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HomeMy WebLinkAbout018-1022-50-001 C o v °o M C; Ci O a C0 ti G ~ C I C 50 O E O N O U M N -O O 3 L) =3 O s o~ E O Z x 0 c i 'O m a a I o y o C Z° E 7 m a U LL C > O O O s O E N O O O E N U ~ M v a ~ Z ~ C i`V a m I'' N o 0Z a N N z E -a O (1) m E M O f N O O C U m o Z Z o N z N 04 l9 ~ > I d N a l0 Y C CO j o c a E N 1C/) O O O Z° • wri ~ a a a I a Lo Ln tq .°.i V a a) a) N e ~ ~ °o N g r- CC) E M O o C) 0 m N to a N N co N w rn Q co rn a w O C 1!1 C CO, G °0 3 o c c E ao rn © N N ffO CL p C o o E E Q) co Cf- -C m o E co t ~ = o5 in ai ^ F- F- ° cv m ° E E • y' O = U N O N=5 Cn \ ~ w v `w ~a III a ~t a L a w CL r- r`i►i N i i c A c°~a~I, oin00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER' ADDRESS Z O d f l ~L1 TiG s SUBDIVISION / CSM#_ Q cL C'e s LOT # SECTION T_Qj,? N-R_LZW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N h o (J r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_~ du,esrer,~J Liquid Capacity: /,aele) Setback from: Well -Z& House-,5-,5- ouse S ,5- Other Pump: Manufacturer_Za j~ c--„ Model#~ Size Float seperation elf Gallons/cycle: /5~/,' Alarm Location e SOIL ABSORPTION SYSTEM Width: Length Z 5-- Number of trenches / Distance & Direction to nearest prop. line: S ' Setback from: well: ~House_ 77 Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: S-- PLUMBER ON JOB: LICENSE NUMBER: 2 INSPECTOR : - J 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and 0tumanRelations INSPECTION REPORT ST. CROIX SOety and Buildings Division (ATTACH TO PERMIT) Sanitary Perm itNo.: GENERAL INFORMATION Permit Holder's Name: E] City ❑ Village ❑ Town of: State Pla o.: GRIPE, ROBERT F. X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: g OX' TANK INFORMATION ELEVATION DATA S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aerati Bldg. Sewer Acx L, 6 c),kr Holding St/ Ht Inlet 97 TANK SE FORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding--- _ J Bot. System ' PUMP / INFORMATION Final Grade Manufacturer Demand 42 Model Number GPM TDH Lift Friction Systerrl , -c~6 TDH Ft , Head Forcemain Length Dia. 0 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of TJenches P No. Of Pits Inside Di d Depth DIMENSIONS 'S / DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHI anu adurer: SETBACK INFORMATION Type O CHA R Moe Number: System: yv~01--6 ~1~ O NIT DISTRIBUTION SYSTEM Header / Ma ifold Distribution Piipe/(ss)) x Hole Size x Hole Spacing Vent To Air Intake Length _rp Dia. 7 Length f Dia. _Z~ySpacing 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 / Tinter Bed / UepF~rEdges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hammond-11.29.17W, SW, NW, 190th Street S Plan revision required? ❑ Yes Q'Ifo- Use other side for additional information. Q/ SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: " Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System., 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County 1 " than 8 112 x 11 inches in size. ~J • See reverse side for instructions for completing this application State Sanitary Permit Number The information you rovide may be used by other government agency ~Oon ~3 y p y y programs ❑ Check if revito prevlo s application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location ebe 1• 114 1/4,S /1 T ,41 , N, R E (or)e 'ej Property Owner's Mailing Address Lot Number Block Number 1.0,047 4 e a-c City, State Zip Code Phone Number Subdivision Name or CSM Number C :2 ( ) II. TYPE BUILDING: (check one) ❑ State Owned ❑ City Nearest Road p Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF Th 3' III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax mber(s) 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 /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. 1-9 Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System --System Tank TankOnly ______________Existing System ❑ 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 KMound 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 rd Re ui d (sq.ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 4-1 2 Q3 3S" fJk- fO r 6- Feet 62.E Feet VII. TANK Ca in galloacitns Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks. Tanks Septic Tank or Holding Tank f 9 G ~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber Sr7 1 C L6L El El El El 1:1 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 Stamps) P PRSW No.: Business Phone Number 'it. M S G 3 ~Z /S~ 3 G -3/2 Plumber's Address (Street, City, State, Zi Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved SEt Permit Fee (includes Groundwater ate Issued ing Agent Si n ur (N Stamps) ge fee) Approved E] Owner Given Initial X Surchar Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divi ion, Owner, Plumber 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 tanks-) 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. i 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- 11 . 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 informatior, requested for numbers ? through 7 Vii. Tank, information,. Fill in the capacity of every new/or existing tank, list the total gallons, r;.;mber of tanks and m,anufacturer's name, indicate prefab or site constructed and tank material. Coo- plete for al!, e )tic, pump/siphon and holding tanks for this systern. Check experimental approval only if tanks received experiment<II product approval from DILHR Vlll- Responsibility statement. Installing plumber is to fill in name, license number with appro::;riate prefix (e.g. MP, etc.), address and phone number Plumber must sign application form IX. County / Department Use Only. X. County / Department Use Only l ;>p .CatCr!5 not Small TC an R .'t' X 1 ? "4 S muss i iPCi t;: e .:nty- he plans must if 01, F ;,.->"ovjlr j CYot~-?an, draws, to scale or 'o h c. i`Iplete C f _llnc tJnk(s), septic primp or siphon ;l SUFI ._OrJt'iJl"1 Sys!:. ?!d ~p'St1T ;1 _ IP . r IIddlnq served; _ st: is, dose volume; >r . n (t - c e rm. 3 rnN 7; nss section 11. II1I;IFe by :.eSt.:aCJ'_?i ..izin-Information. GROUNDWATER SURCHARGE ;r ,--!,,tied the creation of surcharges (Lees) for a nurnber c` ato ".vhi0- can effect- grourld-v ,iter v~ Wo r~yl t7 r;,'~ ~lveSt;CgalJOns lOnltOfing aro The mJ J, C p it r '1~t't I',hrzse Surcharges are used fer n und and establishmer;t of standards- ` SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bo: 7969 Madison, Wisconsin 63707 State of Wisconsin Department of Industry, Labor and Human Relations December 1, 1994 2226 Rose Street La Crosse WI 54603 Y water ~ w.. N WEGERER SOIL TESTING 4 119°$ ARTHUR WEGERER 421 N MAIN STREET' PO BOX 74 RIVER FALLS WI 54022 RE: PLAN S94-41502 FEE RECEIVED: 180.00 WEISS, JAMES SW,NW,11,29,17W TOWN OF HAMMOND 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, Dennis Sorenson Plan Reviewer Section of Private Sewage (608) 785-9336 SBD4928 (R. 01/91) Page of 6 MOUND SYSTEM 6114"4150 2 FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SW 1/4 OF THE N W 1/4 OF SECTION T Zq N, R t7 W, TOWN OF l~ t~~wl OHO ST• Ct2UIX COUNTY, WISCONSIN. INDEX PAGE 1'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 RECEIVED y" ~ s-ti >tEi-I S S N 0V 2 1 1994 ST. ~~~~w~~,wi s~[ooZ SAFETY & BLDGS. DIV. PREPARED BY WECGEF<- EF? SOIL TESTING AND . o®~~ ~~SC ONS DES I GN SERV I CE o•° •ti i O® ' ARTHI R L. : f v R ,_,r F.O. BOX 74 421 K. 11AIK ST. • wec_RaR = i s R I VEF. FALLS. V1 54022 ELLSY:ORTH, ~ k wfs, ~e Z' 715-45-0165 weees® ~s I G ~ Boa, JOB NO. ~`2~ PLOT PLAN Page Z of Scale 1"= T& S94®41502 xwkr-` 3 3Dtc~M RNStDC~L a ~ o Sls4Z1 C ~h'^'k ~ v 7i - V 7 `1Ji~ 131.0 G . LL b tZIJ h O v~ ~ S t P ~ aM4 eTL.. \00.0 ON P OF wt}r, TR\w1 -W? $'J- ~l,\OZ N a OOT10Mt OF M%;rl~ %I01AJG. 8,1 2~, B,Z kn.9'l - Prl~~vc GtiZav~,A~ r t ~L~`-lS`f7tiG S~1~TLC`C'h~1~. A~ ~~-Yw~TCt t-1~ t3F p0aKAJ0o►U ez~, s cat~F . J ~ MNctlu~tlJ 5' CpU~ OU~1Z. C,11~~ ~N6~:: o~-lu~ wM1 o1Z Ikj!S R s PCR cp~d ~ti~ ~Z~ST pR~T'E~Ti o+v , NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to beVb4oj6S0 gallon capacity manufactured by 'F-/1~Dw~'Sl~~ P1~~sT~. ANC. eo►-t3►►~/~`T)o~l T7'Ctik 5. Bench Mark S ~~3ovt - 6. Divert surface water around mound to prevent ponding at the uphill side. S94-41502 Page 3Of Approved Synthetic Covering ,<z) c 3 Distribution Pipe Medium Sand ~G Topsoil _-H F Elev. V00-5 -J I E N D 3 b 7 % Slope Force Main Plowed Trench of %Z"-212," From Pump Layer Aggregate Undisturbed D 1.O Ft. Soil E Ft. Cross Section Of A Mound System Using F Ft. I Trench For The Absorption Area G ~•n Ft. A S Ft. H I- S Ft. B --)S Ft. r t f'r I ~Z Ft. Linear Loading Rate= 16,o GPD/LN FT J _7 Ft. _ 5 r .r Design Loading Rate= 13.35 GPD/SQ FT K \ Ft. F cL7 F Awe Position of Force Main W Z__ Ft. J Foi ee~ B K amain-~ A _ - W I " Distribution Trench Of 2 - 2 2 Pipe Aggregate 1 Permanent-/ Observation Mark r Pipes nt 1 es (Anchor securely) V-IUUVjb \S CtJ)`1cAUL~ -Tvk"C UN \-0V, E Slto S ~~uT PI.iC~ PRA t Z of G. Mound Using I Trench For Absorption Area 894-41502 Page Of Perforoted Pipe Detoll End Vie- t )Perforated End Cop) o PVC Pipe Jo~~ s~occ` Install permanent-marker at end of each lateral Holes Located on Bottom. Are Equally Spaced Q End Cop r r Q ~ PVC Force Main ~ r '`'N Alt. r! Distnoution t! Pipe A-t r .xm. Lost Hole Should Be Next To End Cop Distribution Pipe Loyout p 3y. S Ft. X 3- Inches Y 36 Inches Hole Diameter Inch Lateral 011 Inch(es) Manifold Inches Force Main " Z• Inches # of holes/pipe `Z Invert Elevation of Laterals Nr~k•0 Ft. I .1 " Place lst hole la from tee with succeeding holes at 36 intervals. Last hole to be next to the end cap. Combination Septic;Tank and S OF ~o . ' PUMP CHAMBER CROSS SECTION AMD_ SPECIFICATIONS PAGE VENT CAP WEATHER PROOF S 9 4 4 0 JUIJCTIOW BOX 4'C.I. VENT PIPE APPROVED LOCKING 10' FROM ODOR. MAWHOLE COVER J1.7ly wA(tr.~l►JG 1..Pt6EL. -dINDOW OR FRESH 12'MIU. AIR IAITAKE cor~putT I tel. 1,b 1 S ~ i H~ MIIJ. GRA _ 16Mlu. IbhIIN. PROVIDE I . IA1LE T 7 AIRTIGHT SEAL I III ~ A ( I I APPROVED JOINTS APPROVED JOIAIT I I I W/C.I. PIPE-vc- W/C.O. PIPEOR Tank construction I III ALARM EXTEUDIUG 3' EXTENDIM& 3' shall comply with II ONTO SOLID 601L OWTO SOLID SOIL. ILHR ('13.15 and 83.20 d I C I I, OiJ i LLEV• F T. PUMP ^ COUGRETE q Z SO 6~OEk 3.. APPRW9 RISER EXIT PERMITTED OULS IF TAWK MAUUFACTL~i~R. MII,S~^Stl ltl Apf' OVAL BEDOINr4 SEPTIC SPECIFICATIC)US f D05E MAIJUF/1CTURCR: lpwL~S ~ ~ S'r NUMBER OF DOSES: ' S PER DA4 TAWK SIZE: 1.000 /650 GALLOIJS DOSE VOLUME 1 INCLUDING 6ACKFLOW: GALLONS ALARM MAUUFACTUFLLR: S.S. Z~C-YRO T~ MODEL LIUMBER: ~O L !Aw CAPACITIES: A= 18 IMCHCS OR 30 ~ GALLOAIS SWITCH TYPE: WtQ-lz °V R-,-( 5= INCHES°OR 3q GrLLOAIS BUMP MANUFACTURER: zu~'L- CO►1Ph~`( C= a INCHES OR X310 GALLOU5 MODEL NUMBER: 53 D= LD INCHES OR GALLOMS 1F~IL~R Lr MOTE: PUMP AUD ALARMARC TO 6C b SWITCH TYPE: MIIJIMUM DISCHARGE RATE- Z'.OS GPM IN5TALLED OW SEPARATE CIRCUITS VERTICAL DIFFEILENCE DETWEEIJ PUMP OFF AUD..DI5TRIBUTIOU PIPE-''b-1 FEET + MIAIIMUM METWORK SUPPLY PRESSURE . . . . . . . 2.5 FEET Iooft.FRICTIOU FACTOR. C.-S, FEET SO FE ET OF FORCE MAIM X ~'bj F j TOTAL DtI JAMIC HEAD = \,Z), FEET DIAMETER 38 Pump chamber _ IAITERNAL DIMLWSIOW~ OF TAIJK: LCLIGTH ;WIDTH --•;LIQUID DEPTH BOTTOM AREA - 231= - GAL/INCH AS PER MANUFACTURER l`1.0 GAL/INCH cn I W ~hGt 6 OF W~ HEAD CAPACITY CURVE aura 61/4 a "53-55" SERIES 45% 25 m TOTAL DYNAMIC HEAD/ I 47/8 FLOW PER MINUTE EFFLUENT AND DEWATERING m CAPACITY 20 HEAD UNITS/MIN -11/2 - W FEET METERS GAL LTRS 43/16 111/2 NPT = 5 1.52 43 163 m V 10 3.05 34 129 15 4.57 19 72 Q 15 19.25 5.87 0 0 4 S94 41502 C 10.98 J 10 I Q H O ~ 2 28.08 5 915/16 l 0 I US 10 20 30 40 50 33/x2 GALLONS LITERS 0 80 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Piggyback Mercury Float Switches • Available with special cord lengths of 151, available. 25', 35' and 50'. • Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non-automatic 15 ft. SELECTION GUIDE M53/55 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts-Ph Mode Amps Simplex Duplex 2. Single piggyback wide angle mercury float switch or double piggyback mercury float M53/55 115 1 Auto 8.0 1 or 1 & 7 - switch. Refer to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10-0072 or 10-0075. D53/55 230 1 Auto 4.0 1 or 1 & 7 4. See FM-712 for correct model of Electrical Alternator, "E-Pak". E53/55 230 1 Non 4.0 2 or 2 & 6 3 Or 4 & 5 5. Sensor mercury float switch 10.0225 used as a control activator, with E-Pak (3) or (4) float system. 53 Series - Wt. 23 lbs. -.3 H.P. 55 Series - Wt. 25 lbs. -.3 H.P. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in simplex or duplex operation. P/N 10-0002. 7. Two (2) hole "J-Pak", junction box, for watertight connection or splice, P/N 10-0003. For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; CAUTION Piggyback Mercury Float Switches, FMD477; Electrical Alternator, FM0486; Mechanical Alterna- All installation of controls. protection devices and wiring should be done by a qualllied nator, FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FM0487; and Simplex Control licensed electrician. All electrical and safety codes should be followed in addition to the Box. FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump- , MAIL TO: P.O. BOX 16347 Louisville, KY40256-0347 Manufacturers of . SHIP T0: 3280 Old Millers Lane OELLE/~ ZZ_ Louisville, KY 40216 11 o p (502) 778FAX(502) 774-36248-PUMP QUAL/TY PUMPS ~NCE ~~3~7 ' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labot and Human Relations Divisi )n of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attac In complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST C~ not Ii nited 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION :ypttAkE-S RtuO \-Cwt WC-1 S S 69Vf-E S I3 1/4 tL1141 1/4,S 1 \ T Z-°I N,R \Z E (VOW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 0 6 9 \,°I, o' 1W ST - CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE EVOWN NEAREST ROAD 3f~~ow\ru W 1 Sy.ooZ r) 113) -1q6- ZZC?(C' o►v0 ) CI O T>t sr. [ J New Construction Use [XJ Residential / Number of bedrooms 3 [ ] AdditiQn to existing building Replacement ( ) Public or commercial describe Code derived daily flow So gpd Recommended design loading rate bed, gpd/ft2 0.35 trench, gpd/ft2 Absorption area required 31 S bed, ft2 3'I S trench, ft2 Maximum design loading rate S bed, gpd/ft 2 t' - b trench, gpd/ft2 Recommended infiltration surface elevation(s) o S ft (as referred to site plan benchmark) Additional design / site considerations "buNb w/ S ~x S~ -Ma~jc~4, Y'1 uj • 1 ` of Sf►vD F 4-t- Parent material s@p\wt~►.iT ovM. "rL L_ V, Flood plain elevation, if applicable 'ti A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK S NU ❑ S 1~[ U U= Unsuitable for s stem El S NU 9 ❑ U ❑ S NU ❑ S Lkl U El SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourxbry Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerich o_7 10 \Z zlZ - S1 Z sek My a.S - o.S o.6 Lj Z 7-16 \ts -I y V4- 3/3 - S Z'Fsbk Yn F~ Crv o. Ground 3 It 3s -)•S`tR-3Iy g Zvh b\t yqu'F-ti. cw o.S c~. b elev. ).S`fRS)b _ \oZ.Dft. 4 3S_7t/I 5 `1R ~t LO `tIZ 613 S O T I Depth to limiting fac35 „ Remarks: Boring # x~ Z Z q-33 1 by R 31 ~ - S 1, Z,'~S Uk m ~h C S o. S o. o Ground elev~ ft. Depth to limiting factor _q_Z_ Remarks: CST Name:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: 0144- ZqJ LI_L _9V M00576 PROPERTY OWNER W W- IS S SOIL DESCRIPTION REPORT Page Z4 Of 6. PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0-8 ~o~-►~z ZcZ - sit Z sbk mfr. cS o.S c.b Z 8-19 ~,o ~R 3t3 - Si 1 Z`F sl~k cw o.s o. L Ground 3 lq --S$ IL o~ 2 3l ` S C S ~k V Ck, _ o o . S elev. R&.s ft. L4 35-65 tz 3/L stv SI o~ vv1 S - - Depth to 5 6S 13 5 `l 31 S 1 0 limiting fa or P S S h'f 3 Z Remarks: Boring # ~"~.GCw^~nv`v~u Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # h\4. i•F Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE I"= L10' x w ~L { 1 ~ 3 3DR~M I _o ~`X~3T~tG S ffP~1 C M-vt \i ~ tq , _ Si ~ 1311 6 N 'b"Fezl I m .o ~3wt LL.\on.0 one ToP of w`rtRE TR\r~1 et~-P AT ~l, \pZ° s OOT~1~ OF r-'1 fit, g ~ OIx1(~ . i`~- ~o r~uT CuMt~k~T op Or 11 S~cv ~Z Q ~4-t s PrR~ R. btu' 2I ~ is ~t96 S ~ ~ 00 s 2 F- J 2 L 715 ) 425-01 65 _ 1400576 CST Signature Date Signed Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~fC&%0- C,eiIk- MAILING ADDRESS ,L212 -tN 9L Dr "j S, PROPERTY ADDRESS /90 '114 (location of septic system) Please obtain from the Planning Dept. CITY/STATE a9 k, 1 rJ LJ d~ PROPERTY LOCATION S 1,11 1/4, 1/4, Section T_,g_2 _N-R__Zl W TOWN OF 64 LU ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 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 ~kj)& eT- pe(,-0, Location of property , SL) 1/4 j 1,J 1/4, Section /I T,21_N-R W Township 14dmn7v,J,\ Mailing address A) /Sc)r/-' S% /~,9Lllc~r,.1 [ )l~ Address of site Zp la ,19r' TH SZ" Subdivision name A)01J- Lot no. Other homes on property? Yes No Previous owner of property 61q2'E S LJ C-1 Total size of property G=U 41'fe 's Total size of parcel Date parcel was created Are all corners and lot lines identifiable? i Yes No Is this property being developed for (spec house)? Yes li No Volume ilia and Page Number ~6-9-7 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. L,,.;? k' , 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 ,2 j- 1 yam- , Date of Signature Date of Signature State Bar of Wisconsin Form 2 - 1982 WARRANTY DEED DOCUMENT NO. VqL I' r - IX CO., WI FBFE R`S OFFICE James H. Weiss and Kay F. Weiss, husband and orRecord Wife, 2 7 1995 at 10:10 App conveys and warrants to Robert F. Cripe and Nina L. ripe, husband and wife, Rf Dods THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, State of Wisconsin: (Parcel Identification Number) S 1/2 of NW 1/4 of Section 11-29-17. :IRAN SF 5 1.01 This is homestead property. (is) )0DW Exception to warranties: Fasements, restrictions and rights-of-way of record, if any. Dated this day of February 19 95 (SEAL) 1~7irrl.s-a.. ~pL aJ1~ (SEAL) 61 * * Ja¢mees, H. Weiss (SEAL) .01( a L 411,) (SEAL) * * Kay/ F./ Weiss AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. 3 authenticated this day of , 19_ Personally came before me this day of ~ February , 19_95 the above named James H. Weiss and Kay F. Weiss, husband and wife, _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ authorized by §706.06, Wis. Scats.) to me known to be the person S who executed the foregoing strument an~ ackno edge the sa e. ~j THIS INSTRUMENT WAS DRAFTED BY Kristina O gland _ ANN L. DOSTAL NOTAW 0. Attorney at Law Notary Public _ County, Wis. Ire) (Signatures may be authenticated or acknowledged. Both are not Mcommission is permanent. (If not, state expiration date: necessary.) pia II *Names of persons signing in any capacity should be typed or printed below their srbnatur:s. WARRANTY DEED it STATE BAR OF WISCONSIN Wisconsin Legal Blank Ca. Inc. ~i FORM N. 7 IOR?