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HomeMy WebLinkAbout030-2088-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561045 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bender, John & Patti St. Joseph, Town of 030-2088-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /60 c ~ z; . `d 34.30.19.749 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER n CAPACITY STATION BS HI FS ELEV. Septic Z.~ Benchmark A 3¢ 167. 7 polo. 3 Dosing CQ t 7 Alt. BM AeQUea Bldg. Sewer Pr-,, F a 6 ice: Tonk. 4, 5 9 Holding St/Ht Inlet V TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet ` Septic :;r 50 Dt Bottom J . a 1:5. 7Z. Dosing 7 56' 7 66 Header/Man. t i r n.- Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover Q~ S GPM 3;7 ily) Model Number / d 'PT =ft, Friction Los System Head TDH Ft /6 2.56 Forcemain Length ! IDia. If Dist. to well 5 J~D SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. ]Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: Ivi UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Ve o Air Intake Pipe(s) c Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sy ms Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I Fa Yes 0 No 0 Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1235 Oakwood Lane Hudson, WI 54016 (NW 1/4 SE 1/4 34 T30N R19W) Deerfield Lot 9 ParcelLNo: 34.30 .749 1.) Alt BM Description w 54 K 2.) Bldg sewer length - amount of cover /l~ J Plan revision Required? 0 Yes o Use other side for additional information. LIQ _ SBD-6710 (R.3/97) Date Insepctor ignature Cert. No. County Safety and Buildings Division St. Croix 0 = w 201 W. Washington Ave., P.Q. Box 7162 Sanitary Permit Number (to be filled in by Co.) P$ 1tZ~~1 Madison, WI 53707-7162 A~ aQ~ o ~ .A 5~ ~ b~ 5 Sanify- ermit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate e unit A)k is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are itted to Project Address (if different than mailing address) n the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 m , Slats. Same /Z1315 a W ov L Application Information - Please Print All Information Property Owner's Name , Parcel # John & Patti Bender 030-2088-90-000 7~9 Property Owner's Mailing Address Property Location 1235 Oakwood Lane Govt. Lot City, State Zip Code Phone Number _ NW SE _ %a, section 34 (circle Hudson, WI 54016 715) 549-5611 T -30 N; R 19 E ol~ 11. Type of Building (check all that apply) Lot # Y1_1 or 2 Family Dwelling - Number of Bedrooms C) Subdivision Name Plat of Deerwood Ilk I ❑ Public/Commercial -Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Na Q-row of St. Joseph III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ❑ New System ❑ Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) Addition of septic tank & Filter B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner #240749 issued 8/07/95 IV. Type of POWTS Sys tem/Comonent/Device: Check all that apply) ` ' ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitaw soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component ❑ Pretreatment Device (explain) V. Dis rsal/Treatment Area Information. A PL-525 uent filter to be installed at outlet of 2° chamber. Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation 450 Gpd LDGpd/Sq. Ft. ASTM C-33 sand 375 Sq. Ft. Existing Na 102.85 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a o New Tanks Existing Tanks U rn v V~ w C7 G1+ Septic or Holding Tank 827/411 To be abandoned 1,238 1 Wieser Concrete X Dosing Chamber 800 To be a doned 800 FDL Triple X VII. Responsibility Statement- I, a undersigned, asume responsibility for in taliation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ignature MP/MPRS Number Business Phone Number M James K. Thompson s- PRS 30021 715) 248-7767 Plumber's Address (Street, City, State, Zip e) 340 Paulson Lake Lane, Osceola, W1 54020 VIII. Coun evertment Use Only Permit Fee Date Issued Issuin gent Sign re Approved sapprov C, es 'ft 13 r Given Reason for nial $ 5a IX. ConditS", kf*SReasons for Disapproval 1. Septic tank, effluent filter and 3) 61eY a )PA, dispersal cell! must all be services I maintained as per management plan provided by plumber. 2.. °"set)ack requirements must be maintained At " Pet appics i* code / ordinance Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 11/11) Index & Title Sheet - Septic/Pump Tank Replacement Project Name: Bender Septic/Pump Tank Replacement Owners Name: John R. & Patti L. Bender Owner's address: 1235 Oakwood Lane, Hudson, WI 54016 Site address: Same Project Location Subdivision: Lot 9, Plat of Deerfield Legal Description: NWl/4 SETA, Sec. 34T.30N., R. 19W., Town of St. Joseph, St. Croix Co., WI. Parcel ID 0302088-90-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Replacement Treatment Tank Crossection Page 4 Pump Chamber Sizing Calculations & Cross Section Page 5 Pump Performance Curve Page 6 Filter Specifications Page 7 Septic Tank Maintenance Agreement Mater PI ber Res 'cted Service: James K. Thompson, Dept. of Comm. Credential #30021 . . . Signature: 1-- Date: Page 1 Of 7 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ~ E,xi'sEl~q ~~c~de elec. • o ca.~ UU~a' ~~olo ¢-~ty Sic 2 O L~9 ~/c.~ o~`l~.etrwcrc~ r/cc~yflsE/' Set 35/ 7.'3o4,, /9cJ•, T of SE.. ~Se~r1 PCj- wo3o- ;-vC,B- 9v-Co b&,'79 Propse.d c• ~;escrC'o.,cic wvod~d (4P l,AWY -0 T:IOle Y w/ lyI-,,eA4-S z6' 12 64/41"1 4'1 &,,a.Z out 1 LLc E c l,an, bfr CXi3~ ! ~ou.n bG-5~'uC ~'`•~~/~y v.-,So~aN• We(! EY SEi~q ?G ~S z~ 6e a ~I G~On e~4 S l~° 36~d,w,d,,~ S s 383. t3. ! 2es;d~nc~ L FN CGr►tA n/% ' i o o if u~ rl.E ~~✓~Ge eor•nef ~l /ola3y' 00 ~`LuyL / Cona-e-ft "Sc~•t/o / ,f ~vOc1t~1 a (3~~ ~y ~ cLd; fiv+-~a I ~;•Il e~-fyr~d~°~'S beYa.~/ /Yaund </7C P. - z 54j" AS 84" to REQD D I m 43" z X m z W c m D n m UP 42 ° 4" CAS ° N 38" g ~ = I rn 3" 461" 5" E~ 10" x v °i w 18" ~ N Ln UP 40" N 4" CPLG i g ~ UP 40" 4" CAS z oc O c 41" rj m C7 Z C Z Z ~ r in ~ o D Z g fn Fii m D 0 c~ x 2-V on ~6 ggo~o 12A ;K 00 o m C) L m ow m 1 Dg ~ 7CSQ ~yC Z 1Z 1j pp~j •vN =W M CD Li V) 2 c) 'o 774 r7n~pcj- ° v z W to nD O Nov NvD m p Fu V! b i s ~ O v! OD a C TI C13 mo A H 0 V20 Z mp N D 0 C) m-4~ m cn O° v* -Tl 'Z v FW ~ ~ zzz .v 8 a -_D-I 3 x -O m ~ g D v 0 H ;D Cy7 m O F4 fTl m ;u \ cn WLP1280/800-ML TRIPLE m DRAWN BY: SME SCALE: 1 4"-1'-0" PRE-POUR: ° I SEPTIC MANUAL MIENER conCIETE REV. \ Z W3716 US HWY 10 MAIDEN ROCK. VA 54750 DATE: JANUARY 2010 DATE:. POST-POUR: ° REVISED JAN. 2010 800- 325- 8456 RLE: N1P M-800 FM 3 -f 7 Bender 3 bedroom Mound Pump Chamber Calculations 1. Force Main: Diameter 2" Length 50' Flow rate 40.00 gal./min.t Friction loss 1.65' (50')(3.30 ft./100ft.) 2. Total dynamic head: Min. supply pressure 2.50' Vertical lift 13.25' friction loss 1.65' Total dynamic head = 17.40' 3. Lateral discharge: 37.44 gpm 4 laterals @ 30', '/4" orifices spaced @ 48" = 37.44 gpm minimum discharge rate 4. Existing effluent Pump discharge approx. 40.0 gpm at 4.08 ft./second @ 17.40' TDH Manufacturer: Goulds / Model number: WE0311 L Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser 1280/800FDL Manufacturer 2 in. Capacityl 815.10 Gallons -T Volume 21.45 gal/inch A 6 T Weep hole or anti- Dimension Inches Gallons B siphon device A 19.50 418.34 B 2.00 42.90 C Pump off elevation (ft) C 4.50 96.46 93.00 D 12.00 257.40 D Total 38.00 815.10 Dose tank elevation (ft) 3" Bedding under tank. 92.00 Alarm Manuafacturer SJSJ Electro, Systems Alarm Model Number 101 HW Pump Manufacturer Goulds Pump Model Number WE0311 LL Pg. 4 of 7 GOULDS PUMPS Submersible Effluent Pump 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. i APPLICATIONS ■ Shaft: Corrosion-resistant Single phase: ■ Bearings: Upper and stainless steel. Threaded • Built-in overload with lower heavy duty ball bearing Specifically designed for the design. Locknut on three phase automatic reset. construction. following uses: models to guard against • All single phase models ■ Power Cable: Severe duty • Homes component damage on feature capacitor start rated, oil and water resistant. • Farms accidental reverse rotation. motors for maximum • Trailer courts Epoxy seal on motor end • Motels ■ Fasteners: 300 series starting torque. provides secondary moisture • Schools stainless steel. •'/3 and '12 HP- 16/3 STOW barrier in case of outer jacket • Hospitals ■ Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil • Industry without damage to three prong plug. wicking. Standard cord is 20'. • Effluent systems components. • 3/4-2 HP -14/3 STOW with Optional lengths are available. ■ Designed for continuous bare leads. Three phase: ■ 0-ring: Assures positive SPECIFICATIONS operation when fully • Overload protection must sealing against contaminants submerged. be provided in starter unit. and oil leakage. Pump •'/2-2 HP -14/4 STOW with • Solids handling capabilities: /4" maximum MOTORS bare leads. AGENCY LISTINGS . • Discharge size: 2" NPT. ■ Fully submerged in high- ■ Designed for Continuous • Capacities: up to 140 GPM. grade turbine oil for lubrication Operation: Pump ratings are Tested to UL 778 and • Total heads: up to 128 feet and efficient heat transfer within the motor manufacturers CSA 22.2 108 Standards . TDH. recommended working limits, By Canadian Standards ■ Class B insulation. Association • Temperature: can be operated continuously c us File #LR38549 1041(40°C) continuous without damage when fully 140°F (60°C) intermittent. submerged. Goulds Pumps is ISO 9001 Registered. • See order numbers on FEET r r reverse side for specific HP, McT40 1 1 30 20 V~EISHIN.., 7._... RPM~3`soo LIDS volta e, phase and RPM'S available. 35~ & 110r _ . , _ _11750 . WE20H ( - 5GPM - I FEATURES 30 - 100, i s FT I 901 H $ ■ Impeller: Cast iron, semi- 25- - j open, non clog with pump out 80i E1gH _ - . vanes for mechanical seal 70. 07Fl J-7 protection. Balanced for 20 60 smooth operation. Silicon H bronze impeller available as 1 5 50; WFO05 0 0 an option. 10 30tuuEOM ■ Casing: Cast iron volute type T" for maximum efficiency. ' .Il 20 wlo3L _ _ _ _f .___.I..__: 2" NPT discharge. 10, 1 ■ Mechanical Seal: SILICON 0L 0 CARBIDE VS. SILICON 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing faces. 0 5 0 15 20 25 30 35 m3/hr Stainless steel metal parts, CAPACITY BUNA-N elastomers. 37.s~~f~Rm•Mtntf~~pm•+_ Q~F Goulds Pumps y 2002 Goulds Pumps ITT Industries Effective October, 2002 www,goulds.com B3885 ~J O r- 7 . o ® ;r Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16° removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6° SCHD. 40 Pipe' PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the k installed filter contains an optional alarm, the owner will be notified ..r by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank ! Automatic shut-off pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL 5525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL--525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. I P~.&o-~7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 0~ nerl o L,, 6~, L • 6,af 7 c%✓ NlailingAddress L-611-'_ Property Address 5e" e _ (Verification required from Planning & Zoning Department for new construction.) Cite: State Parcel Identification Number 0 30 - 9~ -660 LEGAL DESCRIPTION Property Location'/4 , SEt/, ,Sec., T -3--)NR 119W, Town of Clo5ep/, Subdivision Plat: 0-e2,~-Wc/Z),1 , Lot # 9 Certified Survey Map # IlQ , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house Ohs e-ro-_ Lot lines identifiable es S,41-e SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper inLiintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site 'wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Plannin- Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we ant/are the owner(s) of the property described above, by virtue of a wawa y deed recorded in Register of Deeds Office. Nun ber of bedrooms e3 SIGNATURE OF APPLICANT(S) DATE. *Any inforniation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) 70-(_ 7 -0 0 ei O~ °u). 0 0 > 0. 0 C zo O ~O a E O I ~ N N C - a i C~ .O N O O N O C 11 '0 O C. L N O O L 3 f0 n m a> y ' w_ os N Y O + N N w O U O c ~c U o c m 3 _ o m E O •3 CD CD Q~ x d E O 3 r> w z E °o ~ I L ° d m M H CY) Z c N O o Z d 0 O V7 I- m as z E E •n O E C0 E 3 0 0, I N C N 0 Z Z O w-_ z N ° c0 E E N N o y ~ Y ~i C _ a ~a w m c 0 t O D a` a c p- o° N Q O N H H H ~ c d 0 0 0 0 z° •N~ a=iaaa ►~i a g m uo Lo 3 0 N J N to J U o rn rn > Y O N O O 04 O O O E LO m a Cl) r~ a (D o U) O o0 3 a N o~ o E 00 (7) ° v ~ a Q O. 00) °O r \ o v 0000 am aa) c o o co 1 O C5 - in ~c -C '0 0 N co t C N O O a n N F- F- C N O y ^]l ° M c ° ca ai E E L • L' O cv) M U) co N O N 7 -7 Cn ;n d •m ~ a V ;t EL L a CL -6 S 4) C 'IV E i C C 0 = U a m o N U LOOZ/OZ/Z " saaans-off ~a}I :a~~n~u~ ~pog/SZ~ZOi/aiai~~tonn-zaarea/uzoa oou~~ aau~ug//:d~~u uoilewjo;ul 4ons uo paseq suolsloap luawlsanul jo 6ulpeil Aue jo; algell ao alglsuodsai aq lou (legs pue 'uollewjo;ul llsuodsai aq lou lle4s ioo4eA •sesodind 6ullsanul Jo 6ulpeal 10; papualul sl dIR0 ou pue 'Aluo sasodmd Ieuollewao;ul Jo; paplnoid sl siamsuy ioo4eA -ul9j94; puno; uollewjo;ul ay; elnqulslpaa of lou 99a6e no A 'ails ioo4ek ay; 6ulssaooe A8 ulaaa4 pouleluoo uollewao;ul )ul 'sjaja leuollewao;ul Aue jo; algell sl sJaplnoid luapuadapul;o Aue you ioo4MA Ja41laN 'aolnpe Jo sesodind bulpeil jo; papualul lou ' (luo sasodind iulweails wnl (ew no k 4-i, :rr::i!a;(! ino 46noj41 algellene We salonb 6ulweaals snonulluoo awii-lean •solnulw g [ lseal le pa (elop aje solon0 )lne polepdn aje salonC) a t! aoueul=l ioo4ek a41 uo pa!;!luapl sJaplnoid luapuadapul (q pallddns uo!lewao;ul ia4lo pue salono Aq pap!noid salepdn AI1ep pue elep lje4o leoljols!4 leuogewalul Aq Pap!noid salepdn AI!ep pue elep lae43 leouolslH rio 1e,j ino eas 'uollewjo;ul mop( asn am moo lnoge ajow weal o f ails sigl uo uollewjo;ul leuosied loalloo aM :30110N -D-)inaas ,o 'pan.iasej s146p II`d'oul ioo4ek LOOZ OO 146uAdoo s Ll IN «`d AL ioo4e~l AW 4e9H laneJl oisnW sdnoaE) t'30 t abed aauLluld JooutA : aauidjzoM auk ui swoons of fax V :a2vn2ub,Z Xpog Parcel 030-2089-10-000 07/13/2007 04:33 PAGE 10F 1 li Alt. Parcel 34.30.19.750 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 i Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BENDER, JOHN R & PATTI L JOHN R & PATTI L BENDER 1235 OAKWOOD LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 1231 OAKWOOD LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.010 Plat: 1901-DEERFIELD SEC 34 T30N R1 9W PT NW SE LOT 10 Block/Condo Bldg: LOT 10 DEERFIELD 3.01 ACRES Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 34-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 2000/238 WD 07/23/1997 1096/144 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.010 78,900 0 78,900 NO Totals for 2007: General Property 3.010 78,900 0 78,900 Woodland 0.000 0 0 Totals for 2006: General Property 3.010 78,900 0 78,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DUS TME'A1T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION N LABOR AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNS HIP/MWi[ OMC MTY: LOT NO.: BLK. NO.: SUBDIVISION NAME: NW 1/ SJ/4 34 /j 30 N/R 191(od VY St. Jose h 10 n/a Deerfield COUNTY: OWNER'S BLX eBWAME: MAILING ADDRESS: St. Croix S, Henning & D. Norell 665 Walsh Rd., Hudosn, Wi. +54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: (PROFILE DES RIPTIONS: PER OLATION TESTS: ~esidence 3 n/a EaNew ❑Replace 7-10-92 7-3C-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: r YSTEM-INS~-FI1ILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S ®U 14s ❑ U ® S ❑ U ❑ S fi" 1 U ❑ S E311 hound If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the n/~ under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS page 42 AT1C2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B_ 1 60 106.13 none >60 - ' - ,7.5yr4/4, sil.; 2 - 7.5 r4/4 sl. very hard. r , L.; 11- , si - 2 65 106.18 none >65 0-11, 10 _ B- 7.5yr4/4,sl. very hard, ~0-6 , 7.5yr4/4, sl. 108.60 0-12, 10yr 12- , si B_ 3 60 none >60 28-60, 7.5 _ 1 G B- r / B- B- P TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD 3 PER INCH P i i P- 9 94 30 1 30 P- i P-_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevatio g the direction and percent of land slope. 10 SYSTEM ELEVATION 109.60 I I 1 I 1 1 9 M '4" ob 3 3 a _ E . f A0 3 3 r I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 7-30-92 ADDRE S: CERT TION NUMBER: PHONE NUMBER (optional): 155 200th. Ave., New Richnond, Wi. 54017 715-246-6200 CST SI RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - l INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include; 1 . Complete 1' I1 description; 2. The w most clearly indicate whether this is a residence or commercial project; 3. MAXIt _J "lumber of bedrooms or commercial use planned; 4. Is this or replacement system; 5. Cc;E,i ;,e suitability rating boxes. A SITE. IS SUITABLE FOR A HOLDIN T NLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbieviat ions shown here for writing pt( 'e descriptions and comp ing the plot plan; 7. MAKE A LEGIBL diagram acc ~tely locating your ' )cations. Drawing preferred. A nark and I elevation referer, pint are clearly date permanent; 9. Co ~ c: late boxes ~ dates, names, adrl,,~ flood pla, ition test exemp- tion, if te; 10. If the if i n (such aS flood plain, elevation) does not apply, ply e box; 11 . Sign th,. a;id place your current address arid your certification n 12. Make legih' copies and distribute as require=l. ALL SOIL TEST`? e WITH THE LOCAL AUTHORITY VVITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cot) Cobble (3 - 10") SS - Sandstone gi Gravel (under 3") LS - Liniesto - Satz . HGW - High t, - C S~ -d Perc - Perco S rid W Well :l B,dg - L ~I. is - Lo<-ny Sand > - G 'sl - Sandy Loam < t 'I - Loam Bn - lsr~, iA Silt Loam BI 1, < si - Silt Gy y ~cl - Clay L( Y iMIJ sci Sandy il R sicl - Silt, C n - I sc S611dy s,c - =y Clay ,J, 1. ' `C y cc Common, pt t . ruin N/Iany, n d distinct p promi'HVV L - ligh vl r . ~Six general soil ;exr.at sr1l?ac fol liquid waste disr)G_~ BM Beni 1i VRP - Wri,c.; TO Ta .ER: _T t report is thr fir l Curing a :-utary I- Tile co y rr,.cluest v c iris -oil „"I'd pr;(-, A cr, le ;)rivate 1 a perrn;t ication me st the ap, r order to Fhe sanitary permit musi be oh d pi for 3cti in, 1 STC - 104 AS BUILT SANITARY SYSTEM REPORT a a a (4 39 d ~s OWNER ) ADDRESS/;s SUBDIVISION / CSM#_LOT # SECTION Tr N-R ,3 W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I a ~ ~ys IIN CATENORTH ARROW Provide setback and vati n information rse of this form. Provide 2 dimensions to ce er of sep is tank manhole cover. 1 BENCHMARK: ALTERNATE BM: / SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_ - 14 ~ Liquid Capacity: Setback from: Well House Other Pump: Manufacturer_ /,~~ti~ Model# ) _~z Size Float seperation 7 Gallons/cycle:_ Alarm Location- 412 SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop, line: Setback from: well:-+_ House Other ELEVATIONS Building Sewer` ST Inlet l/ 7 ST outlet 9l 5/8 PC inlet__2,,~_ PC bottom C Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County abor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 240749 PegittSSJ~Gtliald~t'` NaHN ❑ City ❑ Village (A Town of: State Plan ID No.: l1VVUULLlc St. Joseph CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: L r . A9500243 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G✓v Benchmark 5 7 G1, J) Dosing i~ / F'6v . rP, ~•o 0(0, 3~i CIL Aeration Bldg. Sewer 11,0151 , 015 ' 30 9 7 Ing /eInlet o7,0g4,, / s 761 TANK SETBACK INFORMATION St/ Outlet ' TANK TO P/ L WELL BLDG. Venttc ROAD Dt Inlet Air Intake 3 ro. l Septic 5Z l > SO' 4 NA Dt Bottom 9 Dosing 56, > SO' d 7S ` NA l k/ Man. 20 /d Sk Aeration `NA Dist. Pipe Holding._- Bot. System S - S,Q a~ a PUMP /SJRNV~ INFORMATION Final Grade Manufacturer Demand Q ' Gc i_.a_k + a,, I d l C. q Model Number 55, GPl1~l rn ; !a:, y d3 TDH Lift Frictio I S stems TDH Y Ft 1 oss Fi 9 y 3 L Forcemain Length Dia. h " Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. OfTrenches PtT- No. Of Pits Inside Dia. th C DIMEN h~. - DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA Manu acturer: SETBACK _ INFORMATION Typeo z~ r CHAMBER Mo a Num ut!F . System: We. s~ (n5 OR UNIT DISTRIBUTION SYSTEM H FRRanifoI d Distribution Pipe(s) x H I iz x Hole Spacing oeS a To e 11 1 Vent T Air Intak 7 Length -3Di z, 'I I ~ a Length ?Jo pia. ~ Spacing ~'T / 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 E] Yes No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION St. Joseph.34.30.19W, NW, SE, Lot 9, Oakwood Lane - c. . C. l,' . i' .c rr l ifr U0 Y' fl lsl~_ b Plan revision required? ❑ Yes Use other side for additional information. lp"~ 7 p 9 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. L I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r^~tiL.riR SANITARY PERMIT APPLICATION Bureau and Buildiing Water ureau o off Builn Water Systems 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 8112 x 11 inches in size. ~ e See reverse side for instructions for completing this application State Sanitary Perm`iit/`Nu er ; The information you provide may be used by other government agency programs El CheR ~it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION - Prope y Owner Na Property Location A:q 1 - 1/4, S T, N, R t{(o Property Owned s Mailing Address 16t Number Block Number pCity ;ate Zip Code . Phone Number Subdivis ame or CSM ber ill Nearest Road 1 E 111 D ING' (check one) E] State Owned O ~ City Public 1 or 2 Family Dwelling - No. of bedrooms .-I-- Town OF / III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(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. rV New 2. Q Replacement 3. Q Replacement of 4. Q Reconnection of 5. Repair of an B) Existing System System System Tank Only- 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 I 11 ❑ Seepage Bed 21,ZLMound 30 ❑ Specify Type 41 ❑ Holding Tank f 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) Elevation 775- Feet Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank l ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the ndersigned, assume responsibility for inst la ' e osite sewage system shown on the attached plans. Plu b Nam Plumb "s Si tur amps MP/MPRSW No.: Business Phone Number: PI mber9s Addre (Stre t, G State, Z p Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee (Includes Groundwater ate Issued Issuing enhnatu~re(No a s) Surcharge Fee) r A<PProved ❑Owner Given Initial Adverse Determination X. CO ITIONS F APPROVA / ~tEASONS F ~D/ISAP RO AL: !Zp ~V t r'~~?'jl~~ SOD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, 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 tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsitesewage 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 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells;'water mains/water service; streams and lakes; pump or siphon tanks,- distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model-and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a tl5 form; and F) all sizing information- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 3, 1995 2226 Rose Street La Crosse WI 54603 K 0 CONSTRUCTION KIM 0 CONNELL 308 MIDPINE CT STAR PRAIRIE WI 54026 RE: PLAN S95-40808 FEE RECEIVED: 180.00 BENDER, JOHN NW,SE,34,30,19W 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. Sincerely, 6n Sorenson Plan Reviewer Section of Private Sewage (608) 785-9336 SHDA-7997 (R. IWN) Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Human Relations REVIEW APPL, CATION Bureau of Building Water Systems 'Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606 Phone(715)634-4804 Fax(608)785-9330 Phone(608)267-5119 Phone(715)524-3626 Fax(414)548-8614 Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3533 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have sti ns on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a .completed form is on the reverse side for your reference. e5 W" 4080_8 1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Review Name Plan Identification Number -7m-, ~ 9S- Z~AA)s - 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Proje Name City Village [ZTown Of: County I Project Location / GOVT. LOT A/Jt) 1/4, 1/4, T N,R or 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type 1 (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 A At-Grade 1,501 - 2,500 gallon septic tank $120.00 H Holding Tank 2,501 - 5,000 gallon septic tank $160.00 M ® Mound 5,001 - 9,000 gallon septic tank $200.00 N Non-Pressurized In-Ground(Conventional) 9,001-15,000 gallon septic tank $300.00 P Pressurized In-Ground Over 15,000 gallon septic tank $500.00 O Other: Up To 1,000 gallon dose chamber $ 70.00 1,001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00 4,001 - 8,000 gallon dose chamber $120.00 D ® Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 . P Public Building Over 12,000 gallon dose chamber $160.00 S State-Owned Building Up To 5,000 gallon holding tank . $ 60.00 5,001 -10,000 gallon holding tank ~0.00 Code Derived Daily Flow _ gpd Over 10,000 gallon holding tank . A ED.. Experimental System (additional one time fee) A . 300 Check If Replacing Existing System . Revisions To Approved Plan Z . 44 $62 . Petition For Variance: Setback . Petition For Variance Site Evaluation $ 225.00 O~V . . Plumbing $225.00 Revision $ 75.00 Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00 (other than a proposed subdivision) Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 Subtotal: /15?0_ Priority Review: Enter same amount as Subtotal: 0 MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: ,/20 5. SUBMITTING PARTY INFORMATION Telephone No (include area code & extension) Company ame Contac 7,, ?n3V (ys- > '7 9/ No. & Street Address 0r .O. B x City, To n or Vill State, Zip C de I Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. z Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis Adm. Code, Chapter ILHR 2, and are subject to change annually. The information you provide may be used by other government agency programs [Privacy Law, s. 15.04 (1) (m)). 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O rt O' ~ r+ w ut N a 3 7 a O S rt S m In rt m << O rt 7 N 3 c 0_ 7 r+ r+ o-n cc 7 << a -h o m a c o oio n v 0 of -hrt out ut -n H n 0. c m m 0, C .0 n n 7 n 7 C m << "O O << J O rt 7 n 3 O_ m O -h a m • r+ C 'C o m w u, v r+ 0 n r* C m m tr In r► F o 0 s n < 7 c a n ar►O m Imo Z a.0 m ut rt o 7 G co- (4 a co n y IA n F a a n w+, W 7 I n m c N m r+ S .0 rr w 7 O y -~(a d w ( D (D mt 7 (FD u,m cvm on ~m m m m n C* CL O o5.-4®808 WORKSHEET - MOUND SYSTEM DESIGN PROBLEM: II Design a mound system fora The site characteristics area" Depth to groundwater or bedrock in. Landslope % Percolation rate Distance from dose chamber to distribution system ft. Elevation difference between Dump and distribution system ft. Step 1. WASTEWATER LOAD /sdx3a,~yp~~-~~ gal Step 2. SIZE THE ABSORPTION AREA A) Area required ■ -,<fsD ;'/~~,.✓~>'e/y sq. ft. B) Bed or trench length (B) ft. C) Bed or trench width (A) ft. ^r" r: D) Trench spicing (C) ~o " r!.. wastewater load .24 (jal/ft2/day B = ft. ~te►~ eT s Step 3. MOUND HEIGHT A) Fill depth (D) ft. B) Fill depth (E) D + slope ft. C) Bed or trench depth (F) _ ft. D) Cap and topsoil depth (G) _ ft. E) ap an tops 1 depth (H) ■ J_ir ft. Zign: • Licenue 1,u: gate .7 of -/6 Step 4. MOUND LENGTH A) End slope (K) _ CD + E + F + H x 3 ft. lx~lx B) Total mound e te(L) = B + 2(K = g,3 ft. gy, Step 5. MOUND WIDTH Al) Upslope correction factor A2) Upslope width (J) (D + F + G)(3 (factor) ft. /74, 9S r/ )(,A2y,, B1) Downslope correction factor = B2) Downslope width (I) _ (E + F + G)(3)(factor) _ ft. Cl) Total mound width (W) for bed = J + A + I = C;2 L ft. C2) Total mound width (W) for trenches J+ + (no. trenches -1)(c) + A + I = r I(L ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil gal./ft2/day B) Basal area required = wastewater flow f natural soil infil native- cdpacit = sq. ft. Cl) Basal area available for bed for sloping sites = Bx (A+I) 5,s sq . ft . C2) Bas are4 avail le for trench for sloping sites B W /J + A sq. ft. C3) 1 area available for trench or bed for level i es = B x W = sq. ft. sign: License 7- Date: 4 0 8 8 Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing = in. 3) Distribution pipe length 4) Distribution pipe diameter in. 5) Spacing between distribution pipes =f_ in. 6) Distance from sidewall to distribution pipe in. 7B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes per pipe = 2) Flow per pipe 8~ /,I7P~~j~k= GPM 7C) SIZE MANIFOLD 1) Manifold is _ central/ end 2) Manifold length = ft. 3) Number of distribution lines = 4) Manifold diameter in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate GPM 2) Force main diameter _ in. y 3) Friction loss = 7S ft. 7E) TOTAI DYNAMIC HEAD 1) Vertical lift =ft. 2) Friction loss = ft. 3) System head 2.5 ft. _ ft. Total dynamic head = ~ft. Licen~~ Date _ 895-40808 7F) PUMP SELECTION 1) Pump selected will discharge /,0,_ GPM at _L ft. total dynamic head. 2) Pump model and manufacturer 1 7G) DOSE VOLUME 1) 10 times void volume of distribution lines gal./cycle 2) Daily wastewater volume 4 doses/24 hrs. a- gal./cycle 3) Minimum dose volume = 4ziL gal./cycle 7H) DOSE CHAMBER 1) Minimum capacity required = s-w-- ysv. gal. UcQnse :.`u: Date: 7- ~7 9S I w ~✓~s~s~- S- 9 ,5 - 4 8 0 5 ~jx ~"~/l5//~~N ti *~i~'i~...., '%J'~' y,v +x a• sit 4 r;`~-.i~`~.~', ~ ~Y y yS a - - I II ys i Pag/`e__k V Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe m Uo m Sand H G • • Topsoil F _ 11 E D Force Main Plowed Layer % Slope Bed of 1S"-21111 Aggregate Cross Section of a mound system Using DFt. A Bed For The Absorption Area E Ft. i F Ft. p~Ft. G 1~ Ft. i B / yr Ft. H_Ft. Ft Signed• - . I, iFt. YY~-Ft . License ?D 7 'S W Ft. Date: t«l D( K r e~ t '•th tY_~' Alternate Position of Force Main I L I rte; t.v J rvat'h Pipe f_ K _r B - i--------------- A ~ Forc Main W ' Distribution Pipe Bed of 1s11-211" IAggregate observation I Pipe Permanent Marker Plan View of Mound Using a Bed For the Absorption Area ~v ~ r ® Jc'~w Perforated Pipe Detail n nd View )Perforated End Cop ' PVC Pipe ~ e Holes Located On Bottom, J Are Equally Spaced e P PVC Force Mawr PVC ;/~l' MaNfold Pipe ` v'• 6 1 p1~ " 1Z Distrib•stian Forge' Pipe' Lost Mole Should Be Neal To End Cap End Cap Distribution Pipe Layout_ Ft. R S X _ Inches / Y Inches Signed: - Hole Diameter Inch Lateral Inch(es) License Number : Manifold "-Inches Date: Force Main " 2 Inches # of- holes/pipe Invert Elevation of Laterals.& / -Ft. 31`x_ r ~tri a En A. • s Z N } ~ b ct N N fD I _j . f1 V ` rt ,s y M ~ o ro K ~ c `D ~p N N b m d-==3.~.-_------- e N 'c rt W o U~ 's r rr rrr r • rrr r + r r r r r ~ r r r r rr r r r r r r r r r r rrrrr t rrrrr rr C M r+rrrr y n ra U .4 F, w K a a c~ f ' PAGE OF 1G.c_ PUMP CHAMBER CROSS SECTIOiJ AND SPECIFICATIONS S95-40808 VENT CAP H*C.I, VENT PIPE 7 WEATHER PROOF APPROVED LOCKING JUNCTIOAI BOX MANHOLE COVER 25' FRAM DOOR, WIQDOW OR FRESH F MIU. AIR INTAKE ' I I GRADE IB'MIIJ. COIJDUIT \ 11l INLET PROVIDE I AIRTIGHT SEAL I I i I V APPROVED JOINT A " III APPROVED J010 W/w. PIPE ( I I ( W/4w. PIPE EXTENDIN¢ 3'"Y::~,`~„1 p I II ALARM EXTEIJDIUC. 3' 01JTO SOLID SOIL ~TM. } I I I ONTO SOLID SOIL .l A° Nr 1 i w' ~ I • /mar PUMP OFF CONCRETE BLOCit l a=• RISER EXIT PERMITTED OWLIJ IF TANK MANUiA(:TURER HAS SUCH APPROVAL SPEC, IFI.CATIQQS ,:PTIC AND vSE TANKS MANUFACTURER: IJUMBER OF DOSES:' PER DAy TA►JK GIZE : _ GA LONS DOSE VOLUME: ZZZ GALL0IJS ALARM MANUFACTURER: ' CAPACITIES: A=s~LL-INCHES OR ..sS'/ GALLOQS MODEL ►JUMBER: d= -2 IWCHE5 OP, _YT GALLOWS SWITCH TYPE: C= 7 INCHES OR ..cst 1 GALLOQ5 PUMP MANUFACTLIRER: D= 41INCHES OR LLa OALLOQ5 MCmEL NUMBER'. , /Z NOTE: PUMP AND ALARM ARE TO BE SWITCH TYPE: INSTALLED ON SEPARATE CIRCUITS PUMP DISGHARGIL RATE VERTICAL, DIrr'ERENCE bETWEEN PUMP OFF AND OISTRIBUTION PIPE.. <i~ FEET + M yIIMIIKUM NETWORK SUPPLE PRESSURTTE//. 2 5 FEET _L_>_ FEET OF FORCE MAIM X /-gyp F/ooFLFRICTION FAGTOR..FEET" vln TOTAL •,~Ot3WAMIC HEAD = FEET I~.L IQTERIJAL. DIME IONS OF T UK: LEIJGTH ;WIDTH -;LIQUID DEPTH 31GIJE1) LICEUSE WUMBER', 3-~~~_ DATE: ai, y 1 J~. 'Performance P f}Cow Curv es uf~ s K~~x~ FEET ~ ~ ~ (j ~ 8 j, METERS 890 25 MODEL 3885 80 SIZE 3/4" Solids WE/5H 70 I 20 WE10H 60 WE07H 15 WE05H 40 :TT: 10 WE03M 30 20 WE03L 5 10 0 0 0 10 20 30 40 50 80 80 90 100 110 120 GPM I I 0 10 20 30 m3/h CAPACITY MGOULDS PUMPS, INC. METERS FEET sB*CA Faun NEW rpaK , . 120MODEL 3885 35 110 WE15HH SIZE 3/4" Solids 30 100 90 25 80 70 20 60 O H WE05HH 15 50 40 10 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM I 0 10 20 30 m°/h CAPACITY 1986 Goulds Pumps, Inc. Effective July, 1985 CiW DEPAfTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION .'LABOR 4ND PERCOLATION T E TS P.O. BOX 7969 ® `I 0808 MADISON, WI 53707 ;'IUMA'N RELATIONS (H63.09(1) & Chapter 1405V g151 LOCATfO • SECTION: TLOT NO.: BLK. : NO. SUBDIVISION NAME: W 1 S8j4 34 /T 30N/R 19bor)W St. Joseph 9 n/a Deerfield COUNTY: OWNERS 'S AM T-M-WING ADDRESS: St. ;,'roix S. Henning & D. Norell 665 Valsh T;d., Iludosn, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDR COMMERCIAL DESCRIPTION: I STS: Piesider 3 n/a ®New OReplace 7-10-92 7-30-92 RATING: S- Site suitable for system U- Site unsuitable for system CUNVEN I I NA MOUND: IN-GROUND -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S Mu HS ❑u ❑s CMu ❑s ®u ❑s 00 mound If Percolation Tests are NOT required DESIGN RATE: It any portion of the tested area is in the under s.H63.09(5)Ibl, indicate: n/a Floodplain, indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS page 42 MTC2 BORING TOTAL ELEVATION DEPTH T R N WATER•INCHES A A TER O SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. -OBSERVED TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B. 1' 65 99.90 zone >65 0-13, 10yr4/3, L.; 13-48, 10yr , si 48- 7.5 r4/6, sl. 2 65 101.60 none >65 0-9, 1 yr , L.; - yr , Si l.; 39-65,- 13- 7.5yr4/4, sl. - yr - Yr si B 3 66 101.60 none >66 35-66, 7.5yr4/4, sl. hard till B- 1 B. i j B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP N WATER LEVEL-INCHES RATE MINUTES (NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PERINCH , p. 1 24 none '10 30 P. 2 24 none 30 i f I P- 3 24 none 30 30 P. P. 'LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent ;f land slope. )YSTEM ELEVATION 102.60 Pc $ P I oo n .n jl DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 HUMAN RELATIONS (H63.0911) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/PALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: d 1/4SII/4 34 /T 30N/R 19Lo0 w St. Joseph 9 n/a Deerfield COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: St. Croix S. Henning & D. Norell 665 Walsh 11d., Hudosn, [di. 5401-6 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER AL DESCRIPTION: ®New El PROFILE DESCRIPTIONS: PERCOLATION TESTS: M 1 1 3 n/a Replace I 7-10-92 7-30-92 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) asc~u HS OU ]S Hu ❑s®u OS[~jo Mound If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a PROFILE DESCRIPTIONS Page 42 Ali?C2 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1"', 65 99.90 gone >65 0-13, 10yr4/3, L.; 13-48, 10yr4/4, sil.; 48-65,- 7.5yr4/6, sl. 2 65 101.60 none >65 0-9, 10yr3 2, L.; 9-3 , si - B- 7.5yr4/4, sl. 3 66 101.60 none >66 0-15, 10yr4/3, . - 10yr414, si B- 35-66, 7.5yr4/4,sl. hard till B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD I PERIOD 2 PER PER INCH P- 1 24 none 30 1 P- 2 24 none 30 114 '-24 P- 3 24 none 30 t-1 30 P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 102.60 I k l - I ..~..G.,, t.., L .//)J((.,:.._~- .fig..... t KY~1 - i ; 1.1✓V t 7 3 F^i 3 E!` ~ S 16 a . € a ~ Ste, ~ ~ ~ t r 0~) T 1 T 0 I, the undersigned, hereby certify that the s 'I'ds ~rted on f ere made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorde d h~}q o ~F h sts are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 7-30-92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, 14i. 54017 2298 Z15-4k6-6200 CST SIGNA DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. - DILHR-SBD-6395 (R. 02/82) OVER INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a comp and accurate soil test, your report must include: 1. Complete ption; 2. The use it clearly indicate where is is a residence or commercial project; 3. MAXIMU` r if bedrooms or con iT use planned; 4. Is this a nE 'ent =ystern; 5. Complete w„ rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYS-I E RULED OUT BASED ON SOIL CONDITIONS; 0. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE dia.]ram accurately locating your test locations. Dry wing to scale is preferred. A separate sheet may be -1 if desired; 8. Make sure your b==r * and vertical elevatio,-i reference point ar own, and are permanent; 9. Complete all app boxes as to dates, names, addresses, floor a, percolation test exemp- tion, if appropriate; 10. ' ire information { flood plain, elevation) does riot apply, p . in the appropriate box; 11 _ -'n ertr your current address and your certification, nr1t,- 1 and distribute as required. ALL SOIL TESTS M'. LED WITH THE I r ;L AUTHOI`ITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL_ TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Gobble (3 - 10") SS - Sandstone gr - Gravel (under 3") LS - Limestoi `s - Sand HGW - Nigh _ cs Coarse Sand Pere- Percot', reed s - Medium Sand W - Well fs Fine Safi(] Bldg - Building Is - Le,my Sanct > - Greater "]-bars sl - Loam < L- ; Than Bn B, si Gy - Gr Y _ )w Loarn R - V, ~i Imn Many, rn Mu:.k (,I - distin P - proir, High v, , Six soil w. Bench Vraticr~` Pc~,,t TO THE OWNER: t report is th, it g a sanitary permit. The - y or the DepartmOrtt IIHV uc::St this rrr'r ti; field prior to permit iss '?nce- ^ inl- (p , r, :id a applic:a=- n must be suhmitted ;)'the 1 arc gar, r , obt . n a p y permit must be obtained ar i p. ti ' - ♦ PLAT OF ®E(F i E L®. VEY OF THE SEI/4 AND IN PART OF THE` SWI/4 OF THE SEI/S ,:2A 3 ' AND SECT16N 34, OF CERTIFIED THE NWI/4 N S RI I ' ' ST. JOSEPH;.' ST. CROIX COUNTY, WISCONSIN; INCLUDING PART OF LO IX COUNTY' REGISTER OF DEEDS OFFICE',, DOCUMENT' NUMBERr 438728.. , PAGE 1989 AT THE ST.CRO DEO IN VOLUME 7 CURVE DATA utlun . ' •u~an tK R 1 ~ - C[61I1L• • Ca000 - cmac ARC , • .RH I. [M,t 610I01; i t[Yi10 11~G13 1[1~~IYf 1[[~I YL ' Yt*liiiii Lol' Si 10 t0 1[tC~II A1ttf Jf04J•71•E !d a$ . •f3'Or S73•)4•~.S•t,~ 701.00' 21).p•' I00.1f'SOK « . 1 1 3 143.00• 50 N 3 4 (10.00• f0•tY07• 12f•341Sm-c le[.Oi• 2I7.11 ' 150•H'7rE 100.72't0Y• ~u r 10 SI0.0o•. , 10.1044 443h7•0SK• SS.00• SS N' I; - tS' . t. ,►r0• n ; ' , S IIO.00' ti 7Y01'10• • afs•02'01•1 1 113.00' !)6 01 ' LLI. « ~ - 00 . , Isw3'If• fot•S4'SLS•[ 11.)11 .11.11 al a • • • 6 ,010.001 . s _ 1 ' x4.60•':'•, so•ts'or $25034-53.511 'I 207.8s. 116 .11. ~ $00-22-20-9 ssoar»+r 0 >-I CO 7 • t ..70600' 30•tSwr StS•x'S).NY { '76722• 17111 '$sa•tr:rf t00•t2•!0•Y wl t01 y^ : : n•:1'rr•' S44-34`43.6`111f • 44,52 s 109.00 u ss ~i. ~i .4 sols 00 30.03 _ _fH'fl N'W '20161• 203.21" 11 t'• 'I .I U) LLA I a ' L UNPLATTED LANDS 01 a 'ol x NO11TN LILAC OF 11111C fEW OF SECTION 14 SO' Ial WI CLw to . _ 1 . a.e9 4e I~r : 5e9.27'37*E 1321.14' ~i M w MI + 37.+s• 6b6.00 +40.00' ~1 Y .00' .7 394.40 00.13' a 4I TEYF01•ARY so FOOT MOWS UA n S R CUL-OE-fAC. I _ LJI• ~i 18 Y« 8 C - I of I• 'SCAL'E IN f FF_ 1 R S \ LOT 8 JI Z1 1 r'r'•~ =:'=wo. \I, I S O . 100 ' a : Oil . 131.2.7 $0. IT. T 6 •00 N LOT' 7 CENTER 3.01 ACRE: J i' cui W R x0 a0., F7. 130.0677ACRESSO, FT. ACRES 6.0 301 : /j . 1 PLAT LOCATION 'oao 0 / , I06IN Av[eyt ?may 19•r)' 7'C aN 1{ ti rl~' V 030.16' .0 •4 o • ;-rte LOT 9. i A. 11146.61 FT. 0.41 ACRES 0 ' 410. »I~7 _ x•----3 LOT . 5 MIY[ .2 ST Si. FT. 4 s 51 , n h .I a+1 -«1 13 ACRES LOT 10 t•. 131.290 so. FT. ° I • • Y • 3.01 ACIILS lee' I Tl m3 . ,i' >j :Or• I•s.oo' I yl 41 • . 'r s99•n'37•c 1 06.04 3 f4, 1L.~/W7~ i XI JI SECTION 34, T3pN,•R19W 474.4•' 411.42' ~~~J nn'• ZI 01 • IN• 100' ; 1 00 -i1 -is O Z: ZI LOT 4 ! I 11 „ LOT 14 .8 ~ 01 :3' LEA . 130,679 So. FT.. LOT 1•_ ; 130.481 $0. FT; 3.00 ACME f 136.241 $0. FT- ACES ACRES i~ n I ° 3.11 ES 3.00. \f~• xY.•t _ • COUNTY StCT10N YONOmli - fC tA. F61R19. ' 1 • 1. wai MK •FOVNO ' , • • 1 , MIL K so• MoN SET: WEIGNIAll • $ .Z 1 o - ' W ' • . F, ,S' r ~~iiCC ,l y ' ° Lss; . FLR LINEAR rooT. . d ° f6YrT37•t tef•2r'3TC 404.00'- Is , ALL :TNOI LOT C0.1124- 6.34, Q 314. _ , L . owcmvco WITN A 9 3 410.42' I PIPEIFE It O LW LOS. OT. R Q ~ n % w LINC~ R, FOOT. .O ti 1 9 • 7' 1' 1 CKISTINO FOIC7111i , 'g 7.00• ' ' • 4 _ _ Y r p•,WIOC UTILITY EAfCY[NT•'A 1 `'S 'Al 9L- I o, I. TO LOT Li . . I LOT 12 a L6T 13' % R o ;YYTER RETLNTIoN Ali ITO Q 'LOT 3 E - 1ao.jsoc So. Ft - ELEVATION 4li I 130.679 So. •FT. ea' ° ).0 A A[3 - : Y1111aN •ARCA , 150.679 S0. FT. t , 3.00 ACRES .Z t I l 3.00 Acats I . I 3s• as' I „ YROrofto' oRly[wAY LocA7lon i i - I •N ~-.RO~OIMAY •SLTfACK L1NL ..•~w ..c ~f1• _ 8 . vl al Ull •u,ls•-,rv. a le[ w- - 131.0.' 41 NF9.27')7•w 61).00' ~ Q1 t=1 ~1 004.34' N69.17 at w ROAD - -----WALSH - -a:... rI wI ---N09•t7•»'w 13.00•'-- 6rs.oo• w1 Gj ' MI ' 441 I 85549' • ' I >I d1 lot 396.3•• 746.00, " NB9 27'37'W . • MI 1 « Its, , so 01 MI R-~ It f5ji'Nlr #au~~ I1; 10 LOT 2 x JS~ N I W~ I 25; ' _ _ N uI ?I.• 131.207' so. FT. ] Y~+ M O 3.01 ACRES F~N• O I - R ~~i.o lA ' 2 CERTIFIED SURVEY MA_I IN VOLUME 7, PAGE : 1989 13.o1•_ -33.00' S89.27'37'E 416.90' R AI• SH•27')1'E 440.10• 431'.321 , DOC : NO. A38728 LO I'f 1 s$ RN t 1 1 N 0 . AC? N qe 627 f0. FT- ry ' p. • 7 I 1 I' 'I b0 .7.31 ACACS _ N:P1 ¢ ..16 .,.r,rl `arts -,rl..r, I •.,1 V _ w f STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER i?Q, 41L ~ ry-W tL-- G L VS !2 / 3 MAILING ADDRESS r s-- PROPERTY ADDRESS - J (location of septic system) I ease obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION to 1/4, ~&iC 1/4, Section T 0 N-R / Y W 'SOWN OF ST. CROIX COUNTY, WI SUBDIVISION l r' ► Z.,~ LOT NUMBER` CERTIFIED SURVEY MAP , VOLUME PAGE 10, 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. Tlie 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 Cannichael 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 1 e~ ~11Ad Y^ Z" gam Location of property 4(&)_1/4 t r, 1/4 , Section 3e , T $O N-R__L2_W Township !6-' S Mailing address 1a,~53 13de, e. Address of site subdivision namel-j"~e„Q.r- FI.&Jj Lot no. other homes on property? Yes No Previous owner of property Total size of property 4- Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this pr erty being developed 9j (spec house)? Yes No Volume ✓ and Page Number 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 or 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. oci ature of Applicant Co-Applicant X 7 /~~-/~s hatp of i cinitiir~ il,itn cif S i rinatiirP 530546 Y.,;. 1127PAGE517 WARRANTY DEED 60CUMENT NO. We SP.ea Ro..r,.d rw Recording Data ST.CE ~Ca,vil THIS DEED made between KEVIN F. LOHMETER and tw.-a ftw DEBBIE J. LOHMEIER, husband and wife, Grantors and JOHN JUN 2 Z 1995 R. BENDER and PATTI L. BENDER, husband and wife as joint tenants, Grantees, ut 11:30 A-fJ WKnessetb, that the said Grantors, conveys to Grantees the tt05ir" d c r '.:3 following described real estate in St. Croix County, State of Wisconsin: aea/D f~~/D¢ Lot 9, Plat of Deerfield in the Town of St. Joseph, St. Croix County, Wisconsin. y 21 .00 This is not homestead property. TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-of-way of record, if any. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Kevin F. Lohmeier and Debbie J. Lohmeier warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this day of June, 1995. SEAL) VIN /F. Wf5tMER ,G!,le 'ire (SEAL) DEBA STATE OF ILLINOIS ) Ss. W 1A1NERq6# COUNTY ) Personally tune before me this pq day of June, 1995, the above-named Kevin F. Lohmeier and Debbie J. Lohmeier, to me known to be the person, who executed the foregoing instrument and acknowledged the same. D OFFICIAL SEAL JAMES A DAVIS Notary Public, State of Illinois NOTARY PUBLIC. STATE OF 1LUNOPS My Commission Expires: 9laG/9~ My COMPASSION UPIRES:osnSAIG THIS INSTRUMENT DRAFTED BY: RETURN TO: 4- Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street Post Office Box 802 Hudson, Wisconsin 54016