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HomeMy WebLinkAbout038-1176-90-000 ~ w o I 0 u 0. o o N ~ V CV O O O c O N ° I oou o ~ I aNi ~ x I o a ih z (n c 3 ° m'o o c 3 ' Q E I 3 ~ z w E w w z « °o z w a m v H z _ ° o N O z d n U 0) Z e} = c ° Co F- 0 o m hw E ~ •+~J o O N C l~l C Q N O z z O N z I 4) E c C i CD O m d N m i O N 0 0 (6 > 0 0 d C N ~ ~ > fn N N _O w`~ ON F- ►i ° 0 0 0 a s z o C a a a ~ o N *i g fn U Z °2 ° o ' } o I T3 C, O O N O N E M O (n O O 00 L m N ~ N I O D N N ~ ° cn m G c ^ H O O 3 N N N C C) O T O C C E O O O O F- O O N 4" 6 OR ai a a :1 a) rn °o N _ N O w C C E E m co co y.. N W C O O 5 N N C 7 d a ¢~s N H H cCD W ~n 2 00 ~ a0 M U) ° y E E v Cl) O to li (n N O N =5 =5 2 Cn • y~O ~ I E L 7 L: d EL rr`0 a V C C w ~1 A 0 a 2 0 m 0 9 1 Q STC - 104 AS BUILT SANITARY SYSTEM REPORT Cb RECE10 ' OWNER RAC) STP, O Eg n! ST vN01%, w ADDRESS KCV%l R100,nQN0 1~/L 5J01-j ~ (-G'Jffry ZONINGor-pCE S ~ SUBDIVISION / CSM# yaP~S~J IS LOT SECTIONT 31 N-R_ 1,8_W, Town of-.-'~-VA-R RAE ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM IY f ~ I p GAL WC-06 P.C I O ~ 50 O tiW SE /coo wEe 5.;~ S~- Sd wELL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tangy: manhole cover. BENCHMARK: U ALTERNATE BM: 0 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION LvECKS >000 CT Manufacturer: vve KS Foo P,0 Liquid Capacity: Setback from: Well 50 House 4111 ( Other Pump: Manufacturer ZCAQE2 Model# /U Size Float seperation C9 Gallons/cycle: Alarm Location Z ~ I~t30G'E p~ ~.SOIL ABSORPTION SYSTEM Width:-Idf Length Number of trenches Z Distance & Direction to nearest prop. line: SU E-AS7 Setback from: well: -i So ' House ?O r Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet (-?3,0`7 PC bottom 9?, Pump Off Header/Manifold X15, 2y Bottom of system '7t/. 51 Existing Grade Final grade DATE OF INSTALLATION: 7/Zb'/9& PLUMBER ON JOB: REF ) = rbX LICENSE NUMBER:fi (O SCE INSPECTOR: ~1 VY~ 3/93:jt Wiscdnsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268558 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: STROHBEEN, RAY STAR PRAIRIE CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600271 ?1-266 - A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C yz~ Benchmark Dosing ri it . vLf ' o s ^ Aera ' Bldg. Sewer 6 3yi _HaWn-g-__ St/~tf Inlet S d~ TANK SETBACK INFORMATION StIW Outlet Vento TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet S/ Septic > 50, > 4- NA Dt Bottom Z, 2- Z' Dosing > $50 >/Gb ~ _00 ~ NA Uzzibec-/ Man. S,G)3 Aerati NA Dist. Pipe Holding Bot. System 7 /y' -7, -7-/ P P / SOWN INFORMATION Final Grade Manufacturer 0 ? y Demari"'~ ° p 8 ~6~ Model Number ~®f ~P Mal, 99, TDH Lift Friction ~ j Syste~ i:I TDI ` IFt Loss Head Forcemain Length I()1 % Dia. _~2 ' Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches PIT No. Of Pits Inside Dia iq pth DIMENSIONS a// DIM N I N o SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH ~SETBACK INFORMATION Type Of /lew- , C BER Mode Number: System: n'(ou-aGJ ' OR UNIT DISTRIBUTION SYSTEM Header /laid q Distribution Pipe(s) ,r /t x Hole JSize x Hole Spacing Vent To Air Intake Length , r • Q Dia. o2 Length( Dia. r Spacing S7ir 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: Star Prairie.4 31.18W, NE, NE, 110th Street r: r Plan revision required? ❑ Yes 0_1`1,0 Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ~~■~r■In 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. 5-L Croix • See reverse side for instructions for completing this application State Sanitary Permit Number a~ gss8 The information you provide may be used by other government agency programs ❑ Check it revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pro erty Owner Name Property Location D'h4ill 1"',997 A/ IVei/4 IVF 1/4, S T 3/ , N, R /S E (or) /C Pro pert y Owner's Mailing Ad dress Lot Number Block Number _ 8- V Z , 14 Cot , State Zip Code Phone Number Subdivision Name CSM Number ER WT_ y 00! ( > MALL 1~vAl Ill. TYPE F BUILDING: (check one) ❑ State Owned ° !t Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ° roan OF S RA E 70 I Ak T 57- III. BUILDING E: (if building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo 1.003$- Z © _ /0 S0 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. 3System New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an -----------System Tank Onl Existing System y------------------- 9 - 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 ft.) Propo ed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Z Feet Feet Vll. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existing Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic APp strutted Tanks Tanks Septic Tank or Holding Tank ZQO Z~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 800 C) ~E~KS ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Pt bergs Signature: (No.Sta ps) MP/0rI`WSVM.: Business Phone Number: _8AlZ lumber' ddress (Stre , Cit State, Zip Code . IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing A ntSig Trips) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit 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)-ocal code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this-sanitary permit application most include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax numt)er(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 Dv~elling. 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, re.:cnnection, 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, nurn per of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all s:~ptic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experirnenta' 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. SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations July 11, 1996 209 West First Street Route 8, Box 8072 Hayward WI 54843 CROSS COUNTRY EXC PO 295 DRESSER WI 54009 RE: PLAN 596-20574 FEE RECEIVED: 180.00 STROBEEN, RAY E1/2,NE1/4,4,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, , Thomas L. Braun Plan Reviewer (715) 634-3026 7:45 --4:30 6391R/ 1 SHDA-6928 (x. I(M) i I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations Juba 11, 1996 209 q°~at First Street Route 8, -.ox 8072 Hayti:at::d WI 54843 I '"ROSS COUNTRY EXC PC) 295 DRESSER TvI 54009 RE: ALAN :i96-20574 FEE R'~'CEItTED: 181"x.01) STROBEEN, RAY El/2,NE1/4,4,31,18W TOW14 OF STAR PRAIRIE COUNTY OF ST CROIX MOUND SYSTEM The Department has revir-,-ed the above-referenced submittal. Conditio)-:al approval is he.t.eby granted fcr tine system p:.-rt submittal. All doted items must be corrected. The review and apprv,rai of the system is based on chapter 145, Vlisconsin Statutes, and chapters ILHR 83 and 84, Wis<7onsin Administrative Code, and is Contingent upon ccjmpli.anc w-r-h any stipulations shown on the plans. This system has not been reviewed for the code req_uireffLents :set forth) in chapter ILHR 62 or in chipterz :LHR 50-64, Wisconsin Administrative Code. This h:1ar: submittal app.i,-:val will expi,, a y*:-,ars from the approval date, or it a sanitary permit is -"rained, pla_i approval will e,,:IAre on the day the Ir initial sanitary permit ehpir,~s. The licensed plumber responsible for this installation shall keep (-.ne set of pl.5-ns with the Depar.tm~~nt's stamp of approval at the construction site. The instal..Ler nDtify the appropriate inspector when in--pections can be, made. All permits required ov the city, village, tova--shij.' 'Da runty shall be obtained prior to installation. Inquiries should be di_rect.ed to me at the number its*ed !~~Iow. Please refer t,-, t.'ie plan number shown above. Sincerely, Thomas L. Braun Plan Reviewer (715) 634-3026 7:45 4:30 E391P.~' 1 SHDA•6928 (R.1WN) r Private Sewage System Plan Index/Checklist 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 q Owner's Name 59 4 - Zv 53 Ll RAN S Legal Dc cription Address r l NE V s 131 NR W k6w R e molune WE 5901-7 City/Vi!lagelfown County WIV O SI R PkftRIC" S-r e T Contents Comincnts/Special Instructions Page p Included Two copies needed for all plans 1 Plot Plan 2 Plan View/Lateral F__j Return by Mail 3 Cross Section } Tank & Pump/ Q Fax Letter to (County) (Submitter) 5 Siphon Information Circle One and Provide Fax ( ) 41 Syi; # 0 to~a~ Lt tC Cdr ❑ Call for Pick-Up: ( ) Q Other 1, the undersigned, hereby certify that the Seal (if applicable) plans and specifications submitted herewith were prepared under my direction and control. Plumber/Designer Licenseiltegistration d rdli! r t T~o2Z Address City State RO'K Signature PRIVgX(fal`( lAYSTEM Attachments: Application Conditionally Soil & site evaluation Fee APPROVED Needed for Holding Tank Submittal: One copy of notarized holding tank DEFT. OF INDUSTRY, kIl80R 8 HUMAN RELATIONS agreement. (Originals to County) DIVISION F SAFETY BUILDINGS Needed for At Crade Submittal: Original signed and notarized Application for "Use of an At- SEE CO NDENCE Grade" County on-,site RECEIVED J U l 1 1 1996 One additional ;;ct ofpi.uls SBD-10268 (N.01/96) SAFETY & BLOGS. DIV. S96-20574 i oo r i~~~ I 'p" 2t&¢tdq Lhe downsfope edge of the 1 Absorption System mast remain undisturbed. TO aoQ6 H)Lr. I 0 $9° 860 CAI WP-CK P. C. ZD~o ° F- i206 GAL \MMS S.T. -tai O Fbw b 000sec STROO UCtJ NEw :RICMmara, Wi SVO/7 GP4 NE V4 54 -r 31 Iv, P, i$ w To wN OF- STAQ NAP't E MALLARD Rv O Na 1~►~ ~ 1,01 1Z- 1~1. I~EI'~R>=$~T RQ X10 TM 7 A NORTH ItO~N S?~L~ET Page Of Perforated Pips Detail 0 End View Perforated End Cop] PVC Pipe Holes Located On 8oltom, S Are Equally Spaced PVC Force Main Q PVC Manifold Pipe Alternate Position Of DislriDution Pipe Force Main Lost Hole Should Be Next To End Cap Distribution Pipe Layout P A Ft.4o,'•3")5 R N. $ 8 S 1q. 88 X 6C Inches 57" Y AU Inches 57" Signed: Hole Diameter Inch Lateral Inch(es) License Number; Manifold ~7 r Inches Date: Force Main -Z Inches # of holes/pipe 9 Invert Elevation of Laterals Ft. F - _ ® K I W Observation I Permanent - =Pipes Ma rker~~ \ Distribution Trench Of 2 - 2 2 i Pipe Aggregate Mound Using ZTrenches For Absorption Area A 3 8 8 a I C Jq.88 _ K //'z8 F • 79 1- /06,5(0 G ! .J 73a I,5' i3.zo Straw, Marsh Hay, Or Synthetic Coverinn~ Medium Sand Distribution Pipe I~ H G z r - Topsoil - = - a 5 % Slope Trench Of 2Force Main- Plow(sd Aggregate From Purnp Layer Undisturbed Soil Cross Section Of A Mound System Using 2 Trenches For The Absorption Area Wjnter, February, 1991• No. 458 I'n r. i PLI' ~P CHA,ME,LR Cr,-' 5 SEC 10!.j' AFJG Sf'ECIF I~ I il - - i VCl.!T CAP , PiFC 4PFHOVED L_riC .EATHERPKOOF A ►J Ho Ju►JC1'I01J BOX 1 M~E rove:-e. w'UJDO'+J R FRF5H i2"PAIN. AIR 1►JTAKE 1 GRADE I y" Mt'J. 19"PAIR!, --L PROVIDE lk)LE i AIRTIGHT SEAL. I III ~F I 6 APPROVED JOINTS APPKO`1ED JOINT/ A I III W/C.I. PIPE Wf C.I. PIPE I I I A:AR►^, ExTE~101UG 3' EXT0,101MG 3' I 11 ONTO 501.10 SOIL OQTO SOLID SOIL 6 1 I ~ I I C) ti C I 1 E.L_CV FT-- P Li tA,;, OFF I D _ COQCKETE DLCCK 4w~~w_05_ppro_mve_d- -TURr-PAWK MAIJUFA- HAS SUt 1i APPROVAL, F:ISV~jtI S!TH ~aI ~~IJL 4 SEPTIC +i S IFICAI-1dQ~w GOSH LJ TA1.lKS MAQUFACTURER. +yV _E S _ AI LIMBER OF UOStiS: .PER DAy TAiJK sIZE AL'Z_0QS C)OCSE \JOLLIML KFi.OW:.~~~ GAL40N5 ,ALARn MAIiJUVAC.TUR►R: L9lfL__ I 1(l_.__.......... AODEL kILIMBEK':1 ~DEV~~~ CAPACITIES: A- ZZ INCHES OR GaLLOUS SWITCH TyPC: B = _iWCW:S OR ~~~Q(~_ GALLOUS PUMP AAIJUFACTURCR: C = v JJCHES OR , t_._...~-_ GAL, 000S MODEL UUMBER. __A1 98 - - - D- 8 INCHES GR _ EE G A L L 0 M S SWITCH TYPE: !,9ERoopy 1'JOTE: PUMP AND ALARM ARE TO BC MIRJIMUM DISCHARGE RATE ~LL3.b _GPrA INSTALLED OQ SEPARATE CIRCUITS VERTICAL. DIFFEICEMU: DETWEEA! PUMP OFF A►JO DISTRIB'JTIOW PIPE... r FE:i r 4- MiQIMUM NETWORK SUPPLE PRESSURE . . . . . . z ' FLET IO FEET OF FORCE MAIN X F.T/pprt,FF!CTIOQ FACTGOt..-/•y~_. FEET } _A -TOTAL 0t3QAMIC. HEAD FEET INTER. .IAL. DIME.US%OQt Cr TAIJK: LF."a(,TH ;WIDTH b5 +fli~~~LiGUiD C,CPT►~ ~D >i Him ~ P HEAD CAPACITY CURVE 3 7/e 6 1/4 MODEL "°98" 4 5/8 -1 30 a I T2 3 5/8 6 -F + 15 4 3/16 e 4-- 10- 1 1/2-11 1/2 NPT 2 5 install per manufacturers requirements. 0 U.S. GALLONS 10 20 30 50 60 70 80 VIERS I 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC NEALYFLOW PER MINUTE EFFLUENT AND DEWATERMN3 12 CAPACITY HEAD UNITS/MIN FEET METERS tuns LTR8 5 1.52 72 273 10 3.05 81 231 15 4.57 45 170 3 5/16 20 8.10 25 95 Lock Valve 23' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback mercury float switches are available for or without alarm switches. variable level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs. - t/z H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback mercury float switch or double piggyback mercury, float 96 Seri** Control Selection switch. Refer to FM0477. Model Volta-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.4 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. D98 230 1 Auto 4.7 1 or 1 & 7 - 6. Four (4) hole "J-Pak', junction box, for watertight connection or wired-in E98 230 1 Non 4.7 2 or 2&6 3 or 4 & 5 simplex or duplex operation, 10-0002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For Information on additional Zoeller products refer to catalog on Combination Starter, FM0514; AN Installation of controls, protection devices and wiring should be done by a qualified Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0488; Mechanical Altemstor, licensed electrician. Allelectricaland safetycodesshould be followed Including the most FM0495; Alarm Package, FM0513, Sump/Sewage Basins, FM0487; and Simplex Control Box, recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Loulsyl8e, KY40256-0347 Manufacturers of SHIP T0: 3280 Old Millers Lane p Loursy8le, KY40216 Ift /~r (502) 778-27319 1(800) 928-PUMP , EWArYI AHM 5•~CF/9s79 FAX (502) 774-3624 ro a Jr. ~ N a ' N I1 (D 7C M N fD r• n n rt n a o ~t N h' N N (D n rt o 0 M ro n (`D N N rt ~A rt I rt O fr H- (D 0 :j r M ~ U ht W ~ r a ==C) a 0 I rt o y rt rj r• w ~ w n °riuk- OPTIONAL WORKSHEET 1. MOUND SYSTEM / 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 = ~D gpm• Ad m. Code and PROVIDE ADETAILED Diameter = in. - LIST OF SIZING, ON PLANS. 11. Total Dynamic Head: Z It . + System H~ ad a 2.5 ft. 2, Depth to Limiting Factor = Vertical Lift = ft. 3. Landslupe = % O~ ft. 4. Distance from Dose Chamber to I riction Loss = _ yo ft. I D,: = / T 5__1 5- ft. Distribution System = 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = ft. Purn w1 I discharge at least --YO _ gpm at 6. Absorption Area Sizing: -ft. total dynamic head. ZrruE Area Required = D~ sq. ft. Pump model and manufacturer! Bed or Trench Length (B) _ Pill ft. _ bed or Trench Width (A) _ ft. 13. Dose Volume: Trench Spacing (C) = ft. 10 T imes Void Volume of 5/ 7. Mound Height: Distribution Lines - gal. Fill Depth (D) _ ft. Daily Wastewater Volume -i Fill Depth Downsiope (E) ft. 4 Doses in 24 hrs. so gal. ' s Bed or Trench Depth (F) _ . 79 ft. backflow = 6-160 gal• Cap and Topsoil Depth (G) ft. Minimum Dose = 15C--%gal. Cap and Topsoil Depth (H) ft. 14. Dose Chamber: ~1~~ 8. Mound Length: Volume = m gal. End Slope (K) ft. Total Mound Length (I-) _ 11L. ~5 ft. III. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. %1ounJ Width: 1. Wastewater Load, Total Daily Flow = gal. Upslope Correction Factor = 875 Use section H 63.15 (3) (c), Wis. Upslope Width (J) 3_-~ ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = -1-IL-8 LIST OF SIZING ON PLANS. Downslope Width (1) = 1 ZO ft. 2. Required Septic Tank Capacity = gal. Total Mound Width (W) = 3 Hej ft. 3. Percolation Rate = - min./in. 10. ba~dl Area: 4. Absorption Area Sizing: I11tiltrative Capacity of Refer to fable 2 in chapter H 63 NJtur.ti Soil = 13 gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required = ''70CO sq. ft. SIZING ON PLANS. Basal Area Available = -ZZsq• ft. Required Area sq. ft. I I. It Standard Tables from Chapter Length = ft. H 63 are Used, Indicate Table No. Width = ft. 12. F or the Distribution Network, Use Numbers 5-14 in Section II. Number of Trenches = Trench Spacing = ft. J. IN-GROUND PRESSURE SYSTEM 5. Distribution System: 1. Depth to Limiting Factor = ft. I dterai Length = ft. 2. Landslope= % Number of Laterals= 3. 1ercolation 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 111 Required Septic Tank Capacity gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = i3 min./in. 1. Capacity _ gat. A1ea Required = _5 sq. ft. 2. Manufacturer: System Length = 2 f0.(i0(A ft. 3. Show Site Constructed Tank Details on Plan System Width = 3 ft. 7. Distribution Pipe Sizing: VI. DOSING TANK 1_a____ in. 1. Capacity = gal. t{otc Siic = Hole Spacing it. 2. Manuf.;cturer. Lateral LenK1h it. :1. Pump ManWdcturer. I ateral Siie In. 4. Punrp Model: I ilvral Spacing TM.- It. 5. Operating Head= It. 0111a1ILV 110111 Sidcwdll•to Pipc In. 6. flow Rate= gpm. S. Disu Ihution Pipe Dischaigv Rdly: 7. Show Site Constructed Tank Details on Plans Number of Itoles Pei I'Ipe 1 low Pet Pipe ttprn. VII. HOLDING 1 ANK 4. M.uliluld Siting: I. Capacity = gal. I ype (u•1110 01 end) Ct^ N~Q 2. Mal tut ac l u r e I: Lcogill _ 1q, it. 3. Show Site Constructed Tank Details on Plans Diameter Z In. -SHOW ALL INFORMATION ON PLANS- III. HR SBD•6761 (R.03/82) ~ Wisconsin Department of Industry, SOIL AND UATION Labor and Human Relations / Page of 3 Division of Safety and Buildings in accord c vet Wis. Q1 Attach complete site plan on paper not less than 8 1/2 x 11 inche 1 e. Plan ml}st y my include, but not limited to: vertical and horizontal reference poin dirid[~nd C percent slope, scale or dimensions, north arrow, and location a nce to nea[estroad. ar I I.D. # APPLICANT INFORMATION - Please print all info tion. fl&iewed by Date Personal information you provide may be used for secondary purposes (Priva fuu~s. 15.04 pJ ,4n )Y Property Owner U Al 6 Property ,dVa U l E dam, D• Es tit. iZ liiiN6114,S T 31 N,R /U E (or) W Property Own is Mailing Address Lot # Block# Subd. Name or CSM# / 1o 4, / l e'e / .Z /yap/~~~d Gl AJ City State Zip Code Phone Number dK /f a2 Nearest Road City ❑ Village Town /M t~ sx e~di'07~ ~yo~o (?/J) ~B3 337$ El New Construction Use: 2Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: 2 Code derived daily flow/ gpd Recommended design loading rate bed, gpd/ft2 03 trench, gpd/ft2 Absorption area required/(.). a , bed, ft2 , d' trench, ft2 Maximum design loading rate `bed, gpd/ft2 ` trench, gpd/ft2 Recommended Infiltration surface elevation(s) 1 ft as referred to site plan benchmark) Additional design/site considerations o~ y d c~L1 i~T d6 /e -Sa Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S k u LkS El U El S U El S ~U El S U El S U 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 6'Y41 /'01/f 'S 13 _YX Ground .2- .3 9 lift 5/ 7..S7h / J/'~ . ,o ~✓p Depth to S ys4 limiting factor 13-L--In. Remarks: Boring # f 0 /O -3, y. 6/~ /sr+ t.J y O sf / 6~ G~.✓ /v ;9 j Ground N i~ LJT i G~4J AJ~p nJ.P elev. ;7 Al 74 Depth to limiting factor 1_.I---In. Remarks: CST Nq;j (Please Print) Si ture Telephone No. 71,f - Y727 - 9Y vie Addre Zoe Date CST N um ~i ;/J, O U~ e ~ ~f.3 41 / p /,'f J'- ;76 um u jA) d6 SOIL DESCRIPTION REPORT ' PROPERTY OWNER Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench z - /Q/lo b~ c.J IV/4 Ground 3 "R vi[ AG /f Y%/ . - , T 6/t 7 d j • Z- 3 elev. S ZJ-14 --Y Depth to limiting f ctor Remarks: Boring # /40 Z~~2j,61c V: 7 :;L o /a "le. /v 7 •,S c2j .2 -3 Ground lJ la c~l 1O 5✓ el v. D , Depth to limiting factor c30-in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 1,j-6e Tic eL- d ep N . y . S 47 ec-j /V/ s C-) Y/l IX e;;j Z- -3 7 A cep / a Ground -4 Lj ~ . J 1 ~ ~ /y`~'''"~i i ~ e-yr► ~f i ''`f + elev. d 'Tel Depth to limiting factor j / in. Remarks: Boring # Ground elev. ---ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) c o L- M lI~ V ~ N o ,/28/96 10:19 Tr COUNTY CLERK 9003 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County aw1v.RBUY1rR MAILING ADDRESS 7 PROP ERTY ADDRESS (location o septic system) Please obtain from the Planning Dept. CITY/STATE YN l PROPERTY LOCATION / 114, 1/4, Section T_31 _4<,_W TOWN OF Spa ST. CROLK COUNTY, WI SUBDIVISION Ck 1 d r LOT NUMBER 12-- CERTIFIED SURVEY MAP , VOLUME ALPAGE RMLOT 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 cos 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 ye a ation d SIGNED: - DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 U3~ 26; au lu:la V .L~.... STC-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 ir. sold and submitted to this office with the appropriate deed recording. -----------'s-----------~------------------------------------ Owner of property E,1/4, Section T__N-R W Location of props 1/4 lj4 Township Mailing address ? L ~A y, goo Address of site , Subdivision name Lot no. A Other homes on property? Yes -"-No Previous owner of property 2A ] g Total size of property r^ P to . Tlotal size of parcel r 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 and.Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TIM FOLLOWING: A WARRAN'T'Y DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER-AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the., property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an- easement, to run the above described property,-for the construction of said system, and the same has been duly recorded in the office of the County Regiater of Deeds as Document No. ig ture of Applicant Co-A licant 7K- U\ Date o Signat a Date of Signature VOL 1193PAc[4.77 U r~ 547781 WARRANTY DEED Document Number `^u `x' rc 1 0rF1Cr- ti. CIAO1X V 1 .1 W1 A I'dbrft=d Return Address AUG, 5 ).996 MISTINA OGLAND At- 1: Zilz, Estreen & Ogland , 4F L-A~1 P.O. Box 359 'ludson, WI 54016 Parcel I.D. Number: 038-1020-10, 50 Allen L. Lunde and Pamela E. Lunde, husband and wife, conveys and warrants to Raymond A. Strohbeen and Cynthia J. Strohbeen, husband and wife, as survivorship marital property, the following described real estate in St. Croix County, State of Wisconsin: Lot 12, Mallard Run in Town of Star Prairie, St. Croix County, Wisconsin. This is not homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of July, 1996. (SEAL) (SEAL) P~ - 4~a Allen L. Lunde Pamela E. Lunde AUTHENTICATION TRAgjFER Signature(s) Allen L. Lunde and Pamela E. Lunde, FEE husband and wife, authenticated this day of July, 1996. aOglanTITLE: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016