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HomeMy WebLinkAbout022-1025-40-000 Q c ~ ° 3: C; d M ^ O ~O dO O O tl N l', a O 'O N I ~ '0 Ili. O ~ N N O N LL c 0 _ Cl) O ~ tq N O U O E Q (n r (D ~ M a) w O d 9 OL co y y a m 0) H Z c O O z d v v o -o ~ M a~ ~V I c I • ~ .p ~ o I c ca O O Z Z o N z N E ~ :3 m O t6 O od .r c y a a~ o CO 24 F• F• H O Q O O O •rv a a a d w I~~ 0 CO Cl) o N o rn rn y fA U o> rn } O Cl) O E2 O_ p W 0 0 ~ ~ ~ E N N ~ O _N d N 0 m a) O p m a) Q O V N 10 Q } ~ O c r~ 0 3 a c Sri c 0 o ~ co api c y a o 0 0 0 V O O O O ui 06 c c m` E c4) rn m O N N m C O O N O C6 V N N -00 F N CO N C L m 15 =5 • N O C U t N O E U y O O Y (4 O - Z i C4 CL N c r~ E L c c A uCL 'Ov~U • r L~4s~`+~'s part r ~n~NIC 9.28 TMVPMEWAGE SYSTEM County: Laborand Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 19 Q 9 2- C) Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: Elev.: Insp. BM Elev.: BM Description: R Parcel Tax No.: II ~s / , Cd CS" Q /~a n22-in25-An_nnn TANK INFORMATION ELEVATION DATA A9300334 I~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ •1zx~` Benchmark t I l ~d Dosing Aeration Bldg. Sewer Holding St/ Inlet C.Ciz c TANK SETBACK INFORMATION St/ Outlet S/1 Ventto TANK TO P/ L WELL BLDG. Air intake ROAD Dt Inlet 60' Septic NA Dt Bottom ,~A8~- 3.'-'Z 9 .87 / Dosing Co7~ ~5~~ ~~71 NA F4ead27_-/Man. Z,51 / Z,f ✓ (3 1I~ 43 ~Aera n NA Dist. Pipe 2's Z_5-fl y~ 2s3 olding Bot. System 313' 07 ~~79 PUMP /IINFORMATION Final Grade Manufacturer e nd~°~Q SS~ ~9~ r Model Number be 7 and TDH Lift dr~ Friction, Syestem TDH r7?Ft Forcemain Length Dia. H~ Dist. To well - SOIL ABSORPTION SYSTEM BED/ TRENCH Width / Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 3 DIMENSIONS ~O DI EN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufac y SETBACK INFORMATION Type 0 sz. CHAMBER Model Number: System: a( - DISTRIBUTION SYSTEM ss'„ k4e et /Manifold Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Sparing 36 yet sj`- , SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only A+*+rUW xx Mulched 17Depth Over Depth Over d xx Depth Of xx Seeded / I ` Bed/ Center Bed/T.booeh-Edges /Z Topsoil (D es ❑ No 0_*0`s_ ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KINNICKINNIC 9.28.18.138A 7S, e"/ tl 811r, 10Y. DZ Plan revision re Ired? ❑ Yes [rl~o / q Use other side for additional information. / SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH r , SANITARY PERMIT NUMBER: ~ ,cam-~-~' ~ ~ ' ~1!_HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY or` x E~1(11 ' STATES 9T7k'YA -Attach com plete plans (to the county copy only) for the system, on paper not less than 6'/f(f~o~/ 8% x 11 inches in size. ❑ Cen pr ious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 1;5f3- 035'65 PROPERTY OWNER PROPERTY LOCATION ~TA 5e,4013&7, IV&; %4 SA) Y4, S ~ T'&, N, R 4 E o PROPER OWNER'S MAILING ADDRESS LOT # BLOCK # . Ali- I CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER a&XIrs ls'foo'--J-3 1(Vj-5,)2-00_3 :;p v€ II. TYPE OF BUILDING: (Check one) CITY ST ROAD ❑ State Owned VILLAGE : /e{l,VXI pieeeiiole-E- E7-,rt-f L„ ❑ Public L`71 or 2 Fam. Dwelling-# of bedrooms A UMBER(S) CZ O III. BUILDING USE: (If building type is public, check all that apply) 7i -2- - l / o ~7 Cr S7 ` 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 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. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ 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: ld 8 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) 3d ELEVATION 1~O 375 Feet Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Aey-lew ('Z,) I wiZrg egve_ . Pump Tank/Siphon hon Chamber 9001 ba R - o EE11 r-1 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 Stamps) SAP/MPRSW No.: Business Phone Number: P-0 3>R7- Ztlhif GhT ~ 336? Vwl- P95- Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Tlssu i ng Agent S mps) Approved ❑ Owner Given Initial I ~rcharge Feel 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 y 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 ail appropriate boxes, that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f6 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 tarks; 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; (Jose 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) NAI-, 14:14 Gr1.vr`72 ~a13%,v So,~ ' l 3 A) 0 /JO 0 2,0 L STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER z7- ADDRESS 7~e ' ~~~rs ~/S. <s'yoZ3 dZ21/0 00 SUBDIVISION / CSM, LOT SECTION I T e d N-R If W, Town o f I/'UN/ e ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Plot 3 \j z 4 .A ..1. ~/l~aY 1 Y y T INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Pt,fL SfrA;q P - TOP g`_s` lNti.?i~ /-10.5r- aF i-wo PRr~PwAY Cv1v~_T5 BENCHMARK: CO /D0' 0 r ALTERNATE BM: lvE~/e5 6 i5 Z G- All &W f goo - SEPTIC TANK / PUMP CHAMBER / ON Manufacturer: Liquid Capacity: /d~ YMV - S~ •C / r !C14 O+- 20• Setback from: Well 95 r House Otherr e. G ) Pump: Manufacturer 2O ella~___lc Model# d Size ~Z- y Float seperation 7. Gallons/cycle: r7 /3 L IfOV u T Alarm Location SOIL ABSORPTION SYSTEM Width: Length 5 Number o nches _v 20 *0 6AS l- 4. 1- . Distance & Direction to nearest prop. line: S ' ` c L Setback from: well: /0 House Z Other I~e~ Z ` i sr 400in - /o yD ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet /04O/l r PC bottom V7•2 r Pump Off r~' 33 ToP s ~ ;Q 2 S Header/Manifold Bottom of system to 7' 3v ~a~•<~ Existing Grade 16CO Final grade DATE OF INSTALLATION: ,l~lbV 'l,Q NDU "10 ~7 PLUMBER ON JOB: P-0l3 Z5~1 7"'" ?V /,b/e r eA-7 LICENSE NUMBER: lWte S 330-) INSPECTOR: 3/93:jt . , i os o + 0 c0E3 T Lo7' y ca o ICY w O 4~ C ~ S M ~ c ~ b i V r 0 C G t`~ r t'N rt+ , i + 16 N Y I I - I I C~~F I ' I r E 457- LO r L. as ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants S93-03963 PROJECT INDEX DILHR Plan I.D. # 593 - 0 3 q63 Date /VO(~. / / 9 93 Owner ~'4,Py ~C R/ 13 ER Phone 71-:5 = V2 z o0 3 Address elov IEe- T~f' ~4zM~ 40e) R0136e77s, /S. $~yoz 3 Legal Description 2.5y .Gies /o,t/P~E/ f;~ /3~'-~9 Ncu yam, sw if, SEC % rzgv ~j~ - 5/T Ao0/PEsS ///Y ~ol~/E~- TiP. ~'O/3EaPTS WrS. S510Z3 Town of County ST', cRorA. C.S.T. ~e 7w413R,rA7- csrct .2-v~r Installer Local Authority/ Supervision 557. SRO X Cvuory ZO/Jf'tillr T PROJECT DESCRIPTION ThE Sc4,el'13c- Ce Deoloaery 1'5 13&-I;of' solo 7Lo R01731&Z LAR500. AN OLDER haMtF- / 5, r odJ 4 F~ UA)P4 T/'o A.) 40/// 13 C- C't -r v 4:) f-I D 0 u CA C H 0~3i i E' ~ ~t U i.,`-1 (SOH e , ~5Tt M ITED N•Ew DA, WAS ~ E"F/ow - 'j y o jQ..PS . It -A. EU ACVATi'ooc RLUCAL Iw'- tXISTi~1~ Iti1'9J?OV~1v DRA;A -T;tLp ova 1JOT- 131 I?e - <",AjeCTLl.7 ; SoiIS APE ' N-r A j'_ 2-y , (~tr12M I'/f l3l C (3 t~'1' SE SO~^ /l~/ S 33 2t~D~ c~~•~ te~~+t.~ F~ncT-vyet.t~ L►M_) t:- A T- -rk ►~tw FioM L will 3~ St~'ufp w ~ A I~ ~cE ~T Ito v~1~ Sy S tt"l US I.A.)6- I;L S~1u0 l Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS ,~~~~aaaaauy~i Pg. 3 PIPE LATERAL LAYOUT ~yGO Pg.4 DOSING CHAMBER CROSS SECTION A uUncliT Pg.5 PUMP PERFORMANCE SPECS D1160 - t ~o- wis. ~ 1 4D 4P 4~,tje*- R ` o----- ° i z m yy7, so ' S93-03963 - (A f% w o m rct ~N y 1 c lb Z i N Z l ' t%k n ° 0 K t n ' ' ' 1 ; s,ropES > Z67~ J L `~H I I 1 G O b \ 1 tj Ile 'tu o s 'sN ~ . SEA ~OIA rax f tsT 1-or r; wm►dc-wv,~d n m A+ M N P- Fes'' 0 ~ V - N. it o 0 o m W v~cVfDwno w r 0 00 ~o Nw ~ w a~•o N O m crOanMfD ' L Ph p mm0 cn cn C , 04 w m `A P. 1 4rr p a N Z O - Q N coo LP i J ~mn~vw ..d m 0 w w oo cn l~ w<+,~w~co C 11 m o w m o o w mt c+ f7 Ol (n ]rx o c°u n E w co m ° 1 s. Y.t ti oti 107,90 ~t&V,tTI•0n0s rop OF ROCK L /oQ. ' Z Page - Of -5 Top OF i~ IATE~nLS /0-7, 7$/ Synthetic Covering Distribution Pipe Medium Sand s y sTem _ H G EIEVATION Topsoil F - /O 30' ._J u E D 3 ~ . LEU A 0 Aj 10 y. Slope uN~R C3t~ Bed Of it Force Main Plowed Layer /,96 - 30 Aggregate U~V~ v~PM ToE w~vE 0 /o Ft.' /O1/,O ~4 E Ft. Cross Section Of A Mound System Using F -90 Ft. A Bed For The Absorption Area _ G ° Ft. Abe ~re8 below A. dow~lope e~~e of the ~5~~~ A (P Ft. H ~ s Ft. S ILA tim mist 1i , 40'x, •Gs B (,I Ft. sod mill o s . 011K 12- Ft. Coll L d2 Ft. Ft *S93 -039 63 F ~~DUSt~F Ft . Ra n 30 Ft. OFtR~ P - Observation Pipe .r B - -i--- K A o ~0 i _ W Y li Distribution Bed Of i Pipe Aggregate Observation Pipe Permanent Markers y pvG G.fPPED SyEEL ,PODS Plan View Of Mound Using A Bed For The Absorption Area 2~Qc~i,rZ~n ~,¢S.4L i9iPE~ = 0.414 41,4 7E f -1040 r.4,3),,-=- o~ ~~PoPosEo ~~ts A-L 6P,I, Y, Page 3 Of -6 Vold- V o/vME )a,-0, R GO r~~ °r Z Pile- jrOR Ids. f/r4C€ AS r kle- Perforated Pipe Detail. uP RiGV r A& IIA[V n6w V/f! v,9 i ~'v~v 0 , End Vim! )Perforated End Cop PVC Pipe oe~e e Moles Located On Bottom, \ Are Equally Spaced R PVC S93--03963 Manifold Pipe Distribution Isr Pipe Hole Should Be 411o Gv roe Z Next To End END l,[Jif s , N,~N,fotD/ Distribution Pipe Layout P ~O Ft 4/ r /I /l0 w ~DiP ~ 2 R 3-0"'L- & 0~w~t N~ Fo~Pcf i''IAii✓ Q ~VYg'tEM'(/G X 6, 6'0 O ~ Inches PR1VpTE S~A Y Inches t 9 001wily Hole Diameter = Inca, coil i Lateral ! Inch(es) fop NOV Manifold Inches N I N ~so~ Inches ~v Ho 1Ndis~ A r Force Ma * n _ SAfE~ w~s~oN of ~ - # of*' holes/pipe 13 G Invert Elevation of Laterals 107 . Ft. O Invert Elevation of Laterals '07 f? Ft. SEE ~DiST'R66Urto~ ~15C HA RGE RATE FcaR er^r- li Mt.~ L,aTER AL , PAr OTiS Z-7 ( S. 2J T RG IF P. ^1' E Fn R. • TOTAL- "DiST R►c3u T'l0~ T~IScNA 1jeTWO P.K 3 0, yy _ Mi►J ~ ~'S ~i~Vt'MV~1 t~} ff A D 1J eS l' (T-~ 7 l 1 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS pr} yE ~f of S VEUT CAP 1 3 039 6 3 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAJG JUNCTION BOX MANHOLE COVER 11 25' FROM DOOR, IAMI WINDOW OR FRESH rmlU. I AIR INTAKE I r /EWt7/ON GRADE I 4" MILL y''RaD~ ~ ~ le MIN. /0140 I IV CONDUIT _ 3G ~IEv~n. oti 11~ /04 d ' PROVIDE IAILET AIRTIGHT SEA SON NOS I v T * APPROVED JOINTS I~G . APPROVED JOImT A ~N4 R~1~ P ~ 1~ I I W/C.=. PIPE W/C. PIPE ,~0~ EXTENDING 3' EXTENDING 3' ~0 q0 ONTO SOLID SOIL OWTO SOLID SOIL B ql, ??,,I \ ~~st SafEcy I gg 7 ELEV. FT. ' PUMP S D I3 ~O 4^P K p p/a V I I ~FbEK . ~/EV>~fio~ 1 RISCR EXIT PERMITTED OWL.4 IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC,IFICATIOUS DOSE GfJE ,f'S C'OVC,PE7E IDiPOD WMBER F DOSES: 3 PER DAy TANKS MANUFACTURER: ~j TAWK SIZE : 6 d GALLOIJS DOSE VOLUME 9 O GALLONS E UEL AL-^kOM 4r' INCLUDING BACKFLOW: ALARM MANUFACTURER: MODEL AIUMBER: -D. L.V. CAPACITIES: A=17" Z IMCNES OR GALLONS SWITCH TYPE: DER cvR y FI U T' ga n INCHES OR 3(40 GALLOAIS Z 0 E//`cR C, INCHES OR X60© GALLOIJS PUMP MANUFACTURER: MODEL NUMBER: 24 Y ;z. qp Ua IL/ D= I(' INCHES OR ?~i GALLONS SWITCH TYPE 71 &&Y (3AcK 4EFCVEY F-10AT MOTE: PUMP AND ALARM ARE TO BE . 35 GPM INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE 17,1 -1'Ai S~~GS • VERTICAL DIFFERENCE BETWEEN PUMP OFF AMD DISTRIBUTION PIPE.. FEET -F- 2-5 FEET EAO~. , O~ Pte- ' MIAIIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . + ~o FEET OF FARCE MAIN X z o5 F/00 ~FRICT1otJ FACTOR.. /'2_3 FEET t-40,A S Q- 2- ~3 Gr.. _ TOTAL DtIMAMIC. HEAD = FEET O TANK: LENCsTH ;WIDTH -LIQUID DE INTERNAL DIMEIJSIONS Ro W.9 , I PTH It, ' 39 63 N HEAD CAPACITY CURVE 3 7/E,,, 6 1/4 MODEL "98" 1 30 4 5/8 a 1 25 e 3 5/8 6-20 i- + 015 _ 4 3/16 4- 0 _ 1 1/2-11 1/2 NPT 41 2 1 4v 5 _ 0 U.S. CALLONS 10 20 30 40 50 60 70 80 c LITERS ' So 1 iv] 240 y, 0 FLOW PER MINUTE 4G r•~ TOTAL DYNAMIC HEAD/FLOW PER h14IUTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS GALS LrRS J 5 1.52 72 1; 3 r'" 3 10 3.05 61 231 ' 15 4:57 45 170 20 6.10 25 95 3 5/16 Lock Valve 3' Lam) CONSULT FACTORY FOR SPECIAL APPLICATIONS -1 9 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 lei without. alarm switched, variable level long cycle controls. SELECTION GUIDE Standard all models -Weight 39 )5s. - h H.P. 1. Integral float operated 2 pole mechanical sw :ch, no external control required. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model YO'!a• Ph Mode Amps 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 i Non I 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 230 1 Non 4.5 2 or 2 & 6 3 or 4 &5 _ plex or duplex operation, 10-0002. -'1 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a guali- Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0466; Ms:chanical Alternator, fied licensed electrician All elscfrieal and safety codes should be followed includ- FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the most recent National Eler ric Code (NEC) and the Occupational Safety and FM0732. Health Act (OSHA). RESERVE POWERED DESIGN For'unusual conditions a reserve safety factor is digineered into the design of every Zoeller pump. } NAIL T0: P.U. BOX 16347 ¢ ZA911ZJjff 01 SHIP TO. , KY 40256-0347 Manufacturers of . SN/P 70: 3280 0%.^ Millers Cane '01/w 1 Louis vide, KY '40216 /f!/Al/fir S S NCE (502) 778-2731 0 FAX (502) 774 3624 AO 96;e TS. 4L~ I'S 3 o 7-~-,v #r i,Js p CrEv cI. 3a t I ST. CROIX COUNTY ZONING. .OFFICE r3Y my seL~- . CERTIFICATION STATEMENT A FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the C-ARy residence located at: AlW 1/4, 51A) 1/4, Sec. , T29 N, R_4? W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. T+A)1< SCvM /5 _ /Av Si'*N k'Fc*CA A* r- A-# j< 9o&-5 NoT Last time serviced N67 a(r- Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: 16vt go-Q• Construction: Prefab Concrete v Steel Other E/%EZ~,E7J 76 /Qe CO'c~-L7~4 Cv-- . Manufacurer (if known): Age of Tank (if known): (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). 74 Name ROBI 2T 1612(gGG, 7~" Signature *PVMPRS .33a7 5/88 -7efd --et A0196X757. 4V'S 5-Yo2-3 w6mwjnDepertrnentorIndustry. SOIL AND SITE EVALUATION REPORT Page / o3 labor and Human Relations Division of Safety 3 Buildings in accord wi h IL.HR 83.05, Wis. Adm. Code tpal~06gy SE- TD_421//57 COUNTY S'7-e/ 1 - 7-0 ~,eoposty . ST Cof°oi`X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: tl PROPERTY LOCATION sw GOVT. LOT Nz'- 114,fW 1/4,S 9 T 2 N,R & E (or) W PROPERTY OWNEFC-S MAILING ADDRESS LOT # BLOCK # SUED. NAIL OR CSM # ,(hi/. CITY, STATE ZIP CODE PHONE NUMBER QCFTY ❑YILLAGE BrOWN NEAREST ROAD ;QOBOP7's 4JIS . 5Y,023 (pis) gzs ^2oo3 eav/ee T•.P, ( ) yew Construction Use Residential / Ntunber of bedroom c3 Addition to erds*V building lkfRe;ilacarrient O Public or cornmerdal describe Code derived daily flow ysO gpd Recommended design boding rate - S bed, gpiW - G _trench, Absorption area required O- 6 bed, ft2 Sao trench, ft2 Maximum design loading rate S bed, gpd/ft2 - trench, gpd/R2 Recamrended infiltration sw1ace elevation(s) SEA 3 It (as referred to site plan benchmark) Additional design / site considerations TE-s 7- 5,7iF ov 4y s 0-17,W A ,Xo,e ,40440D 711,4E- 5YS7f',Aj parent nre iai 51(f5 75- - /p ,}A-t .1 lj~PAVP S/ Flood plain elevation, d applicable /f/tf- It I D .4 00 tJ c> S = Suitable for system cmwnON6L MOUND U ❑ U ❑ ~ROLM PRESSURE AT-GRADE SYSTEM N ML HOLDW TANK U = Unsuitable for stem S M -T' ❑ s C a S OT ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Camislence BolrXkVy Roots GPD in. Munsell . Sz. Du Cont Color Gr. Sz. Sh Bed Isrtctn /o y,4 2,-f, SAe /bra v,P-Ir- ogs zf , s - Ground io ye 3 SI/ /.f sd.~ s /vf 4 . S elev. ft. 16 J's /0 /e g/~ 5. / 2, h,C CS , . S ~ Depth to factor limiting a C 3z-s3 /o //e sf f1 -14 51 451' 4" f/ 4? S - K ~3- 7 75-a 716 I/~.GD,uSO/iQil7~D S// f/t~iy 41;11 s~J Np NP Remarks: > $'D ~o >~~~l,Pz<7> Li%yf5~~'~P Boring # s,/ z,f Shy v~~ ~YS Zf . S G 23 5,1 MIAe e5 Ground elev. /o J/le 7/!7 ft. Depth to /oy~ 5/y 7 SyIe S/CP S/ O•f fit' 7c- -T . S fie , . l - S limiting C'i 0 7 /o y/t' U• 45 D of m factor 474-r- yr f oe S470,4147ioA / Remarks: T Name:-Please Print X 013-;9 7- Phone: 71S _3A~- (P/(P S Address: (oJ!'S d /N~/ L ,P~ . ~/v~so,J 4~i f. Sf~oilp o -z z- 93 Cs rAf 2yP2-- - Sgnature: Date: CST Number: 2wC,f .fioTE aF ~f'Q/,4i;~,tTiov soI/s 'F1aT"4e•E-u r Tv ~'x is tip ORIGINAL y This test site NOT APPROVED 13,-13 j7 $3 for a conventional septic system. See explanation. 5o~/s 4~P,5- f Jp.} e 7V to &D Li =4E S ? ozSE- ~~dvE T~i.S' PROPEffrYOWNM . SOIL DESCRIPTION REPORT Pepe Z of PAMEM-t Depth Dominant Color Motes Texture Svucture Gonsislenoe Boi fty Roots GPD Boring # Horizon in. Munsell 0i. Sz. Cant oolor Gr. Sz. Sh. Bed Toth 3 fJ 0-/3 /o YAP a 2 / z, , 6dAt 'M vfe S Zf . S E- /3.4 /0 Ole X/3 5,11 /,f, sbk 00 f~e !vf , 1 s Ground [1y io YR Ohl 5,1 Z.,w►, 6~ .,r~f~ ' c's N P OP elev. .~r xfv.E?E - ~5/ /,7` s6.f at vf'/', Q .C "P ' U Depth to C , 7.5 /z 61F a Y y/ I S D, UF. II Z - /0y/? 7y fO' U if L/~/ $ 7~ E- O IJ.vT 7Q Remarks: i 20 .y C z G~•} S ~j~1P~ W t T~ ~ /MD S T Sr4 7`y/c'~Tz~ Boring # 13 Ground elev. h. Depth to log" 18M Remarks: Boring # Ground elev. tL Depth to tailor _ Remarks: Boring # Ground elev. ft Depth to fmniYn9 factor Remarks: 00M ",Mto ncinn" ' i III 74 I - _ O ~ bw ~ o IoPR- • o c rn 3 ~ssu.~~ f;~sr Lor w G m r ~ ~ ~ c1~ p o o m V~ z o N N z o °v O o e o ~ I r DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA s STATE BAR OF WISCONSIN FORM 2-1M 463595 vc: SSMva'45m. REGISTER'S OFFICE Lenore Schriber, a widow ST. CROIX CO., Wl • Rec'd for Record OCT 2 9 ar 900 A. conveys and warrants to ...Gary-- J S.chriber . .......f... -a sin9l.. man C~'~ C 1"0- Reg►sterof Deeds . . . . . . . RETURN TO S the following described real estate in .....S.t. C> O1X ...County, State of Wisconsin: Tax Parcel No: PART OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER {NW 1/4 of SW 1/4) OF SECTION NINE (9), TOWNSHIP TWENTY-EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, DESCRIBED AS FOLLOWS: Commencing at centerline of Town Road S 79°44' E 606.2 feet from West line of said Section 9; thence S 79144' E on said centerline 247.5 feet; thence North parallel with said West line 447.5 feet; thence N 79°44' W 247.5 feet; thence South 447.5 feet to the place of beginning. Subject to existing easements including Town Road. I i F EXEMPT This -._is homestead property. (is) (A.4MCQ Exception to warranties: easements, restrictions and rights-of-way of record, if any. Dated this ~(q day of October 19.-90 .(SEAL) (S EA L) Lenore Schriber --------------------..-(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) f Leno-re Schriber STATE OF WISCONSIN ' - . --.--..County. auth t c d this;..6day o OC tober , 1990 Personally came before me this .......day of 19------.. the above named 1000 C. . Leo A. Beskar TITLE: MEMBER STATE BAR OF WISCONSIN (If not- authorized by $ 706.06, Wis. Stats.) to me known to be the person . who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS CRAFTED BY Leo A. Beskar, Attorney RODLI-,---BESRAR ----BOLES, 5.~-------- - 19 Nortb Main St Notarv Public _ _.County, Wis. Vetr FAT -te---- - 2 My Commission is If not, state expiration tgna ures may eau erittcate or acknowledged. Both permanent. t are not necessary.) date: •Namet of oersons signing in any capacity should be typed or printed below their silroar.,- ~trt~ srwrFORM N OF 2 - 19 Z WISCOSIN Stock No. 13002 r I S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWN ER/eWtER S G A '13e-l~ ADDRESS C0471JEZ7 -7R* FIRE NUMBER " CITY/STATE &-,e 7-5 ZIP- /0 PROPERTY LOCATION: Nw 114157W 1/4, SECTION, T a N-R ~f W TOWN St. Croix County, SUBDIVISION N,+- , 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 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 b the owner and by by nd 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 j 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: DATE : St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 I' STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenia 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 / 7 A x.13 Location of property N&)1/4 `sue 1/4, Section , T N-R /6 W Township lkt~'vvi/• C-- Mailing address /ea,B4c;e7_:5 Gv S. sy~ z 3 . Address of site Subdivision name Nor Lot no. Other homes on property? yes X No Previous owner of property ,,4' /f 4.5 Total size of parcel 'Z' S" Date parcel-was created Are all corners and lot lines identifiable? =Yes No Is this property being developed for (spec house)? Yes No Volume 0Land Page Number s~ 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 the office of the County Register of Deeds as Document No. 41X- _ j f S , 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. . Signs ure plicant. Co plic Date of ignature D e of Signatu !'j ST. CROIX COUNTY WISCONSIN A N x u u x x x■ rrrrG ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 540 1 6-771 0 _ (715) 386-4680 November 4, 1993 Violation # 93-V-62 Gary Schriber 1114 Coulee Trail Roberts, WI 54023 Dear Mr. Schriber: The St. Croix Co. Zoning Department has determined that the septic system serving the above property, located in the NW, of the SW; of Section 9, T28N-R18W, Town of Kinnickinnic, St. Croix County, is a Category I failing septic system as defined by Chapters 145 & 146 WI Statutes as evidenced by the discharge of effluent to the seasonally saturated soils. This failure constitutes a violation of Section s.146.13 WI Statutes, s.ILHR 83.03(2) (c) & (e) WI Adm. Code and 15.04 (3)(b) St. Croix Co. Ordinance. A sanitary permit should be obtained within 60 days for a new code compliant system. This system should be installed and in use within 90 days of this notice. You may be eligible for partial reimbursement of the cost of replacing your septic system through the WI Fund Program. There is an income limitation for qualifying for the funding, that being no more than $45,000 net total household income for the year 1993. You may check this from your 1993 Wisconsin tax returns. We have enclosed an application form should you wish to apply. Return the application along with a copy of your 1993 WISCONSIN tax returns, and the application fee of $50 to the Zoning Office. Application may be made as soon as the permit has been issued for your new system, but no later than May 15, 1994. Failure to comply with this order will result in this office seeking enforcement through circuit court as allowed by Chapter 145.20(2) (f), WI Statutes and/or through the issuance of a citation in the amount of $250 per day for each day the violation continues beyond the deadlines given above. Respectfully, Thomas C. Nelson Zoning Administrator cc: File