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HomeMy WebLinkAbout020-1073-00-000 4 o a~ o I 1~ p~q O ~ 4 0 c Of O CO N O O N o o E N O d M 7 m .-E C Lo O y III I!. N - pQ !i~ Uw EN O CL -0 Q E N a.c N c cu 6-, E C! N N C C c IO O N o E L N E. ~ > 3 O T 7 N N N O ~ N O Z N CL= o C V N L M c N N LL c ti d O C c O O " > N N O r- N C O O x'O .0)'O N O N _ C Q ru, m0CL N i 3 ~ v (D Z y a o ° a Z I, d d o CY) N w a m v N F- Z o V N C C7 C C O Z O N N H r E N (D cu N N CD. 7 O N O c a to N V O o 0 • ►~l ~ L L_ N jp (6 N U w V U O N Q 'w w N N Z~Z zzo w M 10 - Y d Q ~ w (D C Mo co D a jo o L E r- 2 M> tin H H r O O O a J CL CL CL o 0 N 'D U) (D cn }y in J U = N N v o a o _ E O O N c co N c d Y 'p d Q } in Q in w ~i O O O n (n a O O D C ` O C C 0) 0 oo C) o 10- a a a 0) o 0 L M ~ a E E o o 40. O c M C L t N 7 o v t' N O S W N I- F- C N • N FN O N 2 J N O Z N °d fA CC I O rr dt a ` a i STC - 104 yi r AS BUILT SANITARY SYSTEM REPORT 4 ( ` Y OWNER t)~S KF 1A I1 OfLf .c 'T -Pj ADDRESS 5j~_C SUBDIVISION / CSM# ( LOT # SECTION _T_ N-R_ W, Town of ~Sq/1 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM P''4 on p C-~ G W INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: r /00 is 0 S Imo( n 1/LP Q I ALTERNATE BM:. / tC0 0s- s ' I(~ ~I SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~/~~11~f Sf Liquid Capacity: iooo 7S6 Setback from: Well House ,5 Other Pump: Manufacturer AAr1 rv,4A-h(' Model# Size Float seperation -7,40 Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 7 Number of trenches Distance & Direction to nearest prop. line: 'fib L f Setback from: well: ©O House /yo' Other ELEVATIONS a Building Sewer ST Inlet, q ST outlet c~ 7. S PC inlet 63 S0 PC bottom Pump Off BO, ~e/ Header/Manifold ~y J Bottom of system Existing Grade Final grade DATE OF INSTALLATION: `",..)Cj q(/ I I PLUMBER ON JOB: _d l zqm A Qq LICENSE NUMBER: (V INSPECTOR: J i/V\ 3/93:jt III _ _ v Wiscor?sin L)epartment of Industr PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and guildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.: Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State Plan o.: KRUEGER, JAMES X Hudson CST BM/Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA „?/1_2 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / 6/ .,,-5 /1~! iiF Cr f ~J Benchmark' JG %;d Dosing 9~ <l~p . 6.5 Aerati__. Bldg. Sewer b Holding y St/ Inlet e,56, 99 TANK SETBACK INFORMATION StIX Outlet ?7,6,';P' TANK TO P/L WELL BLDG. FAir rIntake ROAD Dt Inlet ~Z1rj q3S~ r Septic > Sj' NA Dt Bottom 14' -29,99' NA Header/Man. r Dosing >SO SD'0 Aeration - A Dist. Pipe Holding Bot. System PUMP FORMATION Final Grade Manufacturer Demand %en~ 'S ' U,/j~ p Cm' Model Number GPM T S Loss riction System TDH Ft TDH Lift F - Head Forcemain I Length 3 Dia. ZDist.ToWell7ZS 97~ SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PI No. Of Pits Inside.Dia. Liquid Depth DIMENSIONS 75 / DIME SYSTEM TO P/ L BLDG WELL LAKE / STREAM Manufacturer. SETBACK INFORMATION Type O / i CHAMBER Mo a Num . System: /d OR UNIT ,C61ALr, L4± DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x 44c4 -Size pacing N~Vent To Atr+q;ake Length Dia. Length Dia. r Spacing SOIL COVER x Pressure Systems Only xx Mound 0rM::Grade Systems Only Depth Over Depth Over xx Depth Of Tx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes C] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.26,.2?"48W, NE, SE, Lot 3, Kinney Road f G7 ~.e'~{ t >.~~0 ,2a , i ~ ~ ~.p .t-,.-~1.~. j~,.rl' • r;,7:L. ' ~ Gvt~ l ~}~n-._ ° - tZC"Inspector's i t - (,(J 7 c d/1 L< t LP~w; Plan revision required) r❑ Yes No Use other side for additional information M 6191 SBD67 (R 05/91) Date Signature Cert. No. CI~.!r-~ ; v~,~..,..~ p ~i. ~ jf//'.~~ ry~~~%`G!-X~ f~..(~ y✓) ~O ~(~~.l/O.6/G r4 t// l _61 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: li I I~ i 1 SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildiinWater Systems ngWater 201 E. W3shingto'n 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 81/2 x 11 inches in size. 541- • See reverse side for instructions for completing this application State Sanitary Permit Number PI'9~7-?3 The information you provide may be used by other government agency programs eck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan LD. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property cation _rA 1/4' 1/4,S~(p T a19 ,N,R~ or Property w~r's Mailing Address Lot Number Block Number City, State I~ Lt~ Zip Code Phone Number Subdivision N e or CSM Number t,.90oC,1 11. TYPE OF BUILDING: (check one) ❑ State Owned C!ty Nearest Road ❑ village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms 7 Town OF C44 / 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) f 1 ❑ Apartment/ Condo - " 0-73 ` O O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1.,K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting 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 ERSeepage 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 El v. 7. Final Grade (000 Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft(Min./inch) ~ / , / Elevation 74-6 -7 45n 97s Feet Feet Ca act VIL. TANK in gall0 5 Total # of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel lass ANew Existing strutted g PP- Tanks Tanks Septic Tank or Holding Tank _Ijoc) es ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1-7501 75 Q / 0 a ❑ ❑ ❑ ❑ ❑ I 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: ( Stamps) PRSW No.: Business Phone Number: k1w in LPM(\<co MP/ v 7 c;)Q Plumber's Address (Street, City, Stat., Zip Code): IX. C (XJN / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issuue Issuing A nt Signature (No Approved E] Surcharge Fee) Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO-6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Di- ion, 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 systern, 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 numbe (s) of where the system isto be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwe' ling. 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 throug`1 7 V11. 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 sys';em. Check experimental approval only if tanks receivea experimental p: oduct approval from DII_HR VIII Responsibility statement Installing plumber is to fill in name, license number with apprcpriat prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only X County/ Department Use Only. u. - smaller th;?-` R "lit X 1 InChIP_s bF.- -It n(; 1(y. Mans mUSt it L••;5r' the '0 ,,w n i'/ ~;.J, (_Jiavvn tc SCaic- gi with conlp![ septic c F•.c Cpl lf]or :>Ipi o-l (i'_StiS ce, _Ac,_.... !n;.7unf_rmation. ,t GROUNDWATER SURCHARGE 1g63 Wisconsin Act 4 1 C, inclu(-ed the ~eation of surcharges (fees) for a nuinber oi t1,~'~atea pr:,~ ,s vhich can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contarn ~ )jic ~i nvesJgations and establishment of standards 3~3~ i •q ~o , *WELL c 0A x ciz, 7 li E L/O PAGE GF PUMP CHAMBER CROSS SEC lor,l Ah1G SPECIFICA'f10uS VENT CAP 'i"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIKIG > 25' FROM DOOR JUNCTION BOX MANHOLE COVER - , WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I I 'i" MIN. 16' XI U. - CONDUIT INLET PROVIDE I _ AIRTIGHT SEAL A I j~l I III II ALARM a I II I I *APPROVED i oN JOINTS WITH I ELEV. FT. APPROVED PIPE 3 ~ ONTO PUMP OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFICATIOUS DOSE _ TANKS MANUFACTURER: f`~A A~pP~P(iAE~~ CUMBER OF DOSES: C PER DAy TANK SIZE:_ SO GALLONS DOSE VOLUME ALARM MA►JUFAGTURER: _ r 41? C.+Y-o INCLUDIMG 6ACKFLOW: /GALLONS MODEL NUMBER: _1n I H CAPACITIES: A= P(O ~.W CHES OR GALLOWS SWITCH TYPE: - rn Qr( C'-AC_ l AlLONS ( 0_1 1 B= ~ INCHES OR W-ALLOUS PUMP MANUFACTURER: _ 71~ CIUCHES OR MODEL NUMBER:D= INCHES OR Z GALLONS SWITCH TYPE: _I"LD~Q *C1C`~(~" dY1.e('Cc.IP~ NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEIJ PUMP OFF AND DISTRIBUTION PIPE.. - FEET + MINIMUM NETWORK SUPPLY PRESSURE , , , . 2.5 FEET + -FEET OF FORCE MAIM X FT✓ iooFLFRICTIOU FACTOR._~~Z Qppd~~ FEET TOTAL DYNAMIC. HEAD = [~,[dQ~L FEET INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGUED: LICEIJSE HUMBERM I P a C) ~r nATF~ Safety and Buildings Division r-~■~r■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 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. 5L - erUiiC • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro erty Owner Name r Propert Location C/4 = 1/4, S 4j( t T~` , N, R ! tKbr Property Owner's Mailing ddr ss Lot Number Block Number City State Zip Code T(P hone Number Subdivision Na a or CSM Number A~ WT -I ) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cityage Ne,~rest Road ❑ .tea y ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ToVIIIwn OF +J~'511 ( y~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo (~9 Lo 7a 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System_ Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 N 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. S stem Elev. 7. Final Grade ® Required (-ssq. ft.) Propose©(sq. ft.) (Gals/day/sq. ft_) (Min./inch) (o Elevation Feet Feet VII. TANK Capa- c" in gallons Total # of Pr fab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer's Name Con rete Con- Steel Plastic p New Exlstin strutted glass App. Tanks Tanks Septic Tank or Holding Tank W ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ~Q CO O l t El I El El 1:1 11 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) P umber's Signature: (N tamps) RSW No.: Business Phone Number: le vi n y7c? O 7(S-d ~5 - 7Y Plu ber's Address (Street, City, Stake, Zip Cod ra~°I sr 71 IX. C NTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing A ntSig ature (N amps A rOVed Surcharge Fee) pp ❑ Owner Given Initial~ Adverse Determination CJ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Ruildings Divi ion, Owner, Plumber INSTRUCTIONS ,r . 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: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all informatior 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 experi -rient,d c,roduct approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appro:)ria'".e :;refir (e.g. MP, etc.), address and phone number. Plumber must sign application form IX. County / Department Use Only. X. County / Department Use Only. :ete plans and spe,- iiicatic~ns not smaller t".an a U:! x 11 inches rr a i?c suhmotted t , d-~P _ci,nty. The plans must fo lowing: plot an, drawn to or with complete ,1ocaiJ f Jinc. tank(s), septic +.11t1ySevVers. Nell`; wale r)all.i 0;i.' k pUrr'lpOrslphon SG I _ E`- C>n SJsL"i S; rz~~a erllEfi i af~ 17, t`i;' JJ:_'. ? c.~ tz ilding served, c eV, 3r ce, C cc)- N2 fCr Ul%r'• r-. t X15, ;]C~ 2 VOIUme; 71 4. ~^Ci.`, !Iftl n Jy tY. r~C,"-n 3'1': J'. - 'p f.J _]el cll ~(T17 _ r D,i c.l"'lsssectlon _ s ,orptio, L d b} u e _ounty; ) s,. a: r, i . nct inlorrnation_ GROUNDWATER SURCHARGE 198 V% isconsin Act 410 included the creation of surcharges (fees) for a number o recaulated Itr:lctie> which can effect groundwater The monies collected through these surcharges are used for monitoring groundwater ;ontarrr i ltai< r inve,,tigations and establishment of standards. i LOT tiE ~iy sE iY sacs 7-d9 N.R, i9 ~ Ped 1V ~((n ~~Ce q-7/ S rSf- /rl:edr~,n ~ cee ~ t~-~Z~"y ~~l MoPc, -7 3,)0 P~ i ~I~+ Pig, 3 p ur,p c ~,i.rv.c.. y S y ~fe~ C (-OsS S .ecti~~ 9 -a5' ~g5 \ ~~9 lqx d ,~OSo TM► K i a 09~~ ~ov~ •W~L L .~6.3 ~tA 0 C~ ` y # ozr Page Of COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" CI Vent Pipe with Approved Locking Manhole Cover Approved Cap, +251 With Warning Label Attached From Buildings n Weatherproof Approved _ Warning Label Junction Box Vent Cap 12" Minimum 6" Minimum ~ - Final Grade-~ i 4" Minimum T 6" Maximum 4" C.I. Quick 18" Minimum } Insp. Pipe Disconnect I 1/4" Weep Hole Baffles Alarm B On 6 C *APPROVED Off d' JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Beddinq Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ of Doses: '-S Gallons Volume of Backflow:....... +Gallons Tank Manufacturer: M OL062~+ f9reCA~'-f-. Total Dose Volume: _r,3 ' Gallons Tank Size-Septic/P p: o w Gallons Alarm Manufacturer: Model Number: w( 1,4 _ Capacities: A, ~ i nches or Y7) YGal l ons Switch Type: m et- 'r rj-'4 + B_ 2 inches or3;7-Gallons Pump Manufacturer: H'L4'-)-11-"-V%A tie- + C~ginches or Gallons Model Number: 5 1" 32 + D_& _inches or/ L2 Gallons Minimum Discharge Rate: .75~ GPM Total _ _inches or c Gallons Vertical Difference Between Pump Off and Distribution Pipe:_ Feet Minimum Required Supply Pressure:.......... eetAAFeet of Force Main x Friction Factor/100Feet: =eet Inch Diameter Force Main Total Dynamic Head:...= eet Internal Tank Dimensions: Length Width Liquid Depth ~r Signature 4ju-A License NumbeVV 7Yz)UDate - 'S y~ P o-Fq L•i Performance Data Pump Characteristics 32 Pump/Motor Unit Submersible Manual Models SW25M1 SW33M1 LL 24 Automatic Models SW25A1 SW33A1 a 1/3 HP x Horsepower 1 /4 1 /3 g 1s Full Load Amps 8.0 10.0 > 1/4 HP Motor Type Shaded Pole (4 pole) a R.P.M. 1550 0 $ Phase 0 1 Voltage 115 Hertz 60 0 0 10 20 30 40 50 60 CAPACITY-U.S. G.P.M. Operation Intermittent Temperature 1204 Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation ClossA GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Discharge Size 1-1 /2" NPT Solids Handling 1/2" Dimensional Data Unit Weight 30 lbs. 3-1/2 5-7/8 - ~ l . All dimensions in inches Power Cord 18/3, S1TW, 10' Std. 4-1/2 2. (omponent dimensions may (20' optional) vary +1/8in(h r 1-112 NPT 3. Not for construction purpose 3-1/2 j DISCHARGE unless (erlified Materials of Construction °`proxi ns°ndweighsare approximate 5. On/Off level adjustable Handle Steel 3-1/2 6. We reserve the right to make revisions to our lubricating Oil Dielectric Oil products and their Motor Housing Cast Iron specifi(ations without notice Pump Casin Cast Iron f Shaft Steel I - Mechanical Seal Faces: Carbon/Ceramic Shaft Seal Seal Body: Anodized Steel Spring: Stainless Steel Bellows: Buna-N PUMP 171/8 ON Impeller Thermoplastic 10-1/8 9 112 Upper Bearing Bronze Sleeve Bearing DISCHARGE HEIGHT Lower Bearing Single Row Ball Bearin Strainer/Base 3 3-1/2 Plastic PUMP Fasteners Stainless Steel OFF AURORA/HYDROMATIC Pumps, Inc. 1840 Baney Road, Ashland, Ohio 44805 (419) 289-3042 T 0 0 77- s_ Wisconsin. Department of Industry, SOIL AND SITE E V A L U ATIQ,N, R E PORT Page 1 of 3 tabor and Human Relations Division of Safety 8 Buildings in accord with ILe.' 'Co COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches bu not limited to vertical and horizontal reference point (BM), direction ~ PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro3 r2 :3 00 APPLICANT INFORMATION-PLEASE PRINT ALL INFOR ® 1995 REVIEWED BY DATE T C' PROPERTY OWNER: CATIO 1m, 1/4,S 26 T 29 N,R 19 for) W Lk.n 'W Glenn Waxon PROPERTY OWNERS MA!I_ING ADDRESS T et~v # BD. NAME OR CSM # 726 Co. Rd. #N csm vol 3 page 731 CITY, STATE ZIP CODE PHONE NUMBER []CITY (]VILLAGE OrOWN NEAREST ROAD Hudson, WI. 54016 (715)386-2254 Hudson Kinney Rd. [new Construction Use Pq Residential / Number of bedrooms 3 Addition to existing building j [ Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 - 8 trench, gpdm2 Absorption area required 643 bed, tt2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd.tft2 .8 trench, gpd."t2 Recommended infiltration surface elevation(s) 93.6/91.1/90.1/86.1 ft (as referred to site plan benchmark) Additional design / site considerations step down trench system Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ds 0 U E 3S X11 CBS C31.1 ❑ S t3U El S ou O S m1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Motbes Texture Structure Consistence Boundary Roots GPD/11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-23 10yr3/2 none 1 2mgr mfr gw 2f .5 .6 1 2 23-30 7.5yr4/4 none sl 2mgr mvfr gw if .5 .6 Ground 3 30-82 10yr4/4 none S Osg ml na na .7 .8 elev. 90.14ft. Depth to limiting factor +82" Remarks: Boring # 1 0-21 10yr3/2 none sl 2mgr mvfr gW 2f .5 .6 2 2 21-34 7.5yr4/4 none is Osg mvfr gW f .5 :.6 3 34-80 10yr4/4 none S Osg ml na na .7 .8 Ground elev. 89.2 ft. Depth to limiting factor +80" Remarks: CST Name _Please Print Gary L. Steel Phone' 715-246-6200 Address: 1554 200th. Ave., Upy Richmond WI. 54017 Signature: r•~ :"p Date: -18-95 CST Number 02298 PROPERTY OWNER GlennJWaxon SOIL DESCRIPTION REPORT Page'? ' of 3 -7 00 PARCEL I.D. # ©2 D G 3, Borin Depth Dominant Color Mottles Texture Structure Consistence Bwxivy Roots GPD/ft Boring # Horizon in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed iTmrich >3 1 -22 10yr3/2 none sl 2mgr mvfr gw 2f .5 .6 2 2-42 10yr4/4 none s1 2mgr mvfr gw if .5 .6 Ground 3 2-88 7.5ry4/6 none S Osg ml na na .7 .8 elev. 94.14 ft. Depth to limiting factor +88" Remarks: Boring # 1 0-10 lnyr3/3 none sl 2mgr mvfr gw 2f .5 .6 4 2 10-16 7.5yr4/4 none is Osg mvfr gw if .7 .8 3 16-84 7.5ry4/6 none co s Osg ml na na .7 .8 Ground elev. 97.14 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-22 10yr3/3 none sl 2mgr mvfr gw 2f .5 .6 5 2 22-31 7.5yr4/4 none is Osg mvfr gw if .7 .8 3 31-82 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 97.14ft. Depth to limiting factor +82, Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Glenn Waxon 15154 200th Ave. CSTM2298 NE%SE% S26-T29N-R19W New Richmond+ WI 54017 4 4 MPRSW 3254 town of Hudson (715) 246-6200 I- lot #3-csm 3/731 N 1"=4p' BM. = top of 1" steel pipe C el. 100' Alt. BM. = top of 1" steel pipe @ el. 99.36' 114 Lp i~. OtA " er p,5 ScwNt2 _ _ Cr"7~i~'IEI7 232 10. ~z 35' i 2(0 4n 1.40v. QO Gary L. Steel 8-18-95 o FILED In o 197F. ~ wig I _ 353145 s7 ~ ti CERTIFIED SURVEY MAP ATTED LANDS 43.31' ~Y~L----- - EJ con er APPROVAL OF THIS MINOR SUBDIVISI6N corner N 8 0 7' 22" W 32.0 ' Section 2 T29N, R19' DOES NOT MEAN APPROVAL FOR 18.47' N 89 372'BUILDING SITE OR SEPTIC SYSTEM, 32$•32 REFER TO H62,20. Co a8 3 I POINT OF I BEGINNING Scale in Feet IN 0" 0ut10t 1 O ~ Ic • APPROVED 0.114 Acres o N 0 -0 I o ID 14 0' 200' 400' W o o `x•771 Acres C I ro v NOV 17 1978 r _T 4 t~ LEGEND .14 CU „ 1" iron' pe: found W -4 S'. :)IX COU 2n 9y, Q, I J A co .1P .cHENSIVE PARKS PLANNING iron pipe found I~ N Ae +t' c0 N .O AND ZONING COMMITTEE ,S3` section corner monument a, W +1 46 226 , - 02 • s Berntsen cap found d 0 °s°~J 2 0° ro Q) „ 1"x24" iron pipe weighing Q) o; 1.68 lbs/lineal foot set (U C 1h EQ -1 - existing fence ~o S 012` W 16 I n/l E A 'his instrument was drafted by C\J a) 13 11~ 9J? 1 I Scott B Lohman C W 4-3 W 00 rN DESCRIPTION Cal I A parcel of land located in the NE1 of thei W 3.492 Acres 4 ,~I L~ • 3I4 of Section 26, T29N, R19W, Town of Hudson, - m I Croix County, Wisconsin, described as followsmi 0 r,mencing at the E4 corner of said Section 26; P: m mN 89056,53" E fence N 8937122" W (assumed bearing based on a: 0 417,00' ie: monumented East line of said SE-1 4 ) bearing .p l urned North) 43.31' along the North line of saity `n - 2.000'Acres to the Westerly right-of-way line of Kinney Road °o the point of beginning; thence continuing N 89037'22" W C 2 I ;,'.00' along said North line; thence S 13048' E 469.85'; N N 8 056'53" E i,,nce S 76012' W 202.46'; thence S 0003'08" E 806.72' to 17.00' i existing fence; thence N 89°56'52" E 377.99' along an J•.sting fence line to an existing 1" pipe at the Westerly 00 2.001 Acres E*ht-of-way line of Kinney Road; thence N 0003'08" W is N 89056152" Ek 9 x.50' along said Westerly line; thence N 89°56'52" E cw 39.00' -01 IJ .00' along said Westerly line; thence N 0003'08" 15 ° 18 ;4.25' along said Westerly line to the point of 2' v ,ginning. ~N 905 '52" E 377.99' ~r. Subject to an undelineated easement for the operation of a IM power transmission o distribution system. Containing 12.477 acres, r O z ~-SE corner .1, James E. Rusch, registered Wisconsin land surveyor, do hereby certify that I have rveyed and mapped the above described property; that such plat is a true and correct presentation of the exterior boundaries of the land surveyed; and that I have fully -nplied with the provisions of Chapter 236.34 of the Wisconsin Statutes;and the Subdi- sion 00dinance of St. Croix County to the best of my professional knowledge, under- anding and belief. James E. Rusch _ ~~~~~®N~'~sr Note: Outlot 1 is to be sol- aisconsin Land S rveyor 5-137 `4 r\RUSCH Cj S`to Badlands Recreation, Inc.Engineers, Inc. 10.0 .1409 Coulee Road -Box 321 11 A new fence is to be erected iudsonWI 54016 by Badlands Recreation along the South line of Outlot 1. ctober 30 1978 permanent access easement across the Easterly 75' 'of Outlot 1 is to serve as the finer & Subdivider: Glenn Waxon °0< •4~o°° joint driveway for Badlands Recreation, Inc. and Lot 4 o: Rt. 1 Hudson, WI 54016 ~•k,h UR,-Jl %%.416 this map. 'cis map is herby approved by the Town Boar of the Tow of Hudson. ` Da e- 1 e A. 13, er, clerk Volume 3 Page 731 F,'EV-_T'Y Hi_Ii_j~,_i.! ~$OC F. Ol: 02 The o and of ~~.djm-Iaaient aa"iet oo Th.tir ~99'-. lemt:ers Present 'were NIVe z 1- rzozf-jN ~hJ € O-iaii:' , ::arla n at e4, Jo rtnt, Joljyasoaj., Z{-jaje Bc)ll(-.atl 4a.ii Rich S € iilz- (1-1 Setback a-egvcst f:" oin 1.001 to 50' for k aaaaes L. Krueger, oil, Lot 3 of t AM.. #353145. See attached. -Pre"Wintatlv+_' fron-i Edina IV, the uest: is made, Basked about the Perk X-Sts av-i cl the locat on o stacl l-rlan questioned the lay 3A the land and tie low-e pot,tlon of the slobe of the lta":rJ hei g behind the IlIc-a-i-se. ~2..~el sc'-.llz LII by ~lii A9Lld ii 5.1~~.Rr?a t\_P ;$3 Well s e d oll h _ l z - 7 i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER ~AmC- S 4 ef, GC2 MAMING ADDRESS S 73 (-7-V RD ~T 4J-- S' PROPERTY ADDRESS )o 5 a ~ --a 1 i - (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4,/ 1/4, Scction r~-Ilo, T_N-R TOWN OF JAJOS-'A ST. CROIX COUNTY, WI SUBDIVISION Utz ,,~.►1=,r 0w% 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 I, 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 o«vner and by a mater plumber, journeyman plumber, restricted plumber of it licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) afler inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. U\Ve, the undersigned have read the above requirements and agree to maintain the private se"'agc disposal system in accordance with the standards set forth, herein, as set by the Wiscol-111 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 d, 7- SIGN[:1q- DA-1T St. Croix County Toning Officc Govenuncnt Center 1101 CM TIIIcIIaWI Road Hudson, W1 S4016 1 1;93 S T C - 100 ,J ,JtThis 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 !~C✓~." Location of property/12C1/4 5F 1/4, Section 2 T N-R ~_W Township 1_ J_, _ '424 Mailing address Address of site +37 G Z411 G7k1_1 s ..-L -4- Subdivision name mil[ is Lot no. Other homes on property? Yes No Previous owner of property (J le- Total size of property . `I Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number L 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. , 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. S natur of plicant Co-Applicant Date of Signature Date of Signature .;?~32 State Bar of 1Vi~_onsin Form 2 - 192 a WAlyflFDEJD, v. 11 DOCUMENTNO. REGISTER'S OFFICE ' - - ST. CROIX Co., WI Sedd to( Record 1 Glenn Waxon~a'/k/a Glen Waxon and Vycella M: C EP -Waxon, a~Tda vYce a Waxon, husband and wifei - 2:15 P. M James L. Krueger, a sins~le _ i conveys and warrants to - 'r of Deus person, 1 D 0 T11I:11 SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS James L. Krueger 573 County Road J, No. 8 St. Croix Roberts, WI 54023 the following described real estate in County. State of Wisconsin: (Parcel identification Number) Part of the NFL of the SFk of Section 26-29-19 described as follows: Lot 3 of Certified Survey Map filed November 17, 1978, in Vol. 11311, page 731. fRANSFL- FOIE This is not homestead property. ~ (is not) if an ii Exception to warranties: Easements' restrictions and rights-of-way of record, any. Iv95 7th day of eptembe Dated this (SEAL) '-j (SEAL) .Glenn Waxon, a/k/. Glen Waxon (SEAL) (SEAL) a yyce 1a._S, Waxen Vycella- M. WWaxon, ACKNOWLEDGMENT AUTHENTICATION Signature(s) GlennWaxon a/k/a Glen WaxonL STATE OF WISCONSIN ss Vycella rI- Waxon,a/k/a Vy._CellaS-- t7axQn county. day of September l9 g-5 Personally came before meths 19- the above named ` day of - authenticated ,this Kristin Og and TITLE: MEMBER STATE BAR OF WISCONSIN who executed the (If not, to me known to be the person foregoing instrument and acknowledge the same. authorized by §706.06, Wis. Stats.), - THIS INSTRUMENT WAS DRAFTED BY Kristin 0 :,land Wis. _ Notary Public County, _ state expuauon date: Attorney at LaW__-_---.---- My commission is permanent. (1( not, 19 ) (Signatures may be authenticated or acknowledged. Both are not - necessary.) _ or printed helow their Qgma w" Wisconsin Legal Blank Co.. Inc. •Nam~h u( perurns ~Ignmg in am wPacity chawW be typed STATE WAR OF WISCONSIN Milwaukee. Wis WARRANTY DEED FORM 2 - 1982