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HomeMy WebLinkAbout022-1028-80-000 4 0 a) 00 03 03 d a) m a N X O N p O c O C .2 w9 O m c C N CO 00 a U w 00 m N 3v N O Z y E C Z 1i N n m LL o y o 3 - wa =3 Q °a ac~ y Q CC 3 C7 U M m m > Z w N > E E Z Q-' o o d Z m m € 0 F Z d m c O O Z o y o ~ F r z E E N > .C c6 N N N N d U) L g ' O O a -0 Q Z ca Z Z Z Z N z co m m _C 1 R > N CL CL M Lo LO to fq m ` N+ N m 0 0 0 1 ° rG r G r a E m Cl) G r G a E m N N Z> N 3 3 3 ° u `n 3 o LL. o v v O Z O O •ti 4i aaa aaa a to to (V O y vv~~ LO M N -00 rn a) co co y N J V L } N O- - 0 fOD M 0 N tf) O O O O E 0 _0 :3 m y I t co c a c O O) O O N L 'd d Q > U) = 'p _m Q Z U) ca O 7 w U) 7 3 0 1 (a C to c E 00 p U) 0 o o~ v z o m a o rn l + pp U _ L 0. C 'p o o N_ m om IU `o E c °~v v l C6 C') om .5 CD m a~ c m n p ° °D ° m Y o o a N o = o N m m O N E U • O O Y O Z c 2 CO N O Z r2 (n L40 € om. € a ::a ::ate • a m '2 m m c m m c r`Iv E , c c c r A uIL2i 8.5 'o oC%0 , Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ZVI TOWNSHIP KKj'S,SEC. T a N-R W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE ~aG(Lra. PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y k y 7 I ~~1~`~i ----~3 Bin I I' I~ p~fi' l~cH ~ - 3 8 s' _ - 52 07 /7` ' INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~~~~Ts PUMP CHAMBER GtI.C~~S Manufacturer: z Liquid Capacity: X90 Pump Moz3 Pu-~ del: Pump/Siphon Manufacturer: ~0 mp Size Elevation of inlet: 9 147 Bottom of tank elevation: Pump off switch elevation: ~9 d Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, &Side, O Rear, 0 i Number of feet from well: ~oy Number of feet from building: l (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: ~y Length: ~ 7 Number of Lines:. Area Built: Fill depth to top of pipe: L Number of feet from nearest property line: Front, O Side, G'Rear,0lk Z- Number of feet from well: y/ Number of feet from building: > y0 ,~iLe,~srovaf' (Include distances on plot plan).,,,,. SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: 4 DEPARTMENY OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION ' BUREAU OF PLUMBING MADISON, WI 53707 nCONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number ❑ Holding Tank 1:1 In-Ground Pressure El Mound (1f assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSPE YO DATE. Bill Mueller R. R. 2, River FAbls, WI 54022 I's- BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. . PT. ELEV.: CST REF. PT. ELEV.: NW NW, Section 10, T28N-R18W, Town of Kinnickinnic Name of Plumber: MP/MPRSW No.. County Sanitary Permit Number: David Fogerty 3289 St. Croix 64934 SEPTIC TANK/HOLDING TANK: • AL~ • 2 MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL JLOCKING COVER _ q Q PROVIDED: PROVIDED. w S //s YES ENO DYES ENO BEDDING: JVENTDIA.. VENT MATL.. HIGH WATER NUMBER OF ROAD: PROPERTY WELL: JBUILDING: FR NT TO FRESH JALARMFEET FROM LINEINLET. , 00, XYES ENO ` . DYES ENO NEAREST DOSING CHAMBER: MANUFACTURER . r;EINGS UID CAPACITY PUMP MODEL. PUMP/SIPHON MACTURER WARNING LABEL JLOCKING COVER D PROVIDED PROVIDED o IPUMP (J AND; I :j YES ENO DYES ENO GALL e-,e k CYCLEYE ❑NO Q CONTROL OPERATIONAL. NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH (DIFFERENCE BETWEEN - FEET FROM LINE' I AIR INLET: , PUMP ON AND OFF) Q YES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I[EIVI, I H IDIAMETfR MATERIAL AND MAR ZN4 or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH J NO.OF DISTR. PIPE SPACING COVER INSIDE CIA #PITS LIQUID TRENC S LRIAL P=-~ DEPTH. DIMENSIONS 7 7 GRAVEL DEPTH FILL DEPTH PIP RNUMBER OF PROPERTY WELL: BUILDINGENT TO FRESH BOVE COVE]DISTR BELOW PIPES. A : E V. IELEV. END. P S LINE AIR INLET FEET FROM NEAREST--. J.3~ ~00 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ENO DYES ENO DEPTH OVER TRENCH!BED DEPTH OVER TRENCH/BED pEPTH OF TOPSOIL ISODDE D. SEEDED MULCHED. CENTER. EDGES. DYES ENO EYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.: ELEV.: DIA.. ELEV.: PIPES: DIA.: ELEVATION AND . DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLAN& DYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ENO DYES ENO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATU TITLE: DILHR SBD 6710 (R. 01/82) 7;_ DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. 1 Property Owner: ' Mailing Address: Propert Location: City, Village or Township: County: t/a '/aS /JP /T,?/ NCR E (or) L t Numbe : Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: (If assigned) TYPE OF BUILDING Number Bedrooms: s: ❑ Public* El Variance* El Other (specify)* E01"1 or 2 Family *State Approval Required. I TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER a MANUFACTURER: c r EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): El"New ❑ Replacement ❑ Experimental L7 Seepage Bed ❑ Seepage Pit ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name Plumber: S' a t u • MP/MPRSW No.: Phone Number: arvr_ r a (707 6J_ZG Plumber's Address: Name of DesslaaaLL, e, L O.z _A .ti COUNTY/DEPARTMENT USE ONLY Signat re of Issuing A nt: Fee: Date: APPROVED Sanitary Permit Number: .►~.741D ❑ DISAPPROVED Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) 1'J • APPLICATION FOR SANITARY PERMIT S T C - 100 v 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 Section /O , T N - R 13 W Township L%f RZC f"f r iA n.~r' Mailing Address Subdivision Name Lot Number Previous Owner of Property Tom, j` e Total Size of Parcel L ..Date Parcel was Created C( y 93 Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for resale (spec house) ? Yes -I~No ~-Volume / / and Page Number y Q (v as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAti,6y that att 6tatement6 on .th.iA 6oAm aAe tnu.e to the beat o6 my (out) knowledge; that I (we) am (ate) the owner (a) o g the phopeh ty dee cA i.bed in th.iA in6oAmati.on 6onm, by vi tue o6 a wa anty deed teeonded in the 066ice o6 the County Reg.L.aten o6 Deeda ae Document No., U ; 1 ; and that I (we) nn.pAentta own tho_ nhnnnaod alto Lnh ttin 01,0nD iAnnAn A//A}'nm Intl T 1J11A1 L.ir..n oocUMENT NO. WARRANTY DEED THIS SPA.E RES.:: N, STATE BAR OF tWISCONSIN FORM 2-19,9,2 ' ~s 7o .U! 712P 5 REGISTERS Off ICE ` ©OIX CO., WtS; Gordon.D.Mueller _and__an9herill A.-.Mueller,-_ JJ ST, y Cp J ~ - _ ..------husband_and_wife_as.Grtors------------------------------------ of May A.D. 19 85 8:30 A _ ; ttL conveys and warrants to as-Grantee__.- 8. ;cicr of :rxio RETURN TO r ~"9 - - the following described r al esta~~ ...COLU1ty ..............County, State of Wisconsin: lr' y~ I Tax Parcel No: Commencing at the s-rroer of n 10; thence S 0055140" E along the West line of the NW4 of Section 10 a di .72' to the centerline of a 66' wide roadway easement; thence N 87°34'27"E along centerline 827.90' to the point of beginning; thence continuing N 87134127" E 279.841; thence S 52°08'45" E 393.351;thence S 63°39'07" W 255.78; thence N 46027126" W 497.97' to the point of beginning. Contains 2.19 acres (95,388 sq.ft.) Including a 66' wide roadway easement for ingress and egress purposes located in the NW4 of the NW4 of Section 10, and the NE4 of the NE4 of Section 9, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, being further described as follows: Com encing at theNW corner of Section 10; thence S 0°55'40" E along the West line of the NW4 of Section 10 a distance of 626.63' to the point of beginning;.thence N 87°34'27" E 886.86'; thence S 46°27'26" E 45.891; thence S 87°34!27" W 91.801; thence S 46027126" E 45.89'; thence S 87°34'27" W 1031.79'; thence S 72°15'06" W 90.44' to a point on theEasterly right-of-way line of U.S.H. "65"; thence N 17°44'54" W along said line 66.00'; thence N 72015'06" E 99.32'; thence N 87°34'27" E 181.82' to the point of beginning.(Xontains 1.73 acres. This ......15 110t homestead property. IM (is not) E.XE, 7 Exception to warranties: Easements, restrictions and rights of way of record, if any. Dated this 17th--------------------- day of --.-Kay . 1985---• -----------•----------------------•-------------•------------•------(SEAL) -lss C~!L-.------(SEAL) :Gordon D. Mueller (SEAL) (SEAL) * Sb~.eri]]. x -P,._Mue,ller-- AUTHENTICATXON ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN -.f` PIERCE ss. County. authenticated this .----...day of... 191M-- Personally came before me this day of .Mav A5 - - s CERTIFIED LOCATED !,Y THE SURVEY MA--P-- 4~~ ti~:~ NVV114-NV1114 AND 10 AND 7ilE NEiNW1/4,SEC. _ 729 N NE 114 OF THE NE 114 Of SECTION 9 Ix co, wt. RIBV'~, TOWN OF KINNICKINNIC, ST C O'W'VfD HY, GORDON MUELLER, .RT. 2, R/VER FALL, W1. 540?2 faCTE : S~ `o " o . S.N.. ` ~ 'J. -54 m ~~o wy r- .m m `i~h\ ay ail 1 `m jL O mO nhjy0 31 1 i iomz `L m~ 0 zm ~x -IZ -cn cZ no DO~ 0n, of i ml~ io ~m 2 a, ! MONUMENT TO MONUMENT) nl NI a _ S 0055'40 O m 2 6 3.9 4 V~ I c (TOE 3 3. 7,--- Z.' < cn r ~j I~ 62 s3' VJ ou fn t N N O I m I V w C, aI A O.N m ~v m'O W X- 'c m~,tga o s m ti o o c° ° m Lk: 1. gy ra "1 vk- O rj ` DTI ~ 'C tr C o m L m .Y L~ O (n o rv r _ w~O z y n,~° om p w` Ogw U) r ~ tb ci n b~ ' ^ Rt rTt r,, l~ u+ O y ,r, n a 0~ 4. r , O D Li W '4 , z ^ o z m ~C"p, H S T C - 105 r SEPTIC TANK MAINTENANCE AGREEMENT I,~yy Ho St. Croix County OWNER /BUYER e! /.l/I I I Zt 'P C) 13 r& a ROUTE/BOX NUMBER Fire Number CITY/STATE /fir-VG, Gaj-_ S -Z3 ZIP PROPERTY LOCATION: V41 k, W&I 14, Section, T N, R W, Town of /CjHy~C P01l C. , St. Croix County, Subdivision - , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days / of the three year expiration date. SIGNED n DATE tL-~ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. _O y r n S n ~ m m (~D N N 'Co ".C 0 N Al CD a (Dco (D ' 7 0~aaw 3 Z 0 O a (D (D O A 30 m ado °i ° m (D' ooo ma su (D Err (D -w O ? (O n - ° (D O 3 d 0 - 0 0 cc vr > > Err (D O w 0 0) r ° p - < ~ c S N z Z oc3oao a c~ a° ° w ~ N a ~ 7 p1 0 2.-0 ° -coo-,vv D < ID aAcc Qo (D y c o D C_ . (D (r O w A - n ~c (G =O 60-5,* O N m ~ p ' Co C ° (D w 0 Z a vl~ NON `~Eo O Z 3~NmNa a D w~ OL ~0) ?o ~g ffl O A 7 a cD w ? a (c p1 N 'p o aN ° ~ ° ~ C Al -0 CD (o CD(DcsD 0S' emu, n 'S (fi _ a (c m CD = 1 ID (D r- 0 Q a of:_ aoF a,cmCN? w m m w (D a CL 0 (D :E 06 y c N c `c(° ?w 3 to c~ m 0 C ~(p O ~O N a n (CD O 7 g n°:3 ocoa c-.~CD C(D S CL c m %J 0. =r ' a 0 2. CD 0 0 CD K: li. O LDINGS NDUSTRY,NT OF REPORT ON SOIL BORINGS AND SAFETY & B DI VI ON LABOR P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LO AT10N: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: / /D /T ffN/R E ,-dr; 'k- COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVA ONS MADE NO. BED MS.: COMMERCIAL DESCRIPTION: PROFI E DE CRIPTIONS: PERCOLATION TESTS: LJResidence 2 New ❑Replace i. "7 -21 - or 3 7- z2 -y3 RATING: =Site suitable for sy em U= Site unsuitable for system CONY ZONAL: MOUN IN ` PO~ PRESSURE: SIMS EM-IN-FI UJHOLDI TA RECOMMENDED SYSTEM: (optional) ❑u ❑u s F_111 ❑s A. ;L kZ zy. If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS % PP~_ a 761 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WI H TIMICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 AlAfle- Z an r, 'r, B- B- ,.3 p > ..s" B- 7, i v. > L / B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER1003 PER INCH P_ / it- Xp-de 2- z s P- P- Z ~'6 t o L P P- 3 3 P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION Jll I -e _ -e ......r i ~ I 1{I r --.._.,,_._.j..__..... 1 F € E i W«'rl I TIONS FOR COMPLETING FORM 115 - SBD - 6595 To ira' st, your report elude: 2. -(y in.: whe, is a ce r n - 3, Mf K ems or 11el a Ii 4 4. Is l'7 ystern; _ 5, co i,.g boxes SITE IS SUITA _E FOR A H-OI'D'ING T) Y IF ALL OT - RULED OUT BASED ON SOI'_ `',)NDITIONS; 6. PL-A, Lions shown here for writing I`. descriptio 1 plot plan; 7. "1V": i accurately 1c atir±g y<,° ~ ~,~rcitions. L rr.r _ A desired, ra,k and veitir tai boxes as to names, r flo flood does riot apply, FBI x; .'`cur3 'it and your certification c, .l. distribl,,' -lived. ALL SOIL TEE S E TH THE UTE-ORITY WITHIN 30 D S OF COMPLETION. ~,.Z-VIATIONS FGR CL -IED SOIL T> Soil . and Textures S -rhbols ~3iee 1fl"1 F= - 3") _ rr c( -s - P ~ , ~ i [ T ~a. TIC I t Y . R rr~vt - ff( Sic C Y3 S7 - VR wild ~ f 14. I A 00 r / t' I 10 IV i oool 3 ~ ~c, ~°x, ~ b 3 00 100, • v 0 Q\ F s \ I I/N h i L e o ~ 'Ib 3 A 1 ~ h O 1 1. ~ ti ~ A PAGE OF ti PUMP CHAMBFR CROSS 'JCCTICd AMD SP(CIFICATIOMS " VCNT CAP M"C. I. VENT PIPE WEATHER, PROO F APPRO'/ED LOCKING JUNCTION BOX MAWHOLE COVER 2B' FRGM DOOR, WIWCOW OR FRESH 12 Mlll. AIR INTAKE I GRADE I y"MIIJ. , I 'o I k~i I0"MIU. COWOUIT I111..l:1" PROVIDE I AIRTIGHT SEAL I i i I V I T APFR.OVE.C JOINT A, I III APPROVED ;DINTS W/C.I. PIPE r I III W/C.T. PIPE EXTENDIAIC• 3' I II ALARM EXTENOIUC, 3' ONTO ;,0!.ID SG.:. 8 I I ONTO SOLID SOIL I I i I ON C I I pump---- V OFF ID CONCRETE BLOCK RISER EXIT PF-RMIITED OQLy IF TANK MANUFACTURER HAS SUCH APPROVAL 5PEC.IFICATIQKJS SEPTIC AND DOSE TANKS MAWUFACTURER: NUMBER OF DOSES: 2 PER DAy ,~perj~ yS$ - z = 21 S TANK :IZE: ~.__SLd ._._.r_..,GALLONS DOSE VOLUME 9 GAL~0►~►5 ALARM MANUFACTUFRE.R: ~~(LCQ ~L4ers't l+ BAGKFLOW: MODEL NUMBER: - =,.a~3al CAPACITIES: IWCHES OR ?79 GALLONS ~~jj ~a . TIES: A= ~ SNITCH TtIPC: LL~ - L'eue'lCd-wig Q = INCHES OR 35- GALLONS PUMP MANUFACTURER: ZOZ° l~ °l7 7 C x -LZ_.INGHES OR 22-7 GALLOMS MODEL NUMBER: D- [[//9~~~ INGHE'"o _ -7P GALLOAJS SWITCH TYPE: NOTE PUMP ATJDALARI~TO BE PUMP DISCHARf.E RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE ®kYwcrAI PUMP OFF ANO DISTRIBUTION PIPE.. _ FEET -I-• MIMIMUM NETWORK SUPPLE PRESSURE . . . . . . . . FEET A Se> ♦ -49-L- FEET OF FORCE MAIN X .,c YjooFT.FRICTIOW FACTOR..-._,L_ FEET l TOTAL DYNAMIC. HEAD = a• FEET ys IAJTERieJA4, pIh1E1J5lON~i OF TA►JK: LEIJGTH -;Vtffi FFLIQUID DEPTH ~.U.AF 91f31il LICENSE iJUMBER:. DATE: -117- 1`77777"'"77 = ..m.•T. ,..~...p-s,, sa T D'H HEAD CAPAC[TY CURVE ~n . W ' yj 2 ILL , 100 30 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 95 SERIES 53-55-57-59 97 137.139 163 165 e ;T! M +L LTRS GAL LTRS CtAl_ LTRS 'tAL LTRS LTRS 28 90 1.52 43 163 248 04 394 5i 231 231 EFFLUENT AND DEWATERING 5 3.05 4 129 i 216 X91 300 61 231 231 6 ' 4.57 t 9 ~ 72 43 163 Pa 242 60 227 26 227 \ - SEWAGE AND DEWATERING 6,10 27, 104 36 136 ;a 223 1227 7.62 9 30 7. 216 1 223 L-T - 9.14 55 206 220 24--.- - 12 19 ab 172 206 'f f~ \ ) 15.24 33. 125 + 191 • % 1629 - - - 15 57 4,1 ! 161 \ - 1 22 \ ?0 21.34 301114 - 7/t \ 80 24.38 - 141 53 I V MODEL M O D E L Lock Valve: 19. _ 24.5 26 _ 66' 87 20 E 163 \ 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE \ \ I SEWAGE AND DEWATERING \ \ SERIES 267 268 282 284 293 18 \ \ FT M 1771 LTRS GALLTRS GALL LTRS GAL LTRS LTRS \ 5,1 1.52 8 408 ~2] 386 130 492 180 681 55 3.05 VO 227 273 9 360 154 598 { 4- 4,57 ':J 1 76 43' 163 c3 238 1' 511 !tl5r"y \ - '0~ 6.10 8 30 3 125 1C 401 _ iJ \ 5 _ 7.62 _7 288_ 14 f \ i 9.14 - 4 163 :292 ~s5 \ S 1067 -J 227 40 12A9 46 174 - :5 13 72 L8~ 106 .~.r . 12 -40 - - - \ 50 15.24 _ 17 45 F - ` I MODEL Lock Valve:- t8' 21 26 _-35' 53'-- 10 35 I 293- ~I 30 8 MODELS 25 137 139 6 ^0 ` MODEL 4 15 284 MODEL MODEL 10 268 282 2 j MODELS k 53, 55, MODEL MODEL _ 57, 59 97 267 U.S. GALS, 10.. 20 30 40 50 6070 80 90 100 110 120 30 140 150 160 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Mlilers Lane Manufacturers of... P.O. Box 16347 zn7aw D~ Louisville, Kentucky 40216 , (502) 778-2731 Qul[/IY 1JURS SNCF /939 8 ST. CROIX COUNTY WISCONSIN ZONING OFFICE p p p p p p""~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road AN. Hudson, WI 54016-7710 (715) 386-4680 March 17, 1995 To Whom It May Concern: On March 4, 1995, soil borings were done by David Fogerty, CST003233, on the William Mueller property located at the NWY4, NWY4 Section 10, T28N-R18W, Town of Kinnickinnic, St. Croix County, Wisconsin. The report confirms suitable soils for an on site sewage system. When proper permits are obtained, and all additional regulations are complied with, reconnection to the existing system may take place. Should you have any questions, please contact this office. Sincerely, l [ Mary )J?nk n( s Assistant Zoning Administrator CC: Bill Mueller Jim Claycomb, C-21 Don Waalen, C-21 Wiscdnsin Department of Industry, Sol A L U AT I O N REPORT Page _ of Labor and Human Relations 4 Divis<n of Safety & Buildings cco with .05, Wis. Adm. r Code COUNTY IV it Attach complete site plan on paper not an 1 in Ian must include, but not limited to vertical and horizontal ref a point dire n an f slope, scale or PARCEL I.D. # dimensioned, north arrow, and locatio di tangy nr~ road. APPLICANT INFORMATION-PLE NFM REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION VIA, C / GOVT. LOT ,1w 1/4 1/4,S o T X8 AR E (19 PROPERTY OWNER':S ILING ADDRESS LOT # BLOCK# SUED. NAME OR CSM # V91 . /A - ~s / CITY ST E ZIP CODE PHONE NU MBER QCITY []VILLAGE MOWN NEAREST ROAD _ Y05- .S-Yvo 'AINAC J! [ J New Construction Use [ Residential / Number of bedrooms 3 [/j ' to , mg [ j Replacement [ ] Public or commercial describe Code derived daily flow ys a gpd Recommended design loading rate bed, gpd1ft2 trench, gpd/ft2 Absorption area required //ag? bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan bench ark Additional design / site considerations /Z at, o 4u /9 f/ o Xpr~ Parent material Flood plain elevation, if applicable ft F = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK =Unsuitable fors stem 0S ❑U ❑S OU 0S ❑U ❑S ou OS [AU ❑S OU 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 Trench Ground Z ~j o - 6 v - - elev. l a, v ft. t' Depth to 3 S- j ;t .S S m r limiting factor Remarks: -3 Boring # d v "o Vu Z40:-7 S Ground ele . iuft. r Depth to r ` 01 limiting factor a 01 Remarks: T~ CST Name:-Please Print Phone: _ p T s Address o 6reA'g 3 fs I3,? IL4 Signature: Date: CST Number: r O R m c eo cam G7 x :I tu mo=w ~ 7i~ K 41- t o h3" al 00 N C x t~ II i I Aa r \I II C v q 1! CW tcrC Z 0 a 0 v n 3 a t t O 7 ~ v - j Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Saf;,ty and B$ildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284183 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SAMBS, CHARLES KINNICKINNIC 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 Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irito ntake ROAD Dt Inlet TANKTO P/L WELL BLDG. A Ar Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss ead Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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' KINNICKINNIC.10.28.18W NW NW HWY 6 tcc.r Plan revision required? ❑ Yes ❑ No / Use other side for additional information. V1 SBD-6710 (R 05/91) Date / Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division rl.~■~■~ii 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. t • See reverse side for instructions for completing this application State Sanity ermit N mber The information you provide may be used by other government agency programs ❑~heck it reLvlisLion(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 if fffX4)C,-V 10 s yt/1/4 N 1/4, S p T , N, R E (or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Plame or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City ~1\14arest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms J [Z Town OF f,>^w /KIP/ 1/00, III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) d r o - D 1F1 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. ❑ New 2. ❑ Replacement 1 ~ Replacement of 4. g Reconnection of 5. ❑ Repair of an _____System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit Ruo~~~rl 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 q, a 75-0 E- , y Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank z Az 10 v ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber a S ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATE ENT I, the undersigned, assume responsibility for installation the onsite sewage system shown on the attached plans. Plumber's Name: (Print) _ Plumber's Signature: (No amps) W/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): !3a Zo r ?3 ©-~-3 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved San dary Permit Fee (Includes Groundwater ate sue Issuing Agent Signature (No Stamps) #Approved ❑ Owner Given Initial t5 ZZ Surcharge Fee) r4 Adverse Determination f X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber - INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. IL 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 8 112 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. ~l C A *_IS e \ Q O Q 1~ ~ VN4 ~ ~Z-w~ 11 11 it ~ n i~ 9' Z-w$ NCI i i I I 1 I IN ti I c ~ f i s ,i o I I v ~ I `C M ~ ~ ~ ~ dv,oQl Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not les 1 Plan must include, but not limited to vertical and horizontal refer (of slope, scale or PARCEL I.D. # dimensioned, north arrow, and locatio nd stanc!APPLICANT INFORMATION-PL A RINT N REVIEWED BY DATE k {N PROPERTY OWNER: ct 00 PROPERTY LOCATION 1•~l ff~~~ C> GOVT. LOT W 1/4 w 1/4,S G T 21, N,R E (ora PROPtn i Y OWNER': AILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Cl , ATE ZIP C NE IN []CITY []VILLAGE OrOWN NEAREST ROAD Qr Gv > Q 1 ~ ~ Ol/ ~3 [ ] New Construction Use [/J Residential / Number of bedrooms Z VI 4-- Maw. L J Replacement [ j Public or commercial describe Code derived daily flow J* gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 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 o!~ Parent materials w; ic,F ~ium t Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem PS Elul ❑ S JZJ U V1 S❑ U ❑ S O U ❑ S CI L ❑ S O 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 Trench Ground elev. Qf.~ ft. t Depth to limiting factor Remarks: 2 s io • Boring # ACIZ Ground elev. fj.'~ ft. t e% Depth to limiting RYA t c factor Remarks: S-!o7 CST Name:-Please Print Phone: r 6 J-4-091 'e Address: o w .Syc1 Signature: Date: CST Number: 1n~ S M /s r = f e rn o a J O- Nm fN h R Si \ vAN, A Hnf ~C Off N® 01 n N t . a 0 n 1 ( z N • }a I I 3 a ~ J ~ yr I I i V # 1 1 DEPAF?TMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND . PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ 1 MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LO ATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: UNTY: OWNER'S/BUYER'S NAME: MAILING- ADDRESS: r f a 2 USE DATES OBSERVA ONS MADE ~~~NO. BEDRMS.: COMMER AL DESCRIPTION--. PROFILE DESCRIPTIONS: PERCOLATION TESTS: Fl,,,= RNew ❑Replace Residence U RATING: = Site suitable for system U= Site unsuitable for system CONV ZONAL: MIN-GROU PRESSURE: SYSTEM-IN-FI OLDING TA ECOMMENDED SYSTEM: (optional) V~S DU ER, ❑u [:]S El S may' DU If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ~OM L PROFILE DESCRIPTIONS , t.0 12 761 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF S 1 H NESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. 1 HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- Z 7 J- o, Al, Pl e- An I, Z_7 17, r' 4 'e, B- 7 IV > / B- ,3 ? , 0& Z B- IL oo. y C-1 IPA z7n P- A Y4 B- 7 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PER INCH P- / P- P- / P P- P-Or .4 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION . . i r 4 l { =7 IN . _ a Y.-. -T' r 7 _7 a U .Q N - cr L oll , 4, ol . I eV ~ h ' / J / J J / of ,Ilk I ♦ / Tj\ N J r a ' M 3h- - Ilk, N N • N d ~ c ~o 14 _o h 4 a i ♦ o J! Ilk 1 n PAGE OF PUMP CHAMBFK CROSS SCCTIv:J ACID SP(CI('ICATIOkIS VCMT CAP N"C.Z. VENT PIPE WEATHER PROOF APPROVED LOCKING a JUNCTIOAI BOX MANHOLE COVER t5' FRCM DOOR - , WINCOW OR FRESH IZ"Mlll. AIR INTAKE I I GRADE I •1~ MIIJ. Ilk, L ~ Ie' M1u. COWDUIT IB"MIN. ~ IAILLT PROVIDE I ~ AIRTIGHT SEAL I I ~ I ~ II v APFROVEC JOINT A I III APPROVED :DINTS W/C.I. PIPE. r I III W/C.I. FLOE EXTENDIAIC• 3' I 11 ALARM EXTENOIU:, 3' ONTO ;,01.10 SC::. 9 I ( ONTO SOLID SOIL C I 1 I ow •I I PUMP OFF 0 CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TAWK MANUFACTURER HAS SUCH APPROVAL SPCC.IFICATIOUS SEPTIC AND D2Sg TANKS MANUFACTURER: NUMBER OF DOSES: Z PER DA3 TANK ; IZE : OO GALLOMS DOSE VOLUME y~ 1 21S ALARM MAAIUFACTUR.ER: M WA.U,D•l" BACKFL0W: 9 GAL.ONS __Xerjel z2,4,14-1- MODEL IJUMBER: 2LI/ - +~io li? Div A 3'7 CAPACITIES: A= -W_INCHES OR US GALLOWS SWITCH TtIPE:.~~✓~~~~ B = INCHES OR •35- GALLOWS r PUMP MANUFACTURER: ZOt'~~-l/Y ~f /77C= -LZ_INCHES OR --22-7_GALLOUS MODEL NUMBER: 13 D- yIN%,HE' o JP GALLOWS SWITCH TYPE:. MOTE:~'pUMp AIJD ALAR:~TO BE ~4/ PUMP DISCHAR4,C KATE GPM INSTALLED OM SEPARATE CIRCUITS - 1Y VERTICAL DIFFEKILUCE OljY?-wr J PUMP OFF AND DISTRIBUTION PIPE.. /ZV- FEET + MINIMUM NETWORK SUPPLU PRESSURE . . . , , . . , FE.ET 7 Se> + 4-00~ FEET OF FORGE MAIN X ~FYo,TFRICTIOII FACTOR...- 7 FEET I ,I TOTAL DYNAMIC. HEAD = a• FEET ys„ A/la h INTERUAI., PiML .15101Jfi OF TAUK: LENGTH ;WT T V A i LIQUID DEPTH same 91GA1 LICEOSE UUMBER:1 2$ / DA-TE: _.117_ IF X l Os 6' CA 'c 6 CD 38911"o !J. 55" 'It', CERTIFIED SURVEY MAP LOCATED IN THE NW114-NW114 AND NE114-.NW114,S.EC. TEL 10,AND THE NE 114 OF THE NE 1/4 OF SECTION 9., T2S'N, R18 W, TOWN' OF KINNICKINNIC,ST. CROIX CQ,WI. OWNED BY: 60RDON MUELLER, RT. 2, RIVER FALLS, WI. 54022 NOTE: SEE REVERSE-SIIE FOR DESCRIPTION. / S• y v NIT° 00 .0) X66\ \z m o\. v NCO \ CP_'D N O ' D, ~ ,O' +UxD V) X U) z =N O~ tOj2 ~ -C) m O Dk-IO ym y I I '{n-1~ 3o aNOZ y aol °DIm ;OCNO~ . 14 0 ;a °Zm ; !2 0l I ~l0 2ZZ D O ( MONUMENT TO MONUMENT)-bI N W (TO ) K` ~Zp SO°55'40"E 2633.94 N1 1 7? 659,7' 626.63` O f i ro I (TO R.O. W. ) ~ N+VI C7 I ~!W r OI O N Ml M. (n m W V OBI O O TIM g I I m ~z i N m o ao 6 ~ v i ° of , p ~ X O O_ p~4 -t ? N A O 20 V a01 L _ UN C)ti m a° v ^ ON Q Z Q, m m 2 y L 2 Ln y p ao `y w ~o Q rn ca ~I cn n •nI co b. N7 w 3 O 3mZ O om cmn STC - 105 SEPTIC TANK MAIN'1'1,"NANCE AGIZI,'I:N 1,"N"l- St. Croix County OWNER/BUYER C/f G~Ck S.~ It~J49j MAILING ADDRESS PROPERTY ADDRESS Y~ 3 6 ~a5 f-.' Qcr (location of septic system Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION IV 64,-' 1/4, 1/4, Scction /0 T X r N-R Ze TOWN OF /c~Wyrck ,tr ~c ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME, PAGE /33 , LOTNUMBER 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. SKJNI D: I)A' L:: 7 ` Qty St. Croix County Zoning Office Government Center 1101 Carmichael 1:oad Hudson, %VI 54016 103 /11-t- r a,e N l ss - 6 as ~vr~r~rT s Sa oN ,fir -r /zc~sv T 2o~v~-~v~ Of Fi« ~cvc.Rr~Locs,E~ ~ a.~ i~iLo w, - / 7 /y6 K/ ~rC/F t f/(G,it ~77 S T C - 100 A 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 ct/aclc fiy~/yiBS Location of property N w 1/4 ,yw 1/4, Section 16 , T --Y N-RAW Township /Cxrv,A-reMailing address /l3(0 /'rr~6womf> L,v, Address of site _ VZ3 Subdivision name Lot no. Other homes on property? Yes ✓ No Previous owner of property 'c'~Z ~ ~'/Z Total size of property 2-1 1f c /Z ,F-s Total size of parcel Z.1 Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house) ? Yes L-~'No Volume / S and Page Number /3 3 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. 54 5W , 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. rs 6 !~'rt / Signature of Applicant -Appli n 4r 9 IG Q- / / -J6 Date of Signature Date of Signature Sate hr of Wisconsin Form 2 - "82 ' WARRANTY DID DOCUMENT NO. i~~f ! hJ itcsoocS OMCE col wl did for Record Yill l Mueller, , m _y_gj a_j • Tier, MAR 4 199b husband and , at 2t00 P.p+ ooare and va"aab b A+.r1~e F SAmbe .jtldith • ` ' _Ubwd Wd fete: at TNb ME8EMMD FOR MCOftXN0 DATA NAME AND MTUM ACCOM *a FaMn da At red mace is St. OMIX l O~r~tK V ~ sub 4 e 022-1028-80 (Parcel wat~atiDa Nombcrj !'fart of M U/4 of OW4 and Wl/4 of AW4 of Section 10-28-18 described as fo learist bat i of Certified Sw.ey Map filed Ilciiwember 9, 1983, in Vol. "Sr', IM MU 2365.. WM 66 foot wide roa&my easement as shown on said certified Mhp- ,w Y b t •-_k Wank" pl"a y ~s rEBLZiCtiOn and ri&t8-of-my of nwAxd, ' , ~ '.e%c r~ rs DaMdtilir- ~ ipd_- Mare , I! ~ x ` ` 'aEA~) s A. (MAL) T --(sUt.) ClariaJ. !filer (L) a A•RT ACIKNOW MMMENT STM(WWISCONM CiX I IL _ db at , I! l "Oft.cam betme66 Z2nd day of N-21_ at Am maw l A. Mueller ~~r - - AultIlIC lilt ler . husba nd STM RMt of WISCOlm ,amok auftr( by SM. Wk ![pr j C ltlfli6 M. (31 pn r •e kww to be me i afro ed The tea "STnu~s► WAS ORAFM ari _ Win a~ ~ ~ . / NOR ~ pi~bliC