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HomeMy WebLinkAbout020-1154-00-000 /4,~w y STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CsM# /491 LOT SECTION-. 23 T_ __N-R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 3 'X 'Cot 1 (f c G~Glhrli'~ / /l fr~t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- J BENCHMARK: /oo o ~a/7~ vc ALTERNATE BM: ®u SEPTIC TANK / PUMP CHAMBER / HOLDING.-TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well Huse /S Other Pump: Manufacturer Model# 9 7 Size Float seperation Gallons/.cycle: Alarm Location Z- I/ SOIL ABSORPTION SYSTEM Width:. 1~G Length 33 Number of trenches 44r,1 ~,r Distance & Direction to nearest prop. line: > s-a ' Setback from: well : 7aoo ' House > 1,oD' Other ELEVATIONS Building Sewer / 2m0 ST Inlet; ST outlet `s+wol PC inlet PC bottom ,,P, p " Pump Off F7. y1 ~ Header/Manifold Pit 7 ' Bottom of system S6, p Existing Grade Final grade DATE OF INSTALLATION: d° f e'l PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt / L~s~snlHrtnReust?y3.29.19.8 Sabo: IVATE SEWAGE SYSTEM County: and Human Relations Satfety and'BuilBings Division INSPECTION REPORT ST- CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ` 199934 ❑ City ❑ Village IR Town of: State Plan ID No.: Pe?mit Holder's Name: 1HUDSON Wffl?~v__: Insp. BM Elev.: II&I&Lscription: Parcel Tax No.: !f /1)F ' / ; 020-1154-00-000 TANK INFORMATION ELEVATION DATA A9300338 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j f ~Q 0 Benchmark ~p/. g wo Dosing /0/, d Aeration Bldg. Sewer i Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Aiir Intake ROAD Dt Inlet C/10 owl Septic 75 / 5S0 # IS 0 >/5' NA Dt Bottom /3,7y (7A Dosing > 7,5 ' '~O U,,, end NA Header/ Man. Aeration NA Dist. Pipe h; dY Holding Bot. System S,BoZ ter`„ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand c~ Model Number GPM TDH Lift (r,0 friction ~j Systems ~ TD Hu Ft Head Forcemain LengthDia.' Dist. To Well Apo SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length i I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth y DIMENSIONS $ (o DIMEN IONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type 0 /Lc~f• OR UNIT Model Number: System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ~ Length _")O Dia. Spacing N' on l3 J` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over qq , Depth Over VV ' xx Depth Of xx Seeded/ 9edded~ xx Mul ed Bed /Trench Center U'd Bed / Trench Edges 1D Topsoil PrYes ❑ No R"Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ,LOCATION: HUDSON 23.29.19.848 tu'.&~, fi(`-. t.4✓ L+L-`c•.. w G R 4'~.+ ° Mfr` /1L/ j { ~J .k', G~? y f ~L i. 11 t4 E < ~;.1 L-( E• e. ~G--SF E (~(.~(.~:Yit'y•y,1.i.t u'~ l E3 ,-C' ~ G)-i / ' ~ _ . ? ~J'Q~a.~+ • ~ Gam' ~"L-a.-~~~'~ ll~~Lt: rwa~ ~ L E , c , 6 l ' B d f l0' ( ,3 _Z~ Plan revision required? ❑ Yes ❑ No Use other side for additional information.) SBD-6710 (R 05/91)' t°e '~1 C date Fv ~r}I:SSi r Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ` s 1~ 5 , SANITARY PERMIT APPLICATION :1D&HR COUNTY In accord with ILHR 83.05, Wis. Adm. Code j STATE SANI Y# -Att6ch complete plans (to the county copy only) for the system, on paper not less than ❑8% x 11 inches in size. Ch k i application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPS OWNER PROPERTY LOCATION rlE Y. = %s, S ,23 T , N, R E (orff_ G' PROPERTY OWNER'S M (LING ADDRESS LOT # BLOCK # S .c IlO CITY, ST T ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM-NHMBER~ .le J,C re ! 13 CITY : NEAREST ROAD 11. TYPE OF BUILDING: (Check one) State Owned ❑ VILLAGE : - MN 14: ❑ Public 01 or 2 Fam. Dwelling-# of bedrooms - PARGEL TAX NU III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 1100 Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. 0 New 2.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 m Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 Seepage Pit Pressure 43 ❑ Vault Privy 140 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 ap 2- 96, A Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 10 200 !G Li El 1 0 Lift Pump Tank/Si hon Chamber, (C 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 Stamps) MIN PRSW No.: Business Phone Number: i' m ~r 1-8 f 36 P u er'a Address (Street, City, S e, Zip ode): GtJ~ OS-~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e Issued Issuing Agent Signature (No Stamps) ` Approved ❑ Owner Given Initial yd' Surcharge Fee) Adverse Determination 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 " A 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: I. 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 l 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% 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 pointsi C) complete specifications for pumps and controls; (Jose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; Dycross 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 1 SAFETY & BUILDINGS DMSION State of Wisconsin Department of Industry, Labor and Human Relations November 1, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSO 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S93-03943 FEE RECEIVED: 180.00 HANSON, CRIS NE,SE,23,29,19W TOWN OF HUDSON COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, A K nn th Stiemke Plan Reviewer Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. thu Fri SM7W (R. oihu f . y SAFETY & BUILDINGS DMSION State of Wisconsin Department of Industry, Labor and Human Relations November 1, 1993 201 East Washington Avenue P. O. Box 7969 Madison WI 53707 ULBRICHT & ASSO 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S93-03943 FEF RECEIVff): 180.00 HANSON, CRIS NE,SE,23,29,19W TOWN OF HUDSON 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. Thrs review and approval of the L.ystem is based on chapter 145, Wisconsin Statcat:es, and chapter-,; ILHR 83 and 84, Wisconsin Administrative Coda, 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 II,HR 82 or in r.hapter I! HR 50--64, Wisconsin Administrative Code. This plan subcrcitiai 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 expire,_ The licensed (:lumber reponsible for this installation shall keep one set of plans with the Department's stamp of approval at the constroct.ion site. 'The installer shall notify the appropriate? Inspector when inspections can be made.. All permits required by the city, village, township or county shall hw obtained prior to installation. Inquiries should be directed to me at the nuimi)er listed below_ Please refer to the plan number shown above. Sincerely, T K nn rthtiernke Plan Reviewer Secti& of Private Sewage (6C8) 266-8230 7:00 to 3.45 Mon. thu Fri asn.m~ ca. oi~u ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I.D. # 593-03yy3 Date ✓Aa0, I~Pf3 Owner CffiP/S #4A)50A) Phone CO~~ - `r3G - -,Wo Address 4?v,A.)7- ,4 MC. NO12tt-- ~ LAkELk,O O~ J1 i'NAJ . SSA y 3 Legal Description LOT 3:1F 20 Fox VAilty AODt-rio4 Town of County S%. C R 0 r X' C.S.T. ART, wEGeRtR Installer -D.9UE -Fo&eery Local Authority/ Supervision ST. CP0CYL ('OVAJ Ty Zprliha 6- PROJECT DESCRIPTION )Jc.w co,aST~ u c'T:o~ - woe /F /~it'OP'os £a f ~~~.t°~-1. /~Mt . SST/ti1~T~D Gv.f STf F/ot.~ - CoDd G•PF~ Soi/S fJ-,f'~ Pakm 1,44 / - S" BPD / f } r N +t.Q„ 1sT 3 0 + a o r SeNSoaALL',r SA,-rupAT£o Ar 3 O Neu NoU--jo SysTt 1 I'S Ppopost''D. Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS %011113111114q It Pg.3 PIPE LATERAL LAYOUT' 'y ~Roarw. s~ Pg.4 DOSING CHAMBER CROSS SECTION "°CHT D1160 MOWN, Pg.5 PUMP PERFORMANCE SPECS wis. o0i®9i~~ ~I ~ ~fet 5 100 v ak 2 ser fay cs7- g" 3/y" PL)c SCALE-: yon ~'f~uhr~oa = 9a,3' - ~s o - - - - - - _ _ _ The ~~ea X511, NOW the boslope edge 01 18 14' i ~ Soil 6o011 S101 Id noa MM18 •J • BJ1 1 ° 2 s 70 1 ' 7-,}/ of G /o 13~-t # 1 se r (3 y -cs r s 7- PUAflo -4,'y 13 CV, o o C011(fill, ~gptt & Lp1NCIS I. 1NDNS OF SNf son- 11 1SoON SpoNpEN~E SeE GOR Sc4.4o Pttc • oo r of ° Z op ~ T't~' k S j _ ~ E~.► s T Stp ti c T-l~v,f V 1S s Couc,PEj- P.PoJ)v cTS 6T,t,E-ED Ou7- E 0 P~'opaskb w-// ' tw L°T Prior To Plowing- Installer will carefully o co~,v shift or orient mound position ( toe line and area under bed aggregare) so grouuu so L6 elevations across slope are as uniform as r possible. Suggested elevations (staked on site with lathe markers) are shown herein and on pg. 2. .39 4 3 - _ INVERT o~ ~ ~s}Tc ~P~1 /S 1~ •.50 - 4!F1,EV,t7-1'OAJ S 770P OF K o C K 1(v . ?o z S page _ Of - Top OF -r-E 1? 6 L- 5 Synthetic Covering Distribution Pipe Medium Sand s y STEM - ErEVAT►•N Topsoil F 9G • D ' 3 E D 3 % Slope uN R Fat L7 Bed Of i~ Force Main Plowed Aggregate Layer Uti~v~P.ti ToE uNE D O Ft 9a . 80 S Cross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F • 7S Ft. • G ° Ft. I yea Z5, below ibe dowaslope edge of the- %S A . Ft. H Ft. Sill INOIN ON I ~ . e Ft. 0110 K Ft. Ft. o~ o<a~~ ' Ft. OF 1~as ~F SaF a~ -l Ft. F Main N 33 Ft. Observation Pipe B K A 0 ----------------------•I w Distribution Bed Of i Pipe Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area &645 TE F/cW _ 6 / T~t13 le O I Poo SQ. GT ~Po osEO ~~ts fJ-L I P x ,q f 1 - ,,t 166X SO. r-77 I i I III ~I r. -..:.-H,.4m+wnMeNtR't.m1-9 +sra. wM+w..k:,rr~A~+rc~w .s .na..w.....:. •r 9 a 39 4 3 PUMP CHAMBER CROSS SECTION AM SPECIFICATIONS 4je If of 5 VEWT CAP i, 4"C. I. VENT PIPE WEATHER PROOF APPROVED LOCKIWG JUWCTIOW BOX MAWHOLE COVER ' IT W 2S FROM ODOR, 41,V 11,0(! 1AV1 WIWOOW OR FRESH 12"Mw. I AIR IAITAKE i 0~?/O At GRADE I y"MIW. 00 ~ I I B" MI Al. l/~ CONDUIT-- (moo ~ ILI r- ~l % 13,o IAILET PROVIDE i -7 t^1 coy / S I Y T APPROVED JOINT A smT."'ON I `kilQ`t'S APPROVED .101WTS K 'E IN ~N O~ $ vo I GS W/C.I. PIPE EXTW/C.I.ENOIPIAIG PE 3' ~1(,~'~ s~'al, 0B AL M EXTEMDIM6 3' '00 ,NpV st'g l I II ONTO SOLID SOIL OWTO SOLID SOIL a gg,15 . df I,S~~N of goys c >E GORRESpOrj ELEV. FT ' PUMP OFF D ~,1 BLOCK /EVl1 rioA! RISER EXIT PERMITTED OIJL4 IF TAWK MAWUFACTURE:R HAS SUCH APPROVAL SEPTIC F SPECIFI-ATIOA.IS DOSE TAWKS MANUFACTURER: evcL 'S efvoeerr IJUMBER OF DOSES: PER DAy /000 150 TAWK SIZE: GALLOWS DOSE VOLUME y Urt<~ ~I"At 4r- IUCLUDIWG SACKFLOW: GALLONS ALARM MANUFACTURER: /1/ IkICHES OR GALLOWS MODEL WUMBER L V CAPACITIES: A= 2,0, 7 IWCHES OR y©~ GALLOWS : q SWITCH TYPE' Ht' f LlJI~ y IWCHES OR .3 / GALLOWS PUMP MAWUFACTURER: Z6715/4~le C= ~ IWCHES OR 15y GALLOWS MODEL WUMBER: k~_" 1/0 V D= 20,6, INCHES OR y0 7 GALLOWS III SWITCH TYPE: pI &6YgACk, Raeaey {/~±r NOTE: PUMP AND ALARM ARE TO BE MIWIMUM DISCHARGE RATE _s S GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL OIFFEKEWCE BETWEEW PUMP OFF AND DISTRIBUTIOU PIPE.. (0,0 FEET TALI` TPECS + MIWIMUM METWORK SUPPLY PRESSURE . . . . . 2.5 FEET EAC(A- Oar plkfL o FT ♦ 2L FEET OF FORCE MAIN X 100FLFRICTION FACTOR. FEET & TOTAL OyWAMIC, HEAD = 9 0 FEET T IWTERWAL DIMEWSIOWL OF TAWK: LEWGTH ;WIDTH - ;LIQUID DEPTH i t . i~ `~~~3943 i y . to o: HEAD CAPACITY CURVE 3 7/86 1/4 MODEL "98" 30 4 5/8 - fi l -w7. 25 e 3 5/8 6 20 1D I O t - + 0 J < 15- 4 3/16 4- J o 10 - 1 1/2-11 1 /2 NPT 2 `y 5 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS BO 160 240 e 0 FLOW PER MINUTE s~ UOA/ P~ TOTAL DYNAMIC HEAD/FLOW PER Mt,,UTE 1'-) EFFLUENT AND DEWATERING CAPACITY 12 , HEAD UNITS/MIN FEET METERS GALS LiRS 5 1.52 72 2-13 i~ 10 3.05 61 231 15 4.57 45 170 ' L_J 20 6.10 25 95 3 51/16 $r Lock Valve CONSULT FACTORY FOR SPECIAL APPLICATIONS ~F • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and ` supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without. alarm switches. variable level long cycle controls. SELECTION GUIDE +`f 1. Integral float operated 2 pole mechanical switch, nG external control required. Standard all models - Weiht 39 IbS. - t/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode FAmps Simplex Duplex 3. Mechanical alternator 10-0072 or 10.0075. ` M98 115 1 Auto 9.0 , 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N98 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify D98 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) float system. 6. Four (4) hole "J-Pak", junction box, for watertight connection or wired-in Sim- 'E98 2,10 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 - plex or duplex operation, 10.0002. 7. Two (2) hole "J-Pak", for watertight connection or'splice. For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection davit:ea and wiring should be done by a quafi- Piggyback Mercury Switches, FMO477; Electrical Alternator, FM0486; ti?schanical Alternator, fied licensed electrician. All electrical; and safety codes should be followed taclud- FMO495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, Ing the most recent National Etectria Code (NEC) and the Occupational Safety and FMO732. Health Act (OSHA). l RESERVE POWEKD DESIGN For unusual conditions a reserve safety factor Is lneered into the design of every Zoeller pump. - MAIL T0: P.O. BOX 16347 4 Louisvil';, KY40256-0347 Manufacturers ol... 0 SHIP 70: 3280 0%' 0216s Lane ZAIZZIA-ff Low:'viil~~, KY 41216 QUAL/7YPl/MPS ~NCE I9JJ (501) 778-2731 0 FAY (502) 774-3624 .L/N.~?L;;G7TT~0 .~/~NoS Ef-~,ST ~ COQ. 2 ~ z9 /9 c/~ST-/~t/EST 4 Z-///E C) 4~ sz' ' - - - - / - - - -23.x= - - V / / e gB ~11~ • I q0 _OT /c`3 / 6P/ I \ OK/ T'~ hl eavl / a X07- ~ CO ~ ~ 14 \ w \ / / ^2.9^2 ~c~ES ~1 \ C J c , . S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS S-~; FIRE NUMBER CITY/STATE ~-4ryt - ZIPD I' PROPERTY LOCATION: Mot 1/4,-Sf- 1/4, SECTIONS, T a-N-R TOWN OF, St. Croix County, SUBDIVISION , LOT NUMBER i 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 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 septi has been maintained must be R completed and returned to the St. Cro x Co. Zon g officer within 30 days of the three year expiration date. J SIGNED: DATE : St. Croix.co. Zoning Office 911 4th St. P 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 enly result in delays of the permit issuance. Should this I. development be intended for resale by owner/contractor,(spec house), thensa second form should be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. - i owner of property Location of* property A16114 - X1/4, Section , T_7-q_N-R_L2_W Township Mailing address f)rz^vc Address of site f) Subdivision name J'0`~Y- V Lot no. Other homes on property? es No o h Previous owner of property Total size of parcel gra3 ? a..~~ Date parcel-was created 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume/-OD 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'. avoi d 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 (ar6) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the county Register of Deeds as Document No. -1-CD rf 57 / , 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 reco tded i n the office of County Register of deeds as Document No 5-/ Signatu f applicant Co-applicant Date of Signature Date of Signature WARRANTY DEED W111111"", AAM 43, ~'a531 V OL 1 r r.-GIST'-'1113 OFFICE This Deed, made between John C.;Hansen and Judith A. leC'd for Recont Hansen, bushand and wi fe SEP 10 1993 Grantor, 5:00 P. C'A' and GhEistilan Hansen, a-aj-pgle person ft a Vim,. L,,, 0 tit Doeft Grantee, Witnesseth, That the said Grantor, for a valuable consideration RETURN TO conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 20, Plat of Fox Valley in the Town of Hudson, Tax Parcel No: D.LU lh Od St. Croix County, Wisconsin. This i G nni- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And _ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. 4dDa this 10th day of ';Pni-ember '19 93 (SEAL) r (SEAL) John C. Hansen Judith A. Hansen -(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ~ t • , 0 ss. t ~ County. authenticated this day of 19 Perso ally came before me thi day of 19 the ab ve amed 1 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person O ho exc `ted e authorized by § 706.06 Wis. Stats.) for going instrument and aeknow same THIS INSTRU T WAS AFTED BY I •Not ry Pub lc T iS. (Signatures may be authenticated or acknowledged. Both Commission is permanent. (I 46#-AM ion are not necessary.) date: fN 19 ) Names of persons signing in any capacity should be typed or printed below their signatures. s81 NTF 0020 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms, P.O. Box 10208, Green Bay, WI 54307-0208 FORM No. 1-1982 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Divisio:tof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY s~-. ct~.c~ t x Attach co)nplete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited t8 vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE NT INFORMATION-PLEASE PRINT ALL INFORMATION APPLICANT PROPERTY OWNER: PROPERTY LOCATION Q_'It\ . S N) NK1 S rJN GOVT. LOT NF 1/4 SE" 1/4,S 7-3 T Z of N,R 19 E (orf PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # S°tS QvNPJT- 1-NE . NUR'H 'Zo - ~x PM TD IT10N CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD LRh~: V~fvD "N S Su~4 3 (W Z) q36- s~Ro `t'~v surv t3V_jlalllotei Q~ New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow boo gpd Recommended design loading rate y bed, gpd/ft2 - trench, gpd/ft2 Absorption area required SOn bed, ft2 Sod trench, ft2 Maximum design loading rate o- S bed, gpd/ft2 0• trench, gpd19 Recommended infiltration surface elevation(s) °l (I • _Q) ` ft (as referred to site plan benchmark) Additional design/ site considerations `t't Ov >J~ WtDi H' x b Q - M t &j! HUNl ' or- S Drub t=t -t- Parent material _ Flood plain elevation, if applicable N • 'A - ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S O U WS ❑ U ❑ S ®U ❑ S 2$U ❑ S ICU ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed Trends \Z1 Q'IQ 7?_ Z Z tZ_3y Io~t2 37L sib Z~ Sbk~~- S l~ t o.S o.b 5 `1-R 3l 3 e 1c~ s 1 0~ wi~1-- _ - 416 s Ground 3 3Y-SS z.s~ y s Lt V_ elev. of Z . ft. 3 fv S t' R O t= ItiJ ~A1rz ~1 C 'T S { Depth to limiting factor, 3y ' Remarks: Boring# 1 0-lq J~' cS F :111 2 Z ILL-3~ 1.0 `i1Z 376 - S t ~ 2' ~ 1 c S ~~u~ o. S o. SI,8 3 3y-St; 10 `1Z yL~~ ~b`lR l~lZ L` I ° Yv'`t t. Ground 4 elev. 911 -,6 ft. Depth to limiting factor Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: ,r, 1 S 9 3 CST Number: °13- 1-17 M00576 I PROPERTY OWNER ~~~Pc~vSuty SOIL DESCRIPTION REPORT Page Z. of 3 PARCEL I.D. # + Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounds Root§ GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench S11 L ~.S~1~ mfg cS Zui o.S u.b lo`tQ y!y - S1I z4sbh. N,, -C CS 1uf o.S u.b ~•S`i2 31y C1 S`aLW6 S) `C- Sbvz Ground 3D-48 bpy1-Z 3LL I lu`t2 (PI s~1 ti'''Ft- C S - - elev. Vcs ~t 9- Y/ s o m y C) ~-Z ft. y Q-60 6 si inn h - - Depth to co>\, uv S R r ` 3Tv NE: A GM @U S . limiting factor 3~N Remarks: Boring # Y Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 1. tc: n'•i Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page -S of 3 v + . SCALE 1"= Ijo ' L 2 J o Ott-lt..g2.3'orv 8"tttGN 31V'UTA PVC PIPt k)/L" • ti ~o ►`10T ~PRtT O\Z ~1S1VVLL~ `j111S Pri2lrA M ~ IV/ Ptlz eL q6. J B•Z qv 6 8 o as, ~'L7 aF L ~s 8tJ L'L.lpp.p' p►J cl kt~l6la 31y'' plH, PVC ptPL ~w t,. 96. !i a A° '•J O \ Cio~gE W.» WELI. ~ 9E > 1.po~ Suu'~t~.l.y OF wiou~r0 IZ 2. Y-)~ ~l~hts i ~p c) 3-Z37 (715 ) 425-01 65 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Lat~or arnd Human Relations Div,sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5T . G~..O l X Attach oomplete`site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION C,l\"QLt S K 1VS oN GOVT. LOT tvF 1/4 SE" 1/4,S Z-3 T Z 01 N,R 19 E (or&W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # s s v ~r L NU2`T-N Zb ~ SOX vn`~~'-r ~A rno►~ °l Q ~ Irv , CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD LRtti. u~fup >~N S SUU3 (61Zf ~13b- s~[Ro `~~sorv Q~ New Construction Use Residential / Number of bedrooms IV [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow boo gpd Recommended design loading rate Q •y bed, 9polft2 - trench, gpolft2 Absorption area required Sao bed, ft2 Soo trench, 0 Maximum design loading rate o- S bed, gpd/ft2 trench, gVW Recommended infiltration surface elevation(s) q b . O It (as referred to site plan benchmark) Lk- s A>l,D t=r Additional design / site considerations 0Q >•'D W tW 8' y b ~3C~ - M7 ► t 1y uM t OF Parent material - Flood plain elevation, if applicable N - A - ft AT GRADE SYSTEM IN FILL HOLDING TANK I -1 S = Suitable for system CONVENTIONAL MOUND N~ GROUND PRESSURE U= Unsuitable for system ❑ S ®U + S U 0S ®U (j S U ❑ S U S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Cortsistence Bandary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rertctt 1 'z- 1o~ltL 2_(2 St\ Z-77 GS 77 o•S o.fo };ntt<s y Z tZ-3y Iontz 3IL si Z sbk ~n~~ cs lvF o.s o,b is Ground 3 3Y-SS y e 1s K¢ L/.f; elev. oi Z ft. 3 ~,s ot= w y e~ L s 1 Depth to limiting factor Remarks: Boring # 1 0-1q I,DL[(Z 2Lz Zi5\b12 W1 f1_ cS Zvi o.S 0.6 11 3 Z 1~-35/ ~v `tQ 3!~ - s t ~ 2-'~ sbk vn c S ~ of o. S o. L 3 3N-S~, to`1iz y~3 cl ~.s\iQ sJg C, owe vvt~i r Ground Mw 10KR ~l2 elev. X14 _,b ft Depth to limiting factor 3y4 Remarks: TName:-Please Print Arthur L. We erer Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: p Date: 10 ^ t S - q CST Number: a( 93- 7137 M00576 PROPERTY OWNER VVN--Nj Suy~,3 SOIL DESCRIPTION REPORT Page?- of 3. PARCEL I.D. # Boring# Horizon Depth Dominant Color _ Mottles Texture Structure Consistence Bouxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ed TrerSdi O- l l L~`lR ZLz - s 1 Z s c S Z vi v•S v.6 ~Z 1-t V y l y - S1 I Z4s ~k rn ~f l- CS ~u f o, S ~•S`tQ 3~Y Cl 5~1R~116 S1 `C-sbrz Ground 3 30-48 \2 3LL lu`tR ~t2 5c- t ti`'~'£l- CS - elev. V o 1-1 ~z y i ti ~ ~ o~ w, v Fh C l Z ft. y Q-6a \o ~~z / 6 s i inn h - Depth to 3 cxvv i~ S R Vkkj L t M t 3Tv tiE A GM ej S limiting factor 30" Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: Boring # Rao Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05/92) : PLOT PLAN Page 3 of 3 SCALE 1"= 'AO ' J 9Z.3,oti B ~H~Gli 3/v 'Um PI~C PIPS W~L~I1N J ~"aZ,/~~\ ~o ►voT co►1Prc<T O\Z ~lSlu~t~ 7Ws Pak% 2 ` n ~ CL 46? B.Z may l 8 o e s, • ~ti OP e a . 31yOIt1. PUC ptpe , 96 C w / L tM* o ~ ~~ovgt" fwo weu. 7 ►oo' Sou`Ct~c z Y of Hovrw q C) 3-2.37 10-1S-43 (715 ) 425-0165 MO 576 CST Signature Date Signed Telephone No. CST #