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STC - 104
AS BUILT SANITARY SYSTEM REPORT
A OWNER I ► ~
ADDRESS O Lo ~tiynb e~l~y~d wt* kj
So rner~s~T ~y a a-S
SUBDIVISION / CSM# au~Q U1 ~ LOT #
T
SECTION _T 0 N-R_J_~r W , Town o f- )Q't- m o f1
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
tl4~ 3p3
7
1600
rz
RECEI ED
~o
311
SEP 2 1993
co 3
ST G ix
000 ,
INDICATE N RTH RROW
9 y If
Provide setback and elevation information on reverse o this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER /
Manufacturer: WQ`~Syz~ Liquid Capacity:
Setback from: Well 70 House Other
Lo 'E o 3 I I L
Pump: Manufacturer Model Size P
Float seperation Gallons/cycle:
Alarm Location
-:SOIL ABSORPTION SYSTEM
Width : Length 93, 7s Number of trenches
Distance & Direction to nearest prop. line:
Setback from:. well: House Other
ELEVATIONS
Building Sewer g3Fev ST Inlet. 9,2•~~ ST outlet
PC inlet /r 405 PC bottom 57, 85 Pump Off $g, S 5
Header/Manifold , SS Bottom of system 1.~
Existing Grade 7 Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: C~y;,r~. ~10 w Q rS Y%.
LICENSE NUMBER:
INSPECTOR:
3 / 9 3 : j t
-s '
LOQMiAl pa rEA1QHMNtdy,14.30.18 . FRR& MA SN19WmTURE, n .
Labor and Human Relations INSPECTION REPORT
SMe~,ty and Buildings Division
(ATTACH TO PERMIT) sanity nni
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village Town of: State AMP
SWAP, Insp. BM Elev.: BM Descripti Parcel Tax No.:
e26 1:041-40 00e
TANK INFORMATION ELEVATION DATA A9300170
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss Head
Forcemain Length Dia. DiSt. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer-
INFORMATION INFORMATION Type O CHAMBER Model Number:
System: OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: RICHMOND 14.30.18.200B,NW,NE,LOT j!LAVENrM, 157TH AVE.
t r 1. o
} .la, : j e .ti q V
Plan revision required? ❑ Yes ❑ No ~ 18 R3
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
.e~ vas _
A
DIL R SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
STATES ITARY PERM #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8/ x 11 inches in size. ❑ Cfieck if revisionvious application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER \ PROPERTY LOCATION
%4, S j T N, R t E (or
PROPERTY OWNER'S MAILING DDRE LOT # BLOCK # Al
CITY, STATE ZIP CODE PHONE N MBER SUBDIVISION NAM R CSM NUMBER
II.4 TYPE OF BUILDING: (Check one CITY NEAREST RO
❑ State Owned ❑ VILLAGE : { 15Z ~11 A V
K2 =N QF ❑ Public ~ 1 or 2 Fam. Dwelling-~# of bedrooms PARCEL TAX :
III. BUILDING USE: (If building type is public, check all that apply) Q r _ ^ I O L( 0
1 ❑ Apt/Condo VJ
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 411 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 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
130 Seepage Pit Pressure 430 Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ~j ELEVATION
T 3? ~1 37~ Al. A (`5' Feet V, Y Feet
VII. TANK CAPACITY Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding Tank QZn7
Lift Pump Tank/Si hon Chamber SIP 17 5D
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installatio f the onsite sewage system shown on the attached plans.
PI ber's Name (PPeZAX.,_~ Plumber's Sig ature• (No Stamps) ~/MPRSW No.: Business Phone Number:
I; ic, i s 3 Yre 5/
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater a Issued Issuing A %nt Srt~=) ❑ Approved ❑ Owner Given initial Surcharge Fee) -7-12
.
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
t ~
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Yqur 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 uwriership or plumber requires a Sanitary Permit ?'ransfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewn-e sy:;!t.rns must be properly maintained. The tank(s) must be: pumped by a. licensed
pumper whenever necessary, usually every 2 to ° 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:-
_ A
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.
Vl. Absorption system information. Provide all information requestr.d in ##1-7.
Vli. Tank information. Fill in the capacity of every new and/or ex;sl+rrt
wank, list the total gallons numter of
tanks and Y~anufacturer's name. Indicaia prefab or site cons3,~.: and tank material. Gomr.iete for all
septic, pump/siphon and holding tanks for Ills system. Chp- lr ~ ~,erime:ntal approval only if tanks received
experimen-a' product approval from C)FLHl 1.
Vlil Pesponsibility statement. Installing piumbgr is to fill in :rr ;irt {rse number witn arproprr!lte prefix (e.g.
MP, etc.), address and phone number. Plumber must sign app, i(.iJ,on form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and speciflcations.not SIT,ar!ar than 8'/2 x 11 it the mast be ~,ubrrittcd 'o thc. ocunty. The
pica s mu-;, ioc;;a(Je the tollowing: A) plo s`;-!-,, draw"1 to scale complete ~Itx~c„?n; rc, F4c3'tion of
hold g tank(s) or other t',.:.Ament tanks; bU.' i. vers' wells; waaier mni s 'Hater service;
strear7is and lakes; pump or siph(.,,(r tariKs distribution boYC : ~rhsoiption systesris -ui~a- emert system
areas: a:.. "hr :ocati )n of the bui ``art r B) horizonta -•rtical elevation -:4,_7r,>nce points;
C) complete specifications for pumps ar.d cortrols; dose voiuned:--, ?ievation differences; triction 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_
GROUNDW* ER SURCHARGE
1983 "Jiscon=_.ir; Act 410 included the creation u_ swc Hart(?? - (1c,-s) for a number of
regi-i '_:.tr d p -,:`ices which can e ect g-oundw. ei,
The `~s ,:;-y ected Orrough t'.ese surcharges are used for : ionitorir .^ro!. rldwatc: gr~ an ;J
.
water contarYiirl,AilOn in-estitgations and establishment of stan'lards r
SBD-6398 (R.11/88)
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEMS Private Sewage Section
Labor and Human Relations 201 E. Washington Ave., Rm. 141
Safety and Buildings Division PLAN APPROVAL APPLICATION P.O. Box 7969, Madison, WI 53707
Bureau of Building Water Systems (608) 266-3815
INSTRUCTIONS: Please fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The
reverse side of this form describes most of the required plan information. Further requirements may be contained in the Wisconsin Plumbing
Code, which can be purchased from the Department of Administration, Document Sales and Distribution, 202 South Thornton Ave., P.O. Box 7840,
Madison, WI 53707, Telephone (608) 266-3358.
1. PROJECT INFORMATION (Type or print clearly) Plan R view ppointment Date Plan Identification Number
7 9 659 7
N e of Submittin arty (plans returned to same) Project me
Street Address, P.O. Box # or Rural Route Project Address or Legal Description
APO"' /kOL tre. T30 .)V.-
City
City or Villa State Zip Code City ❑ County.
,5-S/p/ Village ❑ of
Telephone No. (include area code) IF& -5/ 3S Town ICh YYI OdaII 5+, "dtX
Designer Name f Owner 7
E >9II eve
Telephone No. (inc de area code) Telephone No. (include area code)
.
Address, P.O. Box
Street h or Rural Route Street Address P.O. B x or Rural
o* o Route
4010 r„b'w/'t
City or Village State Zip Code City or Village State Zip Code
S o.DS
2. PPLICATION FOR; ❑ Experiment Mound System ❑ Holding Tank
New Construction ❑ Large System (over 8,000 gpd) Conventional System ❑ Groundwater Monitoring
❑ Replacement ❑ At-Grade ❑ System in Fill ❑ Petition For Variance
Revision: In-Ground Pressure
❑ ❑ ❑ System in Flood Plain (attach SBD-6698) ❑ Other
'3. FEE COMPUTATIONS (include existing tanks) FEE SUBMITTED FOR OFFICE USE
MAKE ALL CHECKS PAYABLE TO SAFETY & BUILDINGS DIVISION.
a. 750 1,500 gallon septic tank $110.00 hfO
b. 1,501- 2,500 gallon septic tank $120.00
C. 2501 ; 5,000 gallon septic tank $160.00
d. 5,001- 9,000 gallon septic tank $ 200.00
e. 9,001- 15,000 gallon septic tank $ 300.00
f. Over 15,000 gallon septic tank $ 500.00
g. 500 - 1,000 gallon dose chamber $ 70.00 7O
h. 1,001- 2,000 gallon dose chamber $ 80.00
1. 2,001- 4,000 gallon dose chamber $100.00
j. 4,001- 8,000 gallon dose chamber $120.00
k. 8,001- 12,000 gallon dose chamber $140.00
1. Over 12,000 gallon dose chamber $160.00
M. 500 - 5,000 gallon holding tank $ 60.00
n. 5,001- 10,000 gallon holding tank $100.00
o.~ Over 10,000 gallon holding tank $150.00
p. Revisions $ 50.00
q. . Groundwater Monitoring - Per Site $ 60.00
(other than a proposed subdivision)
r.. Petition For. Variance: , Setback $100.00
Site Evaluation $225.00
Plumbing $225.00
s. Experimental System (additional fee) $ 300.00
Subtotal:
t. Priority Review: Enter same amount as Subtotal
Total Fee:
go
NOTE: Plan reviews should be scheduled prior to submittal. You may contact one of the offices listed below.
Hayward Office LaCrosse Office Madison Office Shawano Office Waukes~ a Office
209 W 1st Street 2226 rose Street 201 E. Washington Ave. 1053A E. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 P.O. Box 434 Waukesha, WI 53188
Hayward, WI 54843 Phone (608) 785-9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548-8606
Phone (715) 634-4804 Fax (608) 785-9330 Phone (608) 267-5119 Phone (715) 524-3626 Fax (414) 548-8614
Fax(715)634-5150 Fax(608)267-0592 Fax(715)524-3633
SBD-6748 (R. 05/92) NOTE:Fees ate pursuant to Wis. Adm. Code, Chapter ILIIR. 2, and OVER .
are subject to change annually.
WORKSHEET - MOUND SYSTEM DESIGN
PROBLEM:
Design a mound system for a 2 r r7
The site characteristics are. V 11
Depth to groundwater or bedrock Sa in.
Landslope G ~0! ?
Percolation rate .'...3 •
Distance from dose chamber to distribution system ft.
Elevation difference between sump and distribution system ft.
~.r
5o
• Step 1. NASTEWATER. LOAD =
gal.- Step 2. SIZE THE ABSORPTION AREA
ti
A) Area required sq. ft.
j , B) Bed or trench lengthy (B) ft.
C) Bed or trench width (A) _ ^.y. ft.
• ! D). Trench spacing (C)
Wastewa ter load .24 gal/ft2/day B = ft.
trenches -NzL
Step -3. MOUND HEIGHT
A) Fill depth (D) _ ft.
B) Fill depth (E) = D + slope (A)+P ft.
C) Bed or trench depth (F) _ 18 ft.
D) Cap and topsoil depth (G) ft.
E) Cap and topsoil depth'(H) _ ft.
Nipn: Id,
Zicenc~e i~U:.,_ I-S
Step 4. MOUND LENGTH n:7
~t ry
A) End slope (K) CD + E +F+H x3= S 3`~~,•/' `
am--~ .
5 J )t 183f7, X-3 =/0 °S
B) Total mound length (L) B + 2(K) = ILL ft.
93,~st a&o,)= l 3 5
Step 5. MOUND WIDTH
Al) Upslope correction factor = 97
A2) Upslope width (J) (D + F + G)(3)(factor) _ got 3 ft.
• C /t.83
(3)( X97,. 8
3 ~
B1) Downslope correction factor = '40
B2) Downslope width (I) _ (E + F + G)(3)(factor) _ t.
Ao 3)
Cl) -00
Total mound width (W) for bed J + A + I ft.
I.
C2) Total mound width (W) for trenches
J + + (no. trenches -1)(c) + A +
t.
g,3 i0, s_
Step 6. BASAL AREA
'y A) Infiltrative capacity of natural soil 3 941./ft2/day
B ,
Basal area .01
required = wastewater flow
natural soil infiltrative• a acity /-sue sq. ft.
SD 13
~1~ff . /S5
'i C1) Basal area available for bed for sloping sites =
B x (A + I) _ sq. ft.
C2) Bas W are Ja+aiil le for trench for sloping sites = 1171,4
q . ft.
YJ
93,75 ~,3t 1J = !/~/,k7s
C3) Basal area available for trench or bed for level
sites = B x W = sq. ft.
Sign:
License P
Date: S 0
,
l~~s~ 1
a 3
Step 7. DISTRIBUTION SYSTEM
7A) SIZE DISTRIBUTION SYSTEM r
1) Hole size = in.
2) Hole spacing = a in.
3) Distribution pipe length = in.
4) Distribution pipe diameter in.
5) Spacing between distribution pipes = D in.
6) Distance from sidewall to distribution pipe = in.
S~3340.4.)7
7B) DISTRIBUTION PIPE DISCHARGE RATE ~ ft.
1) Number of holes per pipe„
2) Flow per pipe 7 GPM.
7C) SIZE MANIFOLD
1) Manifold is central/ _ end
2) Manifold length ft,
3) Number of distribution lines
4) Manifold diameter = 3 in,
1 7D) SIZE FORCE MAIN
1) Minimum dosing rate GPM
2) Force main diameter ,-3 in.
3) Friction loss = p~ ft.
7E) TOTAk DYNAMIC HEAD
1) Vertical lift = g ft.
2) Friction loss 076 ft.
3) System head 2.5 ft. oar S ft.
4) Total dynamic head ft.
Sign:
License
Date:-_-
~
of 7F) PUMP SELECTION
1) Pump selected will discharge ?D GPM at /a ft.
total dynamic head.
2) Pump model and manufacturer
G ohs P
7G) DOSE VOLUME S 9 4 0,49 7
1) 10 times void ovolume of disXrioutionlines = gal./cycle
09~ s
2) -Daily wastewater volume : 4 doses/24 hrs. _ gal./cycle
14
3) Minimum dose volume L.:K SS gal./cycle
76 7H) DOSE CHAMBER
13
1) Minimum capacity required = ScrD- 7Sd gal. ~ar
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siga;
License '.'u: -/S
Date:-
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LI`~~ l e F' Page 006
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
-Medium Sand
Tops J r - _ r
3
Bed Of 2 Force Main Plowed
Aggregate- Layer
k< D_LFt.
Dt SAFE""'.
ion A Mound System Using
A zS ~ E dY Ft.
N ENCE-A `Bed For The Absorption ATea F Ft.
G Ft.
n A ~ Ft. H h.S- Ft.
Signed: ~s
B_ Ft.
License Number: 56,3 K /bj Ft.
Date: 3Z.51 3 5L 11Y Ft.
TT- f~,3 Ft.
Alternate Position Z 1~ Ft.
of
Force Main W 303 Ft.
L
Observation Pipe
i3 K
W ~ Force Main
Distribution Bed Of _2 2 12"
Pipe Aggregate
1
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
1
PAgo. q /D
•
Perforated Pipe Detoll
S934099.7
n
End View
Pertoraled
End Cop PVC Pipe
Rio woe ,
0+~~ Holes Located On Bottom,
s Are Egyally Spaced
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Reet To End Cap ' L--
a;.
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Distribution Pipe Layout P 7S Ft. a
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X -QY_ Inches
Y PVT Inches
Signed: Hole Diameter - Inch
Lateral Inch(es)
i i✓n~ Manifold Inches
Date: , p > I Force Main " 3 Inches
# of holes/pipe a.3
w. Invert Elevation of Laterals g2ia•3 Ft.
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PAGE OFD
`Pl1MP CHAMBER CROSS SECTION AAJO SPECIFICATIOUS
VENT CAP
~ 'i"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
25' FROM DOOR, JUMCTIOU BOX MANHOLE COVER
WINDOW OR FRESH 12"MIU. S 9 34 0.4 9
AIR INTAKE I
GRADE
1 -
10"MIN, - - - -
- - -
PRPVIDE I _
AIRTIGHT SEAL I III V
APPROVED JOINT
WI C.I. P I PE . QF e±yR:;wTlt t , I III APPROVED JOINI
CNDINIC- 'lPr. 3' ISI431I sps -.Ty I III W/C.L PIPE
C /C
ONTO SOLID SC::. I I I ALARM EXTCNOIAIG 3'
B I ( ONTO SOLID SOP
eKH • i'+. I I
C S i I ow
'I I
I
I1 PUMP
r OFF
0
CONCRETE CLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC AND SPECIFIGATIOUS
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DOSE TAIJKS MAQUFACTURCR:-LAS.US6e - IJUMBER OF DOSES: _.-_4--PER pAy
TANK SIZE: - 7SD GALLONS DOSE VOLUME
ALARM MANUFACTURER:_S ESP i INCLUC!!!-- Z.;C!.FLOW; A3/,S GALLONS
MODEL QUMBER: ,l0/ -q I CAPACITIES: A= o3 INCNES OR 41104 '
CALLOUS
SWITCH TtIPC: I G
B-- INCNES OR 3's47 GAILOAIS
PUMP MANUFACTURCR: -G Os q - /DI
C = INCHES OR (O ~ GALLOfJS
MODEL NUMBER: 3r 3 f P
D' INCHES OR GALLONS
SWITCH TYPE: Mehe IA ~ NOTE: PUMP AMD ALARM ARE TO BE
PUMP DISCHARGE KATE J
Gp ej/ INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERCNCC 15 1:u PUMP OFF ANp STRIBUTION PIPE., - FEET
+ MINIMUM NETWORK SUPPLY PRESSURE 2,5 71~
T~ FEET S
+ Z~ - FEET OF FORCE MAIN X i~F/ .
ioo ILFRIGTIOAI FACTOR.. ~ 76 FEET
TOTAL DYNAMIC. HEAD = Jlfc2. FEET
INTERNAL RIMENSIDAJC OF TANK: LEAIC,TH ;WIDTH /jla ~
-V--;LIQUID DEPTH
SIGfVED: LICEMSE HUMBER: _ 45/4-
-117- OATE~
.
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Y. ..G t) ~b.S '.-SUUMERSIPLE. ~
; 4: •S 1 AG 'AC ID:. EFFLUENT PUMM'
EP0311 ~a•
•x• . " LIST DTSIC.
, t v GO. 3i1 142 FP0311 tat 11S v Etflumt pwr ~olidb 2S6:E0 17z.10
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Fti , , . • 7t ,S a
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a AEf#luent, Pump ¢ M' tj 04,9 7 .
DEL OLDS
SIZE
~AE7'!R2 FELT. 1:• .
30 . ~s
} Vii',
c •141 rEiQ}; '?:t: t < 10 t F.t
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10%88 CEhT 30 PAGE OIu. :'i .
w. .r~•
W scgnsin Uspartment of Industry, SOIL AND SITE EVALUATION REPORT Page of .3
Labor and Human Relations
Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
r COUNTY
S`f. G I-c 1 a(
Attach complete site plan on paper not less than 8 1/2 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 OWNE~ PROPERTY LOCATION
L All ip GOVT. LOT NA) 1/4 Ne 1/4,S T 30 . ,N,R jibr) W
PROP RTY OWNER':S MAILING ADDgESS LOT # BLOCK # SUBD. NAME OR CSM #
O!c la rt ~t / N/ Phi II, .C a Ue.~'t u.Ne.
CITY STAT eY•g,,mT ZIP CODE HONE N MBER ❑CI []VILLAGE MOWN NEAREST ROAQ
w sy ~Ghm /S 7.$ A .
New Construction Use [ ] Residential / Number of bedrooms 3 [ ] Addition to existing building
[ ] Replacement [ ] Public or commercial describe
Code derived daily flow ~5b gpd Recommended design loading rate bed, gpd/ft2-, ay trench, gpd/ft2
Absorption area required bed, ft2 /5 ao trench, _ft22 Maximum design loading rate bed, gpd/ft2 ~3 trench, gpd/ft2
Recommended infiltration surface elevation(s) > ff ft (as referred to site plan benchmark)
Additional design / site considerations + fviw erta
Parent material We Y Flood plain elevation, if applicable ft
.
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S vg u cgs ❑ U ❑ S X U ❑ S U ❑ S U ❑ S I w
16 ,7g$ SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
B /5-a6 s r y S/ b k mv3 , s 3
Ground C li640 7,S h S /S f k m sli G 5 1 /
elev.
9gft. C yfs-~y ~S- S/G S~i-Is a s h*
m~~ G S 1 -
Depth to
limiting
factor
C22 Remarks:
Boring #
s • 3
Q-/7 /o t v s,! 56 1 C_%
~,s' w S ,5bk m~ cs a , 3
<a 17-,)-3
Ground.... a a3'yU 7. ~k 5 S - l 5 3 SDK M► c S 1 y
elev. C' `f0-~S 7,S r 5 s°ht; C ov ►►Ifr C5 ( g
ft.
to r;l y5_40 71 5s _ S 1 S ►►1 GS
Depth 1 - y
limiting c 3i 7a 45/ 4Q 1
rntl~f G 5 •
factor -
7A C`/ 7a-Fy .5i- a- s fs/ 1 to rnot~f- &s l
Remarks:
CST Name: leas Print Phone:
Address: / w c.;. c'~ M o (j s~ o
Signature- Date: CST Number:
w ~ - s -9.3 .ss
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of
PARCEL I.D. #
Y
Depth Dominant Color Mottles Texture Structure Consistence Bourclay Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
IV, t!! rh a s 3 r3
n-13
Ift ,15 d? 75 r -YJV S f.5m 3. C 5 '3
Ground C -S 7,,5 1 4 6 53 no; cs l , 3
ele
V.1 ft. v. y C S
Depth to ,
limiting
factor
~0-
Remarks:
Boring #
MIN ft' E
Ground
elev.
ft.
Depth to
limiting
factor
Remarks: ,
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
4...... <
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
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Wisconsin. Deparanent of Industry, SOIL AND SITE EVALUATION REPORT - Page Of
Lr':or and Human Relations
D~OWn of Safety 3 Buildings in accord with ILHR 83.05, Wis. Adm. Code
• COUNTY
st 0 ix
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I D #
not Hated to vertical and horizontal reference point (EIR, direction and % of. slope, scale or z
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALLINFORMATION IRE?WEDS a JA
0 A
- PROPERTY OWNE~ , PROPERTY LOCATION ,
GOVT. LOT NW 114 /V s 114.5.7 T 3a . N,R /8 , w
PROP VTY OWNER' S MAILI G ADDgqESS LOT BLOCK # SUED. NAME OR CSM # ;
Ot'o ~r,lo.' ,nl1 h, II, .C K ~
CITY STAT erS4'r ZIP COD~Fy HONE N MBER []CI []VILLAGE MOWN NEAREST ROAM
New Construction Use [ ] Residential / Number of bedrooms 3 Addition to existing building `
L ] Replacement Public or commercial describe
Code derived daily flow 'el5t) gpd Recommended design loading rate bed, gpd/ft2 trench, gpd1ft2
Absorption area required bed, ft2 5 ao trench, ft2 Maximum design loading rate bed, gpdM2 f trench, gpo
Recommended infiltration surface elevation(s) S ft (as referred to site plan benchmark)
Additional design / site considerations
V 01
Parent material tw Flood plain elevation, if applicable WIA- -It-
S - Suitable for system CONVDMo MOUND KGROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U- Unsuitable for stem ❑ S .4u cgs ❑ U ❑ S W U 0 S U IDS B(U IDS fit! ,
akf. 7-5B SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmrdary Roots GPD/ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed rends
0-15 D S/ 5k M Cs 3 :3
P41 r9 51 tQ5
Ground C (,-it0 7, 5 r 5 /5 f'rt ~i C'S Y
elev. %Sit c yfs- ay z s' r G 5+js
Depth to
limiting
factor 4
i
Remarks:
Boring #
0-/7 /OX). z sty/ S6 c s. s 3.
15 a -'3 "),s' t YZ2 s 4,1154k Mil cs a ' 3
-#0 7,.ryh 5 'S I s 3 sjK YA f' c S
i Ground
elev. . YO-Y-5 7. S r _rIAI
s-r~ C t~ rqf r cS [ 4- : $
girt
5 S ' s m s; y
Depth to $c
limiting 3 S yr .5A i• Yildl;?'
factor
r- s era-~ 7, s b tv% 4 i d-$ - ,
Remarks:
CST Name: eas Print Phone:
pis
Addres3
/ w
`5'26 A
Spnature• „ Date: CST Number;
N
PROP.ERIYOWNERf_ SOIL.DESCRIPTION REPORT pageof
PARCEL I.D.t
- i
Boring# Horizon Depth Dominant Color. Mottles texture Structure Consistence GPD/ft
In. Munsell r- OU. Si. Cont Color Botrx3aty Roots
Gr. Sz. Sh. Bed with
"1S S / s c s 3 .3
8
-a 7
.Ground Gti "s 7,S ,.':5 d s 3 S n► cs> .1,~ 3
elev...
Depth too,,
limiting ' ;
_ • nor; ~
1
Remarks:
Boring #
f ^v i t;SfL
Ground r•. 1
elev.
ft I
Depth to , .
limiting
factor .
4• ,
L11
Remarks:
Boring
own=
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Ground
elev.
ft.
Depth to
limiting _
factor , . . < _ .:c•s
Remarks: , . ,
Boring # ,
• Ground ' . ,
r
elov.
Depth to
limiting
factor f
Remarks:
eJ _
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404
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D - -
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SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER 5 1/0
ADDRESS:- O 1 l \04 ~~_FIRE NO:
LOCATION:~fJ 1/4, t)o 1/4, SEC.- /TT.3,N-R_ZI_W,
TOWN OF: )6_~ m.Qrc~ ST. • CROIX COUNTY
SUBDIVISION:_ LOT NO. /
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 to
help with the cost of the replacement of a failing system, which
was in operation prior to July 1, 1978. St Croix County accepted
this ro ram in August
P g of 1980, with the requirement that
, owners
of all new systems agree to keep their system properly
I; maintained.
The property owner agrees to submit to the St. Croix County
w Zoning a certification form signed
g by the owner and by a master
,r plumber, journeyman. lumber► restricted plumber or a licensed
P pumper verif in that 1 the on -site wastewat
Y g ( ) er di
sposal 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 from 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 DNR.
Certification form must be completed and returned to the St.
Croix County Zoning officer within 30 days of the three year
4 expiration date.
SIGNED:
_~~r~c
I. -
DATE:
~'St. Croix County Zoning Office
911 4th St. "
Hudson, WI 54016
I
Z
I
I
STC-100
This application form is to be completed in full and signed b
the owner(s) of the property being developed. Any inadequacies
will only result in delays of the
development be intended for resale byt owissuance. ner/ ontr chtor,i(spthis
ec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of
property ~ 1 6
Location of property A)bj 1/4 NF 1/4, Section
- T_30 N-RIk W
Township Eli
1-failing address
S 5 -/0 -
Address of site ~ -S 7
Subdivision name
Lot no.
Other homes on property? yes_ No
Previous owner of property - y ^I-
Total size of parcel S
Date parcel was created VY1 193
Are all corners and lot lines identifiable? -Z-V_
Yes No
Is this property being developed for (spec house)? Yes
No
volume /D and Page Number 37 as recorded. with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WA-111U ITY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER & THE. SEAL OF THE REGISTIR OF DEEDS.
certified survey, if available, ;would be helpful I o asdtoiovoid
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
the property described in this information f(are) the owner()
orm, by virtue sof oa
warranty deed recorded in the office of the County Register of
Deeds as Document No. ~99 .
own the , and that I (we) presently
proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described rt, for
the construction of said system, and the same hasp been duly
recorded in the office of County Register of deeds as Document
No.
Signature of ap~ll~aant~A
Co-appl cant
Date or Signature
Date
of Signatur
4 IWANTYRI-D
9926 7 vot PAGE REGISTER'S OFFICE
ST. CROIX CO., WI
Grantors; Patricia A. and Philip M. LaVenturet Rec'd for Record
Wife and Husband
MAY 181993
- _ to 2:15 P , M
conveys ard warrants to Bernadette L. and Eugene J.
L'Allier, Jr., Wife and Husband, as joint
tenants. &KVIAA
Reg~br of D"
RETURN TO
the following described real estate in St. Croix County,
State of Wisconsin:
Certified Survey May Vol. 9 Page 2605 Tax Parcel No:
Land 'Located in part of the Northwest one-quarter and in hart
of the Northeast one-quarter and in part of the Northeast
one-quarter of the Northwest one-quarter of section (14)
fourteen, Township (30) thirty North, Range (18) eighteen West,
Town of Richmond, Lot (1) one.
(A (5) five acre parcel) F
EXEMPT
This 1S not
homestead property.
(is) (is not)
Exception to warranties:
Dated this ! day of 19 3
Gh~//!// A e~(SEAL) - (SEAL)
ricia A. a enture
Aat
(SEAL) (SEAL)
,
Ph lip M. LaVenture
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
lloIIV" County. ~~pp
authenticated this day of 19 A rsonally came before me this__
day of
19 913 the above named
ri C, ii
TITLE: MEMBERS?ATE BAR OF WISCONSIN
(II not,
authorized by § 706.06, Wis. Slats.) 'kndwp to be the p rson f who executed the
THIS INSTRUMENT WAS ORAFTEO 8v~' • , 'fltxeSgtno,IT►9~rtumenl an aCkno ledge the same.
- fat`
r ~ r ~~Rt "i . is
f~1 i1.
may •e : gtJ .tar b County, Wis.
(Signatures ma be authenticated or acknowledged nth i~ssio are not necessary,) is
permanent. (if not, state expiration
19
r
' Names of persons s,oninn m nn ems.
CO lell '71e le';'
Q 49'7119
SURVEY Ily
CERTIFIED
MAP
Located in part of the Northwest one-quarter of the Northeast one-
quarter and in part of the Northeast one-quarter of the Northwest
one-quarter of Section 14, Township 30 North, Range 18 West, Town
of Richmond, St. Croix County, Wisconsin.
OWNER LEGEND
Phillip & Patricia LaVenture 0 Found 1" Iron Pipe
1035 HWY. :64
New Richmond, Wi. 54017 o Set 1" x 24" Iron Pipe weighing 1.68
pounds per linear foot
NW CORNER Fence line NE CORNER
SECTION 14-30-18 SECTION 14-30-18
CO. MON. NORTH LINE OF THE NW 1/4 NORTH LINE OF THE NE 1/4
EAST 2643.01' WEST 2643.01'
NI/4 CORNER j EAST 330.37' H 2312.64'
SECTION 14-30-18 $ Zy
Bearings are referenced (FALLS IN AG-LAND. `4 w o-+
NO MONUMENT)
to the East line of the &Z
1p=y+
Northeast Quarter ';0
assumed to bear UNP TATTED LANDS m f=
- - -
N00°47'59"W 1C - o
1Z N89048'30"E 416.65' -1 1Z 0) M
x IZ
SCALE 1 11 = 2001 I~ 3' m a
Ir is it N
=MINI 1Z
200 100 0 200 ~D Z 204 LOT I SHED ID
"t 8 x 0 g o 1--1
M 0 0I~ TOTAL AREA 0-~
,
e y
(A 2,17 ,8 11 SQ. FT. W
N N,C 0 .4
5.000 AC. 13s A X Im
to -4 1 v p 10 E V4 CORNER
',S EXCLUDING R/W m z SECTION 14-30-18
Ir ao 200,385 SQ. FT.
ID N m p 4.600 AC. m A ID
1Z a Ir 0 1Z
I N - 1Z N Z 10
_ @I~JLQINO SET@ACB- DRIVEWA 1 1n A 10
~O 100' FROM R/W
WI
R/w ' 4.
this instrument was drafted by; ' S89.13'01W 416.91'
Douglas J. Zahler _ 157TH AV_E. _
-e _
S89048'30"W 85.85 S331.09'
SOUTH LINE OF NE I/4 OF NW IM SOUTH LINE OF NW V4 OF NE 1/4
1
UNPLATTED LANDS
COUNTY GENERAL NOTICE
Each parcel shown on this map is subject to State and County laws, rules and
regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before
purchasing or developing any parcel, contact the St. Croix County Zoning
Office for advice.
CJ
OF ws0a
o, ` ~IL~N 3 h~ ~HLAS
'R 00
N 0 " R 0 71993 ► * S-2145 "
H C c7 AP
sue. n. is JAMES O'CONNEs 4 H WIS. IJ~
H R < Q R69tst6r of Deed
? Q 16 < . SL Cro►x CG•, Wt dip p
w g SUFN
I< 0AZ_
VOLUME 9 PAGE 2605
Parcel 026-1041-40-100 07i08i2005 09:22 AM
PAGE 1 OF 1
Alt. Parcel 14.30.18.2000 026 - TOWN OF RICHMOND
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* DALLIER JR, EUGENE J & BERNADETTE L
EUGENE J & BERNADETTE L DALLIER JR
1354 157TH AVE
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1354 157TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE
SEC 14 T30N R18W PT NW NE & PT NE NW Block/Condo Bldg:
BEING LOT 1 OF CSM 9/2605 5 ACRES
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-30N-18W
Notes: Parcel History:
Date Doc # Vol/Page Type
07/23/1997 1010/39 WD
2005 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/30/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 5.000 54,000 192,100 246,100 NO
Totals for 2005:
General Property 5.000 54,000 192,100 246,100
Woodland 0.000 0 0
Totals for 2004:
General Property 5.000 54,000 192,100 246,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 222
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00