HomeMy WebLinkAbout012-1058-40-000
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,QC Titn9,epartERAgndus-f~ RIE 26.30.17.400-4 SE SE,-130TH AVE.
Labor nsi Human Relations y PRIVATE SEWAGE SYSTEM County:
an1d
Safety and Buildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 175653
Permit Holder's Name: ❑ City ❑ Village QtTown of: State Plan ID No.:
CHMIT TOM ERIN PRAIRIE
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
/Gd 012-1058-40-000
17, 4c~A9200314
TANK INFORMATION ELEVATION DATA
a - 7
19/ / TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV.
Septic / , r Benchmark '
Dosing lul Aera Bldg. Sewer
Holding St/X Inlet S
TANK SETBACK INFORMATION St/Pt Outlet
Vento
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
Septic /,v / NA Dt~ Bot 215
Dosing NA 1 adw/Marl.
Aera ' NA Dist. Pipe
Holding Bot. System
PUMP /INFORMATION Final Grade
Manufacturers f° Demand, z
Model Number Z> 2 GPM
oss ction System T D H 3,~ Ft
TDH Lift q~I Fri
>5 i mead
Forcemain Length Dia. Dist. To well
are , SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length'/// / No. Of T enches PIT o. Inside Dia. Liquid Depth
DIMENSIONS Y MEN I N
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man Sm er:
SETBACK
INFORMATION Type O e.,-J CHAMBER berl
Z~ _r Mode Syst em: OR UNIT
i DISTRIBUTION SYSTEM
.i*w4er /Manifold Distribution Pipe(s) x Hole Sized x Hole Spacing Vent To Air Intake
Length ~ Dia. Length Dia. Spacing / }ZS
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
No [ e5- ❑ No
Bed /Center I O Bed / Ti&dhEdges Topsoil 4- ~Z [ms's E3
COMMENTS:
q (Include code discrepancies, erssonstp~reprit, etc.) i .
~.~C 4~ ~~f ~ f , r.2~~ r :..~r ~/~~°"f ,r,~,~"~ ~/tl, ~G1~Q 7 ' c^~-C .
`4 G(/ 1 1 o4</ f GG C =s _ C CIS.-LAP ,
Plan revision required? ❑ Yes EJ-N6
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
s
SANITARY PERMIT APPLICATION
ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
-
LZOMMMMEMEMOM
TATE SANITARY PERMIT #
S
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 61
8% x 11 inches in size. c eck if revision to prey application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBS
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. Q
PROPERTY OWNER PROPERTY LOCATION
Gxi . Se," t Se- % St '/a, S ~i T 30 , N, R I E (or) W
PROP? ERTY OWNER'S M/ ILING ADDRESS LOT # A BLOCK # )I CITY, STATE
BER
ZIP CODE NU BER SUBDIVISION NAME OR CSM NUMBER
M
13 ~c✓w A. ki,s s ~ ~JPHONE
2
O
/ 5
11. TYPE OF BUILD71*orC? heck one) CITY NEAREST ROAD
VILLAGE f~~s, 3G G
❑ State Owned ❑
F21 TOWN OF.
❑ Public Fam. Dwelling-# of bedrooms PARCEL AX NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply) 1,-2 _ 165-9'
1 ❑ Apt/Condo C/
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. ~Q 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 C& Mound 30 ❑ Specify Type 41 ❑ Holding Tank
1120 Seepage Trench 22 In-Ground 42 ❑ Pit Privy
130 Seepage Pit Pressure 43 ❑ 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
11/6-6 312& ~j /664rFeet 142s Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tstructed
Septic Tank or Hoidin Tank ) f'J G 6 JYt i t ti t/'
Lift Pump Tank/Si hon Chamber &--1 Sa ' [4-1 El El I U E] 1:1
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber Signature: (N mps) PRSW No.: Business Phone Number:
4 "4 GG e-/ ? G ?.P-
S~ k
Plumber's Address (Stree ity, State, Zip Code):,
EGG A/"/// a. Dig I1/c f0(w,• c >'`11~24r
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater Date Issued Issuing Ag nt Si ature (No m
Approved F-1 Owner Given Initial >9~ CPA G? Surcharge ~ Fee)
Adverse Determination 4) (J X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber
INSTRUCTIONS
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. t✓hanges 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.
If. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
111. 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; 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)
L
~ I
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL Western Regional Office
2226 Rose Street
LaCrosse, Wisconsin 54603
WEGERER SOIL TESTING Owner: TOM SCHMIT
PO BOX 74 747 240TH ST
RIVER FALLS WI 54022 BALDWIN WI 54002
RE: Plan Number: S92-40673 Date Approved: August 10, 1992
Gallons Per Day: 450 Date Received: August 7, 1992
Project Name: SCHMIT, TOM Location: SE,SE,26,30,17W
Town of ERIN PRAIRIE County: ST CROIX
The plumbing plans and specifications for this project have been reviewed for
compliance with applicable code requirements. This approval is based on Chapter
145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are
stamped 'conditionally approved'. This approval is contingent upon compliance with
any stipulations shown on the plans. All items that are noted must be corrected.
All permits required by the city, village, township or county shall be obtained
prior to construction. The licensed plumber responsible for this installation
shall keep one set of plans with the department's approval stamp at the
construction site. The installer shall notify the appropriate inspector when
inspections can be made.
This approval will expire two years from the date approved or if a sanitary
permit is obtained, it will expire the day the initial sanitary permit expires.
The Section of Private Sewage has reviewed these plans for private sewage system code
requirements only. These plans have not been reviewed for the code requirements
set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the
Wisconsin Administrative code.
This approval is for the following components only:
- NEW MOUND
Inquiries concerning this approval may be made by calling (608) 785-9348.
Sincerely,
1.17 -
64g-~ 14
GERARD M. SWIM
Section of Private Sewage
Division of Safety and Buildings
PPP039/0009n/36
cc: TOM SCHMIT X Private Sewage Consultant
SBD 6423 iR. 01/911
Page 1 of 6
MOUND SYSTEM
FOR R EC _~'J"ED
A 3 BEDROOM RESIDENCE
AUG 719y'L
BLVS. DIV.
LOCATED IN THE SC- 1/4 OF THE SE 1/4 OF SECTION Z6 , T 30 N, R l'I W,
TOWN OF COUNTY, WISCONSIN.
INDEX S92-40673
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
" SC-VA'fn 1T
4 -7 Z Ll 0 Tit ST.
Q1~L1~W11~1,bvl svz~6Z
PREPARED BY
~~ss~4lOBBfmlB~~ ~
WECERER SQ I L TEST I h!C-a .~1►d~~5C0N.91
AND
DES I C-a{1V SERVICE ~ ,i t
O~ : ARTHUR L. •
wlmm =
D.915 p
sLLSWOR
P.O. BOX 74 421 N. MAIN ST. _
woRrH,
RIVER FALLS. NI 54022 wis'
715-425-0165
I G14
JOB NO. Z - 1
r PLOT PLAN
Page Z of b
j Scale 1 30 '
~n
N ~~'1J e~ r'1~lZhc. to0 .p o,..1 Tol~-
w N o STEM- Va\ Pe W/ M PnV,-?R Pi PF .
r 25` 320~2 O\ Slv\i.~ II I ' 3 D!
B' II
I r
~ .ro I I ~ I ~
i ~
~ I
~S I r
a
I-x 3 TW G c&vT0vj
y Ss'oF zu ~`E SYSTEM
z S1 ~ 1S O F W `PU,;C
4L ED to ~.op RELATIONS
o s L t APPROIR, AND
N
B D 2~ D PART&'EtIT F SNDUSTRY , f SU,
Viso ~ r
e~jc
41 SECS
1Jp w~ TU 8 E 1)r-r LA S T S a
ow, w► ova PY►vp AT
L~RST 7-S' Pfz-om 'rte VS.
0,1 M1142 -to
z o o T)j s r,
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( y required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be ~ooo gallon capacity manufactured by
5. Bench Mark S l~oyCr
6. Divert surface water around mound to prevent ponding at the uphill side.
Page - Of
Approved Synthetic Covering
Distribution Pipe
Medium Sand
G
Topsoil = F Elev o o. Z S
3 E
pNS1T~ SSwA e
conj 11106a % Slope
Bed Of 1 2' (Force Main Plowed
ft Br! r%
IL ff A gregate From Pump Layer
PIR AP N
KWSTRY, OAsjj
RQ LOINGS- D •p Ft.
Tt,~
DEPAG
Cross Section Of A Mound System Using E V7, Ft.
F o. B Ft.
SEE A Bed For The Absorption Area
G 1- o Ft.
A 6 Ft. H l• S Ft.
Linear Loading Rate= q. 6 GPD/LN FT B u-1 Ft.
Design Loading Rate= o.y GPD/SQ FT j ~b Ft.
J g Ft.
K 10 Ft.
.A! t to o L 61 Ft.
-a in W 3Z Ft.
Forc M
L
Observation Pipe
$ K
A
W I - - -
I•----- ----------------------I Force Main
~,Distribution Bed Of 2«- 2 2
Pipe Aggregate
1
Observation Pipe Permanent Markers
)
(Anchor securely)
Plan View Of Mound Using A Bed For The Absorption Area
Page L4 Of
Perforated Pipe Detail
0
End View
)Perforated
End Cop_ PVC Pipe
ooze Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q S
PVC Force Main
P
PVC
Manifold Pipe
Dislri ution
Pipe
Last Hole Should Be I
Next To End Cap
End Cop
P Z Z Ft.
Distribution Pipe Layout
S Ft.
SON AGE SYS~SM X L4 R Inches
GN51TE Y q8 Inches
C~tjA Hole Oi ameter <<V Inch
Q
Lateral 1 Inch(es)
~iJt'S
WEB Manifold
A Z Inches
AS~ID
wI L Force Main Z
Or t~ypt}S'f Inches
pEt,r~lp~cNS IVISIQN 'p4 # of holes/pipe b
SEt CO Invert Elevation of Lateral sWoo ,SR.
Place 1st hole Z4Ufrom center of manifold with succeeding holes
at 4 $`'intervals. Last hole to be next-to the end cap.
PUMP CHAMBER CROSS SECTIOW •AMD SPECIFICATIOMS ' PAGE S OF G
VENT CAP
ti"C.I. VENT PIPC
WEATHER PROOF APPROVED LOCKING MANHOLE
25'FROM DOOR JUNCTION! 80X OVER WITH WARNING LABEL
-rT C
~ .
wIMOOW OR FRESH It"MIU.
AIR INTAKE I
GRADE (
LZL.48 $ I 40 MIN. ~
COWDUIT--
!8"MIN.
~GioE
INLET O(dSITE SEwp AIRT T SEAL I I I
APPROVED JOINT A (f0j`jo I III APPROVED JOINTS MILO! T-1 I II
WOW
I M
pfk I
A11 RELAT,P~I I ( ALAR
e
INWSTRY, ~ABQR AND
E tI.DINGS I i ON
C gEPARjIJ1EN 1SION D I I
CLEV.=11:51~3fT. ~E I
SEE COAR Pump--,_
- -
OFF
0
g, S CONCRETE BLOCK
J3" APARavCc
RISER EXIT PERMITTED OWLy IF TAWK MANUFACTURER HAS SUCH APPROVAL. 6E00INIQ
SPECIFICATIOAIS
DOSE MIDw2S1Y ~ Q[34- cOf3i IA) c, 3.$
TANK MANUFACTURER: NUMBER OF DOSES: PER OAS
TANK SIZE: -150 GALLOWS DOSE VOLUME \Z~ ,
ALARM MANIUFACTLIKCR' S -S- ELJE~CWZ S'-1$ TL*tS INCLUDING GACKFLOW: GALLONS
MODEL WUMBER: NQ~ Nw CAPACITIES: A= ~b INCHES OR 311' O GALLOWS
SWITCH TSPE: ~a 15= Z INCHES OR 11 O O+LL01J5
PUMP MANUFACTURER: Z-°~-LLR CO►'1PPrN`'( C= 61~Z 11JCHE5 OR \Z CALLOUS
MODEL NUMBER: 1 31 D=--L-INCHES OR 31Z'o GALLONS
SWITCH TYPE: `I'1L1ZN~1~ ~9 MOTE: PUMP AMID ALARM ARE TO OE
MINIMUM DISCHARGE RATE GPM INSTALLED ON 5EPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AUD..DISTRIBUTION PIPE.. FEET
f MINIMUM NETWORK SUPPLY PRESSURE . 2.50 FEET
♦ SS FEET OF FORCE MAIN X 1`3, F ooft.FRICTIOU FACTOR.. "•-S FEET
TOTAL DtIWAMIC HEAD = 15' 7 FEET
DIAMETER
INITERNAL. DIMENSIOW~ OF TANK: LENGTH I I ;WIDTH S~~I~LN ;LIQUID DEPTH
S'-4Ilvi
BOTTOM AREA 231= GAL/INCH
AS PER MANUFACTURER = ...x.9:5.. GAL/INCH
4'w b, - 7%
W
WW
TOTAL
ETERS DYNAMIC HEAD FEET/ o
LL HEAD CAPACITY CURVE M
MODEL137-139 CAPACITY GALLONS/LITERS 0 4%
30•
CAPACITY
HEAD UNITS/MIN 0 00 + 1Y2-1 l'h
8 FEET METERS GAL LTRS NPT
0 25 5 1.52 104 394 513/32
< 10 3.05 79 300
W
= 15 4.57 64 242 0
U
g 6 20 6.10 36 136
a 25 7.62 8 30
z
p 26 7.92 0 0
F 15'
O
H 4
10' 28
2
5'
1
12% fin
0
U.S. 10 20 30 40 50 60 70 80 90 100 110
GALLONS
LITERSI 80 160 240 320 400
4
0 FLOW PER MINUTE
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Three phase pumps are available in 200/208V or 230V. • Mercury float switches are available for controlling single
• Electrical alternators, for duplex systems, are available and and three phase systems.
supplied with an alarm. • Double piggyback mercury float switches are available for
• Mechanical alternators, for duplex systems, are available variable level long cycle controls.
with or without alarm switches. . Long cords are available in lengths of 15-25-35-50 feet.
• Combination starters are available. • Over 130°F. (54°C.) special quotation required.
Standard All Models - Weight 47 lbs. % H.P.
SELECTION GUIDE
SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required.
137/139 series Control Selection 2. Single piggyback mercury float switch or double piggyback mercury float
Model Volts-Ph Mode Amps Simplex Duplex switch. Refer to FMO447.
M137/139 115 1 Auto 10.4 1 or 1 &8 - 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075.
N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 &6 4. Combination Starter. Refer to FM0514.
0137/139 230 1 Auto 5.2 1 or 1 & 8 - 5. See FMO712 for correct model of Electrical Alternator "E-Pak".
E137/139 230 1 Non 5.2 2 or 2 & 7 3 or 5 & 6 6. Mercury sensor float switch 10-0225 used as a control activator, specify
•H137/139 200-208 1 Auto 8.2 1&8 - duplex (3) or (4) float system.
•1137/139 200-208 1 Non 82 2&7 3 or 5 & 6 7. Four (4) hole "J-Pak", junction box, for water tight connection or wired-in
'J137/139 200-208 3 Non 2.2 2&4 3 & 4 or 5 & 6 simplex or 2 pump operation, 10-0002.
'F137/139 230 3 Non 3.0 2&4 3& 4 or 5& 6
*G137/139 460 3 Non 1.5 2&4 3 & 4 or 5 & 6 6. Two (2) hole "J-Pak", for Watertight connection or splice, 10-0003.
No molded plug
Three phase units require a control switch to operate an external magnetic or combination CAUTION
starter.
All installation of controls, protection devices and wiring should be done by a qualified
For information on additional Zoeller products refer to catalog on Combination starter, licensed electrician. All electrical and safety codes should be followed including the
FM0514; Piggyback Mercury Float Switches, FNt0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the Occupational Solely and Health Act
Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump/Sewage Basins, (OSHA).
FM0487.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
L- 3280 old Millers Lane Manufacturers of...
sv~e, Kentucky 40216
ZZ711-ZZff O. Loul out p
(502) 778-2731 QL(&IrY PUMPS Fi=r ,fJ N
i
.SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER tG `+l
ADDRESS: / s It e4 d 41 FIRE NO:
LOCATION:-Se- 1/4, S 1/4, SEC.- T a N-R_J_~__W,
TOWN OF: ~rCI'n t"A- ST. CROIX COUNTY
SUBDIVISION: LOT NO.
Improper use and maintenance of your septic system could result
in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or
sooner, if needed, by a licensed septic tank pumper. What you
put into the system can affect the function of the septic tank as
a treatment stage in the waste disposal system:
St. Croix County residents may be eligible to receive a grant to
help with the cost of the replacement of a failing system, which
was in operation prior to July 1, 1978. St Croix County accepted
this 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 the 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 from will be sent approximately
30 days prior to three year expiration.
I/WE, the undersigned have read the above requirements and agree
to maintain the private sewage disposal system~in accordance with
the standards set forth, herein, as set by the Wisconsin DNR.
Certification form must be completed and returned to the St.
Croix County Zoning Officer within 30 days of the three year
expiration date.
SIGNED:
_rz
I.
DATE : "
St. Croix County Zoning office
911 4th St.
Hudson, WI 54016
+ 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 / G rY1 S~~ t
Location of property 1/9 S E 1/9, Section TN-Rjj_W
Township 1, )'h ~9 /7 ) xi e.,
Mailing address 121-16";-, SL~
vo 2
~UU gee 1,41
Address of site 3 G t-4
Subdivision name
Lot number
Previous owner of property ,
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for resale (spec house)? Yes ~o
Volume qGS and Page Number 3~S as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, 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
; and that I (We)
the County Register of Deeds as Document No. 767645-1
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 th County Register of Deeds, as Document No. - 1A ~ / 2iZ~' Ignature of wne Signature of Co-Owner (If Applicable)
Date of Signature Date of Signature
• DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
487625 STATE BAR OF WISCONSIN FORM 2-1982
r 965ME REGISTER'S OFFICE
W~
Martin F. Eberhard and Rosemary Eberhard, $TG'RO
h u - s b a n .n - d a n d w i - f e --e - a . s - Reed forReOrd I
, t --ten
- j-- -o-- i--n._-•---- a.. --n-t-- s
AUG 251992
- - -
Ct '
conveys and warrants to _ . - . Thomas-_- J . S c h m i t and Connie 3: 50 P.M
......0.._.S.G.hrnJ-t- h_us.b_and- a-nd--__i_fe.,.__h_o.l.ding- a-S
- - -S u-r V i-V o_r sh-i-P---m.a.r i t-11 _ -pr-oper-t.y------------------------------ ewv
RDe eds
- RETURN TO
. _
the following described real estate in S_t,---C.r.oJX-------------------- County,
State of Wisconsin:
Tax Parcel No:
Southeast Quarter of Southeast Quarter (SE4 of SEA) of
Section Twenty-six (26), Township Thirty (30) North,
Range Seventeen (17) West.
SE
FM
I
This 1_s___no.t.._----- • homestead property.
XNX (is not)
'I
Exception to warranties: Easements and restrictions of record. it
I~
I
Dated this
- - - day of - -
- - (SEAL)
- - -
- - - Martin F. Eberhard
- - (SEAL)U~!t.~hL.D` - (SEAL)
Rosemar Ebhrhard
AUTHENTICATION ACHNOWLEDGMENT
Signature(s) STATE OF WISCONSIN i
ss.
Sr. C&e(
-------------------County.
authenticated this day of___________________________ 19 Personally came before me this -eo/ST _-day of
Aug.U_at------------- 19-92__ the above named
Ma-rt i-n-_-F .._.E_b_e r h_a r-d.. a_n d---R o s em a ry-
Eb.~r_ h.a r d--------------------------------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
to me. known to be the person .S_________ who executed the
isrunrnT ; n -IN d _Acknowledge the same.
fo ing it
THIS INSTRUMENT WAS DRAFTED BY `G•~.i~~~.,,•
L
+y
T
homas A. McCormack
•.C,. I Baldwin, WI 54002 • p ;J ;
• • , oL T CIKDIX
Pu
c7N blic -.._County, Wis.
(Signatures may be authenticated or acknowledpd. $pt$. , Z M,v,•C ommission is permanent. (If not, state expiration
are not necessary.) / '•-.hy•4 ddbp, ----Wi - ------19
d~, ' ~ • • , Ptiblao.9tate of s W------
'Names of l persons signing in any capacity should be typed or printiEM,Vdoun.thVir signatures.
it
WARRANTY DFFD STATF. BAR OF WTSCONSTN Wisconsin Legal Blank Co.. Inc..
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDU~fRY, C DIVISION
H 1MAN NDLATIONS PERCOLATION TESTS (115) MADISON W 7969
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/Ni"tIbUMLITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
SE 1/4 SI% 26 /T3o N/R 17fXor) W Fr _n Prarie n/a n/a n/a.
COUNTY: S BUYER'S NAME: MAILING ADDRESS:
St. Croix Tom Schmi_t 1747 2ZL0th. ST. Baldwin, !-.]j-. 54002
USE DATES OBSERVATIONS MADE
ITS NO. BEDRMS.: COMMERCIAL DESCRIPTION: (PROFILE DESCRIPTIONS: AT ON TES
Residence 3 n/alew ❑Replace 6-23_92 TS:
RATING: S= Site suitable for system U= Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUNDPRESSU RE:SYSTEM-IN-FILLHOLDINGTANK:RECOMMENDED SYSTEM: (optional)
❑ S EU BS ❑ U ❑ S 1®U El S DU I ❑ S U mound
[un Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the /
de r s.H63.09(5)(b), indicate: 11/a Floodplain, indicate Floodplain elevation: n a
decinal' PROFILE DESCRIPTIONS apge 45 SaB
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.)
B- 1 77 99.50 Vane >77 0- , r l_ , L•; i .~Tr.a S. Sid
24-77 7.5 4/4 sl..
B_ 2 54 9'.50 none 29 0-9, 10yr4/3, L.; 9-19, 10ry4/4, sil_.; 19-29,-
-B- . 29-54, 5 4 not. sl-. 7.5vr4 4
B 10yr5/3)
B- 3 75 91 •35 6S' 60 0-9, 10yr4/3, L.; 9-24, 7.5;Tr4/4, s. sil-. ; 24-60,:
7. r4 4, sl. 60-75 7.5vr4 4 mot. sl..
B-
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PERINCH
P_ 1 21, none 30 1'2 1? 4
P_ 2 24 none 30 2 1 ; 1
P- 3 24 none 30 1 1 V~ Z4
P-------
P
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 99.35
I
t
_ ...j_ . S _ _ }E
i
W I
ol ow f} ,rye, 6
f
i
m.,,......_. _ _ _
.7 _.s.
r
TN
< i
i
i
, t f
i ~ , - , f~ t i ~ ( 1
E
z
! i [
R \6 ,
I, the undersigned, hereby certify that the soil tests reported on this form were d me in accord wit a cedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests ar c~ too the bef"f my kno and belief.
NAME (print): G) n N l T WE MPLETED ON:
Gary L. Steel o ~ c~ 6_ 2
n -j ADDRESS: OESffIFI A N NUMBER: PHONE NUMBER (optional):
1554 200th. Ave. , New Ricrmond, wi-. 54017 -715-21s6-6200
CST U
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) OVER
-
W-TRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395
To be a comp accurate soil test, your report mast include.
1. Completrr n;
2. The w gust clearly indicate whether this is a residence or commercial project;
1 MAXIMU I r; i her of bedrooms or commercial use planned;
4. Is this a ni rent system;
5- Complete "y rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL
OTHER SY__ s= RULED OUT BASED ON SOIL CONDITIONS;
S. PLEASE use th tions shown here for writing p> descriptions and completing the plot plan;
7. AKE A LEGIBLE Tram accurately locating yr ;t locations. Drawing to scale is preferr % A
heet may I if desired;
o. o-w~ ~ your be..... rk and vertir_<;I , ;son i point are clcarl s=. d ate pe
9Corr,olete all appropr to boxes as to (lei s, names, resses, flood plain data, p °rcolation test exemp-
f a;'or te;
10. i ~jch as Elood ~ain, elevation) does not apply, place=, N .A. in the appropriate box;
1 1 . Sr ,n ci ace your cerr - r - ddress and your certification number;
12: M-il,: leg i and distrik, reoUired. ALL SOIL TESTS MUST BE FILED WITH THE
LOCAL AU RITY WITHIN )AYS OF COMPLETION.
ABBREVIATIONS FOR CERTIFIED SOIL TESTERS
=parates and Textures Other Symbols
Stone (o,,- i 1") BR Redr
Cobble 1 SS - -
Gravel ) LS - Lin
S - Sand HGW - H' ' ster
_ P
Co _Sand P sate
- ntu Sand W -
Lc ny Sand n
°sl -:Ay Loatr!
Bn
sr _ Loam 131
s: - ~,lt Gy
I - Clay Loam y -
rdy Cla, I R -
'ty Clay L_ mot - -
'y Clad bJ1 i
Clay fff
P - rrIrn -
rt r d
p - r
H VV L
dis;=BM - t, ff
V R F h
4
r
~ j
TO TFlC G1
T;` 4s ! in San, I T t. The cot11 n, ' ~11,'A
i1
J
ST. CROIX COUNTY
t
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
July 23, 1992
Division of Safety and Building
Bureau of Plumbing
P.O. Box 7969
Madison, WI 53707
To whom it may concern:
An onsite investigation of the Tom Schmit property, located in the
SE1/4 of the SE1/4, Sec.26, T30N-R17W, Town of Erin Prarie, St.
Croix County, has been conducted with the assistance of Gary Steel,
CST #2298•
This onsite revealed suitable soil to a depth of 29" and meets the
requirments of tha A + 4" rule. This site is suitable for new
construction utilizing a mound septic system having 12" of sand
fill.
Should you have any questions, please feel free to contact this
office.
in eely,
ames K. Thompson
Assistant Zoning Administrator