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HomeMy WebLinkAbout030-1086-95-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT n r OWNER i4R V I3 lgo6t)A1 S/ b Vff-l~ ADDRESS :3,-2,8 4 RD, le- #OaL 7-0jV 114 SUBDIVISION / CSM# AIA LOT # e4 SECTION 30 T3_N-R_Y~_W, Town of r7bSEDA ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Uc! sfs /00cvs C- 8400 p,G r u.tr0's7u~i?eo i EL./dp `s"rL ~ 13o -ro/-r s rA/,v 6- SOACE 1;~, Yo 5 6 ~ 6 i y Ru INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. :UOZOgdSNI UagNnN aSNaDIq :90f NO uaewnqd 9- NOIZV-1-IVISNI aO aJVG ap~Ib Tsut3 g ape.IO but'4sTXS L '0 uta-4sAs 30 uo-4-409 , pTo3TUPLd/-T9pPaH 33o dmnd utoq-4oq od 4aTuT od 49Tgno IS 49TuI IS IaMaS butpTTng sxolsYnsgs .Iaq.40 ( -asnog --,-i-O-VT: TTaM :mOa j xoaq-4as n s , : auTT • do.Id 4sa.Iaau o-4 uoT-4oa.Ita )3 aoua-4sTQ ~ z;;~-3o .IagmnN u-4bua'I ~ uqPTM xassas xolsauosav zlos uoT-4leooZ UUP-EV -7'7-: aTOAO/suoTTPO uoTgpaadas gpoT3 - azTS -#Tapow jajngopjnuvN :dmnd zauq0 r asnoH -TTaM :mo.i3 xopq,4as 1~ d :A-4Tosdpo ptnbTZ : a9ango~ jnupw xolsNumoaxi xxKS DmiagOH / usaxvHo dwad / xxKS olsass :Ka alVNHalgV -9 7/y _ • xHVXHC) sa ' 1 L QMXW,t=t.of-A%WH 30.30. Labor and Human Relations WO' EWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ( Town of: State Plan D No.: SC9PffV9RRICH r-PRAR01 DWLqT- JOSEPH ev.. Insp. B ev.: B Description: Parcel Tax No.: r a's 0-40-1 086-95 TANK INFORMATION ELEVATION DATA A9300299 TYPE MANUFACTURER CAPACITY STATION BS HI FS Septic S d,4e_. /d Benchmark Dosing Aeration Bldg. Sewer l~ 0J 1 Holding---`-- St/ Inlet TANK SETBACK INFORMATION St/ Outlet re 9s Ventto r TANK TO P/ L WELL BLDG. Air lntake ROAD Dt Inlet 12,d7 S. 5Zj Septic 3p- i NA Dt Bottom 7 ,Zo /D/, 3~3 >56 NA 4-}/M an. Dosing 2:5 "5-. Aeration NA Dist. Pipe d/, ZS Holding Bot. System PUMP/ INFORMATION Lojrj -0 54P 1(1/ Final Grade Manufacturer s Demand ~ ° a f, S / n, 32, Model Number e q- GPM TDH Lift (.p6 Friction q° Syeaem TDH pg? Ft Forcemain Length 57 Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length, ! No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS d DIMENSI N LEA Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER tuber: System: ryl . cam! /4.S X50 DISTRIBUTION SYSTEM 6. Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 7 ~ Dia. ~ Spacing 60,/ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over D Depth Over xx Depth Of „ xx Seeded/ Sodded xx Mulched Bed/Try Center Bed /T+ep*Kfdges Topsoil UjYL!rs ❑ No Fj-Y ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) zg 6„ LOCATION: ST. JOS H 30.30.19.314F2 6' i3 = G 70 ~~Ce v~71J J CD Ot~*- b J ' f~ t~'yt CYO E lJ a ~P >/OY1 eyes Plan revision required? Izlto Use other side for additional informatio . ~p F4 /1 SBD 6710 (R 05/91)~- Dat Inspector's Signat re Cert- No- 7Q s~/ a SANITARY PERMIT APPLICATION DILH COUNTY In accord with ILHR 83.05, Wis. Adm. Code ~o S-f e4014 STATE SA ITARY PER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ A 8% X 11 inches in size. If e 1.9 v4 ious 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 GIERARn '/a W'/4, S T Q, N, R E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /V114 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER e O IVA II. TYPE OF BUILDING: (Check one) VILLAGE: ✓ Q d'" JOWU ❑ Public ~ 1 or 2 Fam. Dwelling-~# of bedrooms-, PARCEL X • U E O III. BUILDING USE: (If building type is public, check all that apply) _ 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 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. El 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 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 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 L fS0 3pq 38/-/ 5" 1,06, q Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank X O C~JE~ S Lift Pump Tank/Si hon Chamber, 1 joent VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum 's Signature: (No Stamps) M PRSW N Business Phone Number: (&5- Plumber's Address (Street, City, State, Zip Code): y 0E 1 -0 7,e zr S IX. COUNTYIDEPAR MENT USE ONLY E] Disapproved Sanita(((yyy Permit Fee (Includes Groundwater [Date ssue [IsbUing Agent Si ) , urcharge Fee) AL: 1~ I Approved E] owner Given Initial 99D Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6396 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r r 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; (lose 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 uses' for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ;i •r.~.HxiTirM~rerw,aR..:pRr.. ~~pct~iv ~Go T ~06AJ V o I M QJ ' N a j 1 I - FN 40 -7 F-/13 PROJECT TNDE'X STI!;FT OWNER : 6!4XY BiPoCv v 3W- 770 ADDRESS : 3y0 Ty. ~D ' TUS ~0 GU/ S S yd ~'Z SITE LOCATION: .SE /y tilu yy ~ SQL 3l' T30~(J ,~/y,~ 7b1~/,v O~ Sf ToS ,o- PROJECT DESCRIPTION: cT- C~t°p/'.r ~DU,uTy 3 41,-f,5 i05fi/.-v 6-- Day.0ell ~~ys rF~ • ~sr~:~~ rE~ 6'~9i~~ ~i~sfc f/o~v 10, ~l ~avv~ rio.v~r~ ~yo oti~ s y s r~,~-t ~s yf'oyos~v PAGE 1. PLOT PLAN VI4WS PAGE 2. MOUND CROSS SECTION & SYSTEM PLAN VTEWS PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERFORMATIC ' SPECS OR SIPHON SPECS Sqs-01987 PLUMBER : DESIGNER lot~ i DATE: F03M w UUNCH'T D1160 SIGNATURE: ltd w~rr ~~tltN~ ll~ W N b a `1 0 Is n C~ rn ~ y o n W a r j ~ ~ • No If 41* D °A wn y h3 N fD~ a w ~0 (k ID rr O bc~+•c~o O oofDir°so O 04 ~ • y w m oro !,3 cc roroooon.ca (D 0 ley, J W c0+ti W WM 1> t n Q ~t e ~ V n1 ~~QtR&~ ~rOA m ~ o -4~ 1 s~opE` o ~Ny ' F© 5~F w o co ID JID 1 o Al EC-+ ~a O w m ~t--~ o v H 1 ~ l1v N rn w ~ NITS ~ O ~ v n ~ ~ w y d~ 'Ilk i` (A © ap G Q 4A i r~ G 0 r E,q•~'T LO i Li~~ .fit: ;t; ;F~° tl~. ~~yy,,~,. ~/C~, I 1 A 9 . N V ER 7- o/ /co. .a GEV,tri'on) S Tap OF R O C K /O Z o z ~ „ - Page Of S r0 P° F/-- I R-r•E P n L- S /0/07 Synthetic Covering Distribution Pipe Medium Sand S tTEM G y ! - Topsoil - : _ F E~evhr-.r _ X00 , • 3 E , 8 % Slope UA10L-R S Bed Of« Force Main Plowed Aggregate Layer y9. Y~ U411;A9AI -t 7-0E 41~ve- D Ft l 7 ~D E G Ft. S40%'C' Cross Section Of A Mound System Using F . ~Q Ft. • G ~ ably A Bed For The Absorption Area G ~•o Ft. SP P~ . 1'ti QRw {~,rpm " S Ft. H Ft. A ~ ® B y8 Ft. K Ft. ~s4 so L Cn Ft. `s~oN of oNpENo~ ~ 7 Ft. Go(~R sP T /S Ft. foR~~~ E~ W 30 Ft. Observation Pipe A o L-- - w I - Distribution 7 Bed Of 2 Pipe Aggregate w Observation Pipe Permanent Markers y'~ PvG c~t~PED s~EEE... ,Pons . , 593-01 9 8 7 Plan View Of Mound Using A Bed For The Absorption Area ~~Q~i~E'D • l3~¢S~-L. ,q-,pE',~- = , DAi~. y ;1uf15 7E F/e:sJ _1D ~ ~T' .,f13 O 1 y / = sQ y77 l Page 3 Of 30' ~0/ 1/0 /Um6 ~Vlwr /43I ~ole' Perforotgd Pipe Detoll )POrlo(0104 End Cop PVC Pips ~o`a•~d`O holes Lecale4 On sotlom, Are Equally Spaced R 9 Q PVC ~ Manifold Pipe Distribution / Fr Isr Pipe w/drJ /z H,.-is should 6., &4411 Next To End 6--" 1 M~„+~folD/ Distribution Pips LoYout P Ft. -4--- Fo-Pcf /91,4/k) X Inches Fr SHIP lly Y Inches p~~vP ,~~0114 dole Diameter 1 Inca, colt(I lateral Inch(es) u~a" a Manifold _.Z__. Inches Force Main " 2- Inches ,IAX U - F>yS of ~S~oN Of sp of : hol es/pi pew ORR~Sp0N Invert Elevation of ~ axer8ls_^____ Fto EG._ rr "DCSTR►f3L)-r%0 J 3)t5ctjA,R(,E RATE -FOR tr'Ac H L.ARTERA1_ bAr. OTis IQ NlN Sg4`3-oi9 7 70ThL -DiSTR%Bu1'Lo N 1) 1S) CMARGE RnrE FpR K)eTwo kK Z 3, yd C :2-5 'M" AJ I'M UM MI VAL/l''fCA APA 01:564 Ai'~'le ,30 ~tt /,,*/A;L PUMP CHAMBER CROSS SE(:TION AMD SPECI ICATIONS pf} E /OF rj VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER 25' FROM DOOR, Af-W/ WINDOW OR FRESH 12"MILT. ,AIR INTAKE ~/1AD~ ~~E ^T/o n/ GRADE I 4, MIN. U {{~~1v A I B"yMIW~-. _ pCOQDUIT S g pn - ~Ev~fi. ow R N TA I hfl1A 1~Lfl1 - - - - 93,o ma INLETA J/ OF 0_1 APPROVED JOINT A INS 19~ K oNpEN ~ I I W/C.IVPIPE01NT5 w/C.-I. PIPE EXTENDING 3' ~0 G~RRE P ( I I ALARM EXTEWDIAIG 3' I I ONTO SOLID SOIL ONTO SOLID SOIL 6 ! I I ON I 0 I I ELEV. FT. - I PUMP-~ __J OFF ~p D p/,J lr D K O~ , 4A 5LOCK IE v~ f ~o ~1 gj,/✓ RISER EXIT PERMITTED OWL4 IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC f SPECIFI.CATIOKIS DOSE TAMKS MAMUFACTURER: Gc~~ S WMBER OF DOSES: PER DAS v.PD g~a G /IALLONS DOSE VOLUME //2 TANK SIZE: ✓ G - 1/ 41~R,i,( L~ INCLUDING BACKFLOW: ~'2 GALLONS ALARM MANUFACTURER: S' /('S So/b GALLOAS MODEL NUMBER: CAPACITIES: A= Z INCHES OR SWITCH TSPE: -INCHES OR 3 GALLONS PUMP MANUFACTURER' ZoF lle-k C= INCHES OR GALLONS ~q MODEL NUMBER: f f Y~" H"p IIQ U D= /2 INCHES OR 3 GALLONS SWITCH TYPE: E"1510#\Ck mePc.uPy F1 Ar NOTF: PUMF AND ALARM ARE TO BE MINIMUM DISCHARGE RATE-30 INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION! PIPE.. /0.0 FEET -rAA)k !9PfGS' + MINIIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET EAG(n' P-IfL ' + J~~! : EET OF FORCE MAIN X /'S F o iLFRICTION FACTOR.. ' 77 . FEET E-40,A ) C. gi 2-- TOTAL DIJUAMIC. HEAD = /3,3 FEET . Gov D ' " INTERNAL DIMEI.ISIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH 11 8 7 S•13 no 019 y _ EAD CAPACITY CURVE 3 7/8 6 1/a s MODEL "98" „-r 4 5/8 30 I ~ - e e z 3 5/8 P _ 2 i 0 115 4 3/16 1 e I -4 i 10. 1,1/2-11 1/2 NPT ' s 0` U.S.' GALLpNS 10 20 30 40 50 60 70 i30 ~ , , UTERS ap 160 240 t) FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE - - EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS GALS. LTRS . 5 1.52 72 273 i 10 3.05 81 231 31 A 15 4.57 45 170 3 5 16 Is`' 20 0.10 25 95 i 1 1r1 ` Lock Vahre 23' r r i CONSULT FACTORY FOR SPECIAL APPLICATIONS O- Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and suppliQcl with an alarm. three phase systems. t Mechanical 4,t ternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for ,wltttout.tarm;switches, variable level long cycle controls. SELECTION GUIDE ry 1. Integral float operated 2 pole mechanical switch, no external control requirej. R Stand rd all models Weight 39 lbs. - y/s H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98-serls Control selection switch. Refer to FM0477. Model ' Volts-ph Mode Amps simplex Duplex 3. Mechanical alternator 10.0072 or 10.0075. r 145 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". 5. Mercury sensor float switch 10-0225 used as a control activator, specify 315 1 Non .0 2 or 2 & 6 3 or 4 5 duplex (3) or (4) float system. D98 230' 1 Auto 4 4.5 1 or 1 & 7 - . 6. Four (4) hole 'V-Pakunction box, for watertight connection or wired-in sim- . d zrr vlE 8Q : 230 1 Non 4.5 2 or 2 & 6 Tor 4 & 5 plex or duplex operation, 100002. 9 7. Two (2) hole "J-Palk", for watertight connect(on or splice. r i 4°1~ CAUTIQN ter information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices'' and wiring should be dons by a quali-. 1 Piggyback Mercury Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, fisd licensed electrician. All electrical and safety Codst should be followed induct- 4 FM0406; Alarm Packag9, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Box, ing the moot recent National Electric Code (NEC) and the Occupational Safaty and Ffv(p732 Health Act (OSHA). RESERVE POWWD DESIGN t For'unlasual conditions a reserve safety factor's dngineered into the design of every Zoeller pump. { s^'~ - MAf1 T0: P.O. BOX 16347 ` Louisville, KY 40256-0347 Manufacturers pl. , . \ ~ 1 O SHIP T0: 3280 Ojd Millets Lane ;71 y Louisville, KY 40216 ((U~IL/lY A WS /NCE Aff (501) 778-2731 • FAX (502) 774-3624 '""iii. ~Tk ~"^Ta'°' ,~""^".'`'~,fxg+~•' _ _ _ . _ . _ , - a.. . Rcl"I 019 7 8 r is E SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 5, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 BOB ULBRICHT 655 O'NEIL ROAD HUDSON WI 54016 RE: PLAN S93-01987 FEE RECEIVED: 180.00 BROWN, GARY SE,NW,30,30,19W TOWN OF ST JOSEPH COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. ..Sincerely, Kenn` th Stiemke Plan Reviewer Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. thu Fri I i SBD 7997 iR.01/911 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER GEXPab seNeldgmeN~ E G BLOW-Al ROUTE/BOX NUMBER Z A ~~U~ TY Nn E- _ _ FIRE NO. 32-A CITY/STATE kga&za& vvi5ry-jusiA/ ZIP 's-91M, PROPERTY LOCATION: S W 1/4 NV /4, Section .36 , T,10 N, R_12_W, Town of 5T, I d3ge"u , 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 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 I D~ l4~ ~j 3 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT 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), 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 _r-,tiAhe o . ~3laowly at2,4 14 EbWAO& 11 Location of property 51N 1/4 _Nw 1/9, Section 3,0 , T, 3 y N-R_q_W Township ST ~D~FPIa _ Mailing address 33 et)P4 /LD E Nayyzo~r ;,w15 5~to~iZ Address of site 3Z6 GDywLt 2D E Gc,t-o '.w15 5`feb7l Subdivision name Lot number - rS M V©1L PA6 E l 32 Previous owner of property (5r/iA 5CN a/~2t~t{ ~Eb1yAY1,0 6,~3nowN~EOWApe A,imea w Total size of parcel I:93 A6AE'S Date parcel was created A U 6 1 97 f~ Are all corners and lot lines identifiable? -X_Yes No Is this property being developed for resale (spec house)? Yes _No Volume .3 and Page Number 63 2 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, and 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. • and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owner Signature of Co-Owner (If Applicable) I Date of Signature Date of Signature L jl DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1882. THIS SPACE RESERVED roR RECONo1NG oA.A S, QUIT CLAIM DEED 48s~is REGISTER'S OFFICE JANE_A:--.BROWN,-a__widow-_not remarried Grantor ST.CROIXCO.,VA Recd kX Rtcad AUGO 6 1992 quit-claims to ---DWARD__G..._BROWN d'nd::"JOY C~ _R._.BROWN;_:husband and-.Wife-,--an--undivided one-half---(0- interest; and to at 8:30 A. M GERAR.D..D....SC.HN0BRLCH -and MARLO M SCHN0BRICH,,-husband C ....and..W~f.(~s.-dn .-undi-vided- one-hal_f__-(~ -interest,,-grantee ! In..considera,t.ion of $17,50-0.,_09. the following descried real estate in CrO. X _ _ County, State of Wisconsin: IIETURY TO William J. Gilbert 206 Second Street - ;I Hudson, WI 54016 Tax Parcel No: Real estate describeduin ADDENDUM. S } } I This 1-S-SLO.t........... homestead property. (is) (is not) Dated this 1st July.. 19.92._. day of I (SEAL) (SEAL) I • Jane A. Brown i (SEAL) (SEAL) i AUTHENTICATION ACKNOWLEDGMENT Si ture(a) _._Jane A. Brown STATE STATE OF WISCONSIN Ss. County. nut n iV of Ill 1992.. Personall came before me this .day of ----------------•---•-Y---------•--••----+ 19........ the above named - .W Gilbert TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 4 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. } THIS INSTRUMENT WAS DRAFTED BY William J. Gilbert, Attorney 206 Second Street, Hudson, WI 54016 • Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date- 19---......) I QUIT CLAIM DEED $T:\TP: BAR OF WISCONSIN 0.'facnnxin L.¢.] BIAnk Co. Inc. .I FORM No. 3- 1982 Mil-.ke . W- ADDENDUM VOL 762 PAvi.389 Part of the SWV4 of NWY4 of Section 30, T30N, R19W, more fully described as follows: Lot 2 of the Certified Survey Map in Vol. 3 of CSMs, Page 632, Doc. No. 350084. Part of the SWV4 of NWY4 of Section 30, T30N, R19W, more fully described as follows: A strip of land 33 feet wide lying immediately West of and abutting Lot 2 of the Certified Survey Map in Vol. 3 of CSMs, Page 632, Doc. No. 350084; subject to recorded easements for roadway and utilities. All that part of the SWys of NWY• of Section 30, T30N, R19W, lying Southerly of Lot 2 of the Certified Survey Map in Vol. 3 of CSMs, Page 632, Doc. No. 350084. and Southerly of the strip of land 33 feet Westerly of said Lut 2; subject to the right-of-way of St. Croix County Trunk Highway "E" thereon. The NEY+ of NWY, of Section 30, T30N, R19W. The SEY• of NWY• of Section 30, T30N, R19W, EXCEPT the lands described in a Warranty Deed in Vol. 502, Page 636, Doc. No. 318424, AND EXCEPT the lands descritd, in Certified Survey Maps in Vol. 1 of CSMs, Page 272, Doc. No. 334044, Vol. 3 of CSMs, Page 632, Doc. No. 350084, and Vol. 7 of CSMs, Page 2052. Doc. No. 443725. Part of the SWY. of NWY. of Section 30, T30N, R19W, described as follows: Beginning at the NW comer of Parcel 1 of Certified Surrey Map filed in VoL 1 of CSMs, Page 272, Doc. No. 334044; thence North to the North line of said SWY. of NWY•; thence Easterly along said North line to the East line of the SWV4 of NWyi; thence Southerly along said East line to the North line of Parcel 1; thence Westerly along the North line of Parcel 1 to the point of beginning. Together with a non-exclusive easement 66 feet wide for roadway and utilities, running from the South line to the North line of said SWY. of NWA of Section 30, T30N, R19W, which easement lies immediately West of and abutting Lots 1 and 2 of the Certified Survey Map in Vol. 3 of CSMs, Page 632, Doc. No. 350084, and is centered on the West lines of Parcels and 1 and 2 of the Certified Survey Map in Vol.1 of CSMs, Page 272, Doc. No. 334044, and the centerline of which easement is also generally recorded as being 821 feet Easterly of the West line of said SWV4 of NWYi. Grantor, as the owner of Lot 1 of the Certified Survey Map in VoL 3 of CSMs, Page 632, Doc. No. 350084, retains title to a strip of land 33 feet wide lying immediately West of and abutting said Lot 1, and also retains a non-exclusive easement 66 feet wide for roadway and utilities, which lies immediately West of and abutting Lots 1 and 2 of said Certified Survey Map in Vol. 3 of CSMs, Page 632, Doc. No. 350084, and also retains a water-line easement and the rights and obligations to shared use of a private well on said Lot 2, all as more fully described on a Quit Claim Deed from Grantees to Grantor dated July 31, 1992. Said strip of land and easements shall run with said Lot 1 and inure to and be binding upon Grantor's heirs, successors and assigns in title to said Lot 1. Labor and Department 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 COUNTY sT, C~o~ X 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 OWNER: 6,V✓ PROPERTY LOCATION , /'f- GOVT. LOT SE 1/4 Nw 1/4,S 30 T .3a N,R /9 E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 3 SAD /fpuG7o.✓ CITY, STATE ZIP CODE PHONE NUMBER []CITY EIVILLAGE [DOWN NEAREST ROAD sf aoSt-p/t yo BZ (715) 5c/ - L770 57' 0,56-, h~ 110vly- E [ ] New Construction Use [)(J Residential / Number of bedrooms 3 [ J Addition to existing building i ()Q Replacement (J Public or commercial describe i Code derived daily flow y. O gpd Recommended design loading rate S bed, gpd/ft2 trench, gpo1ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate " - bed, gpd/ft2 " L trench, go* Recommended infiltration surface elevation(s) G 3 ft (as referred to site plan benchmark) Additional design / site considerations So,'/s i1 t'i E St'i r,1W1, o.-Jzy '4s0v.C, v SfiS TE-y Parent material SGS y/ - 4MfieY s/ - 6-'14c,:41 Ti/ Flood plain elevation, if applicable 4.1-4-- -ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL T HOLDING TANK U= Unsuitable fors stem ❑ S ®U ©S ❑ U ❑ S a EIS ®U ❑ S o U ❑ S JE~u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPI/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed minch L~ Is 2- Ground C 2/-1/,f 7•S YX f 7 S~ 1,1~ sd n~f/ S i , y . S elev. 5,17 ~rElJ 49 E S/ vf~ i • Y s Depth to limiting factor~ Remarks: Boring # z - o i o y,f nom, f;~ cs .2 . s . ~ 11o, 70'rle .5 Ground i i 5 elev , z d1 t S/ If 54t, iw+f I' C'S `r ' S ft. ~z o 75 Y 31, ~ 5VAD Depth to limiting " fr+ factor - Remarks: CST Name:-Please Print Phone: / 0~ Ad C PLUMBINGCO. WK dress: HOMESITE SEPTI 65; O,NrlL RID.. HUDSON, WIS. 54416 Z Signature: ROBERT UtBRIGHT Date: umber: YAS MASTER PLUMBER LIC. N0.3307 M.P.R.S. CS ~/672_ t'MN. INSTALLER & DESIGNER LIC. NO.1N1883 e i ✓~Di ~S Al ~7- -'l AA1 - /4,+S S%UF - AT 2~ aa, DOw-vcc~~'D . s 10beAtI441W rY PfC 577e t'c 71-d Lp 41004,0 Sys r~-y ~So•/SP~~ Z) /SoSG-v rl/~ S~`v~P~1-Tz~v •~-T yo i :~G--(3) ,~i¢C ~-ate AvT 0' 3 1;4p 4 v 51 PEZOA// o ~ V filW5 47 l D Ste - ~s sc~~'T ice' ati ~y ,9-- .moo v s ys 7-jr- -fl Ilk, 10 ~3\ y PROPERTYOWNER SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D4 ZCKALt ZL11 / Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. B;Ftench 3 Si/ 2 6-41r 1w V /e cs vle V/~ 1411Y 511 L, f, Irk Al C15 .-t Ground 316 -Zoo /0 y/e ~►6k- 7~/ ~s Zen . S , /aft. (o ~syA yy s.2 3 S'r Depth to 2 , S AIM// limiting factor 2 1110,e/20, j 11 1D OSE' ? 7i6101E Alley - /jl G(J Flo rv ~T l~D Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # e Ground elev. ft. Depth to limiting factor Remarks: Boring # Lwk- AM Ground elev. ft Depth to limiting factor Remarks: 00M I I i , E.~ytiQ" tj E a ~ o ~ n y N ~ 0 3 ~ / R r k. N r n w o ; of 3 1 y ~c rz~ z mI~ 1 ` C. n'D c 25 s~ 25 ~ rte- S °b p 98 c4zo w ~ N Z ~ O~ aa~ O ~0 c `dC w 0 T LAJ