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HomeMy WebLinkAbout004-1055-60-000 i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Q ~PUIy~(1~ ADDRESS 22d (Ali I '/~1 lcCc?hJ`S SUBDIVISION / CSM# LOT # - 41% SECTION T N - R~W, Town o f Cc[ d ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r~ ~)5 C' d' cS v~~ q,5 ~eU~srv .9f o~ vtsid~ 1S y q Igoe ff r" INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Y BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model #Size Float seperation Gallons/cycle: Alarm Location -;SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop, line: Setback from: well: ~ House_ _Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt LQAA=Q*pert9@4W M44tty28 .15W, NUI`VATE WhMAIN County: 'Labor and Human Relations INSPECTION REPORT Safety and Buildings Division PIT (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION 29 Permit Holder's Name: E] City E] Village R Town of: State Plan ID No.: S ev. Insp. BM Elev.: BM Description: 1~ Parcel Tax No.: d 94' 0 a~5 TANK INFORMATION a ELEVATION DATA A9400053 TYPE MANUFACTURER CAPACITY STATION BS ~~HI S ELEV. Benchmark Septic X'' SZ6n e east Dosing 690 3 L~, r L53 O Aerati Bldg. Sewer U ng St/ Inlet Holdi 17, 8~ 9(f o- TANK SETBACK INFORMATION St4W Outlet ' Verit TANK TO P / L WELL BLDG. Ai,lnta to ke ROAD Dt Inlet Ar I Septic > /OD ZS NA Dt~ottom f7' d Dosing NA tZwkL/ Man. Aeratio A Dist. Pipe le7 O/a5' Holding-- Bot. System ,*4NFORMATION Final Grade PUMP /AVWd Manufacturer 2 ema,-,iticf t 3 38~ Gb-`, 6,-' Model Number 3COM TDH Lift,, Act Friction, ,t~~l S stern T D H q/'Ft Forcemai n Length ~D Dia. F~if 'r Dist. To WO SOIL ABSORPTION SYSTEM BED/TRENCH width I Lengt " No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS CT / DIMEN I N LEACHING anufactu SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM INFORMATION Type O kI Model Number: f, 14. System: d 57 r OR UNIT DISTRIBUTION SYSTEM Feet+Manifold Distribution Pipe( s) , „ ~ x Hole Size x Hole Spacing Vent To Air Intake Dia. Spacing T SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes E] No i0 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Cady.24.28.15W, , NW, 329th reet i_ 09,64 Plan revision required? []-1`e~❑ No / Use other side for additional information. SBD 7'W(R 05 1) ~ to Inspector's at Si e e~o L(/P.X G'V7 t _,.a✓-~' ~Qe -mot'-~ /ti.-> t~r~ ~-xLCi E . w. Safety and Buildings Division r^~•~`~~' SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. , In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. S Cr o) • See reverse side for instructions for completing this application State Sanitary Permit Number ao89 The information you provide may be used by other government agency programs Crevision to previous application [Privacy Law, s. 15.04 (1) (m)I. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION ' YK71 _5Y-00,0 Property Owner Name rope L cation ✓`eh 0 1/4 1/4, 5 o'Z T ,0Q , N, R J) or) 0 Property Owner's Mailing dress 9- 7 320 A S Lot NuN r d Block Number, City, State V; U. V% Zip Code / Phone Number Subdivision fya/tJ~ CSM Number /Y WlicO^u ( ) ~V ~y 11. TYPEF BUILDING: (check one) ❑ State Owned ❑ ity NearestRoad El Vlt age Public 1 or 2 Family Dwelling - No. of bedrooms Eaff own OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © q ^ 05x__6 0 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 ew 2. E] Replacement 3, E] Replacement of 4. ❑ Reconnection of 5. E) Repair of an System Tank Only Existing System Existing System system B) A Sanitary Permit was previously issued. Permit Number 9,,L') 4? 9 Date Issued V. TYP OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 211 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 2 ❑ In-Ground Pressure 42 t] Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade r Required (sq. ft.) Proposed (sq. ft.) (Gals/d; y/sq. ft.) (Min./inch) Elevation Feet `j Feet VII. TANK Capacity gallonTotal # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank loop 7trAiAPII NO ❑ El El El 11 Lift Pump Tank /Siphon Chamber mklr/La ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name:( rint ) Plumber's Signature: (No Stam s) MP/MPRSW No, Vsiness P on Numbe V o(~ S Plumber's ddress (Street, City, State, Zip Code): U Yllky C, IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A Tit iture (No amps) L pp roved E] Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBO-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ` 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be.renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division" 08-266-3815. To be complete and accurate this sanitary permit application must-include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit- Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and, manufacturer's name, indicate prefab or-site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or_with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 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 contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 17, 1995 2226 Rose Street La Crosse WI 54603 WEBSTER PLUMBING & ELECTRIC N3659 CTY RD C ELLSWORTH WI 54011 RE: PLAN S95-40571 REVISION TO PLAN S94-40120 FEE RECEIVED: 75.00 SORENSON, TOM NE,NE,24,28,15W TOWN OF CADY COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. I 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. - The approved changes will become an addendum to the plans previously approved. All other portions of the installation shall conform to the original approval. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely ar -M. wim Plan Reviewer Section of Private Sewage (608) 785-9348 S11DA-7987 (K. 10/84) 3 c 0 7 . ~ 'A U Ul QQ=`t It+ 00 353 feet to CD 320th str street West lot tine .-r} C jl CD t -31,000 3 0 n3~- 0 4 a=CQ . 0 00 r -►a -o 5 --a OD 7 a z -0 3 1 ~ -C+ VI r4- ET -0 m 0 P 0 rq ~ C~ "0 :3 IA X (9 p -0 0 4-0 IA n N m C -a 0 +:T 0 North o 06 P-0 0 0,0 x- 0 IA -0 01 ru ID l< P S? rq p 3 cF o pl~'~TE S v `D 0 2:g n6 U X1(0 Q ~ fo C:) c+ OV YPR ,aa ~F it6DllSjA~. '~~j , SAFE S L~ a 1 11J1/J t r` r l t~ ~r r iJ f r f~ f if f CID 1 U9 :r l crl r 1 i x I 1,D ~ F n ~--4 0 V ~ >J a --3 1, 0 0 0 G~ c * -F Q ro G n a iy I! 14 ~ 4 NO, -0 --11107 ro 11~ 0 tty Q f7 G w w n7 a 0 -0 c no Ul 0 ct -C. i 4-D -AL f.136_ Page `71 Of g COMBINATION SEPTIC TANK/PUMP CHAMBER 9 5 -40571 ~ (No Scale) 4" Cl Vent pipe with Approved Locking Manhole Cover Approved Cap, +25# With Warning Label Attached From Buildings 2 Weatherproof Approved _ Warning Label Junction Box Vent Cap :L 12" mum Final, Grade 6u Minimum 4"Minimum C.I. 6 Maximum 4" C.I Quick', 18" Minimum ..Igetinsp. Pipe Disconnect K 7-Y e~ 1 /4.. Weep hFa - Hole IDu A y y. 06 ,ustat, T Al arm Q~ 9Z.z3 . B L ' 0"-lV~ * 2 6 On f C S. *APPRO D Off ILV 9/ 31 JOINTS WITH APPROVED PIPE D '3' ONTO Conc. Block V~ SOLID SOIL 90.6 . 3" of Beddinq Under Tank--/ Note: Pump and Alarm Are On Separate Circuits ;,Number of Doses: Per Day 1t2 Gallons Per Day/ ofi-Doses: t-;Z Gallons • Volume of Backflow:....... 4 9 Gallons Total Dose Volume: = i-3- Gall ons MJU)6y h PW-01- Tank Manufacturer: • Tank Size-Septic/Pump: ItAp / ~ a ons 1 ?-'z. - 34-. Alarm Manufacturer: • Model Number: )Of Mw Capacities: A ranches or; Gallons Swi tch Type: Me,,r_ OL11 _ + B_-i nches or - 2. al 1 ons Pump Manufacturer: 2j 12CIlle" on, + C_~i nches orZj:!&_Gal l ons i4b 1.S C Model Number: ` Z o t'll K33~ y + D-1-inches or -,_Gal l ons i3c c Minimum Discharge ate: 2.() 2c: CV-, ~rM Total ijf) inches or 6SQ Gal l ons Vertical Difference Between Pump Off and Distribution Pipe: Feet 4''4h Pj-oz 44 Required Supply Pressure: .!......+~Feet 0 Feet of Force Main x ,S Friction. Factor/100 Feet: + s- Feet ~g 0 /10 2. Inch Diameter Force Main ccrr ! Total Dynamic Head: Feet Internal Tank Dimensions: LengtWidth/'~4 Liquid Depth 4 Si9nature ' ' License Numb e~ Dateu~a LHR SANITARY PERMIT APPLICATION COUNTY (~y In accord with ILHR 83.05, Wis. Adm. Code Sf Cro j STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than A P C9 C l 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLANI.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S79- lot 10 PROPERTY OW R P P TY OC TION 0 /a, S 2 T 2~ N, R [5 (or W 11^045111 1 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # C TY, STAT ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ,.r I J% r7 %g_ 6655'Zy~l II. TY E OF UILDING: (Check one) CITY NEAREST ROAD ❑ State Owned 3 ❑ YILLAGE: Al C sftet ❑ Public ~ 1 or 2 Fam. Dwelling4 of bedrooms - PA EL Ax N R( ) 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 7 2 ❑ Assembly Hall 60 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. P OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2.E] Replacement 3. ❑ Replacement of 4- El 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 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 5-0 375- 3 7 5- r~2_ Y-.n Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank it kA-.? of Z I El F1 F1 F1 Lift Pump Tank/Si hon Chamber CM 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's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: G~3 1(7/.rF O 30,11t) P mber's Address (Street, City, State, Zip Code): r Po)c O fi 2-3 IX. COUNTY/DEPARTMENT USE ONLY Disapproved Saaa~~~Itary Permit F We includes Groundwater a e ssue Issuing ps o Surcharge Fee) Approved ❑ Owner Given Initial Adve De rmin ti n X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. ; 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & 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. 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 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 (8.11/88) it SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations March 22, 1994 2226 Rose Street La Crosse WI 54603 WEBSTER PLUMBING RT 3 BOX 231 ELLSWORTH WI 54011 RE: PLAN S94-40120 FEE RECEIVED: 180.00 ORENSON, TOM N''N=,24,28,15W TOWN OF CADY 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. Sin rely erard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 3352R/ 1 SBM6423 I R. 411#31) S94 40120 PC D , cvt~ T-0, P S t ctlv~( CV tie COP33 34 s g 1f ~~s P I -2pT c3T r ~ C S ~ ,~r~ cam. CVO h S P4 wog t - r V p~ 3 lb Plea z~ 9 cvoSS Se chbi? a~yJ I / S & 14u f4-&"7 f a ~ ^ C ~ 55 SP C I'1 v~ RECEIVED MAR 2 1 1994 SAFETY & BLDGS. DIV. r InNAL .WORKSHEET . .7 4 4 ® 1 2P0 Of 9 P #347-S j MOUND SYS I EM 1 tr-~'1 t JAII?q 11, IN-GROUND PRLSSURE SYSTEM-Continued. 1. Wastewater Load, Total Daily Flow= gal, 7 10. Force Main: L$r0 Use s. ILHR 83. 15 (3) (c) Minimum Dosing Rate ~.5 • gpm, Adm. Code and PROVIDE A DETAILED Diameter in. LIS,I- OF SIZING ON PLANS, r2 11. Total Dynamic Head: 2: Depth to. 'Limiting Factor= ft. "System Head = 2.5 ft. .3. Landslope % Vertical Lift ft. 4. 'Distance from Dose Chamber to Friction Loss = 145MBO e~o eft. Distribution System = 12. ft. TDH = ! ~ ft. 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System ft. Pump will discharge at least fpm 6. Absorption Area Sizing: at 51-C ft. total dynamic head. Area Required= A?5 ~sq. ft. Pun irc' m el ~fuf'tturer: Zor LV Bed or Trench Length (B) _ ft. -1377 Bed or Trench Width (A) ft. 13. Dose Volume: Trench Spacing (C) _ ft. 10 Times Void Volume of 7, Mound Height: ' Distribution Lines = ,oyl,l10' i b '5_0 gal. Fill Depth (D) Daily Wastewater Volume .r Fill Depth Downslope (E) _ I. 4Q ft. 4 Doses In 24 hrs. gal. Bed or Trench Depth (F) ■ 6.?s ft. Backflow=,161= : 301 ~•9fb ~ gal, j Cap and Topsoil Depth (G) ft: Minimum Dose gal. Cap and Topsoil Depth (H) _ 1.5• ft. 14. Dose Chamber: f- . 8. Mound Length: Volume = `7 . gal. Enid Slope (K) = ft. Total Mound Length (L) _ .aL ft. Ill. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: gp 1, Wastewater Load. Total Daily Flow = gal. UpslopeCorrection Factor = Use' s. ILHR 83.15 (3) (c)., Wis. Upslope,Width (j) ■ ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (I) _ ft. 2. Required Septic Tank Capacity = gat, Totai Mound Width (W ~5• ) ft. 3, Percolation Rate = min,/, 10. Basal Area: 4, Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83 Natural Soil = 0.5- W/sq,ftjday and PROVIDE A DETAILED LIST OF Basal Area Required = _l sq. ft. SIZING ON PLANS. Basal Area Available = sq. ft. Required Area = sq, ft, 11, If Standard Tables from Chapter ILHR 83 Length = ft, are used, indicate Table # Width = ft, 12. For the Distribution Network, Use Numbers 5-14 in Section 11. Number of Trenches = Trench Spacing ft. 11. IN-GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor = ft. Lateral Length ■ ft. 2. Landslope Number of Laterals = 3. Percolation Rate = min./In, Lateral Spacing = in. 4. Proposed System Elevation- ft. Distance from Sidewall to Pipe = in. S. Wastewater Load, Total Daily Flow: gal. System. Elevation = ft, Use s. ILHR 83.15 (3) (c) , Wis. Adm. Code and PROVIDE 'A DETAILED IV. , SYSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All Items from Section Ill Required Septic Tank Capacity ■ gal, 6. Absorption Area Sizing: V. SEPTIC TANK Percolation. Rate min,/in. 1. Capacity = . Area Required gal. sq. ft. 2. Manufacturer: h PireaeT a C System Length = ft. 3. Show Site Constructed Tank Details on Plan Syki;em Width= ft. 7. Distribution Pipe Sizing: VI. DOSING TANK Hole Siie in. 1. Capacity = 7 gal. Hole Spacing = r fl. .2. M,tnufaclurer: l_etcral Length • 30. ?_S je ft. :1, Pun1p Manul4cluror: 21 gill a- L.orr.d Sue 4. Pump Model: _ I'Meral tip.icinK It., 5, Operating Hcad= ..r~• ft. Di%wilce.trnnr lidew.dl lu Pipe in, b, flow Ralcc gpm, 8. . Distribution Pipe Discharge Rate: 1 7, Show Site Constructed Tank Details on Plans Nun►hcr of I lolrs Per Pipe 1 luw Per Pine : 7,0L , gpnt. VII. IIOLU1NG I ANK . rl. Manilold Shang: I. Capitcitya gal. I Y11c (center air und) C e 2. MmWircturer: LenkUr - 3 It. 3. Show Situ Constructed Tank Details on Plans Diameter io. X94 M -SHOW ALL INFORMATION ON PLANS- DILHR SOD-6761 (R.03/82) S94 40120 Pte.3v~,P oil^ a o T~ a Q d v d. ry A~G OJ ^'i ' . I c~f` ~ 'mss /e r5 ~ ~ yr cc o co s CIO A! Qr Asa ~ ~t C? 3 aR` a a$ W co O b J S 4 4 p 1 2® M t` 4 ci . N {1 +i / r r S 1 e~ )r P y Cam/ a~ s~~ 3 o y 74 q s i Ce Clt o Nr V L A%,C , kb y y Page Of S94 40120 I Straw, Marsh Hay, Or i Synthetic Covering Distribution Pipe Medium Sand I H 6" Topsoil - - _J I 3 E D b j 16 % Slope Bed 0f Z~- 2 %2 Force Main Plowed Aggregate Layer (6" Below Pipe) D Ft. Cross Section Of A Mound System Using E R. A Bed For The Absorption Area F L1,957 Ft. G :1 X Ft. Signed: A Ft. H Ft. /Utitc,l~l~1 nn B zFt. License Number: 7 K I Ft. Date: L ~ Ft. 5<1 J Ft. tr ~y position I Ft vpsl of Force Main W~ Ft. LSI t co "irewo" L Observation Pipe 6 K r - - - _ - I~ W ~o Force Main Co Bed Of Z- 2 P` Dist ib ally 71 rRe WOO Aggregate I k P m010Permbnent Markers f o • a our, N c~ E~ Plan Vi Sam ing 8 For The Absorption Area to - 17 S94 401 ` 0 Distribution Pi e roeo f 1 ' F p t or *9 'L eral Network V Position E P Force Main ' a s K: P 'PVC Distribution Pipe P Holes Equally Spaced PVC Manifold Pipe On Bottom X S t AGE SYSTEM \ ' X. ~F Ss-W 1 t X d oncil C„ *-Last•Hole Should Be Next To End Cap * ~ ~;~,~3toNS ~,BOEi & HU4R~+~i oEM• of ►NOCts Oi: s~~ ►►~a~~~ ~ P ~ . P= 3012S ~v►S► S 3 Ft. SEE Co X Inches Signed: Inches g Hole Diameter Inch License Number: ,tA,. bate: l Q~ Lateral Diameter _f- Inch(es) •u Manifold Diameter Inches Force Main Diameter Inches I Holes Per Pipe Invert Elevation Of Laterals Ft. S94 4012 0 PAGF (;Fg PUMP CHAMBER CROSS SEC T IOIJ AUD SPECIFICATIOkIS . VEUT CAP 'i"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKING 25' FROM DOOR, JUAJCTIOkJ BOX MANHOLE COVER WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE -i ' 4" MIN. G ~ _ Ie^ Mlu. AGE SQs1IT I8"MIAI. pF{IVATE SEW - _ nditionialu 11~ IIULET ROVIDE TIGHT SEAL I II' .Arr gY LABOR & H011A FELA3IONS p . p¢ fNDt1ST FEiY AND B ItIOS i I IM ISIDR OF I I ( ALARM a .N.GE i ' SEE CO HE° P N O *APPROVED i Om ELEV. FT. JOINTS WITH I APPROVED PIPE 3' ONTO PUMP crF 0 SOLID SOIL CONCRETE BLOCK RISER EXIT_ PERMITTED ONLY IF TANK MAUUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC,IFI'GATIom§ DOSE . (/hdTANKS MAWUFACTURER; ptO"4 Pyp ,asf.-_ ~JUMAER OF DOSES' PER DAy TANK SIZE _ GALLOWS DOSE VOLUME ' ,I4''~ 6AC-. MIS ALARM MANUFACTURER: J J4Mrj INCLUDING dACKIFLOW: ~ GALLONS MODEL NUMBER' 43(. CAPACITIES: A= IWCHES OR GALLOW SWITCH TYPE: 14 t fj--44 11 1t B = IRICNES OR - CALLOUS PUMP MAUUFACTURCR: ^Zb_P &w0 jay Az 25 C - WCHES OR GAlLO1J5 MODEL NUMBER; 67 D- FICHES OR ~ GALLOIJS SWITCH TYPE: V NOTE: PUMP AND ALARM ARE TO DE MIAIIMUM DISCHARGE RATE GpM INSTALLED OW SEPARATE CIRCUITS 2le q oiz~ VERTICAL DIFFEKEAICE BETWEEkI PUMP OFF AUD DISTRIBUTION PIPE.. „ FEET + MINIMUM 7. L. NETWORK SUPPLY PRESSURE . . , , , , , _ Z•5 FEET + FEET OF FORCE MAIN X -F~ ~ooFxFRICTIOW FACTOR.-l"_ FEET .ICI TOTAL DyWAMIC. HEAD = FEET 10.69r belim IIJTERWAL DIM$IJSIOWS OF TAUK: LEIK.IGTH • ~ ~`I ;WIDTH IDI/ ;LIQUID DEPTH' SIG►.JEO: f LICEWE 5 IQUMBER: DATE:/ M ix s X 94 40'12 0 HEAD/CA;CA , EFFLUENT & DEWATERING oTN:o>icHEaoncln 11 53.66 Ion 100 .N!:a!„~.i,•,~i i 3Q:;;•: ! tae . 95 n: 90 ! : . 8s na j! ii!I,v~,~ji!! ! ! j t06 186 ! I i Am 10 02 MEN -9m i 65 165 7 Lock Wlw: 19.26' 7S' 78 116 91 ......>:i 55 ts; . 163 WAMING:,Model 185 should not be subje< 30 feet TDH. 4,9 INS FAQ Capacity on Model 112, In p ,pump, see FMO219. 'i SS t85 30- - 189 20 :2%;` 15 161 188 t 0 37,39 13 139 U.S. GALLONS 10 20 3040 S 60 70 80 90 100` 110 170 11130 140 501 •t'~ i1 i `i'`%2:i: i;:;: ::yi:i~i ~ •'}:;5:<i: "2:::::S:ii :;<•::a: • • :::•:•>:a:^:•r • : 4S _ r •::•::::•:::•::::;:.,.,t1. ,xs0>:•>:< :.;{Q:•:>i.'•:SitO:i:::::;::>5~..:::::::i:;::i:: #0::::`:ii :i1+X _ W SEWAGE & DEWATERING' mru.orUwucHE►crcncirvPl i75 SERIES 262 >~da. '+`f:^i fi ft2 au ZO¢ 2W 29a . FT. C#IiU^ :OIL r9di ~ ~„EEi,o,a al. ,L 65 16 6 to e 100 166 0 20 i 10 110 160 100 ~ 108 ; E. Wisconsin Dr a-rtment of Industry, SOIL AND SITE EVALUATION REPORT Pa e of Labor and Homan t'.rairations g Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code d• COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but Cvo] 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. _ s-- 6a 0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION JSO/ PV)Sorl GOVT. LOT /VF 114 If 1/4,S~_ T 2 N,R (o W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # , p, 0 2- CS - 0 / 902 CsT A0.2- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Vh, le. Wis 767 (711"'16 _ 2YY6 ca)" 3 F• New Construction Use YQ Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow SO gpd Recommended design loading rate (.2 bed, gpd/ft2 trench, gpd/ft2 Absorption area required ~ Z5 bed, ft2' trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) L, r) LA. oFroA2-ft (as referred to site plan benchmark) Additional design / site considerations UIVP If CA2 11 EP Parent material J-or SS-e S Flood plain elevation, if applicable ~7 " ft S =Suitable for system CONVENTIO AL M ND 711EN3GROUN D R ESSURE AT-GRADE SYSTEM IN ILL HOLDING T NK U=Unsuitable fors stem ❑ S ❑ U U El S U ❑ S ❑ S U 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 Trer& { [ b-G (o `~R l3 r 2 w, v- C_ 3 C-) 57 ► fi i °ll3 s.I z F d F,, S 2 ~o - d s 0,4 Ground J 2U7 9,5 YR w, ~ty'f w► f~~l. S 2 co ~,S ~,6 elL'L6 ft. Y 3 S 9-C Olt 1-r- S -v G,5' Depth to 5 sy-~~ 2 ,5Yii S Z w, b vh ✓ ~f - O'l o, limiting factor„ Remarks: _Ae ail5t d#- C04,~r/D„3 iti Sur.^ad•1 ~ftr ~~a~rf 1l~hc y c t/aT y3~f Save as h 7 Boring # to 1 312- 2 .2 VA 04 10 Y9 k" Q k/ M 3 11-`13 T- YR V Y s/I It77 a W 2 4 M 0- o, S p.6 Ground elev. Y 13-S5_ 5 YR d CS Z y " ~f 6, l d~ n, ✓ W lt. Depth to S ~6 lb Y S 6 CS 3 I / _ 011 limiting C6- S` A S S 3 f, 0, ~ factor `13 RR Remarks: 6eC4U_)'e 09 r f 10_? rroo ti f- W p ~Slin, qf~ GGt/ --1- 1311 sy A CST Name:-Please Print M Phone• vc~ l W 6s+ev- 7 I S y' 060 Address: 3 2-3/ WJ5 Sy0> Signature: Date: CST Number: 2 PROPERTY OWNER SOIL DESCRIPTION REPORT Pagg_of + PARCEL I.D. # k Depth Dominant Color Mottles Texture Structure Consistence Bou Roots GPD/ft Boring # Horizon n Munsell u. Sz. Cont. Color Gr. Sz. Sh. r~dary Bed Trench 9,5 VR 312- J/ Ground 3 elev. '1 9~ft. 3q6-N~ 6 Depth to 5 f 6 limiting - factor A Re arks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. i Depth to limiting factor Remarks: SBD-8330(8.05/92) PROPERWOWNER Tnrh %►r4v,~Oh SOIL DESCRIPTION REPORT Pag of PARCEL I.D. # 001- 105s-- 60 ~rrJ If 3 eti F~rti~ Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Bouxiary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tench 2 4-z► to 5/ ,•1 F~1 6,s o,/ Ground C $ elev. Sih ~e rqi .S 0.7 ~•8 . A-6 ft. y 2~6"3Z S Y '!~6 i ~r V4 0-S- D ~6 Depth to 5 32-9 2 iYR 6 sc l 6 F, b- e 0,~ '0.3 factorg TY 6 Ft'F;.MYR / scl 2 F• - 0a 0 ~ Remarks: Boring # E ( o os s ro YR sl Ground ! 'I-S rR s 6 s r., Ff o- 0,7. elev. loo ft. 9, 1R ~a6~r r~ 0.2 Depth to limiting factor Remarks: Boring # ~"7 ro YR 312- r F 1, v, r c 0.5' 6 to YA Y/1 Ground Zy'3~ SY 5' $ 2 '7 0•? too,Sft. 31"q2 Z w, 4 m P; ► I v o. 'o, S' Depth to-s2 s16 F1~ s S C o.~ limiting factor 66 ^ Y 6 F 0,3 o, 1l Remarks: Boring # 1 b- io R 3 12 f I 3 14- o-S N 2 7121 0 ~R s F v Ground 7,S YR C vr" 0'r:: 0i6 elev. ft. 21' 1~ 1 51' ` !;c 0, Depth to q-72 , plc 9-I srR V9 a") limiting factpr V F-1 Remarks: SBD-8330(R.05/92) c4 S H .s t v K 3 cr o Z ~ ' ct 42b o- n ~ w 1 ~ O O. ~ V e ' T M }J'~ b e~ ri p ~ e Y N f .13 V'r v !cap Y s ; O C4 a- B 0 V V lY~ ~ O rs i v _ s t 4 y c~ i S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER To V ~Cf j/ 4>L- 50 ADDRESS Pi(/ L 6'6 .3 2 FIRE NUMBER 19? C y CITY/STATE 2 r W•r )CC417 ZIP 7o17 PROPERTY LOCATION: 1/4,§14/1/4, SECTIO~, T~N-R w TOWN OF r ✓ , St. Croix County, SUBDIVISION , 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 a 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 Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : /rt4< ti.~,~. 3 19 y y St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 • f 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 160-1 'SO p lj Location of property-_.+1/4 1/4, Section T )f N-R ) W Township CCjj✓ Mailing address !lay <0v~~y u!Iley j k) Address of site / 7Jo'V TVP _ d Subdivision name Lot no. Other homes on property? -yes No Previqus owner of property Total size of parcel 4t( f~L Date parcel was created Ty1,/ 2 ( Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume 7w 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 & 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. y g S 4 ~,L , 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 dul record d in the office of County Register of deeds as Document No. Signature of applicant Co-applicant Date of Signature Date of Signature v DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1902 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED • 485482 VOL 958 PACE 45 REGISTER'S OFFICE ST. CM CO, wl ( GARRETH AND PEGGY GUNDER.SON / 14648 Street S. L Recd for Record Afton, MN 55001 JUL 0 21992 . conveys and warrants to TOM SORENSON & ARLA J BASKIN. JT TENANTS 4:15 P. M 107 W Statei Street Spril3g Valley, WI 54767 of Doe& RETURN TO the following described real estate in ST. CROIX County, State of Wisconal. Tax Parcel No: 004^1055-60 -THE NW 1/4 OF NW 1/4 OF SECTION 24 IN TOWNSHIP 28 NORTH OF RANGE 15 WEST" iMAN S EM This IS NOT homestead property. . (1s) (is not) Exception to Warranties: NONE Dated this .;711 dayof- (SEAL) (SEAL) SEAL) (SEAL) pg: j A G1lloffSod AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 33. Ste Croix County. authenticated this day of , 19 Personally came before rite this 2nd day of July ,199_ the above named Garreth and Pesum H,. Gunderson TITLE: MEMBER STATE BAR OF WISCONSIN (if not to nown to be file ~•'11~ho ex led the authorized by § 700.06, Wis. Slats.) for of g instrument ar1P► ' THIS INSTRUMENT WAS DRAFTED BY tE - • amen GARRETH J. GUNDERSON Notary ubuc + County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is anen4.70tf & trite expiration are not necessary.) date: April "83:f, Ing'A t9 ) 'Naves of persons signing in any capacity should be typed or printed below their signatures. S82 mTF oo2t WARRANTY DEED STATE OAR OF WISCONSIN Nolco Tax Forms, P.O. Box 10208, Green Bey, WI 51307-0208 Form No. 2 - 1992 / i _ _ / 1 e q _ I I _ I I I I i i 1 i N a Wi C L~ C wr,C)C:1 ve w ~G tl( w~ ur v L S+,a r6e r '1 G ci v~ ~4 uv S 4 1 j e e V t 1 t - t 7 - - - ► f - - - - -