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HomeMy WebLinkAbout034-1040-80-000 O STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER / ,S j / A4.4 ADDRESS_ t~9 ,4 P SUBDIVISION / CSM# O - ye LOT # ~ SECTION__~~T_2-~N-R__Z,LLW, Town of ~ N/A/g Biel y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 'YO 4ev 4 ~ 1 ~ O 3 2 X, ~:c?ti'arv ~ '9- I~G o ye INDICATE N RTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i 0 BENCHMARK: ALTERNATE BM: ~e_- - SEPTIC TANK / U~1rL CIL BER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer ~G1,/ -Model#.Size /00 Float seperation 1., Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length 1,0Z Number of trenches a s Distance & Direction to nearest prop. line: % .10 Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off - MY, 70 /03, y3 Header/Manifold /,o-? Bottom of system l•~ Existing Grade 1,01,77 Final grade 10 , 6 _/S, ~ Y f DATE OF INSTALLATION: -s - -®a PLUMBER ON JOB: 'e~a_e~ LICENSE NUMBER: f,7 INSPECTOR: 3/93 : jt 73 /0.70 fl/is Onsin%partment of Industry, PRIVATE SEWAGE SYSTEM County: Lahp(and Human Relations INSPECTION REPORT ST. CROIX - Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No_: GENERAL INFORMATION Pee 's NIS ❑ City ❑ Village ( Town of: State Plan ID No.: s 9 ~v~ 03 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 00 ' ~ltj fr~~ Fc.~ TANK INFORMATION ELEVATION DATA 6-16-7r 10► TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing jp 10,4S loo, Aeration Bldg. Sewer /,y~ 93, qj Holding St / Ht Inlet 11.3 y Gu 3 ~r TANK SETBACK INFORMATION St/ Ht Outlet - Verit ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic > /p NA Dt Bottom rq e, Dosing >J S y, l A / p NA Header / Man. U, 7 Aeration NA Dist. Pipe p S /p q,6 S 3 Holding Bot. System '2"1 PUMP/ SIPHON INFORMATION Final Grade /0( , 6 Manufacturer Demand a 9(j , I/ Model Number ~P GPM TDH Lift Friction, b System TDH; 5 Ft + Loss ea Forcemain Length D~1 Dia. ~P Dist. To Well 7 5p' SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Ty ches PIT No. Of Pits Inside Dia. Liquid Depth 17 DIMENSION r / DIMENSIONS-- SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER i INFORMATION Type O , q _f System: /7)b(,-LD 3 p v1A OR UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length '95 Dia. Spacing _1:~t ~gv 1, 60 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over a Depth Over t' xx Depth Of xx Seeded /-Sedeierr xx Mulched Bed /Trench Center Bed /Trench Edges /0?- Topsoil l~ PYes ❑ No VYes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Sprinfield.17.29.15W, SW, SE, 90th Avenue cc'_'tl Plan revision required? ❑ Yes eNo Use other side for additional information. y/ lc~ Cs SBD-6710 (R 05/91) Date InSpector's Signature Cert. No. SANITARY PERMIT APPLICATION • ~'~~-nom In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE9NITA PE2T# -Attach complete plans (to the county copy only) for the system, on paper not less than ll 'revision 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. S O 2 3 PROPERTY OWNER PROPERTY LOCATION Des# S h m.4 S5-W Y4 S,~ '/a, S T27, N, R 15- r) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 6 O V e CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER CITY NEAREST ROAD 13 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE/ ❑ Public R] 1 or 2 Fam. Dwelling-#~ of bedrooms ~ ARCELTAX NUMBER ) III. BUILDING USE: (If building type is public, check T11 that apply) p r~ ~D p~ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. [K 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 X Mound 30 El Specify Type 41 El Holding Tank 12 E] 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 , O O G e ..r- /0,?, 71 Feet GZ.Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed o`~O e Se tic Tank or Holdin Tank :K:F Ira Lift Pump Tank/Si hon Chamber X / 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 Sta s) MP/Moa"No.: Business Phone Number: Al e r's Address (Street, City, State, Zip Code): Plumbe 2 $ 70 IX. COUNTY/DEPARTMEN SE ONLY Disapproved Sani ry Permit Fee (Includes Groundwater a e Issued Issuing Age Signature Surcharge Fee) ;Approved ❑ Owner Given Initial Adverse Determination ° X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.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 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 if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in, line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. 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. r 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) L v ht v 40 ~h -L ex, A o L N J r ~ - 3 a - 47 O'y N r P. I. e d f Z2 p G - - - - z AV/ - - - SYS7~ i--- - - -I f pil WTE - i - sEr~r - - - - d UM N - LAIN S - fit/ 6 r - J - - t.l :fir ;.r...,, ,w Page' -L Of Straw, Marsh Hay, Or, Synthetic Covering Distribution Pipe Medium Sand G Topsoil 3 j` b tE SExE. c`IBTE~ % Slope r w Bed Of i - 2 i (Force Main Plowed it10nall Aggregate From Pump Layer corld ® oNs AN R Cross Section Of A Mound System Using 6KUM KGs 84A ~ti1.Ol F ~ y ~ to f► B~,~qp~/~ 0. 0~ IN pF $AF '1~"' A Bed For The Absorption Area G FtRppNpENG ^ 5 F t. e G fL l~s O~z~ b F L. License Number: 3 l t . Date: ~y----- f: F t. t.o3.7Gi L 0 3o, 7:z"F t . r I Cb:f:rvotion t! , A t-- - \~orce Main From Pump ' ( r Dislribution E3ed Of z - 2 i Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Arco S94-20203 Page Of Y Perforated Pipe Detoil tA End Vi ✓ - /J Pe.foro,ed 1 Ertl Cop f'VC P.pe 'o e n P >~~d H01es Located on eot,orT Are Equally Spoced l~ t ~ ~ E Nd v F bed bed t' S Yj : r. ~ ;Hplp 5, ou iii, 1 Ft Next 10 [-d 5,0 ~n F . /Yv Rfy r 7~" rt . , GD Inchnt !V~►R~h Y-Y--- Inches /Hole (liveter Inch Lateral / - Inch!(-:.' license IIu-!ir,r: _Al 13 IU0 Manifold 11 Inches Date: Force Main Inches jr' of holes/pipe //794/-4- PRIVATE SEWAGE SYSTEM Invert Elevation of Laterals/09aftt. Conditionally APPROVED ~ DEPT. OF IND Y. LABOR i HUMAN RELATIONS DIYI F SAFETY UILDINGS SEE C RESPONDENCE -116- S94"20203 • PAGE -3 OF PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS r: VEIJT CAP 4"C.I. VENT PIPE Io+ WEATHER PROOF APPROVED LOCKING FROM DOOR, .!UNCTION BOX MANN LE COVER fa~~ a~i~1~ WiNDOW OR FRESH 12"MIU. ✓ AIR INTAKE ~ LUX GRADE I 4"MINI. } 4.-. ~ IB"MI~f. C0QDU1T INLET SCE SON lv PROVIDE 'z' ( ~~',\V ltl~~~a~ J AIRTIGHT SEAL i I i I and II I AFfROVED JOINT A 1 1 I APPROVED ~G 1~ k%','C.1. PIPE mzo I I I I W/C.2. PIPE ' REIA II EXTENDING EXTEND NG 3 pN I O►JTO SOLID SOIL B ~gpR ~,'►U~ \1O~N~' I I I ALARM ONTO SOLID SA csi l I o~c. oo s I I oN J v O~rIGE I I I; L E V. r ( F T. OR~~SpGN _ _ 1 PUMP OFF r D CONCRETE BLOCK RISER EXIT PE.FMITED GIJL4 IF TAUK MANUFACTURER HAS SUCH APPROVAL D_ t n SEPTIC E S U SP/~E` GIFICATIOUS ^ DOSE ~„r/~.SG>/!j (L~C~NI~o A►JKS MANUFACTURER: _ .,L IJUMBER OF DOSES:__PER DAy TANK SIZE: 7~ © ,[GALLOIJS DOSE VOLUME ALARM MANUFACTURER: S.T ~LPL~/ /~O INCLUDItiIG BACKFLOW:~~G, GALLOr.i$ MODEL IJUMBER: - CAPACITIES: INCHES OR GALLON i SWITCH TYPE: Meg6 *1Rv gc_ - INCHES OR l3~ GALLO~!S PUMP MANUFACTURER' M/1 7~'~G' G.INCHES OR / 6 ~ A LONS MODEL HUMBER. ~.SD®33 D= INCHESOR _ kALLOKIS SWITCH TYPE: Si ozed fR0 ,U FD MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 36,~ZGPM INSTALLED OOM SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEW PUMP OFF AND DISTRIBUTIOI~I'PIPE.. ~O FEET C ~la~ Q + MIIJIMUM NETWORK SUPPLY PRESSURE 2.5 F ET P~ L`, ~`GV11n~c~ + FEET OF FORCE MAIN X W-..- /oofXFRICTIOU FACYOII. FEE!` TOTAL DyRJAMIC HEAD f FEET S94- 20203, INTERAIAL DIME.W510MG OF TAAIK: LENGTH ;WIDtH ;LIQUID DEPTH - ,,y~ SIGUED: LICENSE 1JUMBER:.~V~~`~~9d DATE: ~~~6-~% i E F F LUSIPP T a ~ OSP33 OSP33AB:; SPD5.'['OOH MAX. SOLIDS 5/8 "SPHERE MAX SOLIDS,5%8" SPHERE MAX SAO IDS~3I4"SPHERE 1/3 HP,~ 1 3 HP . - 1/2 AND-T:HP 1750~~RPML . 175 RPM 345~RP M V, 1 r uX_+c+eF+7 r . yyS..~ ttyy++ >rS{ 0 ~x..a. Y r C .w mom 7_6 A, 7 ` demon. c ~ . • Available in automatic or manual • Available in automatic • Available in manual or automatic • Non-clog bronze impeller • All bronze construction • Automatics feature reliable • No suction screens to clean • Non-clog bronze impeller diaphragm pressure switch (1 /2 HP), • Oil-filled, double ball bearing motor • No suction screens to clean wide-angle float switch (1 HP), both with built-in overload protection • Oil-filled, double ball bearing motor with piggyback plug-in • Carbon/ceramic faced mechanical with built-in overload protection • Dual shaft seals standard. Seal fail- shaft ,seal • Carbon/ceramic faced mechanical ure sensor capability available (wired • Great for septic tank effluent, shaft seal to alarm device) on manual pumps elevator pits, high capacity sump • Reliable diaphragm switch • Non-clogging 2-vane cast iron service;' industrial circulators • Completely fie Id serviceable sewage-type impeller Reliable diaphragm switch with • 1-1 /4" ischarge • Rugged cast iron construction piggyback plug-in • 1 /XI , o 115V • 1/2 HP (SPD50H) and 1 HP • Rugged cast iron construction G t • Com letel field serviceable opt l~ (SPD100H)xmotors Ball bearing P „ y a S construction and oil filled . •1~1 t/2~ NPT discharge` p~ • 2 NPTdischarge (3~ flange,opt) ! i/3 HP '1'4 1]5V or 230V , ;_Qp.~'`) • 1/2 HP lra i~. "5 0 230 'and Jo t*4Y 200V; 460 , =05,7.5 iY .230V'a 00 3 2 Qk 5~ ` kr fi c~` ..Y 2n... uar., m. -c.. nrtarE iiuai M 4'0'iay *esw+c is W ! LL 048 _ ! _ - iT-F - 17N_ 1 32 0 0 10 2 50 60 0 10 20 30 40 60 60 00 24 48 72 30 40 _ 96 720 T 144 CAPACITY-U,S.P.M. CAPACITY-U.& G.P.M. CAPACITY-U.S. G.P.M. 4 `~7~ SOIL AND SITE EVALUATION REPORT Page of LHR in accord with ILHR 133.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but ,51• C l~ O / not limited to vertical and horizontal refereripe 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 A IN S / GOVT. LOTS 1/4,5 Z= 1/4,S J;~ T 2 g N,R 1,3` SW W PROPERTY QWNER:'S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [WOW NEAREST ROAD .6-110 2- 5~ X el- I-e- -j New Construction Use (SCI Residential I Number of bedrooms _ (J Addition to existing building Replacement ( ] Public or commercial describe Code derived daily flow > O gpd Recommended design loading rate ~bed, gpol0. ~trench, gpd1ft2 Absorption area required oe bed, ft2 /V f/ trench, ft2 Maximum design loading rate bed, gpd/tt2-!Jtrench, gpd/ft2 Recommended infilVation surface elevation(s) ~D F 7 ft (as referred to site plan benchmark) Additional design I site considerations D r S,,f N d g e X If i i? c~ d w k de X SY Sr-el-I Parent material A- C t'4 7` / C Flood plain elevation, if applicable - ft HOLDING TANK LUs Etab le :floerfor system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL tabs stem[I S ® U ®S U El S 8 U ❑ S ®U ❑ S ®U WS ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o.. Ground 3 -,;2a /o' s 7 S/ C, 6 r G' 114 F Z w IV F /VH /Y,.,.* elev. Al ~ i1 5 t ?~HK A d e 1\4. V'C f V/4 Depth to limiting fact Remarks: Boring # El I d: a d spa S Ground .elev. N jo ft. -Depth to limiting , factor Remarks: CST Name _Please Print M t1 Phone: Z dJ~ ~3 c3' C/r~e iv s/; Address: 2.~? 02 Yi - Gee Spnature: ~ez p s ate: _ CST Num7r.~&, PROF I.. Y011NER C7e N /i/ tS (:241yhly SOIL DESCRIPTION REPORT Page 2 of 3 PAKk IA LD l7D Sy Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench x Al A .2 A- _I o, W X14 5-lel- X5,6 r iyC" Z ,5- C S Po ~-S' Ground .2d 3 Ia %y /D' vl 7 J 5 /G a~~i; c ~S A- /Yr A elev. ,o srr~e,~ ~v c • 79 it. o 5" -6-YI? 7A? L aA 61 e /H A y Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor i Remarks: Boring # Ground elev. ft. Depth to limiting ' factor Remarks: Boring # lf3 s Ground elev. ft. Depth to limiting factor Remarks: S94-20203- a i ° i t e, .4 i'm - 2~ ai i ~ i I x s J - - - -VT - - ---1- I I i } I L I F --i L -4 1 : i- t r I I ~ I- I ; ~I ' ' I 1 ' I Ir , ' - I I I -r- II ~ - - I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER oP-e, =,La MAILING ADDRESS Z z~6 jzr*e- G~ lt~y PROPERTY ADDRESS / (location of septic system) Please obtain from the Planning Dept. CITY/STATE 2~ PROPERTY LOCATION 1/4, S~ 1/4, Section /7 T Z~ N-R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER r-- CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: /ee r"41 ~ DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 Y S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only 'result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property k42~ Location of property,Et,2_1/4 _1/4, Section 1ZT_af_N-R_,/c0_W Township _ii Mailing address FIF 91'a-Ze 4_1 4: Address of site Subdivision name - Lot no. Other homes on property? Yes No Previous owner of property Total size of property .j Total size of parcel d~ Date parcel was created /f 7 q Are all corners and lot lines identifiable? Yes X No Is this property being developed for (spec house) ? Yes No Volume and Page Number 64* as recorded with the Register of Deeds. 51y// 6y INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No.07 and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. y f -5- Signature of-Applicant Co-Applic t Date of Signature Date of Signature j ,FOC_N-FNT NO STATF bzkn OF R"ISCONSIN FORM 5--1982 T,r S-E RESERVED FOR RE~ORD,NG DATA PERSONAL REPRESENTATIVE'S DEED 481615 uEER 9111PAH SA Patrick- Mahoney-•-----•-•-- ' REGGIST.STER'S OFFICE CROIX CO., VA as Per-sonal Representative of the estate of • Reed or Record Rosella Mahoney, a/k/a Rosella Mahoney ARRO? 1992 ("Decedent"), Ot 8:30 A. M for a valuable consideration conveys, without warranty, to . Dennis R. Ohman and Margaret A. Ohman, as marital I------------ - - - - property _with rights of surv-•-ivorship ~ - Dee& , Grantee, RETURN -O the following described real estate in St.___Cr_Q1X County, State of Wisconsin (hereinafter eJ- led the "Property") Tax Parcel No: 16 2/3% interest in the following described real estate: The Southerly 250 feet of the Easterly 475 feet of the Southwest Quarter of the Southeast Quarter (SW} of SE}), and the West Half of the Southeast Quarter of the Southeast Quarter (W} of SE} of SE}), all located in Section Seventeen (17), Township Twenty-nine (29) North, of Range Fifteen (15) West. This conveyance is a distribution of the Rosella Mahoney Estate of the Vendor's interest in that certain Land Contract between Rosella Mahoney and Grantees, dated February 12, 1979 and recorded February 13, 1979 in Volume "589", page 369, as Document No. 355027. +o- 30.sa Personal Representative hp this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedert's death, and all tl:e estate and interest in the Property which the Perscnal Renresentative has since acquired. P-itvd this dap of :'larch 19.92 l (SEA L, (SEAL) -Patrick Mahone ATITHFNTICAT10N ACKNOWLEDGMENT S!:•nrit,;!-- Patrick Plahoney Ca t~;<! n~~15 } autF nt ro ed t , _ I- dxy,o h! t9-92- P rsonally came before me this ..day of 19 . . the above namMl Hendrik W_ Van Dyk... TITT.F,: ',T1-'NlBFR.ST.•.TF RAP OF Wi~l'O.\.,IN . - i l: nt aut zrd I c O•; or;, ij-ic sent .1 to me : n n to he the rwrson who executed the f re^o^'- in<tr;:nur.t and ac--nowledze the same. 7, R- :`/A5 rRAFTt-o ny Reinstra, Van Dyk & :Needham, S.C. 201 South Knowles Avenue, Box 127 New Richmond, WI 54017 ~..n ~,l Co7nrc, R is. i~i,.l,,•rte~ .,...,.v e?-wrnti,'n r• 19 oftt` :A1. Rf Pn:. IYF 14,Fn W`•1 V. 1 SOIL AND SITE EVALUATION REPORT Pap Z of_ in accord with ILHR 83.05, Wis. Adm. Code COUNTY I LHR Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but s/' C R / not limited to vertical and horizontal refererre point (BM), direction and % of slope, scale or PARC):L I.D. e dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY : DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION S GOVT. LOTS W 1/4 SP 1/4,S 1,7 T ,'L N,R 1,5- 1* W PROPERTY 7NER.'S MAILING ADDRESS LOT # IBLODK# SUED. NAME OR CSM # 9- _T40 rjh-- Are, ITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE [WgW NEAREST ROAD [ ] New Construction Use b(] Residential / Number of bedrooms - Addition to existing building 04 Replacement Public or commercial describe Code derived daily flow i a Q gpd Recommended design loading rate 1~Ibed, gpddt2 . _ f- trench, gpddt2 Absorption area required A', A0 bed, 112 /V trench, ft2 Maximum design loading rate -,-d bed, gpd/lt2_,_S- Vench, gpd/tt2 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site Considerations 0 SA N I( R e 4 if i'? & d t/ N de g 5y s1 `ei~! Parent material e- f .41- 7` i L Flood plain elevation, if applicable - - it S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HIDING T MK U= Unsuitable for system DS W U ® S ❑ U ❑ S ®U ❑ S ®U DS ®U -[--WS AU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell G1u. Sz. Cont. Color Gr. z. Sh. Bed Trench 5/C/_ .2 ',A Y F17 C U s ~o rs- ~ w 1 v~ /I JYi1 Ground S All C w F elev. P4 oz /0 5t1?e.pK C , A(~ l~ h'~ V 6Z i Jt- 6 l "-O 7 r ft. 2e r 2 17 Depth to limiting factor ' X X Remarks: Boring # ZROX a- On 7- l o 51e,4- 2 SG ff M -1 o- w / F , .e.~ z d s i°o s 5 C a 4 JA_ C M r w i v /V,# w Ground /10 R-fi" 7 tev. p, i~~ft. - -Depth to limiting factor" Remarks: CST Name:-Please Print Phone: ress: 2~ Gv 1 / 7d 61 e/v tv d O C ^7` / O/ Signature: ate: jr CST Number- / .5 =o?- 70 8 P Rn O MER Ve lS/N IS Dl MA& SOIL DESCRIPTION REPORT Page .2 of 3 "PAIiL`IELII). t 0 9 - / Lio -$4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD/it in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ranch / v- /o ,opt-;q w F , 1d 5RO7S" Ground 3 a-/ /D 8' FS Aj /v *A /VA elev. ~,2PSrRBA Depth to limiting factor „ I Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # :ryf Ground elev. It. i Depth to limiting factor ' 1 Remarks: Boring # 131 Ground elev. ft. Depth to limiting factor Remarks: I ~ ~w n / e c - o - a 0 - - - -I - - _ I v - - - - 8p _ d _O ~U $ e I o _I~- cy ~R N I ~ - - - f !Akd G tic y . v • Alto Ia 44. 7+4 N 14- 6'h 1 0 1 W W ~ LL TOTAL DYNAMIC HEAD FEET/ ° HEAD CAPACITY CURVE METERS YGALLONS/LITERS ~ ° MODEL137-139 30. CAPACITY - 1 "11 _HEA_D UNITS/MIN ° 00 FEET METE-RS GAL LTRS NPT 25' 5 1.52 104 394 °a 10 3 05 79 300 ° = 15 4 57 64 242 y 0 20 610 36 136 c 6 20' 25 7.62 B 30 Z 26 _ 7 92 0 0 a 15'- 10 4 , TT. t o,- 2 (r 2 5' 12% o I U's. 10 20 30 40 50 60 70 80 90 100 110 GALLONS 4 LITERSI 80 160 240 320 400 - 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V or 230V. • Mercury float switches are available for controlling sinale • Electrical alternators, for duplex systems, are available and and three phase systems. supplied with an alarm. • Double piggyback mercury float switches are available for • Mechanical alternators, for duplex systems, are available variable level long cycle controls. with or without alarm switches. a Long cords are available in lengths of 15-25-35-50 fec, • Combination starters are available. a Over 130°F. (54°C.) special quotation required. Standard All Models - Weight 47 Ib1. 1/2 H.P1 SELECTION GUIDE SELECTION IJIDE 1 Integral float operated 2 pole mechanical switch, no external cor reau red 137/139 Series Control Selection 2 Single piggyback mercury float switch or double piggyback : float Model Volts-Ph Mods Amps Simplex Duplex switch. Refer to FMO447. M137/139 115 1 Auto 10.4 1 or l &8 _ 3 Mechanical alternator "M-Pak" 10-0072 or 10-0075. N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 4 Combination Starter. Refer to FM0514, D137/139 230 1 Auto 5.2 1 or 1 & 8 5 See FM0712 for correct model of Electrical Alternator "E-Pak E137/139 230 1 Non 5.2 2 or 2 & 7 3 or 5 & 6 6 Mercury sensor float switch 10-0225 used as a control actin 2tOr. specify H137/139 200-208 1 Auto 8.2 1&8 - duplex (3) or (4) float system. 1737/139 200-208 1 Non 8.2 2&7 3 or 5 & 6 7 Four (4) hole "J-Pak", junction box, for water tight connecbJ^ c- v ,ed-in 'J137/139 200-208 3 Non 2.2 2 & 4 3 & 4 or 5 & 6 simplex or 2 pump operation, 10-0002. F137/139 230 3 Non 3.0 2 & 4 3 & 4 or 5 & 6 8 Two (2) hole "J-Pak", for Watertight connection or splice, 10-0'T G137/139 460 3 Non 1.5 2& 4 3& 4 or 5& 6 ' No molded plug Three phase units require a control switch to operate an external magnetic or combination CAUTION starter. All Installation of controls, protection devices and wiring should be done by a auaiRfied For information on additional Zoeller products refer to catalog on Combination Starter, licensed electrician. All electrical and safety codes should be followed Inc!.d.rq Me FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the Occupational Safely and N«"~ Art Mechanical Alternator, FMD495; Alarm Package, FM0513; and Sump/Sewage Basins, (OSHA). I 'M0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller purn(- MAIL To: P.O. BOX 16347 Manufacturers of. Lcuiswi:e kIr 40256 C,47 Z,9,FZZ1,-ff TZ7. SHIP TO: 3280 Ofd Mi ie's Lane 11 Lcutwille, KY40216 QUALITY PUMPS 5NCE M9 (502) 778 7"?' • FAX (5C' 774 36?4