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Home My WebLink About006-1082-60-000St. Croix County Planning and Zoning Tuesday, September I1, 200.7af 5:13:23 PAY Detail Sanitary Information Page t of I Computer #: 006-1082-60-000 Sub/Plat: >35 acres Section: 35 Parcel #: 35.31.16.550A Lot: TN/RNG: T31 N R16W Municipality: Coon, Town of CSM: 1/4 1/4: SW 1/4 SE 1/4 Owner: Alexander, Joseph D. 2466 County Road S Emerald, WI 54013 State Permit: 259425 Issued: 12/05/1995 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 12/08/1995 POWTS Detail: Trench - Seepage Bedrooms: 2 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Jim Thompson Yes Schumaker, William This parcel had a mobile home with an existing $0.00 Jim Thompson n,yned Off: Yes bed system shown on plot plan, with addition of new house next to it. Installed Midwest 1000 gal. septic to 750 gal. dose tank (revision on 1/19/96) with 259+ of forcemain to 2 trenches, 5' x 75' each. Don't know if there still is mobile home with fire #2468. Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 12/8/1998 4/14/2005 4/14/2008 St. Croix County Planning and Zoning Detail Computer #: Sub/Plat: NA Section: 35 Parcel #: 35.31.16.550A Lot: S �,� TWRNG: T31N R16W Municipality Cylon, Town of CSM: 1/41/4: SW 114 SE 114 Owner: Alexander, Joseph 2466 County Road S Emerald, WI 54013 State Permit: 259425 Issued: 12/05/1995 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 12/08/1995 POWTS Detail: Trench - Seepage Bedrooms: 2 WI Fund: POWTS Pretreatment: NA Thursday, September 07, 2006 at 3:30:1 S PM Page I of I Notes Issuer/inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined Yes Schumaker, William $0.00 Jim Thompson Signed Off: Yes Maintenance Scheduled PumD Date Pumped 1st Notification 2nd Notification 3rd Notification 1218/1998 4/14/2005 4/14/2008 ------------------------------------------------------- - - - - -- v STC - 104- AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSMJ_ /QO-r G�cria s LOT SECTION--s.?-r T.?/ N-R_Zj�;_WI Town of ev/ ST. CROIX COUNTY, WISCONSIN PLAN VIER ok d SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �v % n J J D 1� o� 1 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ,tea ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: /y/,',/,,,e9�-�Y� Liquid Capacity:/sed Setback from: House /T` Other Pump: Manufacturer Modelq Size See c: � /X Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 7 S Number of trenches ,2 Distance & Direction to nearest prop. line: 414 c,.y/Fd Setback from: well : ,Z/4 0- House ,,,Z3d , Other ELEVATIONS Building Sewer ST Inlet. PC inlet PC bottom ST outlet Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: /T/q.�- PLUMBER ON JOB: f�l'f LICENSE NUMBER: oe2 Z,;? INSPECTOR: �- 3/93:jt Wisconsin Department of Industry, Labor And Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Permi d 6Ma[ne:.70$EPH E� ❑ City [I Village C7 Town of: 7i CST BM Elev.: �v Insp. BM E ev.: i v BM Description: 16a . QS TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic CUf �../ Dosing e( Aeration- Holdi - TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD Septic �,�' NA Dosing NA Aeration NA Holding PUMP / 911110DI41INFORMATION Manufacturer Demand Model Number GPM TDHTLTDH Liftr Friction System TDH Ft iftI Loss Head Forcemain Length Dia.,�- Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA ountyST. C'.ROIX Sanitary Permit No State Pan o Parcel Tax No : /n/., )(;� STATION BS HI FS ELEV. Benchmark Bldg. Sewer St IX Inlet 1.2,77 3 St/g Outlet- Dt Inlet Dt Bottom Header Maw Dist. Pipe Bot. System .' 7 ' Final Grade BED/TRENCH DIMENSIONS Widths , Length , No. Of Tlenches IT DIME No Of Pits Inside Dia. InsideL�gwd D epth SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC acturer: INFORMATION CH R UNIT Type /ILAP System: ecmrY .�/� ^oZ9J ,,{ /��. Moe Number: DISTRIBUTION SYSTEM Header 11dompWd Distribution Pipe(s) x Hole Size x acing Vent To A-irintake Length Dla l` Length 4 Dia 4i/ Spacing SOIL COVER x Pressure Systems Only xx Mound Or - rade Systems Depth Over Depth Over xx Depth xx Seeded / Sodded xx Mulched I Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Cylon.35.31.16W, SW SE Plan revision required `' ❑ o Use other side for additional information. � 4ate SBD-6710(R 05191) Inspector's5,gnatu a Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division �.�.... SANITARY PERMIT APPLICATION Bureau of Budding 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 �/ C;11_40, than 8 112 x 11 inches in size. y-C. • • See reverse side for instructions for completing this application State Sanitary Permit Number 4_#o4vT� .5___ The Information you provide may be used by other government agency programs k tl revisron to previous apPliulxxi IPnvacy Law, s 15.04 (1) (m)I State Plan I D Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location TO sr 1/4,5'E 1/4, 53,- T3/ N, R E (or& Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number /= I- VeIA ( /s) 2e5-y18 -e TYPE OF BUILDING: (check one) ❑ State Owned 0 C Ity Nearest Road Public 1 or 2 FamilyDwelling- No. of bedrooms 2-5 Towan OF c S III. BUILDING USE: (if building type is public, check all that apply) Parcel TaxNumbr(s) 9er4:1.0 ~ /-4 1"/ _ 0��5 6'r 1 ❑ Apartment/Condo 1 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ___System System _ Tank Only ExistinQSystem 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 ESeepage 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 13. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (MinAnch) Elevation ` �s•e 7S6 ,rret, 9'rC 0 Feet Feet VII. Ca cit INFORMATION in g Illons Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Con- Steel Fiber- glass Plastic Exper App New ExistI strutted Tank Tanks Septic Tank or Holding Tank 1 C pZj fQ y t/ RI El El El❑ Lift Pump Tank /Siphon Chamber 7 S6 % 7'e [5 [5 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature. (No tamps) MPRSW No : Business Phone Number: J Plumber's Address (Street. City, State. Zip Code). -;7ellr G / IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Vml% V6 ndwater Date Issued Issuing A ent Si ture ( Stamp Approved ❑ Owner Given Initial sUrc6"`ge"`I �915- Adverse Determination j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Se1).6398 (I n`M) DISTRIBUTION Original to County, nne<urvy To: Sufoiy a Building. Dlro.on, Owner. ►i;,n.b.. INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: L 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. Ill. 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. 0 �l e YXo -Al T qw' PAGE _ OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS vENT CAP Y'C.I. VENT PIPE -T WEATHER PROOF APPROVED LOCKING > - 23' FRGM DOOR. JUNCTION BOX MANHOLE COVER WINDOW OR FRESH I2'M.iu. AIR INTAKE GRADE I I Y" MIN. cououlr le'nIN.� - - - - - - - - - - IAIL.I-T PROVIDE T I AIRTIGHT SEAL I III I II v APPROVEC JOINT A I III APPROVED JOINTS W/C.Z. PIPE. I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING 3' ONTO $OLID SC::, B I I I I ONTO SOLID SOIL C I I I ON 1� 1 � -t I PUMP1 __J 4 OFF O CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOMS SEPTIC AND " �S�c`� DOSE TANKS MANUFACTURER: NUMBER OF DOSES: '? PER DAy TAMK SIZE: _ 7S4 GALLONS DOSE VOLUME Syr yG ALARM MANUFACTURER: 4eyel- INCLUDING eAC�KFFLOO-W: � GALLONS MODEL NUMBER: 12ak CAPACITIES: A=/-+ INCHES OR 410799 GALLONS SWITCH TYPE: MQY' B = �INCNES OR��GA'_LONS PUMP MANUFACTURER: / / Z OG/ ` ,2y C� e �qa � C 1L._INCHES OR GA,_LONS q,F /�_ MODEL NUMBER: - Cl- _L:.2._INC HESOCAMWGALLONS SWITCH TYPE: %1-eL-'G t17A NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE Bf9oh1EEN PUMP OFF AND DISTRIBUTION PIPE.. Ar FEET + MINIMUM NETWORK SUPPLY PRESSURE ✓.. . , , . —=FEET ! + ILL' FEET OF FORCE MAIN X �GLFiIOortFRICTION FACTOR..Yr ✓ FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DDIMMEIJ�SIOAJSSOOF TANK: LENGTH ;WIDTH �j ;LIQUID DEPTH //',// 91GAJED:` —�" LICEOSE NUMBER. dW;� ZLZ L%Y�7� DATE: -111- Y • � 6 I � 4 ]Mj 2 j ,1 e U.S. GALLO !( LITERS S HEAD CAPACITY CURVE MODFL "gir SO 6o 1 70 se 160 FLOW PER MINUTE TOTAL DYNAMIC HEAoeLOw ►En LMUTE EFILVE7n ANO OEWATEaNk: CAPACIIT HEAD UNITS/MIN GALS LfR3 FEET METERS 5 1.52 72 ' 3 to 3.05 at ?!1 Is 4.57 45 Ito 20 6.10 25 05 Lock VON* 23• 3 )/tl- 6 1/4 4 5/a A 3 5/a 1 o f .\ 4 3/16 6 1 1/2-11 1/2 NPT CONSULT FACTORY FOR SPECI :L APPLICATIONS Electrical alternators, for duplex systems, are available and 0. supplied with an alarm. , p Mechanical alternators, for duplex systems, are available with or without alarm switches. w' ,1• 'i Standard all model& - Weiaht 39 Ihs.. i, N_a_ !9'" ale+ control Selection Modal volte-Ph Mode I Am • I Simalex F Ou ant Mg6 11s 1 4uto go,go,l I or l a 7 NN 115 1 4 a 230 1 Auto tt7DINS a 1. E" 230 1 Nat 4.1 20(2a6 3a4a5 ;y Par information On •d015pra1 ZOION Pmdued r414r to calslog an Combiluso l Surer. FMO514. Piggyback Mercury SwitcMs. FMo477; Elocia" ANarnalol. FMW/e: N.,ctuncal A•arnalor, FMIMM; Abel Package. FM0513; SlatrpJSewspe Bas;n% F6007: and ;x plea CaltNtd Boss. FMOnZ '16 as Mercury Iloat switches are available for controlling single and three phase systems. • Double piggyback mercury float switches are available'Jr variable level long cycle controls. SELECTION GUIDE 1. Integral 000 operated 2 Pole Inochmticai switch, no external control tequired. 2. Single Piggyback mercury float switch or dotrblo piggyback mercury float switch. Belem to FM0477. 3. Mechanical altainalor 10-0072 at 10-0075, r 4. Soo FM071Z for corroct model Of Electrical Alternator,-E•Pak" 5. Mercury Sande I" switch 10-OM used as a control activator, specify duplex (3) or (4) 1" system. 6. Four (4) hole ••J-Pals". function box, lot watertight connection or Initud-in Sim• plex of duplex operation, 10-0002. 7. Two (2) hole -.1-Pals". kx watanrght connoction or splice. CAUTION AN Installation or conlsolo, prolectlon devkss and wising aboaM be done by a gwlF tied lieenrd elaetric" AN okArical and soars, codes sborW be suaowod IrMrb Ing Law arsol record National Ekcuk Co" (NEC) mW the Oscopaaanat So" And Health Act (OSHA). RESERVE POWERED DESIGN 1 ; For unusual conditions a reserve safety factor is dfrgineered into the design of every Zoeller pump. Yell Tn• 0 rl 011V 19717 Safety and Bwldmgs Division �iLF:R 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 rattacn compleTe plans tto the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 81 • See reverse side for instructions for completing this application State Sanitary Perm Number a5g4a5 The information you provide may be used by other government agency programs (Privacy Law, s. 15.04 (1) (m)) ❑ Chxck iI revision to gevxws apple algn State Plan I.D. Number I. APPLI ATI N INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location eA A -a 1 114 _ 1/4, S s T N, R E (or 1 Property Owner's Mailing Address 'Z <!GG Lot Number Block Number Cc _ City, State Zip Code Phone Number Subdivision Name or CSM Number /r fcr��Gl —yalz (7 ?Gs. 18 11. TYPE OF BUILDING: (check one) ❑State Owned ity Nearest Road Public or 2 FamilyDwelling- No. of bedrooms Town of o III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Num r(s) oaG-/r,�/-95-�' •'a 1 ❑ Apartment/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Mote( 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_ E] Replacementof 4, E) 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 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 3 �� Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation <a ?�'� ?� Feet a, Feet VII. TANK Capacity INFORMATION in gallons Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Cun Steel Fiber- glass Plastic Exper App New Existing Tanks Tank strutted Septic Tank or Holding Tank X 1,4 jo Lift Pump Tank /Siphon Chamber VII/. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature:(N Stamps) MPRSW No . Business Phone Number: JAL �31-7 Plumber's Address (Street. City. State, ipCode). IX. COUNTY / DEPARTMENT USE ONLY E] Disapprove Sam ry Permit Fee (1nd=Groundwater ate IssuedIssuing Age Sig ature (N tam ) Approved [:]Owner Given Initial /f Surharge"`I �v�(� �Id5- Adverse Determination X. CO DITION'SAO APPROVAL / REASONS FOR D_ISAP�PRgVAL: .�P� �..�...,.y��.ei .0 loamy. unrr copy io: �"rely a xuanmgv Dw�aon, nwMr, PlumGr 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: I. 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. r4'/G4/ To�/.✓o/� C +�<o .�/ S'c 0A -- ! ' ,�r y0 F✓e iw. ,&x lnJ ,2;2.9ac vC-s R �l B/ ,✓/ '�� 1 S7 e lot {. U t row./ i r � 5 % F re �v de pbayslsd Wisconsin DurnanRntoolndustry, SOIL AND SITE EVALUATION REPORT La rant! I1u"ran Relations of Sa" a Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on Paper not less than I Ian must include, but rot limited to vertical and horizontal reference direction a pe, scale or dimensioned, north arrow, and location and disfancvlo nearga o441111 APPLICANT INFORMATION -PLEASE t�iNT A4�INIF 0 r, pW 1 of 3 COUNTY St. Croix PARCEL I.D. # 006-1082-60 REVIEWED BY DATE PROPERTY OWNER: -- i , , J ERTY LOCATION Joseph Alexander \ " c� �y9 LOT SW v4 SE v4s 35 T 31 N,R 16 fal«I W PROPERTY OWNER':S MAUUNG ADDRESS 2466 Co. Rd. #S /�, a BLOCK • SU91�. NAME OR CSM s �., a na LLLL2 acres CITY, STATE ZZIP CODE Emerald, WI. 54012 P S fTY ❑VILLAGE MOWN NEAREST ROAD (71 C ton Co. Rd. #S [ J New Construction use (31 Residential / Number of hedrooMS 2 [ I Addition to enstmg building (xI Replacement [ I Public or commercial describe Code derived daily flow 300 gpd Reconmended desian loading rate *3 ._bed. oWt2_4_hanch. oWt2 Absorption area required bed, ff2 hr4h, ft2 Mapmun design loading rate • 4 bed, gpd/lt2 •5 tenCh, WU t2 Recommended infiltrabOn surface Nevation(s) 97.60 alt. = 97.97 It (as referred to sile plan benchmark) Additional design / site cortsideratiorns na Parent material pitted glacial drift Rood plain elevation if applicable na It S a Suitable for system CONVENTIONAL U a unsuitable for system a8 ❑ U MOUND [2 S ❑ U IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TAM( [3 S ❑ U ®S ❑ U I ❑ S ®U ❑ S Sul Boring # 1 �f Ground elev. 100. 75h. Depth to limiting %M +801, Ground 100_N Depth to limiting hador + of SOIL DESCRIPTION REPORT Horizon Depth in Dominant Color Munsell Mottles ou. Sz. Com Color Texture Structure Gr. Sz. Sh. Consistence � I Roots GPD/ft ie Bed fTmr& 1 0-13 10yr3/2 none 1 2msbk mfr gW 2f .5 .6 2 13-35 7.5yr4/4 none sicl lmsbk mfr gw if .2 .3 3 35-80 7.5yr4/4 none scl 2msbk mfr na na .4 .5 i Remarks: 1 0-12 1Oyr4/3 none 1 2msbk mfr gw 2f .5 .6 2 12-20 7.5yr4/4 none sicl lmgr mfr gw if .2 '.3 3 20-60 7.5yr4/6 none sl 2msbk mvfr gw na .5 .6 4 60-80 7.5yr4/4 none scl 2msbk mfr na na .4 .5 Remarks: ICST Name: —Please Print Gary L. Steel Phone: 715-246-6200 [nu' 15,54, 200th. Ave.,, New Richmond, WI. 54017 B-8-95 cstm PROPEF17YOWNER Joseph Alexander SOIL DESCRIPTION REPORT -?age 2_,,, of 3 PARCEL I.D.9 006-1082-60 Boring # Amwe 3 Ground elev. 100.6ft. Depth to limiting facia +80" Boring # IW 4` Ground elev. ' 101.4ft. Depth to irtreng faClor +80" Boring # 5 im&" Ground elev. 101.5 ft. Depth to limiting factor +8011 Boring # Ground elev. ft. Depth to limiting factor Horizon Depth I in. Dominant Color Munsell Mottles pu, z. Cont C,� Texture Structure Gr. Sz. Sh. I Roots GPD/ft Bed i7ietd� 1 0-12 10yr3/3 none 1 2msbk mfr gf 2f .5 :6 2 12-24 10yr4/4 none sic 2msbk mfr gw if .4 .5 3 24-54 7.5ry4/6 none scl 2msbk mfr gw na .4 .5 4 54-62 7.5yr4/4 none sic 2msbk mfr gw na .4 .5 5 62-80 10yr6/6 none of s Osg mvfr na na .4 .5 P&MArlec• -- 1 0-10 1 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 2 10-22 7.5yr4/4 none sic lmsbk mfr gw 1f .2 .3 3 22-60 7.5yr4/4 none scl 2msbk mfr gw na .4 .5 4 60-80 10yr6/6 none of s Osg mvfr na na .4 .5 Paenarkc• 1 0-12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 12-30 10yr4/4 none sic 2msbk mfr gw if .4 .5 3 30-80 7.5yr4/4 none scl 2msbk mfr na na .4 ' .5 Remarks: Remarks: SOD-e330(p.05/92) Gary L. Steel CSTM2298 MPRSW 3254 STEEL'S SOIL SERVICE Joseph Alexander SWkSEk S35-T31N-R16W town of Cylon I 1"=40' Hn.= top of 111 steel pipe @ el. 100, Alt. BM-= top of 11, steel pipe @ el. 100.021 ,4 Gary L. Steel 8-8-95 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 3•Z MAILING ADDRESS PROPERTY ADDRESS STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County &(0 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Z.*j e 6V , ' !'may' Bl -el— PROPERTY LOCATION .1W 1/4, 1/4, Section , T_xFj� N-R l,6i W TOWN OF liailwpK ST. CROIX COUNTY, WI SUBDIVISION .?;Z %1 G—ey + 9 LOT NUMBER CERTIFIED SURVEY MAP , VOLUME ::,-PAGE LOT NUMBER r 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 8 T C - 100 0 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 !S, Location of property /4 F 1/4, Section Townshi91� S4, failing address_ Address of site ,T_JLN-R_Lrl _W Subdivision name 2A ,4GCAC S Lot no. Other homes on property? )_Yes No Previous owner of property Total size of property �� ✓ t y Total size of parcel :2 Date parcel was created Are all corners and lot lines identifiable? Yes _A _No Is this property being developed for (spec house) ? Yes �j ,_No Volume .rG and Page Number 0.-2,f 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. 32oG yam= 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. i r�J1 lof�Applica Co -Applicant Date of Signature Date of Signature