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HomeMy WebLinkAbout030-1095-70-050 N °o o 0 h 69 N ~ U O Q O O ~ C V) l~ II N O N U N M O N co M O 4) ` N U d Y y ~ N ~ ~ O C c z° 3 pcDcC') cq o p ° - N v co "O `mC: to c Q > o Er-U)070 m o - Co p O N O O O. O c C w o E -C co '-m 00 y N Q O-5 E~ 'O N U Ul) O x C p w a O U) Z co x fu,'v 3 0a)0 a)) LL c c~;L Z m y o p s ~ :s Q) ~0.Ln3wop d N N N Q i m (6 to 3 ~ V N Z N O E Z O O Z m aai M IM- ~ ! a m 0 0 2 d c 0U) Z d p o fA l- a- I'I N Z c E -O 0 O) M N O. O N N N (n N C L C O C C I U Q Z Z w N *6 z _(D Cl) N E a) N ` ~ O I IL G r a. p O cD N d 0 0 0 o C a N N E Q) 0) 0 a p ~ H H H O O I O Z > _ LL LL O O O ° •ti cc c a a a A Z a N r~ Atoll m0)0) p (n J U 2 a) rn Z Z: :z ~J > o ) ° 0 Q N :0 O N O 3 E O -6 N U 4 d . X31 ~ 04 d ~ p N ~ I N C ,V O 7 p 3 o © o Q p ° M o o 0 r-- ~ y c c o-j o \ M L Y Y ' N N a) v Oj 0 C C C N' c (D a) C ° O O C N 2 O 6 CY) 213 a) c) C,~ 0 CC) U) co m _5 O M (n N O Cn C3 I m n m a ~ I • C a d d C 0 r 0 a o (n U (REAEw D STC - 104 i-'~7 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS _zoZ32- /,7L7' L.- -e h % )r Z- 85'0 2 7 SUBDIVISION / CSM# 4!Q1 J'73 LOT # 7 SECTION 3 Z T 3a N-R Wr Town of ? 1~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHO EVERYTHING WITHIN 100 FE T OF SYSTEM 2' /gyp t Sao Sboa \ /`t ~ SHRv'~'yD/T l ~ 0/1 3 ' T° I cvfG~ ~ Ste' ~oRti~~ of ~'FS'E, Z 'O~L G7,- '00f dv.'4 INDICATE NORTH ARROW ?rQV,j de e k t rHZthd elevation information on reverse of this form. d Provide 2 dimensions to center of septic tank manhole cover. w BENCHMARK: T?>~ Or ,vr y e-a2•GAC_'fl fAf~'!/~Lo.~ 6 D IM-0 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION J,r, oo Manufacturer: 61-le-e L-C Liquid Capacity: ~•S, d'rd Setback from: Well > /oo ° House 7--,' -other Pump: Manufacturer '519 UGs.) Model# e icq_?Z Size Float seperation /y" Gallons/cycle: ~Sz Alarm Location e5-,wv7- SOIL ABSORPTION SYSTEM Width: 4/ Length 7s'" r Number of trenches Distance & Direction to nearest prop. line: o l .l'/.j47`4 W if f L fNG 'rLrf~ /Nit ~e 6G Setback from: well: ;>/-17-0 i House / ~ o Other ELEVATIONS Building Sewed/oa. ST Inlet: ?1J:IV ST outlet: FJ.9Z PC inlet r'1,82 /PCpbottom yS.3 Pump Off 9,5; f _ r, i is z Header/ManifoldA~a ~o Bottom of system 111113 ioo•oExisting Grade /©L,3 Final grade 1v6,3 DATE OF INSTALLATIO : /n6 C PLUMBER ON JOB: LICENSE NUMBER: 3 y.p~ INSPECTOR: r` Gr e~ FWMY PLUMa 3/93 : j t DATE: JOB PT: _ : G - 5-/z I JOB SP: l a, r ).+t a.•. : A& 14C r=.'.:,75.. a. rs -l?''R'rsY♦ in //,-y. at ♦t'. LS.. VOL 13:30PAU-1,116 CaS . F., GRANT OF EASEMENT ~r t, DELTA CONSTRUCTION, INC., a Wisconsin corporation, Grantor, record owner of the real property REGISTER'S OFFICE i, described below, f.)r good and valuable consideratie i, the ST. CRO!X CO.. WI receipt of which is hereby acknowledged, does hereby grant to ' BRIAN THOMPSON, his successors and assigns, Grantee JUN 0 9 1998 herein, a permanent easement for a sanitary drain field located 8:00 A M on a portion of Lot 6 of the Certified Survey Map, Volume It. H., llalb , .r o..d. J ~v Page 3180 as recorded ir- the Office of the St. Croix County Register of Deeds, being part of the South half of the Northwest Quarter of Section 32, T30N, R19W, Town of St. Joseph, St. ra ° Parcel No. . Croix County, Wisconsin, described as follows: RETURN TO: - % 1~►, z_.il Commencing at the Northeasterly corner of said Lot 6; thence along the easterly line of said Lot 6 S26°52'04"W 60.00 feet to the point of beginning; thence continuing along said line S26°52'04"W 50.00 feet; thence N63°07'56"W 15.00 feet; thence N26°52'04"E 50.00 feet; thence S63 °07'56"E 15.00 feet to he point of beginning r; This easement is given for the purpose of establishing, constructing and maintaining on the subject x. property, a sanitary drain field for a homestead located on Lot 7 of above-described Certified Survey. ° . Map. c VA ,A Dated this Jii'7C.day of June, 1998. r DELTA CONSTRUCTION, INC. %A ;Y By: Virgi D. Fedorenko, President STATE OF WISCONSIN ) ) ss. a ST. ('ROIX COUNTY ) ' Personally came before me this ~ay of June, 1998, Delta Construction, Inc. by Virgil D. Fedorenko, to me known to be the person who executed the foregoing instrument and acknowledged yA the same. Syr„ No lic, State of Wisconsin My Commission (expires r THIS INSTRUMENT DRAFTED BY: Attorney Barry C. Lundeen 'MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, Post Office Box 469? Hudson, Wisconsin 54016---i PAGE GF PUMP CHAMBER CROSS SECT1014 AUD SPEC' FI1CAT10k!S DAVE FOGERTY PLUMBING Licensed Perk Tester & Plumber ` - ZS9 VENT CAP 03233 M3 p~~#y tS 5102 3 ydIRSNSIN Phone WEATHERPROOF 'P"V VED LOCKIAIG ' FROM DOOR, JUMCTION BOX I-N / } t C1 HOLE COVER Z5 +'s WIMDOW OR FRESH IZ"MIU. AIR IMTAKE GRADE I I `I" MIN. CONDUIT I8"A1M. INLET PROVIDE AIRTIGHT SEAL *f A I ~~I I III I I I ALARM a I II t I *APPROVED i ON JOINTS WITH i ELEV. FT. APPROVED PIPE 3' ONTO PUMP--_ OFF D SOLID SOIL ` COIJCRETE DLOGK RISER EXIT PERMITTED OQLy IF TANK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFI'CAT10MS DOSE ®~p TAMKS MANUFACTURER: r!/Ot CS IJUMBER OF DOSES: 2 PER DAy TANK SIZE: GALLONS DOSE VOLUME -7,7,7 7`-Z ALARM MANUFACTURER: iii 0 j^/yL INCLUDUJG OACKFLOW: cs-.3T GALLONS MODEL 1.1UMBER: L//e !/is~.,a~ CAPACITIES: A=IMCHESOR GALLOAlS SWITCH TYPE: e - 6=-.-1_IUCHES OR GALLOAIS PUMP MANUFACTURCR: G-~ihu ~p t C,= INCHES OR T-2-_ GALLONS MODEL NUMBER: 4V49011, D--•~IMCHES OR -f GALLONS SWITCH TYPE: Af9&t &f MOTE: PUMP AMD ALARM ARE TO DE MINIMUM DISCHARGE RATE SD GPM IN57ALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREUCE DETWELU PUMP OFF AUD OISTRIBUTIOU PIPE.. Z-9-_ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . , . . . . `elifr- FEET _t,41 F T,1 + _LZ_ FEET OF FORCE MAIN X L Ioo FLFRICTION FACTOR.. FEET _ TOTAL OtiWAMIC HEAD = FEET INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH Ir ;LIQUID DEPTH 51GIJE0: ~S LICEOSE NUMBER: T M performance Submersible Effluent Curves Pumps METERS FEET 30 100 I ; SERIES: 3885 SIZE: 3/; SOLIDS : _ 1 _ ; L_.... _ ; RPM: VARIES 80 f j 5 GPM 5 FT L i - At a t 2 20 60 ly _ { a - i I ~ Z 40 ly : O S _ F- 10 M f I ~ I f : I _INQ 20E 3 I I r I ' I 1 I I f I , 0 00 20 40 60 80 100 120 140 160U.S. GPM 0 10 20 30 m'/h FLOW RATE [qGOULDS PUMPS, INC. WATER TECHNOLOGIES GROUP SENECA FALLS. NEW `lOW 13148 METERS FEET r SERIES. 3885 120 i 35 i:..._ SIZE: 3/4' SOLIDS RPM: 3450 110 ~ s,~~ ~ ~ %5GPM ' i I 30 100 I I ~ 90 w 25 80 -i-- I .-1_ - - U 70 a 20 f I z 60 - J 15 50 - - . . _ O 40 . .1 z 10 30 I : : i 5 20 ' I. L_........ . i. 1... i......_ 10 0 00 10 20 30 40 50 60 70 80 90 100110 120 U.S. GPM 0 10 20 30 m3/h CAPACITY Fitective July. I9s3 1993 Goulds Pumps. Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRIN IEi) IN 0 5 A. W S 038853.150 WiscoRsin ~epartmentof industry, PRIVATE SEWAGE SYSTEM County: La ora ~manRela±~onsr^' ST. CROIX Safety an Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION nn 284226 Rtlki NU1V NarViLLIAM -ST y JOSIEI~H Town of: State Plan ID No.: CST BM Elev.: Insp. B Elev.: BM Description: 2 Parcel Tax No.: 4,roG.r Ir TANK INFORMATION ELEVATION DATA A9600472 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~GJ •p Benchmark Dosing Aeration Bldg. Sewer 8G Hold St/Pt inlet 9,66 TANK SETBACK INFORMATION St/ Outlet y~ 30' TANK TO PI L WELL BLDG. Vqe Intake ROAD Dt Inlet c/d Septic ® NA Dt Bottom J 40' i62- %Z' Dosing NA r / Man. Aeration NA Dist. Pipe Bot. System c PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand -e- "o, d $(o /i 1 e C-P Model Number GPM TDH Lift Friction System TDH Ft Head yzo, F o r c e m a i n Lenf"t r Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS EN 1 N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ~facturer:SETBACK CHA R Number: INFORMATION TypeO System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x H ing en Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound O -Grade Systems n Depth Over Depth Over xx Dept f xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Tops: ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) jf f ~s n C LOCATION: ST JOSEPH.3230.19W.SE.NW 126TH Ay,E © a.,~u n . , mac ,dom. a< 60'~~ j~,Q.~ cJl t l~. C7G.,4-k~.1 112, Q d¢~r,a~ r Jj ~t ~c,~1r~ 1617p -7r Q~ lO' tot, Plan revision required? 2"Yes ❑ No U Ti- I I Use other side for additional information. SBD-6710(R 05/91) ✓IA nJ(c;tt Q~ Datf~., Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w ' 4 d~~E. clerk ~f cale r1 X~ t SANITARY PERMIT APPLICATION Bureau and uil ingWater ureau o off Buildin 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. p • 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 Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION ZffqA7_4 Property Owner Name Property Location t 0, e 1/4,4, 1/4, S 2 T V , N, R E (or) W Property Owner's Mailing Add~rg ss Lot Number Block Number 17 4tv 7 City, State Zip Code Phone Number Subdivision Name or CSM Number Mo L 2,7 ( AOt ? - I. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0,70 - L4 3 O ®SW 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 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 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 120 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: ,fj/s z, F 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) 1p.,, y" Elevation S'd O S' YVAIP i Feet Feet VII. TANK Capacity Total # of Prefab. Site Fiber- App INFORMATION in g Gallons Tanks Manufacturer's Name PConcrete Con- Steel glass Plastic Exper New Existing structed Tanks Tanks Septic Tank or Holding Tank zom ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation o 349e onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumb Signature: (No S )s) M+I1MPRSW No.: Business Phone Number: U I , j ~~J~7 7 ~Yf -,74 s 0~ 7- Plum er's A dress (Street, City, Stat p Code): J- is 23 IX. OUNT / DEPARTM NT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps) E] Approved F1 Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ' S 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. 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. K w W L ~ q 1-, a, 3 T sc / Ilk K O. ~ X f p ~ a a Z ~ M v b 4 p to . Labor Wscon-tin Department Industry, SOIL AND SITE EVALUATION REPORT ` labor and Human Relations Page / Of _.7- Division of Safety 8 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 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. S- _ 70 - s'-.0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Cv f ' rr GOVT. LOT S6 114W&) 1/4,533 T_ro N,R E (o~ PROPERTY OWNER-:S MAILING ADDRESS LOS BLOCK SUED. NAME OR CSM It 20.2 2 _ CI `STATE ZIP CODE PHONE NUMBER (]CITY (]VILLAGE MOWN N WEST R~9 v 14 r5.0 .2 .7 Jr? - k New Construction Use [ j Residential / Number of bedrooms 3 [ J Addition to existing building (J Replacement [ J Public or commercial describe Code derived daily flow S~o gpd Recommended design loading rate bed, gpdtft2Z z trench, gpd1ft2 Absorption area required bed, ft2., , _7, 'trench, ft2 Maximum design loading rate bed, gpditt trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations /fIDlLUL~ Parent material Flood plain elevation, if applicable It F TUnisu ble fo r system CONVENTIONAL MOUND IN-UND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK itable fors stem ❑ S U m S ❑ U ❑ S )zl U El S ®U S 14U (]S [4U 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 2G zc F s Ground c L_ /N elev. WL ft. r' I Depth to limiting factor Remarks: L3 Boring # Ground elev. X~> ft. ECEI Depth to limiting Q 1~9 factor ° s Remarks: CST Name: Please Print Phone: 9 Address: Signature: Date: CST 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 1/2 x 11 inches in size. • See reverse side for instructions for completing this application state saniifary~Per~mitt N~7uom'S7berr The information you provide may be used by other government agency programs El Check It revision to previous alpplication (Privacy Law, s. 15.04 (1) (m)]_ State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location .t. 1/4 11W S r~Z T..?&) , N, R E (oq6 Property Owner's Mailing Address .,tom Lot Number Block Number A ' 44 7 city, z t Zip Code Phone Number or CSM Number D >°.~ZI~ L 'v II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 E] ToVillage 1.7,6 wn OF Sir. ,E Y 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Numbers 1 ❑ Apartment/ Condo D 70-1V - 70 - O 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. 0 New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System ------System System Tank Only______________ Existing System ---------Existi 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 ;A Seepage Trench 22 ❑ In-Ground Pressure 42 Pit Privy 13 ❑ Seepage Pit 43 Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 2.>f 'r 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 Feet fva APO _75- jf .0 feet Z0.7 4 VII. TANK Ca in galloacits Total # of Prefab. "eft Fiber- Plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete st u~ted Steel glass App. Tanks Tanks Septic Tank or Holding Tank ❑ ❑ IJ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's, Signature: (No amps) r~_ RSW No.: Business Phone Number: c • P.~ AV 7 PI er's Address (Street City, State, Zip Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial p~ Adverse Determination O X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 6' IV V SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings 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 tewage.system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate thissanitary 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 13 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 orawith complete dimensions, location of holding tank(s), septic tank(s) or otherareatment,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. V v ~L W J ~ ~ O ilk 6o\ r ~ ^1 ~ ~4 ~ ~ x O 0 d +4s W /-7 M ~ r~ K Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749-3656 TYA'~ . •Tr= / 1. e/[v. /02. 8' 1A ' n 9 - ck : /r/dyiF Wisconsin Department of Industry, SOIL AND SITE EVALUATION -Labor end Human Relations Page of t Vision of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 6 1/2 x 1 Plan must County include, but not limited to: vertical and horizontal refe c bi t B it n and cgoz:r percent slope, scale or dimensions, north arrow, a and dista est road. Parcel I.D. # APPLICANT INFORMATION - Pleas t all gr~. xr- Reviewed by Date Personal information you provide may be used for se n purpos;s ( ny Lav 5.04 Property Owner c P Location ` i2 t °t,, o of 1/4 1/4,S T N,R E (or EC T w v SE w 3_ 3a / er Property Owner's Mailing Address ! m t Block# Sabd-.dame or CSM# City State Zip Code Phone r Nearest Road ❑ City El Village ~ Town ~ v New Construction Use: ❑ Residential/ Number of bedrooms y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0O gpd Recommended desigp loading rate bed, gpd/ft2 . S_ trench, gpd/ft2 Absorption area required bed, ft21T2,9a rench, ft2;XFWe'4 *1 i b2, 8 MaximTj design loading rate bed, gpd/ftz -trench, gpd/ft2 TRE~vt/(~a Recommended infiltration surface elevation(s) d r~F>ucN 3 ioo. o ft (as referred to site plan benchmark) Additional design/site considerations &&&Ued TjZF,t/c~f~S QVI-K ^ *Si.sf t©Zede--) e-am7p uR F)rxc7-T_ Parent material h.~~frl 401, 66t'_ M X- 2 ~Fn C /fE•S Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding TanlU U = Unsuitable for system [A S ❑ U ❑ S [Z U 0S ❑ U ❑ S ~ U ❑ S m U ❑ S ~ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Imo' Z - o- sL w - ,f Ground 3 L S S L - • s elev. /Qd.2ft. Depth to limiting factor in. Remarks: 4-3 .7- RAI= " I EF4 EEC 7-5 MaD 2_l~T Boring # S 2 S l - 61 i rL c Ad FIZ L -2r M F cv - - 8 far, -7 - - G~ AAL Ground elev. 1p~2 ~ft. , Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number o /~4 E wS ~z 6 Zo 311,3 PROPERTY OWNER yE L T-4 SOIL DESCRIPTION REPORT Page .Z oft PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 1 S F i oo, z Z - L o- L Fr , Ground 3 2 -21 0& tor" Al 4. elev. Depth to limiting factor in. ~fTf'/L T 3 T /t- 6f Remarks: A^Aof> : 9%#'ee'Me:W puT Boring # I V- /a o - .Z SEZ- 2 AA .5 c `Gt fps E p 6-- - - Jwz- 57- Ground elev. /o L•3 ft. Depth to T-_ limiting factor _ in. Remarks: #3 - S~r!?iF 1¢S !AZ=-&Z 6US Ak 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # r _ Z F-k S S` -3a /0-(/- -3 44 S 9,t AA F.z w - 4S ItgA, AA L Ground elev. /o l • 3 ft. Depth to limiting factor in. Remarks: Boring # 62=z a- i - .r'L z F-1Z 27 52 3; r- 3 7-9 - L~;ARUej&6 44 L - - - . o Ground elev. ok -3 ft. Depth to limiting factor - in. Remarks: &I - SIB *IE L 5 4481b ~ 6')U cElZ Al S . SBDW-8330 (R. 08/95) ° t 3 w w k lL N LL 'A' OCN LA 014, i v $ M W ~ v jz 8 Ix' , Ar yiF' a~ s ~ M i ~ b ° v i1 i .__.~_..__t_.~.. _.,..e__ ____y.-_.--r.__ ~ i ~ 1 i r i I i r i _ r_ ~ 1 j ~ t 1 i- i i } ~ + r I i i ~ 1_ i i i _ . ~ _ . - - _ _ _ . _ _ j I ~ ~ i i ~ r 1 ~i i ~ ~ 1 ~ i { ~ ~ ~ C 3E Ln a j ~ Bearings are referenced to the C o r west line of the NW>k of Section o o ' 32, assumed to bear N01°48'04"E. o C) z rWVC'o 1" Iron Pipe Found ' o -n UNPLA T TED LANDS S20°37'35"W, 0.49' - - - M csol°4e'23"Wl of computed position. N0104810411E West line of the NW7k o N01°48'04"E 531.04' N01°48'04"E U) -4 773.29' / 00 = i / /0 1304.33' 0 t0 n ti M 10 3E 1 :3 0) 01 / ` ' (S At N I C) / S01 °48'04"W -1 K s~+ 265.02' s tt Itn / +-3' u? I< W O 0 / d o W r .0 nr zD ooi o I r- lit ro N tD t1 K rt v3 o olm (n(D it / 1 / O 0 I? - N IN m 1'Lt ~ En O to Cr o a s -o s~ l(.l Z M 83.33' / o co a u-3 c O ar Ct n v° N I` ICS w o co N OD co IUD I CD Q. I FJ I Ct N (t a N o gr - n vO1, (D a~ ct, !n U1 10) I I :E OD o,~ea :;,a~at < s W E 1-h M H -~1 o co c or 14 0) tr 0 ;0 CD 28 w 9 0 0) (D -n Ip ww 1 is'O t:V -CF- 0~ ENO rf I~ ~ d Ct 'a) x as ~ ~ ~ Cw~' v _ 1-J Ir C (D 0) tii v' a J-Q~. S' ti e,v Q 1 IL Q K M UHF Iy c. IGl H- I RA 0 Ot 39 1 1 o v` 3?9'?3. 0~'`` Q 10) 00 _ L 1U) N N 0 Q I ~xn~c~v~ o q z - I c o w c~ r W t1j I 3S N °i O- m oa- -2Jr I I 686 o~<a z z no (A 0 0 -7 09 ~c~•t'n S ss. ?6°s0,r O FcA-~ o~ cc(ltkli\1'1'1' / I 3?,,* , o c a n , (p . 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PROPERTY ADDRESS y-10 C A&Z (location of septic system) Please obtain from the Planning Dept. CITY/STATE 17zlk46~ ~r UZ y0/~ PROPERTY LOCATION ,5:;5~_ 1/4,4~ 1/4, Section 3.2 T_N-R11,9 TOWN OF %Bl~ ST. CROIX COUNTY, «'I SUBDIVISION - LOT NUMBER 7 CE TIFIEDSURVEYMAP VOLUME PAGE LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l) 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. (/«Ie, 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. 1,,, , l DAT1- r L Z - 9 St. Croix County Zoning Office Government Center 1101 Carmichael Load Hudson, \t'I 54016 11/93 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS V2-,a /-Z 2,0 (location of septic system) Please obtain from tfie Planning Dept CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section , T N-R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER -,7 CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • 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 &~,*W IWc "~Iwey Location of property_S6 114114, Section .CZ- , T Z O N-R/,0'_W Township (7. ~df~yff Mailing address Z0 332 'V, J',02- L.q o.m~i~Tx . 2 Address of site -'f,2p /.26 f/~. Subdivision name Lot no. 7_ Other homes on property? Yes ✓ No Previous owner of property Total size of property Total size of parcel -F ,gG~Es Date parcel was created Are all corners and lot lines identifiable? t/Yes No Is this property being developed for (spec house)? Yes _~No Volume /~7s and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ~j_ f'Sf/ 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. Signature of Applicant Co-Applicant 1 Z - -I- . q Date of Signature Date of Signature . 515854 107 420 iiZCxl~ tR~S Q~/ STATE OF VVISCONSnN a SS. COUNTY OF Sr. CROIX ST. Cit01X CR. y 11~d~orfOrwty Recor requ ested by and APR 2 6 1994 when ernrded mail to: ~ 1 i 30 . _ j]tA VrILLdAM N. McKINNON 20232 North 17th ]:•~e phoenix. Arizona 85027 WW'- MIN DUR CLAIM IREED THIS IINDE,IVTUItF, Made this 25th day of January, 1993, VVIILTAM N M Ka~tNON and an unmarried person, party of the first part, and PHYLIJS of THE McKINNON FAMILY TRUST, estabUsbed -'M. McKINNON as Go-Trustees January 25,1993 and any amendments thereto. party of the second parL WnwosseM That the said party of the first part for and in consWeradw of the sum of Ten ($10.00) Dollars and other good and vab s" consideration to her in hand paid by the said party of the, second part, ft., receipt whereof is hereby confessed and acbaowledged, has 6 soK ni" r . , and con& ed and by these presents gang; bang" s4 rendkP, 10444 . t air anS confirm unto the saitt party o ft second put his or Yu r beft and` &wi- ed reef iWited in ft 4 a" Of St. Clc* and State of See legal desc riptton attached hereto as Exb bit "A" and expressly made a part hete0 .r. TOG ER wuh alt and a the $erecfibumrents and , Wonting at in any., wise and 'aft ttie estate, ri^ tilt, demand ar~ver a[ ft said path of t it f M parr air is Ieat. of mffse~,, awl agty: Inpossession nr a of in and W the abov b ps t E~ ' y r'. a> m k:' ~r a T ~k nts and appurtenances. 3 u e9+ ' a N r TO HAVE AM TO HOLD the said premises as SBove ~~riD~d with the b me^X1 , WOPS an tcnances, vuo the said party of the second`'ywt. Wa or her beta and IN V1t1TNESS WHEREOF, the said party of the first part has hereunto set her band and` seat th 25th of . Mat 34 Kafthin - r rttic,t' w-.MCKlmm and Phyllis M. ~ . z {s,~i~~. mat = f71 { .'iGr y cprscfssian M<$rnoos~y- as e--~;¢x7~ 1997 JJ►7/,7t. P t;~. ~ ~°~rr ~ ~ 'mow 'P ✓ ::'M. .f ~h y~ k: - w » » se JKr o ~ 1F~'~irj - •.f.« ts0 followius described rsat -stela 6e S~ • Cr0 x ..»....Oooa4s Staft of Wie"Usia: Two larw Net .-M-1925=72 SE*NWt except that part North of 01 Highway "r; also except Lots 1 and 2 of Certified Survey Map recorded in Vol. 6.-page 1736; also except Lot 1 of Certified Survey Map recorded is Vol. 6r page 1587; further except Lot 1 of Certified Survey Map recorded in Vol. 6. page 1737. Sec. 32-T30N-R19W. • Subject to an easement as described in a deed recorded is Vol. • page as Doc. no. Tbb XM Of _Q amptim is varraatks: Existing highvayst easements and rights of way of `record. Dated tom: ........~f dy o! ;Tune 3t..... (REAL? . ..«............N.....«.«(S~tL} (STAL) Ph Zia K. McLinnoa...... • « • . - .N•....... iv:RANTICATio>>s ACZNOWLBVGMNNir Iii BTATS OF WUMNSIM 1l~Q. pessoastb came bstor0 ass tlda .»....:_,.....daic at - t14......• the ago NUO" • IIa tar~l-el~~ ,1 , a 'M ' - .-M` ve. ...........3 S. 4 SYTS~ is a» U"M to as pax= i a r ? anteing G-ats="A* and aetaowbdp t1u aaaw n E Two MaTnumspa WJw DRAFT1 or ar f s w z -Au"Ut Wig A.- go -fin &M AL, Swim wi IMM., aqp if t. t M aa; . ~ 1 r COPMAW" „ „ ~ 'fir-. qn~of s-eMas dsnba b wr a a-MY Awld W A g O M 91404-4 bdow 1wMr -tnobvw j < L ~l