HomeMy WebLinkAbout018-1068-20-100
STG - 104
AS BUILT SANITARY SYSTEM REPOR, v'
OWNER
4 ,
ADDRESS /747 flS~• <<~.r,~ Syr
C%?PalArqr~ c~~:
SUBDIVISION / CSM# LOT # o~
SECTION T?9 N-RJ7W, Town of d m,v-v-..
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF TEM
or
9
s~
0
.
q 0
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
S
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I
BENCHMARK :
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
r 7.~v
Manufacturer: L.13QA4A^- Liquid Capacity: loan
Setback from: Well House Other `
Pump: Manufacturer Model# 6 7 /f Size .3 P
Float seperation C 7 Gallons/cycle:
1
Alarm Location /NCrLL's
SOIL ABSORPTION SYSTEM
Width: ~i Length IpA.5 Number of trenches 1
Distance & Direction to nearest prop. line: AS N a--A
Setback from: well: House .36" Other
ELEVATIONS
i
Building Sewer ST Inlet _77,4 / ST outlet 9~. D9
PC inlet /G•~! PC bottom `ca-~rZ- Pump* Of f
Header/Manifold D Bottom of system
Existing Grade /D.~• Final grade /d6
DATE OF INSTALLATION: 7 -
PLUMBER ON JOB: K?,C-~Oke
LICENSE NUMBER:
INSPECTOR: ~~•yy~
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety anciBuildings Division AT- TX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.:
lev.: Insp. BM Elev.: BM Description: t~ Parcel Tax No.:
TANK INFORMATION ELEVATION DATA A9400039
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 7.99
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet /0.49 97.f 0
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet I .S 8
Air I
Septic NA Dt Bottom
Dosing NA Header/Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand /S.190
Cfa , 9`
Model Number GPM
TDH Lift Friction Syestem TDH Ft oss Forcemain I Length Dia. Head Dist- To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Di;. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Hammond.30.29.17W., SE, SE, Lot 2, Near 160th Street
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
DIL,HR SANITARY PERMIT APPLICATION
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In accord with ILHR 83.05, Wis. Adm. Code COUNTY 5-f (
` STATE SANITAtjY PERMIT#
-Attach complete plans (to the county copy only) for the system, on paper not less than Ad ~Gli' g
8%k 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. -57X- b D 5
PROPE TY OWN R PROPERTY LOCATION
SF %459 t/4,S.90 T07 ,N,R 7 or W
PROPERTY OWNER'S MAILING ADDFIE$S LOT # BLOCK #
C, C~ N
17 *7 -5- CITY, ST E ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
W~ 5~a/7 /S- Y -~V YVIA-
11. TYPE OF BOIL NG: (Check one) ❑ State Owned ❑ CI VILLAGE ~J NEAREST ROAD
: S
❑ Public1 or 2 Fam. Dwelling- of bedrooms / ' PARCEL TAX NUMBER(S)
Y-r
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
50 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.X New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 DA 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
-37 -?;7,5 4 N D b Feet /O-S► / Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks Concrete glass App.
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber /
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name ( t): Plumber's Signature• Stamps) o.: Business Phone Number:
,P JIIFF;~
1 6_3
L 0. T.
P umber's Address (Street, City, Sots, Z p ode):
IX. NTY/DEPARTMEN USE ONLY
❑ Disapproved San ry Permit Fee (includes Groundwater Date s us Issuing Age Sig a No m
Approved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-8398 (formerly Pib-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
INSTRUCTIONS
Y
i
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.
II. Type of building being served. Check only one and complete of bedrooms it 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
W. 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; (Jose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
_
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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1=t1'~ATE SEWAGE SYS''-~
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Wis4;in Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3
IL J
. luman Relations
on Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach cotnplete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
riot limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
1,4- GOVT. LOT 56-- 1/4 56,- 1/4,S 30T zcp N,R /7 eJrs jor) W
PROPERTY OW R':S MAILING ADpRESS / LOT # BLOCK # SUBD. NAME OR CSM #
7_ AV
1 7
7
CITY, STAT ZIP CODE PHONE NUMBER ❑CITY ILLAGE WOWN NEAREST ROAD
[ New Construction Use Residential I Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow Y5 d gpd Recommended design loading rate • S bed, gpd/ft2 ~~trench, gpd/ft2
Absorption area required 3 75 bed, ft2 .375 trench, ft2 Maximum design loading rate S bed, gpd/ft2 , G trench, gpd/ft2
Recommended infiltration surface elevation(s)//~ 3 (O= ft ;as referred to site plan benchmark)
Additional design / site considerations
Parent material Flood plain elevation, if applicable V04- It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = nsuitable fors stem 11 S D~S ❑ U El S U El S c®1L. ❑ S E] S .U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxiary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1:9 M.516 9 4~)
2-
.~/s S
Ground f J 2 ~c7 /f/~ ~'l/h'1 5~ . 2 fY!/531 yh u~ we . S .
elev C z 7syr~/Z
f D 2.• eft. - D n S S s , a 1, r4- .ti fit- W- Wes- ~A
Depth to
limiting
factor
Remarks:
Boring # /
- I/ z/Z 'C- 2-rY~ 5 G3/^C ~p CJ 2 e
.::00
4 Z- Z 1/ ` ZD 0 IZ f /rte /s13/ / -te . S . G
?`.w>
Ground 2 d -z.7 CD A14 Z 3
eIev.F Z7- 0 >z. s/ C zP 5C I.• Y✓)
ft.
Depth to
limiting
factor
7,/ Q Q
S~
Remarks: S1 C
CST Name: Please Print Phone: ZO1v►N 'A
Address:
Date: CST Number:
Signature:
V .6
ii -
PROPERTYOWNER~~/~i/~.t%~~i BLS SOIL DESCRIPTION REPORT Page ofd
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots, I 'GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed TO&
2- V1 e- Pee
Ground z_ 3 0 nay S•C • / f
elev~ 2- 10 $ .
pL-ft. _ j /0 I ~Z SL. V1017137MX 1- 5 61) ALA Depth to 0 rli 5 z ~S' rL ~.L
limiting
factor
.3L'
Remarks:
Boring #
y£,4
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
.~4
:}i}Jvti;titi:•:i:
Ground
elev.
ft.
i
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
' STEEL'S SOIL SERVICE
Gary L. Steel 988 N. Shore Drive
C.S.T. 2298 / New Richmond, WI 54017
MPRSW-3254 (715) 246-6200
S~ y~c sG-yam 53a P AV - 4--)
TIT
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L
9 3
WisconSn Department of Industry, SOIL AND SITE EVALUATION REPORT Page Of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
nat limited to vertical and horizontal reference point (BM), direct' % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearesta 4 4 0 V 5 9
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT 5&-- 1/4 SG 1/4,S .30T Z 9 ,N,R 17 k1or) W
PROPERTY OWN R':S MAILING ARESS / LOT # BLOCK # SUED. NAME OR CSM #
171 7
CITY, STATE/) ZIP CODE PHONE NUMBER []CITY ILLAGE gOWN NEAREST ROAD
rrlo~r u~~ 5 i7 (7 )zv-b •106/
New Construction Use. Residential / Number of bedrooms (j Addition to existing building
(j Replacement Public or commercial describe
Code derived daily flow Y, !;'Q gpd Recommended design loading rate L S bed, gpd/ft2_. trench, gpdM2
Absorption area required ;3 75 bed, ft2 375 trench, ft2 Maximum design loading rate S bed, gpd/ft2 , french, gpd/ri2
Recommended infiltration surface elevation(s) //2 3 g-° It (as referred to site plan benchmark)
Additional design / site considerations ~w~
Parent material a 14d4'61 Flood plain elevation, if applicable yt P- It
S ■ Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= nsuitable for s stem [Is as ❑ U ❑ S ,0U O S k-U_. O S sm] ❑ S
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 rench
ce- 4,7 '5 , 4.
O- d sG Z ar~S /C
13 2- t /9 We= 4 e::~ ye 5
Ground 2 /d ylrf7'! IF- 511• y /f/3~! yh Gtr . ~j .
elev C° z 551 e 7 z
f 0 Z• ~-dt. _ d h S 114e S S , c ~4 - r✓ /9- 1v fA- W)) - WA•
Depth to
limiting
factor
I
Remarks:
Boring # Z/Z . Gtr 2 , ! • G
Z 11 ZD D L
• D i
Ground z v -2.7 lo L E_ b-. 5 yh 41- CD A14 X 13
e1ev~
It. TVA, & 5 I- YYI r" VA 7W aw
Depth to
limiting
factor
Z7
Remarks:
CST Name:-Please Print Phone:
Address: At/ ~ \ , S
Signature: J ~.tJ Date: CST Number:
f
PROPERVOWNER~~L'?~' Ge; SOIL DESCRIPTION REPORT Page Z--:Of -3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Ba xkvy Roots QPD/ft
Boring # Horizon In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
s-
ko
Z Z /a i oS; ass r
Ground Z- 3 D !2 h071
el ev. i S Y' SL. 1 o~--
5 a~.S rL S, CL
Depth to $
/0 vd,
limiting
factor
.3LLI- I
Remarks:
Boring #
~ k
t
Ground
elev.
'
it.
Depth to
limiting
factor
Remarks:
Boring #
Ground €
elev. ;
ft.
Depth to
limiting
factor €
Remarks:
Boring #
i
Ground
elev.
tt.
Depth to
limiting
factor
Remarks:
$QD-8330(R.05/92)
Tag - / 2 w
/74,7 s 5yo~:
- WORKSHE FIt6 S STE#~ DESIGN •L;o..~ ~
J
S94 40059
PROBLEM: l+
Design a mound system for a
The site characteristics are:
Depth to groundwater or bedrock in.
Landslope % z
Percolation rate
Distance from dose chamber to distribution system ft.
Elevation difference between sump and distribution system ft.
Step 1. WASTEWATER LOAD X 3 gal.'
Step 2. SIZE THE ABSORPTION AREA
A) Area required DSO sq. ft.
as
B) Bed or trench lengthy (B) ft.
C) Bed or trench width (A) ft.
,Do Trench spacing.(C).
r, Wastewater load 1 .24 gal/ft2/day B = ft.
Wenches
Step 3. MOUND HEIGHT
A) Fill depth (D) _ ft.
B) Fill depth (E) = D + c. rApe JP,
-x
C) Bed or trench depth Ff = o g aft.
D) Cap and topsoil depth (G) = f „ ft.
E) Cap and topsoil depth'(H) = ft.
Sign: C a"
License Nu:.r_ Ls~~
Date:
i ~
. _ 1" a 1'
S94 40059
Step 4. MOUND LENGTH
r A) End slope (K) D + El + F + H x 3 =
\ 2
-t.S3 X-3 /l ~l7
B) Total mound le th (L) = B + 2(K) _ 8jY ga,glt.
Step 5. MOUND WIDTH
Al) Upslope correction factor
A2) Upslope width (J) (D + F + G)(3)(factor) _ ft.
-,S3 ~ 3 X 9 = ?,9 ~
Bl) Downslope correction factor = /~d
B2) Downslope width (1) _ (E + F + G)(3)(fa tor) ft.
I ; P- Y- I)x x go~ =9,38
F Cl) Total mound width (W) for bed = J + A + I ` 3r ft..
C2) Total mound width (W) for.trenches
J + + (no. trenches -1)(c) + A + Ift..
Ps N
f:. Step 6. BASAL AREA
A) Infiltrative capacity of natural soil = f`° 'S g4l./ft2/4ay.
B) Basal 4rea required = wastewater flow
natural soil infiltrative capacity = qL~ sq. ft.
i Cl) Basal area available for bed for sloping sites =
Bx (A+I)
q. ft.
r ba15 X - V.y)- C'4 z 5"
C2) Bas are •avail le for trench for sloping sites =
B W ~J + A 1 Ar sq. ft.
C3) Basal area available for trench or bed for level N
nsites 6 x W sq. ft.
Sign: aLL,~ po=
`
License Nu:
i ~~rlo
Date : - - 9
~of;L .04 40059
Step 7. DISTRIBUTION SYSTEM
1A) SIZE DISTRIBUTION SYSTEM r,
1) Hole size = N in.
2) Hole spacing = ~ in.
3) Distribution pipe lengths.
4) Distribution pipe diameter = in.
5) Spacing between distribution pipes = .3(o in.
6) Distance from sidewall to distribution pipe = in.
1B) DISTRIBUTION PIPE DISCHARGE RATE
sft.
1) Number of holes per pipe
2) Flow per pipe GPM,
7C) SIZE MANIFOLD
1) Manifold is central/ r end
2) Manifold length = ft.
3) Number of distribution lines
4) Manifold diameter in.
7D) SIZE FORCE MAIN
1) Minimum dosing rate = 7.2 GPM f
2) Force main diameter --3 in.
3) Friction loss o ft.
7E) TOTAL DYNAMIC HEAD
1) Vertical lift = ft.
2) Friction loss =
3) System head 2.5 ft. ft.
4) Total dynamic head
Sign: cv.~,ti ~ -
LicenaE:
Date :_._-12 -
`
\ r: f' r-
v 4 . Y - o
- .coca 4b,
S94 40059
• r
7F) PUMP SELECTION
1) Pump selected will discharge ~ GPM at ft.
total dynamic head.
2) Pump model and manufacturer
7G) DOSE VOLUME
1) 10 times void volume of distribution lines M-2tal./cycle
2) Daily wastewater volume 4 doses/24 hrs. _ Jgal./cycle
3) Minimum dose volume =^l/1,,gal./cycle
l l Z .5 + V60 vote VOL-) &AL- j C%(C LE P% e? V'D .
7H) DOSE CHAMBER
1) Minimum capacity required 9a1.
Sign: ,
License i`u• /
Date: C,-)' z
i
i
i
W
Page of
S94 400 59
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand
_ H -~G
Topsoil F
3
3 E D
% Slope
Bed Of 2 (Force Main Plowed
Aggregate Layer
. D _L Ft.
Cross Section Of A Mound System Using . E Ft.
A Bed For The Absorption Area F Ft.
HG l,/~~~"" Ft.
A Ft. ~
qGE Ft.
Signed: SEVN
License Number: 15A3 K IN FtConditivnally
ga,8y
Date: ,42 . ~ - 91 L ~ PFt ) JE
oNs
R ~
Alternate Position tMOR OMAN Gs
I 9 ro.wousrnr.
of
Force Main W 2 3 ~FVw~t
L
CORR E
E
Observation Pipe--,.\ _
F A
IF-..,... -
~.Distribution• Bed Of 2N- 2'2
Pipe Aggregate
1.
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
S 4 4 0'0".
9
L
47
pago 4?
Perforated Pipe Detail
End View
Perforated ti
End Gap , PVC Pipt }
e~~O ale - j,
Holes, Lototed.10n Bottom,
Arq Equally Spaced
Y
PVC
Monlfold Pipe
Orsl►it! dio1~ d Position of
Pipe fares Main
Last "Hots $Aould Be
Neat To Eno Cop
5
End Cap Distribution Pipe Layout
P. 6 Ft.
V z S
cc y -2!Vqnches y
Signed: tl~ Hole Diameter ye~ Inch
Inch(:~~)
LicAGE 3 Lateral* a
Manifold " Inches
Dater Force Mein Inch>J3
0 of holes/pi pe (Co
Pp"ROVED Invert Elevation: of Lateral
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DEPT. OF INDUSTRY, LABOR i HUMAN RELATIONS
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PAGE 9 OF~
PUMP CHAMBER CROSS SECTION AND SPECIFICATIOWS
A. S94 400.59 '
VENT CAP
4"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
23FROM ODOR, JUIOCTIOM BOX MANHOLE COVER W/ WQYn 7Y
- 1 arA j
WINDOW OR FRESH 12"MIU.
AIR INTAKE
P~ I
GRADE
( 'i" MIIJ.
. ~ IB"MIN.
CONDUIT
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SE 0A `
INI..ET cDy~ltlOna PTIGVHTESEAL I II
I III V
APPROVED JOINT A 14~e~~1DNS I III APPROVED JOIN1
W/C.I. PIPE. NpAAN I I W/C.I. PIPE
II EXTENDIIJG 3
ONTONSOI 10 SCIVRDUStRY'$LABOR A UAL I~` S ALARM
0 ISIS 0~ i ( ONTO SOLID 5011
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0 F,
SEE c ' 96. i
!'~fl PUMP -'j OFF
tt11 O
CONCRETE BLOCK
RISER EXIT PERMITTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL
3PI- C.IF'ICAT IOQ5
SEPTIC AND I , 1
DOSE TAWKS MANUFACTURER: ~/lt ~ WMBER OF DOSES:- '/7/ PER DAB
TANK LIZC: _ 475;0GALLOUS DOSE VOLUME
ALARM MANUFACTURER: _ s.~I_; I ~-Fr6 INCLUO!!!;, ,C„FLOW: _ FQ _ GALLONS
MODEL WUMBER: CAPACITIES: A-~_INCHES OR - 11)1-5%6ALLOuS
SWITCH TYPE: Y`4P-v ~Ddt~
-,INCHES OR .35i7` C),~1-.q S
PUMP MANUFACTURCR' -_G` 0u-kAJs wtol H CI ~.IS
~ C INCHES OR ~v7CCL9 S
MODEL IJUMBCR: /3~ S D • -INCHES OR r. , - X8N
SWITCH TYPE: r I NOTE: bJMP AND ALARM ARE TO BE
PUMP DISCHARc r. RATE - 7~ GptA INSTALLED OM SEPARATE CIRCUITS
VERTICAL DIFFEKEIJCC BE'9?WECN PUMP OFF AND DISTRIBUTION PIPE.. FEET / LLq,-40w
+ MIUIMUM NETWORK SUPPLY PRESSURE . • ' 2.5 FEET
+ -_1-46L FEET OF FORCE MAIN X Z_104 F0 • J 70?
ioo rLFRICTION FACTOR.. FEET
TOTAL OyWAMIC HEAD c FEET
IIJTERiJAI. RIMEWSIGWC OF TA►JK: LENGTH ;LIQUID DEPTH
31G U E 0: rr
LICEIJSE .1UMBER: /J6-R DATE:2
-11~-
S 9 4 40059
i h'1^ r .A~ J ~M
GOULDS ..SUBMERSIBLE
SEWAGE AND EFFLUENT PUMPS
4 EP0311
rs4 LIST DISC.
r OOUPEP0311 142 EP0311 1/3 FP 115 V Effluent Pure 1/2" solids 256.80 172.10
Submersible:.
MODEL EP0311 k
r r Effluent:' Pump.
n r 'ems, METERS FEET SIZESOLIDS
25
'd
20
. • ~~"4~1' fr T'1►1
15
S4,!
F.,....:;:a.: 4
k " } G 10
sx 1
t
0. 00 4 8 12 18 20 24 28 32 36 40
GPM
0 2.5 5.0 7.5 m'/h
CAPACITY
Performance
Curve 3885
MODEL 3885
ti a SIZE 3/4" Solid
(iw '1t7! a 1ZY 90
t Is
r OSII
40
so-
70 W(DA
L .1 L .1
•i••' 10
hr'1i o 0
y' } tA~I o 10 00 00 40 60 w 10 1 10 100 1+o 1w GPM
ss a, k, ;1~ 4' 0, to 20 30.01%
!i1•; . - Y LIST DISC.
•6~,0.,, CDtht,'E0311I. 142 1tE0311L 1/3 HP 115 V Lu+ H 3/4 solids '491.5S 329.35
79Yi~";
GKX,Pt,'E031]M 142 ' HE0311M 1/3 HP 115 V Mod H 3/4" solids 491.55 329.35
r-
tr V- ; ;l OOlmwi051111 112 WEOSIIH 1/2 HP 115 v High N 3/4' solid, 704.25 01.8s
4 .
~I~a CJUFS.'E011211 142 F.E071211 3/4 HP 230 V High W. 3/4" 561 ids 843.65 565.25
tXaa`:s•.:. ir••~SEE'Faltl•tINC PACE FM P1RF17WVit= AM SPECIFICATI(Y•LS. ~y' 4t
`DATV 10/88 DE3rP 30 PAGE 07u
;r
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division'
Labor and Human Relations REVIEW APPLICATION Bureau of Building Water Systems
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C
• Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188
Hayward, WI 54843- Phone (608) 785-9334 Madison, Wl 53707 Shawano, WI 54166 Phone (414) 548-8606
Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614
Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633
INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment atthe office
where your review was scheduled. Please call any of the listed offices if you need help filling out the form or hsti s on whptfo~a 'on tQ
submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your referenc 4 U J1lVVVlJ1'
1. APPOINTMENT INFORMATION -if you have scheduled an appointment, fill in the information requested below to save time:
Appointment Date Reviewer Name Plan Identification Number
S Os
2. PROJECT INFO ATION If this review is a revision or extension to your existing
plan identification number, provide that number here:
Pro'
PrZect, ' Name
AP City E] Village n Of: County
Location H ^ q- O
GOVT. LOT •50-1/4 SE1/4 S 30 T Q X R r W a r+t m on r l~ k
3. APPLICATION FOR - 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type t (include new and existing tanks)
Up To 1,500 gallon septic tank $110.00
A At-Grade 1,501-2,500 gallon septic tank $120.00
H Holding Tank 2,501 - 5,000 gallon septic tank $160.00 .
M Mound 5,001 - 9,000 gallon septic tank . • $200.00
N Non-Pressurized In-Ground (Conventional) 9.001-15,000gallonseptictank $300.00
P ❑ Pressurized in-Ground Over 15,000 gallon septic tank $500.00
❑ e3
O Other: Up To 1,000gallon dose chamber $ 70.00
1,001 - 2,000gallon dose chambei $ 80.00
Building Type (check one): 2,001- 4,000gallon dose chamber $100.00
4,001 - 8,000 gallon dose chamber $120.00
D Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 .
P Public Building Over 12,000 gallon dose chamber $160.00
S State-Owned Building U To 5,000 gallon holding tank $ 60.00
Jr O 5,001 -10,000 gallon holding tank $100.00
Code Derived Daily Flow 9pd Over 10,000 gallon holding tank $150.00
❑ Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00
Revisions To Approved Plan 2 $ 60.00
Petition For Variance: Setback $100.00
Petition For Variance Site Evaluation $225.00
Plumbing $225.00
Revision $ 75.00
INCE Monitoring Groundwater Monitoring - Per Site $ 60.00
(other than a proposed subdivision)
~DDG r6bp5ir u Nal i in lieu of
d r onitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00
SAFETY & BLOBS. DIY. Subtotal: L
Priority Review: Enter same amount as Subtotal:
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee:
5. SUBMITTING PARTY INFORMATION
Telephone No. (include area code & extension) Co ny Name Conta Person
S) dA6- ~5,/3-5 6 t,.t2.r S V n 4 u l h_C~ c.a e rs JV..
No. & Street Address Or P.0 x Cit , own r Village, State, Zip Code
9 Oe Kic Y,d Z 556
Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose cha bers.
2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals.
NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually.
SBD-6748 (R. 03/93) OVER
CERT'hFIED SURVEY MAP i'AP ROVE
Located in part of the SEh of the SEa of Section 30, T29N, R17W, in
the Town of Hammond, St. Croix County, Wisconsin.
SCE I ; .93!
N 5 CROIX COLJN-
LOT I LOT 2 LOT 3 LOT 4 • or,t;rel-lensive Pfz;n
w m co
ACRES INC. R/W 2.11 2.11 28.84 5.00 Zoning and
d rt
N r ~
N SO.FTINC. R/W 91,799 91,799 1256308 217,749 Commiitto
c t • La
M M N ACRES EXC. R/W 1.90 1.90 27.92 4.75
a a If not recordod
SO. FT. EXC. R/W 82619 82619 1216100 207024 v ithin 30 days of
rt ~
v- z co
X aPgCmrod $ball L
m fp
C) 44- o (SEr;ld1+60a3 9
° 0° SURVEYOR OR
a p CORNER TIES. )
C, rt O
_ ° 1A\,'1DLATTLr---D LA i\J D A m
m to
N ~
U) NORTH LINE OF THE SE y4 OF THE SE /4
N p _
N89 4830"E 1315.69' I 33'
3 1282.69'
I rt .3 -3 6 6'
ii
rt
a
I
W yO
0 ~oN W
M 1C= 01
I~ M Z 0 0 I~
a IrU 0 LOT m' 0o N 10-)
I U
c 1> r ° I ~ ~ IO 11_
I_I M K) N88'O6'E O m
33 r I-I 1
297.00 M
I=
I-I
° O N89 58'06"E 33.001
325.00 117
IlJ = v `767A-10 p
° m 2' m N v I .4 I Cf)
V m LOT 2
~I M W '~a m N M IM
co I ''E m Irn ID
w 1> O o v N8AO
N 3 O rn
31 - ~
n 0) ~G717-30 S
° N 297.00 A I
LOT 4 w 0 w 33.00 ILA
fTl 0 0 y m 431 v N N I J~
rrnn CLo C o LOT I T12,
o a Nb7~ 33.00 S89 58'06"W
297.00'
0.. SMALL Iyl 330.00'
w =-S89°58'06"W 987.027- \ (nn TRACT g
S89°58'06"W q 325.00' 33.00' 662.02' 33.00 710 9/392 m 0
4,- _
_ 325.00' 662.05' 0) S890
58'06°W n SE CORNER OF
131 .06' S89°58'06"W 987.05' 0' \ 33 SECTION 30
SECTCION R ORNER 30 OF w S0
SOUTH LINE OF THE SE 1'4
SE
0*16'o4"E
70TH AVENUE 198.00'
4 UNIDLAT I ED LANIID-'-")
LEGEND
Aluminum County Section
Monument Found
i `
.ti
_ w' 0 1" x 24" Iron Pipe Set,
VOLUME 9 PAGE 2684 weighing 1.68 lbs. per
linear foot
OWNER
SCALE IN FEET Halle Builders, Inc. 1001 Roadway Setback
1767 115th St. -r Fence Line
10050 0 150 300 New Richmond, Wi.
54017
. _ . ~,w..,
HALLE BUILDERS, INC.
1767 115th Street
New Richmond, WI 54017
Phone: 715-246-6813
w.
NontieA,
Welcome Home. March 7, 1994
To Whom It May Concern:
This is to certify that Halle Builders Inc. will not put a
bedroom in the third level of a home to be built on Lot 2
of CSM recorded in Vol. 9, Page 2684. (Town of Hammond).
yL
Wesley W. Halle
President
171.E-~I ,~.LJ~~~7('i~'~ ~Lc''~c-/ j"1.~'f1 ~
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
I
OWNER/BUYER UJ'0 a
MAILING ADDRESS 'l bj I z t K 4 r~ n ✓i c (mss
PROPERTY ADDRESS '7 1
Cyr
(location of septic system) Please obtain from the P ing Dept.
CITY/STATE -lqd. to M 0 _V1 ed LOT- J y D I S
PROPERTY LOCATION 1/4,_ 1/4, Section 0 T_N-R__L_W
TOWN OF yn e ST. CROIX COUNTY, WI
SUBDIVISION AJ A LOT NUMBER
CERTIFIEDSURVEYMAP50S~ SVOLUME PAGE --W'&BrLOT 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 mpleted and returned to the St. Croix
County Zoning Officer within 30 days of the three year expi ri" dat .
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11193
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 ~n delays of the permit issuance. ,Should this
development be intended for resale by owner/contractor,(spec
house), thenta 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 L I'
Location of property SE 1/4 S~ 1/4, Section --j j, 'T_.-13N-R-_L'JW
Township
Mailing address I '7
•2~,J `
Sip l
Address of site 71,
~CL Ylnlnn n W~ S (.f ~ all
Subdivision name
Lot no.
Other homes on property? yes____~~_No
Previous owner of property o rt~(h I- L
Total size of parcel , -3 2 c re- s
Date parcel ,was created
Are all corners and lot lines identifiable?
Yes No
is this property being developed for (spec house)? Yes No
Volume_~7 ' I`
and. Page Number -.-L- as recorded with the Register
of Deeds.
A WARRANTY NDEED EwhWITH THIS ich includes LaCDOCUMENT E NUFOLLOWING
MBER, VO•
NUMBER & THE SEAL OF THE REGISTER OF DEEDS LSE AND PAGE
certified survey, if available, would be helpful I o asd to oavoid
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 i , t e- f ce of the County Re ister o
Deeds as Document No. g f
own the , and that I (we) presently
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.
,i ~
signat re of applicant
• Co-applicant
Date of Signature Date of Signature
r
CIJMENT No. WARRANTY DEED .,IS SPACE RESERVED FOR RECORDING DATA
STATE BAR OF WISCONSIN FORM 2 2
k 493432 VOL' MID OnPAr. LREG
S Gi-~ II,.4
GERALD- J.•_ SMITH. and JEANNINE_.B.-_.SMITHx__Grantors_______________ X CO•, W1
r Record
0 1992
A. M
conveys and warrants to ..1JALL. 3VTUERS,._ INC,.a..A.V1sconsin.------ coxpQx~tioa,...Gxant_ee------------------------------------....------
dDeeds ~
TO
.
the following described real estate in .............St. Croix ......County, -
State of Wisconsin:
Tax Parcel No:
it
I
Southedst Quarter of the Southeast Quarter of Section 30-29-17 EXCEPT South
12 rods of the East 20 rods thereof.
I
FEE 'i
TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and
rights-of-way of record, if any.
I
i
This is. not
homestead property.
OW •(is not)
Exception to warranties :
Dated this I tf! _-6 day of -----------------1) eC PP-M eT--- 19....92.
-----(SEAL) - ------(SEAL)
* G RAID MITH
- - -
-
- ------(SEAL) - > (SEAL)
* JEANNINE. B.. SMITH
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
St. Croix County.
authenticated this ........day of 19...... Personally came before me this ...1.6....... day of
DeCembeY 19_.92.. the above named
* Gerald-J' --Smith__and__,Teannin.. -Smith
TITLE: MEMBER STATE BAR OF WISCON,AijlTiattatd,,,
(If not, .t►° ~,'~5.~ ~~~~0~,
authorized by § 706.06, Wis. Sta=sill~~oey„eaemoo, 0n's•°~'>~,' o m know to b he ons----- o executed the
°
*.r 2`gNfgre ng i tru an know same.
THIS INSTRUMENT WAS DRAFTED Y ft t+ c~~.
- -
a
Attorne Barry C. Lundeen
y••-•--•-••----••......-------•---~t----- C 4-f-L- 2 ►'IONTg, LL u
MMUUDDGE, POZTER & LUNDEEN ;J.
11............................. SStreet uds3n 4t~libtL~~ 19 t. .
-X------- . ~otary Public 5 Gro1X-----------•-----..County Wis
(Signatures may be authenticated or ace !8$ y Commission is permanent. (If not, state expiration
19 / )
are not necessary.) date:
~~Ntt n t sea*~de
-Names of persons signing in any capacity should be typed or printed below their signatures.
Wisconsin
WARRANTY DEED STATE BAR OF WISCONSIN Legal Blank Co., Inc.
RnAM_Nn__9 - 1 482 Milwaukee, Wisconsin ,
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