HomeMy WebLinkAbout030-2093-60-000
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AS BUILT SANITARY SYSTEM REPORT
OWNER ,1 r~, ,
ADDRESS d r m.✓ 1.~1G L ..4 yy
OMNOE
SUBDIVISION / CSM# LOT
SECTION `t A7 T Sd N-R~W, Town of ,577,7e.9 ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
Y
7 Pe-
i
e
o~
~W
<~o -e--
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
I
BENCHMARK: ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:__~~~(~ es 7-~,.J
Liquid Capacity:./a-4-96-1)
Setback from: Well
O?`~ House ,®,FO Other
Pump: Manufacturer
Model ~ 4JC U -,3!
Size
Float seperation Gallons/cycle: /O2
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S Length ~,I'
Number of trenches (
Distance & Direction to nearest prop. line:
Setback from: well.
House 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: 5;1 3-
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
-
3/93:jt
Ir epar xmentofIndustry, PRIVATE SEWAGE SYSTEM County:
uman Relations INSPECTION REPORT ST. CROIX
Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village Town o : State PIA
BRANCH, JOHN St. J1913 Ph
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/UQ b
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /ov.
Dosing V
Aeration Bldg. Sewer
Holding St/ Ht Inlet q,a a ` 93.a 3
TANK SETBACK INFORMATION St/ Ht Outlet q,yo' g9.85
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet N' 9 0/
Air Intake
Septic -117 S' NA Dt Bottom 3r/S`
Dosing ra S ~~T" NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System o
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number //'L GPM
TDH Lifts g Friction System TDH/,~Ft
Loss /,5" H
Forcemain Length 7( ' Di a. Dist. To Well >a S
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS .S, DIM N I N
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type Of If) CHAMBER Moe Number:
System: 1-4 OR UNIT
DISTRIBUTION SYSTEM
Header / Maai460 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length _5_~ Dia. Length 94 Dia. Spacing IL- I /.,?6"
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ± ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: St. Joseph.29.30.19W, NW, SW, Lot 6, Highland view
Plan revision required? ❑ Yes 03"No
Use other side for additional information. 61,21 ILI
SBD-6710 (R 05/91) Date I spedor's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
Safety and Buildings Division
v,'■LHE : SANITARY PERMIT APPLICATION Bureau of BuildinWater Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
4 Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Cour
than 8112 x 11 inches in size. 1v~/-,
• See reverse side for instructions for completing this application State Sanitary Permit Number
aas39 8'
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 ID1,5_01044
D Numb{
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location
0.4W,,A c 41 114 ,d 114, S Tad , N, R /9 E (or)&f
Property Owner's Mailing Address Lot Number Block Number
.9 T7 7 ,lfo TA Sr" Ti 11 ~a7~Pr ^4," d F2_
City, State Zip Code Phone Number Subdivision Name or CSM Number
5?i !(evwl er Af Aj ~4 2 V12 ) y p .07P F ~.ard ' <
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ qty Nearest Road
E] Village
E] Public 1 or 2 Family Dwelling - No. of bedrooms -%f'- iff Town of T oS1 A"
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment / Condo 030 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. ~J 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 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevatio
S / f f 7 Feet . S Feet
VII. TANK Capacity
in gallons Total # of Prefab. Site Fiber- plastic Exper.
INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App.
strutted
Tanks Tanks
Septic Tank or Holding Tank 10 /Q 14 al/e57` ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber Q < ~J4 tr.rfOJ ® ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number:
LIZ /(.',z C~ ly-ek- I M_
Plumber's Address (Street, City, State, Zip Code):
G
-7 O
5 ac
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issui g Agent Signature (No Stamps)
~Approvecl Surcharge Fee) `
❑ Owner Given Initial ~ ~ pr~
Adverse Determination O W ~ Q&L~_L _el
X. CONDITIONS OF APPROVAL / REASONS F
OR DISAPPROVAL:
SHD-6398 (R. 05/94) DISTRIBUTION: Original to Coonly, One copy To: Safety & Buildings Divi ion, Owner, Plumber
i
I
INSTRUCTIONS Irk,
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:
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 information requested for numbers 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.
c,inplete plans and specifications not smaller than 8 112 x 11 inches must be SUL itted the county. The plans must
It it locie the following A) plot piar, urawn to scale or 'Nith complete dimen5ic ocat on o holding tank(s), septic
o oth<_r treatr,~,ent tanks; bu 'r~ir,c~ e r~ers; wells; water mains/vvate 5. ,e. <1treams aid lakes; pump or siphon
c r:)ut~on boxes; soil absorption ,Isterr.s; replacement system are,~< i the Ic~~ alio~~ --f the building served;
~ia1 ~.nd vertical eke vouor r<fe; noir?ts; Q complete speofi<, , for pur-ps,m controls; dose volume;
friion loss, F _-mc r ;~~,rm~nce curve, pump mfr+e! _w; ?ump m:.nu urer; D) cross section
ct
; ~ ~ti r ,}ester.; :f rc qu d ;~y (_o.1.-.Ly, E) soil test dat<, on on m; z: c al 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.
".1)LBRICHT & ASSOCIATES CO.
655 O'Neil Road - Hudson, Wl 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX
DILHR Plan I.D. # S95-01044 Date may S, Lgg,S
Owner John Branch Phone 612-430-0783
Address 13877 No. 116t.1, St:. Stillwater, Minn.55082
Legal Description LOt 6, Hi hland Hills Subd. Parcel #030-2093-60
SE 1/4, SW 1/4, Sec. 29, T30N, R19w.
Town of St. Joseph County St. Croix
C.S.T. Robert Ulbricht Installer
Local Authority/ Supervision
St. Croix County Zoning Dept.
PROJECT DESCRIPTION
Nev Construction. For a 3 bedroom home; estimated
daily vast-E,flov: 450 gals.
Soils are very permiable in the top 2811, but stratas
below this are forming a very restrictive permeability barrier.
Dense tills, massive in some pits, will be taken into account
in the design. A very long narrow mound syst.err, is necessary,
using a low design loading rate (.4 GFD/ft2).
~I
Pg.l PLOT PLAN VIEWS
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS
Pg.3 PIPE LATERAL LAYOUT
Pg.4 DOSING CHAMBER CROSS SECTION
Pg.5 PUMP PERFORMANCE SPECS
Any use of this POWTS design ty any licensed plumber, or any
related unlicensed parties or persons (excavaters, laborers)
shall not be construed as an assumption of responsibility by ra
the designer for the workmanship, construction, f ~
substitution or selection of any components not specified, or f)(l,'
any assumptions by the plumber that any unspecified components
are state approved or proper, or the effects of poor judgement
if working under adverse damaging weather conditions (wet/frozen Ryv
soils) by any such parties or persons.
MAy 5 - 1995
& BLDGS. DIV.
JIM
~ . l~
" tis C oNs
ROBERT W.
,ULBRI 01160
HUD
SON, WI
4
~S
yS
2
~ r g l l I I I I I l l l l t i\ l\\\\\
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
May 5, 1995 201 East Washington Avenue
P. 0. Box 7969
Madison WI 53707
ULBRICHT & ASSOCIATES
ROBERT ULBRICHT
655 O'NEILL ROAD
HUDSON WI 54016
RE: PLAN S95-01044 FEE RECEIVED: 180.00
BRANCH, JOHN
NW,SW,29,30,19W
TOWN OF ST JOSEPH 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.
7ame ere ly,
s Quinlan
Plan Reviewer
Section of Private Sewage
(608) 266-3937 ORIGINAL
SBDA•7M (8.10/94)
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E 3 INVERT- of " IATERMS I
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• Top of Rock 97.0
H FT • Top °F I TERA
PLAN VIEW of MoujiD Wi T"Vt BED
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yl f a~u ixE .,1 Il ~k'4~ •[fw ea,.. t"iSIDN OF AF6Y 2-7
Bev v of
To I
PVC. CAPpED
013SERVAr►0,u A 91PEIATE-
Pipes
PERMA,J E-uT M AR ICERS
Rec2uiRep RASA(- hQeA _ vAr~y whsrE+Fioco /la5-
501t- 10-fOrRATWE y 54. Fr,
C AfAci ty
PRoposEv 13ASM ARL-,N = B X (A +
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l l s Ip. FT.
CP-uTRP%L. MA~j► FOLp DISTRt*B0T,0N Pipe uerwoRt<
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9%5TRIQ0TIa►-3
PVC CENTRAL LATERAIS
MAIJO Of_o -
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Y i pVC FORCE
~J MAW
LAST ~{o l E s "A Il !3E
N Ey.T TO E N p CAP
FT.
VOID Vol urn t FOR '75'
0r 2. 11 FORCE MAiN /2-•3 IMS.
-tN V ERT G I EVAT-1vN
i Tl WfliS,n 0F OA f'+,:'S i IN4 f4M ktL§'4~, ,
-7-7 ED SEE OCD F~ESPO~I~ :7ENCE
PERFeRAT- (~1pE DETA L
4 Oles I0cATED o~
G oTrOM SH All BE'
I` `I MtiAPSLS' y G2 V hll~~ SPhGeD
Y DISTANCE
P 36- Fr Hole WAKRTe R IN.
L ATERA L
R 3•~
MAw FOLD 2, 10.
X 3 Co
FoRce- MAiN Z..
Y INcI,ES OF 1i0IE5/ p,,pE 15
DISTIM pu'rIOAj DISCHARV E RATE PER LATERAL 6AI
Co;AL TISOkAR VE RATE / NErWOR k 3 0. Y2- GAL,/ M~•,V ,
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 E ~f of S
-VEIJT CAP
4" C.I. V0.17 PIPE WEATHER PROOF APPROVED LOCKING
JUAIC.TIOM BOX MAAIHOLE COVER
25 FROM DOOR, W/WAVAIIA),
WIUDOW OR FRESH 12"M11J.
AIR ItJTAKE
lfeAflr r~E~r1T/ON GRADE I 4"MIIJ.
CONDUIT aa(o '0 I ~ IB"MI1J.
f IEU~n ov \ 11~
/ •0 PROVIDE i
IIJLET AIRTIGHT SEAL
y I J I I i APPROVED JOINTS
APPROVED JOINT IN r)K ) II W/C.I. PIPE
W/C.I. PIPE 1 n~~U~ I III EXTEIJDIAIG 31
EXTENDIIJG 3 ~O fJ ALARM ONTO SOLID SOIL
O►JTO SOLID SOIL b~ I II
B 3 Yo
/ ✓ I I OIJ
C u~EPT OF aQDt9STFt~°, t~._
S OF SAFETY Wiu b',jiL.j"' I
DWI It~P!
ELEV. ~ FT. -
1 MP OFF
D
k tE pp(A) SEE CORRESPO D
BLOCK
~(A~E VA f io
RIStR EXIT PERMITTED OIJLy IF TAUX MAIJUFACTURER HAS SUCH APPROVAL
SEPTIC E 5PEC.IFItAT10KJS
DOSE #1PwEST~,t' foRE(4ST NUMBER OF DOSES: PER DAS
TAIJKS MArJUFACTURER: iyo
TAMK SIZE: 1S GALLOMS DOSE VOLUME 2-
ALARM MAUUFACTURER: S.J. IMCLUDIMG SACKFLOW: GALLONS
Q,a
MODEL IJUMBER: J 0 IQ' 0l CAPACITIES: A= INCHES OR 3 fj GALLONS
SWITCH TYPE: Al~Q Co~/ F/ o A r B = per/- INCHES OR GALLOAIS
PUMP MANUFACTURER: GbV LO C =IAICHES OR (6* GALLOWS
MODEL NUMBER: Ya 14 3KS W60 3 It L D- 13' INCHES OR 2-50 GALLONS
SWITCH TYPE: ei95Y(3h4e- 1%RwV FIOAT MOTE: PUMP ANO ALARM ARE TO BE
INSTALLED OW SEPARATE CIRCUITS
MIIJIMUM DISCHARGE RATE GPM ~ S•
VERTICAL DIFFERENCE BETWEEU PUMP OFF AND DISTRIBUTIOM PIPE.. CO ~ FEET A - ACS
M11.IIMUM IJETWORK SUPPLY PRESSURE 2.5 F Et EACIA' of-
2,T- FT OIJ FACTOR../.s F~6T
75FEET OF FORCE MAIN X oftFRICT1 t-qUrIS
TOTAL DIJJAMIC. HEAD = /0. 94 FEET
It / O
INTERNAL DIMEMSIOMS OF TAUK: LF-M&TH ;WIDTH / ;LIQUID DEPTH
0, 04
Submersible
Effluent Pumps
too I
3885
AVAILABLE CERTIFICATIONS
ETL LISTED SUBMERSIBLE PUMP I~~
CLASS I AND 11 DIV. 2 AND E
CLASS III DIV. 1 AND 2
ETL TESTING LABORATORIES, INC.
CORTLAND, NEW YORK 13045 G1086131480
CANADIAN STANDARD ASSOCIATION sP
PERFORMANCE RATINGS (gallons per minute) MODELS
WED511H WE0511HH Series HP Volts Phase Max. Amp. RPM Solids VA. (Tbs.)
Uri@$ WE0512H WE0712H WE1012H WE1512H WE0512HH WE1512HH WE0311L 115 9.4
No. WE0311L WE0311M WE0532H WED732H WE1032H WE1532H WE0532HH WE1532HH WE0312L 230 4.7
WE0312L WE0312M WED534H WE0734H WE1034H WE1534H WE0534HH WE1534HH 1750 56
HP %3 %3 Y2 % 1 1'h '/2 1'/z WE0311 M 73 115 1 9.4
RPM 1750 1750 3500 3500 3500 3500 3500 3500 WE0312M 230 4.7
5 100 70 80 90 106 - 60 - WE0511 H 115 13.0
10 80 65 76 87 102 112 56 84 WE0512H 230 6.5
15 60 57 72 84 100 108 53 82 WE0532H 208/230 3 3.4
20 36 45 65 79 95 105 48 77 WE051 WE0534H 1HH '72 115 460 13.7
13.7.0 60
" 25 25 59 74 91 100 45 75 Z WE0512HH 230 1
6.5
30 50 67 85 96 40 72
35 40 61 79 92 35 70 WE0532HH 208/230 3 3.3
5 40 26 52 72 86 30 67 WE0534HH 460 1.65 %11
a5 10 43 64 80 25 64 WE0712H 230 1 10.0
WE0732H '/4 20030 5.4
50 30 54 73 18 60 3 3500
WE0734H 460 2.7
55 17 42 65 12 58
~ WE1012H 230 1 12.5 70
60 6 30 54 3 54 WE1032H 1 208/230 7.0
• ~ 65 16 40 51
5 26 47 WE1034H 460 3 3.5
75 14 43 WE1512H 230 1 15.0
75 4 40 WE1532H 208/230 9.2
90 33 WE1534H 460 3 4.6 80
100 24 WE1512HH 1 /2 230 1 15.0
110 15 WE1532HH 20111230 3 9.2
120 5 WE1534HH 460 4.6
metal parts, BUNA-N
elastomers. METERS FEET
• Temperature: 1600 F (710 C) 90
maximum. - ` I - i MODEL 3885
• Fasteners: 300 series 25-
80 SIZE Solids
stainless steel.
I
f WE15H
.
• Capable of running dry
70 - -
}
without damage to 20 WE101i
•
components. 60
• a /H i f -I 5scPn
Motor: J WEO f FT
50 t
Single phase: /3 HP, 115 or a 15 i
230 V, 60 Hz, 1750 RPM; o WEO H I
1/2HP, 115 V, 60 Hz, 40
3500 RPM;'/2 HP through to wen I I
1'/2 HP,230 V, 60 Hz, 30
3500 RPM.
Built-in overload with 5 20 wa ! I 1
1
automatic reset, class B 101
insulation. f _ i I
• Three phase: Y2 HP through o o T I }
1'/2 HP 208/230 V, 460 V, 0 10 20 30 40 50 _ 60 70 80 90 100 110 120 GPM
60 Hz, 3500 RPM. I I I 1
Class B insulation, overload 0 10 20 30 m3/
protection must be provided CAPACITY
in starter unit.
8 -w'11044
{
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of -3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST c kOt'1L
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # O
dimensioned, north arrow, and location and distance to nearest road. OW - 2.413 r~
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION Mer or-
U0 , Sw
N K C3 R N C GOVT. LOT SE 1 /4 $W 1/4,S 17 T 3 0 N,R / y E (o&W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAM), G CSM #
l
13 ?77 X0- /Ca 5T• Co 17 f{{
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE WN NEAREST ROAD
S-Fillcv~l-TE~ AV. 550,f~- 012-) 0 -07F3 sr. Tose- IHIJAI-4-JD U►'Ew
(w*iew Construction Use [Residential / Number of bedrooms 3 Addition to existing building
j ] Replacement ( ] Public or commercial describe
Code derived daily flow y~o gpd Recommended design loading rate • y bed, gpd/g2 trench, gpd/ft2
Absorption area required .376- bed, ft2 3 trench, ft2 Maximum design loading rate7bed, gpd/ft2 • S trench, gpd/ft2
Recommended infiltration surface elevation(s) S-0-C • 3 ft (as referred to site plan benchmark)
Additional design / site considerations ZISE oN~ f !/Ei r /OA, G- NiY,t' eoeo w/ 12 5.4•~T~
Parent material .SC'S f~t- /lvhh4wP s t 4-AfAFO S1 Flood plain elevation, if applicable N,f- ft
O(AE)Q 5.
S = Suitable for system CONVENTION~ M~OUyD IN-GROUND PURE A❑T S DE ESYS l TTEM I El S NG TANK
U =Unsuitable fors stem ❑ S IRO LA'S [I U 11 S [RV
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
.MV •yxt•:.
Y'# 14,1
Ali V7'~e -5 S'
2 /o yle Y zrl ~s inn 'rle " / S /11 7 • 9'
Ground 3 15--32- 7,5 VP ~//J/ S/ l w j,,~& ~7~iP ~t'C ~ • S
elev. C.
9S Z~ l
ft. 2 So 7. S yp W6 s ZR! ,yy N
Depth to 10 V R- 5/3
5 S%U
limiting
factor
-3
yss
Remarks:
Boring # R 313 / S
2- Y/? 31
74 M
3 G- 3o 7. s v~ y 51 1 14m s,C(- cs s
Ground 9'G1v S~
elev.
• • y '-s
14, 7. S yjt? y ,rri 065 Q04
Ll D • y
S• LO ft. G I &
-5 5 4' 7•S 64 6 Sl D, ~ /yN.[ _70c/
Depth to
limiting
fact/ or
S$ S Remarks:
CST Name:-Please Print ROBE I? 1 ?A LB F. ( C 14 -j- Phone: 715 - 3 ,M • Rl ~S
Address: (Q SS OFF' i L ~D • o.J I . Sg01(a y-23-~ CST~'9i~~
Signature: Date: CST Number:
~t~ l C
ORIGINAL.
L
F
ti
PROPERTY OWNER SOIL DESCRIPTION REPORT Page?- of 3
PARCEL I.D. # LO f # CQ ~f / ~iJ v(~ V /L= ZJ
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botr>by Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
/ n 7 /0 Q 3 S 17~
/3 ufie
el, /4ij c!A S -R S .S •G
Ground .3 •5 .S R
e
93. ~ .
Depth to d-, -7. Y* s/ L1,9, "Ofl• , /V 10 Q3
limiting
factor
, i
sss
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
I
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
con ooonio nrmrn
III
I,
"0' 1
.w
No. Go T
0
R o N ~
m
U, o
O N
V\ y
b\ c
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o
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 14 i2 . rt IQ .S . JO tj AJ 6 Q A A.3 C, 3 0 • O "t cP3
MAILING ADDRESS 13 Q7 '7 NO • 1 ! & S T • S' i ((w &*e4-- . S S O ~Z
PROPERTY ADDRESS fAF# y/7 111-6-41,4,u4'..) PR- 401.
• (location of septic system) Please obtain from the Planning Dept.
CITY/STATE f u S °,y w i S.
PROPERTY LOCATION /V 1/4, 5W 1/4, Section T 30 N-R I ! W
TOWN OF ST- T OS E' P L--- ST. CROIX COUNTY, WI
SUBDIVISION lT C~ k-a D 91 tl S LOT NUMBER ~O
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 needeO
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 ear expirati date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government. Center_
1101 Carmichael Road
Hudson, WI 54016 11/93
R
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 Wl M 6-r ~3ta i~ O,
Location of property N GJ 1/4 5UJ 1/4, Section , T30 N-R~W
Township 54 ' 7OS~P+ Mailing address
Address of site q 17 1' 4-j V llscW D k DSS,O j $ tf t -G
Subdivision name `1 ( (r-(-.L A-V,0 If(-t(5 Lot no. (~o
Other homes on property? Yes No
Previous owner of property c7o 4A..--a
{~S i 4r--'
Total size of property •O -1- X4425
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 L-~No
Volume /A07 and Page Number9C?, 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=~-9.5--
Si trp ture of Applicant Co-Applican
Date of Signature Date of Signature
if
1 t1MENT NO. TNIS a/AC[ R[a[RV[D IOR R[COR IN6 DATA
X I WARRANTY DEED
i STATE BAR OF WISCONSIN FORM 2-1982 II
- 52597
VOL 1In9~asF`~~8 REGISTER'S OFFICE
ST. CROIX CO., WI
Highland Hills, a Partnership, consisting of ROdditfRaord
-JoAiiri--Persido---- Roger Ruel-in arid-Bruce- Perersdil-
JAN
1 ~~995
at 10.30 A.M
.........V__ _
conveys and warrants to ohn nch.and Mary tC.:~rancFl,:
husband and. w1fe, urvi~;orshig--1 ;#,ta -,Property............
a~Dsed~
RETURN TO
' the following described real estate in St. CrO1X ..,,..County,
State of Wisconsin:
Tax Parcel No:
Lot 6, Plat of Highland Hills in the Town of St. Joseph, St. Croix County,
Wisconsin.
rR.
F-EB
This i9- nOt._...._. homestead property.
(is rot)
Exception to warra_,ties: Easements, restrictions and rights-of-way of record,
if any.
I
Dated this 1.Y day of January................. I9..95._ ~
Highland Hil`l~ Partnership
py:
(SEAL) BY.: cG : IGZY_ lMi,[~gEAL)
J n Persico Roger Ruelin
- -
Batt.A?&~!~%~s'!t~~o...Rtt✓--!!~c.~~Ll . . .......(SEAL)
....Bruce Peterson
AUTHENTICATION ACKNOWLEDGMENT `
Signature(s) STATE OF WISCONSIN
aa.
St. Croix IIIYYY
County.
authenticated this day of ..........................119 Personally came before me this __-~1p....... day of j
--Jr January 119.9-5 the above named
. JoAnn__Persico_
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by j 708.08, Wis. Stata.) II
to me known to be the person who executed the
foregoing instrument and knowledge the some.
THIS INSTRUMENT WAS DRAFTED BY . . i
Kristina_ 0 land /
g
Attorney at Law State-Df W4179l x
Notary Public ......County, Wis. I
(Signatures may be authenticated or acknowledged. Both My Commission is ermanent. (If n at, state expiration
are not necessary.)
date: - 1 )
Names of persons sivnina In any capacity should be typed or printed below their sisnatures. I
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Lenal Blank Co., Inc. II
FORM No. 2 - 1982 Milwaukee,'Wsaonsin
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 Of 3
Labor snd Human Relations
*vision 6f Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
` COUNTY
revised 2/2~/9q (Sub T & R) St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited 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 part NW-SW &
JoAnn Persico GOVT. LOT SE 1/4 SW 1/4,S 29 1 30
N,R 19 W
PROPERTY OWNER':S MAILING ADDRESS LOT # LOCK # SUBD. NAME OR CSM #
700 Second St. 6 - land Hills
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
Hudson, WI 54016 (715) t. J se h CTHW "E"
[X] New Construction Use rX] Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 45n gpd Recommended design loading rate -4 bed, gpd/ft2---5-trench, gpd/ft2
Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.5 ft (as referred to site plan benchmark)
Additional design/ site considerations install 5' x 75' rock bed mound on 95.5 contour as upslope edge of rock bed
Parent material till 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 ❑ S L] U n S ❑ U ❑ S n U ❑ S nU ❑ S M ❑ S n U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
1 0-11 10YR 3/2 - sl 2 m sbk mvfr cs 1f/m .5 .6
....:1 2 11-27 10YR 3/3 sl 1 c-m sbk mvfr gs if .4 .5
Ground 3 27-46 10YR 3/3 - lcs 0 sg ml cs - 7 8
elev. w/ gr & cots
94.6 ft.
Depth to 4 46-60 7.5YR 3/4 f2d 10YR 6/2 sl 0 m - - - .3 .4
limiting
factor
46"
Remarks:
Boring # 1 0-13 10YR 3/2 - sl 2 m sbk mvfr cs 2f/m .5 .6
Wft
2 2 13-23 10YR 313 - sl 1 c sbk mvfr gs if .4 .5
w/ occasional or
Ground
elev. 3 23-32 10YR 4/3 - lcs 0 sg ml as if .7 8
94.6 ft.
w/ gr & cob ,pJ \ j0
Depth to
limiting 4 32-48 pink till, res'stant to penetration, effect
factor
32"
L~A -
Remarks: o
CST Name:-Please Print Henry F. Grote S cm hone: 715- 81
Address:
PO Box 57, Knapp, WI 54749-Op~!&,'
\
Signature: CST Number:
5/293 3065
L
PROPERTYOWNER JoAnn Persirn SOIL DESCRIPTION REPORT Page 2_of 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Bo~xldary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-9 10YR 3/2 - sl 2 m sbk mvfr cs 2f .5 .6
3
2 9-32 10YR 4/3 - lcs 0 sg ml aw 1f 7 8
LU Ground w/ gr & cob
elev.
eft. 3 32-50 dense till, resistant to penetration, effective bedrock
Depth to
limiting
factor
- 3"2-
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
F-1
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
~a.~s:~„ -Lei ~~a~r S'1a~ ~o\~ \o~ z>>
Q t-t Cl ~o.o
tt
oS LOCK b, o `41'S~Z ¢/~MC94.g~ a
o.s ~ b
C44-. b)
nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
„or and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
revised 2/25/94 (Sub, T & R)~ COUNTY
i
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited 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 part NW-SW &
JoAnn Persico GOVT. LOT SE 1/4 SW 1/4,S 29 T 30 N,R 19 W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
700 Second St. 6 - Highland Hills
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD
Hudson' WI 54016 (715) 386_8236 1 St. Joseph CTHW "E"
[X] New Construction Use rX] Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 45n gpd Recommended design loading rate .4 bed, gpd/ft2-5-trench, gpd/ft2
Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2
Recommended infiltration surface elevation(s) 96.5 ft (as referred to site plan benchmark)
Additional design/ site considerations install 5' x 75' rock bed mound on 95.5 contour as upslope edge of rock bed
Parent material till Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTINAL MOUND IN-GROUNQPRESSURE AT-GRADE SYSTEM ,ICJ, FILL HOLDING TANK
U= Unsuitable fors stem E] S U] S❑ U E] S U ❑ S nu ❑ S U ❑ S fnU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
` 1 0-11 10YR 3/2 - sl 2 m sbk mvfr cs 1f/m .5 .6
. 2 11-27 10YR 3/3 sl 1 c-m sbk mvfr gs if .4 .5
Ground 3 27-46 10YR 3/3 - lcs 0 sg ml cs - .7 .8
elev. w/ gr & cots
94.6 ft.
Depth t0 4 46-60 7.5YR 3/4 f2d 10YR 612 sl 0 m - - - .3 .4
limiting
factor
46"
Remarks:
Boring # 1 0-13 10YR 3/2 - sl 2 m sbk mvfr cs 2f/m .5 .6
2 2 13-23 10YR 3/3 - sl 1 c sbk mvfr gs if .4 .5
w/ occasional r
Ground
elev. 3 23-32 10YR 4/3 - lcs 0 sg ml as if .7 .8
94.6 ft.
w/ gr & cob
Depth to
limiting 4 32-48 pink till, resistant to penetrai i rr, ef`fec ive B
factor
32°
i
Remarks:
CST Name:-Please Print Henry F. Grote S' PhO c-665-26
Address:
PO Box 57, Knapp, WI 54749-005,7_41
Signature: CST Number:
,V41 1_,C~ 3065
PROPERTY OWNER JOAnn Persico SOIL DESCRIPTION REPORT -L7~
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
3 1 0-9 10YR 3/2 - sl 2 m sbk mvfr cs 2f .5 .6
2 9-32 10YR 4/3 - lcs 0 sg ml aw if .7 .8
Ground w/ gr & cob
elevlev.
ft 3 32-50 dense till, resistant to penetration, effective bedrock
94 7
Depth to
limiting
factor
Remarks:
Boring #
}
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
G:
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
L ^ ^ INA ~¢,r 9:~.io - l.uT ~\oT 1 IAN Co~cX \o` Zg~
Q !-1 C1 tt-o.p
o h G S ,S c m dO w, ati ` ~°l4. C~
I
I
+ ~I
t l C44-. b)
Val `l•_~ ` \ eA 4r yf rt' • O G.@.~ K O.4 VM• SAAC `W 0-0.0
l
LJ V .rL ~ O ~ ~ ~ ~V\" U
Zt t{' a~ ~ U