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HomeMy WebLinkAbout022-1047-70-000 i ! fl //~''YJ STC - 104 AS BUILT SANITARY SYSTEM REPORT.,, O OWNER ADDRESS SUBDIVISION / CSM# LOT # SECTION 11f, T2r~ N-R_l W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ` 33! /4 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. t BENCHMARK: Co ~ f ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other 6 Cl Pump: ManufacturerModel# Size )!S Float separation Gallons/cycle: Alarm Location -,,e ` ~s~P •GC ~Y r 4' SOIL ABSORPTION SYSTEM Width: Length f Q(^ Number of trenches' n f Distance & Direction to nearest prop. line: Setback from: well: Qp/ House' Other ELEVATIONS Building Sewer ST Inlet y ST outlet PC inlet 9 7, / e) 1 PC bottom I /Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER:'"' INSPECTOR' 3/93:jt Wisconsin Department of Industry, County: Labor and Human Relations PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI o.: FULLER, F. WILLIAM X CST BM Elev.: Insp. BM Elev.: BM Description: P , Parcel Tax No.: 501 Gtr (:,x TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark eij CSC/ c r7 Dosi ng a ,9 Aerati n Bldg. Sewer 99,35~ Holdin St/ Inlet TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 97, 7 /0 Septic NA Dt Bottom 173 1(11 3 9- 5-Dosing 35~ - >160 r X19' >30, NA an. i Aeratioll N Dist. Pipe AO2 9Y H ng Bot. System PUMP / NFORMATION 8 „C)4~- Jcr7 Z(>a_- Final Grade Manufacturer 0 Q f errand Model Number + 53-G PM TDH LiftD Friction 3a Systems ' TDH p~/ 'Ft G Loss Fi ead Forcemain Length / Dia. Dist.ToWell,>/dD/ SOIL ABSORPTION SYSTEM BED/TRENCH Width , Lengt~6 / No. C) jrenches PIT No. Of Pits Inside D iquid Depth DIMENSIONS CGS` / DIME SYSTEM TO P/ L BLDG WELL LAKE / STREAM LE Manufacturer: SETBACK CH BER INFORMATION Type O 1 Miaa / 7 Model e System: > /A R UNIT DISTRIBUTION SYSTEM an fold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length (OO Dia. Length _ Dia. Spacing /r7n2 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 / .center Bed / Tf =h+dges -1,7 Topsoil C~ p'1 es ❑ No ❑ No COMMENTS: (Include code discrepancies, persons present, etc. LOCATION: Kinnickinnic-16.28.18W, SE, SE, 'ghway 65 t!-l ~?~.P ,,✓~~i. ~ L' ~.r<<. Z ~,ct~/? ire 'C1< CL.~ r, c' - / 1 ;I y/!! cam. Plan revision required? ❑ Yes ENo Use other side for additional information. 6 5---- SBD-6710 (R 05/91) Date Inspector's Signature Cert. No- 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Wiscopsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Lab,)rand~Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irIto ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO 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.) Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 1 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: LHR SANITARY PERMIT APPLICATION . ta. In accord with ILHR 83.05, Wis. Adm. Code Cou =====H STATE SAN^ITA PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than C C / ~ l 19 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 0 ffi. S E '/4 $ E'/4, s f T N, R ~ 16 lftl~ W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 9 S 6 6T, AJ,4 ~l 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER mil- Fa. 4C,7ll 11 /5 J5' "Y l4, II. TYPE OF BUILDING: (Check one) 173 CITY : 1:t f r? h f G K NEAREST ROAD ❑ State Owned VILLAGE ` 1 w ❑ Public ~1 or 2 Fam. Dwelling of bedrooms PARCEL TAX /4 ;zs C3 b 9-/ 8 p a S-9- Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 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. ❑ 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 79-0 f e 0 j 6 8 O • l O a o;Z Feet !O Slid' Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION I New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank h$i 'A'- Lift Pump Tank/Si hon Chamber ®60 O®a e brG Vlll. 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/ Plvl RSW No.: Business Phone Number: -7 -71 Plumber's Address (Street, City, State, Zip Code): R 6-1 & g- Gc~ ti Y e IX. COUNTY/DEPARTM NT USE ONLY L,, Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issu'ng Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial Adverse Determination / v 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 M renewai 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/Rer owal Farm (SB'_) 6399) to be sub~wtted 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 'ranks 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 3'% 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 mainshNater 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) soil4est 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) SAFETY & BUILDINGS DIVISION A State of Wisconsin Department of Industry, Labor and Human Relations August25, 1994 201 Fat Wa hington Avontte P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN 594-03543 FfF RFt;E"IVFD: 190.00 FULLER, WIL[..IAM SE,SE,16,28,18W TOWN OF KINNTCK1NNXf_ COUNTY OF ST CROIx MOUND SYSTEM The Department has reviewed the above-referenced submitt.,11. Conditional approval is hereby granted `fo h-V syst-ew plan submittal. All noted items must be c:orre~cti, The n iew.. d appro.vai of the system is based on chapter 145, Wiscor7 ~n Sttutv.sl, and r.hapters It HR and 84, Wisronsin Administrative Cce, a~fd "s' orrtNgent upon compliance witl; any stipulations shown on the plans". Tsy,;tem has not, been reviewed for they rode requirements set, forth in chapter Isl . --vT--1 :ttaf3t,~rs T€HR 537-64, Wisconsin Administrative Code. This plan submittal approval will expire two year from the approval date, or if a sani prj)-.Abtained, plan approval will expire on the clay the" initial s permit expires. The li-ensed 1111LIfither' r0'sj)Orrsihle far this insta14,a k o set of) plans w)th the Pc-,pirlnent's :tamp of ~ r•uct.ir;n ante. The m>taIIor, ha11 notify i:he appropriate approu at ,h._ Al ,ni inspec. r can irls e-c.tions ,r..an he fpafe, r t A 4 ! G ,Ail permits required by thy, c.~i y, x111 ~t► i ~}r c: c;.rrsty ~h~~11 be ohtained prior to in,, llaticr Tnquiries sharj'ld be direct ~d to rep at the number liJed helow. Pliasp refer to the plan number shown SInc. PreIy, ...nnm h Stivmke Plan eviewer Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. t:hu Fri ORIGINAL SBD.64231s. u1/9i) ULSRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems ` 715-386-8185 Private Sewage Consultants I' n r~ c~► PROJECT INDEX S` 4,.~ J*54J DILHR Plan I.D. # S94-03543 Date 8-25-94 j Owner Mr. & Mrs. Wm. Fuller Phone 715-425-5848 Address 298 Hwy. 65, River Falls, Wis. 54022 Legal Description part of 154 Acre farm. SE1/4, SE1/4, Sec-16, T28N, R18W Town Of Kinnickinnic County St. Croix C.S.T. Robert Ulbricht CSTM2482 Installer Local Authority/ Supervision ST. Croix County Zoning Dept. PROJECT DESCRIPTION REPLACEMENT SYSTEM. For a 5 bedroom farmhouse. Estimated daily wasteflow: 750 gals. Soils are permiable (.5 GPD/ft2) but seasonally saTurated. at 29". A mound system using 12" sand fill is proposed. All indicated/ and discovered old tanks (assumed to be nor,--code compliant because of age) will be properly abandoned per ILHR 83.03 (2). All-new tanks used will be heavy duty type for deep buriel in tight soils (Wieser Concret Co., Maiden Rock, Wis. Pg.1 . PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIERS Pg.3 PIPE LATERAL LAYOUT 9.4 DOSING CHAMBER CROSS SECTION p ~ P9.5 PUMP PERFORMANCE SPECS o► a P-10 1 003 Y 03548 L~~ ~ ~ ap N N O i C ~o .~I h n1 O ~ c^ ~1 `i- r c% 41 tA v ~ Z u N w - ~ SK jaw dtt~° 01% ~s a Q eon v e QoNO~N CUP . 3 ~ N ~ SEE G o C ORIGINAL >N O \ J - - 5 C2o55 SECTIOAJ OF MouAjD w i r ti aeo BED OF ro . S 94 ari. 035 43 Pi ST943uT%oy '2.' Ajje9-5ATE' G , Th cka es s Pi p la G- s s r eiA of TOP so L UPi FORM ToE u, H k, 102.20" RATIO MEo. to SAwp . • i, •/ll llll 111 i// iii -i o uu F RM 4 °70 510pE roRtE EtEVA'CZOa UuDER N him i3ED 101.201 1.0 FT: ELEVArIO~ 5 F. , Fr• tNVeRT' OF 1 1/2 IATIERAIS 102.70„ FT• ToP o F Rock.: 103.02 G 1.0 FT• H ' Top OF 1 1 IATERAIS lag-Rd, 1.5 FT. i FLAW VIEW of MOUND Wirff 13ED 4 FoRc~ MAiN s.o FT, I 4 8o.o Fr K 10 Fr l 4 - ~ T L_ 100 ~r 13 Fr Co w o w 29 FT' PRIVATE SEWAGE SYSTEM Bev e F , Conditionally To I .L PVC. cAppsD nVED dT3SERVhTIO,~t A J3Pr~ATC p R A I'm Pipes ~ p INDUSTRY, u►BOR li OMAN p1Y►S10N OF BAFECY D BUILD PEQMAA) "T MARKERS SEE CURS REGZuiRED (3ASAl. RRkA ^iLY whSTE'Flow S011- 8010'rPATWE' .5 CA?Acity 15 at. r, RopoSEb 4AsM AReIN - (A + :1 - 1680 80 D I S T R 1 3 uT t o A3 PIPE M E T - W O R K . . LA%. S94--0354.3 R vA AN) 0 p 78.0 Fr Fr X FoRcE M 7___2___ INCNES Riti1 -100 Fr. of 211 pvG Y 7-2r.. 1u •!;r5 TOTAL VC9I0 ValurtE 17 GAts. 'DisT,Nacim Hole D,AmeTER _ 1/4 INGHES RA L It 11.3c ties MM IFOLD " FoRce MAI 2 1Nc ~s SCNA,GS 2 I tv G I~ E 5 14 Gig zMvERr C L ~pri 'ED ~V ATjo►~ of LATeRA1 S ?V0 It a & j, tds 102.70' ~oUStnr.SA ~ BU~~.n ~E Ca 'DETAi L Eup CAP • REMovE- All DRill f3vRR5 ` Y HoIES 10CATen ©4 r6ouom Eqv.AIIY SPACED V(5TRi 8uTj0X) -Dt5ChAR(>-E RATE FOR IEF/4ch LA-rF-R,4L. PER °-Tl S , ti IS GAL TOTAL. T)i5TRi3UTIoi0 Vi5cl1,,NRvE' FATE FOR NETWOR K 32.76 ~.Af~./I~1',V. a•5' 1 MI*01 MUM Pg. 3 of 5. 8:94 035 4 3 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS )P ,41e OF 5;.__ VENT CAP 4"C.I. VENT PIPE T WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER _T j . 25' FROM DOOR, eN10l- 1AACI WINDOW OR FRESH 12"MIU. I AIR INTAKE "9RA9,, ,rA5p^7/VA/ GRADE y" MIN z1_ I I e„ M►N. 106.0' COQDUIT 9.01 ~IEU~ri 97.0 PROVIDE I - 1LET AIRTIGHT SEAL I I V r-T 51 UE PRIVATE SEWAGE SY i APPROVED JORITS APPROVED JOINT . . W/C.I. PIPE W/C.I. PIPE ,(0 Condrtrona , EXTENDING 3' :.XTENDING 3' ~0 ALARM ONTO SOLID SOIL ONTO SOLID 501E B ~ i 93.75 pto .251 A~ONS C INDUSTRY, LABOR & D 8~ R GS T ELEV. 94.5 FT. 1 DIVISION OF SAFET PUMP K ,g~Dpl,) l- D .80' ,EE CORRK F CE 40 vA 93.50' RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC e - 5PC CIFI'CATIOUS DOSE TANKS MANUFACTURER: Wi PGPr (`_nnrarat ['O. IJUMBER OF DOSES: 4 PER DAS TANK SIZE: 1000 heayyr- duwGALLOMS DOSE VOLUME INCLUDING BACKFLOW: 205 GALLONS ALARM MANUFACTURER: T.Pual Alarm ro - MODEL HUMBER: DVT, CAPACITIES: A=19-5 INCHES OR _500_ GALLOWS SWITCH TYPE: MPr^»rg float B=-9 INCHES OR 51 0 GALLONS PUMP MANUFACTURER: 7,081 1 cr C= IS INCHES OR -?OC; GALLOWS MODEL NUMBER: 98 1/2 HP 11.5V D= Q Ej ~BICHES OR 241SGALLOMS SWITCH .T9PEpdar_r.yhac_k mPrc-nrvr float MOTE: PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE '15 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEELI PUMP OFF ARID DISTRIBUTION PIPE.. 8. 2 FEET TAOk TPIECS • + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET EAGfA_ tj /It, 100 FEET OF FORCE MAIN X 2 • 05 FYo Fr.FRICTION FACTOR..~(15_ FEET ~40r S 25. 6 Als. TOTAL 09MAMIC. HEAD = 12.79 FEET 39 INTE,RMAL DIMLWSIONS OF TAUK: LENGTH 104" ;WIDTH 86" LIQUID DEPTH S9403543 N HEAD CAPACITY CURVE 3 7/8--- - 6 1/4 MODEL "93" 30 4 5/8 8 I 4. 25 e 3 5/8 6 20- -I- U O 15 - 4 3/16 4 i 0 10 1 1/2-11 1/2 NPT 2 i 5 - I ° t U.S. GALLONS I 10 20 30 40 1 50 so 7o ao : LITERS I 130 160 240 0 FLOW PER MiNUTL I TOTAL DYNAMIC HEAD/FLOW PER t.vouTE EFFLUENT AND DEWATEMNG CAPACI I Y 12 0 HEAD UNITS/MIN - - i FEET METERS GALS LIRS 5 1.52 72 1:3 10 3.05 61 231 15 4.57 45 110 516 ' 20 6.10 25 95 - 3 / Lock Valve CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, fo.' duplex systems, are available and a Mercury float switches are available for controlling single and suppled with an alarm. three phase s, stems. 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 - Weiaht 39 lbs. - Vr H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-El Mode Am; : Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 Auto I 9.0 - 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alteroalor, "E-Pak". N98 115 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify 098 230 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 wired-in sim- 58 230 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex 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 r r d wiring should be done by a gwli- Piggyback Mercury Switches, FMO477: Electrical Alternator, FMO486; M~+chanical Alternator, lied licensed electrician. All electrical and ra.*,Ay codes should be followed inNud- FMO495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, Ing the most recent National Electric Code {NEC) and tM OceupalionaI Safety and FMO732. Health Act (OSHA). RESERVE POWERED DESIGN For'unusual conditions a reserve safety 9 factor is neered into the design of every Zoeller pump. 2, MAIL T0: P.U. BOX 16347 ` OELLEfi' O. LW l KY 40256-0347 Manufacturers of . ~ .SHIP TO 10: 3280 0,'., Millers Lane a I Loci; villa, KY 40216 ,4V.I_11Tr V-VS Ski ~Ego (501) ,778-2731 • FAX (502) 774-3624 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page -3 Labor and Human Relations _ Of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but .ST Cit°Oi }C not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ~v MER GOVT. LOT $,6F- 1/4 5--- 1/4,S /(o T 2-P N.R /oo E (or) W PROPERTY OWE~ NywER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # y JF /7' . PiW of 15Y 4I e I CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DFOWN NEAREST ROAD ,~;uEk FA//S Gv/. 5tiozZ (7 15) ~tlS-S~Y~ [ j New Construction Use [ Residential / Number of bedrooms S [ J Addition to existing building j,0'eplacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate S bed, gpd/ft2 ' ~ trench, gpd/42 Absorption area required bed, ft2 &J5 trench, ft2 Maximum design loading rate r bed, gpd/ft2 ~O trench, gpd/ft2 Recommended infiltration surface elevation(s) /0 2 2.10 ' ft (as referred to site plan benchmark) Additional design / site col sgerabons S Parent material 5i-^5 N' 'GKiw - '014 s~pi;yF,vTS Flood plain elevation, if applicable 'U ft -/77, -1 •v S lsystem CONVENTIO MOUND- IN-GROUND PRESSURE AT-GRADES SYSTEM IN FlLL HOLDING TANK fors stem ❑ S en 1 2S O U ❑ S Me` ❑ S E u 0 S 0~ ❑ S t~ 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 .r Ground 3 7y 37 /o ,P z W sd.~ es , S elev. /0/. ;4- It 7 7-5- /o rK `116o s/c, 01 S u w , S C Depth to limiting factor " 555. Remarks: 4-T 5 / - L -fiV-S •v E v0/d.y i' 7",6- E.v e-0 U •f' Boring # Cv 2- S 240 4rJ Z 13-If /oyle 31Z/ Ground !a/e1i ft 3 ~y'3S /0 Y,,61 7W C-40 Depth to .S 2 /p k S/ 9,-f a,P 4P /s / f~ Q S , S limiting $1 /i c d U ~1 ~V factor 7 S Sss Remarks: ---~~P~iGrpif ✓ Ct~'~iF'~r l3fi~DS ~~;Tit'r'~Ti yG- P,~fr/~i L~ . CST Name:-Please Print ,z3F-~e T- _3 r ~to Z1/Aoi cl j Phone: 7r5 Address: CQSS D' u t' L 1~ KUPSO-13 C.t) t . 5 4 01 C. & -1~ L'57 12 Signature: Date: CST Number: ORIGINAI,.-- fv/lE~' Z PROPERTY OWNER SOIL DESCRIPTION REPORT Page Of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxl3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed n-nch L 13 -i~ /O YR 2 7 ~e S /C)S ~ Ground 3 /o .3/ _ / . 2 6,~ iw► ~i(' ~s - ,S elev. yft. y- y /o ,P / S Depth to )-65 loY/e limiting factor 7,5- /2 5/ S5S Remarks: Boring # i Ground elev. ft. l Depth to limiting factor Remarks: Boring # Ground ` elev. ft.- Depth to limiting factor Remarks: Boring # Ground elev. ft. i Depth to limiting factor Remarks: con ooonio ncInrn t a h H ~ ~ ~ oZ 0 °v O N ~ o o ~ 1 ~ 3 0 J l ZA, I 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), thenla second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. ----------------------------------n-------------------------------------- Owner of property LO-1-ri Location of, property S 1/4 1/4, Section ! , To'Z8 N-R /8 W Township k, Mailing address l ti Address of site subdivision name ~V r Lot no. ~91 Other homes on property? ves No Previous owner of property Total size of parcel 41 C , Date parcel -was created Are all corners and lot lines identifiable? 4--_Y930 No Is this property being developed for (spec house)? Yes ~o Volume a01b "and. Page Numbers 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 n t office of the County Register of Deeds as Document No., 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 ir~, the office of County Register of deeds as Document No. a0l 6 C` Signature of applicant Co-applicant _~Z Date of Signature Date of Signature 5`8 J successors and assigns, against all and every person or persons lawfully claiming the whole or any part there- of,"by, through or under said party of the first part, and none other, it will foreve WARRANT and DEFEND; sub j 1^ ,ject t the foregoing reservation against warranty as to mineral rights. .I IN TNESS 'NHEREOF, the said party of the first part, has caused these p esents to be executed in its (corporate name its duly authorized officers, and its corporate seal to be ereunto affixed the day and year' (first above written, it !In Presence of: ($3.85) THE FEDERAL AND BANK OF SAINT PAUL GWP it (R. S.) EN R. C. Cordell Can. ) By P. . Johnson Vi e-President E. E. Naeseth (Co ) (Seal an E. E. Thwing (STATE OF MINNESOTA 'I ) Asst. Secretary )SS. County of Ramsey ) On this 15th day of December, 1942, before m a notary public, personally appeared P. N. Johnson and !E. E. Thwing, to me personally known, and to me ersonally nown to be officers, to-wit, Vice-President and it Assistant Secretary, respectively, of The Fe eral Land Bank of nt Paul, a corporation, and to me personally. ;known to be the persons who executed the ithin and foregoing instrum t in behalf of said corporation as !such officers, who being each by me ly sworn, did each forhimself say th they are such officers of said corporation described in and whic executed the within and foregoing instrument, that the seal affixed to the I' I within and foregoing instrume is the corporate seal of said corporation, and that id instrument was executed :in behalf of said corporati n by authority of its Board of Directors; and said officers a cnowledged said instrument to be the fre act and deed of said corporation, and further acknowledged to me tha said corporation ~I (executed the same. I! iReceived for Record: Lillian N. Clausen Lillian N. Clausen February 18th., 1943 at 4130 P.M. (Seal) Notary Public, Ramsey County, Minn. I David Hope, Register of Deeds. My commission expires Aug. 28, 1947. i. 201699 Form FSA II 195A (WI) WARRANTY DEED 110-29-42 UNITED STATES DEPARTMENT OF AGRICULTURE I,I #66060-W FARM SECURITY ADMINISTRATION WARRANTY DEED j (Corporation to Individual) Wisconsin KNOW ALL MEN BY THESE PRESENTS: That, THE FEDERAL LAND BANK OF SAINT PAUL, grantor, of Ramsey County, Minnesota, hereby conveys and warrants to F. WM. FULLER and ESTHER FULLER, husband and wife, grantees, of St. J ICrvix County, Wisconsin, for the sum of Four Thousand Five Hundred and No/100 Dollars ($4,500.00), the follow-' it ing tract of land in St. Croix County, Wisconsin, to-wit: Southeast Quarter (SE-.-), Section Sixteen (16), Township Twenty-eight (28) North, Range Eighteen (18). I 'West, except .2 acre in the northeast corner thereof used for school purposes, and also except that portion i. ~ u Iconveyed to St. Croix County for highway purposes by deed dated November 4, 1932, and recorded November 7, 11932, in Volume 226 of Deeds at page 69. i IN WITNESS WHEREOF, the said THE FEDERAL LAND BANK OF SAINT PAUL, grantor, has caused these presents ' I to be signed by P. N. Johnson, its Vice-President, and countersigned by E. E. Thwing, its Assistant Secretary„', gat Saint Paul, Minnesota, and its corporate seal to be hereunto affixed on this 15th day of February, 1943. Signed and sealed in ($4.95) THE FEDERAL LAND BANK OF SAINT PAUL 'I (R. S.) 'the presence of: (Can. ) By: P. N. Johnson MGP Vice-President JCC ilk it R. C. Cordell (Corp - ) (Seal ) Countersigned: Doris Nyeggen E. E. 'fhwing 'i Assistant Secretary (STATE OF MINNESOTA) )SS. ;COUNTY OF RAMSEY ) i i Personally carne before me this 15th day of February, 1943, P. N. Johnson, Vice-President, and E. E. IThwing, Assistant Secretary of the above named corporation, to me known to be the persons who executed the for going instrument as such officers of said corporation, and acknowled,ed that the executed the same b its J authority. Received for Record: Rose C. Cordell Rose C. Cordell I February 18th., 1943 at 5:00 P.M. (Seal) Notary Public, Ramsey County, Minn., q David Hope, Register of Deeds. My commission expires December 2r, 1949. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 201724 F.L.B. 34013-W - So. Polk Wis., Mich. DEED Limited Warranty Deed THIS INDENTURE, Made this 12th day of May, 1942, between THE FEDERAL LAND BANK OF SAINT PAUL, a corpora- tion, organized under the Laws of the United States, of the City of St. Paul County of Ramsey, State of Minnesota, rty of the first part, and Wenzel J. Humpal and Alice Humpal, usband and wife, whose post office, address is Cle r Lake, State of Wisconsin, parties of the second part, WITNESSETH, That the said party of the first part, for and in cons'deration of the sum of Seventeen Hundred and No/10 ($1700.00) DOLLARS, to it paid by the said parties of the second part, the receipt whereof is hereby confessed nd acknowledged, has given, granted, bargained sold, remised, released, aliened, convey- ed and confirmed, andd these presents does give, grant, bargain sell, remise, release, alien, convey and 1 confirm unto the said parties of the second part, their heirs a d assigns forever, the following described real estate, situated in the County of St. Croix and State of Wisc sin, to-wit: The West Half of Northwest Quarter (l1~zNW) of Section F fteen (15), Township Thirty-one (31) North, Range Fifteen (15) West, subject to all existing easements and rights of way; also subject to all taxes on said premises for the year 1942 and following years; als subjoct to all unpaid parts and installments of special assessments on said premises which have fallen dueor will fall due hereafter. Excepting and reserving to the part'•v of the firs part and its successors and assigns fifty per cent of 'all right and title in and to any and all oil, gas nd other minerals in or under the foregoing described land) with such assement for ingress, egress and use of s rface as may be incidental or necessary to use of such J rights. The foregoing exception and reservation if' any) and the resulting remainder of mineral rights (if any) to be included in this conveyance shall ea h and all be with reference only to such mineral rights as the party of the first part may own, as disclo ed by the public records. TOGETHER with all and singular the here taments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, ti e, interest, claim or demand whatsoever, of the said party of thel first part, either in law or equity, either in possession or expectancy of, in and to the above bargained i~ premises, and their hereditaments and appu tenances. TO HAVE AND TO HOLD the said premise as above described, with the hereditaments and appurtenances unto the said parties of the second part and to their heirs and assigns FOREVER. AND THE SAID party of the first pa t, for itself' and its successors,~does covenant, grant, bargain and agree to and'with the said parties of e second part, their heirs and assigns, that the above bargained pre mises, in the quiet and peacable posse sion of the said parties of the second part, their heirs and assigns, against all and every person or perso lawfully claiming the whole or any part thereof, by, through or under said party of the first part, and non other, it will forever WARRANT and DEFEND. IN WITNESS WHEREOF, the said par y of the first part, has caused these presents to be executed in its corporatename by its duly authorized o ficers, and its corporate seal to be hereunto affixed the day and year first above written. In Presence of*- ($2.20) THE FEDERAL LAND BANK OF SAINT PAUL (R. S.) JWB Isabel Mitchell (Can. ) (Corp.) By P. N. Johnson (Seal ) Vice-President E. E. Naeseth EN and E. E. Thwing ESTATE OF MINNESOTA) Asst. Secretary ~I )SS. COUNTY OF RAMSEY ) n.. .i.,. 15r ~!ac. ~ ~ S ~ ~ . ~ ~ ~~''YV\. \ \ \ C \~L S~ 'i STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O DYER MAILING ADDRESS x ` 8 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE A "L' PROPERTY LOCATION ✓ 1/4, E 1/4, Section ' T o2 S N-R-1 8-W v e , TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP t 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: &/t, M J l 9 y St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93