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HomeMy WebLinkAbout032-2092-70-000 a STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSMJ LOT SECTION -":5~TTN-R__Z_~)_W , Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW S W EVERYTHING WITHIN 100 FEET OF SYSTEM ~dCde4cc J7 ~s INDICATE NORTH ARRO~~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK •o ALTERNATE BM•~,. ` o m ~7 7jP SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: I'd ts~~S Liquid Capacity: Setback from: Well- House i 7 Other Pump: Manufacturer Model#_ Size / Float seperation ,:;~9 Gallons/cycle: Alarm Location '4L SOIL ABSORPTION SYSTEM Width: G Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House qs--, Other ELEVATIONS Building Sewer ST Inlet ST outlet 88~7~ PC inlet PC bottom g4 9_~ Pump Off Header/Manifold Bottom of system 97 Existing Grade 22 !2. Final grade DATE OF INSTALLATION: _ -S PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:- 3/93: jt Wiscorsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LBborand Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State P159 PAP 2 GERMAIN, MICHELLE X CST BM Elev.: Insp. BM Elev.: BM Description: -v Parcel Tax No.: fi no *9500e76 TANK INFORMATION ELEVATION DATA ,5-_ JCc TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV. Septic >s ")_J Benchmark Dosing , h SIOb'r~ 77 Aeratio Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/ Outlet ? gyp' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Q ~7Ct Air Intake Septic >2S NA Dt Bottom 1' Dosing NA F/ Man. 5 23~ 9~ 3.x'3" 3 ~i Aeration NA Dist. Pipe ; z y, 3 C/, Holding Bot. System 3 9 9.7 PUMP4,INFORMATION pr+~ ' Final Grade Manufacturer GC2c1~~~ Demand Model Number LJi: 03 / / L (0 GP 0 TDH Lift?ql Friction Systern,2 11)' TDH ~ a Ft Forcemain Length Sr Dia.,P-' Dist. To Well),O/ 7T- 1 SOIL ABSORPTION SYSTEM BED/TRENCH Width i Lengt / No. Of Trenches PIT o. Of Pits Inside Dia. Depth DIMENSIONS & DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Model INFORMATION Type O e<, i OR)AT Number: r System: OR IT DISTRIBUTION SYSTEM i Manif9)d hh Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length D i a o` Length ~ Dia. 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.24.31.19W, NE, SE, Lot 4, ?05th Avenue 1 F ~2 Plan revision required? ❑ Yes ❑ No / Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SA IIT PE IT # -Attach complete plans (to the county copy only) for the system, on paper not less than p 3 -n, 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNE PROPERTY LOCATION I AIX '/a '/4,.? T , N, R (Orffl PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # r CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION ME QRS /MBER i II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE : NEAREST ROAD. R TOWN OF: - RCEL TAX NUMBERO 1''~ ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms = PA III. BUILDING USE: (If building type is public, check all that apply) -Z~OV ^ yl~ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 411 Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [91 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 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 Al Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 0 Lift Pump Tank/Si hon Chamber N El El I El E3__ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name Pri : I Plumber' Si ture: (No S MP/MPRSW No.: Business Phone Number: Plumber's ddress Street, City, Sta e, Zip Code -Tog IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing A ent S• nature (No tamps .Yv Approved El Owner Given Initial Surcharge Fee) Adverse Determination (f -v4 ' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a 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 the 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)-ft be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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 115 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 25, 1995 2226 Rose Street La Crosse WI 54603 K 0 CONSTRUCTION KIM 0 CONNELL 308 MIDPINE CT STAR PRAIRIE WI 54026 RE: PLAN S95-40273 FEE RECEIVED: 180.00 GERMAIN, MICHELLE-LOT 4 NE,SE,24,31,19W TOWN OF SOMERSET 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. 6ra e- rel r M. Sw' Plan Reviewer Section of Private Sewage (608) 785-9348 8202R/ 1 SBUA•7W7 (R.1WN) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L of Labor and Human I 'Divifion of Sal110 in accord with ILHR 83.05, Wis. Adm. Code 1`l2 4 ®rG 3 COUNTY INS r AftachcompletARR 13 le r not less a8 x 11 inches in size. Plan must include, but not limited to vertical and horizon eference point (BM), direction and % of slope, scale or PARCEL I.D. # ,4 dimension e&($___ an and distance to nearest road. APPLICANT I'N'•F•ORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/45. 114 T N,R / X(or& PR TY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE 2FOWN NEARES-ROAD New Construction Use Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ j Public or commercial describe Code derived daily flow LSD gpd Recommended design loading rate 1,,2 bed, gpd/ft2 Z.2 trench, gpd/ft2 Absorption area required bed, ft2 _ trench, ft2 Maximum design loading rate _ 1,_2 bed, gpd/ft2 ,/_~2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors system [IS S ®U 21S O U O S IOU 0S ®U O S ® U O S ,EU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground _ elev. S~P6 ft. Ali Depth to limiting factor T-T Remarks: Boring # S AIZ Ground elev. 22.~ ft. ' Ile Depth to limiting factor -rid yC Remarks: CST Name:-Please Print Phone: Address: Signature: Date: CST Number: :iLZ4Z 7 `=197 - .4 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Pa of PARCEL I.D. # - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench - Ground 1.114 elev. 1-3 ft. Depth to Ile Abo limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ti4 Ground elev. ft. Depth to limiting factor Remarks: Boring # `...ti Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05/92) Page_,,;~_O t_ S95-40273 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H G Topsoil F 31 E D $ Slope Force Main Plowed Layer Bed of k"-21111 Aggregate Cross Section of a Mound System Using Ft. A Bed For The Absorption Area D D E Ft. F 83 Ft. AFt. G 1,6 Ft. B ..L2, s Ft. as H Ft. Signed: K /,0, Ft. L Rte, 3, 7_ Ft. License J Ft. e ~M Date: tjoll ® PN S S ~ 8V k_: -rea,t-e Position of Force Main L I I Observation Pipe J B Imo..-- K _----i A - - - - - - - - - - - - - - - - - - - - w Distribution Pipe Bed of 12"-211" Aggregate Observation I Pipe Permanent Marker Plan View of Mound Using a Bed For the Absorption Area 5 9 5- 4® 2 '7 3 pAga z 0fAaz Perforated Pipe 041011 n vi" )Perforated Fed Gap ' PVC Pipe `ore Holee Located On Bottom, Are Equally Spaced Q PVC Force Mohr w .7 Q PVC Monifold Pipe Alternate Position Of Distrib'dion Force Main Pipe Lost Hole Should Be Nest To End Cop End Cap Distribution Pipe Layout P _ Ft. R S _r X Inches Y Inches Signed: Hole Diameter Inch Lateral Inch(es) License Number- - Manifold -Inches Date: Force Main Inches © 4 # of holes/pipe ' Invert Elevation of Laterals Ft. b fD o P 4 O to n rt r• 0 c rn i~ln tt N 1 - w .0. --FT I twt m p0 p n M O C rt ►i a r- ti t:r ~r rt c rt ~n r• L .a w K a a a }V 7 PAGE OF ,LIL PUMP CHAMBER CROS5 SECTION AMID SPECIFICATIOMS /TI,~Nllt veNTCAP IS 9.5®4®2'73 4"-G=#. VENT PIPE WEATHE R PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER > 25' FROM DOOR, WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I Y" MIN. mim. ~r~~(dPG'~6NDUIT - \ too INLET ID HEAL I III Q N~ S I I APPROVED JOINTS APPROVED JOINT A Of 1N I I w/ =:r. PIPE p~V1S~~ I I I W/4:2, PIP E EXTENDING 3' N~vv~ I II ALARM EXTENDING 3' ONTO SOLID SOIL $ RR i iI ONTO SOLID SOIL. c I - Q~:rl GF~ PUMP _J OFF D CONCRETE BLOC 4( RISER EXIT PERMITTED ONLY IF TANK MANUWACTURER HAS SUCH APPROVAL SPECIFICATIONS :hP-fIC AND )OSE TANKS MANUFACTU9, ER.: ui--' LIUMBER OF DOSES: 3.7 -PER DAy TAPJK :,IZE : -no GALLONS DOSE VOLUME: GALLONS ALARM_ MANUFACTURER: CAPACITIES' A= _INCHES OR ._.S"_S=L GALLOMS MODEL NUMBER: /zq ~W - B=- 2 INCRES OR S GALLONS SWITCH TYPE: SL 4S / C=~_INCHES OR LE. GALLO►JS 161 PUMP MANUFACTLIRFR: r44g D= _ INCHES OR _r/l_ GALLON5 MODEL NUMBER: : jvt , it NOTE: PUMP AND ALARM ARE TO BE bWllCH TJPE: INSTALLED ON SEPARATE CIRCUITS PUMP D15(.HAR(.E. RATE GP 37 LF'M ~MIHl VERTICAL.DIFFERENCE BETWEEN PUMP OFF AND D15TRIBUTION PIPE.. 64G FEET + MINIMUM NETWORK SUPPLY PRESSURE , 2.5 FEET IooFTFRICTION FACTOR.....J,3f FEET FEET OF FORCE MAIN X -~F~ TOTAL DYNAMIC. HEAD = 4Z:;:es' FEET INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH_ 1 SIGNED: LICENSE NUMBER: ~C-9 DATE: .iZZ-?~ y.*Y~ky Performance Curves Pumps METERS FEET 95 -40273 - 90 MODEL 3885 25 - 80 SIZE 3/4" Solids WE15H 70 20 WE10H 7 60 WE07H 15 50 WE05H 40 10 30 WE03M 20 WE03L 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i i i 0 10 20 30 W/h CAPACITY U GOU LDS PUMPS, I N C, SekcA PALLS ~'Ew Y Ya J.:;. METERS FEET 120 MODEL 3885 35 SIZE 3/4" Solids t 10 [WE15HH 100 30 i 90 25 80 70 20 60 O H 50 WE05HH 15 i 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i i i 0 10 20 30 m3/h CAPACITY 919W Goulds Pumps, Inc. Eftcliys July, t985 C3W / JJ11r 1~ ~ L ~o+y/y AGE SYSTEM pRiVATE S~ - ioha 7 Upp & HUi+ Ard ._._r_ . _ per; Of •t1{DL18~• _ ~ p gGa.tit+~~+~ . . YiS1 SEE CORR . IC't~G' E _ r Z_' r'_ `~4 _7S'o~%u~cc,~✓. y ~ ~ ~=t~1. , P~,'++~P 'f At~i`~ _ _ _ ~ ~ - 4~ 'IV i~ 9k/ - -40 2 713- J-w„~J K 3S D'"/ oO isa WORKSHEET - MOUND SYSTEM DESIGN S9 5-40273 PROBLEM: Design a mound system for a The site characteristics are: ~nYa S Depth to groundwater or bedrock in. Landslope % Percolation rate mi Distance from dose chamber to distribution system „x ft. Elevation difference between Dump and distribution system ft. Step 1. WASTEWATER LOAD 3,,y y.~. sal. Step 2. SIZE THE ABSORPTION AREA A) Are a r e q u i red sq. ft. B) Bed or trench length (E) - ~ ft. C) Bed or trench width (A) - ft. r.. • -0) Trench spacing (C) wastewater load 2 .24 gal/ft /day B - r' ~reic e~Fi s~'~' ft. Step 3. MOUND HEIGHT A) Fill depth (0) - ft. B) Fill depth (E) ■ D + slope (AJf~~ % ft. C) Bed or trench depth (F) - it. D) Cap and topsoil depth (G) ft. E) Cad a d topsoil depth (H) - /_5 ft. Licunue 1,1u: Step 4. MOUND LENGTH S95-40273 A) End slope (K) • ~0 + E 1 + F + H x 3 , J ,9,f t . B) Total noun length (L) • B + 2(K) . S f,~? ,V, Z) = ,V -7 f t . , Step 5. MOUND WIDTH , Al) Upslope correction factor • A2) Upslope width (J) - (D + F + G)(3)(factor) • 7_ ft. x,93,, L) (2.IJ : 7.? B1) Downslope correction factor ■ 82) Downslope width (I) ■ (E + F + G)(3)(factor) -ft, , C1) Total mound width (W) for bed • J + A + I . 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 ■ gal./ft2/day r B) Basal area required ■ wastewater flow s natural soil infiltrd ive capacity - ~1~~/~~ : /mss- ,/'-2Z sq ft. Cl) Basal area available for bed for sloping sites ■ Bx (A+I) ■ C2) Bas are avail le for trench for sloping sites • B W ~J + q sq. ft. C3) Basal area available for trench or bed for level es BxW= Sign:. _ sq. ft. License Nu: Date: Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing ■ in. 3) Distribution pipe length ~Q im.~~ 4) Distribution pipe diameter ■ in. 5) Spacing between distribution pipes in. 6) Distance from sidewall to distribution pipe ■ _,1 in. 7B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes per pipe = 2) Flow per pipe x,l/24011141 GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length_ ft. 3) Number of distribution lines = 4) Manifold diameter ■ „ 2 in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate ■ GPM 2) Force main diameter in. 3) Friction loss ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift ft. 2) Friction loss = ft. 3) System head 2.5 ft. ft. Total dynamic head f t. ai Licerge:~ 1 ,l2 8'95-40273 7F) PUMP SELECTION 1) Pump selected will discharge f_ GPM at ft. total dynamic head. 2) Pump model and manufacturer a.~~11„Z„,~,. 1.~../i~lr(Li.I.IY_~ ■ ■~M~YY/I-~ / Sri n.~~~ w 7G) DOSE VOLUME 1) 10 times void volu of distribution lines ■ z,„4 gal./cycle /0 X (3o) (,09"? /10.S 2) Daily wastewater vo ume 4 doses/24 hrs. `./S gal./cycle 3) Minimum dose volume gal./cycle //mss 7H) DOSE CHAMBER 1) Minimum capacity required cam- 75Vyg/ &6 gal. i Sign: - p Licvnse !.u: Date: Wisconsin Depertment of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labor and Hungn Relations Division of Safe:y & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT A~i 1/4~ 114 T N,R X(or)ff PR TY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 3' CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 13TOWN NEAREST ROAD y V /E-) E _S; ~ ] New Construction Use pCf Residential / Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow SSD gpd Recommended design loading rate bed, gpd/ft2trench, gpd/ft2 , trench, ft2 Maximum design loading rate bed, gpd/ft2,Z_2_trench, gpd/ft2 Absorption area required , 3:7 bed, ft22- Recommended infiltration surface elevation(s) -9:$'• / ft (as referred to site plan benchmark) Additional design / site considerations Parent material ,~Oa~,~ §14 41jR Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S O U 23 S❑ U ❑ S IOU ❑ S O U ❑ S O U ❑ S JEW SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD/ft in. Munsell Qu. Sz. Pont. Color Gr. Sz. Sh. Bed Tilench Z"2 4_1~1~1 IV _::51 ljl4k Ground _ elev. ft. 3 Depth to limiting factor ~ Remarks: Boring # S Ground elev. _ 2L~ ft. / r Depth to / limiting factor Remarks: CST Name:-Please Print Phone: Address: ` L Signature: Date: CST Number: PROPERTY OWNERC SOIL DESCRIPTION REPORT ,ge,2 or.2 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 3- J1 Ground ` elev. 1-3 ft. -s / - s S ~ 8 Depth to A/,10 Al/a limiting fact Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor r-T I I I I Remarks: Boring # 'vG• 4tii .r4 Ground elev. ft. Depth to limiting factor r-T I I Remarks: SBD-8330(8.05/92) 4114-1 /,sr`/7.~in; x®i9~✓ .1 Xe, Iylme- ~G~of/ s ~~f- ,moo JR Sm ~i~~i✓~ S M 3S D ~ ,y y ' isa 08/11/94 14: 03 $ COUNTY CLERK Q1001i002 UNE 1ElM,~EC•Y4 Nf CORNER Of E 1/i4 OF SECTION 24,T31N pf! ~ r r; Jam-- N87°5705"w...dJ+e.rS.... e saoJ N 87.57' Od " w---,,l5 S TREE T sue. ze .oo a~• zeoo a aoo • 9 W s W , p ~ aW h ,Q h ~ A N Q 2 r• 3 14 NA 33/s ,t, x / q 133,951 sq. ft, 13I,599 aq ft. !33,881 aq. ft, 97 Ped-00 9 280.00 g~ ~O a`, 2edoo N57'5rO5"w 570.00 0 0 8 g sk 1, 001 sq, ft. NeT•5T'od"w - - s7a0o 0 ae 9 w N 159, 600 sq. ft. N 87.57 G5"W By, 170.00 pO C~ a+ g N O ~ .aa UN,R.r9W. B•9° O °P OS„ 159,600 sq, ft. e 1='48.56 1 y . w_ N N 7•dT'05"W 47M--l~ y~ ~ 470.00 s„ ..'T298'PL -°"Tr" Now 03a- -209LL- 70 IV. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT /St. Croix County OWNER/BUYER 9~7 14 MAILING ADDRESS PMO Qty 37 d PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION C 1/4, S~ 1/4, Section ~,YT-3j_N-R /7 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION 4 LOT NUMBER 'a CERTIFIEDSURVEY MAP , VOLUMFl043, PAGES, LOT NUMBER J Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 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 Location of property I Ur _1/4 , Section 2_, T 31 N-R / C! W Township zma'x Mailing address ,4' ~ 320 Address of site 'Aoo w5 Subdivision name 40&j Lot no. 2. Other homes on property? Yes'_~•-No Previous owner of property Total size of property N-5 Total size of parcel 131 , Sad Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? X -Yes No Volume 01 q3 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. j q b q g , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant - - 'DOCUMENT NO. WARRANTY DEED r..is s►~,:. nr scnv¢o ,nK R[CnnOIHn DA,. 9 y ~ti0J~.7 STATE BAR OF WISCONSIN FORM 2-1982 J V0L 1093Pa,F495 _ Richard. M... Hansen. and.. Jane A.. Hansen, ST. CROIX CO.. W1 hls?~anc~-. and.. W..> e...-•........... ReC'd t'Of R? ord SEP 1 1994 co..... and warrants to ..M..Ch£....4'........'d.1dSS£'....1_"one-?~a..f•--_-.•._.. iaterest".and..Bichard.0....Stout-.and.. Janet..P....StoutA.......... hustand..and..wife....a..one-half interest.,..as.. enant;~......._.. ~@st~rai~ in_Com om the following described real estate in ......,St•.-C)q~X•_••_. County, State of Wisconsin: - Tax Parcel No Lots 4, 5, 6, 7 and 8, Block 2, Hansen's Turtle Lake Hills First Addition in the Tow1 of Somerset, St. Croix County, Wisconsin. This -45. ROt... homestead property. (is) (is nct) I Exception to warranties: easements, restrictions and rights-of-way of I record, if any. v..l..._...... Dated this JJ day of~L . i. >L l9. 94 rf/ )7 . - ~tL!'L ......-(SEAL) err'.. (SEAL) ~ Richard M. Hansen J A. Hansen ----"-.............(SEAL) - AUTHENTICATION ACKNOWLEDGMENT Signature(s) Richard M.• Hansen, STATE OF WISCONSIN Jane A. Hansen ss. • St. Croix ya- County. authenticated this ___day of__jc 'j ffat' 1~~ 19•Z•--- Personally came before me this day of M. ----._se - - ~ 1 e A. the above named . Kristina Ogland -.Richard M. Hansen, Jane A. Hansen _ TITLE: MEMBER STATE BAR OF WISCONSIN . not. authorized by ~ ?06.06, Wis. State.) - to me known to be the person .5..---_... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland - At}omey "at'"Law-__-__•-•-----------------•-------•-- a . - - - - - Notary Pablic (Signatures may be authenticated or acknowled ed. Both My Commission is - County, Wis. are not necessary.) g Permanent. (If not, state expiration date- 19 . 'Names of persona sianine in any capacity should be typed or printed below :heir sizoatures. - WARRANTY DEED STATE BAR OF WISCONSIN Wiscnnsin Legal Rlank Co . Inc FORM No. 2 - 11392 Mdwauwo►, WIScon51n f