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HomeMy WebLinkAbout010-1055-10-000 L J ` FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~U2 L`7G Li4.2~d TOWNSHIP ,CZj7L72z SECTION_2_V_T,50N-R-Zj~-W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE <661M(44-Q PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S f z _ 8 L~ o-Zoo j q, x/tlc~ 7-"C- 14 r C, Y T INDICATE NORTH ARROW BENCHMARK : s~ Elevation and description: LAO ~?--rl', #C-,P Alternate benchmark --r- 0 SEPTIC TANK: Manufacturer: _l ,v../FS r~ac'UssT Liquid Cap. looc~ Rings used: I Manhole cover elev: 9Z,,4-3 Final grade elev:~3 ; of Tank inlet elev.: jc)~5 Tank outlet elev.: jam, -74- No. of feet from nearest road:Front__)C, Side , Rear Ft. 530 From nearest prop. line:FrontX, Side , Rear Ft. ~j 9l No. of feet from: Well 1.2-2- ' , Building: j ` (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: 75-' Cttr Z OcL,[UG Pump Model: .o 97 Pump/Siphon Manuf act. • -Pump Size /a Ao Elevation of inlet: o S 7Bottom of tank elevation ~S✓~ 7 Pump on elev.:~Pump off elev.:X4~-;'Gallons/cycle: Alarm: Man.: 6,1-t gZ~e77zej Switch Type: Location Distance from nearest prop. line: Front, Side_, Rear_Ft.~~&-)• Distance from: Well Building 1.2,5- SOIL ABSO ION SYSTEM Bed: Trench: 75 Seepage Pit: Width _Length_ /c )C) of Lines:orlf Area Built Exi Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: No. feet from nearest prop. line:Front Side Rear Ft. No. feet from well: No. feet from building HOLDING T Manufac rer: Capacity: No. of rings used: Elevation of bottom tank: Elev tion of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road I Alarm Manufacturer: INSPECTOR: sJi,.,~, a•»~so~ DATE : d PLUMBER ON JOB : -jr, /✓welr f LICENSE NUMBER: 6/90:cj I~ DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 h State Plan I.D. Number: S2,NW4,N2,SE4,Sec. 24,T30-L6NVENTIONAL ❑ ALTERATIVE (If assigned) Town of Emerald ❑ Holding Tank ❑ In-Ground Pressure Mound cc 7, NAM OF ER IT H LDER: ADDRESS OF PERMIT HOLDER: INSPECTION A E: x.,,141 Emerald, 9_V)10 jjj~~ BENCH MARK (P anent reference point) DESCRIBE IF DIFFERENT FROM PLAN: EF. PT. ELEV.: CST REF. PT. EL i D ' Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: SEPTIC TANK/HOLDING TANK IZ. ' ST - 5~ is~•s S MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: . CI l cam" A, N 9 X587 9~' o YES ❑ NO ❑ YES NO BEDDING: VEW DIA.: MENF-MATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH e.,0v,:_ ALARM: FEET FROM 7 LINE: AIR INL T: « > l~ ❑ YES NO eA,~4 ❑ YES O NEAREST 10 DOSING CHAMBER: U, c> 1" ~ - r%F 3/ .(11-C: , 4et1sel) MANUFACTURER: BEDDING: LIQUI CAPAC Y: PUMP MO EL: PUMP/94PH9N ACTURER: WARNING LABEL LOCKING COVER 97 PROVIDED: PROVIDE ~2~ S~ YES ❑ NO S ❑ NO ' ❑ YES GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERT WELL: BUILDING: VENT TO FRESH i~ LINE: , I AIR INLET: PUIMP ON AND OFF BETWEEN P'VfS- ❑ NO NEAREST >/a wa SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: / or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN cJ/ j~~ (ld ~U C the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LENGTH: NO. OF DISTR. PIPE SPA INSIDE DIA.: # PITS: LIQUID BED/TRENOVJWOT TRENCHES: MATERI T DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER IF PROPE BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: LET: NEAREST 00- MOUND SYSTEM: S(J Mound site plowed perpendicular to Check the texture of the fill-material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW (L-1' ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ctJ~PES ❑ NO C411Efr❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED. MULCHED: CENTER: EDGES: ❑ YES O E~KEs ❑ NO U S ❑ NO PRESSURIZED DISTRIBUTION SYSTEM:(,/,/ 14V ' (6 S , = , WIDTH: LENGTH: NO. LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: BED/TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DlgTRIBUTION PIPE yh4T /PI RKING: ELEV.: t ELEV.- ' DIA.: -7 ry ELEV.: PIPES: NA.: 'Sc.E• v ELEVATION AND _7M _ _ a G DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERI L: VERTICAL LIFT CORRESP3NQS TO INFORMATION n / ED PLANS -r , r1 . = Z2 } ES ❑ NOS" ❑ YES C~'I~ (c.P• L PERMANENT MARKERS OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: LINE: ' ❑ NO FEAREST~ YES ❑ NO CPrEONO' d cx-tic. /~88 - 22z -Z --:7, --pan ~7,d ~.T►o~,-i d Q . cad s/ e r ~a o~ .y( ,:~o rcT) ~j c r e ain in county file for audit. Sketch System on 1, Reverse Side. SIGNAT E: TITLE: 3D-6710 (R. 06/88) 6e f/ 4,-z -e o~~o . sFL G.p~l. t "tc SANITARY PERMIT APPLICATION 0 4 IA g. U D1L.HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SA TRY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 7- 8'!z x 11 inches in size. ❑ C if evisi ntoeviousapplicatfon -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. _5 g9- l PROPE TY OWNER PROPERTY LOCATION 4 6,1 1,0995 1, S'2 `f T.3 , N, R E (or PROP RTY OWNER'S MAILING ADDRESS LOT # BLOCK CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER r_l II. TYPE OF BUILDING: (Check one) CITY NEAREST R AD ❑ State Owned ❑ VILLAGE ❑ Public X1 or 2 Fam. Dwelling-# of bedrooms a PARCEL TA NUM ER() Ole- /0575-_ III. BUILDING USE: (If building type is public, check all that apply) `U/ '~-3 1 ❑ Apt/Condo l~ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ 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. ❑ New 2. g Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5-E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 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 9~To v6u 4r- %dCj / Z 5_3 16 1,1.7 Feet 407,5 Feet VII. TANK CAPACITY Site in allons Total # of 's Name Prefab. - Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Manufacturer oncre Con te stCon glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber El I L1 I El 1 11 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu bar's Name (Print): Plumber' Signature: (No Stamps) P MPRSW No.: Business Phone Number: `c S-2 L., Xe n. W /29 ) L14 Plumb 's Address (Street, City tats, Zip Cod IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater L4 sue Issui gent Signature (No Stamps) *Approved ❑ Owner Given Initial Surcharge _ Fee) -DA Adverse D ter In tion 57_ K11 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: -AD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & 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. 1 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 purnped by a licensed pumper whenever necessary, usually every 2 to 3 years. e 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, (108-266-3815. 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. 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; purnp or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation refer nce 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, soiI 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 grQuundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) ' . S 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 ~Ge-,~,~%Gf[ "4 Location of Property 41). Se5 4, Section 2 , T~ 6 N-RW 1 Township Mailing Address ~~f)GcLU Address of Site Subdivision Name Lot Number Previous Owner of Property C /1,►a ~ J L ~J 1 ,SC, 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 f~ No Volume KS and Page Number (Q-l 7 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 I (We) ce a6y that att .statements on thi,6 bonm au tAue to the beat ob my (ouh.) knowledge; that I (we) am (au) the owneh(s) ob the pnopenty dean bed in this .inbonmati.on bonm, by vi tue ob a waAAanty deed heconded in the Obbice ob the County Registen ob Deeds" Document No. ; and that I (We) peesentty own the phopob ed bite bolt the sewage dtis pots s yes em (o& I (we) have obtained an easement, to tun w.cth the above de6ctoibed ptopenty, bon the con6t ucti.on ob said sybtem, and the same hays been duty %eco&ded in the Obbtice ob the County Regi6ten ob Deeda, as Document No. SIGNAT 0 OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED .w ur. ~ ltS1 t r i• ..SMR t C r~ 4 i i WNW" slat) North (T. 9- 4V .12 ;Jtllllw , - - 4*~'~ iiA i ! 471 s1~o- 'fig WN *FAY. darl" lowed to shilw f"We"d.M-0- , } k . a if-INS tlt+iRli Laassa0s~" 1 vest leer aSaass :!s po mb"o *0 Property a" W pq » Yt~iae st • ` ~ ; _ _ b><tha taM+~wt swsrR: ~ cos ..act; s. W the bolas" of f /1.7 Li to tlisi~ at 60 seta of t..lt xl: Wr'aMq~, iroai line . XAA ear~riraee esitalPasdllS ats of - pstsclPal ash ° at- in as, Seal-animal. Pam fl a* Mtciber d tide 1 day, aI I yable; as the be 4101 Z3Q • dQi' k balloon payrsnt shall be due after five Pews tvb"tom j sign the; laud c4a~ntrs ~ K i►, April 1, 1989. The Purchaser „y an 2pilct sa>w4 rtRS on &l wises. ally liable or he say rssell >the p r ;1MUaeus per fullo>n or before Pe+N3ieli► bwoo a, the entire outstanding balance shall be paid is l9A9.. ( the iaatarttY date) 60 payment, interest shall accrue at the rate of ..13_.... % per snows on >t i. anY default e, ~ is diatilult (which shall include. without limitation, delinquent interest and, upon acceleration er aiatnt~k~`► V-1-0 agrees tt/ paY 4* k taxes. special , fire and required insurance premiums when duc go** mow 0. In N ah3satss,aa.M..dMe.-~aelr.+ws„e1 s8si..+w+s` brt ` inks 6--nd 06- x Pub shill be applied first to interest on the unpaid balance at the rate specified and tbos to . p~ stsret "aped without premium or fee upon principal f at a , ro-v is tie e+eat of any payment. this contract shall not be treated as in default with tgaMet to sa~** maNld balance of principal. and interest (tad in such case accruing interest from month to month )►S Voodpol) is lees than the amount that said indeibtedshall nes ~w old hand ibeen n the event o monthly o sa 0,04A above: provided that monthly paymen W"* W 1~t s 'er cps e nation, the condemned premises being thereafter excluded herefrom. ry sf iq%ysiMrle siatas that Purchaser is satisfied with the title as shown by the title evidence subodt64 NwAbooor- wdetn d `z far ISAA WAIM esaw none. F t ? iJ Piixelituter agrees to, pay tlie.cost of futon title evidence. If title evidence is in the forth of si* 00 Msined'by Vendor until the full purchase price is paid. x Purchaser shall be entitle to take possession of the Property on... •cus. 00 us•. STATE. tAa of WISOON`41ii ! - ieet+ferri •ae P0 U No. It bit - _ , as, A"RfI r r lMi li 114 Vendor sw 007 !tb► tbdk tll4. amNalinmersama ~7 M _ t~Werllrtr~V: !s _ ~e~s~lilad tLr V~~Mlrrr . Nsllrrsitt ` waste to be csamaitted as 'the Prspl is free from boos supwkr to the Dow * f i the Property. ilw a41s w!Ith ifsi at and ate Sys ebail be fift pea !M i~' ~ abaww spacided. Vendor wig e:. de~asxd. p{~tlwwMtt a !eM airadtar P116 Y. free ahd tint of all liens sad , 71 11Mr<I(si by the act or dotaalt,of Purchaser, and except: A micipaL xfttnit x x 4 410o w dlawt fleas is-.at the eseence and (a) in the event of a default in the payment of 'bow Mi~haMel► l4R a pseiod of .Q.:.. days following the specified due date cr (b) in the event of a '4APArIMLof Pbrahtwr which continues for a period of ..40... days fol vt. P o► nmH d by certified mail), then the entire outstanding balance er this- pay" in fol. at Vendor's option and without notice (which Parsba#er hMM-w following rights and remedies (subject to any limitations p:etYai . ltvr} Jaagaity' {l) Vendor may, at his option, terminate this Contract asxd and reeprer the Property back through strict foreclosure with #af isiser's full payment of the entire outstanding balance, with intetesttbereaex ifffeetonsuch date andother amounts duehereunder (inwhichever..t.allanwua4C ralli*ed es liquidated damages for failure to fulfill this Contract and as I; or (ii) Vendor may sue for specific performance of this Coattswet U'-' - 1e outstanding balance, with interest thereon at the rite in effect as !iw . ie which event the Property shall be auctioned at judicial ask sad. Veado: may sue at lavvff for the entire unpaid purchase price qtr say, 14~ - Csatract at an end and remove this Contract as &cloud on title in is insignificant; and (v) Vendor may have Purchaser ej,ctod irewsw ~p alented to collect any rents, :ssues or profits during the PAY of ally a~ nding say oral or written statements or actions of Vendor. awabetioi -}IIIP lew binding upon Vendor if and when pursued in litigation and aU taatr an& fuss Vendor incurred to enforce any retredy hereunder (whether sbatod` or.ataf ' sad ~Igienssa of title evidence shall be added to principal and paid by l'urc}~isar,t k, .fit judgment. er 4nriag the peadeac of any action of foreclosure of this Contraet,'P1s a~ ic'tQllMllt at the Property. including homestead interest, to collect the react, sears. an4 sC such action, and such rents, issues. and profits when so eollected ahaU 4 sseh'~aT e1►J►;eBa~~ 001 +ioasr~ +r--i+ranreiherwsv,1- vW ihit• *aii~bie■~sniwliir.Gartare~-w4irst YmW ie ' tnieres~awdss-tbia-Gairw~E an sit beeme F.~ +innkriiwi dew-eau-payabkiw-fiN-et-iRndrRa"oplielt i pikyments when due under any mortgage outstanding against the Property on tbt § #nMlsct i3re*Aywertgase granted by Purchaser) or under any note secured thereby, provided " " dM e amounts then due under this Co nt-act. Purchaser may make .iny such pay th "10 40-9 nw+nb falls to do so and all navm- ent= so made ',y Purchaser shat, he -onsid(.red pays~wb'epiade Veat4e ssa7 waiso any default 'hoot waiving any other subsequent or prior default of Purchaser.: , 1111 tsiuss of ob caubset shallifte binding upon and inure to the benefice of the heirf, tegai x astd of Vendor and Purrhaser. (if not an owner of the Property the spouse of Vendor ; . m to release homestead rights in the subject Property and agrees to jour in the #f A 'h► is stud! iwi ht hareof.l ' i)ated`'this 12 ,i'ts' / 4 ~t 19 94 K< Pl'hC,}~1SER: ~ IN OP IVNT C KP . /yc'.- (-4E.a1 , x :~a 1 u ~1i~4~Yti (SEAU '3i>t..P siAi $urleigh E. Larson / • a, ..ya Secnetary LaVottne M. Larson ,y `•t.1 . ~C '"JRt. AUTURNTICATION ACKNOWLEDGMENT Signature(sl .ilurlelul,tl_.E.' Laraou and ST-kTE OF lFMO EMM RYLIIN 3 .i.a 0MW.?!_.AA)Clon .httsbi311,d and. wifC.. I t ! A - /Count}. #uthentke*d thfe A_;1 defy of.: #x . 19 Fers,mall; came her ,re me thiab!.. --daif r - rs 19 44 . the above rtariv' Eugene B. Case', Presidentx and Cnscvr Sec retarvr of Bernard FT TITLF: AfF4413F.R STATERA.K OF t~ IS( il\Sl'R DevelopmenL Corp. xutb(wireed by ij 70r,,Od. Wis. to ^:c i Tlotvxi to be thV per?.,n° x~~n. c ,ink instrunte7t :ind arknowl~,siFe - Pxtrick.J. JuttoAu 4f:hre firm of::' r s1c JUNEWi. J01=10IN-.b VOPER.. L11W7i US, S.,C . 'got . t':rhlic _?t 1 i ba7~ t Si,maturPs may is aunt ,,ntieatecl or at i.r,.nrl<<l~ed ttat~ ~i ( ~~:imt .ion nr(tui:i. tl` nat, stars ex" r, not utcedttary.) daf, : f PJJ: sew -Karats n~ per"> avstva lea-OOY 'at".ity f~;:,'.1;1.. '.~Ne+t•ur b,:'AA t~h- ttu•ir.KiRaw•:.tr,. - n f,.`?:. H z En A y ~ ~ STC - 105 r H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z OWNER/BUYER e (A., ^ ie: I I~ rs _ 1446 > ROUTE/BOX NUMBER Fire Number CITY/STATE /~~J~ ZIP-#~ PROPERTY LOCATION: /tSection T 30 N, R 16 W, Town of 1%161 , St. Croix County, Subdivision - Lot number • I . 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 licensed septic tank pumper. What you put 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 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 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. Ho E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ►d ment 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. n S IGNEDd_y. DATE 1 'zz St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. IDUSTR',-, T OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IND.UTRY' DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) LO_CATI N ' Y4 SECTIO %T3~N/R/~ or)w TO NSHIP/ib""t@FP~46+TY: LOT N0.:BLK. NO.: SUBDIVISION NAME: Aff COUNTY: OWNER'S/BUYER'S NAME: MA LING ADDRESS: 1'L 00.1 1. sa ERA USE DATES OBSERVATIONS MADE TESTS: NO. B RMS.: COMMERCIAL DESCRIPTION: IPR`OFILE DESCRIPTIONS: PERCOLATION . I Residence /I t ❑New Replace I 2 p f7 ?_4/_ ~ G~' ✓ LLLfff RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND. IN-GROUNND-PRESSURE: S STEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM:(optional) DS ®'U X1 S DS XU DS DS ®U If Percolation Tests are NOT required DESIGN RATE: If an portion of the tested area is in the under s.H63.09(5)(b), indicate I Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) M j/ .S/~ WJ 4 Q O~S S el ti SOTS B- 3 Y 1013, ✓ I S ~ /s~ 3 -i fw o t~' ~ ~ 28 yaRC 0 101 ` ' - ' w ~d 7s. - 8 /w oar _ fa. yG cis B- y o 90. m o w to-maays B 7 y o 7t~' S PERCOLATION TEST~?,~~Si1 Si~w /Q d -'O S.C TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES W 6if5 NUMBER INCHES AFTERSWELLING INTERVAL-MIN. ERIOD 1 PERIOD 2 ERIOD3 PER INCH P 3 p 3 . - P- ;3 S g P-_ 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. ' f 85 SYSTEM ELE A !ON /A3.7 wE G N lab E 1 I E _ ~ I a 1©" _ I F ~ E TN O A/O a f~a , Ap~i ~p p ~,fo I'Es , 1 1 600 wo C°oe/# r~~y d I,-the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. N E (print : TESTS WERE COMPLETED ON: Ap~aR~SS• CERTIFICATION NUMBER: PHONE NUMBER (optional): /I ~7l i~e~v 1 e 5r 36cl6 265- /6'?"' QSX-S IGNATURE: ~ ~7~CPI'e DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 1 I _ CTIONS FOR COMPLETING FORM 115 SRC „ Tc and accurate soil test, your report ITIUSt inclUde: I { ipt. n; 2. TF nclicate whether tW sidence. or scorn p.oject; 3, r:", "t mis or commercial planned; 4. Is stem; Boxes. A SITE IE BITABLE FOR A H TANK ONLY IF ALL 0"f, I ED Ol SOIL CONDITIONS; 6. PL. own her for writing profil d scriptio ,ornpleting the pltsi plan; •urr:tely locating your t( tir)s. ' Scale is pi A ired; S. . ertical elevation referens wvn, and are pe T,anent; 3. xes as to dates, nanies, ad I flood plan gala, percoiatiors test exemp- t- yin, e' Mien} does r7 ,lace N-A in tho liporop ime box; adc- and your r, lumber. as . tire(E ALL TESTS IMUST BE FILED WITH THE LO )Tt l `.g CLAYS OF COMPLU: ARRREVIA~ FORCERTIF- LT.._ 0 - ols EAR -i< SS - re L c S r rived G - - B? Bn S(l - BI Gy - Lam Y - SO dray Loam R sicl ay Loan mot cs s. _ lay c w; sir.. - ly ff ( _ faint c - d HWL-P Six q-- -),tures for li+;_i posal BM B rcl VRP Verb !,oirrt I T TI T'7* E~ y r ;;uest A private er to fi State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 LYLE J. MYERS Owner: BURLEIGH LARSON ROUTE 2 BOX 47A BOYCEVILLE, WI 54725 EMERALD, WI 54012 RE: Plan Number: S89-03114 Date Approved: December 7, 1989 Gallons Per Day: 450 Date Received: November 7, 1989 Project Name: LARSON, BURLEIGH - RESIDENCE Location: SE,NE,24,30,16W Town of EMERALD 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: - REPLACEMENT PETITION - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 266-8230. Sincerely, i KEN ETH STIEMKE Section of Private Sewage Division of Safety and Buildings PPP016/0009n/ 5 cc: BURLEIGH LARSON Private Sewage Consultant -County _UW-SSWMP -Plumbing Consultant sBD-6423 (R. 06/88) -Owner -Plumber -Environmental Health State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION December 1, 1989 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 Burleigh Larson Emerald, WI 54012 Petition No. S89-03114-P Dear Mr, Larson: Re: Burleigh Larson - Residence Onsite Sewage System SE,NE,24,30,16W Town of Emerald, St. Croix County, WI Section 145,24 (1), Wisconsin Statutes, and s. ILHR 83,09 (2)(b), Wisconsin Administrative Code, allow the owner to petition the department for a variance to the installation for an onsite sewage system to replace an existing onsite sewage system at a site which is not in full compliance with the siting standards in the administrative rule. The system design proposed should protect the waters of the state from contamination. If this system becomes a failing system or contaminates the waters of the state, this variance shall be rescinded. The petition for a variance requested to s. ILHR 83.23 (1)(d) of the Wis. Adm. Code was considered on November 22, 1989, The petition has been approved. The rule requires a mound system site to have a minimum of 24 inches of suitable natural soil. The variance requested was to install a replacement mound system on a site with 14 inches of suitable natural soil. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. riif~a rely, Z r e yer, rc Director, Office of Divis on Codes and Application (608) 266-3080 RM:KS:2750g cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County SBD-8928 (R. 10/87) •~In~r~eic~h L.arso~ . SZ 1/4 Ni% 2e~29 13oN 9i(p w Crhe.rJIToom4~p S4 Croix Co. z 1 t ell W Eta ~ D 14 { loon ~W 759 5.A O 100 ~fYI - sC COJ~/v~~OfS~/=l~ e G4 Groan O 1-i ,.w X07 SO D', "'Q 7 00' l C?NS~ ~pQE ~ ~ - ` OtR FtEtA~ MAN p HU P RAN PA~ATME OF INDUSTRY, LikS 0 BUILDINGS DIVISION OF SAf i' ro f COR SpoN,~~NCE SEE _ E ~ t, , ~ , ti ti * , j /i i.F 'G~ ~ a s.. S ' 04x 4 j~~ w~ ti. n CUSP ACTC-i) S+r-(,,...) o1- Y114r l yr aP~~ rt)v~~~ 5.~-.r>><frr~ cuJcr r~~1 T~ F,)rC<r~o•.~ C ~ow~~ 1a7cr Fro- f~elaJ ~f ~c - JUQr r l 2.o -3 c> rce 1`1 _ 7i 7 y 3 OF L ~ 4v R •f "'~r7f ~Iry9 „ eJ ~ rho y.,•' 41 ; ° Page _ Of _ Perforated Pipe Detoll End View Pertoroled End Cop PVC Pipe ,ova oaSNOP Holes locoled On Bollom. Are Equally Spaced PVC Force Ulan • From Pump ` k e M10*1 SOW •r ~P ~Q s+ Allernole Poelllon Of r Q~:-p~,CteG+v~\~1'OO Gu4 Force Main From Pump Loel Hole Should Be Neal To End Copt r' Layout P Q V 04- ri S - x~ y LI (D j Bole Diameter ~ Inch Signed: Lateral Inch(es) License Number: l~ 4% Manifold Inches Date: Force Main Inches 1123 T ~ ~ .r, a ~ ~ . i ' _ ~ t 3' G j~ 1. < ~ 4 ~ l,. i ' CRY M:. ' tin ~ ~ ~ M' . \Y I-w~` G ,b• ..r M PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 08114 C.Z. VEWT PIPE WEATHER PROOF APPROVED LOGKIIJG JUWCTIOIJ BOX MAIJHOLE COVER ?_5' FROM DOOR, -I.IDOW OR FRESH It~M1U. K INTAKE GRADE I r `i MIAJ. I IB'MIIJ. CONDUIT-- t 11~ P; E I ►A1LE T I~IT SEAL RGS ► I I III APPROVED JOINTS PPROVED JOINT A $ • I /C.i. PIPE I III W/C.i. PIPE KTC►JOIWG 3' ~j •~Q cJ I I I AL )M OLIATEUDIU(s 3' NTO SOLD &OIL QTO SOLID SOIL 6 pKU~PN I I. C A I,p,BOA ~ ~ ow L E t! F T. O o~~1S10N OFF daft 0 Q ~y CONCRETE BLOCK 8 ll ~ w. 3 RISER EXIT PERMITtED IJLy IF TANK MAAJUFAGTURGR HAS SUCH APPROVAL. PpRoveD HODwfq SEPTIC f SPECIFICATIOUS DOSE j~ THNKS MAWUFACTURER: n ` LLa NUMBER OF DOSES: PER DA.4 TA1.JK LIZC: _750 GALLOJJS DOSE VOLUME Ii ALARM MAUUFACTUFRER: I 1'~ p0 e",t INCLUOIIJ(a 6AGKf1.OW: _fil►LLONS pz5 MODEL IJUMBCR: U, ~t CAPACITIES: A= IV 75 INCHES OR ~S p GALLONS SWITCH TYPE: F^ r A^ ` / B= INCHES OR ~ GALLONS PUMP MAWUFACT URCR: INCHES OR / CALLOUS MODEL NUMBER: D~ INCHES OR GALLOM6 SWITCH TYPE: A C MOTE: PUMP AND ALARM ARE TO BE MIIJIMUM DISCHARGE RATE ~GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEW PUMP OFF AWO DISTRIBUTION PIPE.. -15-1-- FEET )3 ►1 + MIWIMUM WETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FLET Q + FEET OF FORCE MAIN FYortFRICTIOM FACYOR..=SL? FEET TOTAL OyIJAMIC HEAD = FEET ~t IWTE51 WAL DIMEIJSIOWfi OF TAWK: LEI.IGTN ',WIDTH ;LIQUID DEPTH OAT E: ~g~ SIGbJED:~ LIc:E1JSE .IUMBER. ti r• I ,r Y , Y A Yt., ae ~ k • HEAD/CAPACITY CURVE EFFLUENT and DEWATERING • 't WARNING: Model 185 should not be subjected to leas than 30 feet TDH. F - 4 4 W W N 8~ w ~ Q TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE H EFFLUENT AND DEWATERING w 53-55 115 SERIES 57-59 97 137-139 161 163 165 185 188 189 FT. M r Gal. Ltrs.; Gal Ltrs. Gal. Ltrs. Gal. 'Ctrs.' Gal ltrs. Gal Ltrs. Gal. Ltrs. Gal 'Ltrs: Gal. Ltrs. 34 5 1.52 43 x:163; 57 ;216 104 .394 106 %401 61 +231 61 231 155 '587; 155 ,587 10 `3.05 34 129 51 „.193 79 300. 100 x:378.. 61 ;231 61 231 148 1'560`. 151 %572 ' 15 '%4.57 19 72: 43 F16371 64 1.242 91 0344" 60 b227 60 227 142 5537 145 V649- 32 105 - 20 6.10 27 104 36 4136 82 1310 59 `223 60 227 136 §515' 140 4'530. 25 :-7.62 - 8 30 74 ! 280 57 'x216 - 59 223 128 24841 - 133 ii, .503 100 30 9,14 65 246 55 1206 58 220 90 340 121 ,458 127 1481 30 40 12.19 - 46 '.174 46 . 172 55 206 75 263 105 397 114 431 50 15.24 21 80 33 125 51 191 58 219 90 ,341 100 x379 95 60 18.29 15 57 43 161 36 136 71 ; 269. 85 %.322 28 70 21.34 30 tta 0 38 51 1:193; 70 •.265 90 80 24.38 14 53 28 F 106 54 t"204 90 27.43 2 8 37 140 100 30.48 21 .-79 26 85 110 132.00 8 , 30 Lock Valve: 19' 24.5' 26' 56' 66' 89' 73' 91' 115' 80 24 MODEL 75 89 22 0 70 Q w 20 65 MODEL N a 60 1 5 Z 18 Y Q 16 55 MO EL 50 163 M ODE 0 188 14 45 - 12 40- I 10 35 - 185 30 8 25 137, 19 6 . 20 L 15 O161 4 7 2 , "10- 5, 5, kti 5:,. -5 -9 t p am I fi LL GALLONS 10 20 30 40 50 60 70 80 90 100 '110 120 130 140 150 160 ~.ITER~ r~:,80r"' X60 . 60 , ~ 7 - - •-ia_.✓ FLOW PER MINUTE Note: For Head Capacity on Model 112, industrial column-explosion proof pump, see FM 219. State of Wisconsin ` Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION !Ivec rie, 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 t~ijrleil~tl Larson -ar L6,-sor: i't rl e i or= Larson _ i~esi dpnce psi i.F set'+aL'e -"YSLei?' l (j>)r' tat Lr;era ki, "It. t. roi A otmty, YA Section 141.r."" 1,11), Uisconcil, Stattite-, r)-i(i e,. sl..d i ~.L.'r wiscor'Sin nrtl~"i r i Striti VP (.o(ie, Al l ov.` the ov.ner to Df'-r.i ti on 'thte .lE'~artr,*r;t for a Wdrl drlC2 to the install %rt;i on f,-)r an onsi tc, se4,.ire s'vsi er? do r&D l aco art exi sti nc, onsi to sewage systerh at a s i tc, hilic it is rlot in fill coriol i aricc with the citing stan(.J,ar(?s in the aaJnist.rative ruli~. ilir: _3yster; e'.esicn orooosed should i.nis system becomes a the R.'aters of the state frorh coat it,,,inatiori. T4 failing systw. or cortarr.inates tiie VoatPrs of thy.: St:atr~, U-'iS variance shall be resci rrteel. Tree oetitiun for a variance rpouester to s. 1LI 61'-~.c-~ l) r1) of the 141 s. A(ip,,. Cor'fo lvai consirF'rEri or. P r DeLltiori nis t)ven avurovec. Thn roic r-t,,ouirLs a ii,wirc systc?f; s1Lt `Vi'i` ts3ve i3 „ir)lr'.1er:; ,)f r inches of suitable nat,oral sail. the variance reoi,&sf's i,;as to instal I c7 tt' li)tc~"'f'rs#. iiio(.nd sVst:erii on a site with l'' inc+eS of ruit.'31.'natl:r'il soli. Al i of the ;ata and Sti~ter, ~i"'.f ~a sGoi,3 1 ttvo w iL- ea l t oi' Cre opti ti over were considers , This vi4r'iar?re is sw,cifi(, to [.Ic sw,~,j -rcT: L:r?Z: Li{ rt and cdnnoL be used for anv a6rtit:ioral ;,100ificarirn . Si ncerel y, 1 , 1)i rector, I f ti cP of '71 Vi SI6r) r Coves aw, Auul icatmn j F! S ly c: I i t) C:~1i;~sr;t - i ii.ric2 : , cC Leroy „anslcv, Private Sewac;r: n 3 Cni ppewe Falls i hor:.as 1 on, ' oni nr A(Irli ri stra-cor• - SL. Croix !-ollnt.y SBD-6928 (R. 10/87) State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL. SAFETY & BUILDINGS DIVISION Ortice rat Division Codes and Applicatioi, 29i tdStWdShifigton Avenue 11.0. Box 7569 Mad►scrn; Wisconsin 53701 LYLL J. MYERS Owner; H10.I11GH, LARSON ROUTE 2 BOX 47A BOYCLVILI..E, Wi 541t5 WI 540i RE; Plan NuTber: 689-0311;4 Approved: December 1, 1989 Gallons Per Day: 450 Date deceived: November 1, 1989 Project Name: LARSON, Kllkl.f UH RUSItI NU l.ocat.ion: SL,NL,L4,3O,1fsW Town of EMERALD Cuunty. Si CROIX The plumbing plans and specifications for this project have been reviewed tur compliance with applicable code requirements. this epproval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administiative Code. The plans are stamped 'conditionally approved'. this <+pprovaal is contingent upon compliance with any stipulations shown on this plans. Ail items that are noted must be corrected. All permits required by the city, viiidge, township Or county shall be obtained prior to construction. Tile licensed plumber responsible for this installation shall-keep one set of pltrns with the d(Idrinient' S ahpr:av~a I stamp at the r:onstr'uction site. the installer shall notity the ;ipprupriate inspector when inspections can be made. This approval wi 1 l expire two years i r tarsi the date dppt saved or 'it a sanitary ~ permit is obtained, it will expire the (Jdy the in'!tiAi sanitary permit expires. The `;,ction of Vi l.va t Sewage hay., reviewed these plans for private sewage system code requirements only, itiese plans have not been reviewed tur the dude requirements set forth in Section 11,HR, tit tar- gvriei i.l 1 lumt)ln(,i or in Chapters 50-64 of the Wisconsin Administrative cede. This approval i for the fo111aw) n(; i_0rP!)0nVntoil l - REPLACE:MEN1 PET1EION kEPLACE.MEN'1 M01JNU Inquiries concerning this approval may be made by cd1l any (60b) 1bb-8230. Sincerely, KEN E1H STILMKL Section 01 Private Sewage Oiuisi<ar► of Safety aril buildings Pi?POIU/0009n/ ' ci': BURLE IGH t.WSUN Frivati~ Sewage Consultant. _Gnuniy Y)WMP _--__i'lu►ri,'Inq Co wner N l,~irif~f`i E rtv i risnrilrrt SBD-6423 (R. 08/88) i:J