HomeMy WebLinkAbout191-1011-70-000
STC - 104 Y
AS BUILT SANITARY SYSTEM RFD
OWNER
T. C Y
ADDRESS '1Q.(o C enn
SUBDIVISION / CSM# N-~ LOT # O.A•
SECTION a(o T aS_N-R l 5 W Town of rA
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
hI
i
I
xl ti
~ I
M 0 caQ p
_16
_l ~p~cA 4a
~ac-,n-eJ
~-5,~A INDI ATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK• no- c~R~`<-ocA L~a~~~~ r~pnr
ALTERNATE BM:
a C' 0.1,E_n _
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ; Liquid Capacity: 1W to otiS~
Setback from: Well 601 House Eesmo Other 0.t~
Pump: Manufacturer a,%.,l Model# FVF-yo Size .41W
Float seperation Gallons/cycle: a 33, 3 Q~
Alarm Location
i
SOIL ABSORPTION SYSTEM
Width: O, 4. Length 10 3 Number of trenches A_aro
Distance & Direction to nearest prop. line: 2-0'
Setback from: well: - House I (,U4 Other o.4.
ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: ~~19
PLUMBER ON JOB:
LICENSE NUMBER: ff\l 5 R1
INSPECTOR:
3/93:jt
V.sconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
dVwmanRelations INSPECTION REPORT ST. CROIX
raQ Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Pe t,H,QWW's NjffkE ❑ City ❑ VjIlage R Town of: State Plan o.: ~
1K~Kt~AiGEEYi, MM1l 7C
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:/~/ r
160, <
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer U'y1 {
~
St/pif Inlet Holdin 7f, '61
' TANK SETBACK INFORMATION St/ Outlet 963' 77,E
U TANK TO P / L WELL BLDG. AiVernItto ntake ROAD Dt Inlet 7~~(
1~,3 ~C>•53 c~P
Septic -7 6 NA Dt Bottom Qf Eo o~~ 13. d' p3,
Dosing NA -6M an.
06
Aeration NA Dist. Pipe
s
Holding Bot. System
.v 07'PUMP / # INFORMATION J2s al?z Final Grade
Manufacturer Demand
o Model Number 6le )1:-.- 06 GPM 17 5
,i~n~~ TDH ~~,D~r 1 Loss ad Friction tem Lift Ft
D ist. To Well `Co
Forcemain Length TD~IaL'
SOIL ABSORPTION SYSTEM
$tp*TRENCH Width Lengt / No.OfTr nches PIT No. Of Pits Inside Dia. L
DIMENSIONS 1` DIMEN I
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH Manu rer:
SETBACK
INFORMATION Type O n,,~~ i Model Num
System: tY1j si -/("o OR UNIT
0' DISTRIBUTION SYSTEM
0 Header / T Distribution Pipe(s) I / x Hole Size x Hole Spacing V nt To Air Intake
Length Dia Length ZL Dia. k Spacing y ~Ud
r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
I Oer Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
enchCe nter Trench Edges - Topsoil M-Y es ❑ No ❑ Yes
I , [A~jfp~~4T~rv
l^'
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Springfield.26.29.15W, SW, SW, 310th Street
-A-1 I
La f Y" 't" _j
Plan revision required? Yes o ry
Use other side for additional information. A 21
~BD-6j'10(13,05/91) ate Inspector'sSignat re Cert. No
J
ADDITIONAL COMMENTS AND SKETCH
y
SANITARY PERMIT NUMBER: t
/S/ ~1=', ~r-r~~ are~Q~/UlmgJO aG~ OYI
12
~aaa a
SANITARY PERMIT APPLICATION
7DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY o
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than D~"I 8
8% X 11 inCh@S In si 1:1 Z@. Check f 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. IqL41) q q-).
PROPERTY OWNER PROPERTY LOCATION
Y4 S ~ Y4, S Biro T Il4 N, R 15 9 (or W
B
PR PERTY OWNE ' MAILIN ADDRESS LOT # LOCK #
C TY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
4,/udnonal
II. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) ❑ State Owned ®VILLAGE:
MIO Y) tl, ~1
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms A NUMBER(S) ~r
19 1. /oil J-W
III. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo
2 El 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)
A) 1. I New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
~J REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
50c) a 0 c , a N • /4 • 9c~- Feet Feet
CAPACITY
VII. TANK Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank 1,150 f y~D
LiftPump Tank/GiphagLhambft DOa -7'- yo co
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 Signa : (No Stamps) MP/Mt X: Business Phone Number:
q r4 Y7 _56 77-5 716 ) ,73 S 416J3
umber's Address (Street, City, State, Zip Cod •
r,
/L-
IX. bJl ~T
C TYIDEPARTMIEWT USE ONLY
❑ Disapproved Sa i ry Permit Fee (includes Groundwater Date Issued Issuing A nt Sgn S
Approved ❑ Owner Given initial urcharge Fee)
86
Adverse Determination ~7
/
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
u
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.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/ Department Use Only.
I
Complete plans and specifications, not smaller than,3% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, ocation 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; repaai ement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; close 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)
I~
i
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
May 27, 1994 2226 Rose Street
La Crosse WI 54603
BOWMAN PLUMBING
2819 KNAPP ST
14ENOMONIE WI 54751
RE: PLAN S94-40492 REVISION TO PLAN S94 40312 FEE RECEIVED: 120.00
KRAGER, MIKE
SW,SW,26,29,15W
TOWN OF SPRINGFIELD 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.
he cere y, N
rard Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
4011R/ 1
8RD•64331 R. 91191)
Bowman Plumbing, Inc. Al
Master Plumber No. 5875 N
2819 Knapp Street
Menomonie, WI 54751
(715) 235-4634
FAX (715) 235-3650 RECEIVED
PLM PLAN MAY 2 F W4
f~ - SAFETY i ILM. DIV.
Mike Kzager ~-T
SWkSWkS26T29N/R15W
Wilson Village
St. Croix County '
17
110/ 30sa4o
j ,
Jack A. Bowman M"' 5 75
Inl ra.zra
too go', q&
LEGEND mar~►c... _ •
BM: 100.1 marker. i as' sa wa
power pole in fe c
line
0-}borings - u r
No Scale p o~ h; l I
Plot is in propo io with
site area
System Elev. 92 16'
on contour 91.*
41,
oL
0 3 s- .,y led, .
Ov,
Page Of
Cross Section Of A Mound System Using
2 Trenches For The Absorption Area
Trench Of - 2}" Aggregate
6" Aggregate Below Pipe may-. Or ynthetic Cover
Manifold Pipe aterial
Medium Sand Distribution Pipe
6" Topsoil H G
E
F
Plowed Layer
Slope
Aim
Ft.
iNDUSTRY, LABOR a HUMAN ! aTi iFmS c~
Dl~jSi OF SAFETY iLii.....: E I.q Ft.
F .-B5 Ft.
Signe H J.5 Ft.
Li ce Number: Ifs 8',7,,5-
Date: IMI
.c F t.
A j, ft. L 103
B C, C~ Ft. J 7.5 Ft.
C 15. (D Ft. 1 13.5 Ft.
K I I. S Ft. W 40.(!) Ft.
A
J Observation Permanent Marker
Pipe
A rDistribution P pe
I1.6 C
Force
W
e "z Main
r g K
1 Trench Of
Aggregate
L
Plan View Of Mound Using 2 Trenches For Absorption Area Z D~
Bowman Plumbing, Inc.
Master Plumber No. 5875
Sad 4
2819 Knapp Street
Menomonie, WI 54751
(715) 235-4634
FAX (715) 235-3650
PERFORATED PIPE DETAIL
J
ApM
PVC
l
R
Signed :
1, ic:ens ber:
1)at x (ol a ►nChes
4-
a t.~ Num. of holes/piped Hole diameter-__~[_
1
36 HvmA Invert elev. of Lateral
q. I'l
t,p,B~R tZ~ gi3tV-. • • laterals *lanifold
Force main
q3.1 ~
page of
' PAf.,t C;F
PUMP CHAMBER CROSS SECTION AMD SPECIFICATIO►JS
VENT CAP L . .
4.9 2
Y"C.I. VEUT PIPE
WEATHER PROOF APPROVED LOCKING
JLIMCTIOU BOX MAWHOLE COVER
~ 25' FROM DOOR,
WIWDOW OR FRESH I2"MIU.
AIR IWTAKE
GRADE i
( `f" MIIJ.
18" mi ki
COIJOUIT
18"KIIJ. \
• ~h
a 'PROVIDE
IAILET I 1 -
T AIRTIGHT SEAL I III ~ J/
Ir u I I I
` I III
APPROVED JOINT A APPROVED JOIk
W/C.I. PIPE x I III W/C.I. PIPE
EXTENDING 3' Vol n'~~ I II ALARM EXTENOIWG 3'
ONTO SOLID SOIL D r°~\^` HB~p4~ i II ONTO SOLID SO
%AsOA PAID ~g I I ow
C
ELEV. 5- 12 FT.VO~~~I r. --j
1
PUMP OFF
H CONCRETE DLOCK
• RISER EXIT PERMITTED OAILH IF TAUV, MANUFACTURER HAS SUCH APPROVAL
C12ow^~ y15u alo- uu'ff~ i
SEPTIC E.I450 9cd •4+~ ink N~3' SPECIFIGATIOAJS
DOSE is e 1 MI P--IPI-
TANKS MANI FACTURE K: E4. ~n ~RQCAS_ (NUMBER OF DOSES: 4 PER DAy
-t- GALLOM S DOSE VOLUME I B?, 5 pL,4--qCL442) uO`~
TANK SIZE:
ALARM /MANUFACTURER: J• F-DackRo IMCLUOING ISACK11FFLOOW: am 7•98 GALLON:
MODEL'UUM6EK: S-Jl• CAPACITIES: A= 9-5 IUCHES OR 56.41 GALLOWS
SWITCH TYPE: MC-VZ RU 13 (sk. INCHES OR -51-9q GALLOW
PUMP MANUFACTURER: Qum4ba A C-IMC14ES OR ,0132 73 GALLOW
MODEL UUM6[R: (REF -`ED io~0.1 D- ~i.INCHES OR-161174 GALLONI
SWITCH TYPE: Me-Rc-LI -x NOTE: PUMP JDAA&RM ARE T0961,84
MIUIMUM DISCHARGE RATE GPM INSTALLED OW SEPARATE CIRCUITS
a 5 Apm In r~ ~ 35.E `l ,A!i l Qitc~l
VERTICAL DIFFERENCE CETWES PUMP OFF A DISTRIDUTIOW PIPE.. FEET
+ MIUIMUM METWORK SUPPLY PKItSSURLTE✓,. . . . . 2.5 FEET
+ .11- FEET OF FORCE MAIN X " -L F/OO Ft FRICTION FACTOR. FEET
TOTAL O't1JAMIC. HEAD = (I' FEET
if
IUTEKUAL DIM SIONS OF TAUK: LEK1GTH 81a1~ ;WIDTH ~I I .;LIQUID DEPTH , am
51GQ Af~ LICEOSE DUMBER: MP DATE: '94
t4 ~~ri
`BSE/BL4 RAW) CAPACITY (U.S. GALLONS/MIN.)
TOTAL
r_ HEAD PUMP t O
13" (FEET) BEF BEF BSE BSE BSE BSE 6.00- /
O 40 60 50 75 100 200
10 115 135 155 180 215 -
15 84 105 115 150 185 230
20 43 68 65 120 150 210.
25 - 28 - 65 117 175
.30 - - - 75 145
,s.oo
e 35 - - - - - 110 t~ u
40 - - - - - 60 --Z
Ie-
MODEL BEF
ELECTRICAL CHARACTERISTICS Shipping
Wt.
BEF-40 .4 HP-115V-10-60 hz SP 59 lbs.
BEF-60 .6 HP-115V-10-60 hz SP . 60 lbs.
BSE-50 1/2 HP-115V-10-60 hz PSC 103 lbs.
BSE-75 3/4 HP-230V-10-60 hz PSC 105 lbs.
BSE-100 1 HP-230V-10-60 hz PSC 107 lbs.
BSE-200 2 HP-230V-10-60 hz PSC 111 lbs.
PERFORMANCE CURVE MODEL BEF PERFORMANCE CURVE MODEL BSE.
PERFORMANCE OUTSIDE THE LIMIT LINES IS NOT RECOMMENDED PERFORMANCE OUTSIDE THE LIMIT LINES ISAOT RECOMMENDED
313 L3 u
W 60
eF<; LIMIT c_a
L6
50% 50 en W
25 60%.
EF 65% LIMIT ° 91 yo
K1,73% . ~Ff,9 40% 90
0% 40 50% ~ - 80
'O6 6 0X n,
20 t- T4% s
73% ,W gar, 70
ugh 15 70% = 30 s~pS 63% 60
= 68%
7E 65% fe' 62%~ 50
6096 12 20 50% 40
10 50% rxumIT 30
LIMIT
10 20
5 10
0
0 50 100 150 200 250 300
0
0 20 40 60 60 100 120 140 160 CAPACITY-U.S. GALLONS PER MINUTE
CAPACITY-U.S. GALLONS PER MINUTE
MPS87
P9 51,E ?
r,y.errvrm,•s /
SOIL AND SITE EVALUATION REPORT : Pa9e._._.
abor ssFnoapart~r»ntofindustry, tN
tlebor and hfuman tRidons
'Div lion of Safety s Buidngs in a= ffilinnehes LN
Attach complete site plan on paper not less than 812 x in size. Plan must include, twt PARCt3LD.:,
not Limited to vertical and horizontal reference point (W. dr ~,pf slope, .sole or .
' dimensioned, north arrow, and location and distance to neare L
` APPLICANT INFORMATION-PLEASE PRINT'ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT 1l4 . 114,SZ GT NR
PROPERTY 17ER':S MAIUN ADDRESS LOT ! • BLOCK # SUBD. NAME OR CSM !
CITY, STATE ZIP CODE PHONE NUMBER QCfTY QVIUJIG !~7 NEARE~T ROAD
{ New Construction Use V1 Residential / Number of bedrooms 3 (j Addition tD existing btn'I q
j j Replacement (J Public or commercial desaibe
Code derived daily flow y~ gpd Recommended design loading rate Z bed, gpd12 trench, gpd*
Absorption area requiredaaso bed, 112 /3'oa trench,112 Maximum design loading rate ' Z bed, 002 • j *X:k gp(W
Recommended infiltration surface elevations) L, (as refired to site plan benchmark)
Additional design! site considerations a
Parent material gu~w,, 14b Pq ,r Gs` p n elevation, if appricable ft
S = Suitable for system CONVeMONAL WXW QJ•GR"1 PRESSUfiE AT•GRADE 5YSl~~A IN FILL 14MOING TANK
U= Unsuitable for stem I IDS OU 0S O U I 0S S U Q S E U 'Os ff'U I a S till
SOIL DESCRIPTION REPORT
Cepth Dominant Color Mottles Texture Structure con:sistertCe Barxiary Roots GPD/ftBoring # Horizon) in. Munsell CkLSZ. Cont Color Gr. Sz. Sh.
Bed r>a1fi
Grounc Id 31le 71
A 7,
Depth to
limiting
fw'tor
30
Remarks:
Boring # / •.S''~ ~ bG~• J'1 Z , 3
"o we
Ground ;
.1 a I.
Depth to
limiting
factor
Remarks: _
cs; var-e Pfbne:.-s ~gL L4' 3~
Azores
s~ S.~f
Ate.
,opEowNER e ep t7 fs SOIL. OESCRPTION!REPORT k +3'
PARCELLD.!
Structure GPD/ftDepth Dominant Color Motlles • Texture Gr. Sz: Sh Co Roo fs f Bed tend
Boring # Horizon Qu.SLCon~C
in. • . ftAunsell
3 .z • ,i . N r.-.. ~i s~'I . sew - f,•,,~ .r ~-w
Ground yialz 1 iA-
1 Si
KL3 ft. i n1y;j
Depth to ;
Gmitino
factor
Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor 4
Remarks:
Boring #
~ t
V•rV ~ i
elev.
ft
Depth to
.amiting
factor
Remarks: •
Boring #
1
Ground
elev,
ft.
Depth to
limiting
factor
f • .
1 1 ,..k rip
16 1,.
r
f
f ~
9
i
~F J
• - Fl., ..s 1
x '
c i I S f0~
TOOP Q.1HSIVI-M 1ST 19%8 99C ST:$ ~:CT rseczeCO
r '
Wisbonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page/ of 3
Labor and Human Relations
• ~IVISIOn 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
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
P=&49*1 PROPERTY LOCATION
%fe GOVT. LOT > 1/4 57V 114,SZ (,T 22 AR {or~
PROPER OW R':S M ING AD ESS LOT # BLOCK # SUBD. NAME OR CSM #
Z4 6 o bIr
CITY, ST TEJ, ZIP CODE PHONE NUMBER ❑CITY ❑VILLAG 0 N N R
[kf New Construction Use p0] Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 7 - - gpd Recommended design loading rate Z bed, gpd/ft2 - -3 trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 - 9 trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site considerations 4,
Gnu p n elevation, if applicable ft
Parent material u a w, fnZL, /,4j
S = Suitable for system CONVENTIONAL Fl~OUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ~U 19 S ❑ U ❑ S O u ❑ S Z U ❑ S C'U ❑ S CgU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
X2 xe
Ground /10 ke . J14
Depth to
limiting
fact,
Remarks:
Boring #
7- 3
0 P2,
y~ ~o /l L 75.,E CA/- s l 6 ✓ ,tt'i - S-
Ground ,
ft.
t,1
Depth to
limiting
factor
Remarks:
CST Name: PI a Pri Phone: ~ x ti
/ l
d~D S" '11\ C
~ f 3.
Sign at e: D
Ly/v
PROPERTY OWNER SOIL DESCRIPTION REPORT Page '-7-of 3
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
07, /0
277 2 3
51-X Id 4-
Ground /01/ C.i'~ - S
eg ft. y
o-~► /b d Z 7Sy,~' 6 5~ sG~~- 1~~fr - l
Depth to
limiting
factor
Xd'`
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
r ~ YY
i
1
r
I
~V
83 0
~ r
ea 10
4011 A
I ' liy'
X11
1
,,A - gM ~ I ~od,o
i
4 >
FAH ~w
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S-T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Gl
ADDRESS- FIRE NUMBER f ~0
CITY/STATE IX ISan ZIP
ROPERTY LOCATION :~1~ SECTION 2, Tc~G N-R_ W
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OF ~Q 1.dwym , St. Croix County,
SUBDIVISION Nons , LOT NUMBER .9- .
Improper use and maintenance of your septic system could
result in its premature failure to handle wastes. Proper
maintenance consists of pumping out. the septic tank every three
years or sooner,'if needed by`a licensed septic tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may"be eligible to receive a grant
for a maximum -of 60%'of the cost o'f 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 maintairi the `private sewage disposal system in accordance
with the standards set forth,•herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the-St Croix Co. Zoning Officer within
30 days of the three year expiration date.
SIGNED : ri~,a.aws,
DATE :
St. Croix co. Zoning office
wa 911 4th St.
Hudson, WI 54016
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`;fozm,;,should be retained and completed when
the propertyis sold .and ".submitted to ..`,this office with the
appropriate deed recording.
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owner of property a.
Location of property,$~W l/4 ,jtAL1/4, Section, TQ._N-R_24j_W
J
Mailing address
Soo/b
Address of site
Subdivision name, _Lot no. 9A
Other homes on property? yes No
Previous owner of property MAP'lu Me- 11 m
Total size bf parcel 90, A C(Z G--_-~.
Date parcel-was created N,4.
Are all corners and lot lines identifiable? Yes No
is this property being developed for (spec house)? Yes .1,<_No
volume 2)j and Page Number ..._1 9 as recorded-..with the RQ~;~~~Y
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} Or« 26/94 10: e,9 $715 386 9281 1st FED-LaX*HUD [a 001
04/26/94 11'35 $ COLNTY CLERK X 001/001
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the foi:o.alhC daseiiWd real aatae• in .....Stn...~TiRiX ........................C*unly, '
State of W16oonsinr
Tax Parcel No:
The West ore-half (W 1/e,) of them Southwest
QUIrter (Sit 1/4) of Section 26, Township 29
North, Range 15 west.
Th[s a. not homestead property.
(kj (is not)
Exception to warrand4s;
subject to eaaements, re4ervatiens ana restrictions of tacvrd_
bawd this ,ir,. day of 1Sarch.................................. 19.94
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AIITHXNT1CATI0N ACSNOWLVDGHZNT
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~ M..........• STATE OF WISCONSIN
St. Croix
.....-_-Cannty. ~ tat
■uthentieaw ehla day al.....~------ ]9..... PersoaaIIy tame before, me this . ......day of I.
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TITLE: 21SEbt1sER STATE BAR OF WISCONS114
iu SOL. ~by......... 5tsla:j' yl{1;...,~
CA tae, keoget~ o(ibAhaS I who executed the
I~ tordgoin a , ge the same.
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Hudson, Wisconsin
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