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HomeMy WebLinkAbout022-1020-10-100 s 00 p 60 C t~ Oq N 0. C a ;n C CV O N X ti O O p C ~ G O O a C) ° _o ~ U tll O 0. Z O C n (D C U. O ) _ t CoO O C O 7 ° O Q E Z N m z O O L Z . m y co z a m rn O O Z d' I. m r j C O d Z to F- rn N Z d E 'O hh~~ o m r+J E ~ h~ o cu ^a - ct N i C _0 L O O m o Q z z Q N Z E N o w E E N o a- L Y Q a T N N c d CL a O o a CD C) 't co y to ~ U q O O O z° • ►v ro y a (L o. 4 rli (~i 7 O V~ O CO (fl p 0) 0) CO -j U of O co oo -0 O O 0) Cl) O N O O N ~ u) E 04 N T O O ~ m W a N m Q i N O O O O Ili v H c E o o mom aooo O ~ ~ Y Y "O N N N Lei N O Y Y r C O N N N N N (n oo -5 ~I N C m"T y (U V w v N W C N(0 N f6 m O O Y Co N 0 C'/)l • 7.~ia r^ L L rl ? Q I L a w e a y a y c L) IL 0 U) f ~ XM S TC - 10 4 S>j r AS BUILT SANITARY SYSTEM REPORT i"EtRi L-p OWNER 1 ADDRESS -1,~ r r Qt:yTY z2 3 SUBDIVISION / CSMt LOT SECTION T,,? -R W, Town of , ST. CROIX COUNTY, WISCONSIN SHOW EV RYTHING WITHIN 100 FEET OF SYSTEM ~r I O ~04~ ~2y IN ICAT NORTH RROW err;f Provide setback and elevation information on re erse of this form. Provide 2 dimensions to center of septic tan}, manhole cover. BENCHMARK' ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Mode 1W Size Float seperation Gallons/cycle: Alarm Location -:SOIL ABSORPTION SYSTEM Width: Length 12 Number of trenches i Distance & Direction to nearest prop. line: A!/,~ S~ Setback from: well: House Q7,C~~ • Other ELEVATIONS Building Sewer, s ST Inlet.JP7 ST outlet PC inlet ,~ySs PC bottom g17 -Pump Off Header/Manifold ZM 72 Bottom of system 1,q~, 1W Existing Grade Final grade fl_ DATE OF INSTALLATION: ~J PLUMBER ON JOB: ✓ LICENSE NUMBER: INSPECTOR: 3/93:jt i Wisconsin Department of Industry, Labor aiid HumanrRelations PRIVATE SEWAGE SYSTEM County: safety and Buildings Division INSPECTION REPORT saT_ C'.ROTX (ATTACH TO PERMIT) Sanitary Permit o.: GENERAL INFORMATION P tiAIVAS I K Na ti'T'FVF ❑ City ❑ Village Town of: State Plan ID No.: WTTJMTrT<TNNTC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark i Dosing Aeration Bldg. Sewer 47142-' .'8, 3 3 ` Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 115,73 Vent TANK TO P/ L WELL BLDG. A ir Ito ntake ROAD Dt Inlet Air Septic } r 11.9 NA Dt Bottom , 56 / E317" Dosing NA Header / Man. G' 10a, 7 9 Aeration NA Dist. Pipe Holding Bot. System 3~3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer y, Demand Model Number 3o,Y"GPM TDH Lift 16, Friction , S stem ,9 Loss ~r~ Hye d• s TDI-a,61 Ft Forcemain Length or Dia.a Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type0 CHAMBER System: /y)dk4 -U Jr' aCT! f1 OR UNIT Model Number: DISTRIBUTION SYSTEM Iff-ea-de? I Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 3' Dia. /"6- w Length Jot ' Dia. /'Spacing X " O r 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 6 Dies ❑ No [ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNI KINNIC.8.28.18W; NE; NE; ST,FFPY HOT,T,QW ROAD 3~ /00 . Plan revision required? ❑ Yes _ & Use other side for additional information. o g 9 b SBD-6710 (R 05/91) Date I pet 'i Signature Cert No ~i 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 3 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. State Sanitary Permit Nu ber • See reverse Side for instructions for completing this application 7 42- *7 The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property caner Na Property Location 1/4 1/4, S T , N, R (or)(/ Prop wner's i ng Addres Lot Number Block Numbet City a Zip Code Phone Number Subdivision N or CSM Num r ( ) II. YPE F BUILDING: (check one) ❑ State Owned El ilr Nearest Road Public 1 or 2 Family Dwelling No. of bedrooms O Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax NNummber(s)/ n 1 ❑ Apartment/ 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 box on line A- Check box on line B, if applicable) A) 1-.g New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. Repair of an System System___ Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft-) (Gals/da /sq. ft.) (Min ./inch) Elevation __-?7N- I Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ 1:1 1:1 Lift Pump Tank /Siphon Chamber - 13 EJ F1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for i stallation of the onsite sewage system shown on the attached plans. Plu b s Nam . (Print9 Plumber's gn re: ( a ps) MP/MPRSW NO.: Business Phone Number: , 0 Plumber' A ress (Str t, Ci -State, Zip Code): S060 y 7,7 S IX. COUNTY / DEPARTMENT USE ONLY Groundwater ate Issued Issuin Agent Signag&FQ (No Staml5s ❑ Disapproved S nitary Permit Fee (includes Surcharge Fee) Approved ❑Owner Given initial ~ Y Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber s. 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. 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) 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. y t y SAFETY & BUILDINGS DIVISION 1 State of Wisconsin Department of Industry, Labor and Human Relations April 29, 1996 2226 Rose Street La Crosse WI 54603 K 0 CONSTRUCTION KIM 0 CONNELL 308 MIDPINE CT STAR PRAIRIE WI 54026 RE: PLAN S96-40270 FEE RECEIVED: 180.00 BANASIK, STEVE NE,NE,8,28,18W TOWN OF KINNIKINNIC 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. Sincerel , erard M. Sw' Plan Reviewer Section of Private Sewage (608) 785-9348 SUDA-799718. W941 Y Wiscr,~nsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave 1340 E Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 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 0608 7M-_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 hisgalti~ gpiwj~Tt r t t~ submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. v ` 0 1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time: Ap oin ment DateC Review r Name l Plan Identification Number - 30- - 27 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Project me I ❑ City ❑ Village ® Town Of: County Protect Location GOVTLOT 41 1/4 1/4,5 T 1 N ,R E or i^l 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type t (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 Mound 5,001 - 9,000 gallon septic tank $200.00 N Nun-Pressurized In-Ground (Conventional) 9,001 -15,000 gallon septic tank $ 300.00 P ❑ Pressurized In-Ground Over 15,000 gallon septic tank $500.00 O ❑ Other: Up To 1,000 gallon dose chamber $ 70.00 1,001 - 2,000gallon 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 Up To 5,000 gallon holding tank $ 60.00 . Code Derived Daily Flow gpd 5,001 -10,000 gallon holding tank $100.00 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 $225.00 Revision $ 75.00 Groundwater Monitoring - Per Site $ 60.00 ❑ Groundwater Monitoring (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: S. SUBMITTING PARTY INFORMATION Telephone No (include area code & extension) Compa /Name Co t Perso ( ) ~ C / No. & Street Address Or P,Q. Box Cltyl~p wn or Vill ge, Stat Zip Code t 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 The information you provide maybe used by other government agency programs (Privacy Law, s 15 04 (1) (m)i SBDW-6748 (R. 09/94) OVER --iiiiiii-,110- Private Sewage System Plan index/Cf~~.~clj~st 4 0 2 7 0 All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. Plan ID # Owner's/Name Legal Description Address ityNil a own County J Contents Comments/Special Instructions Page # Included Two copies needed for all plans I Plot Plan 2 Plan View' Return by Mail 3 4 Tank & Pump/ 0 Fax Letter to (County) (Submitter) .5 Siphon Information Circle One and Provide Fax ( ) System Sizing (Public) 6 Call for Pick-Up: ( ) 7 0 Other I, the undersigned, hereby certify that the Seal (if applicable) plans and specifications submitted herewith were prepared under my direction and control. Plumber/Designer License/Registration # Address City state Signature s i YST ~e Only Attachments: pRIVAjE Application Z t 10 J Soil & site evaluation co nally Fee Y ID Needed for Holding Tank Submittal: y One copy of notarized holding tank ?31~~ Rf{„R1I01AS agreement. (Originals to County) ie Y Lds40R t)F IyI~U~TR 4~J 311ILR ;g • iCIS Needed for At-Grade Submittal: DI pµ OF SRS Original signed and notarized Application for "Use of an At- Grade" C,i. F5' County on-site One additional set of plans SBD-10268 (N.01/96) .41 ~ i i / \ ~AA'000% ~l . ; Page_~~Of~ a Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe WE T G'75 'a Medium Sand H G Topsoil F -3l E D a $ Slope Force Main Plowed Layer Bed of 12"-VS" Aggregate Cross Section of a Mound System Using A Bed For The Absorption Area D~Ft. E /,2 Ft. F + ~~u Ft. A G. G Ft. G t. B Ft. H ~Ft. Signed- K Ft. L Ft. License J Ft. I Ft. Date:- W~Ft. (Z.4,9 L I J Observation Pipe r-------------------------- A I Forc Main w IO Distribution Pipe JBed of ~11-2~" Aggregate Observation I Pipe Permanent Marker Plan View of Mound Using a Bed For the Absorption Area ~S~ PA9e.. O}...Z Perforated Pipe Defoll n Ind View Perforated End Capp PVC Pipe Holes Located On Bottom, \ s Are Equally Spaced R i 5i f/fit PVC Force Maur Q D~NriD•~tion Pipe Last Hole Should Be Nut To End Cop End Cap Distribution Pipe Layout P r _ Ft. ' R~ S X /el; Inches Y Inches Hole Diameter / Inch Signed: Lateral " Inch(es) License Number: ~_2S Manifold 'inches Date: Force Main " ~2 Inches w # of holes/pipe Invert Elevation of Laterals, Ft. S`,B 1 1 ~ r tm a A. to W O M a fo M 1 N Q ~D } w F rt n o ~ N V N N fD n rt O O O M ro K (D N C N b ~ ~C N rt ga ~ o tsi o _ C M fah K m :3 n \i r fD O rt d n t n x 0 rt n r• a w n a a PAGE OF -7 _POMP CHAMBER CROSS SECTION AND SPECIFICATIONS V E NT CAP `I~ VENT PIPE WEATHEKPKOOF _APPROVED LOCKING JUWCTIOm BOX MANHOLE COVER WITH 25' FROM DOOR, WINDOW OR FR ESH IZ'MIU. WOWING LABEL AIR INTAKE GRADE I MIAJ. I6' M'IIJ. COWDUIT Ie'nIN. IAILET PROVIDE ~7- AIRTIGHT SEAL I III ~ Ir I I I \v/ APPROVED JOIIXT A I III APPROVED JOIWTS W/ PIPE I III W/ ` PIPE EXTENDIMC, 3' I II ALARM EXTEUDIUG 3' OIJTO SOLID SOIL e I II ONTO SOLID SOIL I I I ow C ELEV.~FT. PUMP--,, ~ Cev sS , b OFF 0 COUCRETE BLOCK RISER EXIT PERMITTED OWLy IF TAUK MAIJUFACTURCK HAS SUCH APPROVAL 3" APPA0VEa BEDDIr.iG %Ancicr rj%eaK SEPTIC I SPECIFICATIOA.IS DOSE TA AI KS MAWUFACTUREK: - / IJUMBER OF DOSES: PER DA`J TAIJK SIZE: 0 1,) o CALLOW DOSE VOLUME c I r - ALARM MAIJUFACTUR,GR: INCLUDING BACKFLOW: GALLONS MODEL WUMBEK: CAPACITIES: A=- IIJCHES OR LSS GALLOWS SWITCH TYPE: ~a g= IWCNESOR ?Q GALLONS PUMP MAWUFACTURCR: l C =,5IWCHES OR GALL0W5 MODEL MUMBER: D-.INCHES OR GALLONS SWITCH TYPE: I1, MOTE: PUMP AUD ALARM ARE TO BE MIMIMUM DISCHARGE RATE GPM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFEKEMCE BETWEEIJ PUMP OFF A1JD DISTRIBUTIOM PIPE.. L-212 FEET + MIIJIMUM WETWORK SUPPLY PRESSURE . . . , . . . . . . . 2.5 FEET + ~ FEET OF FORCE MAIN X ~F/0" ~,FKtCTIOU FACTOR- 1/- FEET TOTAL 0'3UAMIC HEAD FEET JUTERWAL DIME STOWS OF TA K: LEWGTM iWIDT14 ;LIQUID DEPTH _ SIGIJED: LICENSE NUMBER: SATE: SAS' U b 111,~e~, Perform ance ; Curves' Pumps METERS FEET 90 25 MODEL 3885 80 SIZE 3/4" Solids WE15H 70 _ 20 - WE10H 60 0 WE07H 15 50 i WE05H 40 10 30 WE03M 2 WE03 5 - 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L i J 0 10 20 30 W/h CAPACITY GOU LDS PUMPS, INC.. SBrEG4 ~S rEly rt7cx 3a. METERS FEET 120 MODEL 3885 35 110 WE15HH SIZE 3/41 Solids 30 100 90 25 80 70 20 I ' 60 O H - so WEOSHH 15 i 40 V\ 10 30 1 1- 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 I I 0 10 20 30 ml/h CAPACITY 01985 Goulds Pumps, Inc. Effective July. 1985 S,6 ClBRc y 7,9 OPTIONAL WORKSHEET 1. MOUND SYSTEM 1 11. IN GROUND PRESSURE SYSTEM-Continued- 1. Wastewater Load, Total Dally Flow= gal. 10. Force Main: Use section H 63.15 (3) (c), Wis. Minimum Dosing Rate = gpm. Adm. Code and PROVIDE A DETAILED Diameter = _ in. LIST OF SIZING ON PLANS. ii 11. Total Dynamic Head: 2. Depth to Limiting Factor = 3r- it.jA~ System Head = 2.5 ft. 3. Landslope = % Vertical Lift = ft. 4. Distance from Dose Chamber to Friction Loss = -2,L-2 ft. Distribution System = ft. rD.-i = j y /Q ft. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = 2 ft. Pump will discharge at least 5 f gpm 6. Absorption Area Sizing: at /I //-2 ft. total dynamic head. Area Required = _27~ sq. ft. Pu mp~~del and p)anu~agturer: 14 rD_?//1- ~~I?5 Bed or Trench Length (B) _ ft. l / Bed or Trench Width (A) _ ft. 13. Dose Volume: Trench Spacing (C) = 4414 ft. 10 Times Void Volume of 7. Mound Height: Distribution Lines = _1LL:Z gal. Fill Depth (D) ft. Daily Wastewater Volume T Fill Depth Downslope (E) _ 1./.Q ft. 4 Doses in 24 hrs. J-2 gal. Bed or Trench Depth (F) _.3 ft. Backflow = ;.2z Y2. gal. Cap and Topsoil Depth (G) ) ft. Minimum Dose = gal. Cap and Topsoil Depth (H) _ /_,i ft. 14. Dose Chamber: 8. Mound Length: Volume = gal. End Slope (K) ft. Total Mound Length (L) 2 ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal. Upslope Correction Factor Use section H 63.15 (3) (c), Wis. Upslope Width (1) = 9 ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor LIST OF SIZING ON PLANS. Downslope Width (1) = '/J-` Q ft. 2. Required Septic Tank Capacity = gal. Total Mound Width (W) _ j2< ft. 3. Percolation Rate = min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in chapter H 63 Natural Soil = _c~ gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required = -11-25- - sq. ft. SIZING ON PLANS. Basal Area Available = sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter Length = ft. H 63 are Used, Indicate Table No. Width = ft. 12. For the Distribution Network, Use Numbers 5-14 in Section 11. Number of Trenches = Trench Spacing = ft. 11. IN-GROUND PRESSURE SYSTEM 5. Distribution System: 1. Depth to Limiting Factor = ft. Lateral Length = ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = min./in. Lateral Spacing = in. 4. Proposed System Elevation = ft. Distance from Sidewall to Pipe = in. 5. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use section H 63.15 (3) (c), Wis. Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. Fill In All Items from Section III Required Septic Tank Capacity = ~QQ_ gal. 6. Absorption Area Sizing: / V. SEPTIC TANK Percolation Rate rttirt7FirtJoroAj, 1. Capacity = gal. Area Required sq. ft. 2. Manufacturer: System Length ft. 3. Show Site Constructed Tank Details on Plan System Width = ft. 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Sim = in. 1. Capacity = gal. Hole Spacing t:l.)~) 2. Manufacturer: Laler l Length :1. Pump Manufacturer: Lateral Siic in. 4. Pump Model: I.aleral Spacing fl. 5. Operating Head= ft. Uhlanue Irons Sidew.dl•lu Pipe 0. Flow Rdtc= gpm. H. Distribution Pipe Discharge Raly: 7. Show Site Constructed Tank Details on Plans Number of I loles Per Pipe 1 low Pei Pipc gpm. VII. HOLUING TANK 9. Manilold Siting: 1. Capacity = gal. ype (cenlel Of end) .C1zn 2. Mdnuldclurer Length = ~ ft. 3. Show Site Constructed Tank Details on Plans Diameter = ._,a2_. In. 5-X -SHOW ALL INFORMATION ON PLANS- DI LHR SBD-6761 (R.03/82) / d 4 • ♦ ~ 1 `'Wisponsin,Department of Industry. SOIL AND SITE EVALUATION REPORT Page of __::3 Labor and Human Relations Division of Safety d 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 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 Lc4'~ ~ f -.S 1) GOVT. LOT 1/L' 1/41/4,S g T z 8 N,R Ej f(or) W PROPERTY OWNER':S MAI)}.ING ADDRW LOT # BLOCK # SUED. AME OR CSM # 17- -7 3 KEG °vf. 1114 _5/ 1100 CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE JOTOWN NEAREST ROAD ( .New Construction Use L/Nesidentiai / Number of bedrooms 3 ( J Addition to existing building J Replacement ( J Public or commercial describe Code derived daily flow ~ O gpd Recommended design loading rate / bed, gpd/0-S trench, gpd/I12 Absorption area required a 7 5 bed, ft2 3 75 trench, ft2 Maximum design loading rate Vbed. gpd/ft2 trench, gpolft2 Recommended infiltration surface elevation(s) /DD ~-y ft (as referred to site plan benchmark) Additional design / site Considerations Parent material Flood plain elevation, if applicable rAt E It .21Z,6141 &t1'A( S = Suitable for system CONVENTIONAL P* ❑U IE3 S JUND 2 PRESSURE [I S AT-DE SYSTEM IN FILL I HOLDING SI~K U =Unsuitable fors stem 0 S ~U~_ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trrich /01-14 /V Al 611-W Ground -3Z '07- gi- a /Yl V 6o elev, 9~ ft. Depth to limiting f for Remarks: Boring # °:v " ;x -~z a rYl r yYJ f C S , S ` Z-''{ z 7 Z Q i2 q/ h6 -5 C w, 5,0M Ground 7 Sl ✓L rn t!° elev. ~ Z o?ir~ /Y1 v ,.if 7~2 `f/ & 5/ 7~ 2 5 r/ '6- Depth to limiting factor Remarks: ~tC Q d5 CST Name:-Please Print Phone: , - Address: Signature: to Da te: CST Number: , 1 7:7 L - • • 1. ~ - &2d)aA-.5 ~d SOIL DESCRIPTION REPORT Page Z ofd I ng # Horizon Depth Dominant Color I Mottles Texture Structure Consistence lBourtlary I Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrerdi 3 rN Y c- + to -Mae- I 16 -Zo~Y~ h a-zier ~/C~ lp"15101-1~ 1 Ground elev., a wi in Vr_ z J~7,Sy2 ~C/ / D I Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor 4 LLD Remarks: Boring # Ground Slav. t., n QWi 1. 111nitl c I •1 factor l . , , • ! ~ x Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: ,;nn aanrR osrsz► b' STEEL'S SOIL SERVICE Gary L. Steel C.S.T. 2298 i4 Yl As, New Richmond, WI 54017 MPRSW-3254 S 8 ^ -ILZE3 /V' e. 16 u~ (715) 246-6200 /~/n/1 r cK~nr~ r ~ cd,ash. /J to- edu' Fly ^a c' 90 ' v' 1b. I ~N h r~ r ~7 I° Vn_isin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of _-a Human Relations -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' ' ~l 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 O3~p/~ PROPERTY LOCATION / -n Ad; GOVT. LOT 1/G 1/41/4,S B T Z N,R Fj f(or) W PROPI T ~W ER':S MA}__ GY,ADDREhSB LOT # BL S~ . ~1~~ OR CSM # 0 a) CITY STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE MOWN NEA EST ROAD W~1 .3'30 l (4111) 9/~- 4S i C ~ ~u~ [A.New Construction Use [/Residential / Number of bedrooms 3 [ ] Addition to existing building [ I Replacement [ ] Public or commercial describe Code derived daily flow %i h gpd Recommended design loading rate bed, gpd/ft2 , .g trench, gpolft2 Absorption area required 3 7 5 bed, ft2 3 75 trench, ft2 Maximum design loading rate bed, gpd/ft2 ..S trench, gpd/ft2 Recommended infiltration surface elevation(s) 1670 '--y ft (as referred to site plan benchmark) Additional design / site considerations Al '4 Parent material Flood plain elevation, if applicable x/04 ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ❑ S cau P~s ❑ U ❑ S J2l ❑ S E;wj- ❑ S - ❑ S E;w SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxi3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tre" U -5'/ Ground elevZ,yf 92 ft. Depth to limiting f for 1 Rema,l.s: Boring # 0 Si n17 5,01 GJ / , •-5 Ground el 3 7 -5,y2 `f/& Z 7 2 5/ 'S m y Depth to v e•: limiting factor CA.) Remarks: CST Name:-Please Print Phone: "I" Address: Signature: Date: CST Number: - 3 z PROPERTY OWNER A-S Id SOIL DESCRIPTION REPORT Page Z PARCEL I.D. # Boring # Horizon Depth Dominant Color I Mottles (Texture Structure Consistence Barcbry Roots GPD/ft in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed iTmrich - 3 Y /A- h Ground k4L elev., z .~7Sy26,1 i i X50 ~5 a ~9n S 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: SRMTROM 05/921 STEEL'S SOIL SERVICE Gary L. Steel 908 N. 816'e- . e C.S.T. 2298 ~~L^ ,9 yl ~s j J'1 New Richmond, WI 54017 MPRSW-3254 4/~6 Y4- (715) 246-6200 /I/a/) Ie-A'144 ~~ownsh,/J 4d Pe "'q4- f~p~-ao,olzr4cres 3~©Z y~ / ? v~1 ~o m / 7 - ~13 1 AfAR2 99 JADES 0• N1 9 Of ►y w~ Qo:, YVI 4:67473 CERTIFIED SURVEY MAP LOCATED IN THE NW1/4 OF THE NE1/4 AND THE NE1/4 OF THE NE1/4 OF SECTION 8, T28N, TOWN OF KINNICKINNIC, ST.CROIX COUNTY, WISCONSIN W 00 00 C - O N ull U 00 Z W H ° of ASSUMED BEARINGS REFERENCED TO- al THE NORTH LINE OF THE NE1/4 OF I SECTION 8 WHICH BEARS S87°10'43"W ~I LEGEND ST. CROIX COUNTY SECTION CORNER w z MONUMENT, FOUND. O H r\~ z z o 1"x24" IRON PIPE WEIGHING \ o W 1.686/LINEAL FOOT, SET. P4 °Q s. • 1" IRON PIPE, FOUND. z F~9 x OWNER AND SUBDIVIDER H W~~. Robert Richter 1152 N. Riverside Dr. N. o sel' zl~I Hudson, Wisconsin 54016 w U3 E-4 a 3~ O I r4 I x Oe 06- 49 ~s 0 m O / 1~ Lr) CD AI N -I z I +1 +I / dl w w W / / i-a i : M cY1 U cn O O N O E-4 r-4 AI ^ ^ O O 00 00 C) M z C4 00 HI ~ HI / -41 al ti/~ o z I l i E-I v~ w 44 i I O pq z / N P4 ~-4 y h££Z 92pd 8 'TOA M,00,8LS M,*79,0£N ,00,90,TL M„OO,LZ,99N ,LO'9£L ,T9'98L 100'££9 Z-T SONI ay2lq d'IONV ONI dV2[q HZONB'I HZONd I HZONd I 'ON ZN8ONVI QNZ '3 ZST WHIN8O O2i0HO CIUGHO Oldv SIlIQF72I HAUD ~O > 9T0+79 utsuOOSTM °uospnH 'N •J(i aPTszaAig ZSTT Z8vVS 291uaT21 gaagoa NOMMS 11MIAMUS QNv 2IdNMO 63wvr ZZO*79 uTsuODsTM 'sTTPJ J9ATjj iv :IaaalS InuTsM•M£TT VS00 an401MI + •OO 2uzzaauT2ug uapSO MT-06 'ON qof N8 T-S uOSUpMS •Z sampj' '066T `T aago3Oo :91pa -amps aqq 2uzddpm pup 2uTPTAZp '2UT OAans UT Xjunoo xioaD -IS pup dTUsuMOI OTuuTNDTuuTX 30 suOTIPTn2ag UOTSTATpgnS aql pup sainjejS uTsuoOSTM aql 3o 9£Z jajdpgO 3O SUOTSTAOad aqj gIzM pazTdmoo ATTn3 anpq I IpgI 'appm 3Oaz9gj uOTSTATpgns aqj pup paXanans pupT aqI 30 saTappunoq aoTaalxa aqq TTp 30 uOTluquasaadaz joaajoO p sI dpm Bons jpgj 'pupT pips 30 saauMO aql 3o uozIOaITP aqj Xq dvN XaAanS P9i3TIa9D pup uo3szAZp_pupT ',KaAans Bons appm anpq 13pg1 KJTI aaO I •paoOaa 3o siuamaspa oa io@CgnS • .I 1 Zyj~ ra+i ~ir 1~•aaSV M u✓ N• Y y y aL Ow p 0•~a/~•«x A Y . VW vOpG art. +f~•'~'rt9 o~.r.: ~ o ~v w e~w U ~N$ o.+ '"~oaoorl~i.Y y. i ;i xx~ U 6 r~•.il~~o a~eoE:~9o~ u° 8°.w 7 V jA1 N °o; • KCI . VI ~ xv1 p0 ~ ✓ Y Y . n A ua ~ ~ Y S , w 1 _tr. ~N tnf <N , ~ 1 a v o~ r "fin ~ F N A ~ .1 • a °0 ~ N m N~rN !rya c I Ito N Coo VN ' = I J t N • . e.u},Trf~' jouno oa • ar u~a s V I ~ a~~ h 11 7 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic s st m) Please obtain fro t e Planning Dept. CITY/STATE 2 1 ` L PROPERTY LOCATION k)_ 1/4, _A& -1/4, Section - , 'I' a_N-R_Zg_W TOWN OF L" ST. CROTX COUNTY, WI SUBDIVISION _ 5 G G e.. tP 1~ 1i1~r G Gp W LOT NUMBER CERTIFIEDSURVEYMAPVOLUME, PAG) ' , 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 Cannichael Road Hudson, WI 54016 11/93 i I STC - loo 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 Location of property jVw 1/4A[L'_1/4, Section $_,Tp _N-R Ifs Township~n~,. Mailing address •.,...,,a.. 4~ ! Address of site. Subdivision name G Lot no. Other homes on property? Yes ✓ No Previous owner of property V# Total size of property ~0 . 'PI Z, Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes v No Volume ,/0637 and Page Number 2r/ 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. ~7 7 , 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. Signat e of Applicant Co-Appl' ant hitp of S i t7nat,ii- ilat-n nf S i nnatiirP THIS NO. STATE BAR OF WISCONSIN FORM 1-1882 srACE RESCavED ros RECORDING DATA 104''1'7 WARRANTY DEED VIX 110515PAGE 91 REGISTER'S OFFICE This Deed, made between Robert K. Richter' a/k,/a ST. CROIX Co., WI r - Robert_.Richter.... Recd for Record ; Grantor, DEC 1 4 1993 and.-----Steven-J _.Banasik__and_Yary._II___Prindiville------------------ I1:00 A. M 4. - loam Dieft - - G_ antee, Witnesseth, That the said Grantor, for a valuable cionsideraVon_..___ - conveys to Grantee the following described real estate in St- i.XOJ ?C._.._..__ ! RETURN Tc County, State of Wisconsin: Tax Parcel No-............... Part of NW1/4 of NEl/4 and part of NEl/4 of NEl/4 of Section 8, Township 28 North, Range 18 West, St. Croix County, Wisconsin, described as follows: Lot 6 of Certified. Survey Map filed March 22, 1991, in Vol. 8, page 2334, Doc. No. 407473. =;3 TOGETHER Frith and subject to the right of ingress and egress over the road right of way as shown as Outlot "I" of Certified Survey Map filed March 22, 1991, in Vol. "8", page 2329, Doc. No. 467468. t J1. Cy. „ This i&_IlO.t......... homestead property. ~ . VK) (is not) n i Together with all and singular the hereditaments and appurtenances thereunto belonging; And.... Robert_.K.._.Rxchtex,._aklVa--- obext_Rachter---------------- warrants that the title is good encumbrances e.................................... ce indefeas~bie is fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any; II and will warrant and defend the same. Bated this - day of --------_---•----•--ember................. 199 II (SEAL) -•----•------____...........-....-.....---...(SEAL) !I R I, - ---_.Robert-.K•---Ri.chter.-.a/k/a............. Robert Richter j - ------(SEAL) ------------•------•------------------------•------•-------------(SEAL) .I I y i • II AUTHENTICATION ` I ACKNOWLEDGMENT ! (I Signature (a) STATE OF WISCONSIN u j' -_----------C' -nty , authenticated this day of---- 19______ Person ly came before me his day of 18 the above named it a - _ A____ _ 1 TITLE: MEMBER STATE BAR OF WiSCONSIN I I (If not, . - - ' authorized by 1 708.06. Wis. Stats.) is me known to be the person who executed the iMA nt and wledge the same. j THIS INSTRUMENT WAS DRAFTED BY ~j KriGtinn flvlarvl r r