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HomeMy WebLinkAbout002-1086-70-025 e p °y3 I h ao ~ I 0.0. CCo 1 C lam. O N N p U o ~ I c ~ I h ~ h C N N N to T 4) ~ O N C z (0 0 U. ~ N C -O c E Q o m _ M z ~ d ~ I N d m N F O z V N o 7 ~ M I v+U ~ c N • _ o c 0 z z O z N c E N ~ 0 I N ~ MW O L N O. m w O c (O h~ co c c a 0) cz N ~+J O F F_ F_ .m't- N 7 O 0 N > Q o o z I • o a a a ~~yy a o ~ o rn •i 0) ~ aNi N U rn m C (o Q o m o0 ^1 0 0° ~ _ E o I 00 N d (n 04 (mil N 1M1r Z+" 7 ~ 6 N N O N 2 C C p c E r- 0) O O M o a) a) C N U CL 0Oj C) J O. co 12 G LO C C c O N O C - a) O 0) ~ r a) o li) 0 U) N v Y rn C'4 w • ~a O N N V 00 U m E ti7 U O N m W N O - U) w r~ ik w i v !/Z w M a ~r • CL d .V aJ d `a r~ E i C 1w~0 j ri A 0 a m o U U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C e G n 4 ROrd a h ADDRESS 2 L.f L/ 2 "A A yk SUBDIVISION / CSM# / LOT # SECTION , T 2.1 N-R_&_W:, Town of ~3 a ~C w ih ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I, s t ol ~ INDICATE N TH ARROW Provide setback and elevation information on. reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. J BENCHMARK: t ate, G 1 • r /p ALTERNATE BM: {~s 4 L`y K. C4 Sr c(, 'k 4 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Ms 01 ft eat &e rl Liquid Capacity: /G !7 Setback from: Well $ y House_ Other • s Pump: Manufacturer Z e,`/C /ev Model Size I Float seperation ii Gal.lons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: .5 Length ? S__ Number of trenches Distance & Direction to nearest prop. line: 2 S Setback from: well: 2 U House 2 Other ELEVATIONS Building Sewer ST Inlet: / S~~ ST outlet c PC inlet gU PC bottom Pump Off Header/Manifold Bottom of system Existing Grade q5 Final grade DATE OF INSTALLATION PLUMBER ON JOB: t, r- LICENSE NUMBER: m p (y ff INSPECTOR: 3/93:jt WiscjnsinDepartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) sanitary Permit No.: GENERAL INFORMATION p2~0.7 PeERICler Na meLEONARD O El City 1:1 Village Town of: State PI an o.: CST BM Elev.: r Insp. BM Elev.: BM Description: 1 Parcel Tax o~ A940 210~~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ~eCt Benchmark Septic 't~i? )Lr Dosing Aeratio Bldg. Sewer i Holding r. St/fit Inlet TA#K SETBACK INFORMATION St/ IVk Outlet, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > ' S5 / 17 NA Dt Bottom -INO Dosing >5-6 NA Man. g (Q`j~ Aeration— NA Dist. Pipe 6? -5 Holding Bot. System Z 72 I, PUMP /$1P@0N-NFORMATION Final Grade Manufacturer Deman~ Model Number .#f 3G TDH Lift, U Friction©~($ Syste ,q) TDH ~'IFt oss mead Forcemain I Length Dia. 9 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT o. Of Pits Inside Dia. L' ~d Depth DIMENSIONS 5 ;71s DIM N I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING factu SETBACK INFORMATION Type O ,4_L.9 CHAMBER i , e Number: System: /5d. of > 5D OR UNIT DISTRIBUTION SYSTEM ae -fVani old Distribution Pip//e~(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length3;" Dia. Spacing 1 /1 /1/ -361, 1 >IaD SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of rr xx Seeded / Sodded xx Mulched rI~ Bed /fir -enter Bed /Edges ~o~ - Topsoil s ❑ No E] No r; COMMENTS: (Include code discrepancies, persons present, etc.)4/(S LOCATION: BALDWIN 22.29.26.328B SE SW 80TH l r 116 , 0/ 6e Plan revision required? ❑ Yes No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: j wr SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code :!7/. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than X10090? S 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. S 94,/ - ~/6 lv 3 PROPERTY OWNER PROPERTY LOCATION l ICSc. sV '/4S T N,R 16 E(or)W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Z if `l /z it & r 4 y9 L'c{ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY ` NEAREST R AD El State Owned 0 VILLAGE ED-TOWN OF: ❑ Public ❑ 1 or 2 Fam. Dwelling- # of bedrooms 3 PAR EL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 2- - _ G 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 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 in line A. Check line B if applicable) A) 1.E] New 2. Replacement 3. ❑ Replacement of 41:1 Reconnection of 5.0 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 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE `f 5.-0 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 3 7 r 3'") S - k,3 c / Feet Cff7 G Feet VII. TANK CAPACITY Site 1 INFORMATION in allons Total #of Manufacturer's Prefab. Fiber- Exper. New xistin Gallons Tanks Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank L,- I /V v v t ~'t1 + ~✓t C ",a F] Li Lift Pump Tank/Si hon Chamber i-~ 1 S "tl t - F1 F-1 L1 I [I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' ignatur tamps) PRSW No.: Business Phone Number: jo e- S ~ c, n Plumber's Address (Street, City, te, Zip Code): 4' W t--,tUd v , //e S sue( C IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signatur rhVII Approved ❑ Owner Given Initial Surcharge Fee) ( Q l _ Adverse Determination o v ' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 the time of renewal any new criteria in the Wisconsin Administrative Code will Ibe applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 606-266-3815. 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 y. 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 hold ing,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. i SBD-6398 (8.11/88) PLOT PLAN Page 3 of 3 SCALE 1"=L40 owyv` CRD CTRLck3Wj ~ ~ ~ ivo. ooZ_ 1oS3_ So i 'o eat Z ; \ p KW r C.om PkCT' OR 3 @DRM . o~R~'t t q~ -41 D\s`tvW3 7~+rs /t RSA IZ,/ N NI 9 .Z t;t. L4 s i 3 e.3 q~. IV cb-"S S F~tn.D t_IUUt o~ 9D tjCC PMtC(3Z.~ 8 .L04-O~ 01v \"l1Irvj, 3/0I>Ih g o.~ tNti ~cvC PIPET w/L1}Tn Z4 O T* ST. Qt~_ 133 6:- / (715 )42,5-0169 M00576 CST Signature Date Signed. Telephone No. CST # SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations June 28, 1994 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING PO 74 RIVER FALLS WI 54022 RE: PLAN S94-40633 FEE RECEIVED: 180.00 ERICKSON, LEONARD SE,SW,22,29,16W TOWN OF BALDWIN 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, pl.an 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.. ~ Sincer.el.y, Oerard Swim , t ) Plan Reviewer "tJ 1994 Section of Private Sewage y (608) 785-9348 =~131VT4 Z'JlVIMGC~FFICe C4517R/ 1 -Y SRn-6423 (R. 01/91) Page 1 of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE S94 - 4063 3 LOCATED IN THE SLz 1/4 OF THE SW 1/4 OF SECTION ZZ ,T Z9 N, R I6 W, TOWN OF `apc~. ~W1N S*-. C\?.U 1W COUNTY, WISCONSIN. INDEX PAGE 1'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR z y: q Z 'eo `rN _-py e. WOti~Vlll. Ljj 5q6z.% PREPARED BY owt6~Q~llan._ 0 WEGEF taF? SE3 I L TEST I NG '®s~® ~ ~d®4r AND . DES I GtV S1EF~V ICE 0 ARTHUR L. WE'GERER 0.975 P P.O. 801 74 421 K. KAIM ST. g ~L3WOR7H, L° RIVEP FALLS. VI 54022 p 715-425-0165 4"q j G14 6-139y JUN 2 21994 v' p5y & BLDGS. DIV. JOB NO. g - 3 3 PLOT PLAN Page of Scale 1"= y0 ~wn,`~-' l_~Uh~~(IL1~ ~R-L G2SOlV P t D ~►O. Doi, 105_ 80 • pRIVATE SEWAGE SYSTEM Conditionally V% soft 7W r AIRFROVhl DEPT. OF INDUSTRY, LABOR 8 D 6U ~fl"PE-~ TONS O{VISION OF SAFETY X, w~.L EE SpfllV; -tso Poor C.om Phc-r OR s 01pR t*, °tI Z',vy \ ~ls`rvw3 ~}tS JtiRI~A ~ @DRM Rai D~c~ e 9 y g~ to ~ 4 'V ~ c Op 4r N Put ~9.2 ~t.8'Z8 ~ i T"_ L.1)JUI 0r- 90 tfC. PMte2t> 4 7-4 O T* Sr. 80`ni- ftye • NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted.. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( -F -required) 4. "Septic tank to be 1000 gallon capacity manufactured by 'f%1I Qw ~~J~l 1~ 12.C~•~3T, tti - ~vrr P 1Youk ~-0 1~E W►~ DkJ~ST6R.N ~ S 0 5. Bench Mark S t_r- 3 yj_* 6. Divert surface water around mound to prevent"ponding at the uphill side. Page 3 Of Approved Synthetic Coverings c Distribution Pipe Medium Sand _ H_ G Topsoil F Elev. °14.0 D - 3 E b 1NI' % Slope Force Main Plowed Trench of ,2"-2.12 " From Pump Layer Aggregate Undisturbed D \.b Ft. Soil E N-5 Ft. Cross Section Of A Mound System Using F b-% Ft. 1 Trench For The Absorption Area G N•a Ft. A 5 Ft. H I- S Ft. B ~ S Ft. I 1 S Ft. Linear Loading Rate= 6.0 GPD/LN FT 7 Ft. Design Loading Rate= o.3 GPD/SQ FT K 1) Ft- L °11 Ft. Position of Force W Z7 Ft. L J ~ •Fofec~ --8 Pit K Mail tt Distribution Trench Of 2 2 Pipe Aggregate l 1 Observation Permanent Markers Pipes w , t r=M (An hi securely) j~ I,~Wlitionally V ED' tpgo.,a8, AuMaN RELATIONS Mound Using 1 T%th of 9WM r2WLDI%GS DIVISION SEE O SPONDEN Page Of t" 1 Perforated Pipe Detotl 9 " F+ r 0 End Vie- End End Cop.) PVC Pipe a Install permanent-marker at end of each -lateral Holes L"oted On Bottom. Are Equotty Spaced Q End Cop SYSTEM Q * S PVC Force Main 5 ;`;a OEPT. of INDUSTRY, BOR ND 8 ILQINGS 710N= DI 10" of O;stnoution Pipe Last Hole Should Be C ESPONDE"sIE Next To End Cop E Distribution Pipe Layout P 3~. S Ft_ X Inches Y 36 Inches Hole Diameter 104 Inch Lateral Y Inch(es) Manifold - Inches Force Main Z Inches # of holes/pipe ~ -L Invert Elevation of Laterals 9qsoFt. Place 1st hole c~ from tee with succeeding holes at 36 intervals.. Last hole to be next to the end cap. ' PUMP CHAMBER CRO55 SECTION AND SPECIFICATIONS PAGE S OF C~ % CAP c VEWT S94,400 4* C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE 10 FROM BOOR, JUNCTIOW BOX COVER WITH WARNING LABEL ~ WINDOW OR FRESH It MW. I AIR INTAKE I L GRADE -emu. 10' /r11N. COWDUIT -IMOVID INLET tIGHTESEAL I PPROVED JOINT A Tank A~tio + 1 comply I I I APPROVED JOINTS A wi . H 8 HR 83.20 I III with approved pipe extending ,y-`''t ~wKg ALARM 3 feet onto e j oA~ot~ II it ~,eoa X o ®o4eoe?a~ , I I oN s o l i d soil. Both sides of c oE~~ , oFI sDUSj~. of I tank. o I CLEV. 8g 'ZS pOCvU~i,4 J PUMP j OFF 0 08.00' CONCRETE BLOCK 3" APPAwl9c) DDING RISER EXIT. PERMITTED ONLY IF TAWK MANUFACTURER HAS SUCH APPROVAL I BE SPECIFICATIOMS DOSE TA K MANUFACTURER: NUMBER OF DOSES: 3~ 8 PER D" - TAWK 51ZE: 750 GALLOWS DOSE VOLUME t 1Z6.~ ALARM MAMUFACTURiuR: S.S QLIELIQO S`tSTI~lS INCLUDINfs DACKIF LOW: GALLONS MODEL I.IUMBER: Hw CAPACITIES: A= INCHES OR 331. S GALLONS 3WITCH TyPC: el2cuwy B = Z INCHES OR Si. O Gt LLOU5 PUMP MANUFACTURCR: e-' AT-11 24Yn24Ifi I~f C = G 11Z INCHES OR 210) GALLONS MODEL NUMBER: S3 D= 1S INCH~ES~OR 292• SGALLONS z -7 15 1. SWITCH TYPE: Ls12CuiZY MOTE: PUMP AND ALARM ARE TO BE $ MINIMUM DISCHARGE RATE 2'$'c'~, 6PM INSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEM PUMP OFF AWD..DISTRIBUTION PIPE.. 5' ZS FEET + MINIMUM NETWORK SUPPLY PRESSURE 2.50 FEET + IS FEET OF FORCE MAIN X ' 61 FYooftFRICTIOU FACTOR.. 0' 10 FEET TOTAL Dt JAMIC. HEAD FEET DIAMETER , INTERNAL. DIMLIJSIOIJ t OF TAIJK: LEM&TH -,WIDTH - ;LIQUID DEPTH rZ BOTTOM AREA 231= _ GAL/INCH AS PER MANUFACTURER = Y9.5 GAL/INCH M to W HEAD CAPACITY CURVE 'ill 61/4 LU "53-55" SERIES 4 25 e TOTAL DYNAMIC HEAD/ I 4% FLOW PER MINUTE EFFLUENT AND DEWATERING o CAPACITY + Q HEAD UNITS/MIN -1 - 20 , s FEET METERS GAL LTRS 43/76 111h N PT = 5 1.52 43 163 10 3.05 34 129 15 4.57 19 72 I 15 19.25 5.87 0 0 4 S94 J40633 0 J 10 I H O $15 t- 2 ZS.ob 5 915/16 I 0 l US 10 20 30 40 50 3% GALLONS LITERS 0 Al 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Piggyback Mercury Float Switches • Available with special cord lengths of 15', available. 25',351 and 50'. • Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non-automatic 15 ft. SELECTION GUIDE M53155 SERIES Control Selection 1. Integral That operated mechanical switch, no external control required. Model Volts-Ph Mode Am Simplex Duplex 2 Single piggyback wiceanglemercuryfloatswitch ordoublepiggyback merwryfloat M53/55 115 1 Auto 8.0 1 or 1 & 7 switch. Rater to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 & Mechanical alternator 10.0072 or 10.0075. D53/55 230 1 Auto 4.0 1 or 1 & 7 4. See FM-712 for correct model of Electrical Alternator, "E-Pak" E53/55 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 104225 used as a control activator, with E-Pak (3) or (4) float system. 53 Series - Wt. 23 lbs. -.3 H.P. 55 Series -Wt. 25 lbs. -.3 H.P. 6. Four (4) hob ".i-Pak .lunctlon box, for watertight connection or wirod4n simplex or duplex operation. PIN 104X002. 7. Two (2) hole "J-Pak' Junction box, for watertight connection or splice. PM 10-0003. For information on additional Zoeller products refertocatelog on Combination Starter. FM0514; CAUTION Pippybsck Mercury Float Switches, FM0477; Electrical Alternator. FM0466; Mechanical Alteroa- All Installation of contro* protection devices and wiring should be done by a quallfled nator, FM0495; Alarm Package, FM0513. Sump/Sewage Basins, FM0487; and Simplex Control licensed electrician. AN electrical and safety codas slowed be followed M addition to the Box, FM073?_ most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. xNL To. P .a cox 16 47 Loins, KY40256-0347 Manufacturers of... ZZ71L~~~ ZZ7. MP TO: 3280 Old MXW Lurie (Me Loutsv~e, KY40216 0218 (502) 77x31 * 1(800) 928-PUMP QU.IL/TY PUA/PB ~NCE I~347 r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of kabor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S'T'. C,u b( 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. ' 06?_- LOS 3 - '80 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L_N U: JQ -z _tj Elt..(C4t. S Oti GAUF-QT- S E 1/4 SW 1/4,S 22, T Z9 N,R 16 E (Q PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ,qq -L so` 14 NJIZ - - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®fOWN NEAREST ROAD wooDvt wt s~toz16 (-a1 S) 648- Z 251 ~~c~- w lrv 80 Pfv~ . New Construction Use QQ Residential / Number of bedrooms 3 [ ] Additiif,n to existing building j~ Replacement [ ] Public or commercial describe Code derived daily flow y SO gpd Recommended design loading rate bed, gpdHt2 0 trench, gpolft2 Absorption area required 3"1 S bed, ft2 3-A S trench, ft2 Maximum design loading rate o -S bed, gpcW J' trench, gpcW Recommended infiltration surface elevation(s) 01 q. O ft (as referred to site plan benchmark) Additional design/ site considerations tnov Q\, w / S ' K S' `C\ZC~+Cp( - Y"I t I J, 1 , 01= S h"it F-i t _L_ . Parent material `+O zss 00 !*tt. s~ `t1 `L Flood plain elevation, if applicable ty: R- It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RILL HOLDING TANK U= Unsuitable for stem ❑ S tffU NS ❑ U ❑ S ®U ❑ S CKU ❑ S NU ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrnd3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed hdrich 0-% \O`1.~Z_ 3f3 S i I Z Sbk w►' c,_ 5 - 0.5 0.6 Z 8-1-4 VW-t2 3/6 - SO -L 5~\, w,~► C-S o.S o_b Ground 3 \y -Rs ~o R 3o6 - S 1 3 s bk W `f c S - o, s o. b elev. 0 1 It. CIS-S~ -S~iiz Sly 5J16 g r,1AI m'F~ ~-w - " Depth to S S\4 S `l R V limiting fac qS y Remarks: Boring # Y^ . S tl 0-8 1p`-iR313 S\~ ZMSb\~ o cS 167 Z 8-tY lu`L2 3/~ _ s i I Z'Fsbk wI cw _ n. S v_ L iy-28 ,.s ~Ia 3iy - ~ 1 lc.sbk -w►v~~ CS - o.y o.s 3 Ground _ 8R ° z8-sz s 143 e. ~ 1 oo h I wChk~ ~ So o sg o- i' c to - 11 limiting factor;' ~ ILI W. arks: e eP Ar° hur L. We erer Phone. 715-425-0165 _eg ~e Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 n e: Date: CST Number: 4y-133 6-13_4 M00576 PROPERTY OWNER AMR C-~M SOrv SOIL DESCRIPTION REPORT Page?- of. PARCEL I.D. # DO Z - 1093-8-0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench w C7 -4~ 1 O `12 313 S 1 Z. w, S b~ 1~n`F1 CS - p. S o- b wi ~s - v.s o.L 3 s -\5 1 - Yl S') J n' Z $ O `'l R f 2.'F S k. Ground 3 ~s-Z~ l t3 ~trz- V/ - s 1 \ csUk v~F~ CA - o-44 0.5 elev. S k x 3lyr 1,0 ft. 2~-b9 SH~z yl -1-S YR sl0 g 3C- Depth to limiting face Remarks: Boring # w: 4 t Ground elev. ft. Depth to limiting factor Remarks: Boring # +V iiikt) xh,. A k :t h:syfinv: t.:~v:. Ground elev. ft. Depth to limiting factor Remarks: Boring # ralown, Ground elev. ft. Depth to I limiting factor i Remarks: SBD-8330(R.05/92) ' I I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County a} OWNER/BUYER %i_<..~ MAILING ADDRESS % V G .,Z PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE w , l PROPERTY LOCATION ✓ 1/4, ,u. 1/4, Section 2 , T ,,1 r_ N-R_4~_W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION rte' LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 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: c i ti ry. CI St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 f STC-100 This application form is to be completed in full and signed by the oViller (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.~1/4 1/4, Section' ° L, T_,L_~N-RC W , ~.Township ~6_, f -~A13 ; A H jailing address J Z .jr~~ ~_.L.-j- r ..•t„=c~ ; e ` Address of 'site _i; 4 Subdivision nameLot other homes on property? yes L No Previous owner of property /i% Total size of parcel ,Date parcel was created Are all cornors and lot lines identifiable? Yes No 1s this property being developed for (spea house)? Yes /LNo Volumee-?S-and Page Humber as recorded,with the Register of Deeds. 1I4CLUDE WITH THIS APPLICATION THE FOLLOWING: A IIARRMITY DL•:ED which includes a DOCUMENT NUtiDER, VOLUME MID PAGP. HUMBE.11 & THE SELL OF T11E I EGISTLIt 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 referencoss to a certified survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(wc) certify that all statements on this form are true to the best of ny (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 i the office of the county Register of Deeds as Document Ito., U 2_ , 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 county Register of deeds as Document No. Ug5^1b 2, S1gnEure of appl cait Co-applicant Date 0 f signature Date of signature