Loading...
HomeMy WebLinkAbout191-1012-40-000 o O C 5.p I I ? C c w 0 0 N 0o CD N ~ aG y Q y I "ZI w p M O C CD 0 Z O C _ LL m c LL o O c = 6 U N 'fl m I E Q U U Co N a r y un W E O N I ~ i O Z rn C\j W L a co N F- Z N 0 ~ I C C7 O Z m cu d Z d' N c _o N F- r N Z N E M w O c N • _ O c :5 N O Z Z O 2 N _ ° E C N O £ a) L cc m Q) III', n C t0 w C C CD CL a~ ~ g N °v a c 1] h Q LO fn !A N a O Z > O O O d Z p 0 IL a. CL a N a o v) co rn tq U rn rn } a) M W a) CD O C ) 6 E ~ y IL I 1V c°o a Q i~a O O C Q) N C o O O C C E p N ui o co c E E m a) o M f ❑ ° of 75 rn = , - t 2 o N 0 N QO a) F- F- 4) • ° - rn E E O L N m O N UJ CC{ r d .C a v ~ ' a* n 1 4) L~ CL CL U 4) E c c A U d !II O in U STC - 104 AS BUILT SANITARY SYSTEM 4E-'?(ORT„ OWNER ADDRESS I~ U CIL) LISy1-- SUBDIVISION / CSM# /C LOT SECTION . Cf N-R W, Town of _ rv~ 1t c~-~ 2'1. 2°1, i S .7? ST. CROIX COUNTY, WISCONSIN PLAN ER SHOW EVERYTHING WITHIN 00 FE OF SYSTEM t INDICATE NORTH TAO14 Provide setback and el vation information on reverse of thiProvide 2 dimen to to center of septic tank manhole cover. BENCHMARK: C>.0'0 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: ti(l fore<-✓) Liquid Capacity: CCJ 0> Setback from: Well House Other Pump: Manufacturer Model# 42~~ Size 45- Float seperation Gallons/cycle: 17 Alarm Location A'loc,~t --SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: 26 Setback from: well: / b House Other ELEVATIONS G~ Building Sewer fi ST Inlet; p ST outlet PC inlet PC bottom Pump Off C)?, Header/Manifold . Bottom of system ) d Existing Grade Final grade DATE OF INSTALLATION: S e- PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L{f6'¢artWus$~7.29.15 PRIVATE SEWAGE SYSTEM County: Labortin8 Human Relations ,Safety and Buildings Division (ATTACH TO PERMIT) Sanitar rTnit GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town o : State PI v.: n . B EI v.: BM Description: Parcel Tax No.: 14 /6101 60 aS /06r_( iq6L, r_/; TANK INFORMATION ELEVATION DATA A9300242 - TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W C l 5 ~p v Benchmark r, ' I 0 y 2A y, LO I `1u Dosing 1 Aeration >1 Bldg. Sewer 92.16 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA F/ Man. 53~ /d.3 GZ~ Aeration NA Dist. Pipe s ea <o/~ Holding Bot. System da, 98 r a PUMP/ S INFORMATION 'nal Grade a Manufacturer <yl C De pd 06W Model Number 0 5)0 TDH Lift LJ ~~I Friction #I System 5o TDH p, t oss mead 1 Forcemain Lengtha/ ' Dia. _12 " Dist. To Well 7- SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS G~ / DIMENSIONS I -W SYSTEM TO P I L BLDG WELL LAKE/STREAM LE N anufacturer: SETBACK INFORMATION TypeO 1J-_-D It r CH E e Num er: System. , K{ / ?~G1 _ OR UNIT DISTRIBUTION SYSTEM 1 Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake d / Dia. L Spacing y p ~e'o , Length } Dia. Length 303"' 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 Aces E] No COMMENTS: (Include code discrepancies, persons present, etc.) . LOCATI : W LSON 2/ ? . 29.15 Sac { 5 Sjrr p f a w i Q ~ t ~:%,~7 C~Wti":--,~, -,7 ~ /~-v, aYr~~"x` ~J~ -yj~ ~!`X2-~-(' • ~~~~4° r17~!'~ "~~a '6`' / q Plan revision required? ❑ Yes P1<0 Use other side for additional information. J SBD-6710(R 05/91) Date Inspector 'sSignatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ` a s D~LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY =9: ST. CROIX EMS RY PPIT # -Attach complete plans (to the county copy only) for the system, on paper not less than STATE/4NITAQ(Q( 8% X 11 inches in size. ❑ Check i revislon to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S93-40833 PROPERTY OWNER PROPERTY LOCATION LAWRENCE BAIERL NE % SE'/a, S 27 T 29, N, R 15 E (or W BLOCK # PROPERTY OWNER'S MAILING ADDRESS LOT # 1660 WILSON ROAD CITY SAE WI ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 4027 715 772-474C , II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned o VILLAGE : WILSON Public Ell or 2 Fam. Dwelling--~# of bedrooms -L PA U WILSON ROAD ❑ Ill. BUILDING USE: (If building type is public, check all that apply) 191-1012-40 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 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. ❑ 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 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ 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) ELEVATION 300 .3 N/A 103.0 Feet 05. -IS Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber 50 500 1 WIESER CONC X Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stomps) MP/MPRSW No.: Business Phone Number: BENNIE HELGESON~ 3215 715 772-3278 Plumber's Address (Street, City, State, Zip Code): W 1229 770TH AVENUE, SPRING VALLEY WI %$&a& 54767 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Si (No Stamps) 'Approved ❑ Owner Given Initial Surcharge Fee) / 9 Avers Determination A~ ` 3 - " X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS - Y 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All eevisions to thir,permit must be approved by the permit issuing authority. 4. Ch& n:fes in ownership or plumber requires a Sanitary Permit I rarisfer/Renewa.l Form (8K,-.) 6399) to be sub ruitesd to rii ~ ,-oun,ty prior to installation. 5. - On<_ ite sey y<'t-~rns must be properly maintained. The tank(s) must be pu('tper' by a licensed pumper wher, ~v2r necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage systum, contact your local code administrator or the Stage 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 rnumber~'s) of where the system is to be installed. IL. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Famdy 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: f system. Check appropriate box depending on system type. V! Abso-p!;on system inform ';c+n. Provide all information requested in ##1-7 VI! Tani,. ,4orr:atio-). Fill i , Pacity of every new and/or exist:7,-g tank, ` st . -I tk i number of tanks and rn.anufact-ire s rtarrre Indicate prefab or site constructed and male'ial. Corrr!ete for all sent;(_, pump/siphor and holding tanks for this system. Check experimc nial approval only . ;auks -eceived ex. Ir.iental product approval from DIL-FIR. Vlll. Resprrnsibi!ity statement. Installing plumber is to fill in name, license nu,(b'?r with appropria=te prefix (e.g. NIP, etc.;, address and phone number. Plumber must sign applica ion form. IX. County/Department Use Only. X. County/Department Use Only. C :rrr' -tans and spe+ g riot smaller than 8'/2 x xrs mast b. submittr ;J ~ co(.'rty. The p -:ns -i-1, inch ide the loko,kr;- plot plan, draw ~ to co-.d< d'rnen:::ocat on of h:~IdE u!tw(S), se7t10 tarlk(,-,) er treatme'it tanks; bul.d, 'q SEv/E':6 r~ J4a N 'AJater SerVICe; stream--4 =rnd lames; pump or Siorl(-, ta!Yks- distribution suu ; i+~SG"~t•'= vs?f'rnS 3 :r?rY'ce!',t system areas an''` `~,e !Dcation of the bu ' nq . e %;ed, R) horizontU! aiiCl vertwj referer-'c' pcints-; C) complete specitications for pumps and controls; dose volume; elevaliOli -a;ffererces; friction loss; pump perfo, manse curve; pump model and pump manufacturer; D) cross sectic:,n ut tie 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 5roord+vater, ar, and-- water contamination inves;lq;:itj.ons and establishment of standards. SBD-6398 (R.11/88) Ysconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _L of 3 .abor and Human Relations vision 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 "!~T CR O l 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. I c~ I / b ) - 4O APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION La-U3 t- e)n C. -e- R e v- ( GOVT. LOT A) C 1/4 S L 1/4,Sa 7 T a N,R ! S' E (orc-W PROPERTY 0 NER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # (4000 W i t s o'-, RA, I J A /t) A- k CITY.'S ATE ZIP CODE PHONE NUMBER ❑CITY ®VILLAGE [rP¢WN NEAREST ROAD CMS o' u~ -)q6,Qj (761 `77.)- y 4v w i I N . [ ] New Construction Use [ Lrl~e'sidential / Number of bedrooms c [ ] Addition to existing building j replacement [ ] Public or commercial describe Code derived daily flow -)C)Q gpd j~,,,jky Recommended design loading rate _ t) t° bed, gpd/ft2 .3 trench, gpd/ft2 Absorption area required A) 2 bed, ft2 foaa trench, ft2 , maximum d sign loading rate t) P bed, gpd/ft2 • 3 trench, gpd/ft2 Recommended infiltration surface elevation(s) 10-?.0 se, fit ~as referred to site plan benchmark) Additional design/ site considerations 'Trc, , S'x 1~j' _ 56 ° oZ sa,,L t e,~ Roc Parent material S,U: noer Flood plain elevation, if applicable AIIA ft S = Suitable for system CONVENT I~ONgI. MOUN IN-GROUNDPR~SSURE AT S DE / S❑YSS M IN_ FlUe HOL ❑T UK 1_ 1 U = Unsuitable fors stem ❑ S Ly TJ ❑ U ❑ S e- ~lU [y t7 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourtdary Roots Bed Trench C ~.J J Ground j v uh s t v . S elev. 3 to 1.13 ft S Q i rZ t 7, s ,e r w. S r~ Depth to limiting factor J.2 6Fsk Id. CS. Remarks: Boring # y 0-S R_J L-L) op rw~JL 3 S. 1 ~ tt w~ ~I P Ground v R o S elev. f 3 to 91L. _93 ft. 1 Depth to limiting O factor J7 Remarks: CST Name:-Please Print Phorre: V- 1 S G-) Address: 6 C} (I-P , I Signature: ate: /3 u3 e09 PROPERTY OWNER ltd t-ev\L-c- ",,S PARCEL I.D. # ~IL DESCRIPTION REPORT Page of l 9I _ -~U Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ( Bed Trench gg- 0-7 u K v+^ 3 s~ Ground j'{?o (o y/Q p e' w.s~k wpb' 4 S elev. cJ~st. Depth to limiting factor Remarks: Boring # t c I ~51 6, Q -7 P, j u- 0 v i cL, 3 Ground:.. 3 2'3- --b ~ ' ~ R 5-'v f c ~ r ~ Y~ ~ Ir a , elev. -ft. Depth to limiting factor Remarks: Boring u # f a t' f sbk ~4, 0.S l . S i c1 l\+ J 2 to vr, s rz % r t~^^ P ii Ground r 3 elev. 41 , 3 p . 5- A F S c LL mo~, q`.LS-,3ft. Depth to limiting factor. Remarks: Boring # < < n ' O ~i l I o e n s 2s S"~ . Ground elev. Depth to limiting factor Remarks: - SBD-8330(8.05/92) Seto pL , Palms 3 a 3 ~1wyt~r . 1-Q VlC ~ l l CLtc G C- ST -'N e l C) l. f ~3 N e w \ e r P /A s S h a~~ ~ 5/oP fires ti \ h oft a~ CA g.r;1L_~ v!fR. ~ toaov . ~ I w►,n at ~S e ~ 1~~~ C 1 SIC K-L 'taN l r~kll Ccki , ~rl~ Woy QUer~IOU: 0~7 ab 41P W:VonsinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety 8 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 S~ CR O l 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. I - I G 1 - Cl APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION -0.w t- ev' C<_ [_~at~ l I GOVT. LOT C 1/4 S F 1/4,S~ 7 T D N,R / S E (orcw PROPERTY 0 NER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1404 ) ,ts~w Ra. Nk A)A k CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ®VILLAGE C WN NEAREST ROAD c-l~% k a.ti 6'p I (`11s) '77'- y 40 w , [ ] New Construction Use [ 9-16idential / Number of bedrooms [ ] Addition to existing building j y-6placement Public or commercial describe Code derived daily flow -)C~Q gpdRecommended design loading rate _ t) P bed, gpd/ft2 , 3 trench, gpd/ft2 Absorption area required _ bed, ft2 loco trench, ft2;,, 5~ mum design loading rate bed, gpd/ft2 ~ 3 trench, gpd/ft2 Recommended infiltration surface elevation(s) tO_,O Tz-a- ierred to site plan benchmark) Additional design / site considerations ~r u•~. (e a , S x = 5~ ° a So,~.~1 t wcl r,- R« 1t K Parent material !',U: Flood plain elevation, if applicable AIft S = Suitable for system CONVENTIIOON& MOON IN-GROUND PRsSURE AT-GRADE SYSTEM IN- Fir HOL aT UK U = Unsuitable for s stem ❑ S &a ❑ U ❑ S 015, ❑ S 91 ❑ S Ly'0 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourtdaly Roots Bed Tmr& _3- e2 7-/ 2 10 Y19 tcsyieAg De s j v,-6L r C LL-) to~ , Ground 3 v)2 t'o I~ ~ ~ s~ b t ~ ~s ,.5 • ~ elev. C 1+1 toj.6ft. Tsu S- U& ~ r7,s-zs Depth to limiting factor jrsk RA3. Remarks: Boring # [ c~ l o rQ 3- 51 k Ica ' , i, vti t Ike of 1 J x 1<3 Ground 2--~g v R o d s t t v,. N P 3 elev. E 3 b k 9 ft. ~3 , 5 1' SC Depth to limiting factor Remarks: CST Name:-Please Print ph e; [S 7 - Address: ,U 7 t ~ 0 I I-P IW" S- 6 Signature: Pate: CST Number: /3 3i PROPERTYOWNER rev~~cx~~~S~IL DESCRIPTION PORT Page Hof PARCEL I.D. # l 9/ ' fG/. -d y Depth Dominant Color. Mottles Texture Structure Consistence Bax~ary Roots GPD/ff Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. a Bed Trend Ilk ,'I Sri 21 / (~1/~.' Lo Z ~ 'J 175 t D-L v lq-lq 10 -y P, 34 Ground `7R p i w.S~k r^'J t S elev. Depth to limiting factor Remarks: Boring # t c _ -7 -23 a v v i C v% Ground elev.. , Depth to limiting' fact i Remarks: Boring # _ L C t u C> ly -7. P- 15L V,, 's VVJ Ground f 3 r elev. , 3p . 5- R S c I 9'•f. 83 ft. Depth to limiting . factor' 7 ' Remarks: Boring`# C-' r I^n'f QS ! S - 0-fl Io n ~~s Ground elev. t ft. Depth to limiting factor +r Remarks: - - SBD-8330(8.05/92) • Site ~~av. At 3 0~ 3 l 1 ti t'C ~y-- ~ ~ F, G C- S:T Q0 $1, a, N l7 l G o cc7l.i3 i ~ e r ~ ~-77~F, Esc, As S h a vv\. Ll v A-t r e. s ` y ~ l \ h n ('~tK ~s 1 ~^trS s 6<f I CO~l< 6..Nt V P, a i~yo. o a a gel EY~S~~y 8tcr.~ SC ruN L (,tk~( ~ 6ckr, , ~r1~~ Ll~n 10 71 (~lDerFloin` Ill ~ ~ I P6 [ e. ~11 ¢ c~ Q Fs _ I of `Qla - w t y 4c rr'es St~p~ \ 4 'alto Illy IOJ /RECS50 F EIVED AUG 1 91993 gAFETY i BIDGS. W. ~-w ~ ~ Dosv'7«..k cM,, 'v jYt. P. boo 1jG1j~Io' [A ~C:L.>•~C ~icL'n - I4 i Lo, _ Shed v ~ Cross Section Of A Mound Using A Trench For The Absorption Area _ t.. Cleo . 10 3. 4 Medium Sand Fill - o Soi 3 E D Trench Of94e Plowed Layer 6" Belowip~`ove 4W D Ft. Straw, Marsh Wad ntihet#o' brig E Ft. Ft. F SI Ft. H Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe i Permanent~,Markers Observation Pipe A o - J- 60 W • r' g _ I K `Trench Of 31" - 2z" Aggregate I L r A 't. I /5,y_ Ft. K Ft. W a9. 93 Ft. B 6~5 Ft. J y.S Ft. Ly•a Ft. License Signed: Plumber: S' /.Sf Date: 21' VLO 1 pry. 'PIP= Z,~ AIL pcRP~F:f, ~ ~ - /~~5, ~<-11JST7iLl. ~-f~HA1J~J- Y,'~i`1---~-"r~ I AT SUD OF ~J\CN Q 1+Ot-ES LUC~~T~-- oU 'cu r, o` / P~1 C -~"FORCE A I 1J FR.OT-i Tau f'1 P >%-NC-E LATT lto'LV-- N E4-r -M T--~J CRP .ba P W FT. ..,r 'D1AnE I: T_._ / IN. r:'; g k~ . OF YcULES./P 1 PE 1?JV, EIEV. OF LAIC JALS ICA ~ I FT. q p\.t~cE t sT HOLE F 01 1 TEL w17N Su cc_Et_~1N G tt~LEs i~T= 1._AcST HOLE ?O ~E )•fEXT' ?D T1}E ~1D C~t-P- ~C~Jt1.•P ~;i k~`~~ ,1r-~U~ C ~ 1 ~ rod e-6- Page Of Q c~ s~ COMBINATION SEPTIC TANK/PUMP CHAMBER S 9 3+ 8 3 3 (NO Scale) 4" CI Vent Pipe with Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings Weatherproof Approved _ Warning Label Junction Box Vent Cap 12" Minimum Final Grade 6" Minimum 4" Minimum f ~ 6 Maximum Quick 4 C.I. 18" Minimum Insp. Pipe Disconnect 4rtA 1 /4" Weep Hole Bfles Approved Joint A w/C. I . Pipe ~ - ~ Extending 3' •w ' ~ Al arm ~ B Approved Join', Onto Solid Soil .4=: 4 61, w/C. I . Pipe 13 On `0 ` - I C Extending 3' o. ' Onto Solid So-, - Off ' D Conc. Block • v 5,© 3" of Beddinq Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: .3 Per Day Gallons Per Day/# oFDoses: /G6% Gallons Volume of Backflow:.......+ v.yy Gallons Tank Manufacturer: WTotal Dose Volume: y. e Gallons Tank Size-Septic/Pump: ~ $ao a ons Alarm Manufacturer: S , El~~tr~sfi~ Model Number: U-) Capacities: A~o_ inches or ac- -Gallons Switch Type: floc' + B;_inches orjq qq Gallons Pump Manufacturer: - -14 + C~_inches or r, Gallons Model Number: + D1 y~ inches or 1,14,13 Gallons Minimum Discharge Rate: S, IV GPM Total.....= .nches or allons Vertical Difference Between Pump Off and Distribution Pipe:/:549 Feet Minimum Required Supply Pressure: Feet Feet of Force Main x 1 iS Friction Factor/100~Feet: + ~,-=8, a Inch Diameter Force Main Total Dynamic Head: = G'•~~eet aC Y Internal Tank Dimensions: Length Width Liquid Depth ~ICCO ; P Sew 7 She e Signature ~~G ~ 'ee5,e,,--- --License Number~Date $ - I'1- i 3 -i -7 -cl 3 E - p ~ n ~~cti ~ {r3S X'14' ~i..~ d y1~ h ~ 5~~~~ ~ e Sc x l {~FU~^r~~ I I I ~ek~~ S fr'~.t p P- ~ u iS 3. TANW, PECIFICATIONS ` _ I CAPACITY: 1000/500 GALLON CONCRETE STRENGTH: 5000 PSI REINFORCEMENT: COVER #4°REBAR ` TANK - 6 x 6/10 GA. WIRE MESH n DIMENSIONS: WALL: 2112" LENGTH: 110" BOTTOM: 3" WIDTH: 93„ s+ + COVER: 5'; BELOW INLET: 57" HEIGHT: 73" MANHOLE: 24 1. D. INLET AND OUTLET: 4" BORE WITH STOP FOR TYSEAL OR FE~RNCOGASKET' " INLET AND OUTLET BAFFLES: P.V.C. *MEETS WI. D.I.I.H.R. AND MN. M,P.C.A. SPECIFICATIONS 1 xs LIQUID CAPACITY: 19.65 GAL/INCH (SEPTIC) 1000 GAL. S gip. , 4-4 I , 9.94 GAL/INCH (PUMP) 500 GAL. WEIGHT: 12,400 POUNDS 4 YM a ~ MODEL WCT-1500 1000/500 Combination Tank NIESER 0000RETE Rt. 2 (Hy 10) Maiden Rock, WI 54750•(715)6472311 y' SECTION 100 Hy-OR-O-fTIAYIC 8 ,,vr-_Lx , . =IF.NSIONAL DRAWINGS PUMPS & PERFORMANCE DATA MODEL: OSP33 SUBMERSIBLE SUMP PUMP -MAX. SOLIDS S/o" SPHERE -1750 RPM TOTAL Lit. No. 113.5 348 ~J N AD - •'/,o HP MOTOR FT. 24 T_ 11 22 20 ' 18 16 14 12 - I 10 8 - 6 FULL LOAD AMPS AT 115 V. 4 6.5 2 i 0 10 20 30 40 50 60' U.S. GALLONS PER MINUTE 319 MODEL:OSP33 4 7 0 43/e O 51/4 91/4 4 • 0 1'/4 STD. PIPE THD. 25/ie f 4 Diu NOTE: CASTING DIM. MAY VARY . '/e STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT I St. Croix County OWNER/BUYER LAWRENCE BAIERL ROUTE/BOX NUMBER 1660 WILSON STREET Fire Number CITY/STATE_WILSON WI ZIP 54027 PROPERTY LOCATION: NE it SE Section 27 T -29 N, R 15 W YO)kEd /d ~1 VILLAGE OF WILSON St. Croix County, Subdivision , Lot number Improper use and maintenance.of your septic system could result in its premature failure to handle wastes.; Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a 1.1censed septic tank pumper. What you pdt into the system can affect the function of the septic tank as a treat- ment..stage,in the waste disposal system. St. Croix County residents may be eligible to receive a grant 1'or 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 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), 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 Depart- ment of Natural liesources. Certification form mist be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED 0~ ' - - 1) ATE St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-4,25-8363 Sign, date and return to above address. APPLICATION FOR SANITARY PERMIT 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 LAWRENCE BAIERL Location of Property NE SE 1, Section 27 , T__29 N-R 15 W Township VILLAGE OF WILSON Mailing Address 1660 WILSON STREET WILSON WI 54027 Address of Site. SAME ..Subdivision Name Lot. Number Previous"Owner.of Property Total. Size of Parcel Date Parcel was Created ' 'ire all corners and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume', and Page Number .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 refer- ences.to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) ee ti6y that att statements on this 6otm aAce ;JLue to the best o.b my (oux) k.nowZedge; that 1 (we) am (cute) the. ownen(.a) o6 the pnapWy descki.bed in thus .in6o,unatton ivon, by vixtue o6 a walvcanty deed neconded in the 044iee o6 the County Reg.iatelc o6 Deedsas Document No. and that T (We) p)Lenay own the p~topos ed .6 to bon the sewage d is pas s ys em (0& I (we) have obtained an eazemewt, to nun•with the above de eiLi.bed pnopuLty, bon the constnucti.on o6 said system, and the same has been dutyrneeonded in the 046ice o6 the County Regizteh o6 Deeds, a6 Document No. SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) c •,..DAT.E GNED DATE SIGNED f DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 +I WARRANTY DEED ,~ty F07 Pr l ~5 5)4 THIS SPACE RESERVED FOR RECORDING DATA ♦ % Edward Z. Baxter and Irene Baxter, HEGISTERS OFFICE THIS DEED, made between husband and wife and each in their own right $T. CROIX CO., WiB, Reed for Record this_~ Grantor day of---- June----A.D.19 73 and Lawrence S. Baierl and Orel A. Baierl, husband and wife as joint tenants, t--- 800 -A A. - Grantee, t W i t n e s s e t h, Th t the aid Grantor for a valuable consideration -Thirty-Five _ Regl9tef of teadf Thousand and no100($35,000,00) Dollars conveys to Grantee the following described real estate in St. Croix County, RETURN TO State of Wisconsin: The Northeast Quarter of the Southeast Quarte (NEB, of SEA) of Sectior, Twenty-Seven (27), in Township Twent Nine (29) North, of Range Fifteen (15) West, Tax Key # This is homestead property. TRANSFER 0 Uji Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And Edward Z. Baxter and Irene Baxter, warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Executed at Spring Valley, Wisconsin this day of 19la- . rr .l'3 sSa ^ ^ ` r',~, " 7'~"~ A"•rsy2.:,-'M.,;y .v ~ -y y%',. .a. ~r~ , _ar., SIGNED AND SEALED IN PRESENCE OF (SEAL) Edward Z. Baxter (SEAL) Irene Baxter (SEAL) I (SEAL) Signatures of Edward Z. Baxter and Irene Baxter authenticated this day of 3 . Ro J. Richardson Titl Member State Bar of Wisconsin or Other Party ! f Aut orized under Sec. 706.06 viz. STATE OF WISCONSIN 1 I County. as. Personally came before me, this day of 19 the above named to me known to be the person- who executed the foregoing instrument and acknowledged the same. This instrument was drafted by iC Rich r son & Skow Notary Public County, Wis. sApring alley, Wi. 54767 The use of witnesses is optional. My Commission (Expires) (Is) i Names of persons signing in any capacity should be typed or printed below their signatures. H.CMil,rrr Comprq M WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1 - 1971 l J . tr 1 I Y TIS az