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HomeMy WebLinkAbout040-1191-50-000 S r'f P STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~►-t- 11V C~ a r .s 0 kia ADDRESS Dk SUBDIVISION / CSM# LOT # ~2p~1 SECTION. Q~_T_N-R~C) W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S ~.ol a0a -7~ S.P INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form- Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION Manufacturer:-R/ VitI S-e Liquid Capacity: 95-1? rfJt. Setback from: Well C House ((,p Other Pump: Manufacturer 2u-c°ltp v 57Modelt 5', Size Float seperation 6„ Gallons/cycle: IqO Alarm Location GArv,,X SOIL ABSORPTION SYSTEM ol_t YV ~ Width: Length \ Number of trenches X11 O (,.k 1l1 c~. Distance & Direction to nearest prop. line: 30 5 a 1& Setback from: well: ~Z SO House d D Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inl-et-4(4G PC bottom Cj<,j Pump Off 7 , Header/Manifold p~(,5 Bottom of system (IS-, 19 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: C G' t'k INSPECTOR: 3/93 : j t I J F~ ■ ■ tt '111111i consinDepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX 9+afety at-id Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: PeyrpiLHSlslgrNanpeAYNE ❑ City ❑ Village ❑ Town of: State Plan o.: CST BBMKKEEleev..: W Insp. BM Elev.: BM Description: 7~ Parcel Tax No.: /00 S u . rC a_ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing , 7Sa Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet o o Air Intake t 7 Septic was ado` o pro NA Dt Bottom gyp,3~/ (00,Y Dosing )a ! o > (Sol NA Header/Man. Aeration NA Dist. Pipe Z /05-,77 Holding Bot. System %f 53 /0!;, 1 b PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Vv Model Number GPM J TDH Lift ')OA friction, y System v`,' TDH (_,,6 Ft Forcemain Length / 1 Dist. To Well >5c SOIL ABSORPTION SYSTEM BED/TRENCH Width 3 g LengtF~ / No.Of yrenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 ` ✓ DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK .9 0. CHAMBER INFORMATION Type Of Moe Number: System: aukiJ 3o' )Do, ~v! /J /A OR UNIT DISTRIBUTION SYSTEM *eelder /Manifold V\ Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length o Dia. Spacing 1~ I/ / 8 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over I xx Depth Of Txx Seeded bedded` xx Mulched Bed /Trench Center t}1 Bed/ Trench Edges Topsoil] Xes ❑ No QXes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Tro 24.28.20W, SE, SW, Lot 5, Plainview Drive Vs3 (z 's q may- y/ oy,~ I Plan revision required? ❑ Yes d No Use other side for additional information. G1 o SBD-6710 (R 05/91) Date Insrpe or Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: w i I L • SANITARY PERMIT APPLICATION I~~~Ilnlin In accord with ILHR 83.05, Wis. Adm. Code C07 STATE SI~Aq 0 RMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than f( C6 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 L)A /1 f /_~y ~J -7 S S/-'/4Soj '/4, S T X , R E (or) 40 PROPERTY OWNER'S MAILI G ADDRESS LOT # BLOCK # GA/ n / / rv Z 5 ,440~ 2 -3 -6 CI ITATE , ZIP CODE PHONE NUMBER SU IVISION NAME OR CSM N MBER rl 0.f ~orJ II. TYPE OF BUILDING: Check one) CITY NEAR T ROAD ( ❑ State Owned ❑ VILLAGE 'inL' e 19 NWN OF: ❑ Public a1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S 111. BUILDING USE: (if building type is public, check all that apply) 1 ❑ Apt/Condo- / ! J 2 ❑ Assembly Hall 6 ❑ 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) 9 A) 1.0 New 2. Replacement 3.E] 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 [Z-Mound S~ n NOT 41 El Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 0 W~ s 1 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressu ' / 43 ❑ Vault Privy 140 System-In-Fill N4#1~ 6, VI. ABSORPTION SYSTEM INFORMATION: O lG~ i~ S / c~ 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. EM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED too ELEVATION 'VII. TANK CAPACITY in allons Total # of v~ Fiber- Plastic Exper. glass App. INFORMATION New P-xisting Gallons Tanks G5 A464 Tanks Tanks , Septic Tank or Holdin Tank / w Lift Pump Tank/Si hon Chamber SCE / VIII. RESPONSIBILITY STATEMENT 's~ y~ 175 gE7- s I, the undersigned, assume responsibility for installation of the or, Plumber's Name (Print): Plumber's ignature: (No S ousiness Phone Number: Plumber's Address (Street, City, State, Zip Code ' Za 4- 1,15 IX. CO TY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued issuing ent t re (N to fi,P~{ 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 8 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. VIM. 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'/s 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) L SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations October 17, 1994 2226 Rose Street La Crosse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO 74 RIVER FALLS WI 54022 RE: PLAN S94-41358 FEE RECEIVED: 360.00 ' to`" TOWN OF TROY 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, zc~ I- ~ );E~ orenson Plan Reviewer_ Section of Private Sewage Ty( 608 ) 785-9336 'XIINGOF-FRGcc : ST CROI X SHD-64231 K. 61/91) Page of 6 MOUND SYSTEM 3 FOR 5 9 4 0 4 1 3 5 8 A BEDROOM RESIDENCE LOCATED IN THE SE 1/4 OF THESw 1/4 OF SECTION Z-Y,TZ-S N, RZO W, TOWN OF U1-( S'~, o-~Ulk COUNTY, WISCONSIN. INDEX PAGE l 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR w PJ L SEAN P~zSOU S RECEIVED OCT 1 3 1994 PREPARED BY WEGEF E:FZ SO 3E L TEST I p4 (-3 AND v pi p ~~a I3ES = (E;;V S~R~1 I CE F.O. BOX 74 421 M. KAIM ST. D ART4UR L. 'm 4'JE~c: ~R RIVED FALLS. MI 54022 0 D-955P r EiLSYrGNTH, lls-4L r-OI6J W'S. l I "SIG k, #0't *10681625 ~ I L) JOB NO. LI- Z SO PLOT PLAN Page Z -of (D Scale 1"= '40 ' S94- 41358 c.~STN 6 S l'1y17 C ~ P,tiu ~,u ~~~-~c.L, S? lS CU~~L'.0►'1PL~i►tiG.C"'~,^,, %4 f3 Grt', . Q0rF-5 IeS J M PLkC,g, %zrjL.~ \F 1~uT, / C~u►~c~ wrn{ ~un~ G~tC.. ~vi~'3l~tz Co,vcR P , n R.e O v c7-s 'S~-►v1z. / wt3~ uJL~ ~.'7 ~j v I Q U'' a,1 o ti Z. 0 i ~ F 1 PU 0- Ale, c3, y / i 1 'l~~l lU0'(' W ~C. U 12 fl \STu2g ~ 1S ►~1Z~ q . ~.Z J x s rrip- D A-Q NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be ~~u o gallon capacity manufactured by S 'F`~ YQ oTt 1N~ U U Bench Mark OF I" !R.o&3 pipe Se~e adou6 F:OfZ Z~~, I,UCl~T1u►V_ Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of 6 S94®41358 Approved Synthetic Covering ,FIs7-r-1 C- 3, Distribution Pipe Medium Sand H 6 Topsoil = F Elev . DOZ. O 3 E b Slope Bed Of 2M- 2 %2 Force Main Plowed Aggregate From Pump Layer D ~-o Ft. E i.3 Ft. Gross Sed,tion Of A Mound System Using _ ~ A Bed For The Absorption Area F F o, ad Ft. Ft. A g Ft. H • 5 Ft. Linear Loading Rate= GPD/LN FT B q-7 Ft. Design Loading Rate= GPD/SQ FT I ? Ft. D Ft. K 1 Z Ft. "ositi0n L Ft. of Force Main W Ft. L Observation Pipe Distribution Bed Of -22 2 Pipe Aggregate 1 Observation Pipe Permanent Markers (Anchb= securely) Plan View Of Mound Using A Bed For The Absorption Area . Page Of L S94-41358 Perforated Pipe Detail 0 End View )Perforated End Cap °t`o E PVC Pipe l_ ° Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S i PVC Manifold Pipe ~ PVC Face Main Distri ution Pi?e r t- - Last Hole Should Be I J Next To End Cop End Cop P ZZ Ft. Distribution Pipe Layout S , Ft. X Inches y 4 8 Inches Hole Diameter ley Inch Lateral Inch(es) Manifold Z- Inches Force Main Z Inches #of holes/pipe b Invert Elevation of Laterals 10Z.S Ft. Place lst hole ?V" from center of manifold with succeeding holes at V8" intervals. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTION AND -SPECIFICATIONS' PAGE S OF VEIJT CAP S 94 - 413.5 9 4"C.I. VENT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE 10'FROM JUUCTIOW DOX COVER WITH WARNING LABEL DOOR, WIUDOW OR FRESH (2•14IU. I - AIR IUTAKE 1 GRADE 4" MIW. 18" MIAl. CONDUIT 18"MIN. T IALET PROVIDE I AIRTIGHT SEAL I ~ APPROVED JOUJTS APPROVED JOIlJ7 A Tank `consttuc;tion -:Shall comP1Y, I I I with approved with JLHR- 83:i5 .a~ho ILHR 83.20 1I11 pipe extending . ALARM 3 feet onto I II e 1 solid soil. U[::;,. ( I ow Both sides of tank. °t61S LLEV. FT- PUMP OFF Sx3 COMCRETE BLOCK 3" ApPRovep RISER EXIT PERMITTED OIJLy IF TANK MAIJUFACTURER HAS SUCH APPROVAL gE00iµQ 5PEGIFICAT10kiS ~~LL oosE w~Z COrv e~2(~ 3 3 TANK MANUFACTURER. ~ WUMBER OF DOSES: PER OAy TANK SIZE: GALLOWS DOSE VOLUME t ALARM MMJUFACTUKER' S S' ~ ~ SalS~~1S INCLUDING SACK/LOW: GALLONS MODEL WUMBER: CAPACITIES: A= \S INCHE5 OR 3 00- % GALLOAIS SWITCH TyPC: ~Z Cu B = Z IIJCHES OR 4 0 ' 1 C+LLOU5 PUMP MANUFACTURER: C= -7 IUCHES OR 1"'3 GALLOAIS MODEL DUMBER: S 3 D- NS INCHES OR 122- GALLOMS SWITCH TYPE: CU~Z~ MOTE: PUMP AMD ALARM ARE TO DE MIWIMUM DISCHARGE RATE 2,b. o6 GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE CETWEEU PUMP OFF AUD--DISTRIBUTIou PIPE.. S '1 S FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.50 FEET 12 FEET OF FORCE MAIN X `"61 F~opLFRICTlo1l FACTOR. FEET TOTAL DyNAMIG HEAD = 8 5, FEET DIAMETER IIJTEKWAL DIMLWSIokj~ OF TANK: LENGTH ;WIDTH - ;LIQUID DEPTH 39 1I BOTTOM AREA t 231= GAL/INCH AS PER MANUFACTURER Z~• oS GAL/INCH _ W w Q r- . _ - W Lu HEAD CAPACITY CURVE f.t 4% 6 6 ' "53-55" SERIES 45/e - 25 m TOTAL DYNAMIC HEAD/ I 47/8 FLOW PER MINUTE EFFLUENT AND DEWATERING m CAPACITY + 20 HEAD UNIT /MIN -1'/2 - Q FEET METERS GAL LTRS 43/,6 11 /2 NPT W m LU 5 1.52 43 163 V 10 3.05 34 129 15 4.57 19 72 l 15 19.25 5.87 0 0 Q 0 4 S9 ~413~8 ~ 10 Q 1 o s.s~ ~ 2 28 .o Y, 5 9t 5/16 i 0 US 10 20 30 40 50 33/32 GALLONS LITERS 0 80 160 FLOW PER MINUTE CONS' ~LIATI` • Piggyback Mercury Float Switches • Available with special cord lengths of 151, available. 25', 35' and 50'. • Variable level long cycle systems • Alarm systems available. available. • Duplex systems available. Standard cord length - automatic 9 ft. Standard cord length - non-automatic 15 ft. ~.-.'ECG 7r, M53/55 SERIES Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts-Ph Mode Amps Simplex Duplex 2. Single piggyback wide angle mercury float switch or double piggyback mercury float M53/55 115 1 Auto 8.0 1 or 1 & 7 - switch. Refer to FM0477. N53/55 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 3. Mechanical alternator 10-0072 or 10-0075. D53/55 230 1 Auto 4.0 1 or 1 & 7 - 4. See FM-712 for correct model of Electrical Alternator, •'E-Pak".. E53/55 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10-0225 used as a control activator, with E-Pak (3) or (4) float system. 53 Series -Wt.23 lbs.-.3 H.P. 55 Series -Wt.25 lbs.-.3 H.P. 6. Four (4) hole -J-Pak", junction box, forwatertight connection or wired-in simplex or duplex operation. P/N 10-0002. 7. Two (2) hole "J-Pak", junction box, for watertight connection or splice, P/N 10-0003. For information on additional Zoellerproducts referto catalog on Combination Starter, FM0514; CAUTION Piggyback Mercury Float Switches. FM0477; Electrical Alternator. FM0486; Mechanical Alterna- Ail Installation cl cont-is. Dmtection devices and wiring shcuid oe done by a qu3'itiec nator, FMO495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487. and Simplex Control licensed electrician. All electrical and safety codes should be!olfowed m addition to the Box, FM0732. most recent National Electric Code (NEC) and the Occupatmnai Safety and Health Act OSHA;. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. z/CL MALL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturers of SNIP T0: 3280 Old Millers Lane O Louisville, 40216 (502) 778-27319 928-PUMP QU,4UTY PUMPS SNCE 1g39 " p FAX (502) 1 (774 3624 4tisconsin Department of Industry, SOIL AND SITE E V A T Page of 3 Labor and Human Relations Division of Safety a Buildings in accord with ILHR~Nis. Adm. Co COUNTY 9~~ti~ r,, 3 S T Cep Attach complete site plan on paper not less than 81/2 x 11 inches i ` . Plan yst 1 Ityde, but not limited to vertical and horizontal reference point (BM), direction o of'"Is ope, 4a%I or ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest roa " c; APPLICANT INFORMATION-PLEASE PRINT ALL INFORM EVIEWEDBY DATE PROPERTY OWNER: WERTY LATION'` ✓ClfA/ /t SONS L {°ilO&) 1/4,S-7 T 24 N,R 2,a E(or)g PROPERTY OW ER':S MAILING ADDRESS LOT -r- "BL K # SUED. NAME OR CSM If ~~J CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE N NEAREST ROAD R1,k;e ~ /f SSloZZ (WS) 3A; -F 3 TiV o New Construction Use Residential / Number of bedrooms [ ] Addition to existing building vi'Repiacement [ ] Public or commercial describe Code derived daily flow ~fSO gpd Recommended design loading rate bed, gpd/ft2 trench, gpW Absorption area required 375 bed, ft2 37f ench, ft2 S 2 Maximum design loading rate r bed, gpdAt trertdt, gpoltt2 Recommended infiltration surface elevation(s) .5.te. P ft (as referred to site plan benchmark) Additional design/ site considerations Sit' AELa W ' Parent material 6C5 P/ SkW-C S 44-7,9K- Flood plain elevation, if applicable 4W ft S = Suitable for system CONVEN 10NI MOUy V ❑ U IN-GROUND PRESSURE T-Gs DE U SYSTEM IN EU HOLDING T U = Unsuitable fors stem ❑ S [9'U [ $ ❑ S [TJ ❑ S M ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistenoe Bounday Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench [Z] 0_6 le gx zz / 5 I-A s 3 .7 .8690 Z ~ 0 eo !2 313 ~51 if sit- 4-0 ,e" s , G Ground 3 dD !f' S~ l7e Ma le; 2 S • S r elev. SyiE' Sje D 4n, ref! Depth to limiting factor .0 11-6iL'lZd tJ !v ,5 S -P/ t rt. Remarks: Boring # ( b-(P !d Z - Ar ie 3 / Fie S * 5 Z /s /Y Alk /W-6s 1 S G Ground 3 !D ~ - /S 7 *f We a S ~ • S 4 elev. p ?S e 2-S A . 3. y9.o /v/ Depth to limiting factor / finInIKIA1 IL FrVTUT I'M M f•5'S' Remarks: l r'zoN & SS/P-X- 5 , CST Name:-Please Print . L(3 P-t. C-k.- Phone: 3 fC Address: ~5S D' iV E/ 9SO,J CU/. JULY Signature: Date: CST Numb: No7~5 11,01'7- 13/ S~lr(~si~ovs ~G~d /off PROPERTY OWNER Awsaa S SOIL DESCRIPTION REPORT Page Z ofy 3 PARCELI.D.E "T Cioi'X /E'%OFE" Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z /a 3,13 /s -14 f/e 4-f S z,...~ 5. Ground 3 y /O '5= ! 'e", f ~ v 7c ~ie f S elev. v 9.ta4'/ ~yf .71._1 ft. 0 7 7s S ~YLi ~ ~C ' y s Depth to limiting , factor ~r Z ' Remarks: COO- i,v G- GD v EN /Z-0 A,' Gi S S,g iE'~TFI~ Boring # C O 7 / s~ f~ S .h • S (n z 7-3Z 7 r V3 Ground Z~S 7• S elev. yid 3l f • 2 . S~ f GfS S U7cI o 1, !o ft Depth to ~'7 7,5 Yl? 31voPlE-v 44, fl .S limiting cv~ factor ~I/ ssf Remarks: • Jr i,v Zo,~ ,4/S6 ~L CEti7`~!~ ~~v S D/ S Boring # Ground elev. ft. Depth to limiting factor r Remarks: Boring # 131 Ground elev. ft. JA0101HU Depth to limiting factor Remarks: OWN oeon,o ncxwn , b /0%i~i✓ U/mow r- n o ~ Z LA cs, W p n Q o w m Q b ~ w 0ci' • Q 1 tj ~a 1 ~MN1Ci ~ o ~ - 7 h ~ O p fro O = ~ O W M ~ o ~ y i s ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the R SD/Jj-, residence located at: SoC 1/4, S r 1/4, Sec. T 9PN, R ~ W, Town of Q ® Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced f Did flow back occur from absorption system? Yes'/ No (if no, skip next line) Approximate volume or length of time: 7 gallons !Q nutes Capacity: (d v Construction: Prefab Concrete Steel Other Manufacurer (if known): Age of Tank (if known): (Signature) (Name) Please Print L c /;1)'L ~F Ll (Title) (License Number) (Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). _ q Name_ "~4'~S c;:5 S i g n a t u r e -~~-1P/MPRS / 5/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER QC 1- y 17 4 eo ,s MAILING ADDRESS _12 7-3 PROPERTY ADDRESS /'L/ C J' ~ Z (location of septic system) Please obtain from the Planning Dept. CITY/STATE S PROPERTY LOCATION S~ 1/4, S l~ 1/4, Section y TN-R W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION ~ a x Ads;;64ia4, LOT NUMBER CERTIFIEDSURVEY MAP , VOLUME-AGE 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 conditioq and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, 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. 1 SIGNED: C2 i c ~il Q, ,1~J~ DATE: -T St. Croix County Zoning Office Government Centcr 1101 Carmichael Road Hudson, Wl 54016 11/93 8 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 j ,'--,v~ P/p N - 5'-Location of property_,j 1/4 S-4.-) 1/4, Section y T a PN-R ;)~O W Township__ f cm V Mailing address T Address of site 36 Subdivision name Lot no. Other homes on property> Yes No Previous owner of property CplR © ~o~ Total size of property Total size of parcel e Date parcel was created G4 kMxWW Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes X No Volume S 74, and Page Number 5-3 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 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 n the office of the County Register of Deeds as Document No. 1 7 7 y , 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. 3 1 7) `f Snature of Applicant Co-Applicant Dat6f signature Date of Signature • • DOCUMENT NO. n WAIIRANTI DEED 349774 KD STATE OF WISCONSIN--FORM 9 876 THIS SPACE R[e[RVED rOR R[GORU'.Nr DATA I I HIS INI~E,~I CL , adr b Claude W. O' Donnell and Sandra PEGISZERS OFFICE 0 Donne husbnd airl .wi e as 361nt tenants. . CROX CO., WIS. _ _ ST _ - _ . - Rac'd for Record this- 28th St. Croix r nntur - ut- . - ......County Wisconsin, h:rei,v n. ys and Warrants to ..~gayne J. Parsons and Jeanne M. day of_ Jane A. D. 19 _6 Parsons, h1usb.and and wife as Joint tenants at- 10 _ - - _ . grantee. S-.... of hfer OT Vegas V St. Croix .......County, Wisconsin for the sum of One Dollar ($1.00) and other Consideration RETURN TO - the followin tract of land in--....... St-. Croix County, Wisconsin: . Lot 5 of Croixridge Addition located in SW 1/4 of Section 24-28-20, Town of Troy. Together with and subject to a roadway and utility easement over a parcel of land 66 feet in width being parts of Lots 5, 6 and 7 of said Croixridge Addition described as follows: Coming at the NE corner of said Croixridge Addition being the NE corner of said Lot 6; thence S1°36'25"E 421.35 feet along the E line of said Croixridge Addition and the E line of said Lot 6; thence S88°23'35"W 290.94 feet along the line common to said Lots 5 and 6 of Croixridge Addition to the point of beginning; thence S63003'16"W 207.47 feet; thence N26°56'44"W 66.00 feet along the NEly right-of-way line of Plainview Drove; thence N63°03'16"E 207.47 feet along the line carrion to said Lot and Lot 8 of Croixridge Addition and the NSly extension thereof; thence S26°56' 44"E 66.00 feet to the point of beginning. RECITES: Subject to easements, restrictions, reservations and covenants of record. Acceptance of this deed shall be indicated by its recording with the Register of Deeds and shall automatically and irrevocably make the Grantee, his successors and assigns a member of a non-protit, non stock corporation known as Croi.-cridge Homeowners Association and entitle him to the benefits and privileges of said Association and bind him to the terms, conc.itiors and obligations of said Association. The above conveyance is further together with and subject to a road and utility easement over Plainview Drive as set forth on said Plat which said road shall be con- structed, repaired aixi maintained by the grantor until dedicated and accepted by the Town of Troy as a public road. I ON too r TE In Witness VG'hereof, the said grantor.s.. ha..ve_- hereunto set..-...-their hands... and seal-. S. this z. day of... '_1ne. A. D., 19_74- 1- 11 1 i r ~i•:NED AND SEALED IN PRESENCE OF Claude W. O'Donnell . a _(~E1L) Sandra O'Donnell - - State of Wisconsin, St...C.YOZx.... County. ( Personal'- came before me, this 2.8----- . day of June--.. A. D., Fy ,-78 h : A,: n.imed _ _Claude- W. b' Donne . and Sandra O' Donnell _ > r,r:r ~n lwn h) he the rer;r,n q, a-Yto executed the toregoi nstrumen~nid a c k g t* the same, 7 T t iH'S 'N37RUMENT WAS GRAFTED BY, JQ~.ls_ .L.t.. _Jt3 or j w4. Notary Public, . St._ CxQ1X. ( ;unFe, PICIIAP.DS & 'vv %U. 1 MY cornmii6)n (expires) (4y 2( V-79 `I (1) !.e ,t t'Itts pn.vi ct th It a.l r,stnroc •n he --?"I 'hall have piu.ly pr rted r type ."t, tr.r - s f t`e ~.anr n, q. t.c+, w.t rcces ant m,ta:y Crct m '9.°; ;,.lady te, ~t. cs that the name of the r --n aho, .r,.~u :,ency wr.~. h. re.t u.: .i.-rument, shall be r tt 1 ^ p.w t,mped - wtaten thermn t a 'r~.S e a cr 1 s < Tt t,ee,. STA"CE CIF WItf,O\SIV ~c ,c on ;in r.:~,t .+.,-k t rrrnnr I'"I•'t 7 la llwaukee, wl.a. ( r.1, 33004 1 AS BUILT SANITARY SYSTEM REPORT OWNSHIP SEC. T~N, R'Z9 W 0. ADDRESS / CROIX COUN WISCONSIN. BDIVISION°- Tg , OT LOT SIZE PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM f N, x 0 J b~X 53 J5 e 7PTIC TANK (S) )0 0(? MFGR. CONCRETE ~~STEEL NO. of rings on cover Depth " DRY WELL °ENCHES NO. of width length area .D no.. of lines t width ' length area _ depth to top cf ipe GREGATE, RK RATE SF- 677 AREA REQUIRED AREA AS BUILT v`~-- x_sciaimer: The inspection of this system by St. Croix County does not imply complete ;mpliance.with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for stem operation. However, if failure is noted the County will make every effort to :termine cause of failure. 'ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `'INSP } DATED Z5 PLUMBER ON JO LICENSE NUMBER r' j' REPORT OF INSP CTIOIN--INDIVIDUAL SETRAGE DISPOSAL SYSTEM r 7 Sanitary Permit 2 r1 ` State Septic ZIAI F C TOWNSHIP St. Cro' County S`?"TIC T.A'TE. r Size gallons. "umber of Compartments r Distance From: ,Tell r ft. 12 0 or greater slope ft Building -Z 4~,_ft. Wetlands ft 1'ighwater ft. C DISPOSAL SYSTEM Tile Field or Seepage Pit(s) Distance From: I'e11 ft. 12@x, or greater slope ft -7 '51 Luilding ft. Wetlands ft VFiFULD 1lbaphwater ft. 3v ai O oral length of lines ft. slumber of lines. Length of ft a;-mo - (__Jft. Width of the trench 127-ft. Total absorption area -f---sq. ft. Depth of rock below the Zj=_in. Depth of rock over t'le 2._ in. Cover I over rock P--t, of trench in ner 100 LL. I'ioPth to Bedrock ft. Depth to f;cound water ft. P I~"? "-lumber of nits Out (ameter ft. Depth below inlet ft. Gravel around it: yes no. Total absorption area sq. ft. Square feet of seepage trench bottom area required Square feet of seep it ar required Title: i1 - Inspected by: ( Approves, Date 197 Re ected Tate 197 A./ /1 .0 7 PLB67 State an County State Permit # 15 Permit Application County Permit y t for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNE OF PROPERT Mailing Address: B. L CAT N: Section Talff N, R,O~I'W E (or) W Lot# City Subdivision Nam nearest road, lake or landmark Blk# Village > Township C. TYPE OF CCUPAN Comm ial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES- Dishwasher YES NO Food Waste Grinder YES A-ITO # of Bathrooms Automatic Washer i~ YES NO Other (specify) E. SEPTIC TANK CAPACITY /L'pa Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation i__ Addition- Replacement- Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENy DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New Po' Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width- Depth - Tile Depth No. of Lines %;7 41 JIF ir Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land VDistance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifie Soil Tester, NAME C.S.T. # ,Vnd other information obtained from (owner/builder). ~~y Plumber's Sig ature s MP/MPRSW# -Tv'Z7 Phone'y~ Plumber's Address ' -09 4 1 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). . Do Not Write in Space lel w FOR DEPARTMENT USE ONLY Date Fes Paid: State (v County sc/ Date of Application -7 '7P 1 Permit Issued/Rejected (d e)L Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (wh' a copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) l Revised Date 6/1 /76 as _ ~y ~ wr Z~' .is yil li .Y yam,. AS.'iT t .p t~M ~ i hw 4 _.q a ~ z ? E. 3r kt r 1 yTii. 7 7. w~ 's k i ay~ ~ A I ~ • yjyi, - »~#sAp Iti- ~4 F I I `I 1 P` ~ +f [ x - t y f 'may``-'S~•'~`as '~~i. F, £ ~t 4:. •"T*C:_ I 19: Sw A~4qjtp~' , ~ ~ ^n~. 117 +w,.y• 1 f~~.C~ry J~LYS .5 sq 3 ~ { ' ~ i- ~1 1iA [ cr F f h r } AITAN M 54 "T st A F ~•f ~ k ~ . a TA AV 7 EN 34, OF yt A r a . 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