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HomeMy WebLinkAbout004-1012-90-300 -0 C) Q O O O ~ M 0 603, ~n y ti ~ I O C 0. O N G I O N ~ ~ O N ,C ~ N P.. „O h Q N N C ~ h T~ O O ) J Y 0) U Q T O m C w N d N ~ tlr O ' C N C 0- ca QM S N O 12 O Q O y N h m 0 Su > L y C Z a-)> ~ -j5 N w a U. CO Q c N CI- N L f6 ' p C C N U N a) E 4 innm° a~ U E Z Z r L co FN- Z d m c O O Z d o U Z E 'o M N C (D 0 (~1 io T~ 01 p U i N QZZ .o c N l6 C N Lf) L L m ~1l N a N d r1 a C C m N t c G a a U U) co E U V M ICI ?j R. 3r d m 0 O O O • ) IL (L CL Q_ ll~j Cl) M N a) a) v y ~ V rn rn ~l Q o N °O h t~ N O O O N CO m d- 0 N ~y~ N 'a d Q } N 7 C O O ' N II) C i O M N C O E O r i" O CO C = N C fn V) C U a a) O C co 3: W 'a N O O C C C N O I- V) 00 C N N O 0 N V - r MCI N Y M 3 O f6 N C3 O N m m t9 U • O U H O N (J'? CC O ~ r ~ m T CL • a m t 0) y c E 'c c D U a 2 0 ( 00 STC - 104 AS BUILT SANITARY SYSTEM REPORT ~~c7Q OWNER 6aAl-e-Al T4,f~ ADDRESS a pal"~ SUBDIVISION CSM# LOT v SECTION, (p T~ N-RW, Town of • ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM !v b , n 3~+ Yv ~ b 1 ~ ~ ~b~ 5~~~~ 6 ` > s.~ Js .90, INDICATE NORTH ARROW Provide setback and lev tion information on reverse of this form. Provide 2 dimens'o to centerof septic tank manhole cover. B: )I F so (00.00 Te p 6 BENCHMARK: ~a ©d &a 01 co-c S aL cem "A `role of- 0 ALTERNATE BM: y l0 v. ,P_ I,S -r(5 g • SEPTIC TANK / PUMP CHAMBER / HOLDING.-TANK INFORMATION nn /000 S~ Manufacturer: )Al rd "6 f .cry ~jY Liquid dCapaci:ty: 7&_0 Piz ass' 5~~,~- Setback from: Well, House so Other T- Pump: Manufacturer Model# 3871 Sizep 'y to Float seperation S ~ Gallons/cycle: lSq, 37 Alarm Location cA,)cl I 6t ,1 S9a l/tj 1T~ ~70C4.S (A)o 140u 5 -c- y e P,~ SOIL ABSORPTION SYSTEM Width: " Length Number of trenches Distance & Direction to nearest prop. line: Y~ Setback from: well: House ~(p Other ELEVATIONS Building Sewer ST Inlet; ST outlet PC inlet PC bottom Pump Off Q 345- e., r0,-t C lv. Uv%d-k Ode HLAaK Header/Manifoldi!W, Bottom of system ka.Pe--~d 7,' Existing Grade Final grade DATE OF INSTALLATION: C) 7,3 I PLUMBER ON JOB: ~r--- LICENSE NUMBER: INSPECTOR: 3/93:jt Ii?i ii;rP,*art,nWt4lWdu§~C.6,T28,NffApk IZ ROAD AOOTH AVE oun y: .Labor Human Relations S INSPECTION REPORT Safety fety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.: Permit Holder's Name: ❑ City ❑ Village 9A Town of: State Plan ID No.: CADY CST BM Elev.: Insp. BM Elev.: 1772 scription: Parcel Tax No.: Ld Do J ll~ld ~ 0 S4 e m CCri iIN TANK INFORMATION ELEVATION DATA A9200434 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P d 6 6 Benchmark ~a cf~ / u au: Dosing 7 50 Aeration Bldg. Sewer Holding St/ Ht Inlet 3 a TANK SETBACK INFORMATION St/ Ht Outlet q q 7 & Vent TANK TO P/ L WELL BLDG. A irl to ntake ROAD Dt Inlet Air l 7 q a, Septic 1> yo 5 9/ NA Dt Bottom 1//,7/ Dosing ~gv 5-0 ' NA Header/Man. V 07 Aeration NA Dist. Pipe Holding Bot. System > 'f 7, PUMP/ SIPHON INFORMATION Final Grade 99, a y Manufacturer Demand r~-z>t 3 y /v/,/`j Model Number - / _ . L6 GPM r TDH Lift, Lriction e M em TDH e, Ft Forcemain Length Dia. as Dist. To well /ya SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. 7 Liquid Depth DIMENSIONS e 1_/ / DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O -'n.,u..> Model Number: System: at -A6-0,., "(_J1 OR UNIT DISTRIBUTION SYSTEM Header/Manifold d/, Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length t f~ Length -+~10• ~ Dia. Spacing ~l4 3 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: NW,NW,SEC.6,T28,N-R15W (SUMMIT ROAD/600TH AVENUE) P x 7 D ca , t Plan revision required? ❑ Yes ❑ No Use other side for additional information. r SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i I =7DILHO SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY M1ll== ST. CROIX STATE NITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ~I3.(/ 8% X 11 inches in size. Check if revis on 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 HANLEY TERKELSEN NW %4 NW Y4, S 6 T 28, N, R 15 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # ROUTE 1 2741 60TH AVENUE N/A N/A CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER WILSON WI 54027 715 698-2695 N/A 0 CITY VILLAGE NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned O nn CADY SUMMIT RD/ 600TH AVE ❑ Public 121 or 2 Fam. Dwelling-# of bedrooms _3PARCEL TAX Nu R( ) III. BUILDING USE: (If building type is public, check all ;Z9 004-1012-90 1 ❑ Apt/Condo 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) A) 1. ❑X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ Seepage Bed 21 ❑ Mound 30 M Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground AT (TRADE 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 450 750 750 .6 N/A 97.2 Feet 99.03 Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 1000 1000 1 MIDWESTERN PRECAST Lift Pump Tank/Siphon Chamber 750 750 1 MIDWESTERN PRECAST 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's Signature: (No Sta s) MP/MPRSW No.: Business Phone Number: 15 715 772-3278 2 I BENNIE HELGESON r Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE, SPRING VLALEY, WI 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved ary Permit Fee (Includes Groundwater a essue Iss ing Agent Signature (No Stamps) y ) Approved ❑ Owner Given Initial Surcharge Fee j Adverse Determinati n Sa 't ~ ~6 X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 i the Wisconsin Administrative Code will be applicable. 3. All reviFions to this permit must be approved by tle permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Per-nit Transfer/Renewal Fo-m (Sp.() i:3~,9) to be to the county prior to installation. 5. - Ow"- sewage systems must be properly maintained. The tank(s) mist be purl ped ':--y 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 Owelling. 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 ,Absomtiar-°: system information. Provide all information requested in ##1-7. VII. Tanain the capacity of every new and/or existine: is°?n list the tila! ;--J rd)er of tanks ,.anufa,-Jurer's name. lndicate prefab or site constructed and tank nialei-iai. for ah' sLp xr°plsipt,-~~ ,-nd holding tanks for this SystE!rn. Check experimental approval .f ,.3etl:~ received c~ p J -t pyP oval frt n? DILHR. Vlll- Fesp.,mswmty start-meslt. installing plumber is to fill in name, license -,t -nbe! Mill aj-op,t )-o prefix e.g. MP, eta:.', cdress and phone number. Plumber must sign application f,: rm. IX. County/Depart rnent Use Only. X. ;rta:iy/C)=s..:,.~trriet~t Use Only. Cora? r t , ; r,s at"Id specifications, not smaller than 8'/2 x 11 inches mu,--t he Si,briiitlf-lo ^ > the :o± nty. The ~;t;A,e~ nits Gl _ ~ tlie" following: pica ";..an, drawn to scale or with coy Of ho,Ji or other i.r at~r:erft larks; t7uilding s(-wE,: wit,- )star service; 5t~Eer~ 1 lft o:, o! siphon tariks. distribution boxes, soli ab s)-: ii- system area 'hrw fot_,:i r. o t "he building served, S) hcrizontal and v >rtica -rev-non ,rents; C) complete spec:'ications for pumps and controls; dose volume; elevat :)r; d,f(ere ;k?;.; h ,lilac loss; pump performance curve; pump model and pump manufacturer; D) cross sect',.-)n 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 inciuded the creation of urcharoes (Pees) for a number of recjG;;ated prac?ices whir.', roan e=ffect groundwater The monies collected thr0l','1 these s'.lrcha gC-z i-rf ;fOrit' r';rCt- :;dA ctE' Witter contamination ;r.vesiiga!~(,)ns and establi,;hi e SBD-6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, ("spec house"), 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 HANLEY TERKELSEN Location. of Property NW '34, Section 6 , T 28 N-R Township CADY '.:Mailing Address RT 1, Wilson, Wi 54027 Address of Site. 270TH ST & 60TH AVENUE Subdivision Name. IA i Lot. Number Nr' q Previous'Owner.of Property Total: Size of Parcel Date.Parcel w as Created !ire all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume' opq,5_1_ and Page Number 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 refer- ences.to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION i (We) eexti4y that a t .atatementa on this Bohm cute tkue to the but o6 my (oun) knowted e; that 1 (we) am (axe) the- ownex (.b) o j the pno peh ty de a enib ed in thia ,i.njo,kmati,.on 6oun, by vixtue ob a walcxanty deed neconded in the 046iee o6 the County Reg.i6tex o4 Deed4as Document' No. ; and that 1 (We) pteaentZy own the pnopo4 ed z to jon the a ewag e d i b poe d ybtem fan 1 (we)-have obtained an easement, to nun -with the above des cxibed pnopenty, 4on the conatAuCtion o 6 said ayatem, and the same haz been duty neconded in the 04jiee o4 the County Reg-iateA ob Deeds, as Document No. SIGNATURE F OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) i y3 :,:DATE; SIGNED DATE SIGNED F1 DOCUMENT NO. 1STATE BAR OF WISCONSIN FORM 6-1982 THIS SPACE RESERVED FOR RECORDING DATA - PERSONAL REPRESENTATIVE'S DEED 450458, 11 Ivo! 848PAcc 218 REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record j AUG 0 91989 I Hanley Terkelsen and John Terkelsen at 11:25 A. ~I - I as (personal Representative of the estate of Hans-Terkels~n. ~ (`.Decedent"), it for a valuable consideration conveys, without warranty, to ---------•----Hanle Terkelsen y i , Grantee, RETURN TO the following described real estate in St CrplX -------------•-___----County, i H State of Wisconsin (hereinafter called the "Property") : EXEMPT 77.25 (11) Tax Parcel No: PARCEL NO. 1: The Northeast Quarter of the Northwest Quarter (NE-1 NW4) and the Southeast Quarter of the Northwest Quarter (SET of NW4) of Section Six (6), Township Twenty-eight (28) North Range Fifteen (15) West. i PARCEL NO. 2: That portion of the Northwest Quarter of the Southwest Quarter (NW4 of SW 'fl of Section Six (6), Township Twenty-eight (28) North, Range Fifteen (15) West situated North of the new interstate highway route 11103". i PARCEL NO. 3: The Northwest Quarter of the Northwest I~ Quarter (NW4 of NW4) and the Northeast Quarter of the Southwest Quarter (NE4 of SW4) of Section Six (6), Township Twenty-eight (28) North, Range Fifteen (15) West, subject to that certain easement to St. Croix County Electric Cooperative, a cooperative association, dated November 19, 1938 and recorded i~ August 26, 1939 in Volume 1125611, page 22, (No. 89), in the Office of the Register of Deeds for St. Croix County, Wisconsin. I Subject to easements, restrictions and rights-of-way of record. I Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. I' p Dated this a day of 19_.89... 11 I Ir 1112 (SEAL) 'LA•-•• - -----------------------------------(SEAL) -•4,,T, Hanley Terkelsen Johrke ! Personal Representative Personal Representative I AUTHENTICATION ACKNOWLEDGMENT i Hanle Terkelsen anSTATE OF WISCONSIN Signature(s) John Terkelsen_ - County. th d' y of• 19__$9 Personally came before me this day 19 the above named 5---- - ~ . ob rt J. Richardson - - - ! T LE: MBER STATE BAR OF WISCONSIN ii (If not, authorized by § 706.0 06, Wis. State.) i! to me known to be the person who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY i ROBERT J. RICHARDSON Attorney at Sp-Ping- -••Valley...WI. 54767 Notary Public ...............................County, Wis. II (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration Ii are not necessary.) II date- 19--------•) *Names of persons signing in any capacity should be typed or printed below their signatures. STATE FORM No. 5-1982 SIN Stock No. 13005 450457 ovot. 84S PAGE 217 STATE OF WISCONSIN, CIRCUIT COURT, ST. CROIX COUNTY -PROBATE- IN THE MATTER OF THE ESTATE OF 12 HANS TERKELSEN DOMICILIARY LETTERS File No. S rk /-2 -P, 9 To: Hanley Terkelsen and John Terkelsen Name(s) The above named person died, domiciled in St. Croix County, Wisconsin, on October 12, 1988 Date You have been appointed personal representative and have fully qualified. THEREFORE, these Letters are issued to you, and you are required to administer this estate according to law. I BY THE COURT: I Seal Inge Ble'er Probate Registrar Date State of Wisconsin REGISTER'S OFFICE County of St. Croix ST. CROIX CO, WI I hamby cerify that thi3 documont is a full, Recd for Record t,rue and co,rcct copy, ci the original c fil anJ of re;o;cl ;y c;,'i AUG 09 19e9 c and has comp"'cd by dt 11:25 AM Q1 Attest . 19 Elf Rsgist~r of Deeds In -borg lr Register iq Probe PR•1363,.6las(ritiNF) 66 1111Q"IiIA'RYLETTERS (INF. ADM.) s.865.08, Wisconsin Statutes Stock No. 25426 ST C- 105 SEPTIC 'TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER HANLEY TEEKFT SEN - ROUTE/BOX NUMBER RT 1 Fire Number - I CITY/STATE WILSON WI Z EP 54027 PROPERTY LOCATION: NW 14, NW Section 6 T_28 N, R1___W, Town of CADY , St. Croix County, Subdivision JZA Lot number k/A__• Improper use and maintenance.of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-.site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three-year expiration. I/WE, the undersigned, have read t1;e above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkge within 30 Jays of the three year expiration date. SIGNED DATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. p~11 r . y l0{ t ~I O-v~ \1 v t 1{ e e k~ y RjMEN-~ ~F It 1~11~~~SFFE~~ FNS '~U~ -f~ ~ DE~'A DN1S10' OF ( ~ a~ i Po, F-14 pb VvE y QAP6 t ~PL..,,, f 0 w ~a~ / lWa G I ` 4Po~ 'Ift q4/ 61: y 1 3 3¢k iAU vy, i ~ ~ ~ah`rOu.r ca. olds l i i I FtY.CL ~ CI St2rr~ Wek g. M ~ vtR.P. Ibo,oa A r ouhck `o x-t ~ 593- 20,58 4 Owner's Name: ~Ia `nTev- k -c.l S r_t-, Plumber/designer Signature:__ _ -,..,v-.------ Date: G -c, 3 r License Number: '3?ZX " -1~- L 5~ PRIVATE SPNAGE SYSTEM > 5 1 J > 5 2' Ty (srcu klr_ DEPARTMENT ~~F 1,'J~T -,-.l..,L_ W DIVISION OF S L Al j E~uLiNGS Q I I 1 r~ LDENCE - o O v EE 6SP i ~ >5 1/6 B 1/6 B 1/2 B A = 2 ft G = ft B = ft H = ft W = l ft D = ft I = ft B/2 = ya ft F = ft L = ft B/6 = ft Fabric Distribution Lateral Observation U ~V --Soil Cover Well 12 I ` .1 rs~tj . \ Gr«.. Eleu, Fig. 8a. Plan View and Cross Section of Wisconsin At-grade Unit with a Single Absorption Area on a Sloping Site S93-20534 QUA r-h 7 AT CU'J Or X11 C1= Lr,T'f.L p, C<ti-,D c1yP. Q + _.QI.PE Rla~ FtR~ ~'tauF`~t.Y SPh::C~ t Q ~ PVC; / ~'poRCE M A ~ u FRA1-t Tau E'1 P -PVC- 'LATER^LS p~r.c.e ths^r !i-Olt 1.~ExT 1b FU'+J C.ltP JD~S?.R.1$u7701J. PIPE .13'+!•rDUT--. P `fb . 5 rT. PHI ATE SE'vN,^,aE SySTEM ~~~t Y co iN. REl-Al10NS DEPARTMENT OF INDUS SAFE Y AND i UiLDINGS ~otic~ riA„~ ~;c DIVI ION OF Pe Fopo~ l~vteS/P~ y ~J 1. S : EE Hf , =SP DEN +1 .ELEV. of LA7GZ^L-S P g poh TEE PJJ7-H Sv cc-Et~1N 6 I t~LE~ ~T: 11JT~RUf~ L s - ~r'~cE 1ST NUS _ LAcST N'OLE 'i'O R+r lJEXT' TD T}FE 6'VD Ct~P• S93-.20534 cc~ylcr' G~~ PT P►- 6et f l PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT,,,CAP `i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 25' FROMD40R. JUNCTION BOX MAWHOLE COVER WUJDOW 'OR.FRESH 12"MID. AIR IMTAKE GRADE • ( 4~ MIIJ. c ; I S" MIIJ. PRIVATE SC WIT _ _ INLET r~ PROVIDE, _ I AIRTdGHYf SEAL c aT(OHS ( I I') APPROVED JOINT DAPARTMENT OF W/C.I..PIPE ` DIVISION 'OF S":FE ~ (A1'dJ APPROVED JOIUT III W/C.I. PIPE EXTENDINfs I I I • ALARM E)(TEAIDIUG 3' OWTO SOLID SUIT. I OWTO SOLID SOIL SE . CORREs LADEN c I ow 2.5 PROPERLN 15<S PUMP OFF ANCHOR TALI " A NpE.- ESSARY CONCRETE BLOCK ILHR 83 1 54 (b) WAG • RISER ,EXIT PERMI'Il'ED ONLY I~ TAUK MNA MUFACTURER HAS SUCH APPROVAL PTIC ANp'' AA-54M OVA, SPECIFICATIOUS SE TANKS MANUFACTURER: eri, cOS WfABER OF DOSES: 3 PER DAy TANK SIZE: GALLONS DOSE VOLUME: I - 37 GALLONS r ALARM MANUFACTURER: ,77 l): S, . cte c CAPACITIES: A= INCHES OR Sot' GALLOUS MODEL NUMBER: - I Q I I-I L;J B= IMCHES OR 37. S ' GALLOUS SWITCH TYPE: (r (%Y R,, C= S IMC14ES OR i f4,37 GALLOAJS Pump MANUFACTURER: D= • E IUCNES OR )-53.1-1 GALL OIJS MODEL NUMBER: .~11 IIS~,f A' NOTE: PUMP•AND ALARM ARE TO B£ SWITCH TYPE: IUSTALLED OM SEPARATE CIRCUITS PUMP DISCHARGE RATE -:&a. -7 VERTICAL, DIFFERENCE BETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. 33 FEET MI~NI~MUM • NETWORK SUPPLU PRESSURE . ' ?•5 FEET FEET OF FORCE MAIN X[..F~ 10o FLFRICTIOI,I FACTOR.. ' s $5 FEET TOTAL PyWAMIC. HEAD ~.3R FEET '20534 INTERMAL DIMENSIONS OF TANK: LEM&THIc `7 L~WIDTH - I ;LIQUID DEPTH 1,/0 102 ~IG1~1ED: LICENSE DUMBER: .~'o~/ DATE: ` 1 • MODEL: 3871 Su6mersible'"Dare-'~ SIZE: 3/4" SOLIDS RPM: 1550 Effluent Pump HP: 0.4 ~ METERS FEET i i T 8 25 7 - - - a g 20 a 5 Z 15 0 4 g 10 5 1 ~ 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY MGOULDS PUMPS. INC. SB,ECA FALLS NEW 1CW 13148 593-20534 Effective October, 1988 ®1988 Goulds Pumps, Inc. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRINTED IN U.S.A. AT-GRADE SYSTEM CALCULATION WORKSHEET Owner's Name: Parcel Tax Number: Legal Description: , CIV 4, S T N, R_LL-,or W Lot Number:, Block Number,, Subdivision/CSM Name: Town of:. County, Wisconsin At-grade Structure 1. 3 B inches. Limiting Factor Depth 2. _(p percent. Land Slope 3.. gal/day. Daily Design Flow Rate (DDFR),. 4. _ gal/ft2/day. Design Loading Rate (DLR) feet2. Effective Absorption Area (EAA) = DLRR A x B 6. _ feet. Effective Absorption Width (EAW) = A feet. Effective Absorption Length (EAL) = B = EAA EAW 8. 5.3 S gal/ft.. Design Linear Loading Rate (DLLR) = DDFR EAL 9. II feet. Total Aggregate Width = A + C 10. feet. Finished Width (W) A + C* + D + E** 11._ feet. Finished Length (L) = 2(I) + B 12• Finished Height (H) = F + G 13. ly feet. 1/6 B ) ) Observation Well Locations 14. y feet. 1/2.B 15. S 1~ Texture of Soil Cap Material. Notes: * C is 0 if the slope is 0%, otherwise C is 2 ft. On level sites, substitute another D for E. Plumber/designer Signature: License Number; Date: S93-20534 Page of CA-v 4 r iZ ! ~ nt-grade System prc; C. -i~-53 Pressurized Distribution Network Design 16. Distribution Lateral Sizing. ~y inch. Hole Size 3 feet. Hole Spacing 0,f- feet. Lateral Length inch(es). Lateral Diameter feet. Lateral Spacing 9-~,'Kfeet. Lateral Invert Elevation 17. Distribution Pipe Discharge Rate. ~y Number of Holes per Lateral i gpm.. Flow Rate per Lateral Total Number of Laterals 3~ .`1 {o gpm. Total System Flow Rate 18. Manifold Sizing. C e✓~~e~ Manifold Type (center or end) IVA feet. Manifold Length * * If only a tee fitting is used as the manifold, the manifold inch(es). Manifold Diameter * length and diameter may be _ reported as not applicable (NA). 19. Forcemain. inch(es). Forcemain Diameter n feet. Forcemain Length 3~)'?("gpm. Minimum Dosing Rate (system flow rate) gallons. Forcemain Liquid Capacity 20. Total Dynamic Head (TDH) Calculation System Head = 2.50 feet Vertical Lift 5-33 feet Friction Loss = feet TDH = feet! ~3 - 205 3 Page of .Wishcoso-r4n,Hum nReltofIn use' SOIL AND SITE EVALUATION REPORT Page L of3 rIA 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 S~ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELI.D. # dimensioned, north arrow, and location and distance to nearest road. r) 41"-- - 9 6 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION IEWE D E 3 io p ~F o PROPERTY OWNER: PROPERTY LOCATION ' T a h c ~2 r S c GOVT. LOT 1/4 /4,S T N,R E (o W 11 PROPERTY OWNER': MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # I Al iU 4 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 2MWN NEAREST ROAD [L]-New Construction Use [ esidential / Number of bedrooms _,i> [ j Addition to existing building j ] Replacement [ ] Public or commercial describe pp Code derived daily flow gpd Recommen ed design oading rate , C. bed, gpd/ft2 trench, gpd/ft2 Absorption area required Z5Q_ bed, ft2 _ trench, ft2 Maximum design loading rate , 6, bed, gpd/ft2 - trench, gpd/ft2 Recommended infiltration surface elevation(s) 9 7. Gto,.j E(~.j • U",,- 4, ft, (as ref red Vite plan benchmark) s s~l~y~z t-co w y Additional design/ site considerations Parent material C o rm hvh-4-e- Flood plain elevation, if applicable VA ft 7-=SUunisl able for system CONVENTIIONlOUW IN-GROUND PRESSURE A~T GgAaE SYSTEM IN FI HOLDING TANK uitablefors stem ❑ S C,0 MEN El U El S 0-u- 0"S ❑ U ❑ S OT 1 ❑ S SOIL DESCRIPTION REPORT c17r,; ~f'es ~or 14T 6)24 pF` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fit in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed 10 -3) 1 o f Lj U t Ground y F s , c} - o . `f egv. 3 AIL ft. ( o % (n.` e Depth to limiting factor Remarks: Boring # #<.t 2 Ground 3 © LJ v -fla ~ p _ elev. ~v.ft. (b -1S o V s .C! Depth to limiting factor o t Remarks: CST Name:-Please Print f ne ev~u.t~e c 3~`7 Address: 76 /L4_9 /O ignature: Date: 9 CST ber: f3 _3 j PROPERTY OWNER t~ a I.e~_Tea Sew- SOIL DESCRIPTION REPORT Page PARCEL I.D. 06t4 -16i-2 -1/0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& C- 1 r Ground 70 s S ~c~lr e~i •S elev. 10 Lk 4v Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ti, :w:, >s Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) v site- Is IT RmA 1 ~ I ~ \EI 91-a \ \ Lam/ E~~u ~OIM'C/ I r / 1 EL-V / ot~ qu.6 ~ ~ A i A. i ~ Abb0-e- Cis oP ok Cbvcrc,+ ~1~~ CADY PLAT T-28- (Landowners) See Page 1 SPRINGFIELD PAGE 42 2700 2800 2900 60th AVE 3000 3100 3200 Ni°ky Gloria UST 5 Nanette Clifford & 000 Evelyn Joel Daniel & I M Ben Anne km Bunnell zmme Jordatit Lund 41S i Tru 5 Ihrke 8 Lee & OMeara 80' M CIO F 40 40 y 33 3B 114 Norma q Pauline L t Lorraine Bruce & I -a Scott Harold IN 1-: 69 Lacy ° fn M sn N L ;r, ~ao & , Dianne Trust G r, Ackber, bof JAckta, m Duck- Haly rn° A > o 56th Ro 3 Schntts c~ Kuesel I N 40 40 9 -1 r- 20 r~ AVE B Steven & Tn verge a Donald & 5 AVE ohn & M Roolk 81 reete. Meeit E ro etal 100 Kd" nail 150 Gay 116 rd* ~~~~~►yy~~ n I ~ Malrlrch Wallesverd 82 A A 112 57,00 ershi 41 I 194 Kildahl 70 39 p 53rd VE 39 117 11111111 a Lfthe & Clifford & Wendy xr.Q Bake Alice Kuckler ONeN O ursaw aks Inc gg eromr 24 Hjbbm la GeI 35 60 3s 33 33 33 Lund 65 3232 ~ P 1 D fFa-rms benezer y aeedeB Clifford o Troy & 50th mosty~ r 6 & R" waBie I U% Galen 00 eanne 8 9. J F- & Alice Stuart George Brandt USA m cn p n Lund 120 40 & Doris 72 Shawn 4t P 75 = 40 q TJ g Peterson Callahan z I Who, ce~dm a .a & ~n jC1aeY ba jean Cytr n 2 o` Oro, Trust Rex Green- o ntr aldine ro tt eai ` Brenda Ronald & 04 bg y 120 160, Stockman way 40 107 rick a eg 78 40 4. Riek Jsa, 3 Ma ; oAnn Halnnacit9 1 Darin G Br y h & Cy Arthur scan Gruber Johnson Daniel & Kim Farmdt Pr FizinamB Menter a rrm 80 I Trapp 133 Joers 41 40 153 2 Alana 128 & Diane 01 Ronald Jeffrey 9U Bee &Wiillliam Lane s,e Tod, Alt- I 40 Riek Kavltz a Gary cao Fickeen & Julie Kem 120 40th VE 105 40 m"`_s 40 79 3_83 w s 1 110_ 79 Backus 70 to - - - - - 3 Gregory - Z3! RS cae aal - Richard Geo e - - - - - - B ry Douaiar ld a ~ dl 3 10 Kerr 19 a 10 Ia- & Sandra &Doris & Tara & Di- Audrey I Leon 80 L.. b 40 Ling 40 TrPeter ustmn 120 1 1 Keo, b"'Q 77 Broom & leartle' 41 i Robert & - Ronald & ~l I N R N Of Soldiers e'ra w 44O Bonnie Jo & Richard 1 B 1Rl & Brenda OConnell ~ High Christ P d etty a 40 58 as Riek 80 d & Cappenel 115 4s Wheeler 39 4t 5 er $ .18 Carl & Joan Farm Inc James & x r Al 000 Nelson Don 120 J~der Anderson N co 00 o Dianne p o Iv n 0 l N I~ & 40 a Y : 1~ 116 JoAnn y ' w 9 LIN V Johnson 119 o m CO L1..~ 5 e u W do - 00 7 0'Mik ~ d Atitaael a Gerald &-e & John 4 o ,may Q Lawrence e& t rd m l Ito & Joyce Mate Aabel PC A A w e,~ Wiegand Morion taeaer 4p too Britton 60 4J 80 40 60 &P H 13 238 A 3 78 N 80 M y X10 Norma - - - - - r 30t AVE 2 tester & T A N are - - F o H 1 Olson 20 ^ Brian ce Robert & KeAt & Daua soy, b~ 50 NOt Dan & & Patricia stCOtt"d az JHaan S «mt Bo son F- Schloemer 80 llada M 'e ~Ul 40 7th AVE Shelly_ Pinkston & p Walter 36 00 1 J MMt7 ohm & Dean Delmar & 180TH. S Michael James mmaa a cQ j G el ryl ITIMM rlene igboe a X 0 NN 68 Peter 0 25t XC Rondo 78 119 b z 78 21 Robert i&R 2z a 40 Ronald 4 TM QjFWM Nonm & & Eh,e & Gerald & Brian LM W Marleen Ober- Barbara Vickie Scott & Olson 80 40 IF o Truesdell 80 220 m11eBe38 Lamb so Glans 7515 ' Kristine L e Brian Gre ory Kiehneyer Trust Hampton & BernRita ard 1 - g a `unstop- & Kay & Laura w pe 170 80 Hampton 190 person 79 Wang 80 53 80 Buchal 80 > r~ 80 - _ - _ 80 W112 T - 23 20t AVE Ann a OrvWe 4 Howe Jacobs II-Sol Allan & Tv~c: Hugh 40 Trust 138 Tamera J Hampton Harold R Faber StudL7 Robert Thomas a cca w 14 4 40 aw Frye HlMoldenhauer 8 208 Timm Vadker 208 89 James ^ 561. %J V 01,1111 lid U- tj Rex Stringer & RRitad RR„sch aaenne n ^ Da Judith _ & J A King Trust 97 G 36 38 Acres riam 4o 40 ET Genz p & James Gordon Inc 2 3 AL thleen Stringer Brah- Timm a a Tit 41n Illbrkht- Trust an 12A mar 40 i1ft i2 _n _t` all C 39, ST. CROIX COUNTY T 4 ' WISCONSIN ill: A. ZONING OFFICE y"" ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 May 11, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the Hanley Terkelsen property, located in the NW-',NW,, S.6, T.28N., R. 15W. , Town of Cady, St. Croix County, WI., has been conducted with the assistance of Bennie Helgeson, CSTM# 3094. This onsite revealed suitable soil for onsite sewage disposal to a depth of 38" while meeting the requirements of the A + 4" rule. This site should be suitable for new construction utilizing a mound septic system having 12" of sand fill or an At-Grade system. Should you have any questions, please feel free to contact me at this office. Since ely, ames K. Thom on Assistant Zoning Administrator cc: file I State of Wisconsin ` Department of Industry. Labor and Human Relations SAFETY d BUILDINGS OIVISIo ONSITE VERIFICATION REPORT 201 E. Washington Awnw P.O. Box 7%9 M."son. Wisconsin 53707 1. Are the soil and landscape features accurately reported on the Soil Description f o r-n? L,-~Y E s No If no, provide further description. 2. if for new construction, could the developrr,ant occur without an at-grade system? ✓4ES NO IF yes, what other type of sewage disposal system could be used? 3a. State the name of the installing plumber: 4 /7~3-D c1h 5 b. Has this installer received written directives or orders regarding previous construction of at-grade or mound type systems? YES NO If yes proceed to 3d. c. If this installer has not previously constructed at-grade or mound type systems, have they attendeo a University of Wisconsin training session on at-grade systems? YES NO. d. If -~e answer to 3b is yes, or if the answer to 3c is no, the installer must incluae a written agreement to attend a preconstruction meeting with DILHR and county staff, and receive onsite construction supervision by DILHR and county staff. Fees for this supervision will be charged in accord with s. ind 69.1~ ;l), Wisconsin Administrative Code. This supervision may also be requirea for quent installations. unty OTficidr igna ur ate 2, vx'n Le e n n~ GD TZ /S`r.J. . a,~' d 5 ~o~ Kam. _OC3Ctlo n dnd\1Uwner, flame 01!HR-SEC-55.14 Pt1 ~T •V. r .5/~ ~~QS3