HomeMy WebLinkAbout018-1052-00-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
~de
ADDRESS_" & SUBDIVISION / CSMI LOT
SECTION-. a2 ~ T N-R W. Town of ST_ CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
- v
J
p `r
~ h
J
INDICATE NORTH ARROW
form.
y'T)yIide setback: and elevation inform,- ion on reverse of this
r.
"~~r' Provide 1 dimen~ic ~s to center ~1 _-,"ptic tank n;ar::'Ole cover-
BENCH 4ARK • 4Q A/
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION
Manufacturer: JyJ,'~w~4 Liquid Capacity: e2
Setback from: Well f House Other
Pump: Manufacturer Model# Size
~
Float seperation Gallons/.cycle: /2
Alarm Location s < P
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:
/p7
4
PLUMBER ON JOB:
LICENSE NUMBER_
INSPECTOR:
3j93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Laborond Human Relations INSPECTION REPORT ST. CROIX
Safe+Kand Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
lfl4
Permit Holder's Name: El City El Village Town of: State Plan
o.:
PERUCCA, ADELINE M.\ R
CST BM Elev.: * Insp. BM Elev.: BM Description: Parcel Tax No.:
sb p
015
A9400189
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
Benchmark
Dosing
95O
Aeration - - - - Bldg. Sewer
Holding_ St/' Inlet ? B D7'
TANK SETBACK INFORMATION St / $f Outlet /009/1 Vnto TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet
Septic r d 3a NA Dt Bottom
Dosing 5SD 3 r NA Header-
Aeration - NA Dist. Pipe
Holding Bot. System
PUMP / SIPNZW INFORMATION Final Grade
Manufacturer Demand ° ' T
s9
Model Number -7 GPM
TDH Lift Loss System ` TDH Ft
Forcemain Length 1 Dia. Dist. Tower
SOIL ABSORPTION SYSTEM
BED/ TFAMZW- Width Length i No. Of Trenches PI Of Pits Inside Dia. Liquid Depth
DIMENSIONS 8 DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING cturer:
SETBACK
INFORMATION Type O CHAIIQBJE Model Number:
System: y,,v O' 'A, OR UNIT
DISTRIBUTION SYSTEM
NaadeclfoId Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. ,2 Length ,30~ 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 /T4ermSCenter Bed /7dV%iM Edges : Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
rte`--('
0 Cl
LOCATION: Hammond.l23.29.17W, SE, SW, Highway 12
Plan revision required? ❑ Yes El-k6"
Use other side for additional informatio . 19
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
LHR SANITARY PERMIT APPLICATION
cowl. ,Y
'ZIO In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑
8% X 11 inches in size. Check if revision o pre ious application
-See reverse side for instructions for completiikg this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PR ERTY OWNER PROPERTY LOCATION
G,L •%G~ ~t/4Sdr)t/4, S 3 T.2Q, N, R 17 E (or
PROPERTY OWNER'S MA ING ADDRESS LOT # BLOCK #
CITY, STATE ZIP ODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
' d !S s
II. TYPE OF BUILDING: (Check one) El State Owned ❑ VILLLLAGE NEAREST ROAD
CL YlfO.rZ~
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms !~_r PARCEL TAX NUM ER(
III. BUILDING USE: (If building type is public, check all that apply) D / f0 j 2 p p~
1 ❑ Apt/Condo G
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 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 4. ❑ 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 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy
130 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
.1 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
s-/ 2 s 2 ~(j 15 a 0 Feet d / V/. v Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New istin Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holding Tank 2C1t? d ~S
Lift Pump Tank/Si hon Chamber A. IN-1 F] I F-1 El El El
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system show n the attached plans.
711
Plumber's Name (Print): Plumber's Signature: (N tamps) P PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zi C de):
-7,:~ s c
IX. C TY/DEPARTMENT USE ONLY
❑ Disapproved S-Wary Permi ee (Includes Groundwater E~~ Issuing A m Sign
Approved El Owner Given Initial Surcharge Fee)
~~(L
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 ~SPO 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:
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 JN11.5 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)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations A
L
April 15, 1994 2226 Rose Stree
La Crosse WI ~4~903
.Ell 164
WEGERER SOIL TESTING ST Ci~Otx :1
PO 74 ONIyIt~~iCE ~
RIVER FALLS WI 54022
RE: PLAN S94-40203 FEE RECEIVED: 180.00
PERUCCA, ADELINE
SE,SW,23,29,17W
TOWN OF HAMMOND 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.
Sinc .rel
6rar/dSwim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
3161R/ 1
SBD-6423 1 R. 01/91)
r S 9 4 4 0 2 0 3 Page of 6
•
MOUND SYSTEM
FOR
A L4 BEDROOM RESIDENCE
LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION Z3 , T 2,`L N, R l`I W ,
TOWN OF mw'jt , S-'. C TX COUNTY, WISCONSIN.
INDEX
PAGE l '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
0K) t5-. i?evccq
l°l ZF6 l'f1GHlvprv " lv
- -1~ t'11h O i~1~, ~ 1 S ~l u l S
PREPARED BY
~NNiiilliq
WECGEf;t ER SO I L TEST I 1%.1 (3
AND ®~CC36+d~* ~i®®
lit
% bp_
%
F.U. BOX 74 421 N. KAIK ST. AFtTHUF L. i$
'EGrRER
RIVEF. FALLS. MI 54022 C-915.
GLLSwoRTH,
715-4225-0165 w E"ECE1VE® #Ias ~~~d►
3-3)-`ty
APR 1 1 1994
c FETY & BLDGS. DIV
JOB NO. 9 L/- Ll 3
PLOT PLAN Page of
E,
Scale 1"=30
41 4®ti0 3
►vo T ~ artcT oR oc~t~.ti.1 e.\~.~~t -
77 NJ l=u~~n~1R.TXi~
I ,
zs' $-3 I
I I
I
j 8l' I
•
3oS•, of= Ali.: = R S. o
83
8.2 3•)
TLgy 3 3oJ q%L s
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,4 ~u•
vt^
LTL. 0I8.S6 oN 'aV nM of Slb1AUG.
sEE c°
GPCC+-A-G E
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~ S •
~c t 9rW,~ v D"
1b e~ `PC M-'O Lweb1 L-- Qly _ , l0o.po " av 3 uY1"Di j 0j= S I WA-) 6
~ S ~%M eat,~ -
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I
IL
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4
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o . 3 rn ~-o
1 O T* 5r,
S \`Z4 - - -
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. (Y required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be \Zp~_ gallon capacity manufactured by
1'1l\-'~tyt5'1)E!1Z.lJ 101 -'~Pt',SsT - ?vw►ti> `1`('KAL'M ~j N 1M+b U (~S`rQlt-jQ 7S0 GkL, 110kitic.
5. Bench Mark So Uc
6. Divert surface water around mound to prevent ponding at the uphill side.
f 1 Page 3 Of 6
S94 4020 3
Approved Synthetic Covering
Distribution Pipe
Medium Sand
H G
Topsoil . F Elev. O1
3 E D
3 ` -
ci b
- % Slope
Bed Of i~ 2 Force Main Plowed
Aggregate From Pump Layer
R raj I ya ,J4 ~ ~ Fi ~ ~ Ft~k Yk~ y t ~ C
~a~ °,TaaFSS D 1.0 Ft .
pE'PT. 0'F IHbUSTRY, l.A~~R F(4 ~'~a~'"`';"iS k-11 Ft.
Di SION of SAF ss Section Of A Mound System Using E
ed For The Absorption Area F o•g Ft.
SEE ESPONuENGE G t• O Ft.
A g Ft. H l- S Ft.
Linear Loading Rate=9. 5 GPD/LN FT B 63 Ft.
Design Loading Rate= o.y GPD/SQ FT I 1b Ft.
J 8 Ft.
K 10 Ft.
"m+-e~ Position L_ Ft.
of
Force Main W ---I -Z- Ft.
L
Observation Pipe---,,
J 1_ g K
A
F W ° ~ee--Me+fl
Distribution Bed Of 2~- 2 2
Pipe Aggregate
I
Observation Pipe Permanent Markers
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page y Of b
Perforated Pipe Detail
0
End View
)Perforated
End Copt PVC Pipe
1 - -40-. asp Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
.
Q
PVC
Manifold Pipe
Dist'! lution PVC Force Main
4
Pipe
Lost Hole Should Be I
Next To End Cop
End Cap
P 30 Ft
SL tribution Pipe Layout S 11 Ft.
~"NN~ ~ SY ~ ~ X L18 Inches
1 Y
? Y Inches
C~ Hole Diameter Inch
Lateral ) Inch(es)
OF %grolvo so Ut1S 0ti~;5
Manifold Z Inches
p~Pt. ~~15ti OF Force Main Z Inches
t ~.t1C~
c E GoR Np # of holes/pipe
Invert Elevation of Laterals9S.510 Ft.
Place lst hole Z41~from center of manifold with succeeding holes
at 45'tintervals. Last hole to be next to the end cap.
PUMP CHAMBER CROSS SECTIOM ARID SPECIFICATIOUS ' PAGE S OF E~
203
VENT CAP
i" C.I. VENT PIPE WEATHER PROOF
APP
10 ' FROM ROVED LOCKING MANHOLE
JUUCTIOW BOX COVER WITH WARNING LABEL
? DOOR, 12"MW.
WINDOW OR FRESH
AIR INTAKE I
GRADE `i'MIN.
t~ q.Z•* I !
I b" MIIJ.
COQDUIT
1-'(S'VS~8 PROVIDE
INLET AIRTIGHT SEAL I I V
I
APPROVE Tank- c bi; ct all comPly I I APPROVED JOINT$
0 oIN 'r A J
with approved with ILHR 83.20
extending pipe ALARM
S
3 feet onto
solid soil. I' . -TVk1' a PAD I ON
Both sides of s
c 8
tank. - I
1.71
LLEV. FT. PUMP ,i
OFF
R
C,pg
E
O S
LT-lr $1.170 CONCRETE BLOCK
3" APPRWF-
• RISER EXIT PERMITTED ONLY IF TAWK MANUFACTURER HAS SUCH APPROVAL. S&ODING
SPECIFICATIOMS
DOSE 1~•'1l pl~t»3 1J PC~- NUMDER OF DOSES: 3.8 S PER D"
TA K MAIJUFACTURCR:
TAWK 5IZC : GALLOWS DOSE VOLUME 1 ~1 S. S
S S, Sc.ES yJ g IMCLUDING 6ACKILOW: GALLONS
ALARM MAIJIIFACTURER.
MODCL KIUMBCR: 101 IAE-%J CAPACITIES: A=IWCHESOR u0~' S GALLONS
SWITCH TSP9: N1~~2LU~ZL( g o Z INCHES OK G~ LLOWS
PUMP MANUFACTURER: zy~'Z CU~'ti~~u`1 C= INCHES OR ~1S' S CALLOUS
MODEL NUMBER: 98 D- 81'Z'IAICIIESOlt 161-.5 GALLONS
`F'lt'1ZGU12 Tutvt+- = 789- 8
SWITCH TYPE' Y NOTE: PUMP AMD ALARM ARE TO OE
MINIMUM DISCHARGE RATE 3GPM IN5TALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWEEW PUMP OFF AUD,I)ISTRIBUTION PIPE.. FEET
MINIMUM NETWORK SUPPLY PRESSURE . . . 2.50 FEET
FEET OF FORCE MAIN X q 100FtFRICTIOU FACTOR.. 3'~9 FEET
TOTAL Oy1JAMIC HEAD S~FEET
DIAMETER ,
IWTERNAL DIMEWSIOLI~ OF TAWK: LENGTH ;WIDTH ;LIQUID DEPTH y0 I/Z,
BOTTOM AREA - 231= GAL/INCH
GAL/INCH
AS PER MANUFACTURER = Lq.S _
S 4 40 2 0 3 pf~r'e 6OF-
HEAD CAPACITY CURVE 3 7/86 1/4
MODEL "98"
30 4 5/8
8
25 6
3 5/8
6 20- 1 m t
U O
Q
15 4 3/16
~ 4 /3.St3
0 10-
1 1/2-11 1/2 NPT
2 3~•tf
5
0
U.S. GALLONS 10 20 30 40 50 60 70 80
LITERS 80 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC HEADIFLOW PER MINUTE
EFFLUENT AND DEWATERING
I
CAPACITY 12
HEAD UNITS/MIN
FEET METERS GALS LTRS
5 1.52 72 273
10 3 3. 05 05 67 231
31
15 4.57 45 170 3 5/16
20 6.10 25 95 - Lock Valve 23' ,
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
• Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. -'/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float
98 Series Control Selection switch. Refer to FM0477.
Model Voles-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10.0075.
M98 115 1 Auto 9.0 1 or l &7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak".
N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10.0225 used as a control activator, specify
D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system.
6. Four (4) hole "J-Pak". junction box, for watertight connection or wired4n sim-
E98 230 1 Non 4.5 2 or 2 &6 3 or 4 & 5 Alex or duplex operation, 10-0002.
7. Two (2) hole "J-Pak", for watertight connection or splice.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; All installation of controls, protection devices and wiring should be done by a
quali-
Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical ARemator, fied licensed electrician. All electrical and safety codes should be followed includ-
FM0495; Alarm Package, FMO513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the most recent National Electric Code (NEC) and the Occupational Safety and
FM0732. Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
AWL To. P.O. BOX 16347
` /-w IPTTON 3Y 0 Old l~ tManufacturers of... "
ZZL f~ O. Louisville, KY 40216 Lane
QUIL77Y PUMPS yNCE /9.~9
O ) 778-2731 0 1(800) 928-PUMP
FAX (502) 774-3624
VisoonsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page \ of 3
!,Sbor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ST, c.MUX
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 0 1 ?1- I ~ $ Z.- rJ b
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
11 b E'L L k3 E "NMU C CA GAYq.L:T S E 1/4 SW 1/4,S2-3 T Zcj N,R 1-2 E (d(W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAD
cw'1Y'►Ofu~ w~ sYo 15 r~ls)~96- z,~s "N.in'nojuS '-3ZX+" vZ"
New Construction Use (,)(J Residential / Number of bedrooms Ll [ J Add4i.Qn to existing building
pQ Replacement [ ] Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate O.1{ bed, 9 pd/9- trench, gpd/ft2
Absorption area required Soo bed, ft2 SAO trench, ft2 Maximum design loading rate 0 • S bed, gpd/ft2 0.6 trench, gpd/ft2
Recommended infiltration surface elevation(s) °t S . O I ft (as referred to site plan benchmark)
Additional design / site considerations Moves w/ 8 'Y- 63' M - I' *j tbU M I f o*- S AtiD P t. L
Parent material L u > ~s ov QVt- 1Z L~L Flood plain elevation, if applicable N 4~ • ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem ❑ S ®U IRS ❑ U ❑ S W U ❑ S O U ❑ S G$ U ❑ S 0 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 Trench
4 J o-ll ti0`-lR 3~Z - SLR Z -5%%X 0S - C' ,--s C-)
`"`r Z ~1~3o tl7`2~Z 316 - si) Z'Fsbk vK-E~- c~•,~ - 0.5 0•L
Ground 3 30 - • S 2 y! ~sl`1 31 y S -n1-L
elev.
aft.
Depth to
limiting
factor
Remarks:
Boring #
0
1 0_l w 31 s1~ ~S S?u ~
2 b
Z u Z ~3 o Lo Sz 3! - 0-6• S o.~
3 0 3~ 7.S `~R Y!y - sl 1 Csb~ ~ ~~r d s - o. `J o.S
Ground
elev. 34- SO . $ y R K/Y s y 1z 31 SCA 11\'~ own wt `F 1- -
ot 14 i2 ft.
Depth to
limiting
factor
Remarks:
TName:-Please Print Arthur L. We erer Phone. 715-425-0165
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Sgnature: Date: CST Number:
01 ~4- y3 3-31- CIV M00576
PROPERTY OWNER ~~RV Celq SOIL DESCRIPTION REPORT Page pf
PARCEL I.D. # d 1- - l 0 5 _rJ0 `i '
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer~h
10_9 1O`•tR-3l2 S Z`FAk rn~1 ~g - 0•S u-
-t a- 3L S l~ Z 3 bh $ o . S u • 6
Z 19-Z9 \,t,
Ground 3 o-36 1•s4k y1y o~S u os
elev.
013.0 ft. 36-Y ~f s~tR. 3~Y
Depth to
limiting
factor
3
Remarks:
Boring # 3
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
15
Ground
elev. i
ft.
i.
Depth to
limiting i
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
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PLOT PLAN Page 3 of 3
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER `
MAILING ADDRESS ! v~-
PROPERTY ADDRESS FY
t r
(location of septic system') Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION -3 uj 1/4, 1/4, Section T 2 N-R_LZ_W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION 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: -
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
- ; p
S T C - loo -;~-3 T 'If
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 ,a
Location of property S 1/4 .5 y) 1/4, Section ~2 3 ,T_2.~_N-R_j ? _W
Townships Mailing address
Address of site L J. ; (3-yd s
Subdivision name Lot no.
Other homes on property? Yes 4-No
Previous owner of property WQ~
Total size of property
Total size of parcel , g' 4(L
Date parcel was created
Are all corners and lot lines identifiable? Lames No
Is this property being developed for (spec house) ? Yes
Volume and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS.. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (wQ am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded n the office of the County Register of
Deeds as Document No. J-/'? y at. , 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
Date of Signature Date of Signature
r--
D000MEr•,rr ('1C1 r s ift STATE UAR OF WISCONSIN FOMM I
WARRANTY DEED
n p^ VO?- L-•'tSa# I ~~•r~ r .L'-I- THIS 51
ACE RESERvCD f"pR RCCORDING DATA
I
REGISTC-iRS; OF ICE
ST. CO., Wfi&
This Deed, made between Jams - T. Perucca, husband-- ~ e, 21St
Gxantee c d. for Rzxord tails -
I
-1 daY of_
A. D. I949
Grantor at, 0 , M.
<inct..-. Adeline- M.-- Perucca,-- wife--of-Grant
ox / y1-
y
Register o Deeds
Grantee,
Witnesseth, That the said Grantor, for a valuable consideration-..-.-
On- e .~$l.----.00) Dollar and other ood and valuable considers ion I'
conve;;s to Grantee the following described real estate in .-St*.--Croi.X REruRN To
County, State of Wisconsin:
I'.
I I
I,
A parcel of land described as follows: ComTencing at the Tax Key No . I
SW corner of the SW 1/4 of Section 23-29-17; Thence E along S section line
1394 feet to point of beginning; Thence N parallel with W section line 720 I
feet; Thence E parallel with S section line 361 feet; Thence S parallel with
W section line 720 feet to S section line, thence W along S section line
;361 feet to point of beginning, said parcel being about 5.96 acres.
THIS IS NOT HOMESTEAD PROPERTY OF SELLER.
Consideration is less than $100.00.
I
i FEE j
I
i
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I~
This -....NOT------------- homestead property. I
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
I
And..... James --T:---Perucca--•--------
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
NONE i
it .7 j
I
I
j and will warrant and defend the same.
I _
Dated this ' day o y'
(SEAL)
II-~-
-------------------•----•-----------(SEAL)
* ames T. Perucca
.-----(SEAL)
(SEAL)
it I
AUTHENTICATION ACu*1pVVLEDGMENT II
1 ~ 19 - - _ Couuty. ss. I
ii
c"`~"1
i P rsonally came before me, this day of
the above named
sires T* Perucca husban to uyer
- -
TITLE: MEMBER STATE BAR OF WISCONSIN " I - -
I _
.
I AA
1k
(If not,
authorized by § 706.06, Wis. Stats.) fit.
c~, - - who executed the
I J to%n; known to be the person ge the SamC I
I THIS INSTRUMENT WAS DRAFTED BY u" J. 1.O 1i1 1ri5trnlnent and aC1L riOWledb'C .
Robert F. Wall 4
Ij 522. Second..Street ---~1a !Q 1' -
Y
Hudson,
WI 54016 %
L--County,
-
r es 1'ubhc - - n , state ex a
(Silnatu.es may b authenticated or acknowledged.''~~t onlmission is permanent. ( of - i) ~'o )
not necessary.) date:
11-c MY pM,4',IS"Iri1
*Names of persons signing in any capacity should be typed or printed below their signatures.
Wisconsin Legal ]]lank Co. Inc.
STATE BAR OF WISCONSIN milwaulcee, Wis. (Job 33757 1
WARRANTY DEED FORM No.1 - 1977
' DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 2
WARRANTY DEED
Vol F ~,fi 1'~' ~.0 "Z 1 THIS SPACE RESERVED FOR RECORDING DATA
1 REGISTERS OFFICE
ST. C:t NX CQ., WIS.
Wallace C. Vos'.uil rind. Ti r:i_on E. Voskuil, husband and F„ fig' Reid e£-is 18th
wife, jointly ^nd indi_vi.dunlly,
dcry of Dec. A.D. 19 79
conveys and warrants to James T. Peruccn -aid Adeline M. Perucca at 1:0 P , M.
L
husband rind wife ns joint tenants,
1'2~RegI,'twr of Deeds
RETURN TO
the following described real estate in St. Croix County,
State of Wisconsin:
A parcel of land described is follows: Conmencinr; ^t the -
South West corner of the South `;lest One-(`carter. (Sl;n~,) Tax Key No.
Section Tt•;etit~•.T'lree (,'_3), "'ottz hin Twenty-Nine (29) North,
Rringc Seventeen (17) 'r:'cst; Thence ,.st alon South .,Ccti.on
line One Th.ousandThrc Huncared P?iiiety--Four 03910 feet to
point of beginninC; Thence North parr ll_e1_ with blest section
line Seven Hundred Twenty (720) .feet; thence Fast Pa,.rallel
with South section line '.Three Hundred Sixty One (361) feet; ~ O
thence South parallel with blest section line Seven Hundred
Twenty (720) feet to South section line, thence blest alenr
South section line Three Hundred Silty One (361) feet to
point of berinnin;, s'id Marcel being about 5.96 acres.
This instrument is riven by the grantors in full satisfaction
of the terms of a contract between the same parties as herein.
Said contract recorded with the Office of Register of Deeds,
St. Croix County, Wisconsin, on January 15, 1963, in 391,
pages 294 & 295, instrument 271322.
This is homestead property.
(is) (is not)
Exception to warranties:
Dated this 13 day of November
. .
(SEAL) (SEAL)
Wal.la.ce C. VosklAil
(SEAL) ~<'j j.l;tr!~°;tc.~~ (SEAL)
Mri.rion E. Voskuil
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF WISCONSIN
19 ss.
St . Croix County.
Personally came before me, this n day of
* November, 1.979, the above named W'•11<a.ce C.
TITLE: MEMBER STATE BAR OF WISCONSIN Voskuil and Marion E. Vor kuil
(If not,
authorized by § 706.06, Wis. Stats.)
This instrument was drafted by
John. G. Nestinf en, Atto:L jr, to e-k own to be the person who executed the fore-
9 ing in trument and ac n r
ged the same
Baldwin Wisconsin 5-1002. >
(Signatures may be authenticated or acknowledged. Both * Donald J. Dc% i' F
are not necessary.) Notary Public Croi,G~ $outr,t~~~'', Wi
My Commission is permanent. (IFn*6V,'stak-e expirano v) date: 7-17
rY ! . ;
WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 2-1977 ,