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HomeMy WebLinkAbout036-1098-10-100 ~ o ~ o I c~ 0 °60-:~ I N CD ~ I e I O N N ~ I c I I ~ o I ~ I to (D z° c c Li c E I O 3 " I 'mo ~ a M I C I r ~ _ O Z~ III O M M z m i o o z g o I m z z M C • M L ~0q a O I 0 a co z N Z c I cc N ~ I ~1 n N 0 Q1 Iwo O (D N ! y A? C CS co d O y N G G d L Z6 N N U) N N E Z w N N l 3 N '6 o CD •N Laaa y IL o U o 0 3 i arnrn z a o I o o 0 I in o 0 5 a~i CO r_ a V U) 4) ' N 'O d a ~ (n f6 I ~ d1 y Y! vr" co Al O C ~ W C O C C r.+ O~ O O O N d d C d 0 0 1 -0 N 04 oo LQ~ c E E O rn _ 0 0 5 O O y co W N H F- C N 00 a7 • O C f/1 O z N fn O c IL 4-, •ad+ E c ! c ~1 Q 0 d~ NV FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER -4 O - ~ `T~ TOWNSHIP SECTION T - :J,/ N-R_2 ADDRESS/' ST. CROIX COUNTY, WISCONSIN a SUBDIVISION LOT LOT SIZE I PLAN VIEW i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t :361 /y /V tv ~ x;19 INDICATE NORTH ARROW BENCHMARK:Elevation aAid~descriiption:,O-j A" '"y Alternate benchmark SEPTIC TANK:Manufacturer: ( ~g_4- Liquid Cap. /000 OF— Rings used: 3 Manhole cover elev; fS ,93 ; Final grade elev: 7 9 ' so Tank inlet elev.:_ . yg Tank outlet elev.: l G~ No. of feet from nearest road:Front , Side/, Rear Ft. /_5 From nearest prop, line:Front Side , ~Rear Ft. 1 :;~;z No. of feet from: Well Building: " (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAMBER Manufacturer: Liquid Capacity: ~j Pump Model : ! Pump/Sigh Ma uac E/°Pump Size 7; _ Elevation of inlet: ] .91 . Pump on elev.: Pump off elev.: Gallons/cycle: Alarm : Man.: L G.~ /sk `nSwitch Type : ocation , Distance from nearest prop. line: Front; Side, Rear_Ft. Distance from: Well 9 Building - SOIL ABSORPTION ,SYSTEM Bed: Trench. • Seepage Pit: Area Built Width: Length 3 O Number of Lines: U 30 Exist. Grade Elev.14/% 30 Proposed Final Grade Elev. 9/f~ ~G ,d 1y~0 9 7, 91 Fill depth to top of pipe: ~O 5 No. feet from nearest prop. line:Front , Side , Rear °--'Ft. No. feet from well: 7C No. feet from building '-:2 X7`7 A~ 9. HOLDING TANK 9 s 9 Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road I Alarm Manufacturer: INSPECTOR: DATE : -0 PLUMBER ON JOB : ?vu~ a LICENSE NUMBER: S' 6/90:cj i -7, 9 ~ ~3- r 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 State Plan I.D. Number: NA, , NW 4 i Sec. 31, T31-R17 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Stanton Holding Tank In-Ground Pressure ❑ Mound 42nd St. T,c)tq 21&9 5j" NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Rolf Carlqnn ~1896 142nd St., New • Q Q BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. EL V.: ST REF. PT. E ~ Name of Plumber: MP/MPRSW No.: County: n ry Permit Number: f tpr Nechvillp T 112911 R f- C-rn -I 3c 128736 3rjyf" SEPTIC TANK/HOLDING TANK I ,.41_e Ccz B' B' ~w MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER 1 PROVIDED: PROVIDED: , G 4 r YES ❑ NO ❑YES NO BEDDING: -VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY" I WELL' BUILDING: VENT TO FRESH LINE: ( AIR I ET:, eY k n - ALARM: FEET FROM 04 IE ❑ YES C?O ❑ YES NO NEAREST 38 F• DOSING CHAMBER: .6,n,,1) MANUFACTURER: BEDDING: LIQUID CA PUMP MODEL: PUMP/SiFi9IQ MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PR IDED: lA~ e ❑ YES E] NO G~ { r!Ct-r YES ❑ NO YES ❑ NO GALLONS PER CYCLE: IMP AND CON ROLS OPERATIONAL: NUMBER OF PROPERT WELL: BUILDING: VENT TO FRESH 11 LINE: AIR INLET: , FEET PP(DIFFERENCE ON AND OFF BETWEEN ES ❑ NO NEARESTO-t> > ~ 7 ' SOIL ABSORPTION SYSTEM. Check thef soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MA11 TIA ND MARjK~ING/ or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN / / ff a/l~ /Of/c, the soil is dry enough to continue.) LO 7 CONVENTIONAL SYSTEM: PIT INSIDE DIA.: 0 PITS: LIQUID BED/TRENCH WIDTH: LENGTH: TRENOCHES: DISTR. PIPE SPACING: COVMATERIAL: ER DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: NEAREST 10' MOUND SYSTEM: Mon a sl e p owe p _0 heck the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: moun3~ys~erxls to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria io`Tr►~e~ium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMA RKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO E:1 YES El NO ❑ YE NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL BELOW PIPE: FILL DEPTH ABOVE COVER: 1n/, TRENCHES: / +j ' ~e 2Q, DIMENSIONS d~ MANIFOLD PUMP MANIFOLD DISTR. PIPE ` MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: ( PIPES: DIA.: ELEVATION AND b 0 P*" _'C 41r,04 - DISTRIBUTION HOLE I : HOLESPACING: DRILLED CORRECTLY: s} COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION f it APPROVED PLANS L/ $ `f D YES ❑ NO ~G (a'ffS' ❑ NO LINE WELL: BUILDING: COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: 14UMBER OF PROPERTY FEET FROM - 5 -s E Le : 9 . v E] YES EJNt~_ ❑ NO NEAREST ~ 7117 X-"-' Cy~ C.~ G2 t / Q C In in county file for audit. Sketch Sysste%ofi TITLE: Reverse Side. SIGNAT RE: K SBD-6710 (R. 06/88) t DILHR SANITARY' PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ,~~Q 8'r/Z x 11 inches in size. ❑ Chec-kif revise on to►previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER Al . APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. .5 ? 9 Al 3 `7 PROPER OWN R PROPERTY LOCATION W 14 N63'14, S :3 -j T N, R/ 7 E (o 112 OP OW ER'S MAILING ! ADDRESS 2 0 6~ P/1 LOT AI i oP z BLOCK # CITY STATE ZIP CODE P O NUMBER SUBDIVISION NAME OR CSM NUMBER uj ~ ~ 363 ~o~•• W .e.o-~ NEAREST ROAD CITY TYPE OF BUILDING: (Check one II. ) El Stale Owned ❑ ILLAGE ry / AI- ❑ Public L''J 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NU E ) III. BUILDING USE: (If building type is public, check T11 apply) -5-9 7 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 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Off ice/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check 90y one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ 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 ❑Q Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 L In-Ground 42 ❑ Pit Privy 13 ❑ 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 4,W 375- " , !"l •(v~ Feet o1003 Ga Feet VII. TANK CAP TY Site o!n allons Total # of Prefab. Fiber- Exper. istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tanks structed Se tic Tank or Holdin Tank /000 Lift Pum Tank/SI hon Chamber /006 W • 1 El El F] I F1 EJ_ VIII. 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 Stamps) MP/MEW No.: Business Phone Number: 1f de-c- hv~ ll t qtk & 3 7/5' ~y4-33 Plumber's Address (Street, City, State, Zip Code): G J4 f syQ ~ IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue issuing gent Sign Lure No S mps) Approved El Owner Given Initial Surcharge Fee) A v D r i n J `V 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 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. --Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. - 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 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; 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-83M (R.11/88) 1 ~ Ap . i I ~ J;hs r ti~,z ~ m o0 w Y4 cL J` p y N W ~ :3- OD I l~ N ~ ~ s O vo ~ Z. ~ rn 7O a w vi / Nom, , 1 i i c 1 1 y- 1 O y tuh ♦ f"1 4 E5 W 4 \ ,Ajp1 I C'Rt SS S~'GT►D~J - 0,jr) I~ essu t-5' 'B ev ScAiE : I"= 3o' 0( ~ d l'ST i ~ ~ ~ RIDE pow elemrloA~ 10 ~o D 9~' y Is c.o 1./ l0 ~ovE4 ~J~~tDE i 3 3 n covt~Q 3b 31 9 - - O p C Ig Ryyac'GWF VA. Pek pitrv 'Ig -2" Prg g et 4ATF a uE2 ~,4Tt en-c. s 6-Y s~rAl • ASyQ~S~~r~ +b Inc.. 311" whs♦ED rkwu< el4a~vfiTio.v fill (toa ' • 6(eL,ATto~ of 10uE-9TS of-' ~~V Tfo,j Top or 1„ ~~TE~~LS 9G, 00 PL-AA-) V I E LL) OF t A-)G Ro D `13 EI so^ I y0. I - 3o' I I ~ I I i I ONS)Tg 'E eo r1;r FIUMAN RELATIONS j-v p~U,Nt;S~ 1 7. , 1 I 2' I ~!/G D/-~St t°!/ r/O.J /~/P ES (Z.> S f EEL M4MC,43 I 2 A C; oil a" 3 w i rri S. f r ~ 9'd ~ I' • _ °b° C/7 cn CD r' CO • • • rs ~l w kt, C N D J CZ) 11~ N 70 r 70 o O V ~ CA) O N ~ r LAI r- ASS ~ 0, SEPTIC TANK &'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 41' CI VENT PIPE 12" MIN. ABOVE GRADE & !WEATHER PROOF 251 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH ,SIR INTAKE. WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 ~..5 FINISIJED „GRADE 4" CI RISER WARNING LABE14 6" MIN . oor ABOVE GRADE ► ~...►.--4" MIN. 611 MAX. IN I INLET . ` WATER TIGHT SEALS GAS. TIGHT i FID BAFFLE A SEAL i APPROVED JOINTS W/ CI PIPE SiD v ' ' ALM PIPE 3 ONTO ' ONTO uIO~ 0 9. s B I ON 4 5~ 'SOLID SOIL L PUMP OFF ELEV . 90•~ FT. I O RISER EXIT FF 1~11J D PERMITTED ONLY ! L IF TANK MANUFACTURER HA $ APPROVAL 3" APPROVED BEDDING UNDER TANK Z 5 CONCRETE PAD naa06 SPECIFICATIONS . SEPTIC / DOSE /ESE~ co-oval e. L H2- TANK MANUFACTURER: CO: NUMBER DOSES PER DAY: TANK SIZES: SEPTIC /S7vr0 GAL.. DOSE VOLUME INCLUDING 13 4 DOSE 00 GAL. 2,2 FLOWBACK; GAL. ALARM MANUFACTURER: LFVEL- 1440M . CAPACITIES: A = • INCHES 300 GAL. > MODEL' NUMBER. ! , . L . ,±;-SWITCH TYPE: M ofev /o•sr B = .2 INCHES., _ ~ AL. j PUMP, 'MANUFACTURER; ZOVIC? - C /'Z 4NCHES`.~ l3 GAL. MODEL NUMBER: -97 SWITCH TYPE: (64 Y13rKK -4t, to F/o,4rg D = 13'INCHES = .0~3 GAL.. ley REQUIRED DISCHARGE RATE GPM PUMP VALARM WIRING AS PER 1ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE S., FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . 9, 2.5 FEET + (o Q FEET FORCEMAIN X /,/V FT/100 FT. FRICTION FACTOR. . FEET dVitL S HlXp TOTAL DYNAMIC HEAD = FEET n a INTERNAL,DIMENSIONS OF PUMP TANK: LENGTH; WIDTH 7✓ ; DIAMETER. LIQUID DEPTH 'SIGNED: LICENSE NUMBER: DATE: 1/8$~ 7A~ SPECS s d /n~ w,y C/R AGE l1Ol//0~p.= $ b..4~r f Jfi..4" n I~~ tnl ! I' C ( _ 1. F=: O HUMAN RELATIONS 1 ..j (l~'I y Ai t3UI S c . , r.. SEE GGf-,3 S f O ILE;ICE "F u • t ur I- •HEADI 115 34 CAPACITY 2110 105 CURVEr 30 100 - ~ 85 25 90 26 85 so- EFFLUENT 24 I MODEL ONSITE SEWAGE CYST and O 75 MODEL 189 W 22 185 tJiVATER/NG = 70 r~ d• 20 65 2 N s , z 16 -i - p 55 i J 18 MODEL ~ H 50 13 MODEL DEPARTMENT 6- O 8 toIGI- °.R n `.iy0 l {(J'a,WAN RELATION'S A 14 45 188 ~ vll.l~ 12 4- CiWiRES'PONDENCE 10 MODEL 30 737, 139' MODEL .71 8 25 SEWAGE and 195 DEWATER/NG 6 20 MODEL 15 ,MODEL 161 4 7 . 10 v! r 2 MODEL W 5 53, 55, - i 57,59 0 GALLONS 10 20 30 40 50 60 70 80 90 100 110 24 80 LITERS 0 80 180 240 320 400 75 22 FLOW PER MINUTE 70 20 _ p 18 80_ MODEL Q 295 W 55 = 16 60 Z 14 45 MODEL- 294 y p. 12 40- i J MODEL 35 - 293 MODEL C 70 30 284 e 25 MODEL - - - f 8 20 282 ! 15 I' i 410 MODEL ZZ7ZZO. j~ 2 5 287, 268 i - - i 0 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 ;0,80190 10011, 0 120 130 140 15P 160 170 180 190 P.O. Box 18347 r Louisville, Kentucky 40218 j LITERS 0 80 160 240 320 400 480 560 640 720 (502) 778-2731 ' 1 FLOW PER MINUTE a - k { "97" Cast Iron Sedes HEAD CAPACITY UNITS/MIN • Automatic or Non-Automatic. Feel Masers Gal. L 16 ! • 112 H.P., 1 Ph., 115V or 230V. 5 1.52 51 216 10 3.05 51 193 • Non-clogging vortex impeller design. 15 4.57 43 163 • Passes 1/2" solids (sphere). 20 6.10 27 104 • 11/2" NPT discharge. Lock valve: 24.5' • Float operated submersible (Nema 6) mech- anical switch. 97 Series • Automatic reset thermal overload protection. UY listed SC-2225 I err,aa~ • Stainless steel screws, guard, handle and arm and seal assembly. • Watertight neoprene "El" ring between motor and pump housing. n Canadian Slandaids SP Assoc. Approval available N97, non-automatic, available packaged with a piggyback mercury float switch. i S89-40324 PROJECT INDEX SH"'FT OWNER: ADDRESS: 3 ~dI( 70 IVYw /i'iC~.yD•v!' G(>/S . SITE LOCATION: Nto S-ac, 3~, 7 w Tacv.~ off' sr~- PROJECT DESCRIPTION: L~f 1 yZ 2+ S~C~PO~X ' T%~i... W ESQ U~~ . ~DD~ a,✓ , /s' -fo Co,P,c°~c r ~U -X~9' ST/ ~-t p 294 iLY q4s-{, /azv o r~ • .~D%G ~i ~ !/~i~ f i p~~r tit ~ S vi ~it,~'GE Cpl-~-~ l1~•J fi`d.c~ ~ L .S'y S ~'E'~ . PAGE 1. PLOT PLAN. VIF143, j PAGE 2. CROSS SECTION & SYSTrM PLAN VIEWS PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CROSS SECTIONS PAGE 5. PUMP PERF0RMANC' SPECS OR SIPHON SPECS j . PLUMBER: SITE FVALUAT-M/ DESIGNER HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT 05- T ` q WIS. MASTER PLUMBER LIC. NO. 33V M.P.R.S. DATE: 41NN. jNSTALLER & DESIGNER LIC. NO. 00663 SIGNATURE: -W7 P AS ~,2 I t .w State of Wisconsin \ Department of Industry, Labor and Human Relations SAFETY & BUILDINGS DIVISION 140_i!UOF COMPLIANCE bNi t jY A t j, I } r _ttTr T1!.y ._~.l~ff1_..}t"}ino C.i(k.-,53 rp V C ~ 1 b~ SBD-6423 (R. 08/88) INDUSTHY or_ . LABOR A"° PERCOLATION TESTS (11 P O. Box ?ass HUMAN JXLEATION~ MADISON WI 537Q7 (H63.090) & Chapter 145.045) LOCATION:/VW SECTION: TOWNSHIP/A4UAH64?4L4-TY: OT NO.: BLK NO.: SUBDI ISION NAME: ' NA) 1/ 1/ 31 /T3/ N/R 17 E (t, COUNTY: WN R'S BU R S NAME: MAILIN ADDR SS: •3 7 D Pw ~IcflMoNv WI'S / 5~•G.o r~( ~'v!1 ~ ,P/sow R f '13o)( P l` USE DATES OBSERVATIONS MADE N0. BEDRMS.: COMMER AL DESCRIPTION: PROFILE TS; IgResidence ,3 ❑New Replace y'--Ifi40j) tr - [E ,V ~~i a J`~Gll s 4 .S `mil 0.0 &A 44 Q RATING: S= Site suitable for system U- Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND•PRESSUR.: STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) [IS ©U ©S ❑U ❑S ®U ❑S QU ©S DV SEE (3~low 'a UA)l~ W i OkoOF C .t)T z ,v w(,- AV 507 - G ~ ~ icy •o.~ If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09115)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS /N 'AE~lit1/IL FT! I' BORING TOTAL DEPTH TO GR UNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH 1 NUMBER DEPTH FPI ELEVATION BSERVE EST. HE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /,GCv' Pr Ra 5 - S -ropsoi1 0-1 !><fC#A2 Ft/ , .316 El- 1-7, PPryf-.PS ckam.,4#t4y A, oka Cpk e4cT6-t0 GG EX T,tgt,titcy JExit'6' CDrrP~}c ?'~O B- 3,3' Lt-213 - IPh w/ iyytcww 1 cs , 'eA ?#3 'tom © ^ 4 o'f S B- d V B- SSE v rP i B. 76/ s t, B- To CAE Co.at~c rra ' PERCOLATION TESTS ON TEST DEPTH WATER IN HOLE TEST TIME DR IN WATER LEVEL-INCHES RATE INU NUMBER INCHES AFTERSWELL.ING INTERVAL-MIN. PERIOD PER INCH P- p- tit P- P- P- IPA 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 hor(r 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 pereeni of land slope. SYSTEM ELEVATION 3 .2 -A JV ' i.s S A D GQ~L JT '57.-;7E' TO I /_10 0 , T:l~' rt a T /l so rf- - • - S S G 7 t^(JI dam; Si f~ I !l ,ei ,r~i G~ lT D S! _ t H ~ f fi "j 1Lo rr . T- I 1_ 1, 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 Wisco(Wn Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. a I NAME (printl: HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: , 655 O'NEIL RD., HUDSON, WIS. 54016 2W. 1 o q S S optic : ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER( WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 2 y 3P6 /d'S MINN. INS! AUER DESIONER L16. NE), W668 t CST SSIIGN~ATURE- DISTHiBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 4 DILHK 5CD 6395 (R. 02/82) OVER - r ; V, 7 d O w , N i U t7 II 689m *oN'Jil W3NOiS30 8 U31Td1SIri 'r:.. Isli'd'INLoce'ON'oila3aWnld831SVV 'iii,. " '~1►'C _n;., 1Holdaln 1kf3aou Ot0tiB SIM'NOSanH " Od 113N.0 S99 '03 ONIOViMd OI1d3S 311S3J+vN Vh 6 -31o / \ s~ 111 i i ~ 11 X11 o lu 1% AP 'n OE O~ iv °~s-h6 I jot ~ o SliOsd°`~ A0 ► £S z 1 OL X,~z 1 '5.115 0~1s~,SSns ~ ns ~ o, 1 rte.. as{+5f 1 no Y/Y M---> 1 ~ -~0 ~t o'o0/ ps ~ooo i ~Y1+1 q s ~O p4l II~M DUS ~M Y OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LAB614 AND - PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSHIPAMUNIGWArLITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: /vAV/ 3/ /T 3 N/R 11 E (o W AILING CO T Y: S O M/~ . 3DRE3d,< USE t'o - 2w/C Z M DATES OBSERVATIONS MADE JNT_BEDRMS.: COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS: PER A ION TESTS: Residence ❑New Replace e? _ / v nn ! 'I RATING: S= Site suitable for system U= Site unsuitable for system -5c-.51 O J 5TAN RECOMMENDED O~JTI~U ❑S 12A iNG®J ❑UR:S®J 1❑ULH❑JG©U ~/tJ~it°OUtwM:l~tVa)I) L Y6 Ile O 'r111 4 Sv C'6 To Mi1XfHl2~ SPACE If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: C G/4 S S Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS IA-) 'O C,'--I,1L -F4 BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) I / r -67' IY-/3a 5i/ 0"./0. 5_' PcAiy fy- e,.) Si ~ S B-2- 7. C) ?,f ~16 ho Al j K -7 V , B- "O uA' S v , 2 M -1 1-.6 0 5'4.-.j.0 C U H. J` - PI Sr o,P 4107' 5- B- , 'MiX S Gy z. i r 425- B- 3 loO.7 _A6' S' e a,J -yy T A0 - '~Fy PIA~/ oE~Jt A0Sl, be,,e y r5 w/GrP,fuci. PERCOLATION TESTS 'I' UE y CS w~ %Alu£ L TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEV L-INCHES RATE MINUTES NUMBER WGFibS AFTERSWELLING INTERVAL-MIN. -PERIOD 1 PERIOD 2 PERI PER INCH p- / 13. F6' D t/% 2- Z-- S P-2 roof l f 2- / P- 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. SYSTEM ELEVATION 1 y ~ ZlSE U,f} 3 i ~ l° / f fI G 7,6, ail 7 ~-e-- ell i ' r ' TN e _ k . . l I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and pds 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. NAME (print): TESTS WERE COMPLETED ON:, HOMESITE SEPTIC Pll!NIBING5CO. 16 A DRESS: ROBERT ULBRIGHT CERTIFICATION NUMBER: PHON NUMBER(optiona ~J~ , LIC. N0.3307 M.P.R.S. 7 MINN. 4-ISTALLER 8 DESIGNER LIC, NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - k) Q( J iu C `N C 4i r J W • n cS C-NO I M • / M x 1 1 M ~ -y M O Q at / q W ` z 3 W W Zm ~ a t t} 1~ I s 1.5 ` - - e - - - - oo - - ' • P4 ~ z 3D C~~ V ' el STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ROUTE/BOX NUMBER FIRE NO. CITY/STATE 26yo:: ZIP PROPERTY LOCATION: /V4 1/4 1/4, Section, T__3_N, R 7 Town of M? , St. Croix County, Subdivision, ~t~~/~ Lot No Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE o St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address APPLICATION FOR SANITARY PERMIT STC - 100 his 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 Location of Property ~Ix, Section , T N-R 7 ~i Township Nailing Address 8 / ~z Address of Site , Subdivision Name Lot Number ~a l - 2 2- Previous Owner of Property Total Size of Parcel (off r4dCP Date Parcel was Created 9 Are all corners and lot lines identifiable? Yes No to this property being developed for resale (spec house) ? Yes V No Volume A,9_ and Page Number _ as recorded with the Register of Deeds. I INCLUDE WITH THIS APPLICATION THE FOLLOWING: i 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 Wel ce/ttti.6y that att statements on thin oAm aAe ,thue to the best o6 my (ouA) hnowtedge; that I (we) am (aAe) .the owneA(e~ o6 the phopeAty dezcAi.bed in thiA .in6onmation 6onm, by viAtue. o6 a waAAanty deed AeeoAded in the 066.ice 06 the Cotmty RegusteA o6 Veed~s ms Document No. and that I (We) pneeentty awn !Xc pAoposed A-cte 6oA the -sewage di~spo.6 Aye em (o,% I (we) have obtained an vtdhement, to Aun with the above deAChibed ptopenty, 6oA the conztAuction 06 Aaid Ayetvs+, and the dame haA been duty AeeoAded in the 066ice 06 the County Reg•idteA o6 Vttde, ae Vocurnent No. 6Ej j SIGNA Op OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ae~ DATE S GNSD DATE SIGNED 14- •ra ram ~ '1 foes 0.r.~ NNC~ p ; Of ransom U ATIM W DOD b RbGitTl1~ _ ST. CAM COL WIL day of »...,.-.ictaer 'hosenstiei Reed for Recd personal AA I# J ..«..r-.•- uP ntativ. of this stab of a/ kl a .Donald--~G•••-eastie l at 830 A t Donald ji4s ......nty. to ("peeen deat"1. u,. U&N conveys, ,itbwt - - a sin le erson Car son, ~...._.P . _ . wsTUw" To Grantee. • . ...County, St. Croix ase rgsa estate in basinatter called th? "Property") Ta: Pared No: Lots 21 and 22, plat of Westview in the Town of Stanton. .y 01 - {n- to by this deed does convey to Grantee all of the estate bud intereat yte and inter . Prepst~l M papreeentati" ent's death, and all of Abe in tb* *A Dteei~ W prior to Deced ~ , IL9.1i • `remltstive bee sine acquired. October day of >D ;N~,nth - Prr.onr.l RrDr.~rntative r , ~l.eow~l 8enrrenuUor AC=NOws.EaoMUNT 2. AUTHENTICATION STATE. OF WISCONSIN ~ R x, - - ? gi re(s1 St ...Croix........ .County. - PPraonaily came before we this day of 19 ` October . ta..84. a+ Massed aytlt.Aticated this M i chae l_-EZOSenst.. . _ . ti~i r ^l~,E: MEMBER R STATE BAR OF .rc► ~ Wis /.n to he a n' (Ii not, State.) tom aatheri.ed by i~/frYJF+" adcn~~ , THIS 14,TRUtAF•'4' WAS OkaF?F7 nv /J stra Needham, S • ` i a,ul 0. 6w8IIbj1 Rein. r_ Van.. Dyk.. Gt C tx• 54(11 \ota- Pttnlic . i New Richrond, 11 11c t nnttnt-=`nn (Surnature- „a be aa?henticatc+i (jr -r•kp w1+ l_•e+l ~ eXL) 1T'eS 10/ +w +t > 4Y N.. RNa>.w of Dflsiie>w siRn+eR in ..•a , is .h-.:;yf Fw r ; OY N1g[ON~IN ;t'T L f i-. N A!! AR Z i+,11Mt