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008-1088-40-100
~i eru IS+-. Cn r ,r l2 ~aldwi n STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER-Ark CF f s~ L ADDRESS W sm U 0f/ 5f re 'f SQH~'~~ -VAt, 7 w' )r- 2 SUBDIVISION CSM Q C ~~V " U~~ ~l / # LOT # SECTION ~T 2- N-Rl~ W, Town of Ile ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 19 ~ fie ~ ►~S /'v h DO e COW O f ~ vUeS oh~EhvL D~ tc:) e- Iq INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model#Size Float separation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width•: Length Number of trenches Distance & Direction to nearest prop, line: Setback from: well:_ _ House_Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade ~I DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt k SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 10, 1995 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 WEBSTER PLUMBING & ELECTRIC RT 3 BOX 231 ELLSWORTH WI 54011 RE: PLAN S95-01712 REVISION TO PLAN S93-03873 FEE RECEIVED: 75.00 0FTSIE, AitROlt baelh SW,SW,31,28,16W TOWN OF EAU GALLE 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. Sinc ly, Peter E. Pa Plan Reviewer Section of Private Sewage (608) 266-2889 SRDA-7997 (R. 10M) I SAFETY & BUILDINGS DIVISION 'I i State of Wisconsin Department of Industry, Labor and Human Relations k August 10, 1995 201 East Washington Avenue P. U. Box 7969 Madtson WI 53707 WEBSTER PLUMBING & ELECTRIC RT 3 BOX 231 ELLSWORTH WI 54011 RE: PLAN 595-01712 REVISION '10 PLAN 593-03873 FEE RECEIVED: 75.00 OF TSIE, ARROW SW 4($W,3.1 28,,16W CRUIX TOWN OF EAU GALLS COUNTY OF' ST 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 11.HR Eli and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been rcviowed for the cede requirements set forth in chapter'1L.HR 82 or in chapter's ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expiry two years from the approval date, or if a sanitary permit is obtained, plan approval wi'il`expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall beep one set of plans with the Uepartment's stamp of approval at the corrfstruction site. "The installer shall notify the appropriate inspector when inspections can be made. All permits required by the_c.?ty,, village, towr>ship 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. Sine ly, Peter L . Pa Plan Reviewer Section of Private Sewage - (608) 266--2889 SRDA-7987(8.10184) ' a r fo-p-or Rost .00 FeQt. ~ a ~ m III I r ~ 4r+ C, 0 -0 , a F -7 (D LA C ~v 0 o ,C+ 007 O fl p Ulm U) rD - , z 3 -5 - r- = rD m o J1Y S w Car ,may (,A td -I -i -i o,, a Lil a 0 0 0 0 W0 a 0 0 R)M 6):3 Cr -r> rp -t> rp -h ca - -h w f i ~ Z c+ i-+ah o rrp ~ o 0< 0 a70 n + -n Q- P F Qdue G 0,9 FO ~s 9 5_ p 1 7 12 ~►~varr►,kdJ b~' Pageg-_Of SEPTIC TANK O,.PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COV' FIN.ISHED.GRADE W/ PADLOCK i 4" CI RISER WARNING LAB] 4" MIN. 18 IN. 6!!jl X. INLET ALS GAS- TIGH U A S EA L /APPROVED APPROVES JOINTS WITH PIPE 3' B ; ALM APPROVED PIPE ONTO SOIL Daf,. ON 3' ONTO SOIL Kfp e 5 C SOLID SOIL FF ELEV FT. -i- OFF RISER EXI Mra1v►~wa e~ ~5•~ fi+r M197~~~, 'PERMITTED ON' / IF TANK MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: _ TANK SIZES: SEPTIC 1000 GAL. DOSE VOLUME INCLUDING DOSE ~ GAL. FLOWBACK: 1 J GAL. ALARM MANUFACTURER: MODEL NUMBER: CAPACITIES: A = Z Z INCHES = 35'8 GAL. A SWITCH TYPE: B = INCHES = 32- GAL. PUMP MANUFACTURER : _ 2o~Kev ray 1[ MODEL NUMBER: mej ~ 4h Y C = INCHES = 1 r GAL. SWITCH TYPE: Mer ' D = ~ INCHES = 'GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23.WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 1•0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . + 6 d FEET FORCEMAIN XL. 2.5 FEET ' Sj FT/100 FT. FRICTION FACTOR 1.? FEET TOTAL DYNAMIC HEAD = 51 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH)2) WI% TH 910 ; DIAMETER LIQUID I5~" - SIGNED: 995-0 1 7 12' p~ LICENSE NUMBER: 60 7 DATE: 1/88 Safety and Buildings Division ~~■~~nr,• SANITARY PERMIT APPLICATION Bureau of Building Water System: 201 E. Washington Ave. In with ILHR Wis. Adm. Code P.O. Box 796 accord 83 05, 9 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Count I than 8112 x 11 inches in size. CrD1 • See reverse side for instructions for completing this application state anitary Permit Nu ber The information you provide may be used by other government agency programs Check if r.visio to previouslication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number ? L APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 9S~D~11~ s 93"87J Property Owner Name Property Location t 0~Sf~~ 114 1/4,5 T N,R IQIA(o)W' .9 L- A4 Property OwnerlIm ilyg Address vCh J P Lot Number Block Number City, State s ft Cod Phone Nutt Subdivision Name or CSM Number sip '111,1V W6 141j, r II. TYPE F UI G: (check one) ❑ State Owned ❑ Ity Nearest Road C3 Village I Public 1 or 2 Family Dwelling - No. of bedrooms own OF WI III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) f~L~ 1❑ Apartment/ Condo V D 6_Wv`0/ 6 O v 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. TVle ERMIT: (Check only one box on line A. Check box online B, if applicable) A) 2- ❑ Replac ement 3. ❑ Replacement of 4_ ❑ Reconnection of ia+a ______em ________System_____________TankOnly______________ Existing System '"~-Exi3tirrg-Sy'er1a B) Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21ound 30 E] Specify Type 41 ❑ Holding Tank 12 F1 Seepage Trench 2 ❑ IMn-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 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 Ll 5-D 1 275- 7r L2, Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Ca in g aclt alions Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New E xisting Gallons Tanks Manufacturer's Name Concrete stCon- Steel glass App. -cted Tanks Tanks Septic Tank or Holding Tank r ,r s° 0k t ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VI11. 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 Stamps) MP/MPRSW No.: Business Phone Number: D V umber's ddress tr et, City, tate~Ce C, n~~ A/A Kir/ 7 IX. OUN Y / DEPARTMENT US ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A nt Si nature (N amp Approved F1 Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) 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 a 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 and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: L 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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. Complete plans and specifications not smaller than 8 112 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; end 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 contamination investigations and establishment of standards. Safety and Buildings Division vi`riR SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county , than 8 112 x 11 inches in size. cro! • See reverse side for instructions for completing this application state sanitary Permit Nu ber -7 The information you provide may be used by other government agency programs 216he.k if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. Ste Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION S-73-0;97-3 Property O ner Name Property Location A t/ S" T , N, R (O Y)`+~ 0 Property Own r , li g Address ~f~?✓ Lot Number Block Number City, State Zi Cod Phone Nu Subdivision Name or CSM Number (1 6 II. TYPE OF UI I G: (check one) ❑ State Owned Vill ityage Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms own OF w III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo oO _ 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. TYPWOF ERMIT : (Check only one box on line A. Check box on line B, if applicable) A) 1. 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of System System Tank Only Existing System _____g3yst -------y---------------------------------------------------- B) A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 2t~Vlound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 2 ❑ In-Ground Pressure 42 ❑ Pit Privy 1`3 ❑ Seepage Pit 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. y/sq. ft-) (Min./inch) Elevation Feet Feet VII. TANK Ca in gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existin strutted Tans Tanks AA I L+ I Septic Tank or Holding Tank r_1 El r_1 El El It. i El ❑ El 1:1 1:1 /V 630 II&W 171001)7 ffitT491- 21" Lift Pump Tank /Siphon Chamber Vlll. RESPONSIBILITY STATEMENT" I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Stam MP/MPRSW No.: Business Phon Number Plumber's Name: Print) Plu tier's Signature: (No p jZ#A 46L -1 5- ? Z IT V ?(-)j- 4umber's Addres tr et City, State,7.W Code IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (Includes Groundwater jDatelssued Issuing A n7Sinatjure (N amp a Surcharge Fee). ~r Approved ❑ Owner Given Initial f iff, Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: - SBO-6398 (R..05/94) DISTRI8UTION: 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 a 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 and Buildings Division, 608-266-3815. To be complete andaccurate 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 on 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 for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new/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. Complete plans and specifications not smaller than 8 1/2 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.1 15 forms 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 contamination investigations and establishment of standards. LOCITIqN: EAU GLE.31.28.1~RIVATE SEWAGE SYSTEM Wiscons epartmentofIn us ry, County: Laborw*umanRelations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary rt~it PROIN -GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Cj Town of: State PIA MP FSTIE DARIN EAU GAILE CST BM Elev.: Insp. BM Elev.- BM Description Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300344 _ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q'CeJt"` r"i1 ~r CIS / lll~T7 Benchmark -3,/g/ 14j, 12 Dosing Cm rh_ ~v L.:, ~'_l'•~ 0 16-91. d~ Aeration Bldg. Sewer Holding St/fit Inlet TANK SETBACK INFORMATION SV Outlet 9 ( 9v~ a vent TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet j Septic >m) Sd / 3 NA Dt Bottom 9,,?, 63 Dosing i' NA Header/Man.,` 9 D Aeratio NA Dist. Pipe 3''f Holding Bot. System PUMP / JOLON-+NFORMATION Final Grade Manufacturer p.~ Demand Model Number # GPM ~C ! ✓ /!>_z _-7D'~ 16'~ ! TDH Lift Lriction3 Syetem~ TDH Ft oss0 Forcemain Length al F Dia. ~HH Dist. To Well 1 ,z SOIL ABSORPTION SYSTEM BED/TRENCH width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (D "cc DIMENSIONS- LEACHING 11anufact ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION Type O /2e- CHAMBER odel Number: System: /1/jr.✓,, >lGV w~~~ DISTRIBUTION SYSTEM Header / Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Aim ntake Length ~ Dia '-~2 Length .V3 Dia. Spacing o ~sL /Eo 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 & /T1e+~Center Bed /Edges Topsoil ❑ Yes E] No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.)-F/An 11~-')_c LOCATION : EAU GALLJ~r 31.2 8.16 rS/' _ G1 9, i~d Plan revision required? a-'re's 0 No Use other side for additional information. (o a s-~ SB -6710 05/911, _ Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: , QILHR SANITARY PERMIT APPLICATION 70a`HA In accord with ILHR 83.05, Wis. Adm. Code C NTM O lf` STA271TA RY ERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8t% z x 11 inc hes in size. rev o to pre us application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ION PROPERTY OWNER PROPERTY LOCAT s U/' /a /a, S TV N, R 1 (or W PROPERTY OWNER' MAILIV ADDRESS LOT # BLOCK # tJ't CITY, STATE ZIP CODE PHONE NUM ER SUBDIVISION NAME OR CSM NUMBER rr / I11 1k OF EAJILDING: (Check one) CITY y R T ROAD ❑ State Owned VILLAGE ; d Q/'. U 0 r ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms -PARCEL TAX N MB ( ) d9 I f III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo (9 0 /0 40- G() 20 Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.14 New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 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 1ss~ Mound 300 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) L fff ION y5y ~ 7 / e. W---r %6 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New P-xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Mf re VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stam s) MP/MPR No.: Business Phone Number: wetike- M MV 7 1(715-)M-Nd Plu b ar's A dr s (Street, City, State, Zip ode): 1&1 / 47 A4 -0 IX. COUNTY/DE ARTM NT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial 80 ` ® Surcharge Fee) IN Advers et rmin tin L©/ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber I 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. Vlll. 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) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations November 4, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 WEBSTER PLUMBING RT 3 BOX 231 ELLSWORTH WI 54011 RE: PLAN S93-03873 FEE RECEIVED: 180.00 OFTSIE, ARRON SW,SW,31,28,16W TOWN OF EAU GALLE 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. Since ly, Pete Page Plan Reviewer Section of Private Sewage (608) 266-2889 SItU.6423 (R. 01/91 N O V% 6P r s~ c wu~ evf7 waoJ Pe>ts q,.c yrOlcl t t Wovr~o~t+~l YRFoY~- ha s PaJCe(I T~ 00~- jo~~g -HO-Ib° inP~F Post ;s {+ovr~«~( G~•ur~a~ St- Cvoi Y Co u~fy b✓ g, c., use f~ s t l~ P s 3 7 ,~~u flan Wd~Si~Y CST sso 140 '2- Oct 2-V (993 b L - PIT, I- Plot- P)h p~. 1 C da ~ SWIG tt D \ ~ r Wov1 >laflr &F Mot, ~v t lrl 1.~~ar~~t~ Pf~l- 7 ~o II' ~ ~ yo ' 'M ~ o. 1 C M ~rrvh Cvv✓~ ~ `V Py 6 3 ~a P N ~avn+ I.t Use X00 ~ )a00' lot t;~r yyy~ w~ ~vvy~•°e `~E~ qj. Q' ,acs DLO q~ 5 ~4~0~~O ~ 3 1 c CL 2.09 'p ~~+~0~ ~GO ~ ~ a ~ 165 r d t 0 Q ~ L ele W, 13 el o ,o , NOV 3 1993 96 ~ SAFETY & BLOBS. G='='• ~~Q S9,3-0397 1 ilONAL WORKSHEET rP6grg{'°" vh~ev 7 Page Of~ MOUND SYSTEM it. IN•GROIINI) PRI.SSIIRL SYSTEM•Conunued- I. Wastewater Load, Total Daily Flow= gal. 10. Force Main: Use s. ILHR 83. 15 (3) (c) Minimum Dosing Rate Adm. Codc and PROVIDE A DETAILED Diameter _ in, LIST OF SIZING ON PLANS. i1 °d 1 I. Total Dynamic Head: 2 Depth to Limiting Factor G / ft. System Bead = 2.5 ft. I I 3. Landslope = 9G Vertical Lift = 7-n ft. 4. 'Distance from Dose Chamber to Friction Loss =1-5y'fd 0 ; (Od L-2 ft . 13 0! Distribution System fl. TDH 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = ft. h/J'fe w e. Pump will discharge at least gpm 6. Absorption Area Sizing: N(evurao'~ Voce at ft. total dynamic head. / Area Required = 375 sq. ft. 0-19-1111" Pump model and manufacturer: 2oP ley- Bed or Trench Length (B) = 62'r ft rkiG r p 1 " a 7 Bed or Trench Width (A) ft.'r 13. Dose Volume: Trench Spacing (C) ft. 10 Times Void Volume of 7. Mound Height: Distribution Lines=.641- i gal. Fill Depth (D) = ft. Daily Wastewater Volume Fill Depth Downslope (E) _ 1, 0 4;, ft. 4 Doses In 24 hrs. = 1 I ~i gal. Bed or Trench Depth (F) ■ O,q 5- ft. Backflow = , 16'f • 13a gal Cap.and Topsoil Depth (G) ■ __L, 00 ft. Minimum Dose = [ 3 gal. Cap and Topsoil Depth (H) = 1.5 0 ft. 14. Dose Chamber: 8. Mound Length: Cf~g if Volume =gal. End Slope (K) _ / ft. Total Mound Length (L) ft, 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 7 1. Wastewater Load, Total Dally Flow ■ - gal. Upslope Correction Factor = Q Use s. ILHR 83.15 (3) (c) , Wis. Upslope Width (1) ■ 8' I ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor ■ t, O grPk LIST OF SIZING ON PLANS. oOb Downslope Width (1) = ft. G 2. Required Septic Tank Capacity = ~ gal. Total Mound Width (W) ft. 3. Percolation Rate = min./i 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83 Natural Soil = d' Sal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required* sq. ft. SIZING ON PLANS. Basal Area Available ■ J /ZS sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter ILHR 83 Length = ft. are used, Indicate Table It Width = It. 12. For the Distribution Network, Use Numbers 5.14 In Section II. Number of Trenches = Trench Spacing = ft. if. IN-GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor ■ ft. Lateral Length ■ ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = min./in. Lateral Spacing = in. 4. Proposed System Elevation : ft. Distance from Sidewall to Pipe = in. S. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use s. ILHR 83.15 (3) (c) , Wis. Adm. Code and PROVIDE 'A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All Items from Section 111 Required Septic Tank Capacity ■ gal. 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = min./in. 1. Capacity = gal. Area Required = sq. ft. 2. Manufacturer: ! r1 I~PSx Y~'l ~/'p(tgrSi"" System Length = ft, 3. Show Site Constructed Tank Details on Plan System Width= ft. 7. Distribution Pipe Sizing: VI. DOSING TANK 90 Hole Siie = In. 1. Capacity = gal. Hole Spacing = _ ft. 2. Manufacturer: 1V1Le*VPL9PCaSj- Lateral Length It. 3. Pump Manulaclurcr:.-Z-0,01 p" Lateral Si/e itl. 4• Pump M•,dcl tMoJP 19 I.alcr.d SI1.16ng Il, 5. Operating Head= Ui,lance Iron1 Sidew.Al to Pipe in. b. Mow Rate = L_ gpm• H. UWlihuliun Pipe Discharge Rate: 7. Show Site Constructe nkIL o FF~ t0 L-"~ 1 Number ul I lulc> Pct 1'ipc I luw Per Pipe , glint. VII, IIOLUING 1 ANK 'f. Manifold Siting: 1. Cap4cily = i - V 3 ~3 gal. typeGenletor end) Ge~t`rt", 2. Manufacturer: Length = It. 3. Show Site Con%trut D a' an rt Diameter in. S93-03873 -SHOW ALL INFORMATION ON PLANS- DILHR SBD•6761 (R.03/82) i Page~ Of Straw, Marsh Hay, Or Synthetic Covering Di ibution P pe q7 Medium Sand nr „wT tl - 'v - o I~ ~o 95.E 6" Topsoil H;L M i F 3 E D ii % Slope Bed Of 2~- 2 %2 Force Main Plowed Aggregate Layer (6" Be)ow Pipe) D ~.O Ft. t E I-p6 Ft. Cross Section Of A Mound System Using A Bed For The Absorption Area F O'~S- Ft. G x 00 Ft. I A b Ft. H Ft. Signed: 6,111 B Ft. License Number: K I G Ft. Date: 0~ L Ft . ,t_ Ft. Alternate Position I 2 Ft. of W Ft. Force Main - L Obs tion Pipe--" g K of A I.-- I I 1 Force Main W o Distribu ' n Bed Of 2~- 2 iu Pipe Aggregate ,QC Observation Pipe Permanent Markers w V S93-03873 Plan View Of Mound Using A Bed For The A sorption Area b Page Of t Straw, Marsh Hay, Or 0 ~ ¢35 f Synthetic Covering i Distribution Pip aH /7~/ j Medium Sand 611 Topsol~ F G i b 0 Qty n ~d f 21 Force Main Plowed t e Layer Al Pipe) 5~ D D , a(lFt. E~ Ft. s Section Of A Mound System Using <cQPO~~ O .••A Bed For The Absorption Area F Ft. O G ~ Ft. A Ft. HD Ft. Signed: MM B Ft. License Number: M K ~r5 Ft. L Ft. Date: _ c r Ft. Alternate Position Ft. of Force Main W Ft. L 71- Observation Pipe g K r--- of ----------------------•I Force Main W Distribution Bed Of z - 2 2 Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area S93-0387.3 SAFETY 8 SLOGS. C. i _ A: r, ~a' ~ P C~ ~ -4 `r- q t r~ ~ y~~ _ ~i..S r 1~ ~ ~ • • ~ ~ ~As:;~ ; 1'4 a~, 1:. 6 T (;F PUMP CHAMBER CROSS SECTIOIJ AUD SPECIFICA'rIOKJS . is VCQT CAP `i'C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIKIG JUAJCTIOKI BOX MAKIHOLE COVEF. - 25` FROM DOOR, WIUDOW OR`F-RESH 12"MlL1. AIR' INTAKE GRADE I y"MIKI. 0 IT S i I IK1LE T O., A L I I I A ~y vP I I(` P~.~MtiN~~y~s II ALARIA Bw . ~Q►~' I I - ON . c ED JOINTS WITH j i ELEV. FT. APPROVED PIPE (~1 ~ 79, 3' ONTO PUMP OFF I nrrm ~ 1 -t D SOLID SOIL FAY I'?►,~I T7 CONCRETE DLOCK s } RISER EXIT PERMITTED OIJLy IF TAUK MANUFACTURI`R HAS SUCH APPROVAL SEPTIC F SPEC, IFICATIOUS DOSE • TAIJKS MAIJUFACTL1ttER: L! V)PK IJUMBER OF DOSES: PER DAB . TANK SIZE: 000- GALLONS DOSE VOLUME Le% A✓Wl INCLUDING BACKFLOW: GALLONS ALARM MAMUFACTURER: MOD[1 1.3UM6EK: CAPACITIES: A = L 3,4CRES OR ~CALLOUS SWITCH `TYPE: g = 2- INCHES OR j 3 GALLONS ~ I'v w Q ! I ~ PUMP 27 f C = INCHES OR GALLONS MODEL AIUMBER: /~~,el D=.1JL..IMCHES OR GALLONS SWITCH TSPE: -.--mood MOTE: PUMP AMD ALARM ARE TO BE B MIAIIMUM DISCHARGE RATE ~,PM INSTALLED ON 5EPNRATE CIRCUITS VERTICAL DIFFERENCE 15ETWEELJ PUMP OFF AKID DISTRIBUTION PIPE.. 9'0 FEET 2.5 FEET + MIKIIMUM KIETWORK SUPPLS PRESSURE . . . . . . . . . . . ♦ FEET OF FORCE MAIN X iS F% oo FtFRICTION FACTOR..`_ FEET VOY 3 _ TOTAL Mi1JAMIC. HEAD - ~Q'- FEET SAFETY OLD ? IAITERNAL. DIME►JSIONL OF TAtJK: L EKIGTH 5L_;WIDTH a;LIQUID CEPTH 593-43873 S I G IJ E D: /M Jl9Lt~ L i c e IJ 5 F. iJ u M S R• ~S OAT E. . ~ ' ~ ;r ~sw~ ro ~ ~ • '~~1. jl . t -1 ~ `.~f ~y , v. ~1 ` ylrt s~ ~ _ ~w d k :;y`, t . 1. l~r r A n - - rage ~ u t c~ Distribution Pipe Detail For A Four Lateral Network V~ Alternate Position Of 5 Cap ! Force Main g J`~`J 4 ~JJ Q~ PVC Distribution Pipe PVC Force Main P *%-~Holes Equally Spaced PVC Manifold Pipe On Bottom X S t X i 2 * Last Hole Should Be Next To End Cap Y 1 PWFt. S-3 Ft. X ~b Inches Y~ Inches Signed: Hole Diameter Inch License Number: Lateral Diameter ~ Inch(es) Date: -0-rr a q, Manifold Diameter Inches Force Main Diameter L Inches I Holes Per Pipe ~'flV 3 L"L Invert Elevation Of Laterals Ft. SAFk'TY ,LOS$, It S93-03873 HEAD/CAPACITY CURVE F LL' HEAD CAPACITY CURVE EFFLUENT MODELS TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE ~4 EFFLUENT AND DEWATERING 1 10 i05 5155 3? SERIES 57-59 97 96 137.139 161 163 165 185 196 188 189 100 FT. M Gal. LVa Gal. Lba Gal. Las Gal. Ltr3. Gal. Lin Gal Ltrs Gad Um. Gal LVS, Gal. L", Gal. U14. Oal. L1ra. 30 5 1.52 LC 43 163 56 212 72 273 104 .394. 106 401 61 231 61 231 58 220 155 587 -156 587 35 10 3.06 34 129 46 174 61 231 79 300 100 378 61 231 61 231 58 220 148 560 151 672 28 90 15 4.57 19 72 35 .133 45 170 64 242 91 344 60 227 60 227 58 220 142 537 145 549 20 6.10 15 57 25 96 36 138. 82 310 59 223 60 227 58 2211 136 515 140 530. 8 85 25 7.62 8 30 74 280 57 .218.. 59 273 58 220 120 484 13J 6U3 , 24 10 30 9.14 65 248 55 206. 58 120 90 340. 58 ...220. 121. 458 127 491. d+_ 40 1219 46 174 46 172 56 208 75 263 58 720 105 397 tid 431 75 186 50 16.24 21 90 33 125 51 191` 58 219 58 220 90 341 100 379 70 60 18.29'- 15 67 43 161 36 136 58 220 71 269 a5 322 2070 21.34 30 114 10 38 62 197 51 193 70 265 65 16$ 80 24.38 14 63 45 170 28 106 54 204 18 60 90 27.43 32 121. 2 8 37 140 55 100 30.48 18 88 21 79 t6 - 163 110 3200 7 28 a 30 50- Lock Valve: 19.25' 23.75' 23' 26' 56' 66' 87' 73' 15' 91' 112' to 11 1 a5 EFFLUENT & DEWATERING 40 ,8$ Warning: Model 185 should not be subjected to less 0 3$ than 30 feet TDH. 30- 8 189 25- Note: For Head Capacity on Model 112, industrial 6 20 column-explosion proof pump, see FM 219. 4- 97 i88 5, 15 6, 10- 2 5 ,55, 7,59 9E 13J, 139 SEWAGE & DEWATERING GALLONS 10 201 30 ~401 50 601 70 80,1 90 100 11 to 120 130 140 1150 160 1_ WARNING: Model 293 should not be subjected LITERS 1 80. 150 - 240 4c9 560 - 64-0 p to less than 15 feet TDH. w y~ l~~ ~~7 14A I- F w w f LU _ 24 180 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE SEWAGE AND DEWATERING 75 22 SER_IES_ 262 _2.66 267 268 _282 284 _ 211 _ 293 284 _ _295 70 FT_ M Gal Urs. Gal L115 . Gal Ltrs. Gal. Urs. Gal Ltra. Gal Ltro, Gal Ur9. Gal Urs. Gal Ltrs. Gal. tars. 20 5 1.52 90 341 28 484 128 484 -128 484 130 492 1BO 681 140 530 196 742 225 852 65 10 3.05 60 227 89 337 89 337 89 337 95 360 158 598 124 469 8' 685 205 776 15 4.57 22.5 85 50 189 50 189 50 189 63 238. 135 511 106 401 130 492 65 625 185 700 18 60 20 6.10 10 38 10 38 10 38 33 125 106 401 88 333 119 450 150 568 168 636 25 7.62 76 288 68 257 106 401 136 515 153 580 30 9.14 -_43 163 47 178 90 340 121 458 140.530- 55 40 12.19. 5 19 50 189 94 356 115 435 16 50 15.24 - 58 220 89 337 50 60 18.29 13 49 59 223 14 70 21.34 25 95 45 Lock Valve 18' 21.5' 21.5' 21.5' 213 35 42' S0' 62' 77' 12 40 co 35-, IT 10 I 4t M 30 W 293 8 ~(a NN" 25 M 6 20 _ . 1s 2az 4 10 292 2 5- 262 266, 267, 268 284 294 295 0 GALLONS 10 20 30 40 1 50 60 I 70 80 I 90 100 110 120 130 140 150 160 1,70 180 190 200 210 220 230 LITERS 0 80 160 240 320 400 480 560 640 720 800- 880 COUNly + Implete site plan on paper not loss than p 1/2 x 11 inctios in size, ('Ian must include, but 11erC,e clod to vertical and horizontal reference point (BM), direction and % of slope, -scale or PARCELI,O t ~ instonod, north arrow, and location and distance to nearest road. ~~9 1 D/~,O D APPLICANT INFORMATION-PLEASE POINT ALL INFORMATION REVIEWED BY OAT f S E L -L9,,1 4 T PfIOPEfi1Y LOCATION fi J J e I I GOVT. LOT SW 1/4 E.W 1/4,S 3 j T 2 8 N,R 1 6> r l PROPERTY CINNER:'S MAILING ADDRESS LOT N BLOCK N SU80, NAME OR CSM N 4 4: A CITY, STATE ZIP CODE PHON( NUMOGRl CITY VILLAG N NkA t A New Construction Use Q Residential/ Number of bedrooms 3.or 9 Fr-o oer ty on Ma1,,4G7- Replacement ( j Public er commercial describe_ Code derived daily flow gpd , Reoommendod design loading rate bed, gpd/It2 trench, gpd/It2 Absorption area required bed, ft2 trench, 0 Magnum design loading rate bed, gpd/tt2 trench, gpdAP Re-commended Infiltration surface elevation(s) o One For lY1 aur+d Rcyvtvfd It (as referred to site plan benchmark) Additional design / site considerations Parent material L o r-,Xs Flood plain elevation, if applicable Nor A pp 1144 1t S = Suitable for system CONVENTIONAL MOUND IN GROUND RESSURE ATGRAOE SYSTEM IN ELL - WOl DIN U -Unsuitable tors stem ❑ S 14 F4 U WS ❑ U ❑ S U ❑ S 1~U ❑ S U ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GI Boring # Horizo 11 Texture Consistence Baxtiaay Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be( 0-7 ~•5YK 3l2 i 3 b C t4) ~ vo 5•5 i- IoYR 4/q ic1 2 a ~k cvo 0• Ground 3 26 q3 to rp n: elev. SK.~ n. q 43-52 (o YR 5_IG' C I I G l,l~_ . c o. 2 Depth to S .52-56 loyp 5_/g ~(p 25,ie 6 f Sc( +ti a6k MFr W I vM 0.2 limiting - factor 6 S6 72 10 Yk S16 cl( 7,SY,t'~ls~ 0 03 M Remark's: Boring # vF ~ 1 0 -6 9.5 YR 312 S ~I 3 v~ o u V., CV 2 co ;1 vF K, Z 6~Z9 10 YR 4/q- _ I ~4k 41 ► C 0.5 ag, T` Ground 3 0-35 1 o y° 5/6 C- ( a b f r N/ 0.2- elev. - - n 1 3 5-Y6 1 0 Y R 5"16 _ P I P 9• s YR 6/9 d F gA 5 `f 6-GZ 10 YR Wit - c ~ O ~►v~r' ~ NP Depth to - - limiting 6 ~6 10 R 5h S ff T EG (actor, b r r KL Ld J Remarks:V 1993 CST Name:-Please Print Phone: Address: ruff fill e h Web terSAFMA ORS. (q► s); y y- 30 8 0 Bo-?c 2-31 E 011MOY 11 f I r6&iSin 5501 Signature: Dale: CST Number: S93 - 03 8 '7 3 ' SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure ' GGPD%ft 41~1 Horizor Texture Consistence Bmrtay Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. AM 3/2 ~ 2 10-26 io S; C1 2 F rv). ov I ryv 'Q 1 ► Ground I Q ~6 , f4of : x. r +rtyr 1 i . 5t 4:• J l~•l y41 ~M}. 11 t: Remark's: ' i . i{...~Y/ ♦ll. Y~, b.icj•1. l~ } 6ortng:# 4'' ) 0-10 915YR 3/',~ 'I 3v; sang. S, abk v"1 cw 2co a•s,;:t 2 10-35' ! o YR 5/~ 3 3-10; 10 YR 51y s I 2 ab k v ~r C s .-Ground d etev -1 `10'55 (p YS 516 3 , YR 6/9 bk w 917.2 5 5s 69 ►DYR sly SYRS/g Depth to c .h xrf Grrubng factor .14 0 Remarks: Eoring -S 9.5YR 3/2- - .•1 si l 3 aryls ~ v» I cw- 2 8-31 I o R Fat 317 s1q _ -.Ground 30 0 s 2 4 m fv- _5 1 m aL 10 YR 5 5-67 ID YR 5/6 - sl I M - Deptt, a64 ►n ~Y ,.t,..;. 6rr17ting ~ E~,.r ~ yN. ~jG w b. kd 5 - n i wi". = . Remarks: • n u 1 1 Li~i OVC a r, ; ✓y, L7- i } Ground -A elev.' E64 eft.:; ~ E 1 a t/~, 9 00 i ' Depth to limiting SAFETY is factor 9 "3 10 i ; Remarks:- Oct- L S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWN ER/Yl DQ it I' I h 0 4SL Z ADDRESS [V.3 Et 9 PP`IU~. _FIRE NUMBER CITY/STATESPrN V4 #YV W ~S ZIP5M7 PROPERTY LOCATION:,Sgl/4,S 41 1/4, SECTION, T~N-R I- W TOWN OF qV ahe , St. Croix County, SUBDIVISION , 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 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 600 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: a,5~ DATE: (-,It- St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 r S T C - 100 This application form is to be completed in full and signed b Y 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 Location of propert 1/4 1/4, section 31 ; 1_;_N-R 1-6 W Township Ceti e Mailing address W3 `1^ e S W1j 76 Address of site j Subdivision name Lot no. Other homes on property? yes No Previqus owner of property Rodetst Total size of parcel 0.CV'Cs Date parcel was created o C Cc Are all corners and lot lines identifiable. Yes No Is this property being developed for (spec house)? Yes X No Volume 93 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 & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty' deed recorded in t e office of the County Register of Deeds as Document No. $ C/50 , 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 County Register of deeds as Document No. Signature of applicant Co-applicant Date of Signature Date of Signature i' ti0L 973PA;E 234 DOCUMENT NO. WARRANTY DEED I n,is s►ar c gr~crtvco ►nq gCCOMUiNO o~ a 489581 STATE BAR OF WISCONSIN FORS[ 2--1982, REGISTER'S OFFICE - Sr clax Co.," , RKd for Recofd - - - - KENT.RUDESILL and_ANN RUDESILL,.husband and wife OCT C 7 1992 as Joint..-T- enants_, . . M Grantors, 01 8:30 A. conveys and warrants to DARIN.-.S.,.OF.STTE....a. s. ngle..Alatl Grantee., Register of Deeds . . . . . the following described real estate in County, - St.• Croix State of Wisconsin: i Tax Parcel No: Part of Fractional SW 1/4 of Section 31-28-16 described as follows: Lot 1 of Certified Survey Map filed June 19, 1992 in Vol. "9", Page 2492. i I l I` I TRANSFE]k f S-~ FEB ~I i i This .._....iS.-llO.t....... homestead property. (is) (is not) I Fxception to warranties: Subject to easements, reservations, restrictions and rights-of-way of record, if any. Dated this 31fA day of . . _ _ , 19. 92 . - . ................................(SEAT) (SEAL) - Ken udesil , i • . .........(SEAL) x... • (SEAL) • . Ann Rudesil.l.- AUTHENTICATION ACKNOWLEDGMENT i Signature(s) STATE OF WISCONSIN ss. ST. Croix . ...................County. n authenticated this day of 19;.._.. Personally came before me this 3:tk...... day of Si4`.:.-•-----•- 19.92... the above named Kent Rudesill and Ann Rudesill, • ~I ' husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN ~~-L . ; (If not . r authorized by J 706.06, Wis. Stats.) .~ift to me' known to be the persons..;: tom- 'A e foregoing instrument and acknoWhQe the s ^aRie►•', N r THIS INSTRUMENT WAS DRAFTED BY = +.a^J ~:'t• Attorney Barry C. Lundeen - - MUDGE PORTER S LUNDEEN'S.C. '.~*•-1,11--"`_~.•.. HtrdSOR ieFI Notary Public ' -.V ;'•.~is S C-,c~~X...~- --tlitinty. Wts. j (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state exll;siiijon are not necessary.) date: ---------Zl, ..9- - . 19.9-5..) 'Name of persons signing in sn+r capacity should be typed or printed below their signatures. WARRANTT DEED STATZ wascmj-Qn Wisconsin Leaal Blank Co.. Inc. II f 1~,1, Ir'd 46~d Ir'd 11160 T Me I I v p J Z 0 ■a I ~ r-d = _ I y ~ I 1 v $ I K w _ vaM N I ~t ` C C ` 4 o 0 R~ II a II ~ o Lffl II II II rn Mamas F~ 64216 ~ ~fl.f6 ZZL+6 4* L Coronado R30 y • FILED JUN t 91992► JAMES O'CONNELL 484SG4 St Croirop o"~ s►. c co., w4 C ER T I F- I ED S UR V E Y MA P Located in the fractional SW 1 /4 of Section 31, T28N, R 16W, Town of Eau Galle, St. Croix County, Wisconsin. Owned by: Kent Rudesill 2130 Pierce/St. Croix Rd. Baldwin, Wi. 54002 LEGEND W 1 /4 Corner Section corner monument (PK nail Section 31 set from tie sheets). T28N,R16W Section corner monument (Berntsen cap found.) _ 0 1"X24" Iron pipe weighing 1.68 lbs. K, per lin. ft. set. I o ro UNPLATTED LANDS I '53'03~~E Bearings referenced to the South line S 899053' ' of the SW1/4, assumed S89'59 49 W 438.53 378.47' „ 60.06: 3 SCALE IN FEET I= 200, 5060-w o 200 400 600' o) (m O UNPLATTED 100 O -S S ' t w ' rt- - LAND v a7 y (A o N Cr ° S 87' 24 ' 20 "E x t r b55.01' 4 h1 J: :LOT I 10 603, 237 Sq. Ft. (V I N 00 (13.85 Ac.) SLOT 2 to QI m co Including ROW 2 wl - 509, 171 Sq. Ft. 566,290 Sq. Ft. (1.3..00 Ac.) 1 ai 3 w (1 1 69 Ac.) Including right+O'f -way. to - Excluding ROW 551, 104 Sq. Ft. (12.65 Ac.) LO W C:~ 1 to Excluding right-of-way. 0% Hi 2i u~ ~I al m o M CO Co . r wj I 0 QI N .+~v •3o if) ~1 ~I 3 _ orn O Z ( cD Q N (n ZI Qi o N89°59'49"E H1 4I f-I o (2.02 Ac.) °8.58' WI-1 4-4 Z 87,960 Sq. Ft. CD FT255.38: S88038'53"E aI ~i Including ROW ~I tnl 79,539 Sq. Ft. m (1.83 Ac.) ~ - W 5060' Excluding ROW••CU 0 (Ioo' N8 °59'49"E 1162.33' 33.02'0 44533461.62' to 508.2433.28' 458.77' Z 255.00231.98 J'_LERCEI_ S 89'59' 49"W _1222.01' a"LCROIX ROAD i SW Corner U_N_PLA_T_TED_ LANDS S1/4 Cor. Sec. 31 1 Sec. 31 • South line of the SW4 of Section 31 VOLUME 9 PAGE 2492 This instrument drafted by: 4922026