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HomeMy WebLinkAbout038-1126-50-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS ©i"~~rTsr~ G</~ Sf~~~S SUBDIVISION / CSM# LOT # SECTION__,aZ_T N_R ~/W, Town of ~ 4 .0"!r~ ST. CROIX COUNTY, WISCONSIN tG LANVIEW SHOW EVERYT ITHIN 100 FEET OF SYSTEM I V ~Cf INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 i 1 BENCHMARK: Q,' ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House -,-2 Other Pump: Manufacturer ~oo/I " r Model# _ Size 2 Float seperation ~o ' Gallons/cycle: Alarm Location .SOIL ABSORPTION SYSTEM / Width: /r,9 Length -43;- / Number of trenches _ Distance- -Directi-0n-to-nearest -prop.- --1-ne-- d Setback from: well: House other /7 ELEVATIONS Cam' ~'r f 9? Building Sewer ST Inlet ST outlet PC inlet PC bottom Pump Off Header/Manifold fV, Bottom of system 9 / 101-5- Existing Grade Final grade /4:767_S- DATE OF INSTALLATION: 40 -7 G - fL PLUMBER ON JOB: 100 LICENSE NUMBER: INSPECTOR: 3/93:jt mom Wisconsin Doartmentof Industry, PRIVATE SEWAGE SYSTEM County: Labbr and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION C Pe51tHoINI s's NinA .E ❑ City E] Village ( Town of: State Pla2njC#Po4 9 A i star Rra.iriia CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /G~~ /dd , ~d oS~irC' M9Ty^ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark d . Dosing Aeration Bldg. Sewer OY" 7 6.2 Holding _ St/ Inlet ( 7 TANK SETBACK NFORMATION St/ Outlet 7, 9 ' (P ' TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet g Q p Air l Septic moti' f ' NA Dt Bottom , d~9/~ o 6, / Dosing 37 NA Header L (,0/ 9F-6 3 (o, Aoerattor- Dist. Pipe Z/ 0',c( 7 Ho1din9--- Bot. System PUMP /StINFORMATION Final Grade Manufacturer /11 Demand "~JPr a 9,9 y ~3 PM ~~jJ~ ,3 (0~~ Model Number I Loss Friction System TDH Ft TDH Lift Head a _71 Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Lengtb. O No. Of Trenches PIT No _O__f Pits Inside Dia. Depth DIMEN I N <7- DIMENSIONS SYSTEM TO P/ L BLDG WELL 1AXttSTREAM LEACHING Man cturer: SETBACK d Moe Number: INFORMATION' TypeO L CHAMBER" System: e nv, bk0 / o., OR DISTRIBUTION SYSTEM Headers , i Distribution Pipe(s) x Hole size x Hole Spacing Vent Ta Intake Length Dia. LengthsLL Dia. Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems y Depth Over Depth Over xx Deptll,Qf_ xx See /Sodded xx Mulched Bed /_TfEjEELenter - Bed /+zmaci Edges ~D - Topsoil - Yes No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATIO : Star Pra ' rie . 31.31.18W, NW, NE, Lot 7,-,County Road { / art Q¢ZCF;yr{~:t e. F t c_r4i/.~ z.(i ~ _1~~~ f, 't ,r Plan revision required? es ❑ No ~Y Use other side for additional information. c-lv SBD-6710 (R 05/91) Date Inspector's Signa re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: P 1? 0() S-q- d PLOT PLAN PROJECT Dale Secard ADDRESS 1883 Co. Rd. C Somerset Wi 54025 01 / J NE 1/4s 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX ~v w p MPRS BYRON BIRD JR. 3318 DATE 5/21/94 BEDROOM 3 CONVENTIONAL XXX IN- OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE 800 Gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X54' BENCHMARK V.R.P. Base of Door Slab ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark VENT SYSTEM ELEVATION 97, .S 12" GRADE 912' VERING 1"6i SK County Road C 30' Pro e Line 100' 70' 35' 110' B"3 12' Vent 05' o Note: Old I I System will 4 I I -2 g be Properly o Abandond I I r Iti CD 80 54 `C N 10' 5' w V N, CD B-1 w 10' 50' L ST 50 22' 5 40' e • Door Slab ' arage 3 Bedroom House 8 ' 30' 50' Apple River PAr,t GF PUMP CHAMBER CROS5 SEC"IOIJ AMD SPECIFICA-rious VENT CAP 4~~C.I. VE!~T PIPE WEATHERPROOF APPROVED LOCKINM ~ 25' FROM DOOR, JUUCTION BOX MANHOLE COVER wim60W OR FRESH IZ"MIU. AIR INTAKE GRADE Y"MIN. I 18" /`1 I Al. COIJDUIT _ 11~ IIJLET T__T__ PROVIDE AIRTIGHT SEAL T A I III I i III I ALARM a I I I I 1 c *APPROVED I I ow JOINTS WITH I I ELEV. Y FT. APPROVED PIPE I 3' ONTO PUMP 1. OFF D SOLID SOIL H i COAICKETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE TN AI KS MAMUFACTURE:R:: - --Ie IJUMBER OF DOSES: PER DAS TAKJK SIZE: _.,_.&ad GALLOIUS DOSE VOLUME ALARM MANUFACTURER: INCLUDING 6ACKFLOW: GO GALLONS MODEL t.1UMBER: CAPACITIES: A= 4LICHES OR O GALLONS SWITCH TYPE: A -c.rG - W H B iC ES OR _,;~_„:.LLONS PUMP MANUFACTURER: Ada-~fl~.~ C=~-IAICHES OR4~~4040_ GALLOIJS MODEL NUMBER. 'f nn D- INCHES OR Q`y~ GALLONS SWITCH TYPE:t,••cr~~~?2GrGcVfy MOTE: PUMP AND ALARM ARE TO BE MImIMUM DISCHARGE RATE- ylR GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEMCE BETWEEU PUMP OFF AUD pis I TR UT B tOU PIPE.. FEET + MIIUIMUM NETWORK SUPPLY PRESSURE " . . . . . . . _ FEET FEET OF FORCE MAIM X 4j2_F/pp jtFltICTIOU FACTOR.- FEET TOTAL DtOJAMIC. HEAD = 64j 'L5 FEET r/ 1 II~ITER0.IA DIMEMSIOIJSi OF TANK: LEIJCsTH _ / _;WIDTH ;LIQWD DEPTH 7 HEAD/CAPACITY CURVE EFFLUENT & DEWATERING TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE ~w 5366 34.. FT. PA, GAL VA GAL LTR GAL OS GAL LTR GAL LTA GAL LTA GAL LTR _ GAL LIP GAL LLTA 115- SERIES 57-W 9e 137-In let 163 185 186 188 #.90~3.4 189 It 1 T 1 231 59 w 32 105 _ 34 61 231 79 XQ 100 378 61 231 61 al 58 220 161 100 5 I9 4b 84 249 91 344 60 6o 58 200 145 649 95 28 1 466 127 481 990- 30 40 1219 0 174 46 1 75 293 59 220 114 4316 60 16,24 1 90 3~ 125 1 IQI 58 219 68 220 100 379.'. gp 1 36 130 69 71 85 70 21.34 30 114 10 39 52 q97... 51 7193 70 266. 75 106 54 204 22 186 24.38 14 63 45 1 2B 770- 90 V Q 32 1 2 8 37 4 100 & 4S 18 21 79... 20 65 165 110 3200. 7 26 8 30 s. 8 60 Lock Vdvo: 19.26' 23' 26' 68' 88' 8T 73' 115' 91' 112' 55 WARNING: Model 185 should not be subjected to less 16 50 163 than 30 feet TDH. 14 NOTE: For Head Capacity on Model 112, Industrial 45- column-explosion proof pump, see FM0219. ~2 40 185 35 311189 8 25 n 20 61 4 15 188 10 98 51, 5 131.139 57,59 U.S. GALLONS t0 201 _ _ 30 40~ 50 60~ 70 80, 90^100 110 120 ~130 140 150 160 LIT-ERS so 6o 240 Sao 400 460 560 640 0 w SEWAGE & DEWATERING TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE w SERIES_ 26'2 268 267 _2.6_9 _ _2_92 284 292 293 294 295 75 FT. M. ,Gat Lt Gd Ltrs. Gal. LIM Gal. Un GaL Lie.. Gat Um Gad. Ltrs::. G& Lb-, Gd Ltr31 Gal. Lim, 2 ` - 5 1.52 90 341 129 464 129 .484 129 4a4 130 492 180 681 140 630. 196 742. 225 852 70 10 .3.06 60 227 B9 337 89 337 89 337. 86 360 158 69e 124 468. ....191 896.. 205 778 15 457 225 '.85 50 189 50 189 50 189 63 238 136 611 106 401.. 130 492 165 625 185 700 20 610 10 39 10 38 10 38 33 .125 106 401..... 88 333 119 460 150 689 168 638.. IS 30 25 7.82 76 288 66 257 106 401 136 616. 153 680. 30 914 43 163 47 178.. 90 340 121 458 140 &'70 55 40 1219 5 19'.:. 50 189 94 356 115 436 !5 50 50 15.2A , 58 220 89 337 60 18.29 13 49.. 59 223 t4 - 70 21.34 25 96'.. 45 Lock Vaba: 18' 21.5' 21.5 ___21.6' 26' 35' 42' 60' 82' 1. 40 12 WARNING: Model 293 should not be subjected to less 35 than 15 feet TDH. 10 30 293 8 25 6 20 282 15 4 284 10 Z 262 292 5 1 266. 67, 68 294 295 0 U.S 1 1130 140 1150 160 11701801901 200 2101 220 230 tITERc~LLON 10 201 0 40 50 60 70 80 90 10T10 120 T I,I~m.. 0 80 160 240 320 400 460 560 640 720 800_ I SERVICE CHECK LIST WARNING: ELECTRICAL PRECAUTIONS- Before servicing a pump, always shut off the main power breaker and then unplug the pump - making sure you are not standing in water and wearing insulated protective sole shoes. Under flooded conditions, contact your local electric company or a qualified licensed electrician for disconnecting electrical service prior to pump removal. WARNING: Submersible pumps contain oils which becomes pressurized and hot under operating conditions - allow 2% hours after disconnecting before attemong service. CONDITION COMMON CAUSES A. Pump will not start or run. Check fuse, low voltage, overload open, open or incorrect wiring, open switch, impeller or seal bound mechanically, defective capacitor or relay when used, motor or wiring shorted. Float assembly held down. Switch defective, damaged, or out of adjustment. B. Motor overheats and trips overload or blows fuse. Incorrect voltage, negative head (discharge open lower than normal) impeller or seal bound mechanically, defective capacitor or relay, motor shorted. C. Pump starts and stops too often. Float tight on rod, check Valve stuck or none installed in long distance line, overload open, level swftch(s) defective, sump pit too small. D. Pump will not shut off. Debris under float assembly, float orfloat rod bound by pit sides or other, switch defective, damaged or out of adjustment. E. Pump operates but delivers little or no water. Check strainer housing, discharge pipe, or if check valve is used vent hole must be open. Discharge head exceeds pump capacity. Low or incorrect voltage. Incorrect motor rotation. Capacitor defective. Incoming water containing air or causing air to enter pump. F. Drop in head and/or capacity after a period of use. Increased pipe friction, clogged line or check valve. Abrasive material and adverse chemicals could possibly deteriorate impeller and pump housing. Check line. Remove base and inspect. If the above check list does not uncover the problem, consult the factory - Do not attempt to service or otherwise disassemble pump. LIMITED WARRANTY Zoeller Pump Company warrants, to the purchaser and subsequent owner during the warranty period, every new Zoeller Pump Company Contact an authorized service station to obtain any needed repair or product to be free from defects in material and workmanship under replacements parts. For additional information pertaining to our normal use and service, when properly installed, used and maintained, warranty or if service cannot be obtained locally, contact Zoeller Pump for a period of one year from date of installation or 18 months from date Company, P.O. Box 16347, 3280 Old Millers Lane, Louisville, Kentucky of manufacture, whichever comes first. Part(s) that fail (within one year 40216, Attention: Customer Service. of installation or 18 months of manufacture, whichever comes first) that inspection determine to be defective in material or workmanship, will be ZOELLER PUMP COMPANY EXPRESSLY DISCLAIMS LIABIL- repaired, replaced or remanufactured at Zoeller Pump Company's ITY FOR SPECIAL, CONSEQUENTIAL OR INCIDENTAL option, provided however, that by so doing we will not be obligated to DAMAGES OR BREACH OF EXPRESSED OR IMPLIED WAR- replace an entire assembly, the entire mechanism or the complete unit. RANTY; AND ANY IMPLIED WARRANTY OF FITNESS FOR A No allowance will be made for shipping charges, damages, labor or PARTICULAR PURPOSE AND OF MERCHANTABILITY SHALL other charges that may occur due to product failure, repair or replace- BE LIMITED TO THE DURATION OF THE EXPRESSED WAR- ment. RANTY. This warranty does not apply to any material which has been disas- Some states do not allow limitations on the duration of an implied sembled without prior approval of Zoeller Pump Company, subjected to warranty, so the above limitation may not apply to you. Some states do misuse, misapplication, neglect, alteration, accident or act of God; that not allow the exclusion or limitation of incidental or consequential have not been installed, operated or maintained in accordance with damages, so the above limitation or exclusion may not apply to you. Zoeller Pump Company instructions; that has been exposed to but not limited to the following: sand, gravel, cement, mud, tar, hydrocarbons This warranty gives you specific legal rightsandyou may also have other or hydrocarbon derivatives (oil, gasoline, solvents, etc.) or other abra- rights which vary from state to state. sive orcorrosive substances, is in lieu of all otherwarranties expressed or implied; and we do not authorize any representative or other person to assume for us any other liability in connection with our products. SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY Cw ~ J C` PERMIT # STATE SANITA ' -Attach complete plans (to the county copy only) for the system, on paper not less than t G~ 9 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 / Ir PR P TY LOCATION IG acW14 F'/4,S T3l,N,R E(or PROPERTY AMER'S MAILING ADDRESS ^ LOT # BLOCK # - 3 6 13, 4111 - 7 1 - CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check One) ❑ State Owned O VILLAGE N~FAREST ROAD ❑ Public DQ 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) ;7, 4,_ - ooo 1 ❑ Apt/Condo J 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash S ❑ 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. & Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 6 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 420 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 413 xl~ Ile _ , Feet s Feet CAPACITY VII. TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank l X Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber* 'gnature: (No Stamps) MP/MPRSW No.: Business Phone Number: )o - 74d Plumber's Address (Street, City, State, Zip Code . IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sapitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) P Surcharge Fee) Approved ❑ Owner Given Initial it 00 Adverse Determination Cl 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 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. 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) PLOT PLAN PROJECT Dale Siecard ADDRESS 1883 Co. Rd. C Somerset Wi 54025 N 1 / c NE 1/4s 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS BYRON BIRD JR. 3318 _ DATE 5/21 /94 BEDROOM 3 CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 BED SIZE 12'X54' BENCHMARK V.R.P. Base of Door Slab ASSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark VENT SYSTEM ELEVATION 97.8 12" GRADE TYPAR COVERING 12" 3' 6' Q3' i , SEW ER R K County Road C 129 30' Pro e Line 100' 70' 35' 10' B-3 12' Vent I Note: Old 105' I I , System will 4 I I -2 be Properly d Abandond I I r" C 80' I I 4 CD `C N 10' 5' w N B-1 20' 50' ST 50' T 25' 22' 5' 400, ' Well M. Door Slab ' arage 3 Bedroom House 8 ' 30' 50' Apple River Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but - er O 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: GPROPERTY OVT. LOT LOCAT1ON4 1/4,S_? i N,R j~' E (60W &,C 3 PROPERTY OWN MAILING ADDRESS e LQL# BLOCK# SUBD. NAME OR CSM # CITY, STATE ZIP CODE HONE NUMBER ❑CITY ❑VILLAGE .MOWN NEAREST ROAD ~S (7i C [ ] New Construction Use [X] Residential / Number of bedrooms [ ] Addition to existing building (A Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate L~bed, gpd/ft2-. L-trench, gpd/ft2 Absorption area required 6~ bed, ft2 563 trench, ft2 Maximum design loading rate , _2 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem Kj S ❑ U ZIS ❑ U WS ❑ U J O S ❑ U ❑ S 5 ❑ S [at 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 Tmrch 312 S/ Is Vw- 31-1 Ground t71 7 elev. tt~~ 9 ft. A/ t9. !IVA. Depth to limiting factor 7~G Remarks: Boring # ' D- vtjr 312 [~T~ L's f s 6 A: a-6 02 < D ~ s y / y_ 6 A, Ground elev. /0"t. Depth to limiting fact 7 2Remarks: CST Name:-Please Print P ne: _ Address: G ~ / G '0r Signature: O b Date: ST Numb PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu: Sz. Cont. Color Gr. Sz. Sh. Bed Trench 67-6 Ao~ 4A AAP-A! 1b1 I a a / C S s . Ground LI S C' ~f lam, ft. - X4 r y ~!a JV,J4 r or Depth to limiting factora 12 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Soil Test Plot Plan Project Name Dale Socard Byr Bird Jr. Address 1883 Co. Rd. C Somerset Wi 54025 3479 Lot 7 Subdivision Date 6/25/94 U 1 /4 NE 1/4S31 T 31 N/R18 W Township Star Prairie Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft.Base of Door Slab System Elevation 97.8 * H R P Same as Benchmark County Road C 30' Pronwe Line 100' 70' 35' 10' -3 o -2 b ,c N 05' 24' 180' w 1 -1 w 50' 0' T , 22' 40' 2 Door Slab Garage ' 3 Bedroom House 8 ' 30' 50' 1 Apple River STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OVVNER/BUYER le- d i.- a c4- MAILING ADDRESS Z e 8j -3 L CAJ 5`/ PROPERTY ADDRESS G (location of septic system) Please obtain from the Planning Dept. CITY/STATE S 4 /-,n e el-r („2 . PROPERTY LOCATION 1/4, ~y 1/4, Section 3/ T~N-RIL_W TOWN OF J7L-a y ' r C• r'r C, ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP Awp~,-, , 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. 11We, 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( ~'C t J DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 54016 11/93 STC-100 This application form is to be completed in full and si ned b the oc~ner (s) o~ the property being developed. 1~n i 9 Y will only result in delays of the Y nadequacies development be intended for resa le bytowner/contrachtord s h~s House), then a second form should be retained and completed when ~I the property is sold and submitted to this office With the aPProPriate-deed-recording ~ owner of property Location of property~(/JJ,/4 ..x.1/4 ~ section 3 I T,~! ,N-R~W Township ~ 2•lailing address1 6. Sa.,-, C~ ~J~ 1lddress of .site S ~c.s Subdivision name r Lot no . other homes on ro er p t ? P Y es Y No Previous owner of property ~ ~i ~,~c~r _ .ten ~ ; ~ Total size of parcel ~ Z Date parcel was created ~j~ Ire all cornors and lot lines id ent if iable? ~ Yes No Is this property boing developed for . (spec house ? ____Yes ~ No volume~$nd Page Number ;;~~~~//3 of Deeds . ~=.L__ as recorded. with the Register I~ INCLUDE WITH TIiIS 11PPLIC ~ 1i'~IZIWI'i'Y UL•'ED wh.tch includes a I)OCUHENTEN 2iI3ERWIVOLUHE AND PAGP i 11UI•IISIsR & '1')Ir SEAL OF TIIE ILCGISTEIt O c ertificd s F DEEUS. wive if In additio Y, available; ;would be helpful so as to avoid delays of t}ie reviewing process. If the deed description referenc©s t.o u Certified survey lamp, the certified survey Ma shall also be required. p PROPI~tTY OWNER CERTIFICATION I(~~'e) certify that all statements on this form are true to the best of my (our) knowledge that I we the property described in this information Sorm, by vi tue sofoa warranty deed recorded in the office of the County Register o Deeds as Document ?lo. a~; 02 79o f ( ) presently o~:n the proposed site for the sewage disposalt ystem or I we obtained an easement, to run the above described ro ert ~ ) tl~°- construction of said system, and the same has bean duly recorded in the office of County Register of deeds as Document No ~ ~ Signature of"ap~l cant Co-appl cant Date of Signature ' • Date of signature No. 261). \\1l V,11-0 D -d- To II' laud'Anl\\•Irc - Jo ut '1 n.-1 PuDllk.E by Kau Clam 0"k• 8tatl.a.ry CoxF. 7 9 3btDenture, !`lade this 8 th day of June between Urban (lo-nisi n -,»d "nuline Germain, husband and wife, rand e rr_,h in their ow,i Individual capao.ity j; part ies of the first part, and Dnl(, ',innrd rind, `>h,tron Slcard husband and wife, as joint tenants, parties of the second part. tL MICOOCO), That the said part loo of the first part, for an, to consideration of the Burn of One, Poll~-Ir• .-,iA otli,?r f-o0:1 ,nil v 11u:Ible consideration Dollars" them to in hand paid by the said parties of the second part, the receipt whereof is hereby ' I confessed and acknowledged, ha ve given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed and by these presents do give, grant bargain, sell remise release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate situated in the County of >t;. Cr<~iX Wisconsin, to-wit: r±~, 't. urirter of Northeast (:),11-te3, (I'Il1' of 1T-~ ) 11 t,h;~±. . ~Irt; t,Y!~ IT >~.tIoil Tl-,I rt11-013 (31) TlArt•y-one (31) Nort)-I, -,f I'j P;if~htl ~_m (18) •,fi, ~t. ('ro1:. C-111J,y, 1.41,sCon:;11-1, descrlb~'d ';r 'fr„~ I,r)J)It. of 'r)C rJ I IYIr is rI rnSr,'; on thf~ Eristorly line of C(-urit;y rl1~ 11- .~n~, "C"~ rGr>, 3 f t; it rt1: :end 207-6 fe1_~t Enst of the Southlaest COI-%i r Of ,~f1 I ;l of,'I. , t,i nn 31, P-Tr:i::hi P 31 North, P,-Inge 18 b'To P,t; t.hl t ~ t. r.l nar.11e1 t17 tile :i1~lIt1I 11nc of NW1ofNE3, Section 31, foI lt..tl f1,1-. ; N r t h r3ot;~;t '.r,_ ,:;t for 100.00 feet; thence ldest and par:Illt?1. to t,hc ,~71id So'Ith 111111 (1f .P-1 ofN'F:. , ~ct,ion 31 for 167.1 feet to its line of Cou;ity Hic-hivrIy IT"; thence Southerl.,y Iilonp :t ;113 } ,r-1F:tnrly 11no of County :11c-Ivy-;ay °C" for 104.07 feet to the point I e"Iinnl11e. ~.lso ,31.7. th-:t; rt,rlp of land lying, between the 1~'r,: t~~rly of 1;11o. 'it)(?vi~ de: cl^1Y~e-~ Lr,_I t and the Irle.^,terly shoreline r,f -)vr'_,r .nd Ir t~rl~°f~II th(~ Tlort.li and Snutli lidos of said tract E~;3cII f~xLr~t,_ll:cl of nr)ple River. I tit'. j 111) ~ li i it { j~ i it Logrt!)rr, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise i appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part jl of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. jl Zo )abr anb to t)olb, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part, as joint tenants. S111U Mc ~;aio, 1,Irh ~n C il;'t1 !i ~n11 ''~~i111n~~ Germain, husband and wife part I-r: of the first part, for t.ll ~-~1 vos, tht'ir heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said parties of the second part, and to and 'T with the survivor of there, his or her heirs and assigns, that at the time of the ensealing and delivery of these presents t:h1>:,7 arc' well seized of the'premises above described, i i ij 19 Al rVE` 43 to ~ r) rJ 'cz: (b Ln o ~7 t~ 'u y or QF ix ~ ~ o C6 y l o O 7 ii rA. 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