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HomeMy WebLinkAbout038-1075-40-000 -0 C) 0 °v> ~ V !h a O E C O O f.. ~ N N w N O h N 0 CL ° o c N o 0 o 0 ai T a Z c . C ° tL c N O U O ° C ° ~ ° 3: U- j . Q c U) CU 0 3 M I Z E co LU Z O L Z y y M w a m z c ti o c t9 ° m O Z d a c 4) z Q) I- w N Z N ~ T3 O ~ M O N • N N p C O m ° Q Q r Z Z o N Z M I d l4 E E N V N _ is Y ID li i a c am c CD LO l0 N i N c O NO G o d O 76 N Z > > O Z O CL IL IL a N M M zi CD V1 E ° VJ -i tU ° rn rn z Q C) 0 0 fn O O E O N .r N N _ rn 7 w ° N 0 0 3 N N c N Q 0 4 O N co Q O O N S C u O_ O O C) 0 r L M E O c N N V n °O 40. I I c~a N v 0 ° N z -0 N 7 ! L C; c m CY) =3 -0 • ~ O. Gd ,V d y c r.+ E i c c 3 `on A U a O V1 00 , Parcel 038-1075-40-000 07/02/2007 04:54 PM PAGE 1 OF 1 Alt. Parcel 18.31.18.309D 038 - TOWN OF STAR PRAIRIE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - GRAHOVAC, JEFFREY A & ANN M JEFFREY A & ANN M GRAHOVAC 2182 90TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2182 90TH ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 10.680 Plat: N/A-NOT AVAILABLE SEC 18 T31N R1 8W PT OF NE NE 10.68A LOT Block/Condo Bldg: 1 OF CSM V 5/1237 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 952/325 07/23/1997 841/340 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.680 75,400 193,800 269,200 NO Totals for 2007: General Property 10.680 75,400 193,800 269,200 Woodland 0.000 0 0 Totals for 2006: General Property 10.680 75,400 193,800 269,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 138 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM RE OWNER ADDRESS 1-71 a G?. ` Y SUBDIVISION / CSM# SECTION. T N-R IK W, Town of y ~ 1Q. 3I• iS, '60-tv, ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~/mss _ . -2 _ 3T / , ~p S iL b' O INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form,/r' Provide 2 dimensions to center of septic tank manhole cove- BENCHMARK: / ® / i ALTERNATE BM: a: 6~1 SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: A2Eex:s: Liquid Capacity: Setback from: Well. ZQf House Other Pump: Manufacturer a„/a/s Model#4) o?f/l Size / ii Float seperation Gallons/cycle: /S-8, S~ Alarm Location AIX) s~ -:SOIL ABSORPTION SYSTEM Width: Length Number of t~ ~C- Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet : ST outlet PC inlets g 7 PC bottom/ Pump Off ~p Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR:T 3/93:jt L4QAAa0Nj;art£MR irRP.ARIE 18.31.14VAMEAM ) County: Labor and,Human Relations INSPECTION REPORT Safely and Buildings Division (ATTACH TO PERMIT) sanitar rsni GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI X v.. escriptio Parcel Tax No.: 7115 TANK INFORMATION ELEVATION DATA A9300212 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irito ntake ROAD Dt Inlet TANK TO P / L WELL BLDG. A Ar 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 Forcemain Length ID i a. Fi Dist. To weu 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: SETBACK CHAMBER INFORMATION Type O 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: STAR PRARIE 18.31.18.309D (94TH STREET) Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) Date ADDITIONAL COMMENTS AND SKETCH < v SANITARY PERMIT NUMBER: I Iloilo rSANITARY PERMIT APPLICATION D1LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY • STATE SA ITARY ERAA~ # -Attach complete plans (to the county copy only) for the system, on paper not less than [7~j~y~Il v/J 8/z C ck if iev sion to previous application ' x 11 inches in size. ❑ -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPS TY OWNER PROPERTY LOCATION AX. '/a AIX '/4, S T , N, R (Or PROPERTY OWNE 'S AILIN ADDRESS LOT # BLOCK # clo, STATE ZIP ODE PHONE NUMBER SUBDIVISION AME OR CSM NUMBER R / II. TYPE OF BUILDING: (Check one) CITY NEAREST ROA , ❑ state owned VILLAGE' ❑ Public M 1 or 2 Fam. Dwelling- # of bedrooms-=_ PARCEL A Nu e ) III. BUILDING USE: (If building type is public, check all that apply) Q38 _~fj7s=~d 1 El 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 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. New 2. ❑ Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ZI Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120 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./'nch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank B Lift Pump Tank/Si hon Chamber - VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name Print : t Plumb is ign lure: IN ps) MP/MPRSW No.: Business Phone Number: Plum /'s Address (Street, ity, State, Zip Code): IX. C LINTY/DEPARTMENT USE ONLY Disapproved Sa ary Permit Fee (Includes Groundwater ate Issued Issuing Ag nt 18"~ Surcharge Fee) Approved ❑ Owner Given Initial Adverse Det rmination oC/ 0 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R.11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS k 1. A sanitary Permit is valid for two O 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. It 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 manrjfacturer'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 13% x 11 inches must be submitted to the county. The plans must include the following: A).plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all 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) ' r Wicconsi6 Department of Industry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division Labor and Human Relations Bureau of Building Water Systems REVIEW APPLICATION Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office 209 W 1 st 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 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least one working day prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or havelpeQnSn wha4 C submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. V ss Q OrM J 1. APPOINTMENT INFORMATION -if ou have scheduled an appointment, fill in the information requested below to save time: Appoi tment Date Revi er Name Plan Identification Number r 2. PROJECT INFORMATION If this review is a revision or extension to your existing plan identification number, provide that number here: Project Na e ❑ City ❑ Village Town Of: County Project Location J GOVT. LOT,!' 1/4 I 1/4,S T X R f< or T )l 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type I (include new and existing tanks) Up To 1,500 gallon septic tank $110.00 A ❑ At-Grade 1,501 - 2,500 gallon septic tank $120.00 H ❑ Holding Tank 2,501- 5,000gallon septictank $160.00 M Mound 5,001 - 9,000 gallon septic tank $200.00 N ❑ Non-Pressurized In-Ground(Conventional) 9,001-15,000 gallon septic tank $300.00 P ❑ Pressurized in-Ground Over 15,000 gallon septic tank $500.00 O ❑ Other: Up To 1,000 gallon dose chamber $ 70.00 ~J^ 1,001 - 2,000 gallon dose chamber $ 80.00 Building Type (check one): 2,001 - 4,000 gallon dose chamber $100.00 4,001 - 8,000 gallon dose chamber $120.00 D ® Dwelling, 1 or 2 Family 8,001 -12,000 gallon dose chamber $140.00 P ❑ Public Building Over 12,000 gallon dose chamber $160.00 S ❑ State-Owned Building U To 5,000 gallon holding tank $ 60.00 S.Q - 5,001 -10,000 gallon holding tank $100.00 Code Derived Daily Flow gpd Over 10,000 gallon holding tank $150.00 ❑ Check If Replacing Existing System Experimental System (additional one time fee) $ 300.00 Revisions To Approved Plan z $ 60.00 Petition For Variance: Setback $100.00 Site Evaluation $225.00 ❑ Petition For Variance Plumbing $225.00 Revision $ 75.00 Groundwater Monitoring - Per Site $ 60.00 ❑ Groundwater Monitoring (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 Subtotal: / 000 Priority Review: Enter same amount as Subtotal: O MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) Coma Nam Con erso ( ~ 7 No. l reet dress Or P.O. Box City, Town or Village, State, Zip Co e / y ej 2 > a/ 7 1 ' Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. 2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. SBD-6748 (R. 03/93) OVER aaa-aaaaaaaa~o- Wisconsin-Department of Industry, SOIL AND SITE EVALUATION REPORT Page -4of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 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 PROP RTY OWNER: PROPERTY LOCATION GOVT. LOT A/S 1/4 1/4,S T,_?/ N,R i(ord? PROPERTY WN R':S MAILING ADDRESS LOT BLOC # SUBD. AME OR CSM # 'Ty' TAT ZIP CODE PHONE NUMBER CITY VILLAGE [gOWN NEAREST RR AD I A/lUd klt Z~L~ - IYA-L.] Vz) p(j New Construction Use jx] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate -,:~/_bed, gpd/0, trench, gpd/ft2 TYTY Absorption area required, ~S bed, ft2 _ trenchi ft2 Maximum design loading rate _-4 bed, gpd/0~trench, gpd/ft2 Recommended infiltration surface elevation(s) 9s?. 9 ft (as referred to site plan benchmark) Additional design / site considerations Parent material -z-11,4y6 /1 ZV Flood plain elevation, if applicable. ft rU= tablefor system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK suitable fors stem ❑ S O U ®S ❑ U ❑ S O U ❑ S ®U El S ®U ❑ S I U SOIL DESCRIPTION REPORT fol 9 3- 40 7 8 5 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots , GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends y. ! Ground . i. elev. 2Z-9, ft: Depth to limiting factor Remarks: oring # / B f0 ME 11 s-y Ground elev. ~ ' ft. Depth to limiting factor Remarks: CST Name:-Please Print ' Phone: Address: Signature: / ` Date: CST Number: PROPERTYOWNER SOIL 'DESCRIPTION REPORT Page . of. PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boa nd3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -2/9 1114 tiy'{iti?Y.. Ground - 4U AIP i elev. ~ ft ~I Depth to limiting factor Remarks: Boring # ':4 ti i}5~~Y4w 4 Ground elev. ft. Depth to limiting factor Remarks: y_ Boring # t Ground elev. ft. Depth to limiting factor Remarks: Boring # Y ifi 4 l n Ground elev. ft. Depth to limiting factor Remarks: con 0ooAfo ncrorn PRGrERTYWNER ` SOIL;DF,SC:IPTION REPORT,,- P~eof PAMEL 1.OA . " Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 3 Ground P elev. ft. Depth to limiting factor i Remarks: Boring # i 13 Ground., ` elev. Depth to limiting factor I • Remarks: Boring # i f Ground elev. ft. Depth to limiting . . factor Remarks: Boring # , Ground elev. ft. Depth to limiting factor Remarks: "on OOO/VD AC/nIM , z -0" JAd 0 f - ' \ O NAX I 1 ~ C of/D WORKSHEET • MOUND SYSTEM DESIGN S93-40785 PROBLEM:., Design a mound system for a - - The site characteristics are: Depth to groundwater or bedrock in. Landslope ...L % Percolation rate Distance from dose chamber to distribution system ft.- Elevation difference between aump and distribution system ,9,,(? ft. Step 1. WASTEWATER LOAD ■ /SQ~~ x 3~~_ S"D~~-~ gal.' Step 2. SIZE THE ABSORPTION AREA. A) Area required ■ ~S'0~~= s ft. B) Bed or trench length (B) 7 ft. C) Bed' or trench width (A) ■ ft. D) Trench spacing (C) 14 Wastewater load .24 gal/ftz/day B ft. trenceis Step 3. MOUND HEIGHT A) Fill depth (D)' ■ 2 ft. B) Fill depth (E) ■ D + slope ft. . ~ f~ Dl(8~) ; /.OS C) Bed or trench depth (F) _ ft. . D) ap and topsoil depth (G) _ ft. E) C p and topsoil depth (H) ■ ,1,, ft. .Zign. • I;lcenue Nu. uEtte: S Step 4. MOUND LENGTH 893-40785 A) End slope (K) _ CpV/ + F + H x 3 ■ ft. 57X3 B) Total mound length 00 = B +.2(K) • ft. , Step S. MOUND WIDTH y7 "-A ~(~D.a~ Al) Upslope correction factor = w A2) Upslope width (J) n,(D + F +SG)(3)(factor) ■ ft, (i,1-,, 8.3 -j- 6?) 917) , 9,-~3S3 BI) Downslope correction factor = 82) Downslope width (I) _ (E + F + G)(3)(factor) ■ ft. /.l t,83t1~635 0,03) ; 9,oss7 C1) Total mound width (W) for bed ,P J + A + I -„L;j-ft. 3"?, 3 -Pr C2) Total mound width (W) for trenches = (no. trenches -1)(c) + + I = ft. r Step 6. BASAL AREA A) Infiltrative capacity of natural soil 9#1./ft2/day B) Basal area required =--wastewater flow - natural soil infiltrat ve•caipacity ■ sq. ft. C1) Basal area available for bed for sloping sites B x (A + I) _ sq. ft. y 7 ~-(8 t9'1) r 803.7 C2) e% are avail le for-trench for sloping sites ■ 6 W ~J + A sq. ft. C3) _ area available for trench or bed for level Sign: t = x W = sq. ft. ry ' l Liaon~o Date Step 7. DISTRIBUTION SYSTEM . 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size = in. 2) Hole spacing in. S 9 3) Distribution pipe length = -?„2 7- 3 " 4078 4) Distribution pipe diameter in. 5) Spacing between distribution pipes in. 6) Distance from sidewall to distribution pipe in; 76) DISTRIBUTION PIPE DISCHARGE RATE „ate ft. 1.) Number of holes per pipe = 2) Flow per pipe GPM, 7C) SIZE MANIFOLD 1) Manifold is / central/ end 2) Manifold length ft. 3) Number of distribution lines 4) Manifold diameter = in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = GPM 2) Force main diameter in. 3) Friction loss 1Z:~ ft. 7E) TOTAL, DYNAMIC HEAD 1) Vertical lift ft. 2) Friction loss = ft. 3) System head 2.5 ft. _ ft. To al dynamic head Licenee Date" :_.45t&..G,7 U J. 7F) PUMP SELECTION 1) Pump selected will discharge 5~1-. GPM at ft. total dynamic head, 2) Pump model and manufacturer 7G) DOSE VOLUME 1) 10 times vojd volume of distribution lines gal./cycle /0 X~-yXa~X4q~,7~ 8e,~'G 2) Daily wastewater volu'~ : 4 doses/24 hrs. _,rs gal./cycle 0. / -I ZJ19, 3) Minimum dose volume = /,,,'gal./cycle 7H) DOSE CHAMBER 1) Minimum capacity required ■ s-~~ 7sa~,,~ = gal. Sign; Licanse ::u:T~ _ Uate: v I 5 AMBER, 110 Ix Z 6' - I 8 ~o G3 T SEWAI ILA ,,.5 a IDN i D 0 a7N jl~A « J ~ I -fV I 44- i Page~_Of~,_ S93-40785 Straw, Marsh Hay, Or ' Synthetic Covering Distribution Pipe Medium Sand H G ~ a • s Topsoil - - g D J l E $ Slope Force Main Plowed Layer Bed of I%"-2'S" Aggregate Cross Section of a Mound system using A Bed For The Absorption Area DFt. E Ft. F3 Ft. A R Ft. G _ n Ft. B ell Ft. vt H Ft. Signed: K /'!),-:2 Ft. L~Ft. License 2~2 C~r~' F'fa J rFTEM Date : W r'S F~F" ?.'r A~f1QNS ,,y,S3 t t;'` r 1 a~`u`iei$ SI~F[1~ A UAIA Alternate Position of is i=t~i~;E Force Main I L Observation Pipe J 1 A Forc Main W IBed Distribution Pipe of ~11-2Y" Aggregate Observation I ,pipe permanent Markers-J Plan View of Mound Using a Bed For the Absorption Area -4O7 Perforated Pipe Detail 0 Pulorotod vi" End COP PVC Pipe Holes Located On Bottom, 4p Are Equally 40ced a P PVC fares Maim _ P PVC Manifold Pipe Alternate Position Of OiNri!••dion Pipe force Main Lost dole Should Be Nett To End Cop End Cop Distribution Pipe Layout P Ft. R ~r Sir X_ Inches l Y Inches X/Z 24' loctiES f / Hole Diameter Inch Signed: Lateral Inch(es) Manifold "-Inches Date: g- Force Main " Inches # of-holes/pipe " ':LATWNS Invert Elevation of Laterals,9? Ft. DEPT. DF SAFE" Ab+3 . ui~y>1 iC i►GE w V w w M Lq, Ac n ~ b f► o UD r Pb A Q M m I W WC W rt W R, :0 8 a • a - _ a• a a a a a • " tat K aa_- C i~ - vl a " Ily r• V a a W r PAGE OF.. • PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS VENT CAP 40C.I. VENT PIPE ' WEATHER PROOF APPROVED LOCKING 25' FR¢M ODOR, JUNCTION BOX MAWHOLE COVER WIUDOW OR FRESH 12~MIU. AIR IAITAKE I All, I SSE 4" M(N. ~ I JW MILL CONDUIT L- E INLET Tv P OVIDE I TIGHT SEAL I I I / ~E I I v APPROVED JOIMT A i , ( I I ( APPROVED J0I14TS /C.I. PIPE I III W/C.I. PIPE W CXTENDIN¢ 3' ALARM EXTEUDIIJ6 3' OWTO SOLID SOIL d J ( I l 7 85 OWTO SOLID SOIL J 1~/ I I oN c I. I 10 89.6 ~ I PUMP -"j Off CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MAULWACTURER HAS SUCH APPROVAL SPEWFI•CATIONL I:P'hC AND _ OSE TANKS MAQUF•ACTURER. IJUMBER OF DOSES: PER DA:d TANK f,IZE: LL NS DOSE VOLUME: Ke ° GALLOWS ALARM MANUFACTURER: G e CAPACITIES: A= 7.715 INCHES ORJr23 GALLOUS "MODEL. NUMOER: 9a~2 CC IWCHES OR -.6 GALLOWS 26 Gs 3s7/ IIJCHES OR 11GALLOWS .SWITCH TtlPt: U " ` PUMP MANUFACTURCR: D■_.,L.IUCHES OR P-1 GALLOWS MOREL NUMBER: MOTE.. PUMP AND ALARM ARE TO BE bWI1CH TVPE: .L-~. IUSTALLED OU SEPARATE CIRCUITS PUMP DISCHARGE RATE ,._..__GPM V%:KTICAL,D11,FERENCE bETWEEN PUMP OFF AUD DISTRIBUTION PIPE.. . FEET + MINIMUM NETWORK SUPPLY PRESSURE, 2.5 FEET ♦ FEET OF FORCE MAIN X --~F/oo FLFRICTIOU FACTOR.. Z? FEET TOTAL OlaMkMIC. HEAD FEET gy, A, IIJTERNAL DIME 10NL TAIJK: LENGTH ;WIDTH jLIgU1D (DEPTH 51GIJED. LICENSE NUMBER: DATE ` C FYI', 4 M LM1/ t ~i~ ~''•'Yj 0 /0 Performance -Curves Pumps METERS FEET 90 MODEL 3885 25 SIZE 3/4" Solids WE1 70 = 20 WE10H -WE07H 15- 50 1 1 WE05H 40 10 VIiE036 30 I - Z-.- - [ - I \1 20 WE03 5 Ott r 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 9 n h c~ 7 30m"h CAPACITY.) " ~GOULDS PUMPS, INC. S&-,E-CA FALLS Ww ym 13,46 METERS FEET 120 MODEL 3885 35 110 wE,SHH SIZE 3/4" Solids 30 100 90 25 80 70 20 60 O WE05HH 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i 0 10 20 30 m-/h CAPACITY 01986 Goulds Pumps, Inc. Effective July, 1985 C3885 STC-loo 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 pormit 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-) e-W °f- i-tnn G Iro-koy -C. Location of'propertyw E 1/4 N 1/4, Section l , T N-R~W Township I Q Mailing address _1~04 N K nou3leS Qyer e i h►m~~nc~ , s 5~k0 ~`1 _ Address of site Subdivision name_ NO Lot no. Q (5M -V1,3) Other homes on property? yes No Previous owners of property (t&r-T I5S A . e,('snl1 l chae, C XJ e rs Total size of parcel ID . Log Ac,2L5 Date parcel-was created 'Are all corners and lot lines identifiable? _._Yes _No Is this property being developed for (spec house)? Yes X No Volume 5a and. Page Number 325 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. _ =1$38 q 1 , 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. S n re of applicant - Co-applicant 8' 3) 93 Date Of Signature Dat o Signature y 1 381499 CERTIFIED SURVEY MAP NE'/4- NE'/4 SEC. 18 T. 31N. - R. )9 W. TOWN OF STAR PRAIRIES S-7 CRO1X COUNTY, WISCONSIN, ?r 3 N. E. CDR. 'y C. 1. M.. FILED DEC 61982 (01 Lu c. !Awls o' CONNEL RpuN, of p..ds CD P L A TTt D L R N D S 66 Croix. cow ty, I 0(r) WIMSM s a N 89°-5cl-ol w 783.39' I P.O~. 01 '7 L~ "f, 713 S" ~I LLI . L-6S,Lhaa..50 3q FT. 0110 QI c~ 10.68 ACRES _ ~in TNC. RPN rn :a i OCO 0R cn cl ~c6 M y-4I,05a. a5 Sq. F T, o a V) 01 O of J0.1a ACRE'S ± LO I °I te) EX C. RPN 9° I Z M i9 9 D 0 ©,11, w V) 4 - L -Za:W 783.87' II w S 8~° 58- 13 I I 6e a in I I R/w O w o v Rvw APplo COR. C/M 2 SE'F COUNTY SURVEYOR FOR C.I.M. TIES etiagHFNS~v ~ ` '"JN~' 0 loo' Z" p+kk rY 2,00' oo' 0 SCALE 1= a00 LEGEND 0= 1'/ Lf IRON PIPE SET ag®eo~®® ~ 5 sy~~ WT. l3 L8. / L I N. FT ~ _JTOB N0. I q-8) r RICHARD D. BOOTH S-1413 _ CLEAR LAKE, WIS. t , P P r~ Q' ♦0 < ~O Volume 5 Page 1237 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ 2~~ i'll"1 Cal-x y Q, C_ ADDRESS C~ FIRE NUMBER Q2 L (7 CITY/STATE -ZIP PROPERTY LOCATION : (~E 1/4, N C 1/4, SECTION T.~1\_N-R__\1_W TOWN OF ,1 r 1 - , st. Croix County, SUBDIVISION NO LOT NUMBE W ~I Y 3 7 R Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification 'form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)• the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your 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• lrfr V V DATE : _ ~_3 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 DOCUMENT NO. S'l_ 1`E BAR OF WISCONSIN FORM 1-iesi rw,a vwcx assswvm row wseowo,ae eArA WARRANTY DEPED 483891 95 zrAcE 325 REGISTER'S OFFICE /y~ SL WX //yam V4 This Deed, made between Cur.tfsa-A...Anderson..a/k/a---• 'L Reed 6 Record Curtia..Anders.on....and.Michael.-C...Anderson..as..tenants-••- L 1n..common MAY 281992 Grantor, and. _-J affrey..A_..Grahownc..and-.Ann..M...GraIT ovae-j..husb d 8:30 A. ...and::wife.:as..survivnrship_.mat.ital:p.coperty grantee, Repblel of Duds WitnessethI That the bald Grantor, for a valuable consideration...... one.-dollar.. and..o.the-r...conslAerztion conveys to Grantee the following described reel estate in ....$t_-.Croix............ County, State of Wisconsin: Part of'the Northeast Quarter of the Northeast Quarter of Section 18, Towneflip 31 North; Range 18 West described as follows:' `'Tax Parcel No . Certified Sutvel+ map filed December 6i 1982 in Volume 5, Page 1237 (No. 26)+ rya iffiLfAl 12 EXEMPT This dA..Aot...., homestead property. " (is not) Together with all End 'singular the hereditamenta find appurtenances thereunto belonging; And ..........Gran.tou............................................... warrants Mat the title Is good, Indefeasible In fee simple and free and clear of encumbrances except none and will warrant and defend the same. ,f/J O ted'thie ...47,00 ir.- .1.4 . . day of .✓/1Lt..t/....... 19.9.2.. r ..................(SEAL) ...............................(SEAL) . ....Cu..r..ti....s A. Anderson Michael C. Anderson • ..s • (SEAL) ............................................---.--..................(SEAL) AUTHENTICATION ACHNOWLIZD0MI9N'1' Signal (e) STATE OF WISCONSIN S I. t^. t ?7 I x es. County. authenticated thi ......day ol 19.....- Personally came before mthis day of , I --....m ON 19....4. the above named 4 ...........n • C.t~ri55...•--•... n P;r.SOh TITLE: MEMBER STATE B OF WISCONSIN m,: C • nflcr Sq hss.l....• (It not................•--.••- . authorized by ¢ 708.00, Wis. to.) to me known to be the person who executed the foregoing Instrument and acknowledge !1`vpswNSgrre THIS INSTRUMENT WAS DRAFTED BY ,r\kk A, L• Ll e~r~,, Curtiss and Michael Anderson • • ~ N r New ...Richmond,...Wisconsin..54011.......... •Cro_j Cou Notary Public (Signatures may be authenticated or acknowledged. Both Ay Commission/ IS permanent. ( tat*pir If . me not ne---- date 6I :..W ~~fII yl •Namee of nrreone elrnins In any -r-11, ah-M h. Iyn.d nr e,inl.d hAm. lhdr riaaalnrea. ^~^~OO~ .%4~~ , ` W ARRANTT DEED STATE OAR or WISCON91N roam Nr. 1- 19$2 wh~aaele (xya A Dlllaauker, wY. l Ln -Vv- nZ- _ _I <tr,-I0V) yl rD0Or Ot*Tn-~ .~o~ ~ ~ ~O Or) O-1 I N~. or-cc ~m0 x - O-i C)=OCD X M MMMCW>MM-~ m 114 a o> r -i z -I s 1 0: N Z -I 21 .4 m ro o D --I m ~oD- W r-~1Z' m XU) 0z0 n ODC---C0 m-- m=_I X mm-i m I ~Z _ r-i \ nom in ,m CC> C c W:17 ~ OWUM Amin m n° O N 00X. l --I cNi n 0 0 0 r Vin-4'n0 . Z. m Y ? O i O 0 O N', 3 t4 1111' 0-• ~om c43~-+ Ni ZX> 71 f: -now m ~ < --lo; o! v CoT > m Z►+ D'I x Z / K') ~~J 1 ~'I < m, om P C 17 Li I {fi l'7 ZJ X5 m-4 m Mr X I I 3 -1 0. ~ 01 m - - N o In 1-+ M C <C 0 <z , r m: la M m x m m i G H r ~z Z0iI~1 Dm yi MV. m -J i m, A D ro ro o o 10 I ro Ch b .D ,-o m 47) W- w m> m <:0 ~m 61Z OD p o 01% N-`~C.N o~ n~ Z 0!.-A ` . . . . NI co -Jm O ~ O m;< 7 a m I m tC, .9GlnG~ m m <ix v C+ oW-j 00 0 D D 1 =i < ' Z'J iO -f ~ m M O .Zi m r--1 r N mti' ' la'> 11 o O 10 c m 0 -i n _ -n Z D D D o a H Z OX . o Z n m m m U) m 0. -1 z z C7iT.~-Gs ~Im t fl'- °c3~• D m z Z o W o y D m -c o z 3 G :t3 x n (J)C> M Ti -4 -n 0 Zr -n pm 'm1 I I I 1 1 $ U) r I th 3~ C Z - A 0 -i n Vi" Z m 11 a D X N r C? 3 fl' $COI DZ 0 Z M J+ ~~If w mmI~i z: w W-0 .OOr4C> a11 rI X m 1 N ~ xmI n, > i m I $i c, o in choc,IOo ~ ml 7 1 I -n > fyN D O 3) m2-10 rO m LW 0 I a R. _ 10 DI a Z 0 I m o o m n m i a o~Im mz tt C m j 2' T O Co o <z 0 4' < > > w 7D m x ym WX < -n p N an 0 i D~i m 3'. , r m z I= v m m'D r MO tDLn I,D D I n To O<0 i W - < : a m It m <Io m;m t►1C, I Z C) cate. 33g - - m1 < m 000 O D ~ D= C Z n Z Z (n ,0 . x O ~ f 0 C. Z> 1 -n X m O< 11 O O D I. < S Z N Z n n U'i 0 < C7 1 >O j r a Z r 1 C < m (n o oz Z i r W W - c I 9 NIP~m ID m !n w ~i, C n c t RA 7921 (SANV9 11V 03MV310 SVH >103H0 lllNn OIIV/110N) 1d1303lI I 2. is SS 9.02 V5 O-L'Z~ / v • ce„<-< 7~...L o 2a 2G7 ~s Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Hum.,an Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ` COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP RTY OWNER: PROPERTY LOCATION 1 GOVT. LOT AIZ 1/4 1/4,S T N,R g (ore PROPERTY WNER':S MAILING ADDRESS LOT BLOC # SUBD. AME OR CSM # 7 .41 if-, STAT ZIP CODE PHONE NUMBER CITY VILLAGE MOWN NEAREST R~C AD ~~i" -A '44111Z p(J New Construction Use Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow ~G gpd Recommended design loading rate bed, gpd/ft2_,S- trench, gpd/ft2 Absorption area required, bed, ft2 trench, ft2 Maximum design loading rate Jbed, gpd/ft2 S' trench, gpd/ft2 Recommended infiltration surface elevation(s) ,9$. y ft (as referred to site plan benchmark) Additional design / site considerations Parent material 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 Os O U [Z S ❑ U ❑ S 0 U ❑ S [0 U ❑ S ® U ❑ S 0 U 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 i Ground elev. ft. - Depth to limiting factor Remarks: Boring # Ground elev. qz's ft. I Depth to limiting factor 3L Remarks: CST Name:-Please Print r, Phone: Address: Signature: ` j Date: CST Number: oi PROPERTY OWNER {~F SOIL DESCRIPTION REPORT Page PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots Bed Tre in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I A-) vie 's Al/0 AIP Ground e"e, 122 - elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) i I I I i I I j II I i i ~ I I II ~ i ! I I Y i I ~ i l I I t I I I I j I ' ~ i I ~I ~ I I i I ~ I -r i I , I i I i I I I i I I - I I I ~ I , ~ I I , I j I F I I , j I I j ~ I I I ~ I I I 1 , I ~ i ~ i ~ 1 L- _I- I I t i I