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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
SUBDIVISION / CSM# LOT
SECTION- T ~d N-R y W, Town of
C G
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
L `C
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole col-'er.
y
f~
i
BENCHMARK: to(`;.7
s t~
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Ale P b► &V ft04/1 Liquid Capacity: G
Setback from: Well 74r' House( , other
Pump: Manufacturer -#G4 i- 14 Model#JW6,0 3if t Msize #
Float seperation IO foe-L.,- Gallons/cycle: 7
Alarm Location
S//OIL ABSORPTION SYSTEM
Width: Length Cn Number of trenches
Distance & Direction to nearest prop. line: 2 S~
Setback from: well: 3 Sr.V House I PO Other 41:"- ~ S4 e d
ELEVATIONS
Building Sewer ST Inlet. ST outlet
i
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: l> t el
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
S
ab Safety-and Human Relations
' afety:~nd Buii&ggs Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPerm itNo.:
Permit JII~ ❑ City Village ❑_Towno : State Platt
CST BM Elev.:/ Insp. BM Elev./ BM Description:CZ, Parcel Tax No.:
/iz S _ w• /3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic - weS 2 6,&I() Benchmark 17' -31'
Dosing r/ 10 dS
Aerationc- Bldg. Sewer C~J!/c✓
Holding St/ I# Inlet D3
3.
r_~f
TANK SETBACK INFORMATION St/y(t Outlet 9c
L P/'
TANKTO P/L WELL BLDG. Venttake ROAD Dt Inlet / c,//
Air Septic >!5-0 ' /0// NA Dt Bottom /2 7, 90
Dosing NA {Man. 3163 03,69~
Aeration NA Dist. Pipe y
3.s~ 03.E
Holding Bot. System ' 103oy
PUMP / INFORMATION1 Final Grade
Manufacturer dl ~rS emand ,
r~
Model Number I a.GPM
TDH Lift• d~(p Friction I / Systema TDH ~,C13Ft
Forcemain Length 3qd Dia. Ha " Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De
DIMENSIONS 3 DIMENSIONS
LEACHING,acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM
x
INFORMATION Type O CHAMBE Model Number:
System: OR UNI
DISTRIBUTION SYSTEM
Manifold Distribution Pipe(s) N rr x Hole S/iize,r xiPW Spacing Vent To Air Intake
Length s& Dia. 02 Length; / Dia. Spacing,3- / 76 > 3co
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems. _ ly
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ E] Yes E]
No
COMMENTS: (Include code discrepancies, persons present, etc.) /D. sd
y
o' Zvi
LOCATION: EAU GALLE.2.28.16WINWINW.,250TH STREET,
C~ /t~'F) r t f7 s C~,1 {
. I I
~~%L~P tC ,~c7jl~✓N1.~~ G-rnCc m 'ILL /Ci C~.t,^f
Plan revision required? ❑ Yes [:kItfo
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Sign ure Cert. No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: {
Safety and Buildings Division
!-J•L Bureau of Building Water Systems
SANITARY PERMIT APPLICATION
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.
• See reverse side for instructions for completing this application state sanitary Permit Number
da8993
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
Prop Y, Owner Name Property ocation
,#/0/4 (V,/&/1/4, S T , N, R or) W
P perty Owner's Mailin Address Lot Number
: 7 - S (J s Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
wr, d l/e ki. ` 3 Zjo 2 v 1(215 ) _,312
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City _ Nearest Road
Public j~ or 2 Family Dwelling - No. of bedrooms 3 Ei Vown of t e q G-4 `C- 2 SU e-; sL,
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1❑ Apartment/Condo 0 lr-loog- 1 0
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. placement 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 B1VI-6und 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
/ SOU Re wired (sq. ft.) Pro osed (sq. ft.) (Gals/day/sq. ft_) (Min./inch) r Elevation
7 ? 103 r 5 Feet 1 G S~ S' Feet
VII. TANK Capacity
INFORMATION In gallons Total # of Manufacturer's Name Prefab. Site - Fiber- Plastic Exper.
New Existing Gallons Tanks Concrete Con
strutted Steel glass App.
Tank Tanks
Septic Tank or Holding Tank G
1 d"
5 te" 1:1 E] 1:1 1:1
Lift Pump Tank /Siphon Chamber z7" 1 0601 ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility f #r install of the onsite sewage system shown on the attached plans.
Plumber's Name: (PaPlumb s Signatur tamps)
PRSW No.: Business Phone Number:
er rf ~
17
Plumbers Address (Street ity, St I Code):
w e 00 l/e 7-c! s, -C( 0 Z. ~
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Iss ing Agent Signatu a (No Stamps)-
/((Approved I ❑ Owner Given Initial b Surcharge Fee) qc- v__ v'✓vV'
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: original to County. One copy To: Safety & Buildings Division, Owner, Plumber
I 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 Perrr it 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-
It. 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 isto 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 1i2 x 11 inches must be sui, rutted to the cz,unty- The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of ~-iolding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells- water mains/water er,,ice,- stre,a rs u. ! laf es; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; at c! the ~f the building served,-
B) horizor;ial and vertical elevation reference points; c_) complete specificaho:-, for purnps controls; dose volume,-
elevation differences; friction loss; pump performance curve; pump model anc jump r a of ::surer; D) cross section
of the soil absorption system if required by the county,- E) soil test data on a 1 1', dorm, < c r) of 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.
i
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
March 2, 1995 226 Rose Street
Crosse WI 54603
i 4
WEGERER SOIL TESTING J
421 N MAIN STREET
PO BOX 74
RIVER FALLS WI 54022
apt
RE: PLAN S95-40102 FEE RECEIVED: 180.00
ASH, STEVE
NW,NW,2,28,16W
TOWN OF EAU GALLE 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.
Note: The plans must comply with all of the designer notes stated on the plot
plan. They include that the existing septic tank must be inspected for
structural soundness, size and baffles, and must be brought into
conformance with the requirements of chapter ILHR 83, Wis. Adm. Code.
If it does not comply, a state approved septic tank shall be installed.
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.
SUDA-7997 IR. 19/94)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
WEGERER SOIL TESTING
Page 2
March 2, 1995
PLAN S95-40102
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Sincere ,
erard M. Swi
Plan Reviewer
Section of Private Sewage
(608) 785-9348
7687R/ 2
II .
SHDA•7887(R. 10/84)
r
r Page of 6
RECEIVED MOUND STEM
FOR S95-40102
FEB 2 8 1995 A B BEDROOM RESIDENCE SAFETY & 6L.06S. DIV.
LOCATED IN THE NW 1/4 OF THE NW 1/4 OF SECTION Z. ,T ZEN, R 16 W,
TOWN OF e-ihl t C_Au,.E ST CE2p~)C COUNTY, WISCONSIN.
INDEX
PAGE l 'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
- s'-N, y IET AS 1i
____W u o 7 v i LLB w 1 s u oz;a
PREPARED BY
WECCEE:ZEFZ SQ I L TEST I NG
AND i!v c ®.S'~y
DES 2 Cpl SERVICE ` • tit
ARTHUR L.
• •r
F.O. BOX 74 421 K. KAIK ST. o wEGERER
RIVED. FALLS. V1 54022 EUSWORTH j
i
715-42`x-016 i w~
Z-ZS_q ~
JOB NO. q S -:1
PLOT PLAN Page Z of 6
'
Scale 1"=40
S95 40102
(WoP ti'`w,c Q
~ ~ G\tiavn~•p
,
R~3~pt1vC~ ~E C~ C x~uT L4 UwC~
W SA- ADC
D L1'
~ . ~"k\ S'S') N G S~P,CI C `1Y~~ 1z v~.t'{~-1 tom" ~ ~N 1l~.
5ezuiCE l F i-r- t S Q ~-L _C"j ra ""vT'0. Sae
Coi1F cZM1jtk14LNG. 1V- tLePLACe- WL70-
A ~o u v Gam. r~ ► O w ts`TL~w P~<'~rST -_T2 .
Irv oU x.~p S PmtD C?
i~~R, _a3.iS . G z b ~:~v ids ~~Ki,--S-,-- `3ls o~ Z. ` Pv c .
(3~0~ ~ ~ 2 o\z.R•~wer~~k~
c` ~y?~c~~ /~z~01 {!I~`~ ?FE1~S gP-nyC `C YF .1+C2.__-
P~evZ~s .1Z_'PxiVR S~R.siCG.
PRL~v pF~.: t R. NI 4V. Pf$ t SE-" I QN: :i~F
~ Fob ~-ce.~sS Rio cc~oF ep w~ ~ r~Iv c~
-VV
`6r ~
(n ,m by ~ioT Cu~P14CT OR
Q, OE tai a g Fly eFL. tbp 8 7
ull
E GO a i
-4~
cur.~~ivct tTl„ \o Z s S-3
® oTN~^t V F @ ol /o T- kw4 a
k,. SOS-o S~ Oki Sp twe
zz" FMCJUE G"Uhj% mN
b" 0 i►~ . T
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be ~oeo gallon capacity manufactured by
'F'il~k.y~s't~'Ctla ~Z-C~Sl'~ 11UC, LF ~-iST1~uG ~C'kh1Vt w1vST RePUrc.~~
5. Bench MarkS~ pip 7`itit ~b gE ~'t~0►~TCT't~ i0ol~ GAIL- 'MAiNt.
se,L- "\w( iz Ly-i
6. Divert surface water around mound to prevent ponding at the uphill side.
Page 3 Of b
S95-4.0102
Approved Synthetic Covering
FtsTV~ C 33 Distribution Pipe
Medium Sand
_ H _ G
Topsoil = F Elev. l~3• S
~i p
E "
` b
% Slope
Bed Of - 2 Force Main Plowed
r r s
Aggregate z From Pump Layer
AW VIEW
oE~• of ►raQU Y. uaoa AN lu)►~log D \.13 Ft.
pIV151o
E S Ft.
NO~~CE Cross Section Of A Mound System Using
g CO A Bed For The Absorption Area F o- b Ft.
G N- Q Ft.
A 6 Ft: H I- S Ft.
Linear Loading Rate= 7 - l GPD/LN FT B 63 Ft.
Design Loading Rate= a.3 GPD/SQ FT I Ft.
J `7 Ft.
K Ft.
L 8S Ft.
F„rG„ M, ; . W 31 Ft .
L
Observation Pipe--_\
8 \ K
A
~ Force Main
W
Distribution Bed Of 2~- 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchb= securely)
~our~a co►.~ cs~uF to `t~{~ vP 5~..~P~ S l A~
S ~?R 6t Z ot=- 6 .
Plan View Of Mound Using A Bed For The Absorption Area
Page q Of 1-
.
s95-40102
Perforated Pipe Detail
0
End View
Perforoled
End Cop) t~ PVC Pipe Install permanent marker
1.
~aAasa~``° at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q / S
PVC Force Main
P
PVC
Manifold Pipe
Distri ution
Pipe
Last Hole Should Be I
Next To End Cap
End Cap
P Z8 . S Ft.
Distribution Pipe_ Layout S 3 Ft.
`'t~nJl X Inches
9 4~Nrj,~b~
Y 7 6 Inches
Hole Diameter Inch
Lateral 1 Inch(es
Manifold Z Inches
D 1."~88^~S
aU51 AD
Force Main Z Inches
# of holes/pipe S
5 Invert Elevation of Laterals lrj\4.lb Ft.
&,-\•x1= S•'aSX4= ZIS-qr0 Gpm `ro'TftL
Place lst hole 38 from center of manifold with succeeding holes
at Na" intervals. Last hole to be next to the end cap.
PUMP CHAMBER CRI355 SECTION ARID SPECIFICATIOUS ' PAGE S OF 6
VEIJT CAP S95-40102
4'C.L VENT PIPE WEATHER PROOF
APPROVED LOCKING MANHOLE
JUMCTIOU BOX COVER WITH WARNING LABEL
~ 10' FROM ODOR, 12~MIU.
WINDOW OR FRESH I
AIR INTAKE I
GRADE I
EL `I" MI1►J.
46 t I
CONDUIT--
18"MIN.
1
• PROVIDE i -
INLET r Sall-'%RTIGH7 SEAL I I
APPROVED JOIAIT A Tank ,onstr~llC shall comply I I~~ APPROVED JOINTS
qt' ~ 5^,ILHR 83.20
with approved with I
< , I I I ALARM
pipe extending
3 feet onto Is E,1D~'"
solid soil.
Both sides of C I'
1 4
tank.
CLEK 8%. 6-1
FT H y .--PUMP-~
OFF
COUCRETE BLOCK
3" APPRwft>
RISER EXIT PERMITTED ONLY IF TANK MAUUFACTURrK HAS SUCH APPROVAL SEDDINQ
5PEGIFICATICIMS 1
NIENZEEMNEWM~
DOSE
, "\-pyy p~T MUMBER OF DOSES: PER DAU
TAN MANUFACTURER.
TANK SIZE: 1i~j %o &ALLOWS DOSE VOLUME x
S •S SSfSTs'1S INCLUDING OACK/LOIN: 3' O GALLONS
ALARM MANUFACTURER:
MODEL NUMBER: 10\ Hw CAPACITIES: A= IN.
OR 3LZ' GALLONS
SWITCH TYPE: mkmeu" B = 2' INCHES OR SZ.O 4LLOU5
PUMP MANUFACTURER: Mme(. MS C= ti01 I11uCHES OR 11a-0 GALLONS
MODEL NUMBER: ME tm D- 14_ INCHHES~O,R 36\ 0 GA<.1OA15
SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO OE ` b
MIWIMUM DISCHARGE RATE Z3'1IO GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEIREWCE BETWEEN PUMP OFF AUD0 DISTRMUTIOM PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE 2.50 FEET
+ 36S FEET OF FORCE MAIN X FYoFT.FRICTIOU FACTOR. '-LO FEET
TOTAL 0tIWAMIC. HEAD = -LA,o -:sFEET
DIAMETER -
IUTERAIAL DIMEN5ioWJ OF TAIJK: LENGTH _ ;WIDTH - ;LIQUID DEPTH
BOTTOM AREA - - 231= GAL/INCH
AS PER MANUFACTURER = 2.6.0 GAL/INCH _
Gtr ~oF 6
S
95~4U1U2 _
M E40 Series
4/10 HP Effluent MYGM
and Drain Water Pumps
Performance Curve
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40 12
35
10 to
W 30
W
W
Z 25 8 X
24.03 Z
20
6
J =
z3.y
H 15 J
F-
F- 4 O
10 ~
5 2
0 0
0 10 20 30 40 50 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
F. E. Myers. A Pentair Company • 1101 Myers Parkway. Ashland, Ohio 44805-1923
419/289-1144 FAX 419/289-6658 Telex 98-7443
K3326 7/91 Printed in U.S.A.
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' "t . COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S - C-vz_o 1X
not limited to vertical and horizontal reference irrt ( ion and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location an stt%1,j r bog_ 1(~oS-Zo
APPLICANT INFORMATION-PLEJKS pRINT 9L INF ON REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
S ~~11 E 66ff. tiff N Q 1/4 NVI) 1/4,S Z. T Z~ N,R 16 E (MOW
PROPERTY OWNER':S MAILING ADDRESS,-- LOT # BLOCK # SUED. NAME OR CSM #
1l 5 ~INVULD F_~ - -
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [MOWN NEAREST ROAD
l,~v~~VL~~~ wl S44 (-7151 6''9g-z 61~ lkii-Nk3 v~~~L ZSO 'M sT,
[ ] New Construdon Use [~(J Residential / Number of bed s 3 [ ] Addkn to existing building
Dd Replacement [ ] Public or commercial'desaibe
Code derived daily flow 'A SD gpd Recommended design loading rate bed, gpolft2 - trench, gpddt2
Absorption area required 3-1 S bed, ft2 3l S trench, ft2 Mabmum design loading rate o . 5 bed, gpl:W ~ - 6 trench, gpolft2
Recommended infiltration surface elevation(s) t O -Is. S ft (as referred to site plan benchmark)
Additional design / site considerations y')out"b w/ 6 `X 6 3' $ t?A _ L AJ ) "u)i ) i O F S hK) Ft t,t- .
Parent material N C.t h k- a tV ~F-T Rood plain elevation, if applicable N - it
S = Suitable for System CONVENTIONAL MOUND IN414 ND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system ❑ S ®U loS ❑ U ❑ S ®U ❑ S ®U ❑ S Eau ❑ S 14U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Motlles Texture Structure C.onsistertoe Botrdary Roots GPD/ftz
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends
31 Z. - L Z v,-~ 9li `M `Ft, s - o. 5 0.6
Z to Z to-1 ti y/3 si 1 Z sbk ~~h cS _ 0.5 0.6
o.5
Ground 3 Z6-32 l0 `tR 3/6 - s Sbh wtU`FV• c g - d-\4
elev. cz ),S l tz SJg
Zoo .a ft. 3ZS S to
Depth to
limiting
factor
3Z
Remarks:
Boring #
1 0-9 tio`12 312 - Z s Uk ►N►-F~ S - o S u_ b
2 1 - l~`1RV/3 13, 51~ Z`FSI~h Vn`~ CS n•S o.L
3 2r j-16 Votie 3/6 - S 1 \ w► s~k CS - o.y :o.s
Ground c-z-Sye slg
e
9t9 ~-7 ft l y z~-s1~ IOtiR Sly ~l fo ~ti 3 1' s ow, wtv`~. -
Depth to
limiting
factor
Zg `Remarks:
TName:-Please Prat PCB
Arthur L. We erer 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022
Sgnahxe: S - 13 Date: FE3. % 19 is CST Num 0 ber
0 5 7 6
PROPERTY OWNER S ~A SOIL DESCRIPTION REPORT Page
PARCEL I.D. # 00 $ - 1 OU S - Z10 . ,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bardary Roots GPD/ft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed
Trench
%-i TL 312 L ZM 51bl2 m'V►- S - o. S 77
3 ~F
Z $-Lb v- 31t _ sl Zwn Sbk V~q vil" is o.s o_L
Ground 3 16 S l O `1 R V13 1 ~g 1 c -,s b1z v) w l1- C.S o.~ u. L
elev. CZ 1•Sva SJ6
l~~A_Oft. L4 3S-S3 ~~`t[Z 51(, tv R w 3 )~S O~ ~+iV`~ -
Depth to
limiting
factor
3S`'
Remarks:
Boring #
3
I
Ground
elev.
ft.
Depth to
limiting '
factor
Remarks:
Boring #
}
~,4 1
i
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CST Signature Date Signed Telephone No. CST #
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 11 01 L n e4 '~9
Location of property_UZ~v_1/41/4, Section , T ,2i N-R / W
Township 4 u kAffe- Mailing address Sr 7 ~j - 2 U r'~
lAle,Ud&I , (le w's s -.(-(o -L k
Address of site .Q
Subdivision name Lot no.
Other homes on property? Yes No
Previous owner of property S't-e L ,,e-
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? s No
Is this property being developed for (spec house) ? Yes Leto
Volume 103 and Page Number 3 ( U 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. _ f-2(' f-4, 9 , 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.
br'2G S'aq
S1 ature of Applicant Co- pplic t
5~
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER L r ~t y
MAILING ADDRESS S ~av d c,, , S
_ t
PROPERTY ADDRESS -5A4h If--
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE LA"/&0 6`L/- Ye 4
PROPERTY LOCATION 4/4, 1/4, Section T N-R W
TOWN OF i k ct G 4 l ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUMEI I /.3, PAGE ?CO, 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.
L/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: - 4 _
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson. WI 5,1016 1 1/93