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HomeMy WebLinkAbout006-1049-40-000 St. Croix County Planning and Zonin Monday, February 14, 2005 at 3 :02:44 PM Detail Sanitary Information Page I of I Computer #: 006 - 1049 -40 -000 Sub /Plat: NA Section: 22 Parcel #: 22.31.16.336C Lot: TN /RNG: T31 N R16W Municipality: Cylon, Town of CSM: 1/4114: SW 1/4 SW 1/4 Owner: Erkeneff, Nick 2310 200th Avenue Deer Park, WI 54007 State Permit: 363819 Issued: 04 /20/2000 POWTS Dispersal: Mound Permit: Replacement County Permit: 0 Installed: 07/10/2000 POWTS Detail: NA Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Grabau /Sonnentag >4/1/00 - Not Required Powers, Calvin The permit is in blue septic file; this system also $0.00 Signed Off: Yes has a red WI fund file to document dispersement Maintenance Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 7/10/2003 04/01/2004 7/10/2005 1 0isconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix .GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363819 Permit Holder's Name: ❑ City ❑ Village ❑ Rown of: State Plan ID No.: rkeneff, Nick I Cylon Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: 10 (, 1 ((,6 1 V, a c 006 - 1049 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � S^ 7 n Benchmark Dosing , J,J Alt. BM L 1/ Bldg. Sewer' Holding / Ht Inlet e "f TANK SETBACK INFORMATION St)Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt -fnfet — Air I Septic NA Dt Bottom �� Dosing > �' J + } I � NA Header /Man. 2.SS a Ae z. ra to A Dist. Pipe Holding Bot. System 3.z 9 3• � PUMP/ SIPHON INFORMATION ' Final Grade Manufacturer 1 Demand St cover Model Number 3 L 4�.� GPM (" z_ p,+Z 1 CJD TDH Lift Z.�Z Friction Syestenn TDH� Ft �, 040 Forcemain Length !2 0' Dia. F 3 i << Dist. To well 0� yd oss SOIL ABSORPTION SYSTEM BED / T ENCH Width I Lent No. Of Trenches No. Of Pits Inside Dia. Liquid Depth DIM S DIM SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA <ModeFft_U4tL- cturer: SETBACK MB INFORMATION Ty m pe o CHA ��S j `�Ga I a r S s te: �! OR U IT DISTRIBUTION SYSTEM Header / M d Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. I / Spacing 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 ❑ Yj ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Ins /2 ection 21016 I pec n #2: /30 /a D Location: 2310 200th Avenue, Deer Park, WI 54007 (SW 1/4 SW 1/4 22 T3 IN R16W) - 22.31.16.336C 1.) Alt BM Description= 3-2,2 2.) Bldg sewer length = mss' d —9 2.s - amount of cover = > 3.) contour= / // - '{J � /iZ�O(j -6 0;/ m* $ aj4//e o 'r.,�1 �--- Plan revlsl6n requirO. ❑ Yes 94 No Use other side for additional information. 4 - SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division Asconsin SANITARY PERMIT APPLICATION 201 g Washington ington Avenue Department of Commerce In accord with Comm 83. �; s., ode3� Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) forth t , onpper n I,os county than 8 112 x 11 inches in size. �t� • See reverse side for instructions for completing this Akation State Sanitary Permit Number Personal information you provide may be used for secondary purpose 7 n p ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)l. °.'a S < (i .,, .State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT \ NF NN ' Propert wne ame _ Prope o ion r .� / ; Zia, S a7cl� T • N, AF Leh) W Property Owner's Mailing Address Block Number —. State w� Zip Cod `hon Number Subdivision Name or CSM Number aQA_ II. TYPE OF BUILDING: (check one) ❑ State Owned E] Cit Nearest Road Public Nr 1 or 2 Family Dwelling - No. of bedrooms _3 ° Io w a n OF O f9fl & Z-9— III BUILDIN USE: (If building type is public, check all that apply) arcel Tax Number(s 1 ❑ Apartment/ Condo — I v t0 OO o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2 5d Replacement 3. ❑ Replacement of 4 E] Reconnection of 5. E] Repair of an ------ System ____► System __________ ___ Tank Only -------------- Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 0 [:]Specify Type 41 [ Tank 12 ❑ Seepage Trench 22 In- Ground Pressure / 42 ❑ Pit Privy 13 ❑ Seepage Pit S x 43 ❑ Vault Privy 14 ❑ System -In -Fill 04_ V-0 VI. ABSORPTION MTEM 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 5O 1 375 37S /ox 7 9 Feet faars Feet acit VII. TANK in Cap Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete st C on - steel glass Plastic App Tanksl Tanks Septic Tank or Holding Tank Qm ` Q ❑ ❑ ❑ ❑ ❑ ft Pump an rj I ❑ I ❑ I ❑ I ❑ 1 ❑ ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pr Plu er's Sign tur (No Stamps) /MPRSW No.: Business Phone Number: 6r o53 7 `7Is Q- G 51-15 Plu Address (Street, City, tate, Zi Code ): : 10 N , , katan % c IX. COUNTY / DEPARTMENT USE ONLY. J ❑ Disapproved S Itary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Sign ture (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial Adverse Determination 0D X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 5k� C�,� A - a��. P.19-V " r �LW�L�. I , SBD -6398 (R. 4199) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber ' r 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 count prior tq installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licen "sed'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 -3151. r i - To be'complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system isto be installed- 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all 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 toss; pimp performance,cvrve; pump m9det and pump manufacturer; D) cross section of the soil absorption system it requfl`�d by�th`- zo�`ty; E) soil test data on a'l 15 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GR6bNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which I can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. . 3 I - Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 Air TDD #: (608) 264 -8777 \.visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary April 07, 2000 CUST ID No.273085 ATTN.• POWTS INSPECTOR CALVIN POWERS ZONING OFFICE POWERS EXCAVATING INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/07/2002 Identification Numbers Transaction ID No. 305154 Site ID No. 189204 SITE: Please refer to both identification numbers, Site ID: 189204 above, in all correspondence with the agency. St. Croix County, Town of Cylon SWIA, SW1 /4, S22, T3 IN, R16W Facility: Nick Erkenefl'Existing Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 655369 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing POWTS must be properly abandoned. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely DATE RECEIVED 03/29/2000 gut-"'� FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633 PAGELOF MOUND SYSTEM FOR A3 BEDROOM RESIDENCE LOCATED IN THE /40F THE 5w 1 /40F SECTIOTQd— ,T�N,R ISoW, TOWN OF °ri Cr4 COUNTY, WISCONSIN. INDEX PAGE lA OF 9 TITLE SHEET PAGE 1 OF 9 WORK SHEET PAGE 2 OF 9 WORK SHEET PAGE 3 OF 9 WORK SHEET PAGE 4 OF 9 WORK SHEET PAGE 5 OF 9 PLOT PLAN PAGE 6 OF 9 PLANVIEW CROSS SECTION PAGE 7 OF 9 DISTRIBUTION PIPE LAYOUT PAGE 8 OF 9 PUMP CHAMBER PAGE 9 OF 9 PUMP PERFORMANCE CURVE PREPARED FOR NI CK PREPARED BY POWERS EXCAVATING INC. 1p ally aa.o s3 Coll d itiO h�s 1969 185th AVE a.IRR�^E'�� 1 f A �►��i NEW RICHMOND, WISC. 54017 DINO' s 715- 246 -5135 �3EN� JOE C��rcc p0 4231 WORKSHEET - MOUND SYSTEM DESIGN PROBLEM: Design a mound system for a , -3 d The site characteristics are: Depth to groundwater or bedrock in. Landslope - 4 - is z Percolation rate Distance from dose chamber to distribution system ft• Elevation difference between Dump and distribution system _r.L ft. Step 1. WASTEWATER LOAD i�raom. .�� gal.' Step 2. SIZE THE ABSORPTION AREA A) Area required • ISO ; /, t -37 ft. �S B) Bed or trench length (B) 7. ft. C) Bed or tr nch width (A) _ ._.: ft. :D) Trench' spicing (C)`' ok,` Wastewa er load .24 gal /ft /day B = _____. ft. K; • tr�ic es Step 3. MOUND HEIGHT A) Fill depth (D) _ 8) Fill depth (E) = D + slope (AJ"fp /. f t. 4 .a3 xg,_ I.a C) Bed or trench depth (F) _ X83 ft. D) Cap and topsoil depth (G) "= „ ft. E) Cap and topsoil depth (H) _ !S ft. y • iV "CY Z� Imo•¢!N t r •w _ 1 .... Step 4. MOUND LENGTH A) End slope (K) = D + E + F + H 3 x 3 _ 16 ft. C- 2 4 ,83 , r- 3 ! a Z B) Total mound len h (L) B + 2(K) --' � ft. Step 5. MOUND WIDTH ' Al) Upslope correction factor z ! 9 A2) Upslope width (J) (D + F + G)(3)(factor) = 7 ft. (/ +,83+1)A3K.89: 7.556 Bl) Downslope correction factor = / B2) Downslope width (I) _ (E + F + G)(3)(factor) ft. Cl) Total mound width (W) for bed = J + A + I _ k , ft• 7,�tSt /O.y a3 C2) Total mound width (W) for trenches J + � + (no. trenches -1)(c) + A + I ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil =„ g4l. /ft /day r B) Basal area required = wastewater flow ' natural soil infiltrative-capacity = sq. ft. 7-50 CI) C1) Basal area available for bed for sloping sites = B x + I) _ /5.� sq.. ft. A ss C2) Bas are •avail le for trench for sloping sites = _ B W (J + A = sq. ft. C3) Basal area available for trench or bed for level sites u B x W = sq, ft. Lir,ans�: oat a : =:Z --oa ,Step 7. 'DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = „ in. 2) Hole spacing = in. 3) Distribution pipe length in. 4) Distribution pipe diameter ain. 5) Spacing between distribution pipes — in. 6) Distance from sidewall to distribution pipe = 30 in. 7B) DISTRIBUTION PIPE DISC HARGE RATE ` - L ft. 1) Number of holes per pipe 4 . %,[_., 2) Flow per pipe = . 2 4 . Z GPM 7C) SIZE MANIFOLD 1) Manifold is central / end 2) Manifold length a D _ ft. 3) Number of distribution lines = ? 4) Manifold diameter = in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate 2) Force main diameter =. �1 in• D 3) Friction loss ft. �� ...: 7E) TOTAL, DYNAMIC HEAD 1) Vertical lift = ft. 2) Friction loss = ____�_ ft. 3) System head 2.5 ft. ,= a ft. ` 4) Total dynamic head = � .Gicersc ;:_0537_ i N ( CV i 7F) PUMP SELECTION 1) Pump selected will discharge . GPM at IS ft. total dynamic head. 2) Pump model and manufacturer 3t 5 (j o '31 1L �3 � 7G) DOSE VOLUME 1) 10 times void volume of distribution lines = 6 g'� gal /cycle 2) Daily wastewater volume : 4 doses /24 hrs. f /-5 gal. /cycle 3) Minimum dose volume = x{5'0 = 112•f / l• gal. /cycle 714) DOSE CHAMBER j 7h 1) Minimum capacity required = gal. Ucunsc .:u :_ aa D.S Date: 3 2 0 oo -_ s , I , I , T : I ; T : I I I ! ' I I , I , I I i 1 Z I P ' I DI t i �ap� �I a I — I I I � ! I - I I I : : -- I 7 1 , : ' I : : I i I ! i I , I , I I I I I i i I I I I I I � i f i i I I I : I : _ 1 I , I I I � L j I I : Page 11P Straw, Marsh Hay, Or ' Synthetic Covering t4STM C Distribution Pipe Sand. Tops Olh ' J -) %Slope Bed Of 2 %2 Force Main Plowed Aggregate Layer D ..L. Ft . Cross Section Of A Mound System. Using. F Ft' - t F . #83 Ft. '4 ' Bed For The Absorption AYba G 1 Ft. A S Ft. H IS Ft. -- -- B ,_ ZS Ft. tense Number: a DS 3 7 K /6-9 Ft. te: 3 .-00 L cK& Ft. J 7._b Ft. Position I /0.9 Ft. of - Force Main _ W 2 3 Ft. Observation Pipe -� J 6 1� _ n stributio Bed Of Pipe , Aggregate servation Pipe Permanent Morkers Plan View .Of Mound Using A Bed For The Absorption Area i ' ^...� N i Cr^ c r. r 7 7 / Psrforolod PIP* Deloll i • End VI,- End Cop ) PArrotolld PVC Pipe Holes Located On Doltom, t Are Equally Spoco0 x/ •� � // � . l.otl Hoii SA m'd II, Ntil To End Cop Ditlribulio6 Pip$ Loyoul P .3Z_ Ft. I R _ S X Inchec Y_ Inches Hole DianicLer , 4 Inch •. Lateral lnci(e =) Manifold 3 " p • Inchc.. I Force Main " ,-.3 Inchv; B of holes /pi i Invert Elevation of Laterals 9 S, Ft. { E • � °,.:�--- -••.�• � i�Y'1'1C '1'ISNK 6' �_YDfTY C:ti7T1`TSt: ITKV7J JLI:I�v�v t��vL or�..• A•• ••••, � -� +" Cl VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHER PROOF* ? 25' FROM.DOOR, WINDOW. OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE 4" Cl RISER WARNING LABEL 6" MIN. AB OV E G AD E —� ----- 4 " MI " N 16." IN. 6 MAX. i' INLET WATER TIGHT SEALS GAS. TIGHT1 ` 411 BAFFLE A SEAL i i APPROVED Cl PIPE -3_ ALM JOINTS W/ CI � � B i PIPE 3 ONTO SOL -- F_ i ON SOLID SOIL SOIL PUMP Of F ELEV . FT. .- C pf "t RISER EXIT ' -- D PERMITTED ONLY IF.TANK . MANUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK' CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: /zh NUMBER 'DOSES PER DAY: TAN SIZES SEPTIC / pero GAL. DOSE VOLUME INCLUDING DOSE 6PQ GAL. FLOWBACK: GAL. ALARM MANUFACTURER: S.j,? �(.e� �.c CAPACITIES: A = INCHES = G AL.. MODEL NUMBER: doe y y,,,J SWITCH TYPE: J. j o Kt B = 2 INCHES = 33 GAL. PUMP MANUFACTURER: �., ��As C = INCHES = L GAL• MODEL NUMBER: ��RS� W003 111- SWITCH TYPE: r / D INCHES = GAL. REQUIRED DISCHARGE RATE 4, GPM PUMP B ALARM WIRING AS PER ILHR WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE e{ FEET + MINIMUM NETWORK SUPPLY PRESS RE . . . ... . . . . . . 5 FEET + /(D_ FEET FORCEMAIN X � FT /100 FT. FACTOR , ,$ FEET T.OTAL DYNAMIC' HEAD = FEET12,f5 INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER �_• ---- -- LIQUID DEPTH SIGNED: _ LICENSE NUMBER: aa053? DATE: 6� a Goulds Submersible Effluent Pump 3885 APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously Specificall desi ned for the be provided in starter unit, bronze impeller available as without damage. y g • Shaft: threaded, 400 series an option. N , „axn3 Bearings: Upper and following uses: • Homes stainless steel. ■ Casing: Cast iron, volute lower heavy duty ball bearing Farms • Bearings: ball bearings type for maximum efficiency. construction. upper and lower. 2' NPT'discharge adaptable ■ Power Cable: Severe du • Trailer courts ry • Motels • Power cord: 20 foot for slide rail systems. rated, oil and water resistant. • Schools standard length (optional m Mechanical Seal: SILICON Epoxy seal on motor end lengths available). • Hospitals CARBIDE VS. SILICON provides secondary moisture Single phase: Industry CARBIDE sealin g faces. barrier in case of outer jacket •'% and'' /2 HP -16/3 SJTO • Effluent systems Stainless steel metal parts, damage and to prevent oil with 115 V or 230 V three BUNA -N elastomers. wicking. prong plug. SPECIFICATIONS * % - 1 1 /2 HP -14/3 STO with ! Shaft: Corrosion - resistant ■ 0 -ring: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. '/, "maximum. • Y2 -1 Y2 HP -14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities: up to 128 GPM. listed models - 20 foot on accidental reverse rotation. SP Canadian Standards Association • Total heads: up to 123 feet length SJTW and STW in Motor: Fully submerged in TDH. are standard. high -grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat UL Underwri Laboratories carbide -rotary seat/silicon FEATURES transfer. carbide - stationary seat, 300 Impeller: Cast iron in Designed for Continuous , semi- series stainless steel metal Operation: Pump ratings are pump- non -clog with en, p parts, BUNA -N elastomers. op within the motor manufacturer's • Temperature: out vanes for mechanical seal recommended working limits, 104 °F (40 continuous Protection. Balanced for 140 °F (60 intermittent. METERS FEET' • Fasteners: 300 series 90 stainless steel _ _ — _ _ SERIES: 3885 SIZE: 'h' SOLIDS • Capable of running dry. 25 80 NtE1 RPM: VARIOUS without damage to ► 5GPM components 70 Ell H 5FT 20 _.. _ Motor ° 60 Single phase: _ eo - l-- • % HP, 115 V, 200 V, 230 V, 15 So 60 Hz, 1750 RPM; ''Y2 HP, Z — 115 V, 60 Hz, 3500 RPM; 0 40 V E0 4 H '/2 HP- 1' /2HP, 230 V, EX 60 Hz, 3500 RPM. 10 30 • Built -in overload with. E ' automatic reset. 20 • Class B insulation. 5 Three phase: 10 • Y2 HP -1' /z HP 200/230/ 0 0 460 V, 60 Hz, 3500 RPM. 0 10 20 30 40 50 60 70 8o 90 loo 110 120 130GPM • Class B insulation. ' m 0 10 20 30 m 3 CAPACITY ©1995 Goulds Pumps Effective May, 1995 B3885 Wisconsin.,Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page / of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but' not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Propert Property Location L r Govt. Lot S 0 1/4,5 Q 1 /4,S Q T 3 N,R or) W V. Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# D-3 0_D-k-'^ Q v • — — — L State Zip Code Phone Number E city ED Villa e Town Nearest Road n ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building Replacement � Public or commercial - Describe: Code derived daily flow N S l7 gpd Recommended design loading rate PS bed, gpd /fi _ trench, gpd/11 Absorption area required 325 bed, ft 37 trench, ft Maximum design loading rate 1 - bed, gpd /ft - trench, gpd /ft Recommended infiltration surface elevation(s) I re4'4 K /a ft (as referred to site plan benchmark) Additional design /site considerations y; 9 7 1 ...� o". 1,, r Parent material Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S U A S El U ❑ S K,U EIS N U ❑ S a U ❑ S U SOIL DESCRIPTION REPORT P 16V ors Fr Boring # Horizon Depth Dominant Color Mottles Texture Structure 0 Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench o`b v sr ao o r s 1 sl a m 5b►� G S QW.% . 5 Ground P h /o o� T1\5W, 1'S1 lrr e_ LO • 5 ' fie elev Depth to Q � limiting factor Remarks: Boring # 1 1 a 5a hal m r C a rn at , � Ground Jp '7, C S S T 59K m - y - ' S elev. Depth to limiting fa t in. Remarks: CST Name (Please Print) Signature Telephone No. - 7/5 a Address Date CST Number 37 PROPERTY OWNER M-e-A e r x aff' SOIL DESCRIPTION REPORT Page d of 3 PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench F - �, Z 5 / Sb cw $ ',G / '`f S v .L Ground y- t , m r C W t 5 I to elev. 51 At Depth to limiting actor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: Boring # Ground elev. ft. , Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) ! a � �.S 3 l ! cow s w: N , I ; Din /curb : 9s : I ; , I I ! : ! ! I I 1 i : I , I I i i I I I : I : , I 1 : \,I L I t , i i i ! I : ! I : 1 i : : , : I ! I o p I : I I : i I I I � I : I I i I I I _ i I i I I : i ! { i t I I I I � t 1 j i : I � , : I I I I I I I I : I I I , I : Wisconsirl'Department of Commerce SOIL AND SITE EVALUATION / Division of Safety and Buildings Page ! of 13 Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ST percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 060 -10 R- 0 -00 O APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). � _ - 2LX7b Prope caner Property Location ��t 6 S Ito 1/4,S a T3/ ,N,R 14, Vbr) W Govt. Lot S 1/4. Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ vifliaf e Town Nearest Road ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building 9 Replacement N Public or commercial - Describe: Code derived daily flow _� � gpd Recommended design loading rate 15 bed, gpd /ft _ trench, gpd /ft Absorption area required bed, ft trench, ft Maximum loading design � .-� p e� g g rate _ bed, gpd /fi gpd /ft Recommended infiltration surface elevation( E /`2,ra to ft (as referred to site plan benchmark) Additional design /site considerations M G - �/: 9 Z�1 6 �.��- 8b.A. I.. i Parent material Flood plain elevation, if applicable /lY/l ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system El U -4 S ❑ U ❑ S K-u ❑ S k U ❑ S W U ❑ S U SOIL DESCRIPTION REPORT P DYE Fr• Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench D 14 r 5 sl A rYl Sb ,� G S a 5 Ground P ?. 4 a S�k 1 w ( r CLo J �� elev. Ca �� � $ Depth to limiting factor Remarks: Boring # a8 7 s s g 5W m 5 Ground Jt2 7, 5V, CMj 51R, s 5L YY\ r. 5 elev. Q - St Depth to limiting r fact JS n. Remarks: CST Name (Please Print' Signature Telephone No. (� U ecA� Address Date CST Number 5' S 64% Gc� S 201 - 1/6 - 00 p-s3 7 PROPERTY OWNER Nle-k rkQ,n f SOIL DESCRIPTION REPORT of Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 7,5 11 — 5, / 5b N C 0 'S ' rG -17 7, 5 r (b m 5r e,a S ; 4, Ground '� �6 �, r S / rn 5 b(l. f r C UJ r 5 fa Wdalff. ?S re r S 5f Airn 56k Depth to limiting —Jactor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Y4 S w Y.S �-r 31 N R ((off -+� Anal p rs4p e,( °18 . t A)A - _- oo _ _ e _ 09A i • ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address o n 0-0b V k\ Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number Q U 01 (-( 0 V �� 22..3 1,1G. 336 LEGAL DESCRIPTION Property Location ''/4, Sw '/4, Seca Q , T / N -R-) W, Town of Subdivision , Lot # Certified Survey Map # �— , Volume , Page # Warranty Deed # �4 3 �� C� , Volume : Z?(,o_ , Page # Spec house ❑ yes Al no Lot lines identifiable �f yes ❑ no SYSTEM MAINTENANCE 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 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. The property owner agrees to submit to St. Croix 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. Uwe, 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 Zoning Office within 30 days of the three year expiration date. �"_ e - - !Y? / / / 6 � SIGNATURE OF APPLI 6ATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop d�scribe above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r; c' tN.` IN F() KNI ry QUIT CLAIM DEED REGISTER'S OFFICE • 431940 ST. CROIX CO., W1 V Rec'd for Record St K. Erkelieff 9 1987 Qt 8: 10 A M NLCk C. 1"Irkenoff St. Croix County. real State Tax Parcel No: o f the ;outh 663.9 feet of the West 656.13 feet of the rY.e North 33L.95 feet h (2uarter (SW'14 SW of Section 22, 'township 31 Southwest (�uarter of the Southwest North, Rnage 16 West- 4, \pt X'S� sw S LS homestead property. d .. .. .. n SEAL) Sheila K. Erkeneff ,.SEAL) S EAL) AUTHENTICATTO N AC K NO W L E; 'q 7Z C j - e STATE OF wisCON _._ Count_ ... . ........ --day of k7 '-' - , 11� c atcd th: A, Af I eniun L c ame before me this a.e above named 6 0 TITLF`"-IF-ML -;T VrE 11.kR ()F Wis( ()N'SiN (I i not. autborized by Wis. - to me known t.,) he the person '.vh,i executed the instrunw•t snd acknowled e the same. '.AS F�r4'F Ely V ITZ t-f= Aw Am co'111tv, Wis. Nrl- 110t- =tatc expiration 1 �1'tlF It \It (, 1' Nl,•;,]�IV lY.•c•i• �n 1t:ni I'�r4 t'n Inr CLAT7., DEFD QUIT f"KNI sn— I W=ni sin Cepanment'of Commerce . SO EVALUATION REPORT Page 1 ot Division of Safety and Buildings - in accordance with Comm 85, Wis. Adm. Code County ,n ",! .h complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. pnrcent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed by Date' r, �is r:ol information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). 1( 4 Prcparty Ov^�er Property Location IG GY` a rim- Govt Lot S&j 114 5 S ZO T 31 N R I6 W �Proparty Owner s Mailing Address Lot # Block # Subd. Name or CSM# .Z. 1 6 A Opt. G +y State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Rold Q Nev. Construction Use: ❑ Residential / Number of bedrooms _ Code derived design flow rate V ita GPD R�°piacement [] Public or commercial - Describe: -- Ppr^nt mitt lal Flood Plain elevation if applicable p - R General Comments and recommendations: ❑ Boring Borfng # A Pit Ground surface clew. 3 7 ft. Depth to limiting factor _ In. Applica Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 .5 rvxsf F - 1 doting # ❑ Boring ❑ Pit Ground surface clew. ft. Depth to limf4ng factor App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 c t i �� • ETuent #1 = BOD > 30 1 220 mot and TSS >30 < 150 mgA_ ' Effluent #2 = BOD <_ 30 nV& and TSS 1 30 n-G& i Signature CST Number " Q " Date vat on Conducted _ Telephone Number ; /96, • v, s Property Owner PacxiID# _. page- - F Boring # ° Boring ❑ pit Ground surface elev. ft. Depu) to limiting factor in. Horizon Depth Dominant color Redox Description Texture Suucture Conslstc; u,�- :andary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i i i F Boring # ° Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil / Horizon Depth Dominant Color Redox Description Texture Structure Consistet..:c: • I,x,„ndary Roots In. Mtmseff Qu. Sz. Cont. Color Gr. Sz. Sh: •t - i 1 i f i } F-1 # ° Boring ft ❑ Pit Ground surface eiev. . Depth to limiting factor In. S, Horizon Depth Dominant Color Redox Description. Texture Structure Consisir, L�<,,; Roots In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •e . i • Effluent #1 = BOD, > 30 5 710 mg/L and TSS >30 150 mgiL • Effluent #2 = t < mglL and TSS < K The Department of Commerce is an equal opportunity service provider and employer. If y:— i-zt:,, assistance to a=,. need material in an alternate format, please contact the department at 608 -266 5 : c: TTY 608-264-87 . seauso tR.srool } r j t f i I r i I r r 1 --_._ _•_.. __ ..�,�,, ,;sir,_ 1 r 1 l 1 f i J { � I ! i I f � I ! i I i i • i j 1 1 , I 1 _ 1 r , ) r r 1 1 Parcel #: 006 - 1049 -40 -000 02/14/2005 02:58 PM PAGE 1 OF 1 Alt. Parcel #: 22.31.16.336C 006 - TOWN OF CYLON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * NICK C ERKENEFF ERKENEFF, NICK C 2310 200TH AVE DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2310 200TH AVE SC 0119 AMERY SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A -NOT AVAILABLE SEC 22 T31 N RI 6W 5A IN SW SW N 33.195' Block/Condo Bldg: OF S 663.9' OF THE W 656.13' OF SW SW Tract(s): (Sec- Twn -Rng 401/4 1601/4) 22 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 796/185 07/23/1997 498/453 2004 SUMMARY Bill M Fair Market Value: Assessed with: 52771 170,400 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 25,000 148,300 173,300 NO Totals for 2004: General Property 5.000 25,000 148,300 173,300 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 16,000 116,400 132,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch M 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 State of Wisconsin WISCONSIN FUND - PRIVATE SEWAGE SYSTEM Safety and Department of REPLACEMENT OR REHABILITATION PROGRAM Buildings Commerce Division OWNER'S APPLICATION Instructions For Property Owners: TO BE COMPLETED BY COMMERCE You may apply for a grant award for up to three years after you have received Application Number Date Received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in section #7, and send those items to the governmental unit listed below. PART A. TO BE COMPLETED BY THE PROPERTY OWNER Owner Name Social Security No. Additional, owner Social Security No."" AdYre'ss U v Attach documentation of additional owners if needed. City, State Zip Code Telephone Number (include area code) " "Note: Your Social Security Number may be used to verify your "Grant awards will be issued in the name and address of this owner. I income and status of child support or maintenance payments. 1. Was the failing private sewage system serving the principal residence or small commercial establishment constructed prior to July 1, 1978? .rYes ❑ No 2. This application is for (complete both If applicable): -C� Principal Residence Do you occupy this residence at least 51% of the year Oyes u No ❑ Small Commercial Establishment Do you occupy this small commercial establishment at least 51 % of the year ❑ Yes ❑ No Small Commercial Establishment Name: Deq priptlon - of Small Commercial Establishment (farm, restaurant, etc.): / 3. Was the private sewage system replaced as part of a real estate transaction or change of ownership? ❑ Yes 0 No If yes, explain: 4. As the owner, are you a licensed plumber or contractor engaged In the business of installing private sewage systems? ❑ Yes 4eNo 5. Will a portion of this system be funded by another source? ❑ Yes •R No If yes, explain: r 6. How did you hear about the Wisconsin Fund -P ate Sewage System Replacement or Rehabilitation Program? & ,4 L v! T 7. Evidence of income. Attach a copy of your federal income tax return for the year of or prior to the enforcement order or determination of failure if you are applying as a principal residence. If you are applying as a small commercial establishment, submit a copy of your federal profit and loss forms for the year of or prior to the order or determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner (and for each owner's spouse) listed above. Evidence of income will be kept on file at the governmental unit and is subject to verification by the Department of Revenue and by the Department of Commerce. If you or any owner listed above were a part-year resident or did not file an income tax return, contact your governmental unit for further instructions. 8. Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this form and all attachments are tr and c orrect. Own er'. Signature Date Signed Co- Owner's Signature Date Signed �l f �U Personal information you " may used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. SBD -9163 (R.. 1/2000) PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP Does the owner(s) name(s) as listed on the document used to verify ownership agree with the name(s) of the applicant(s) on Part A of this application? ® Yes ❑ No What document was used ocument r to verify ownership? mber 43-1940 If the applicant answered yes to question 3 on Part A of this application, did the applicant own the property when the order /verification of failure was issued or the system installed and incur the cost of replacement? ❑ Yes ❑ No 2. Is this application for a replacement structure? ■ Yes ❑ No If yes, h ave all requirements outlined in Comm 87.20 (4), Wis. Adm. Code, been me ■ Yes ❑ No 3. Is a public sewer available to this property? ❑ Yes ■ No 4. Hasa previous grant been awarded for this property under this program? ❑ Yes ■ No 5. Principal Residence evidence of income. Please indicate applicable annual income: $ Federal income tax form , Line . Year Affidavit of , Year Other form used Line , Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross income: $ Profit & loss for used: Line_, Year 6. Date of Order or / Age of the Determination of Failure: 3 11} o'p existing failed system: Separating Distance from the bottom of the existing failed system to a limiting factor. 7. Private sewage system failure caused by discharge of sewage to (check all that apply): Surface or groundwater ................................................................................ ............................... ❑ Category1 A zone of saturation ............................................................................................. ............................... a Adrain file orone of bedrock ............................................................................... ............................... Cl Category 2 The surface of the ground ...................................................................................... ............................... ❑ Category 3 Back -up of sewage into the structure served ........................................................ ............................... ❑ 6. Replacement System Type: ❑ Conventional ❑ In -ground Pressure ❑ At -grade ! Mound ❑ Holding Tank ❑ Experimental System ❑ Monitoring ❑ Other, explain Uniform Sanitary Permit Number k-Z 3 9 11 Date Issued Plan Approval Number 3 o S i , 54 Date Approved Experiment Approval Number Date Approved 9. Eligible ❑ or Ineligible ❑ Reason Ineligible: 10. Governmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachments and that they are true and correct to the best of knowledge and belief. Signature of Authorized Governmental Unit Representative Title Date Signed 15 zp�