Loading...
HomeMy WebLinkAbout020-1314-30-000 ~ I ~ ° I 3 o o I c O fA a ~ I ~ I 0. 0 I LD o ~~c I Eo, I o c 'v E T y I N bo y > q L r 5D c C 5~ o m II C ` I vC° I -ac am0. m I y z m rn- V I [r 0-a.0 0 3 O a) uJ N O N « C fo Lo (D :D y 7 U (D I a Z 0) z ~ a ~ CL ti o ~ Na I m I LL m o a)E~ 3 a>>c I r 3;a3i~ ¢o awN~-~ I I ~ .ill 3 ~ z iir I I Z rn z I Y p p Z c- M a CL co m co CA N F' In I O O I O z a l c II r Y o 0 z y Z v I cn F- c E ° - M v M N = I N C N y O E 3 L I d o L C. O u c v Y O o N c z° m D o z co z I I z v N I d N E y N II fo I f6 'E a) > tp t6 co d M I 4) 06 M X G r C IA of N T O s V ~la~i N (.0ooCL ~°~j m o o a` a, E rn ~ I 'EO crnvt~v~ rn om~v> O !.o Zo aLL fnM 1333 °'U` 0 a 3 O0 II a a a a n in 4r, C: 0 c% ~ U ~ C;) rn 0) z v I N N C OD = E C 0 I 0 I :5 w CL co ov d Q~cn ° d Qz (n I U 7 O N N O O O' "Do to c N. V/ C '0 E N Q O 'N C C 'JE N N N to N N M! I--' 0 to Y C O N 7 W O I M 0 ' c N 0 M O O d' w L 0 LO °'v 3 coo o 3 cNO c Z g cA • O co 2 W N O z C W N O - Q ~ I = I I = I E a d a d c CL m S I 3 B O `H o m = 3 q 'o ~nv A ua~ O~nc) 0 10 STC - 104 °Y hi4COME a AS BUILT SANITARY SYSTEM REPORT ~ 0. ST CF01 X CcON Y OWNER ZCAtNG0FRCE ADDRESS SUBDIVISION / CSM s~. C~Gp/ ~sjl~y LOT SECTION,g j T,7f N-RW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEE Io O SYSTEM w 0 n ~ lZ N O It x- o v N 1 -C - - • I I v C 14 y V INDICAE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House- to Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: / Z- Length Z Number of trenches Distance & Direction to nearest prop. line: > y0 Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. /p 2 -S-,4*' ST outlet 1,2.Z PC inlet PC bottom Pump Off Header/Manifold .3' Bottom of system Existing Grade C) Final grade_ fd>~ DATE OF INSTALLATION: 1 PLUMBER ON JOB: LICENSE NUMBER: 3 INSPECTOR: 3/93:jt -2 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ST CROIh Labor and Human Relations INSPECTION REPORT Safety and Buildings Division Sanitary Permit No.: s (ATTACH TO PERMIT) 8&6 / GENERAL INFORMATION Permit Holder's Name: E] City [I Village (Town of: State Pla ELWOOD. KEITH Parcel Tax No.: GU ~b GG lev.: BM Description: CST BM Elev.: Insp. BM i , ELEVATION DATA 0~~96 TANK INFORMATION TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (~,~~r, L.4aze Z5~ Benchmark ci /d,s~, Gv Dosin ~0 A( .,6,yv, Aeration Bldg. Sewer 5 S / , 3'7 i Holding St/ I Inlet TANK SETBACK INFORMATION St/ hK Outlet %,3S A 7 TANK TO P/L WELL BLDG. vent to ROAD Dt Inlet Air Intake Septic n NA Dt Bottom NA Header /AUM- Dosing Aeration ' - NA Dist. Pipe Bot. System Holding PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 75 D3, L del Number TDH Lift Lriction System Ft Fo main Length Dia. li Dist. Toweu SOIL ABSORPTION SYSTEM BED /TRENCH Widthl~ ~ Length ~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth N DIMENSION DIM ENSI LEACHIN SETBACK Manu acturer: ~ SYSTEM TO P / L BLDG WELL LAKE/STREAM CHAMBER o e Num er. INFORMATION Type O n e,.,.-Cru Z'1 X95 OR UNtT System:_ DISTRIBUTION SYSTEM Header+ W Distribution Pipes 1 , x ole Size x Hole Spacing Vent To Air Intake Length & ~ Dia. Length S_t Dia. Spacing SOIL COVER x Pressure Systems only xx Mound Or At-Grade S my Depth Over Depth Over xx Depth Of x seeded/ Sodded xx Bed / Trte~+Efi Center Bed /-Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) iF }r Of _X LOCATION.: HUDSON.28.29.19W SW. NW..,-CROSBY6 t2r~~t G~, , r r~~ ? Plan revision required? ❑ Yes Use other side for additional information., o ~Cp Inspe`r s Signatur~ Cert . No. BD-6710(R 05/91) Da 1 G 0(1 -Ldi lJ /"~F~ iy ► t3 j ~P~ C_ GZV~Ce C , c.~--f':t. > p1J~ l _'~2„ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION 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 8 112 x 11 inches in size. - C • 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 Ghec tf revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location v4 1/4,SZe TZ ,N,R! E(o O!F Property Owner's Mailing Addressers ,.~1 n Lot Number Block Number City, State 7 ~vZ de Phone Number Subdivision Name or CSM Number ys- 31 II. TYPE F BUILDING: (check one) ❑ State Owned !t~ IN arest Road ❑ VII a Town OF Public 1 or 2 Family Dwelling- No. of bedrooms ge III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) r 1 ❑ Apartment/ Condo fq 1.71 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 online B, if applicable) A) 1. Z 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 Z1, A y 3 s- 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 DD TX 5 , 3 Feet , Sr Feet VII. TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION Gallons Tanks Concrete glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ - ~ 1:1 El Lift Pump Tank /Siphon Chamber ❑ El ❑ ❑ u VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of t e onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No 5ta s) MPRSW No.: Business Phone Number: v umber's Address (Street, City, State, Z Code): 2 IX. COUNT / EPARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater EL941 ISSui gent Signature o Stamps) 01 Surcharge Fee) Approved ❑ Owner Given Initial 07) 11, Adverse Determination to 91 1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-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. ti To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. Vl. 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 al! sep i--, 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 isto 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 must incLbde the followi.r;g 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 cq.gnty-.. E) soil test data on-a 115 form; antl F) alJ sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 41 O.included the creation of surcharges (fees) for anumber of,regulated practices which can - effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. - - n _ ~ Y o h C I 1 ~ N 1 m 1 V J 1 lu I C Q N n ~ I ( O p W\- _ , - 4 s iG7 t nl c , o s L4 n h 1~1 y d r Q ilk) i ,y O) l ~ y) ~ v 1 ~ ~ N o " 4 d g y >l? ! ~ A 06 ~ ~ G ~ ~ ~ 'FI \ I O - ~ ~ A w ` ~hS j3 i t $ \ V y of - A 100 ~ N '0I ` ~ ANN ~1 S a'Zo°~, aQ. i 8a 1 w` j N Wisconsin Department of Industry, SOIL AND SITE EVALUATION Page / of Labor and Human Relations Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. • County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # Reviewed by Date APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location A'5-_Zr T# # IFZ-1 1 y Govt. Lot 1/4 */0/4,S T ,.2 ,N,R E (or& Property owner's Mailing Address Lot Block# Subd. Name or CSM# ST ~~~~f U v~ J ~ C Nearest Road City State zip Code Phone Number ❑ City ❑ Village 21 Town 15- a (3~6) G Y3 ffUvsp~ Residential / Number of bedrooms _ Z- Addition to existing building New Construction Use: ❑ Replacement ❑ Public or commercial - Describe: Recommended design loading rate _,Z-bed, gpd/ft2~trench, gpd/f12 Code derived daily flow 9Pd Absorption area required bed, ft2 W0 trench, ft2 Maximum design loading rate _,r,? bed, gpd/ft2--o jY trench, gpd/ft2 ft (as referred to site plan benchmark) Recommended infiltration surface elevation(s) .2 9r' Additional design/site considerations 11)0&F Parent material Flood plain elevation, if applicable Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank S = Suitable for system ❑ S 0 U S ❑ U ❑ S U ❑ S [,a U ❑ S U U Unsuitable for system ®S ❑ U SOIL DESCRIPTION REPORT GPD/ft2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Bed , Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y6 i6 _ s I- s /Y1 L Ground 3 - D 7 6 S - elev. Depth to limiting ; factor in. Remarks: Boring # G~ ' a ;:3C/Z_ M IV ~s 7P~7~ ~ 3-, Ground elev. ra~ft• Depth to limiting factor in. Remarks: Signature Telephone No. CST Name (Please Print) 01 Date CST Number Address _7,3 Q f= PROPERTY OWNER SOIL DESCRIPTION REPORT Page_ o? PARCEL I.D.# G 97 Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color ET Consistence Boundary Roots Gr. Sz. Sh. 3 / - Bed ;Trench L S C 7 "'V Ground ► • elev. O L Depth to limiting factor in. , Remarks: YO CE~/~ - O[ EL e~ Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots GPD/ft2 Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) I' ?L ,gc r DAVE FOGERTY PLUMBING f d ( 53233T 032& PWmbw ROBER~TS,-IM SM 5402 Phone 749.3656 7 JL T *1 iz ~~'ZTff GC wraA #2 K X02 ~y' h #3 > 3p' [oT Scac,= i YD ~ h`! 4 = To'y' mf laoepBN Sfi9A'-/tSuM~ ioa,v' #.z d = aotgxN,+ L ,8M of tWA ~40A4~ c~iv~ ~F.v~F X 'e". JBOR I i i i i i i i . : : Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System: 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application state sanitary Permi Number The information you provide may be used by other government agency programs ❑ Check i Isio r6el~us pllca to (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property wner Name Property Location © - 1/4 114, S2 Z T,? , N, R~ E (o Property Owner's Mailing Address Lot Number Block Number Cit , State Zip Code Phone umber Subdivision Name oK-9f -NtwA4 er ( s II. TYPE UILDING: (check one) ❑ State Owned !t~ Nearest Road VII age Public 1 or 2 Family Dwellin - No. of bedrooms- Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ©20 _ 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 online B, if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System _____-__System_____________Tank Only______________ Existing System _Ex)stingSystem 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 110 Seepage Bed 210 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 Al. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 40 1 0 I f. zoa „ S 63 Feet Q Feet VII. TANK Capacity Site in gallons Total # of Prefab. Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existin structed Tanks Tanks Septic Tank or Holding Tank l ❑ 1:1 ❑ ❑ Lift Pump Tank /Siphon Chamber Or G~~e VIII. RESPONSIBILITY ATEMENT 1, the undersigned, assume responsibility for installation of the Onsite sewage system shown on the attached plans. P tier's Name: (Print) Plumber's Signature: tamp #f4MPRSW No.: Business Phone Number: 'a , " 0___ 1 771 i. 8' lu is Address (Street, City, State, Zi ode): IX. COUNTY/ EPARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signatur (N tamps) , Approved E] Owner Given Initial Surcharge Fee) S~° gG Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-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 whenevee necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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. o 0 0 o h C n cQ w m n O O ~ ~v 0 i -x- • 11 PACE CF PUMP CHAMBER CROSS SEC T IOIJ AIJD SPECIFICA-riouS VENT CAP `i"C.I. VENT PIPE WEATHERPROOF APFROVED LOCKIAIG JIJMCTIOU BOX MAMHOLE COVER N 25' FRO.^1 DOOR. 5r' WIMDOW OR FRESH 12°MIU. AIR INTAKE GRADE I '1° MIN. I CONDUIT IB"MIIJ. ~ 1~1 INLET PROVIDE AIRTIGHT SEAL * f A ~ III I I I ALARM e ~ II I I *APPROVED i I oN JOINTS WITH I I ELEV. FT. APPROVED PIPE i 3' ONTO PUMP OFF D SOLID SOIL COLICKETE BLOCK RISER EXIT PERMITTED ONLY IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC a SPECIFICATIOUS DOSE ' TAMKS MANUFACTURER: IJUMBER OF DOSES: Z PER DAy TANK SIZE: 6d GALLONS DOSE VOLUME ALARM MAAIUFACTURE.R: ALy INCLUDING BACKFLOW: 30© GALLONS MODEL NUMBER: ~w /'!CAPACITIES: A=Zf IMCHE5OF GALLOMS SWITCH TtIPC: ryiE-2CaR!/ B= INCHES OR GALLOMS PUMP MANUFACTURER: CIUCHES OR GALLOIJ5 MODEL NUMBER: D= Z INCHES OR .74 GALLONS SWITCH TYPE: _ C411Z / NOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 10 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWELU PUMP OFF AMID DISTRIBUTIOM PIPE.. - /2 FEET + MINIMUM NETWORK SUPPLY PRESSUR~T,E~. . . . . . - FEET + FEET OF FORCE MAIN X ~FY,0 ,,,FKICTIOU FACTOR.- FEET TOTAL DYNAMIC. HEAD = ,L-2--lp FEET INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH l/a SIGIJED: f LICENSE NUMBER: 2 T) A"r F. WisconsnDepartment of Industry, SOIL AND SITE EVALUATION REPORT i f 3 'Labor and Human Relations Diviaion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S. -Ozroi not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA (DEL .D. # 9 ` ti l ~i fi dimensioned, north arrow, and location and distance to nearest road. riding i NE~~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE BY DATE C; iv 4' PROPERTY OWNER: PROPERTY LOCATION John Rauchnot GOVT. LOT SW 1/4 NW 1/4,S 28 t~,R$ r) W PROPERTY OWNER':S MA!I.ING ADDRESS LOT # LOCK # SUBD. NAME OR CSM 527 Co. Rd. #W 3 na St. Croix §states CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE L2fOWN NEAREST ROAD Hudson, WI. 54016 (715 386-3052 Hudson Crosby Dr. ( A New Construction Use [x] Residential / Number of bedrooms 3 ( ] Addition to existing building j I Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2 Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 103.07 It (as referred to site plan benchmark) Additional design /site considerations alt. area= trenches C 102.07' & 100.57' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for svstem I La S ❑ U I Cis ❑ U :1~7 S ❑ U ®S ❑ U ❑ S ®U ❑ S [au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tmrtdl 1 0-11 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 1 2 11-24 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 24-82 7.5ry4/6 none S Osg mvfr na na .7 .8 elev. 106.62 ft. Depth to limiting factor +82" Remarks: Boring # 1 0-8 10yr3/2 none 1 2msbk mfr gw 2f 1.5 .6 .,..,2..' 2 8-20 10yr4/4 none sicl lfsbk mfr gw if .2 i .3 w,~...:.< 3 20-84 7.5ry4/6 none f s Osg mvfr na na .5 .6 Ground elev. 107.02 ft, Depth to limiting factor +84" Remarks: CST Name-Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave., New Richmond, WI. 54017 rt~ Signature: Dad' 11-2-95 cstmuUn98 PROPERTY OWNER John Rauchnot SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.9 pending Depth Dominant Color Mottles I Structure I GPD/ft Boring # Horizon Texture Consistence Bourriary Roots Bed lTrerxh in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-6 10yr3/2 none 1 2msbk mfr gw 2f .5 !.6 3 2 6-12 7.5yr4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 12-8 7.5yr4/6 none f s Osg mvfr na na .5 .6 elev. 105.57 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 4 2 12-3 10yr4/4 none sic lfsbk mfr gw if .2 .3 3 32-8 7.5ry4/6 none f s Osg mvfr na na .5 .6 Ground elev. 103.32 ft. Depth to limiting factor Remarks: Boring # 1 0-15 10yr3/2 none 1 2msbk mfr gw 2f .5 !.6 5 2 15-3 10yr4/4 none sic lfsbk mfr gw if .2 '.3 3 34-8 7.5yr4/6 none fs Osg mvfr na na .5 .6 Ground elev. 103.97 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. j ft. Depth to limiting factor i Remarks: S9D~33~1B.Q5/92) . y STEEL'S SOIL SERVICE Gary L. Steel John Rauchnot 1554 200th Ave. CSTM2298 SW4NW4 S28-T29N-R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 t lot #3-St. Croix Estates N 1"=40' BM.= top of 1" steel pipe C el. 100' Alt. BM.= top of steel fence post @ el. 103.2' „k ~1N i 111 ' 2~, ~1 I~1 Z/ g- ~r~ ,13_3 Gary L. Steel 11-2-95 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER I?_ CL w . MAILING ADDRESS. ~olr/ [~.~T PROPERTY ADDRESS 766 C /2PSd~c/ ~1Zr vc _ ~GfdfDh~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 51,o_ 1/4, IfI44,,_ 1/4, Section Z I T_Lf_N-R_Zf W TOWN OF aS 4UysD,tJ ST. CROIX COUNTY, WI SUBDIVISION ~ . C 4d,ra 6, ,7T 7~ 6S LOT NUMBER CERTIFIED SURVEY MAP , VOLUME,4~ZL, PAGE Eyf , LOT NUMBER 3 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:. G St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property &L -rr-l 're'W,o0 Location of property __56L,,, 1/4 ,yu/1/4, Section-,T?? N-R_f_W Township I~LGl~SoAJ Mailing address 5-S!9 t, Address of site_~1~~_~m~ Subdivision name ST, C,~arxSTl~T~S Lot no. Other homes on property? Yes ✓ No Previous owner of property Total size of property Total size of parcel Date parcel was created 1~~6 Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? Yes _k,-No Volume & 76 and,Page Number 4/,t? 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. r Signature of Ap icant Co-Applicant ~ f1~ Date o Signature Date of Signature ~So'96i~ SiS5i6TpTOS H (A Z v srtv $~S£~TTpTLN 9 mi -F ~L'Z8T B~Sf~TipiLN to ZZ'6TZ X19TITOp00S 8 0 r" o IfL'8ST WfIiSpLOS Q m o ,ES' £9T KNO I LTOUS 100'58 Kett iOSp6BH S c , . IEE'EST !l L TOp00S Y (n m o A v ~N~ZSIQ 19NIlv8S) SSNI'I JMMw$SVX A n m d Nn ~ m N N ~ r_ ,LL•6iZ£I I ot•6~~ ,so of I ,00•GZ A z M P X80 5fil n = „ ZZ,6Oe0ON U) z I 50 N- Z M c r ~G IL N rnn N _ Z I~) m I~ o~ y ~ w c h j n g 40 m N In I-- D Z o ~ !0 -i I-_ N~ ~ w M CO d fn l< N 42 N N ap I Ire a N w O KD Q o' frl N 4~ ~ D n o m ti 24'~ m n ~C: x ~ r- ~ ew~~ ~ y z 00 ro N N cn w N M -4 O OD N CD t0 ~vJ ~ ~ N vv N _ I " \ 4 X O m 01 01. 01 \ n N 74 m 74 (1) OD ` IC7 z•I 9Z Q) \ 01 ,i ~y6\SZ0 w \ w Q ~•gLZ MM N DOCUbIENT NO. STATE BAR OF WISCONSIN FORM 2-1992 7--:"S SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 17fo _ Bridgeland Development Compm), a Minncsoo corp~)Wtj_Qn conveys and warrants to K P i t• h R F j c n I and A F 3 0 -Michelle T Elwood, hushand and wife, cnrvi-rchip marital nrnnPrt4 1l)]UO RHI RNIU the following described real estate in St. Croix County, State of Wisconsin 4/~yL Lot 3 St. Croix Estates in the Town of Hudson. St Cron Countv, Wisconsin. TOGETHER WITH a non-exclusive easement for ingress and egress over the North 25 feet of Lots 1 and 2, Plat of St. Croix Estates 74 e- This is not homestead property. T 3+T a y~.D 1 (is) (is not) l Exceptions to Warrantis: Dated this 30day of January , 19 96 i (SEAL) - (SEAL.) * N+~al K1:4z2,niak Pr d •nt (SEAL) (SEAL) * x AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this _dav of STATE OF MINNESOTA '19 Dakota County Personally came before me, this 30 day of !aniraa" 1996 the above named TITLE: MEMBER STATE BAR OF WISCONSIN N_ al K r z y z a n i a k (If not, authorized by 706.06, Wis. Stats.) This instrument was drafted by to me lnown to be the person who executed the fore-wing instrument and acknowledged the same. (Signatures may be authenticated or acknowledged. 'Da--13 l Bauer Both are not necessary.) N;a Public Dakota Countv_ . LL My --.=mission expires January 1, 2000. DARLA 19AUER VOTARY K 8- C4g#e= OMOTA COUNTY MY ComMmon Ezp,res Jan 31 , 20M •