 (6 L O 7 m a N O) C° C j C LL cO M E V U. U M - - N X a E Q 03v~ U i f0 M M 3 I ~ N II Z N H > O .r O Z N y N N N W a m a m M H U) c O i O z Z U C ~ C - O N N w d Z G C O c m Z N F- E E O ^ N U O c (6 N N J N N cc af N N ~ CO • ly _ -O O j O U 0 Z m Z 2 Z Z Z N c '2 C o 00 0) W M m E co !C E j N t6 U ` t6 IL 4) 4) CL CL c 0 ~ d~ m a~ o f oca aY ooa aIN Z j o H H F ma o FN- FN- H 'LO O O O X 0 0 0 z •N _aaa _aaa y Q U) N O O N (O CO N fA J U M .O- - Z m } M N O N W 00 n R E N m m w m m c a L 0 N O. 7; L '0 N N 0) N Q z C%7 2 N d Q t7 O o O 00 C ICI, C'4 N C N U) a C 3: E O O M 0 O 0 N O O O 4) C N 0 co J U L J U S a pia', d O O O r- O O c CO N C a) E ~ N p 7- -0 (D cq 00 O E U • c6 N N O O U co h y,~ O M 2 n. o> O 2 z d N 0 -01 Z CA E d E N CL a 0, • a a a y c c t`Iv E u 1 A iv a g O N v O U) V I. 1 t Z w Wisconsin Department of Health and Social Services Plb. #674~ 10/69 Division of Health # PEF~MIT APPLICATION for PRIVATE DOMESTIC SEWAGE SYSTEMS A. OWNER OF PROPERTY TYPE OR USE BLACK INK Name Address (Street, City, Zip Code) " i ! County B. LOCATION OF PROPERTY WHERE SYSTEM WILL BE CONSTRUCTED ALTERED OR EXTENDED Check Ones CITY VILLAGE LEGAL DESCRIPTIONS TOWNSHIP ~ LZ'/ `S•~ ~ S~~ 3~ T~9~r~~7 r C. IS LOCAL PERMIT REQUIRED FOR THIS kORK? YES NO ~bPERMIT NUMBER D. SEPTIC TANK CAPACITY _ Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete Poured in Place Steel Other NUMBER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY / Cheek One: One or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated Number of Bedrooms_ F. APPLIANCES, ETCs Food Waste Grinder YES L/N0 Automatic Clothes Washer t/YES NO Dishwasher YES NO Automatic Potato Peeler YES :i NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines ,1 41 1, Seepage Beds Length 3~ ! Width 1~2-1 Depth Tile Size No. Lines Seepage Pits Inside diameter Liquid Depth P E R C O L A T I O N T E S T Test Depth Character of Sotl Hours Water Test Time Drop ir_ Water Level Inches Minutes 1 Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall l 1st Wetted Overni ht in Minutes Last Period Last Period Period One Inch j Example ; P- 0 36" To Soil 10" Cle62611 25 es or no 30 1/2 1L2 _.Y2 60 4ql RECuRD DATA FROM MINIMUM OF 3 TEST HOLES ompute size of absorption area in accord with H 62.20 Wis. Administrative Code. ~ S O I L B 0 R I N G S- Minimum 36" Below Pro osed Absorption System oring Total Depth Depth to Ground Water Depth to Bedrock umber Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches j xample 0 72" 72" Black Top Soil 12"; Clay 18"; Sand 18"; Gravel 2411 S s2 ~ (i' hl'.,..:. l! it ' J~`'/~-`f a E /I 7 I, the undersigned, hereby certify that the percolation tests reported on this form were made by me s or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), } Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME dl G/l e'y Yo '14 I J1 <i TITLE ~~`i? ~e or Prin 1 C or MASTER PLUMBER LICENSE No. I REGISTRATION NO. / C ADDRESS 7 DATE ~t - SIGNATURE 67 MASTER PLUMBER MAKING APPLICATION /I- MP Signatures -C,Z~ License Numbers MP RSW S (To be Completed by Issuing Agent) Date of Application 7 7 Fee Paid / c Permit Issued (date) Permit Number, t?: Agent (name) For: "JA Town, Village, City, County, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. 1 Do not write in space below - FOR DEPARTMENT USE ONLY DATE RECEIVED ~I ACCEPTED BY RETUEWED (Initials) C N (Date) (see Corres. j FEE RECEIVED VALID. NO. PERMIT NO, - Yes or No) I REVIEWED BY APPROVED DAME (Initials) (Yes or No) COMMENTS: G B 6 o too a d o C Co1 T Cf 00) O N O O ~ CD 0) • CD N Ch N 3 FBI CD ff! N _ C b N O N j V v O CL CL N N r ~ Q Cy O O C O O W } OS~ R~ O N 3 a 7 fA N D O 0 dl !J S 0 a 2 v C d v> z I CD ~ D a = = CL o o I N 3 0 z! V N -4 O z (D (0 M W O O O N O co rnrny, 3..c H• Z 000 c 13-2 I v v v 0 m coo I W = m m W I 3 m c N pp CL w ? Z 7 D O O O d O ~ I ~ N I _ W m --i ca I O rn P Z n i' G 7 I o (n C4 m co N a W Z 0 I o to ~ m A W 01 fCD D 3 CL m 0 ~ o' I n@ m m CD? C cDg y z a o >>o m 'CD m I O =r N W ► N JJJ N C A fD f~D 7 rC I ~ ~a b CD 0) ~O V c p. I H ~ u, u, I N •o ;o :3 Q CD ti CD o yy I O i ~ "r % DVI STC - 104 (\ECE AS B 5 1996 UILT SANITARY SYSTEM REPORT T CROiX OUNTY OWNER ~MC30s~CE ADDRESS 6 ~2. Co vti,a-y G~~Lfi SUBDIVISION / CSM# V ll y 0 ~ / LOT # SECTION 3 T_2,tN--R_W, Town of ~►zd~,~ ST. CROIX COUNTY, WISCONSIN Invert cuatruoution pipe b9,27 Elevation pump off to list 5.95 Inf ittration 88.63 Head required f or diet, 2,50 Invert inlet septic 86,25 90' w ,561100 friction loss ,50 Invert pump pipe outlet 85,95 FUTURE PUMPS MUST DELIVER septic manhole 88,29 17 GPM at 8,95 FEET of pump manhole 89,18 DYNAMIC HEAD pump tank bottom 82.51 Pro sed Lot Line Property South of this tine pending sate P w d Field ar we Lawn o o-W 3 47 e+ {iq t C1Z 3 L°ys~ P eF (1J +4 EL SCALE in FEET 0 c( 0 0 SO .r L INDICATE NORTH ARROWI Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. IBENCHMARK: 90"VVVI 0'h-` ALTERNATE BM: TOM r- SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: l /espill Cgi-)-- Liquid Capacity: ~ Q Setback from: Well ? UO House 7 OthersLhA 1--i 5 0 t Pump: Manufacturer Model# S 7 Size ~I Float seperation Gallons/cycle: 136 Alarm Location ~~5er►,e OF M~o~S~ Nay, N~~.~s SOIL ABSORPTION SYSTEM Width: 5 --Length / Number of trenches ,I Distance & Direction to nearest prop. line: So~¢ /ofi IFyP Setback from: well: l Yo House I 0 Other ELEVATIONS Building Sewer Q Z ~urh g _ ST Inlet. 86 - 7"od let PC inlet Cor4v Th PC bottom 92-5-) Pump Off o 3, 2 Z Header/Manifold Bottom of system 8 O 10 Existing Grade Final grade DATE OF INSTALLATION: 15^ W PLUMBER ON JOB: rNUMBER: MP6537 INSPECTOR: 3/93:jt Wiscbhsin Department of Industry, PRIVATE SEWAGE SYSTEM • County: ` S~'a ety a d Bu Buildings D viision • INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268522 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: PETERSON, LYLE HAMMOND CST BM Elev.: Insp. BM Elev.: BM D scription: Parcel Tax No.: / (~C • C~1 /GCS, Cd me a 5 ; `X i. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` J t,_x 5 6I -y, cos ,~r r Benchmark e t-' Dosing dYn Oi a G~ Aeration- Bldg. Sewer Ing St/ Inlet ' 'TANK SETBACK INFORMATION St/ Outlet cam'' Vent TANKTO P/L WELL BLDG. Airl to ntake ROAD Dt Inlet Air l Septic y CD ~ h~ -70 01 NA Dt Bottom ~ Dosing NA Header / Man. i Aeration NA Dist. Pipe .Me Ing Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer emarid g° °t s.-r r Model Number TDH Lift 6.4 Friction 1 ,6' S stem~_ TDH g, ~7 Ft c Forcemain Length gal Dia. FDist.To Welly SOIL ABSORPTION SYSTEM BED /TRENCH Width ~ Length,,, t No. Of Tenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN DIMENSIONS LEACH anu acturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O (,)4 CH BER Mode Number: UNIT System: /a.G.cJ,rorj DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) y x Hole Size,, x Hole Spacing Vent To Air Intake Length Dia.y~ / 1 Length Z Dia. Spacing 11~ 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.31.29.17W, SE, SE, HWY T Plan revision required? ❑ Yes Lrd N~ / Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. vITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: Safety and Buildings Division ~ANITARY PERMIT APPLICATIA Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. S it C✓'0 • See reverse side for instructions for completing this application state sanitary Permit Number v? 479 15_-Z~ The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Pan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION S Property Owner Name Property Location L~~Tv PeI??v30h 1/4S 1/4,S 3 T N,RY7 (or Property Oviner's Mailing Address of Number Block Number City, State' Zip Code Phone Number Subdivision Nam~ oy~ SM Number 91 , 301 ,~r~ cvrs ; ( C5& !/~-t - I/, A II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Ro d ❑ Village -3 Public 1 or 2 Family Dwelling - No. of bedrooms own of s 0 III. BUILDIN USES (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo .019-070 v 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 ❑ Replacement of 4. E] Reconnection of 5. E] Repair of an ______System_____ _Syst~___TankOnly______________ Existing System _________ExistingSystem 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 2 ❑ 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 S. Perc. Rate 6. System Elev. 7. Final Grade tJ C j] Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation l U' 37 5- '6 b 2 Y Feet C`00- Feet VII. TANK Ca in galloacitns Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank 1000 M ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ~q0 ►'h1G ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): C- e IX. COUNTY/ DEPARTME T USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue IssuinZAA nt Sig ature (N a S) Approved ❑ Owner Given Initial Surcharge fee) 7 t2 o~~~ 7// Adverse Determination (~J X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) 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 Dwelling. 111. 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 8 112 x 11 inches must be submitted to the county. The plans mu'st 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 April 11, 1996 2226 Rose Street La Crosse WI 54603 WEBSTER PLUMBING & ELECTRIC N3659 CTH C ELLSWORTH WI 54011 RE: PLAN S96-40190 FEE RECEIVED: 180.00 PETERSON, LYLE SE,SE,31,29,17W TOWN OF HAMMOND 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, rard M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 SUDA-788718. 10/841 S,9 6 40 190 ~w5 L, I WrO-tc- 3 v 4(rfl I4P K 3 -7 src 3) SS0 , got SF ly S C5 ~ :i- Ti H Pc'q-t T4 a F (o-r P1u~ to kl a~ P~q ~ J lectc) 2 ~`~55 SrcHo7 /ll~lh ~i~v✓ Cornb~`r"N~~ Sp~N~ ` rVMI A-e RECEIVED APR - 8 1998 SAFETY & BLDGS. DIV. p1vP~E S *®r,auy ~A o~ eE ~~s ve t©¢ 5~,~ a G d C5 Bottom o-` si(lin.Y S 9 6 - 4019 0 can Southeast corner W c-, 0 house is ele 100 ° 24447 12 L C~.! 0 -9- z~ C ° 4' Qj / 0 L L Q '1Z 4 L Cu CL o f w CL ~r~ i _ ~5 C1J ~ 0 E r+ Ul 1 i mot' 0 W Q ! -y 75 c t - 0 0 U~ pct a 4-> Q/ Ln a, 0 co U OD 75 '(D '0 (c U 1-4 -Q _i CID ditch bottom hQr2 tow point in 4f 13 as -Peet vaiion ditch 32: d '+y F- Q C ounty Road J Page 3 Of_]- X0190 For The Absorption Area Cross Section Of A Mound Using A H o F 6" Topsoil Medium Sand Fill E D Plowed Layer Trench Of ~-z" - 21" Aggregate, Ft. 6" Below Pipe, Covered With D Straw, Marsh Hay Or Synthetic Fabric E II Ft. O Ft. F Ft. H Ft. Cf9uvN'*V mvfv~ elf Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe i J Pipe Permanent Markers Observation JA' o W K B f \Trench Of - 2k" Aggregate I . L ~ K Ft. W ~J Ft. ~ A Ft. I 10 Ft. 2 g Ft. J Ft. L Ft. License Date: rT Signed: Number. rage uT t~ Distribution Pipe Detail For Two Lateral Network G~, ~ Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap * H- C) X X PVC Distribution Pipe P P X * Last Hole Should Be Next To End Cap P Ft. Hole Diameter Inch X b Inches Lateral Diameter Inch(es) Y _ Inches Force Main Diameter Inches z # Of Holes/Pipe Invert Elevation Of Laterals'l~ Ft. Signed: fi &94- License Number: Date: htk~) $ Page__C, Of COMB INATIOU.:SEPtIC' TANK/PUMP tiiAMBER - - - (No Scale) 4" PVC, Vent Pipe with 6 4 0. 1 90 Approved Locking Manhole Cower Approved Cap, +25' With Warning Label Attached !From Buildings Weatherproof Approved . Warning Label' Junction' Box Vent. Cap 12" Minimum Final; Grade 6" Minimum i 4" Minimum 6" Maximum 4" PVC Quick 18" Minimum - Disconnect Insp. Pipe--- 1/4" Weep Ho.l Baffles n * i ~ A 4 Alarm B On 7, 9 i C ~lY 7 ~o~ *APPROVED ~„~r 5r"~ 4 JOINTS WITH Off 73,gb APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3 of Beddi nq Under, Tank Note: Pump and Alarm Are On Separate Circuits Number,of Doses: Per Day Gallons Per Day/f o_FDoses:__ q__ 6a1 l ons M!J Volume of Backflow::......+ r Gallons Tank Manufacturer: u; 5kl. RcwR Total Dose Volume:........= i 'o Gallons Tank. Size-Septic/Pump: . to®alsso -Gallons Alarm Manufacturer: Lgv-e ~rvn Model Number: D1,V Capacities: A 2y inches or Z Gallons Switch Type: ri s Kc O KY ± B 9~- inches or 31 Gal l ons r Pump Manufacturer: + C~_i nches or 36' Gallons Model Number: MODEL 5 7 + D~inches or i Gallons Minimum Discharge Rate: -I I GPN GPM Total.....= y3 inches or 6yt Gallons Vertical Difference Between Pump Off and Distribution Pipe: vi- Feet Minimum Required Supply Pressure:.......... r Feet d~I .S 7 loo Feet of Force Main x t.j& o-Friction Factor/100~Feet: + ,56 Feet (Ci P7 ~ky~1Jti Inch Diameter Force Main Total Dynamic Head:..._ Feet ~M IS ternal Tank Dimensions: Length ~ Width C Liquid Depth Signature_ n License Number Date C~ i Bruce Webster MP 6837 CSTM 5501902 Plan Worksheet for [ y It FY v w Located in the S 1/4 of the s 1/4 Section 3 1 T zy N R 17 W ~',J ; 47 „ S)°j,) b Township of Hq m n„T„.~ j ~ofJ PG 6 County of Sr C ro Ff J J ' .o 6 ar<<. Mound Worksheet Daily Wastewater flow a o f Depth to limiting factor Landsiope 2 `/v~ Distance to dose chamber 10 C Absortion Area Sizing Area Require 37 5 Bed Length (B) 5- Bed Width (A) 9 t Trench Spacing Mound Height C, Fill Depth (D) Fill Depth Downslope (E) 0 Bed or Trench Depth (F) -'t Cap and Topsoil Depth (G) 1 .0 u *9 Cap and Topsoil Depth (H) 1, S Mound Length End Slope (K)0.05t O 3 t 1,91K3 = Total Mound Length (W) 2 3 g15 i~'~ Basel Area Infiltration Capacity 0 gaVsq ft/ dy Basel Area Required 375 93 5 Basel Area Available 75- (s-f i~)' Distributio Pipe Pump Model 7 Hole Spacing Dose Volume Later Length Void Volume " 10 = .667X)r,f 16 Lateral Spacing Daily Wastewater divided by4 _ 11 I _ Distance sidewall to pipe Backflow Pipe Discharge Rate Minimum Dose ► 3v Holes per Pipe -_-7 J Sf Dose Chamber 6 5-v Flow per Pipe Septic Tank gal Manifold Size Capacity _ 11-M C6tv So 14 ~ y Type (end/center) Manufacturer L11-1, ti, , Length Dosing Tank - «G S i- Diameter Capacity ZL~ Force Main Manufacturer /1i,1,,LeSj{rh evrc4S~- Minumum Required Pump Manufacturer Diameter Pump Model l~IoJrl 5 Dynamic Head Operating Head System Head 2.5 Flow Rate Verticle Lift - 9 Friction loss 6 rlc?rt 5 l w, l l ~d 17yr Total TDH t2, ~ Pump Requirements TO Pump will discharge at least -0- I1 gpm at f1, i TDH. Pump Manufacturer Zell?,, HEAD/CAPACITY CURVE ¢ W HEAD CAPACITY CURVE ►W LL EFFLUENT MODELS W Z HEADICAPACITY TOTAL DYNAIC DEWATERIN MINUTE G IIS- 31 use 137436 161 1e3 its 1as ,66 /6t 6f 1,0 SERIES t7i6 6v Do all I" 01l Lft GAL lrr. Or. lb. Or Lr1 'ar u1 32 ' FT. M. GA L91 ad ltn GA 191, G11 tir G1t l.r+ 50 220 ISe 567 1S6 S67 100 S 1.62 A 143 S6 212 72 273 104 AN 106 101 61 231 61 231 229 1 30 10 306 31 129 16 171 61 IN 7f 300 100 376 at 231 It 231 s6 ,u 6e0 51 art N 220 112 S37 to $49 95 227 q 227 t5 4.S7 If 32 36 133 lS 270 N N2 ft 311 60 W 437 SS 220 136 6tS to S39 20 a10 IS -..67 2s Y6` 38 •138 62 3,0 W 423 s6 220 1•26 161 ,13 503 I6 90- 290 67 216 N 223 26 7S 7.62 1 30 71 SS 710 N 206 M 220 210 310 N .220 121 Ise 127 161 85 30 all 7S 263 Sf 22D 106 391 111 431 ~ 60- b 1219 M 21 211 f0 Y 33 172 12S N N 206 IS' s6 219 51 220 90 311 100 379 21 . SO 16.21 16 i7 V 169 % 236 N 210 71 269 IS 3:2 22 30 111 to 36 62 197 S1 193 70 265 V 75- 166 60 I6.29 70- 70 21.31 11 N 43 170 20 106 SI 201 lV\ 32 121 2 f 37 110 20 60 2136 ` 65 16S 90 2,7.43 1 N 21 79 16 60 ,00 30.14 7 20 6 30 110 3200 2S 6•' or 1T )3' its, 9,' 55- 16 - 163 lakVW1' III 2S, 7376' 2Y 50EFFLUENT & DEWATERING 11 15- ~ Ip Warning: Model 185 should not be subjected to less 12 than 30 feet TDH. all 35- 10 18 Note: For Head Capacity on Model 112, industrial I 30- 6 column-explosion proof pump. see 6 ° 261 1116 96 SEWAGE & DEWATERING .2 S .5 7 59 13 139 S o WARNING: Model 293 should not be subjected GA s 30 „ 60 7a 60 90 100 1,p 120 130 "°to less than 15 feet TDH. ERS t 1 a -T-!-r I I _ ~C~{Ry'r~ W •v 1 -I T' 1 .hJ 3 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE - - 26 60 SEWAGE AND DEWATERINO " 212 "1 as 227 248 262 211 _ 7S SERIES 212 266 22 at. 11n. Wt LW. Gat L17a Gal Ltrs. GN Lam. Gal 712 775 e32 20 FT M ' Gal Lira. Gal Llra - Gal ltrs. . 130 162 160 66Q 110 630. - 70 S 1s2 901/1 278 181 279 161 128 '4N 1N Sw 121 4" a, 683 205 Tie M 337 IS 360 tap Ift Ss 700 t0 3.05 2 227 e9 237 ' o 331 hM - S0 .1 e9 63 236 135 311. 106 101 _ S,6See ' SO 189 SO ' I'S ISO •Sp 36e _68 636 20 S 1.37 22 s 6S t0" 33.223 106 101 N 5) 6S - 7,62 t0 ,>e t0 >t 76299. W 25T 206 101 -+>d Sts 66 S60 t 158 ,10 S30 Sp 23 ' T 9.1!21 355 i.•- /3 ~1Q U .1U ,2 '15 135 11 r t. S 19 SO tq 91 Se 220 e9 377 SO 12.15. M'<i+ ~I SS - t 7 19 59 223 16 SO 15.21: i - 75 N 60 16.29 1 --52 17 m- 2134 ,e 215, 2t s• 21 s 16 Lar were I 65 Wisconsin Hu Dr ' a bons Industry, OIL AND SITE' EVALUATION R RT Labo; and H~rnan E 17 ;-yt,:.tions Page pf Division of,Safety & Puildings in r S/ h I Wis. Adm. 1060 COUNTY Attach complete site plan on paper not less t 2 x 1 In size. ust include, but 6-0 ~X not limited to vertical and horizontal referenc t (BM),N W #d % e, scale or PARCEL I.D. # dimensioned, north arrow, and location and ce trest road. APPLICANT INFORMATION-PLEASE T ALL O%IN REVIEWED BY DATE PROPERTY TNER: OONCMIPERTY LOCATION G~ L CMIINGOFFIC VT. LOT SC 1/4 SrS 1/4,0 T~ / AR 11 (or)(@ PROPER OWNER':S MAILING A DR~jSS . - LOT # BLOCK # SUED. NAME OR CSM # ~oZ2 ooh ,kd ,J CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ROW NEAREST ROAD R - Letts IS (71r) 7 bl SS3 2 co." 1- [ J New Construction Use ~XJ Residential ! Number of bedrooms 3 (J Addition to existing building Replacement [ J Public or commercial describe Code derived daily flow I SD gpd Recommended design loading rate C Z bed, gpd/0trench, gpd/ft2 Absorption area required 37 bed, ft2 trench, 112 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations MUU(b'o RCQUa un _ R esfiv(_!+C_ C) N GH c.r 3 6 Parent material _ Flood plain elevation, if applicable ft LU = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK = Unsuitable fors stem ❑ S NU ®S ❑ U ❑ S RU 1:1 S IRU El S ;I U ❑ S l SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Bounchry Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 0-11 ro o 112-- i I 2 c U/ 2-P n, o. S j7-40 10VR YIV 6; CV [C 04 16,5 Ground 3 70-63 1017 ~ 2,5` YR 6~g "e" 1 d 5 d ~ - - elev. 86.5 ft. Depth to limiting factor O11 Remarks: X Layers o1- Stiff wtiA 10YR 511 dy-i a-r edor of ),xaY - ak s10'94 ly c-ew;aal`, is YO-e Boring # o-f~ I(~ YR y 2- Felt C 019 Ground 3 3Z-3$ P R f S Y9 5)6 elev. 8,4 ft. Depth to limiting factor 2 3 Remarks: CST Name:-PI e se Print Phone: Lveb5k-k- Address: -F / Ca✓vr kc), 1~ p~ _ [_V fjSavr~'~ W'S J"Il Signature: Date: CST Number: ,i mg" ) 1996 jV;rn 55.619D PROPERTY OWNER Pefft_5fl _ SOIL DESCRIPTION REPOR Pa',0 of _3' Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon In. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. consistence Banclary Roots Bed Trend, 6, s Ground i I 4 eley, ft. Depth to limiting factor 2-36 Remarks: Boring # xvA"`M` Ground elev. ft. Depth to limiting factor Remarks: Boring # CFCF.. ++kk Lf Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: g80-9330(A.05192) All unmarked lot lines > 100 ` from tested area Soil Evaluation Map of Lyle Peterson property, Mount! Required Bruce Webster C STM 5501902 LA =Southeoast _C' S C a e in F e e -t 15 ~j 0 0 2444 a wel C: r- rv) V1 1 +1 ~ c of O Cr_ / Le o J ~e J'~ .qeS 4 U o NOR~i~I f t5 aN le1o,~ SC G 0 i va 75 Existing Septic - r, U a o Existing drywel,V U c c~i2 a a_ncd--Exlstlng drywell W `i B1, 6OTfv- This dvYwell U 0 - r n 4, Flo pe Top of pipe of 1st W o drywell 89.3 Va c v Ground Ist drywell 88,0 o o Top pipe 2nd drywell 86,8 U ° Ground End drywell 8G,1 p C B3 1 G >1 Q) B31 Elevration R1 56.5 d p mot- Elevation B2 85,3 u-) Elevation B3 83.3 ' U OD W 0-2' Slope _Z7, 0-1 0 0) CU d t-- C ` nt;; R o a.~~ _ -1 FILED 2 - Vn 2 5 1996 ® _ O, KARe0lsferTHLEEN H.WALSH 1G of Deeds ~ ry~ SL Croix Co., Wf ti JI _ -N pia. oo ~'d . CERTIFIED SURVEY MAP LYLE AND RUTH PETERSON Part of the Southeast 1/4 of the Southeast 1/4 and the Northeast 1/4 of the Southeast 1/4 of Section 31, Township 29 North, Range 17 West, Town of Ha ond, St. Croix County, Wisconsin. E.'114 COR. SEC. 31, T29N, RI7W P TIED LANDS /COUNTY SURVEYOR'S P. K. NA/L1 UNPLA N90'00'00"E 302.10' ` 4 64. 28 ' I 37.82' SHIED RUINS ~ W I i I ~ O 7 ~ SHED 10 SILO I O BARN SILO 4i O f W W 2 Imo- O ~ 12 C B IN I J v W O I h W A ° ® Q h '41 K WELL I A y W Q T4 p Q GARAGE DRIVEWAY 3 O C 1~ I I M ~I W O I • O Q h" 4 w O t•. J 2 LOT / DWELL I NO Z I Q O WI Z` M ° Q ZI I I I k QI U, W 5.041 ACRES A PAOV D J h 219, 566 50. FT. a J k 4. 668 ACRES EXC. ROAD R.O. W. W I Q O 203,346 SO. FT. N <n I 33' 33' `t O 465.72' Qt I 136.3 N 90. 00'00"W 502. 1d 1NTrW UNPLA TIED LA hensive4p1mviir Zoning and Parks COmrrilffYee ° SCALE / ? /00 h O 25' 50' 75' /00' 150' 200' 300' " If not recorded ° ithin 30 dayslaf SE COR. SEC. 39PPf 0 7 W, 13/4" IRON BAR Fo&Vwova1Shalllt-e ,`,1►1~~~b/~/II Dated: March 30, 1996 "Revised this 24th danAl&v*ril, 1996." ,~ww~\\\SG0 This instrument drafted by Laurence W. Murphy ~ =rn PHYOwner's Addr ess: 13 o622 C.T.H. "J" LLST.TT rAAl.) Misc-. N 2 . _c. • S T C - 100 • t, 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 L ~ ~e Peievsoh Location of property~C 1/45F- 1/4, Section 31 T .Zj_N-R_-L7-W Township yhmly) Mailingaddress ReS l y ;s c0tip SY043 Address of site `-~2_ jj wy 7" Gbev>1 (Al%cosoc, Subdivision name /o, ,z, 3OYfl Lot no. Other homes on property? Yes _X No Previous owner of property Total size of property J gtre- Total size of parcel s~ert Date parcel was created j Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume 1176 and Page Number C)Z 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. , 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. Si n ure of Applicant Co-Applicant 6 /6 /Z 9 Da of ignature Date f S'gnature ,oA STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Lyle Pefeyrk o o MAILING ADDRESS ~ IVY J PROPERTY ADDRESS 90 6V'K W I S C a h J. 2- w Y (location of septic system) Please obtain from the Planning Dept. CITY/STATE RaLk., W Sl C J n f, PROPERTY LOCATION SE 114,5r- 1/4, Section 31 , TA( N-R 17 W TOWN OF ,C Mma ~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP S 7 , VOLUME PAGE ~C> 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 expiratio ate. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. *E BAR OF WISCONSIN FORK 3 -1982'ACr RWW •O* R[conn N DATA -QUIT M DE 80CK 171 FACE ~ 1~ _ 430288 sEG,szE-im oFF,ck ST. CROiX OC%, wi& La+le Peterson..and Ruth Peterson, husband . and wife d. stir Record fhls 18th . ~ A. D. 1967 quit-claims to ....ZcXle__Pe..erson--.and Ruth Peterson, p a: 'to . ......hus_an.~?..and..-w_i.fe, holding as survivorship maLr t a 1 .Ar.Qpe_1 t.y - _ the following described real estate in at. Croix County, State of Wisconsin : w[TUev .o Tax Pared No: Southeast Quarter (SE4) of Section Thirty-one (31), Township Twenty-nine North (T29N), of Range Seventeen West (R17W). F~ J This 1S homestead property. (is) idxxot) Dated this day of ....f ~ . 19.8.7.... v ..(SEAL) w-.-~~'E<Gt~~ -.....(SEAL) • _--:):,y.~e--Peterson.-.---_ Ruth Peterson - • ......(SEAL) (SEAL) • • _ - AUTRBNTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 1 as -----•---------St-._-•Croix_Coanty_ authenticated this .day of_•.•-°•------•-•------•- 19------ Personally came before me tkis clay of ..PPt 4t~ n_-------------- 1987 the above named L le Peterson and Ruth Peterson y TITLE: MEMBER STATE. BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. State.) to me known to be the person 5:____-_ who ecu the foregoing i nt and sel<mwledee the me. THIS INSTRUMENT WAS DRAFTED BY J FrIk-'.. L I.-n-.-__-._ Parcel 018-1070-10-000 12/13/2004 08:59 AM PAGE 1 OF 1 Alt. Parcel 31.29.17.483A 018 - TOWN OF HAMMOND Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner KLEGIN, WAYNE A & SUSAN K WAYNE A & SUSAN K KLEGIN 622 CTY RD J ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 622 CTY RD J SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 5.041 Plat: N/A-NOT AVAILABLE SEC 31 T29N R17W PT SE SE & NE SE BEING Block/Condo Bldg: LOT 1 CSM 11/3084 5.041AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 31-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type 08/01/2002 685796 1939/631 WD 07/23/1997 791/300 2004 SUMMARY Bill Fair Market Value: Assessed with: 172,100 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.041 36,800 111,200 148,000 NO Totals for 2004: General Property 5.041 36,800 111,200 148,000 Woodland 0.000 0 0 Totals for 2003: General Property 5.041 36,800 111,200 148,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 316 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00