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HomeMy WebLinkAbout020-1102-00-400 ~q STC - 104 S BUILT SANITARY SYSTEM REPORT (P W1WR a &x Z-d JJ4 ` 9 SUBDIVISION ,L/ CSM# LOT # SECTION 34' T_~-N-R J~W, Town of L+0(c F ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYST M n d V' D 6G ~ ~ 0 ('fit-J~ tiI S. `Tc INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. I~ BENCHMARK: S~ S ! l ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:` Liquid Capacity: 1r?'GU Setback from: Well So '94- House 13 Other Pump: Manufacturer Model Size Float seperation Gallons/cycle: Alarm Location ~aw ~a- SOIL ABSORPTION SYSTEM Width: Length Number o 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 DATE OF INSTALLATION: _5 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt LO sTrt? pa'Ft b ~wiaust yt • 29.19.4 V3~FrE W ~I~ S~(ST EI RD. County: Labor artd Human Relations Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION I q13 -9 q Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: r, T M ev.: nsp. let BM Description: Parcel Tax No.: Id, 1 02n TANK INFORMATION ELEVATION DATA A9300019 S 1W1a31 Iti TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /-)rspr.. - Benchmark /0y.85 /00 g , Dosl n , a 90 Aeration Bldg. Sewer Holding St/Ht Inlet u,y 3 /po,~ TANK SETBACK INFORMATION St/ Ht Outlet ! g /Do . 07 Vent ir Ito ROAD Dt Inlet ri 9, p TANKTO P/L WELL BLDG. A Air ntake 5,62 G Septic 5 > 2S ! ! ' NA Dt Bottom 7 Dosing NA Header-/Man. _ /-5 /01,7 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade p~- /0l. F3 Manufacturer Demand 1. ,7 163-/5- Model Number ,r,x,o GPM a cf!-~ TDH Lift ~j0 Friction System TDH Ft Loss 10 , H d Forcemain Length 2S ' Dia. " Dist.Towell y~S SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION ~I DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O JK c CHAMBER / Model Number: System: m9lGwi;4 aS ~f`S > OR UNIT DISTRIBUTION SYSTEM 7' 4~ H aeP/ Manifold Distribution Pipe(s) ! c x Hole Size x Hole Spacing Vent To Air Intake Length -_E Dia. Length ~ Dia. ' f Spacing I 11u ~ I I u~/ I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over U Depth Over t- xx Depth Of xx Seeded!-Seddg~ xx Mulched Bed /Trench Center Bed /Trench Edges L~ Topsoil 91yes ❑ No R-~es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) ST _/;J LOCATION: HUDSON 34.29.19.406F,NZ,NW, LOT 3, BARER RD. c/7& 0 5- 7 FG ~ L Plan revision required? ❑ Yes ❑ No Use other side for additional information. Pb/ I SBD-6710 (R 05/91) Date Insp ctor's Signature Cert No. y ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ; III ,APlaW%ENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION .LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP LOT NO.:BLK. NO.: SUBDIVISION NAME: NEB/nJU)~/ 3 /T4 N/RIIE(or)W HU0960 3 CIS COUNTY: OWNER'S NAME: MAILING ADDRESS: 51-C,eV4 To H,) ' SOt S-f AI~IEc(«/Z 700 rF3,4tkEz /-N fl uo'so-) ~~5. S4oi~ USE ,3 (O Z.0-2- DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION- .1- DESCRIPTIONS: PER OLAT ON TESTS: Residence 3 91 New ❑ Replace e_2_1 P / ( 'RockTaj Si RATING: S= Site suitable for system U= Site unsuitable for system 5C5 G ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) TI S ©U ©S ❑U D S ®U ❑ S DU 0 S ®U 1A o~~ v s ys7 DESIGN RATE: If Percolation Tests are NOT required If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: e. L#t s s Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS lu 'ZjtC/AlAi- 'F4- BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B-~ ~~~r 99-~~ ► l,0' i-t*y -allk.Si S '73~ T3locKy Sr/I ,P3'3a• '~'Lo y 0 ro 0,R S-P, (s . 5 TAN c s I , r 7 f c-F wua.S~ L I'm ES 7`O •v C B- 40' /Wor 371 ,5 Co. 'Blocky vi ~ -G7 ` B-2 ltp 7 v s:/ 43'i cS y C,.e o' lePe4ey L~:v ES lb a E_ B- ' BJ r V' /0/. 32' ~J 'O > 5. Q , w~ '~c ~t+y !3 a I . ~~i ' S . (p 7 ' h1 ~S R C If* E 7W.J B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- I-- o ' its 2- S P_ 2- 67 7 P_ t' 2- P_ P_ P_ dr i~J C S ST Q+F 4 PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface " elevation at all borings and the direction and percent of land slope. O` T 1~/ I,r 1 SYSTEM ELEVATION 7 / /Oi2t,i 7$ i E _r L4A),p~._. Sion _I 7 3 • I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: FIO-IJESITE SEPTIC PLUMBING CO. Sx PT• (Q' t 4 e~ ADDRESS: CERTIFIC ION NUMBER: PHONE NUMBER (optional): ROBERT ULBRIGHT P.R.S. ~-`f ~ 3 ~C ^ ,P/d' WIS,. MASTER P6UMSER Ur NC) 11()7 M r.AINN. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATU E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10183) - OVER - ~J ~T~tilcGkf~. S Tro~f - Lot It SCTIONS WTIPLET FORM 115 - SRC - 5595 r mpl-: _ l accurate sor( t€ report n WEST i-oT ~i a E 1 . Compl, to 2. The use s4 -tIlly indi this ji~jknrnercial project; 3. MAXII- heciroo o . r ec ; Lot 4. Is this a n rnent sy tern; Complete 'lity rati J boxes. A SITE IS St >"kBLE FOR A HOLDI C~ TALK C3t~LY IF ALL OTHER E R LED OUT BASED 0', it CONDITIONS; 6. PLC^ ati ins shown here for write, -.,Ie descriptions and completing the plot plan; 7, MAK dia pm accurately locating yz test locations. Drawing to scale is preferred. A separate ij& if desired; B. Make sue= k and vertical elevation reference paint are d are permanent; 9. Compiet~; > k>oxes as to dates, navies, addresses, flood plain i, € elation test exemp tion, if ap;, '10. If the info flood plain, elevation) does raot apply, place N.A. in the rtplaropriate box; 'Cr 11 l y1 Rk%ign the form /RITY €z rrent address and your certification number; quireci, ALL SCtILTESTS MUST BE FILED:rltll T}lE 'P~ 12. Maake legible te as re L UTVJ a 4,!N 30 DAYS OF COMPLETION. ~ lE✓~tT/o,~ = , 110 Sy~ fP1ABBREVIATIONS FOR CERTIFIED SOIL TESTERS S if Separates and Textures Other Symbols s - Stone (over 90") BR - Bedrock co - Cobble (3 - 10") SS Sandstone ~Jr -Caravel (under 3") LS Limestone Sand 7" $3 HGW High Groundwater c ~ Coar~_ ~_r~~ • Perc - Percolation Fate rued s Med3ori Sand W - Well 7 (o ~p fs - Fine Sand Bldg Building Is - Loamy Sand > - Greater Than sl Sandy Loam < Less Than 'I Loam Bn - Brown sit Silt Loam BI - Black S - Silt Gy Gray *cl - 'flay Loam Y Yellow W scl K Sandy Clay Loam R Red Q 3ic1 - Silty Clay Loam rnot Mottles ~S~andy Clay w.! yvith s~ sic; Silty Clay fff few, fine, faint 3 c Clay cc - common, coal se ~t Peat man - Many, medium nt IMLICk d - distinct $~T p } romme nt I-WL - High wa! 1 Puc PId 4 i y Six er~eraI s«'I textures surfac , for cijurd waste disposal BIB - Bench ~r FiP ~tertical e rr~oi at PL, A i yy• 3 77 i i SC ,a 30 lE f TO THE OWNER i £As T 6o r This soil test report is he fiat step in securinasiuait {~ertrtitrn cctstrnt~®r'ie j5epartment may request ftun--o 7171 s s r test in the fi i r to permit issuance. A complete set of plans for the private sewage system and a er it application must be submitted to the appropriate local xuttTMrii,44&46~+ j obtain a permit. The s sitar permit must be obtained and osted prior to the start ofnyconructior~. s s `d~'~ wood PoS~ - ~ipG iTE' HOMESITE SEPTIC PLUMBING CO. 6% O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT CST W 2~~Z WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN.,INSTALLER & GaSIGNER LIC. NO. WA f i ' .I 1 „1 z • UNPtsiTTED, LANDJ._ NORTH LIKE OF THE y;I G KWI/4 9 °.3'Ov W ••I, so-:co"• tro.l0'1 ~S /1 014,24' N89. 53. 00"W 620.09 ' YY r' T 60:.cb' v C_ r~ 'y' N N~ • ? _ N~14 I N N P / .~U 7% • z O \ ~ 0 Cp IO v % d / a a s 327.12' z, 5 b9. 29, es" W 1? a r'T P \ OBI ~ 1 ~ : O I (/]'~{~(~/QQ-'~/~~ i m m 8i s z ' Y G1 ~ ~ •IN 10 ~ > x O P z 1m ~ / !n • 0,10 Ir O 3 = 1• 1= Q ~ S I= N S u y N m ly / U RJ I' A N V i O ~ P N 2 N W O ] Z~' a 10 N -1 L~~ 'tom D ~ ~ Z Op np O r 74 N N r- > N 257.00' -256.69.__ - r - - sag* 58' WE SS7. aB' S 89• 57' 53" E 1 _ - C,€RTIi1f~D_SU11V C-V, M 1G_ _--_.•a-_ 1 y ;r r 44 i' 04 •'.1 yy N t N _ ' r moo N'N"r A••1MN'M•~ •MM~ r \ lit a • di~ n o I T ~f ~ ^ I i _ •N• •t' •••t see of t 8 _ A It Ara. i 4-0 / 0, n w . o 0 n r r O p _ ¢ ~ 8to 0 9,2 S~ O n SY C) 0 C ~ R9•• n,dA E ~9 A. x a ' '"s 0 1- t4 a • 11, O ~i p f1~irt. G o w Ivy w O 1. 0. O Oo Kw2,g• > n r. R s w • 0: m 0 J> ti •t • .r 6 7 f • • n r 10 (A c o• ~aaVO's 1.0",~> `a F- ^ I Y a ~I •i rn m S = I t 1:11 C, it : fts m T SEE o 0 Do or it 0 yS O E N to ,X=S 0-4 7 ^ W nS~C O v 7 n • Z ° >>no > x o $ cn m 00 70 mnm• n m .4 l< A R ~r• x = m \`~nfD ~~t n ~ [fin ~n a• ~n>» ~ ~ ~ 1 F i n > - Y n b O ~n ~ of Y n a• '6' F N N F C r: C O 'f C N ~ C n a n c. Z C a M O ~ IS ~1 i o N r z 0 A + o z n< _ O G ^ < N < ~ so, = £ 01 or 'O $ rn Al ` % A A n R I~ . l cn . STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER a ROUTE/BOX NUMBER FIRE NO. CITY/STATE /~'~-G.E~•A¢w (cj ~C ZIP PROPERTY LOCATION: N L 1/9 1/9, Section, T Al N, R W, Town of 1ItL'Sdh , St. Croix County, Subdivision 4~,I al, fkLot No. 3 Improper use and maintenance of your septic system could result in its premature failGre 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 $3000 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 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE 16AM St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 59016 (715) 386-4680 Sign, Date, and Return to above address • APPLICATION FOR 8ANITARY PERMIT " . 8 T C - 100 This opplicatlon form Is to be conplated In full and signed by the owner(s) at the ptopetty being developed. My lnadoquacles will only result In delays of the pztmlt Issuance. -Should this development be Intended for resale by owner/contractot,(apee house), then A second form should be retained and completed when the property is sold and submitted to this office vlth the appropriate deed recording. Oxnor at property a r~ rA~ w*t CCU i+ c - Location of property OE 1/4 r 1/1, Section T a9 M-R )c/ V Township f~ LtJSC , Mailing address Qr(.ck 10-.t (JI Address of alto 70C ake^ Act aubdlvlslon name 5 74 , tFcrCr~S ►J Cre Lot number 3 Previous owner of property _ Tor, & k leck,-, Total slit of parcel 3 ~4 tltcwe Date parcel vas created -A - g Art all cornets and lot lints Identifiable? to 1I0 is this property being developed for resale (spec house)? Yes __1to volnne and Page Humber - 179.. as recorded with the Register of Deeds. INCLUD9 WITH TNIB APPLICATION Till FOLLOWINCI A YAARANTr D¢SD which Includes a DOCUNQNT HUMBQR, VOLUMit AND PAOt NUMatR, and' the 91,kL OF T119 R80IGT8R OF DRRD8. In addition, a certified survey, 1t, available, would be helpful so as to avoid delays of the reviewing process. It' the deed description references to a Cattlllad Survey Map, the Cattlfled Survey Hap shall also be required. PROPERTY OWNER CERTIFICATION i(Ye) cettify that all statements on this form are true to the best of my (out) knovledgel that I two) am (are) the owner(s) of the property descclbed in this lnfotmation corm, by virtue of a Warranty des recorded in the office of the County Register of Deeds as Document No. ~1S b: f and that i (We) ptesently own the proposed alto for the sewage disposal systas+ (oc Z (we) have obtained an easement, to run Wlth the above descclbed property, for 1-he conattuctlon of sold mystem, and the mama has been duly recorded in the ottice of the coynty Reglater of Deeds, as Document No. ° signatuct Ovn r signature of Co-owner (if Applicable) + J J (.cv~rJ ~a.~-d Date of Signature Data of Signature II r DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA II i [~pC STATE BAR OF WISCONSIN FORM 2-1982 J`685 8610PAGE178 REGISTER'S OFFICE ST. CROIX CO., WI wife A. _.STAHLECKER- and -SUSAI... A:.._STA.HLEC ; Recd for Record wife ' JAN 0 31990 Grarantors,-............... conveys and warrants to .._CMn_ BROTH R~__CONSTF:UCTION::CO: , 8. 30 A. P ..a_WiSC0nsin_corporation----_-_---_- CA~"''X ._GraMee. RegrsrerofDeeds - RETURN TO ) the following described real estate in t,__ rQ> 4 I Rt jet- Y~,JtS,WtS-C ._..•.•_-..-•_•-__County, 54~a Via. State of Wisconsin: !j Tax Parcel No: Lot 3, together with an undivided one-third (1/3) interest in Outlot 1, Plat of Stahleckers Acres, in NE-1/4 of NW-1/4 of Section 34, T29N, R19W, in the Town of !i Hudson, St. Croix County, Wisconsin. Specifically reserving for the owners, their heirs or assigns of Lot 2, Plat of Stahleckers Acres an easement for a portion of a septic system over and under a portion of the above described property, described as follows: Commencing at the N 1/4 Corner of Section 34; thence SO°09' 05" W (bearings referenced to the North-South 1/4 section line of Section 34, recorded as SO'09' 05"W) 818.38' along the North-South 1/4 section line; thence NO 57' 53" W 256.691; thence N 89°58'39" W 76.55' to the Point of Beginning; thence continuing N89°58'39"W 23.93' thence N23030130"E 60.351, thence S1? 09'05"W 55.35' to the Point of Beginning, containing 662 square feet (0.015 acres) more or less, and being subject to all easements, restriction and covenants of record. j The above described easement shall run with the land but if it is determined that there is no portion of the septic system lying within said easement boundaries of if the septic system fails and has to be relocated said relocation specifially not being allowed on said easement, then said easement shall immediately be vacated and of no further force and effect. SF This is______.....not............ homestead property. (is) (is not) O~ Exception to warranties: Subject to easements, reservations, restrictions and FBE rights-of-way of record if any. jl j~ Dated this December day of 61 - A. ~r ; /0M (SEAL) * Jon A Stahlecker } : * Susan A. Stahlecker AUTHENTICATION ACKNOWLEDGMENT r Signature(s) STATE OF WISCONSIN ss St. Croix County. authenticated this day of_"•----__"-----""._--__.., 19 Personall came before me this _ ~of December_......... 19_-$9_. the above named Jon. A-Stahl.ecker_.and__Susan. A."_ Stahlecker TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ---authorized----by------ § 706.06, Wis. Stats.) to me known to be the person __5 who executed the forego' g instrum n and ck owledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert W. Mud e, Attorney ."--GIL'BERT---1ILM ; PORDM VIUNDEEN----------- ° e'' ~r ter ^z Hixls>,n,..WL.5.4Q16 St. Croix Notary ublic - _ _------County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN R'iernne+n T.. 1 R1-1, r`.. I.,,- 4~ y SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 HOMESITE SEPTIC PLUMBING Owner: CUDD BROTHERS CONSTRUCTION ROBERT ULBRICHT C/O DOUG CUDD 655 O'NEIL ROAD 682 MEADOWBROOK LN HUDSON WI 54016 RIVER FALLS WI 54022 RE: Plan Number: S92-03787 Date Approved: October 15, 1992 Gallons Per Day: 600 Date Received: October 15, 1992 Project Name: CUDD BROTHERS CONSTRUCTION Location: NE,NW,34,29,19W Town of HUDSON County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. y ' This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 266-2889. ORIGINAL SBD-6423 (R. 01/91) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations HOMESITE SEPTIC PLUMBING Page 2 Sincer ly, PETER E. PAGED Section of Private Sewage Division of Safety and Buildings PPP013/0009n/ 3 cc: CUDD BROTHERS CONSTRUCTION -Private Sewage Consultant -County _UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health SBD•6423 (R. 01/91) I.L.H.R. 83.08(2) C' - - PROJECT INDEX SHEET I _ 7iS"- y15 - G x'73 Owner: e7aAO T~3ii'OS. CO.u 5' 7-.,? vac 7-1 v-u p! Address: 2 /ye".19ow3,'oo& Gti. S-,YO 2. Site Location: may-,4K- 3 csy f ,qG~s~ V 40 z 4u Project Description: ?OGVti o~ f/l~pSD-v ST coo k' Ga~~ / s /1/~ Gv Gpv STiPUG T/D~v /~~`Dr`'M • /;~i~t~` ~ ~STi-yet r~1~ O~i 7Ly Gv~i S?F~loc~J ; to o U ~S 7- j' SO iG S ~if°E pt ~t°ti1~~t~!/E , 1307' 3 S 'y s TES p 92-03'787 I Page 1. PLOT PLAN VIEWS Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS Page 3. PIPE LATERAL LAYOUT Oil Page 4. DOSING CHAMBER CROSS SECTION ~~~~E Page 5. PUMP PERFROMANCE SPECS! CO PLUMBER: • G i DATE: SITE EVALUATER/ DESIGNER SIGNATURE i~ HO hESITE SEPTIC PLUMBING CQ. 656 O'NEIL RD., HUDSON, WIS. 54016 ~~~L... ROBERT ULBRIGHT GS7r# ~y~Z. WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. }ATNN. INGTALLER & DESIGNER LIC. NO. 00663 1•: OPIGI IAL I DILH SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY/ Y TA E SANITAR a•, -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. c ec wforio previous -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 Z'C c '/4 %4, S,3~ T2 , N, R l 9 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # eot 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER \ \ L ell Az;, 41, II.. TYPE OF BUILDING: (Check one) El State Owned VILLLL.AGE NEAREST ROAD ~J Gt /~'~B R =W OF. ❑ Public K1 or 2 Fam. Dwelling of bedrooms 411-4 TIRCEL Ax Nu BER III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 El Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPffEII OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. L~Lf-New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 0 ~-j Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 LJ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit' Pressure 43 ❑ Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. 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 Feet /Ul ?rFeet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank lo Lift Pump Tank/Si hon Chamber 11161-4117 r ts' VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) M MPRSW No:: Business Phone Number: r ` Plumber's Address (Street, City, State, Zip Code): G. IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ry Permit a (Includes Groundwater F ale Issued Issuing ent Signatu Sta s Approved [3 Owner Given initial i)1 Surcharge Fee) ; ~f 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 i INSTRUCTIONS 1. A.sanitarv permit is valid for two (2) years. . ' 2. l° Your sapit$ry,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-Af'2tng 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) 1. T 1, / of LM Dt # Z ~S npQR we s T- L-O T' L t a 6 Fc~uap~ 5'FEEL AItR L.Dt ~ EC.E UAr(vA3S G.,N Po' 3 p9. G G ' Sys P I, lo A.r~l "~9l3or too 13 32, 0. . ~ a 3 AS STEM cui ,`l. y•~ S~~D /DD, 23 ea 6A 2-3 ~ • ~RESPO GO 10, i r 9G 5 ~ ~L ~ 9 n 9f.'3 Zy ``1 92 03 78 11 'o-, o o 19,23 f ~S1 11 ~3 1~ 1 • 7 1 0 1 0 New /TAME 1 ~R a , 1 u ew P piPoPos~~ 98 i3 , 15 tick) /boo C*-Q• ,Seori'c O7g~k ~tiliDtv~STFp.~ ser ! Pfee- xsr I y puc PIS- , E/~vfinoa Sy ' 377 j Prior To Plot,ing- Installer will toeeline i shift or-orient ;,_ound position l i 3 and area under bed agaregare) so gruuiic elevations across slope are as uniform as 3v/ possible. suggested elevations (staked on site with lathe markera) are shoran herein and on pg. Z• £,JS 6o r j -F e.Hc~e.~ ~oaa woos i°o5T' = Pt~'c SirEs i HOMESITE SEPTIC PLUMBING CO. E X STi.~ G- ~pqp~ 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT CST # 2~~'Z ~/E v~,~~yS WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. !NSTALLER & DiSIGNER LIC. NO. 00663 i A 1 Page Z Of S Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H _ ~a 5 ySTEM Topsoil F 6IEVAV 0A) , i E - D 100.2-3 3 ' ly % Slope Bed Of 2y- 2 1 Force Main Plowed S v9 ~ESTED H o v~v0 Tfu~;~o,PM 9~ L 3 12 Aggregate Layer TDE Gi:vE 6'/e_ IVATiD.v D Z.O Ft r Cross Section Of A Mound System Using E 2- Ft' A Bed For The Absorption Area F • 75 Ft. G Ft. A Ft. H AS' Ft. Signed: B Ca3 Ft. License Number: 1 X77 K~ Ft. -'0 3` 8 i X92 Date: ~..,y L Ft Alternate Position T 7 Ft, of Force Main W 3-S Ft. K FADistribution Observation Pipe, Io L_- W L L - 2 Bed Of '2 Pipe. Aggregate Observation Pipe Permanent Markers CAppeJ-1, Puc- Sf SODS Plan View Of Mound Using A Bed For The A~WW, FrArea P. (ilia logo v 6 ~o & ,,.?&S k ' i ' Page of 0 2- /A-S r dole Perforated Pie Detail up,?iGtiT Ao-e V,41vA1E VA C U.4 r I'oAv End View Perforoted End Cap) ~\e ya PVC Pipe 1 . ~oi~o once Holes Located On Bottom, Are Equally Spaced R i Q ! * C Fo cc in .9 PVC 592m, 03787 , Manifold Pipe Alternate Position of Distribution Pipe Force Main Lost Hole Should Be Next To End Cap / End Cop Distribution Pipe Layout 3t7 //O~ ` Z Ft. R S• O S E X~ Inches Odd Y 7d[ Inches d • AM&I ® Nv a~N Hole Diameter Inch Signed: N~ /1 License Number: Lateral Inch(es) AF ti► Manifold 2 Inches Date: 0~• Qw Q® Force Main Z Inches 00 # of': holes/pipe /Oo. 7*t . Invert Elevation of Laterals • d/ST/?,,13v?'/OA) pi5'tA-1 ,el 7-r ACJk t„40 OT , 5 y 3 7, • To ~~I / S T~ ~ r v r~o~, ~ ~'s c~ q~~GE ~Pq~E". Fo,~~ ~efwo,~~c yy 14- / M^ A29A Al Sa 106-e- 6f 7746- 91 til~wi, y OA4 If y o~ s A!. PUMP CHAMBER CROSS SECTION ACID SPECIFICATIONS A4 E. VENT CAP APPROVED LOCKING I' 4'*C.I. VENT PIPE WEATHER PROOF MANHOLE COVER I JUNCTION BOX w/ Iv~CN►,OC~ l~f/3E~ 25' FROM DOOR, 12"MIU. WINDOW OR FRESH I AIR INTAKE ~Ey^IYON GRADE I 'i~MIN. I. 7 s 16' MIN. ~lt7 I /a-V.4 ri / PROVIDE t! 0 INLET - AIRTIGHT SEAL I III / G I v (~fi ( III APPROVED JOINTS APPROVED JOINT A ~Nh~~r ( III W/C.I. PIPE tJ/C.T. PIPE ALARM EXTENDING 3! EXTENDING 3' '00 92-03 '3 ONTO SOLID SOIL x+ } OIJTO SOLID SOIL B ^ , I I ° ~3 I ~ ~3,3 • ~ I oN ELEV. ' FT. I PUMP OFF D K `gpo~"' I 2BLOCK N ' RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL 1 SPEGIFICATIOPIS " SEPTIC E DOSE /~'J%~IVESrAEri✓ PeC44S7' WrABER OF DOSES: PER DA`J TAWS MANUFACTURER: /So 750 GALLO►JS DOSE VOLUME TAWK SIZE: INCLUDING BAS FI-OW: GALLONS l , -J, ~Lf'tT& O 1 ALARM MAAIUFACTUKER: S U 3 r' 1iWk /flE~l N /O/!YW vo CAPACITIES: A= 2j._.__IIJCHES OR 7~ GALLONS 'n MODEL 1JUMBER: 2. GALLOWS3J7 . 3e ' ! ~f~jQGU/e V T B= INCHES OR SWITCH TYPE: I' ~OGLQS PU'~'l C= Qq INCHES OR_'r~ GALL01J5~'~~/ PUMP MAI~UFACTURFR: 3 8S Gve03L y3 //P D=INCHES OR GALLONROV MODEL NUMBER: SWITCH TYPE: / MOTE: PUMP AIJD ALARM ARE TO B o GPM INSTALLED ON SEPARATE CIRCUITS ~j MINIMUM DISCHARGE RATE , -rA S fG 5T VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTIOIJ PIPE.. ~ FEET' ~ P MINIMUM NETWORK SUPPLY PRESSURE . . . . . . 2.5 FEET EA S 61 A J + FEET OF FORCE MAIN X Z •GZ F>,/oo pT FRlC71o1J FACTOR..' G FEET 4VA) 7 ZS i. TOTAL D'IIJAMIC HEAD FEET = LIQUID DEPTH ~ INTERNAL DIMEWSIONS OF TAWK: LENGTH ;WIDTH ; 1 'TIE Cottd £r A: r irr { SI•.. , QF It~'Vll51 4a HA ~~I• Ls4r ~ , , 'D~pN15t0~ <y ~ III 3885 G< AVAILABLE CERTIFICATIONS M: ETL LISTED SUBMERSIBLE PUMP SLR, CLASS I AND 11 DIV. 2 AND CLASS III DIV. 1 AND 2 at ETL TESTING LABORATORIES, INC. a a CORTLAND, NEW YORK 13045 G1086131480 Pr CANADIAN STANDARD ASSOCIATION e'fh% Sq sti" th APPLICATIONS • Shaft: threaded, 400 series protection. Balanced for Designed for Continuous t stainless steel. smooth operation. Bronze Operation: Pump ratings are e Specifically designed for the . Bearings: ball bearings, impeller available as an option. within the motor manufacture b • Homesg uses: upper and lower Casing: Cast iron volute recommended working limits, C • Farms • Power cord: 15 foot type for maximum efficiency. can be operated continuously • Trailer courts standard length (optional 2" NPT discharge adaptable without damage. • Motels lengths available). for slide rail systems. Bearings: Upper and • Schools Single phase:'/3 and'/2 HP- Mechanical Seal: Ceramic Lower heavy duty ball bearing 16/3 SJTO with 3-prong construction. • Hosptitals plug. 3/4 through 1'/2 HP-14/3 vs. carbon sealing faces. • Industry Stainless steel metal parts, Power Cable: Severe duty • Effluent systems STO with bare leads. BUNA-N elastomers. rated, oil and water resistant. Three phase: /2 through 1'/2 HP-14/4 STO with bare Shaft: Corrosion-resistant Epoxy seal on motor end SPECIFICATIONS leads. On CSA listed models, stainless steel. Threaded provides secondary moisture Pump: 20 foot length SJTW and design. Locknut on three ba ofouter lacket • Solids handling capabilities: STW are standard. phase models to guard damage and prevent 34~ maximum. against component damage oil awicking. • Discharge size: 2"NPT. FEATURES on accidental reverse rotation. 0-Ring: Assures positive • Capacities: up to 114 GPM. Motor: Fully submerged in sealing against contaminants • Total heads: up to 123 feet open, Cast iron, semi- high grade turbine oil for and oil leakage. TDH. , non-clog with pump out lubrication and efficient heat • Mechanical seal: carbon- vanes for mechanical seal transfer. rotary/ceramic-stationary, 300 series stainless steel metal parts, BUNA-N "4492-0378-7 elastomers. METERS FEET • Temperature: 1600 F (710 C) 90:-.____ maximum.__ ` MODEL 3885 • Fasteners: 300 series 25 ao ; SIZE Solids stainless steel. WE15H i _ • Capable of running dry 70 - - without damage to 20 wE,a components. c 60 5GPM Motor Lau weotH ! +5 Fr • 5 Single phase: /3 HP,115 or a 15 0 230 V, 60 Hz, 1750 RPM; O 40 WE05H _ . . _ HP, 115 V, 60 Hz, - 3500 RPM;'/2 HP through 10 30 WEOW 1'/2 HP,230 V, 60 Hz, 3500 RPM. 20 Built-in overload with 5- automatic reset, class B 10 , . insulation. - • Three phase:'/2 HP through 0 0 _ 1'/2 HP 208/230 V, 460 V, 0 10 20 30 40 50 60 70 e0 90 100 110 120 GPL 60 Hz, 3500 RPM. I I Class B insulation, overload 0 10 20 30m protection must be provided cnPncm in starter unit. ST. CROIX COUNTY ~i WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE I 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 Oct. 6, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Cudd Bros. Construction property, located in the NE 1/4 of the NW 1/4, Sec. 34, T29N-R19W, Town of Hudson, St. Croix County, has been conducted with the assistance of Robert Ulbricht, CST #2482. This onsite revealed suitable soil for onsite sewage disposal to a depth of 341. Should you have any questions, please feel free to contact this office. Sincerely, Ole- Thomas C. Nelson Assistant Zoning Administrator i cj a ST. CROIX COUNTY N WISCONSIN "V-- ...~,k ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - (715) 386-4680 w Oct. 6, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Cudd Bros. Construction property, located in the NE 1/4 of the NW 1/4, Sec. 34, T29N-R19W, Town of Hudson, St. Croix County, has been conducted with the assistance of Robert Ulbricht, CST #2482. This onsite revealed suitable soil for onsite sewage disposal to a depth of 34'. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Assistant Zoning Administrator cj