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HomeMy WebLinkAbout030-1070-80-000 y 7 /N5-1'4 sF P7 - oc% /yfl STC - 104 c AS BUILT SANITARY SYSTEM REPORT 1 ! j~'- DYp ST FvZ- ~DD~t' 'S OWNER $/TE ADDRESS 1370 ~13A~ S So.yE,~s~7 p SUBDIVISION / CSM# SECTION Z~ T 3 N-R W, Town of ST' ST. CROIX COUNTY, WISCONSIN ° f4, fy- PLAN VIER ~`ty1~~ SHOW EVERYTHING WITHIN 100 FEET Ok'§0STOc" i4 TTh G~ ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. o TTo ~D ~C o c a's f3 c v E c rrF L BENCHMARK: 7/;0 ~OD•Q ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / 5•r- boo gas, Manufacturer' CUEE~S~D~ ~e- Liquid Capacity: Poo Setback from: Well X House /6 Other Pump: Manufacturer Model# '7-P Size JL' ~Z -~aa Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: , Length 35 Number of trenches Distance & Direction to nearest prop. line: 20 -~'6 So . Lc~T Setback from: well: 57' House 2-5 ~ Other ELEVATIONS Building Sewer ST Inlet. rt 7.70 ST outlet PC inlet S7 36 PC bottom fy'/O ' Pump Off 77.3 Header/Manifold boy /O Bottom of system to 3. 7S Existing Grade Final grade !O Asa DG f • DATE OF INSTALLATION: II PLUMBER ON JOB: l dl3z.-x/ LICENSE NUMBER: 1,Vtf5' 33O 7 INSPECTOR: ~'~/~s©'✓ 3/93:jt rn~ ~ I ~ w 1 m ~ \l ~ Z Q 3 Z c-n e • Q a N Wiscohsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor end Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: b4 3 o-: PeDENNINGNa DENNIS L ❑ City El Village R Town of: State Plan qrP /I CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No. /~7r TANK INFORMATION ELEVATION DATA o o TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic l awe Benchmark Dosing ubqAp Aeration Bldg. Sewer ng- Inlet 7 Y Holdi St Outlet Y TANK SETBACK INFORMATION St/ 97~s 9. ae ItTANK TO P/ L WELL BLDG. nake ROAD Dt Inlet 739 Septic X50 NA Dt Bottom a 51/P~ Dosing, NA t*ow /Man. 3 0 ' Aeration Dist. Pipe 3 °lS' 2 /DC -33' ng Bot. System 3' m 43, 3. LE 7 PUMP/ SIPHON INFORMATION Final Grade op dr T Manufacturer errand Add,CD Model Number 5,33 TDH Lift Lri oss Head ctio s3' I Systems TDH 1, Ft Forcemain Length C/?' I Dia. ,2 " Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S DI M-EN-Sibln- SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEA Manuf er: SETBACK CHAMBER OR U -Model Number: INFORMATION Type O ? L • ~ 160 System: /yr 2o' -70 DISTRIBUTION SYSTEM i Jam/ Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake ti Length D Dia. ~ Length 3,P Dia. Spacing 36 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 LA Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 26 30,.,-j9.253H,NW,N;`,FROG POND , PTE 7 ~ ~ ~C',. t -t'~/ t/-,k'.LL.r/C ~.-/'Ci~ • -'~'(~.d ,~'/~'lE~ ~L ~r ,(-cd✓1~ / tv~2X~/~1'l -!/1~-Cl ,~l' ( c.l' t=; 1 / Plan revision required? ❑ Yes No J Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: " I SANITARY PERMIT APPLICATION `~l~.lr=lln In accord with ILHR 83.05, Wis. Adm. Code COUNTY 57-- Cte0t% STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 0 5/~ ~v3 8/z 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. Z. PROPERTY OWNER '71E,~,~15 L . PENN PROPERTY LOCATION Z~ G AJW Y4 A16 -1/4, S T30, N, R E (or) W PROPERTY OWNER'S MAILING ADDR SS - LOT # BLOCK # u.~ o~ • V ~I/~1.' 130,9 CITY, S TE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned I ❑ LJ,-TOWN OF VJLLAGE : Tp r6~1~ 13:F6 ❑ Public LYJ 1 or 2 Fam. Dwelling-# of bedrooms - PARCEL TAX NUMBS (S) III. BUILDING USE: (If building type is public, check all that pply) O 3 0- /070 ' F0 • 1 ❑ Apt/Condo 56f 50W*/: 20 Assembly Hall 4,y5l',v 6 edical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School B ❑ 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. ❑ New 2. a Replacement 3. ❑ Replacement of 4.E] 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 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 In-Ground 420 Pit Privy 130 Seepage Pit Pressure 430 Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5.-PEPA-FAW- 6. SYSTEM ELEV. 7. FINAL GRADE J REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 103. /-A_ /75 • 4~ 6 /IA4 7Fe t o S 3 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 IT 1, El El F-1 i M Lift Pump Tank/Si hon Chamber DO VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamp s MM MPRSW No.: Business Phone Number: ~:o[3t T' 2tc.~3>f' T' 330 7 7lS Pe Plumber's Address (Street, City, ~Zip Code): ^ fl~O 1 / • 6/ / IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved San' ary Permit Fee (includes Groundwater Date Issued Issuing ent Si o S ps) Approved ❑ Owner Given Initial Surcharge Fee) 2 I-V Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will ibe applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county. prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. . 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety &Buildi.ngs 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 tine B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) kA r . R -i~ L o S94 024 12'. m 1 i m y r E L d >~ta ° y.. ` H m ~ w as P> r P ` r v1 tam r ~ ti Q I ~ 3 ~~~0 r, p y~ o p t•. D ai .o ~ n 1 g g~ts~~ o• ',I ~ Pow R L; A> r aye ~~~~a~ n Espy r- n SEE G~~ . Q o -.3 - Cn dc" a t7 y C'm SIN !=C` ==or, - r Q I! (n m r, rl) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations July 14, 1994 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S94-02412 FEE RECEIVED: 180.00 DENNING, DENNIS NW,NE,26,30,19W TOWN OF ST JOSEPH 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. `Sincerely, I n2 n th Stiemke Plan Reviewer Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. thu Fri SBD-6423 (R. 01/91) ULBRI,CHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PRO..'CT INDEX °y 2 4 DILHR Plan I.D. S f 7 02- Z Date TOL14- 15 9y Owner 170uA3i 5 '-Dl=N A.) 1'0 Cam-' Phone 61~.-~0l1 ' o rb Z- cJvO ,~}vE. ST• P~}CJL ~~:v-~./ SSl/Cp 1308 Address 5i 71C : /3 90 y,~o G- .OG,yD I-,V . CviS Legal Description PAR r OF &ou `T• LoT ►f N % , N yf/, SAC. z 4, 3o N, tz tq w Town of T T(0SE ~pt+- County ST. cRU I• V C.S.T, l?o(3a RT- 21L-t3iR1 GIST- c5rM 2_q e2_ Installer Local Authority/ Supervision ST. G(~dtX COU~Ty Za~6-a PROJECT DESCRIPTION f} SE~SD,v,+L l /3EOrp,~J, c,~.~r;v ,ra~;r;c, _ 4 -xv-&-I.0 Gtr . ff l~if°%vE 6v S C'~.DE Evy7 131 L ;l c,*,u,V7X Zv aiA-5 - . IePT'• To_. i NsfAll A- COPE. ~•~.~~T- Kl i " SAP, SySTeM. sods PUT seRSP,0611y S,4.-,-ORKMP .'AT Zy-f. SiTr=' 45 St. rr",J~C.£ A C &ou e zTro&3,4 L 1~1 o u a I~ S y s TEM ~ ST + ~v>gs-rE ~ locv - l 5 O b'-~-QS , Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS.& SYSTEM PLAN VIEWS Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION o~ 1 "A)" Pg.5 PUMP PFRFOPMANCE SPECS was. ~I~Ii1Nti~ t C .R.o 5 5 S EcT I O&J o t= ICI o u Aj D w► r ti f3 E D Qeo OF ro A55eC5ATE ~ISTRi(3uT~o~ G, rti►'ckaFSS PIPI,a(- OF To s ysrEM PsoiL - t IEVhI'io~ u)Ji FORK ToE H /~3. 7S PIowE> To P So' L- i uu FORM S % 510 pE FORCE' ElEVATIDa Wimp, Mh~~ - , 7,S • f3ED / OZ O FT. - tLEvArioN~5 E A Fr. lmvf~Rr of / JAT£RA.(S 10'12-5- F Top of Rock /o5!S'L G /,0 FT. H FT ' T°p ~F IATERAIS /04 , 33; SYSTEM ! ~ N - tyoF Moujic) wir" BED r%s FvRcE MAW A ~ FT• ~,BOf1 K~NIAN R wow"'( SAFETI au 6UlL~INCy~ - - - - I d 3.5 Fr ~~aNO~. K /o Fr EE CORK ----4-----------~~ L SS F . , T 7 FT W ----'1 k~ T 13 Fr 00 w o 25-, Fr Bev OF To I-'•" PVC. cAppED OSSERVhrioa H 9JPF5ATE' pip ES PERMA&, ENT M Ae KERS ~A~'Ly whSrE Flow - ~7 a - ~7 REcquMeD BASAL AREA, 5011. W10TRATh9E C ApAcf ty 5-a. FT, PROPOSED BASA4 APeN = X (A t Z 3 X /3 X30 . 3 of 5 D%5TR13 uT► oA P►pE N P-1'W OR K _L•AYO.V r 894-oO2412. i P R \ Maa~F°`° 0 Fr X \ p 3z \ 3.0 R Fr X y~ ~N~ FORCE Mi4iN NES yo Fr Z P V c ! ye ~ucFJE5 of VARi•h(3LE Cv'~D GALS , 'PISTA.-ice TOTAL Unto VolurtE ► Hole WAMETEp, /7 ►NOHES L.Il'rERAL ►Nc lies MAmtFOLD 2. iNct~~s FoRcwNeo -I&I 2. ,je s ally i N e s Qltd1tt tE PE MOVERT' CLEVAT,o►J N o F L ATE ►RA 15 e ,m av VAR $EE G 'D E TAi L D C AP em 1 \ Y R o E Au 5)Ri II (3URR5 . HoIES loCATeD OA3 BoTi'ON1 EqL).AIIY SPACE I> TRi Bur►oN l)tSChARCsE RATE FOR etch LArERi L P R OT S /0.5-3 GAL TOTAL 17(5TRibUT►o,3 'DBCHRR&E RATE FOR NETWOR K 21. DCo G.AL M1-A). a•~ f M(NI MtJM S 94 0 2 4 1 2. 1 PUMP CHAMBER CROSS SECTION AND SPECIFICATIOMS R,4 E g OF S VENT CAP 4%.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER : 7 25' FROM DOOR, w/ (uJ1iQ.v~J(~ /f1AE~ WINDOW OR FRESH 12"MIU. AIR INTAKE I C1l?'06' (~_11&1111T/OIV GRADE I y° MI►J. 1 ~2 4 l00•J M1 W• CONDUIT-- ~IE144n' Oti \ lh PROVIDE ( - ~y I►JLET AIRTIGHT SEAL I T 196 I I I APPROVED JOINTS APPROVED W PIPEJOINT A IN5/~~ I I (i W/C.I. PIPE :.XTENDING 3' ~0 / I I I ALARM EXTENDING 3' ONTO SOLID SOIL B , I II ONTO SOLID SOIL X31 3'i5) I I 3! ow c 'I I ELEV. FT. 1 PUMP-- 1'! OFF D 2`T BLOCK 40 /EV~fiod ~ _ RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFI'CATIOMS DOSE TANKS , MANUFACTURER: WEE CO WtABER OF DOSES:_; Z PER DAy TANK SIZE' goo 42 _ GALLONS DOSE VOL7UME 7 8 2 ALARM MANUFACTURER: LaV-e(_ AlAiP►N ce-' INCLUDING BACKFLOW: GALLONS MODEL NUMBER: -D. V • ` CAPACITIES: A= o INCHES OR /0~O/ --GALLOWS SWITCH TyPE' M R CU R y F 1 ~0 NT B = 2 INCHES OR Yl GALLOWS 02 PUMP MANUFACTURER: C=INCHES ORGALLONS MODEL NUMBER: V4 p - «S y D = Z ZINCHES OR S 7 7 GALLONS SWITCH TyPE: RCMYdhC4~ teRCUay fInAT- NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 25GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE..~•0S FEET -rAA.) SPIELS + MINIMUM NETWORK SUPPLY PRESSURE.. . . . . . . . 2.5 FEET EAL(A, t , Of" PttL L FEET (jUA`S 0 FEET OF FORCE MAIM X ~lD F ooFr.FRICTION FACTOR.. * - t TOTAL DYNAMIC. HEAD = /A FEET p0mvp If .3/ " INTERAIAL. DIMENSIONS OF TANK: LENGTH ;WIDTH -;LIQUID DEPTH pR9VATE SEWAGE Conditionally vo v% APpploljL;u RELATIONS N RED . O '~pU57RY, LABOR 6 H IAA BUILt?t~efia✓' IVISION OF SAFETY A FE COI~IR 4.6d L1 S94 _0242- HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "98" 30- I 4 5/e 25- 3 5/8 I; 6 20- "ei Is- ~ ® 4 3/16 4- 1`7 10 ` i 1/2-11 1/2 NPT ..d1 2-- 5- >Y t, 0. 0 U.S. GALLONS 10 20 31, 40 50 60 70 BO UTERI 80 160 240 0 FLOW PER MINUTE a • - TOTAL DYNAMIC HEAD/FLOW PER,,11r,UTE EFFLUENT AND DEWATERING J CAPACITY 12 HEAD UNITS/MIN I FEET METENt, GALS LTRS I 5 1.52 72 273 10 3.05 81 ?31 31 ' 15 4.57 45 170 3 5 16 _,,f • 20 6.10 25 95 / f, . Lock Valve 23' ~ CONSULT FACTORY FOR SPECIAL APPLICATIONS to Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling sin;,e any 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 cycig controls. r' SELECTION GUIDE ` 1. Integral float operated 2 pole mechanical switch, no external control required. + Standard all models -Weight 39 lbs.. - I/z N.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series _ Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Ames Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075. M98 115 1 Auto 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E Pak". N98 115 1 Non 9.0 2 or 2 & G 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 I - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in sim- 3} 'EBB 230 1 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, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, tied licensed electrician. All electrical and safely codes should be followed includ- FM0495; Alarm Package, FM0513; Sump/Sewage Basins, F100487; and Simplex Control Box, ing the most recent National Electric ! ods (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the de:-ign of every Zoeller pump. t MAIL TO. P.O. 80X 16347 j~ Louisv. !IS KY 40256-0347 Manufacturers of . SHIP 70 3280 0Y 5:116 s Lane AL a ~ ~ amy ~ ~ ~ Lot.'istiile, KY 4 i?16 ,~1lAL/7Y U~i/PS /NCF (507) 778-2731 • FAX (502) 774-3624. 13 f o f'o,vD LN . l3~'pry ` a-,WCP'r„K ~n °a►;a ►°~0 Re`~"eiauo Industry, SOIL" AND SITE EVALUATION REPORT Page of 3 Division of Safety 8 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 s C~di'X 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. 030- /070 ' oOO ' 000 r APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY JATE PROPERTY OWNER: PROPERTY LOCATION 'vw TE'Ai,V( S GOVT. LOT 1/ 114 tiE 1/4,S 24 Tad N,R /y E(040 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1309 J'(Jjo huE . 4,er OF T CITY STATE ZIP CODE PHONE NUMBER []CITY 171VILLAGE WN NEAREST ROAD s`t- PgvL_ MGJAJ - Ss//& (Wx) &f - oyo2 sr. ToSE ff- FI 66-Am't"o ( ] New Construction Use [ ]'Residential / Number of bedrooms I f [ J Addition to existing building jgieplaoement [ ] Public or commercial describe > Code derived daily flow 16-0 gpd Recommended design loading rate y bed, gpd/ft2 S trench, gpd/tt2 Absorption area required 125 bed, ft2 125 trench, ft2 Maximum design loading rate bed, gpd/ft2 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) /0 3.7 5 !1 S,4-,, ) ft (as referred to site plan benchmark) Additional design / site considerations Parent material SCS `I'z 1304&,4 4447- Flood plain elevation, if applicable 44 It S =Suitable for system CONVENTIONAL MOUND IWGROUNDD ftWURE AT-GRADE SYSTEM IN 11U. HOLDING TANK U = Unsuitable fors stem ❑ S Lam] t7 a-S C] U ❑ S Ca ❑ S aT- 0 S Ott- ❑ S CCU 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 rettdl k / I 0 47- /O YA 3/z- s /4t sd.~ cis Cs 3 v~ . 7 •8 a z - ~ /o yle 3 /s 14n SAk W-5 CS • d~ Ground 3 38 /o yX 51 S 2' P Sic/ / 56,E ti elev. 9-V..0 It Depth to limiting factor., L $SS Remarks: Boring # J C~- /o vle y// Sr/. / f s,< dS t' /uf . y . S Z z /a S/ /-~Sl~ s. y S t s 4 y~ ;Z-1 7 3 y iOYg s L s./ /fs6K - •S Ground elev. Depth to limiting factor Remarks: CST Name.-Please Print ~d~ /Pr ~~d~i •C y 7 Phone: 71.:~: 3 JR; c?/ S5- Address: ~oSS 4 ~it1E%L ~f fjlvfl fog Cv~S• S"yo/ 6 f / CsT.y.2 yy((PPZ Signature: Date: CST Number: / 1 2z, e, A i e2ti S/'TE Sol'e v rio w/7t. If g~2q 1aj61-V0 A-) 41 5U .t~ L~" • 1 ti 't 5 Vic,. PROPERTY OWNER -D' I'-)G- SOIL DESCRIPTION REPORT Page? of 3 PARCEL 1.134 030 '/0'70 • -00 '000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends I O-/1 /O Yif S /-f SAt d,5 4,-S' L.., - 1.00 . 6' APy-e y/3 15 '00's cs s T. Y, Ground 3 • ye -7.5 yR elev. Depth to limiting factor Remarks: Boring # ~'Si\rk Ground elev. ft. Depth W limiting factor Remarks: _ Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # •S ft f Ground elev. ft Depth to limiting factor Remarks: CD11 099fl/D AC M~\ (n N r r C~ rn *Ilk ° . > ~ Rl i w a o Z 1 m • r'1 -I 0 Tj ~ti p~ w U~ °o° N _ S , W 1 3 ) v. /p •p CowT • p C70 P W rh i POWE R I Li J r - T FROGS- PbN G r~ L~ . m N c G% I w N • -0 5 a (P v~ L G w N - m Op (A R UD D c t\l ti Q3 w urn N cn p o ~ O ~-h i L W Q 3 'Ao • c m l ~X ~Jf - - c7 30 - /a 70 - ~o a o 0 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS 130,p J V) ' RE NUMBER 13 ~o CITY/STATE 571/1 ZIP Ks// l/ PROPERTY LOCATION:/VIL/1/4,/y 1/4, SECTION 26 , T 3 N-Rff__W TOWN OF Sf` To s , St. Croix County, SUBDIVISION LOT NUMBER / Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and Scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration e. SIGNED: fA" DATE: Q ✓ Lzi z St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-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), 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 . T~'y'V~ Location of propertyN&)1/4 4/,15-1/4, Section 2-6 , T' N-R Lf W Township Sr• 3'oSEpl~ Mailing address /30167 TVIUO 140-e Address of site l3 /0 ~/w~ ~D~vl~ SD,GI~eG ~lS Subdivision name Lot no. Other homes on property? yes No Previous owner of property '4D~'y S Total size of parcel < ale_- Date parcel was created 0 Are all corners and lot lines identifiable? _±Lyes No Is this property being developed for (spec house)? Yes N Volume 53~and Page Number 2// as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid. delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in t114 office of the county Register o. Ueeds as Document No. 3304,22-0-, and that I (we)'presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has, been duly recorded in the office of County Register of deeds as Document No. ,,,,a " i Signature of applicant C applicant Date of Signature Date, of S ature Y STATE BAR OF WISCONSIN-FORM 2 DOCUMENT NO. WARRANTY DEED ' t 1~ t THIS SPACE RESERVED FOR RECORDING DATA VOL 5'32 PACE ~Il 3130820 - rttWSTERS OFFICE BY THIS DEED, Theodore J. Adams and Alma M. ST. CROIX CO.. Wis. Adams his wife Ree'a for Ro=d tf►i_ 211e bey AD. 19-15 Denn is L Denning 42 0 i. Grantor conveys and warrants to -w Grantee-- RETURN TO for a valuable consideration $ t . CrOl X County. State of Wisconsin. described real estate in the following 30 North, Tax Key Part of Lot 4 in Section 26, Township ~I Range 19 West dNortheast acorner follows, the `northwest Quarter Th is _P.Qt- homestead rof the Northeastrcy I~mencing at the Township 30 North, Range 19 West; thence West 628 Quarter of Section 26, 484 feet to the South 430301 East, aWest "I feet; thence South 269.5 feet; thence I !POINT OF BEGINNING; thence South 50° East 66 feet; thence South 540 eon ce No ster j,about 150 feet to the East shore of swhicheistSouth 54°tWest oflthe POINT 'the East shore of Bass Lake to a point BEG BEGINNING; thence North known as Lott 15 onlJames andlENdnaGSimons'aRound 'OF 'de 'described property rty is ALSO Hill Addition to Bass Lake; Range 19 West, Part of Government Lot "4", Section 26, Township 30 North, ,described as follows: Commencing of said Se tiont26;rthence West 628hfeet; Quarter of the Northeast Quarter 54° Westh150Lfeet, ' thence South 269.5 feet; thence South EashencetSo550uthfeet BEGINNING; thence South 50 East 66 feet; on shore thence Northwesterly more or less, to the East shore of Bass Lake; o;. Bass Lake to a point South 54° West of the PTACE OF B GINNING; thence Lot Nt.r $ GLACE OF BEGINNING. Above destr_'ibed parcel known as f * ames A &Edna Simons' Round Hill a Addition part es ahn Thi deed i g in fujfillm(,,, 14 1967 n the officbetof Register o Deeds I I; 11 o IF '25rpco,:, , s. ed AT. 'a es ~59-560,___.189 895• 19-~• for S March County for St uteri at Hudso,n. Wis • , In V° 31'pg this_.24fh day of ___O_V_t0bA2X Wisconsin Executed at ,No transfer fee on this deed. ` " Z' (SEAL) SIGNED AND SEALED IN PRESENCE OFD TheOdO re_J AdamS_ _ - - - f Mp' -(SEAL) - _Alma M Adams (SEAL) (SEAL) T his- wife Theodore J. Adams and Alma M Adams,_ Signatures of October197 5 24th day of _ ~ authenticated this _D._ , - Heysa°Ct - Title: Member State Bar of Wisconsin XrX0bXd("F4X Authorized under Sec. 706.06 viz.-- OF WISCONSIN ss. STATE County. 19 day of Personally came before me, this the above named to me known to be the he person - who executed the foregoing instrument and acknowledged the same. This instrument was drafted by at Law County. Wis. John D. Heywood,Attorney Public HudSOn1__WiSCOn$ln Votary - The use of witnesses is optional. My Commission (Expires) (Is) Names of persons signing in any capacity should be typed or printed below their signatures. a c Mau. Co..a~~ - WARRANTY DEED-STATE BAR OF WISCONSIN. FORM NO 2 - 1971