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HomeMy WebLinkAbout040-1001-70-000 o o o ° p ~ d n 0. o o o o O N m O 0)(D N N o 69 m co E U o O Y w C C ~2 m c I Y°~o o I 'Zt g N `m S, 3 0c"8 3 > m rnEaaiC d N C Z O 8) E X 7 C O a C LL 2 O ~O (3 a) N + fp C C E Q.25 O v I O M C ti > H m N O I', = p n m Z r o y c 00 C14 a m o ~ Z a v> w c m L ~ O Z a III m a r~ ~ I wm•, N~ Cl) V I Y r- m Z v = uN a) cc N E o E y rnv o a~ c m N c E d E O O O N • L N m ~O N O C O E n m w 4U-- rO O Z Z Z Z C) N 00 E m I m (D - m o d Q r O II G G a L U Z M> v 3 3 3 a D • ~aaa ~i a ° N D M J U'! v O O a) i _ O O -d N M 0 0 0 0 0 11~~ Q N N N a I' p p o E O a0 co o ° Q in m H W v O V! C 7 M co O p C U N ~r p' m o j L a~ c c v dcy) 0 0 o T ti+^ f~ O C O O C N N N O O r Vl C m ~aj m Lo (D a) y 3 M N ar O Z a o A t- G OD = A m + a C N CD, U) z 12 k V ~ E as ~ E u (L r A 0 a O N U S'~t ra ✓X i STEVE MUENICH ULBRICHT & ASSOCIATES PUMPING LLC - Private Wastewater Contractors - Hudson 105 East Chippewa Street Main Office 715-386-8277 Cadott, Wisconsin 54727 715-456-1440 Owners Name ~j Date tF - Time Address 0-- 04 ~ idii.GJdAl b e2S'~-~ 3 C 7 Service Call: Routine 1❑' Emergency ❑ Operator Z Comments ; N ~ c~._r" /~~r.._ i C✓~/t~' - C' a utv ~;~"a~/rr ~~"'r /~s /GY nr - Septic System Conditions - S'0- S.T. Size ~Dr1v f~~,~ Amt. Removed /a(ov Gals. Pump Chamber Size 7-c o Amt. Removed Gals. Depth Scum S.T. Depth Scum P.C. Depth Sludge S.T. Depth Scum P.C. Trenches or Drainfield, inches of effluent (D O3 04 - Costs - • Pumping , • Digging up Covers • Adding Manholes, New Covers, Locks, Repairs, etc. • Extra Travel Service Labor • Taxes, if applicable Total Due M/Pd. In Full On Account ❑ ~GS~ Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER f~ N TOWNSHIP rRoy SEC. T Z 8 N-R I W ADDRESS ST. CROIX COUNTY, WISCONSIN r/ lJp.~~/s . S 'yo/ (P SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SEA S~ (~1-2~-T~ ~L~~v U~~rv ~f TT~tG~ TED INDICATE NORTH ARROW 'Q o rCo'`A 19 06-of BENCHMARK: Describe the vertical reference point used HOUSE- si,Pc - four L~ YIP . Elevation of vertical reference point: ~0 0'0 Proposed slope at site: ~C F_ K ('STi~u G- 0 1S c >VEwe-,C) a f ~o~t 4-,f aIt _ - SEPTIC TANK: Manufacturer: Liquid Capacity: 1660 &4 L - Number of rings used: Tank manhole cover elevation: p / Q 0 ' Tank Inlet Elevation: O Tank Outlet Elevation: Number of feet from nearest Road: Front,© Side,O Rear, 0 > /O 0 feet From nearest property line 'Front, D Side 10 Rear, 0 y 0 feet Number of feet from: well J~ U building: 12- (Include this information of the above plot plan)( 2 reference dimensions to septic tank) r- a PUMP CHAMBER Manufacturer: G ,~S 66,V6W~ Liquid Capacity: PC 0 (-4 Pump Model: 7 / Pump/Siphon Manufacturer: Z0E//2FR Pump Size ~ • 7 S , z 6 Bottom of tank elevation: s Elevation of inlet: Pump off switch elevation: R-7, 50 "Gallons per cycle: Alarm Manufacturer: L~1/EL L/~j Alarm Switch Type: II&Rcu ey rla,4 I s 0 Number of feet from nearest property line: Front, O Side, O Rear, p Ft. Number of feet from well: > 10 0 Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM X T - IJ1 R Bed: Width: Length: 717 Number of Lines: Area Built: Fill depth to top of pipe: jy Number of feet from nearest property line: Front, O Side, O Rear,0 pt.7/ of feet from well: 73 Number of feet from building: COS / (Include distances on plot plan). SEEPAGE PIT Size: Number ~ttom Diameter: Liquid depth: f seepage pit elevation: Area Built: ox O or distribution box O been used on, any of the above soil Has either a dr 0,31 absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of fee rom nearest property line: Front, O Side, O Rear, nFt. Number of feet from well: ~~JJ Number of feet from building: Number of feet from nearest road: i Alarm Manufacturer: " J 'EA.,' Inspector • A Dated: 12, / ~D Plumber on job: HOMESITE SEPTIC PLUMBING CO. License Number : 655 O'NEIL RD., HUDSON, WIS. 54016 `NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ~41NN. INSTALLER d DESIGNER LIC. NO. 00663 3/84:mj y ~ Z c ~ >o ~ O - ~ ~ a m VN V's ri~N' »r~1 „ 2 N Oy ` N N ~ M Q I c N r 76 rco i, y z . E rn n' \O 70 rTr W vr w ~ ~~,RTMENT OF_ REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'N DUSTR Y DIVISION ABOR AN PERCOLATION TESTS (115) P.O. BOX 7969 MADISON, WI 53707 AN RELATIONS (H63.09(1) & Chapter 145.045) O A ION: SECTION. TOWI~,SHIP/-V~KY: LOT N .:BLK 0.: SUBDI I ION NAME: 1/45 / 2 /T:~' NlW E (or) W i,J 1- COLIN Y: OWNER'S BUYER' NAME: MAILING ADDRESS: 5l rti TGti,~ ti gJ~ ~Gr~rtc R~,~~ S ~i~ Ile& USE DATES OB ERV TIONS MADE ®fNO. BEDRMS.: COMMERC 'L DESCRIPTION: PR FI I TONS: PERCOLfTION TESTS: ~ ❑ New ~#eplace iesidence 3 RATING: S= Site suitable for system U= Site unsuitable for system CONEIVENTI11.~MOUND: ❑U JI -GE!ND-PRESSURE:ISYSTEM-IN-Fl LLHOLD INGTANK:RECOMM~NDEDS'STEM:(optional) SS S U S U S If Percolation Tests are NOT required DESIGN RATE: !✓1 If any portion of the tested area is in the ! under s.1.163.09(5)(1)), indicate: 3. lFloodplain, indicate Floodplain elevat PROFILE DESCRIPTIONS BORING TOTA P H TO GROUNDI"JATER-!NCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEpTH_jjW ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVE (SEE ABBRV. ON BACK.) .~r~ I l S . 1.3 3 '1"irf ) 915,fk- . 5-S %j: / S B L 1 c~ ' ' SJI~. r en 0117, 51 13- L / G / ~iL" ~ 1 5'8.7 /.L'S- bvt 5 a//~L-• J '~7~t1 j ~.Sy B-3 'ole -7 L~ - ~ s t7'~~~`S~j . ~ /J'r~ . Jr 7 ~J L l~ JL,I✓H .S ~G . ~s ~ 1, ~S f c ~s . Sv B= 1 fC i~• NV 5."3" 5D, 1. , B- PERCOLATION TESTS TEST DEPTII ATFI7IN I.101_F TEST TIME DIIOP IN WATFR LGVEIANCHES RATE MINUTES PER INCH NUMBER AFTER SWELLING INTERVAL-MIN. p " jpjj j IOD PIE R P_ NI; P. 5 3 y 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 _ - - T i) Z: i , ; i.- , ~ I ' ~l~'1 t/•~~ fit. ' ~ ~ ~.I I fio I I I r . - t G I ~y x ~SPk~ • D I,T. iL G 0 - I 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, NAME (print TESTS W E OMPLETED ON: I Clj . lc" i ADDRESS: CERTI IC 10 UMBER: PHONE NU2^B R optional): / i`` l X11 h GJ i l ! 3 y CST SI . U 7 r w ~ ` C ' i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil 'Tester. DILHR-SBD-6395_(R._02/82) _ - OVER 01 IN 1 14 q ()60/p 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: NW4,SW47Sec.1,T28-R19 ❑ CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of Troy ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 7__3j-?,p -3,- d To &IE ~ MIT HOLDER: ADDRESS OF PERMIT HOLDER: INSP CTION DATE: John & Mary Schuna 811 Tower Rd., Hudson, WI 5401 `x`910 3v BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: v, MP/MPRSW No.: County: Sanitary Permit Number: Robert Ulbricht 3307 St. Croix 135465 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER _ PROVIDED: PROVDED: C)c Cf I , U YES ❑ NO )ffYES ❑ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDIN VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST (J (J O Z DOSING CHAMBER: M NU ACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: ROVI D: e YES ❑ NO i C + _ ES ❑ NO ES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERA IONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH FEET (DIFFERENCE BETWEEN ' YES ❑ NO PUMP ON AND OFF) IZI NEARESTD~ LI NE: , I o o AIR INLET: C, n 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 the soil is dry enough to continue.) MAIN l 2 CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID TRENCHES: MATERIAL: PIT 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 MOUND SYSTEM: 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 K YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; i YES ❑ NO YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: a 7 j K /D " U ❑ YES [Z NO YES ❑ NO M YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVF COVER: BED/TRENCH TRENCHES: DIMENSIONS 2 ~L X 6 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV... ELEV.' DIA ELEV.: PIPES:. DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION „ l a APPROVED PLANS IN % ~ YES ❑ NO I a, YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL., BUILDING: COMMENTS: FEET FROM LINE: YES ❑ NO YES ❑ NO NEAREST- * e Retain in county file for audit. Sketch System on Reverse Side. l !C [7NATUTITL SBD-6710 (R. 06/88) ~'',U~ ' t`' SANITARY PERMIT APPLICATION ffILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code 5T, C201 X STATE SANITARY PEERM~IT # -At tach complete plans (to the county copy only) for the system, on paper not less than ❑ ~ X.Yk " 8% x 11 inches in size. ch previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. O " O 00 3 PROPERTY OWNER PROPERTY LOCATION Gel l PkI ash %a, S T , N, R E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CI STATE ZIP CODE PHONE NUMBEg SUBDIVISION NAME OR CSM NUMBER fIv,pse-', tcl i5 15-Y016 1(125' )ST II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned VILLA GE : "rP-Q ~,6LlJ~^.- =WRF ❑ Public 0 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) I 2~ - p 1 El Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.E1 New 2. X 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 21-Seepage Bed 21 IN Mound 30 El Specify Type 41 El 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE C~ REQUIRED (sq. ft.) PROPOSED (s q. ft.) (Gals/day/sq. ft.) (Min./Inch) ELEVATION '75 37 33.3 S Feet !l('S Feet VII. TANK CAPACITY Site ns Total # of Prefab. Fiber- Exper. ons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App INFORMATION in aRaisnt New In Gall Tanks ks strutted Septic Tank or Holding Tank 10 60 Z~.*> tt!vdLc~~✓ Lift Pump Tank/Siphon Chamber ®ox eveTY 40-,V c- 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 Si gnat e: (No Stamps) MPfMPRSW No.: Business Phone Number: RZk__A7- 211-AkirA7- 336 3&6 19.5 Plumber's Addre (Street, City, tats, Zip Code)- Ca b~,t~iL Y-~ , R UPSa,i I s , 3 IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issui Agent Signature (No Stamps) rre-V Approved ❑ Owner Given Initial Surcharge Fee) _0O X07 A v Determination 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 R 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. Vlll. 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; (Jose 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. - - - - - - - - I GROUNDWATEIR 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) APPLICATION FOR SANITARY PERMIT I 8TC-100 This application form Is to be completed in full and signed by the ownez(a) of the property being developed. Any inadequacies will only result in delays of the permit issuance. -Should this development be intended lot tesale by ownst/contcactoc,(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. -------M------•---- Owner of property 1C~n 1~! SC1'L(,C~ d U 1 L/Z 1~,~~1 T- SCL[~~ ^1 T_.~-R= Location of property ~1/4 M, section Township S ONE Hailing address 7oaux, -Rd Address of site I'Yl(1, Subdivision name Lot number Previous owner of property Las pu l Total also of parcel 50c'm Date parcel was created Ate 611 cornets and lot lines ldentiflable? as o Is this property being developed lot resale (,spec house)? as 0 Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING A WARRANTY DINO which includes a DOCUMINT NUMBER, VOLUME AND PAOI NVMsnt and the ORAL OF THE REGISTER OF DEEDS. In addition, a certified survey, If avallable, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a Cestlllsd survey Map, the Ceztlfled survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(ve) certify that all statements on this form ate true to the best of my (out) knowledge) that I (we) am (ate) the owner(s) of the ptopetty described in this lntotmatlon form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. / and that I (We) presently own the proposed alto for the sewage disposal system (at I (we) have obtained an easement, to tun with the above described property, tot the construction of sold system, and the same has been duly recorded In the Office of the County Register of Deeds, as Document No. Signature o wnec Signature of Co-owner III Applicable) 6 115 6 Date t Sign tote Date of Signature Y~ 794 DOCUMENT NO. y err oeeo L' ' STATE "S OF WISCONSIN n.u ~ ° me a ar•~ Ij 1►OIfJ[ 2- 'I Wayne L WGISTM . Handlos and orm • P •c...... Ronald M. Hand 08 tenants ST. C"X C i 0 and not as point.. tenants fled. fOr" Rid ef_ Oct. ~pn t18? .y sch s and warrants to ..John M. IOtSO A una h . Schuna••and_-Mar T. :...~-....uaband. And x►i.~s...s-uzvxxozshxp-......- aarital..PropertY...---- ~ •4 WTURN To 3 . the following described real state in S C= OIx state of Wieoonsin: .............County, Ta: Pared me:..... Lot 3 of Certified Survey • 430431 Lot 3 located in the Map filed in Vol. 7 NW 1/4 of the ' Pate 18, as Being also part of hot 2 SW 1/4 of Section 1 >at Vol. 4, Pate 1161 of that Certified Surve T28No >lllK. , Town of Tro Y Map recorded Y, St. Croix Count 1., Y, Wisconsin. HISM I7_ 0 0A This is not # is sot) homestead prosy ( Mien to warra„tim: easements, restrictions and rights of way of record A~ Dated this if any. eZ.y.................... day or . September I. ~ " ...(SEAL) • - _ (SEAL) Handlos. ~ (SEAL) • . Ao-nald.A....-Handlos._ . 9 AUTBR fTICATIOIf Vi(a) ACSIfOVitLZitDOit XXT . ' STATE or " WISCONSIN leis ! ! Xt G at A 1f,..... SePt~ 7 Came befo mw this . t ii zi- M-- Wayne J. Hand the she" los ` nd Ronald iy. (It BTTATS man O! WISCONSIN Handlos A f r i - -QtaL w_. M.................... 4 ; t9 as knpwa to be the palm • ; •River•Falls,. WL~. Rodlf,~...Beskar-.i--,Boles' LL-• • ~i~:~ a 5402.2 ' C~[!ff! S; rn1 Nt a°%ntia4d or acken d. Both Notary Aiblk _4:.;, y (.•on r p.. . 11 e[ """"'Mrs a w date.: /11 Rr.......- - r+«ns ..mw be or bead DrlnUd Mlev yelr Otnm4tw. ' Or i~sy{, ,•.~t ,Mr»;twl mom INDUS DE!PARTMENT ' OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRRY, DIVISION 69 LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LO,CATI / SECTIO`T, N/I~ E (or) W TOW~f SHIP/~Y: LOTrX]BLK, SUBDI 1 ION NAME: W COUN Y: OWNER'S BUYER' NAME: MAILIN ADDRESS: V USE DATES OB ERV TIONS MADE NO. BEDRMS.: 1COMM_E_RC DESCRIPTION: I S: EIRC~O)LfT19N TESTS: Residence ❑Neweplace RATING: S= Site suitable for system U~ Site unsuitable for system CONVENTIONAL: ~ .aU JI~ TANK: RECOMWCNDED SYSTEM: (optional) ~S S U EIS ®U EIS 12U % 6, e' If Percolation Tests are NOT required DESIGN RATE: , If any portion of the tested area is in the under s.H63.09(5)(b), indicate:}. J Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTA DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER IDEpTHj.W ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVE (SEE ABBRV. ON BACK.) B- ,C~ `vl , j• S , 5/, 1.3,3 fl } .fir ' 'u. . $ s r B- V'Is L i /,G''&/ /,/7 S- ~ Lf •~~d'~//S/~.SU.rS~ .5~'Inc5G/~ IL~/~,i.s' s~/ //I '4j, z .0 B- • y ,5 t- c~., /Re ' ~Cr B- ^✓v~w. /h J~iHj 'J/% Uz }~~rtu,~:y/Ll W~/1~. PERCOLATION TESTS TEST DEPTH ATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER LftCWeS AFTER SWELLING INTERVAL-MIN. Qg1 PER INCH P f .~~i'LC iIy $ LSD.., r•r P. .3 4,433 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 )tl~' Ili j 77 IT— I „ p . I tJ ~5 y i srs ,n~ i _ TH , i , : i (7 I , i i--I----__I--_J I_ __L I 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 Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. TESTS W E OMPLETED ON: ~ NAME (print): I C I~`' ,Oil, 1 / V ADDRESS: ^ L9 y / 4 CERTI IC 10 UMBER: PHONE NU?BR joptional): 0 Z) CST SI y1 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - S T C - 10 5 SEPTIC TANK MAINTENANCE AGREEMENT w St. Croix County 'J r W OWNER/ BUYER Df 1 ~C ~'1 ► + i O - ROUTE/BOX NUMBER l Fire Number gl( 0 Cl CITY/STATE -7~ IV V~l ZIP J~~Cil~o PROPERTY LOCATION:'.' 'Section T N, R W, Town of St. Croix County, Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 's'e tic tank Pum er. What you put into the system can a Fect t ze- function of the-septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents may be eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, whic 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 sys't'ems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a mater 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. H 0 I/WE, the undersigned have read the above requirements and agree O to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed .b and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED / DATE 7 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL SAFETY & BUILDINGS DIVISION Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 ULBRICHT HOMESITE SEPTIC Owner: JOHN & MARY SCHUNA ROBERT ULBRICHT 655 O'NEIL ROAD 811 TOWER ROAD HUDSON, WI 54016 HUDSON, WI 54016 RE: Plan Number: S90-40003 Date Approved: January 30, 1990 Gallons Per Day: 450 Date Received: January 29, 1990 Project Name: SCHUNA, JOHN - RESIDENCE Location: NW,SW,1,28,19W Town of TROY 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 MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, 6~?4ev g j GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings cc: JOHN & MARY SCHUNA X Private Sewage Consultant SBD-6423 (R. 08/88) ~EQ . Y3. og (2) v S90- 40003 PROJECT INDEX SH*I,,FT OWNER : Icy h A t pl " S G 4 4,,V f 715 - -911 ' S 00F 9 ADDRESS : -544 O CP SITE LOCATION: N a ~y ; w Sad • ll ~2 w . `Tou- o~ T.~ oy s 77 coe o:)( PROJECT DESCRIPTION: SGv.vfr S ~x/S%i.vG- CDvvE,~~~CLV~L SyST~., -itt l yw~ /s~ /•s "r't s of L T-Es rs /f s u eki F le i;, / Sy Toter .r/ier/so.a~ 120,v1:4;G- ~1~~~•vi6TiC/ Tale /ti-1) 14,fTE!'- Soi/s 07' A o 0,0 v S y S 71F"l F o Tt~- ~S p P45posv ,qutn~ 9~~c y ~Sri~,~~r Fla 1. PLOT PLAN VT?,WS PAGE 2. MOUND CROSS SECTION & SA'"T,;P7 PLAN PAGE 3. PIPE LATERAL LAYOUT PAGE 4. DOSING OR SIPHON CHAMBER CR~'SS 3rCTIONS PAGE 5. PUMP PERFORMATJC" SPECS CR SIPHON SPECa PLUMBER : HOMESITE SEPTIC PLUMBING CO. IL RD., HUDSON WIS. 54016 STT T7ATMl / DESIGNER 655 0 NE TV ~L ROBERT ULBRIGHT VIS, MISTER PLUMBER LIC. NO. 3307 M.P.R.S. NAl.vri, IN TALLER 8 DESIGNER LIC. NO.OD663 CV HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT DATE: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. M'Ntt INSTALLER 8 DESIGNER LIC.140.00663 SIGNATURE: , 3 3 4 7 /}T -.451'" 25 of 'i1,~~iS~VR(3Ep GROUAJ b Dow,~S(o~E of t4ov-4iD. tow -o 0 Gt ° p aV ° . t~ To ' r ~i v' :r O a Row n F don TIPE~S v 6-vni rv .C\ ~ a V3 Z. L ^f Z~'.. r TIaNS 41. z ~o SEE G-pRRES aENCE _ ~ m T M o► ~r 1 W c 00 0 0 ~ 1 ~ _ tj 1 0 m t o~Z rn ~ 3n"' Z 3 ;p ~ ~ rn y a ' u AI C i Oq3, s- J1, p N rn F p • ✓ 70 Q ca th tN O l Woe wmf ti X90 Opp 03 _ Page ? Uf i Synthetic Covering Distribution Pipe i Medium Sand s y STEM " G fr~v,~n•~ Topsoil F 9S 0 3 E 11 D ~--1 if % Slope Bed Of 20 Force Main Plowed 3 to f 9o Aggregate Layer D Ft. E 3 Ft. TE SEwaG`E SYS~ltross Section Of A Mound System Using F .1 S Ft. QNSZQ A Bed For The Absorption Area G /,s Ft. A 8 Ft. H Ft. f B y7 Ft. ~tUAN RELAX IONS I-ABOP, go K /O Ft. AND tNDS~ PIP L & 7 Ft. ,:~,t~i ~atDN 0~ S CORRE NOENCE b' Ft. i SE T Ft. Force Main W 1 Ft. L Observation Pipe `f K tol~ A ---------------------♦I w 4 - 1 N Distribution Bed Of 2 Pipe Aggregate Observation Pipe Permanent Markers y ,av~ ~~,opFD PUc Plan View Of Mound Using A Bed For The Absorption Area 1 r i S90-40 03 ,X Page 3 Of Luc FoRcF • X010 VolumE /"OR /YS FT of 2-11 r s y s E o Perforated Pipe Detoll ztpl aA r Fob' uAtmAiE vAc v.4 7-1,'o A.;, n ~0~ 5 0~ / ~TEiP~L J/""Lftd View ILcU~Tr~~ s t / O ' J.~ )Perforated j End Cap PVC Pipe ~°tas~°Poe i` Holes Located On Bottom, Are Equally Spaced R e ? PVC Manifold Pipe Alternate Posltlon Of ONSITE SEWA&t Force Main Last Hole Id So ' Neal To LG~y AV , 's V n t ate on Pipe Layout P ZZ Ft: i R it Urtg`:AN RELATION'S LLPA.`tTrv 4 rv~' NoliSTRY, LABOR AND iI GS , - Ul I 10,,4 Of SA ETY AN X !~J Inches SEE CORRES ENCE Y y~ Inches Signed: Hole Diameter 4/ Inch Lateral Inch(es) License Number: Manifold 2 Inches Date: Force Main " Inches # of'' hol es/pipe Invert Elevation of Laterals 95*.5 Ft. • D/ S TRiI3v?'/!~~ L~is'Cli/I.t' E ~P~9TE ~d~ E~} cLl ~i4 TER ~t~ 7• o 2-- y'+~ Ott t,w y ~ 0-r is 2- 7 • TO7 ~~'~TRi/3UT/O.~ L7 /'S Gk Ak'GE' ~PgTE"" ~~e ~C~~vD~Pk Z$ /4V, fil 04, 890 I 1 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS , VEWT CAP `i"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKIAIG JUWCTIOIJ BOX MAWHOLE COVER 12IU. i"'/ 4vIWA)l0(1 1ASerl ? 25' FROM DOOR. "M WIWDOW OR FRESH AIR IWTAKE I T IJRA~~ ~~E~~~/ON GRADE I T y"Mll 7 ~ I C'g,0 CONDUIT 1I~1 PROVIDE I'i9v •O IWLET AIRTIGHT SEAL -7 ~ I III APPROVED JOINT A I I ( APPROVED JOINTS ►~1 I I I W/C.=. PIPE W/C.I. PIPE 00 ~p ta~• I III EXTEWDILm 3' j E DIWG 3 ALARM EXT N ~ I I ( ONTO SOLID SOIL ~ PWTO SOLID SOIL. B AP`asl ~~Ipa ( I ' ~1~ I I OIJ Ny ELEV. FT. PUMP OFF I K ~~Dp/a 11.33 COWCRETE BLOCK 4M gG • S RISER EXIT PERMITTED OWLLJ IF TAWK MAWUFACTURER HAS SUCH APPROVAL SEPTIC E 5PC C.IFI'CATIOKJS DOSE i cc- TAWKS MAWUFACTURER: New R(GC,h n.., O wIS I.IUMBER IS DOSES: 3 PER OAy O TANK SIZE: ~O O GALLOWS DOSE VOLUME t INCLUDIW6 ACKFLOW: GALLONS ALARM MANUFACTURER: L -UL L 1A~M zy MODEL IJUMBER: • L ' CAPACITIES: A= I(o' S INCHES OR 3d GALLOWS M E R t: RY (O A'T g . Z INCHES OR 3 CO GALLOWS SWITCH TYPE: j PUMP MANUFACTURER: zzo 157 NoP-- C = S INCHE5 OR I, GALLOWS MODEL NUMBER: 1 ` ~ Y~ I(S V ~Wv>- 97) D- I(0 INCHES OR 2 GALLOWS SWITCH TYPE: Mt-CCU R~/ ~IO~I~S MOTE: PUMP A1J0 ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE-..°'s_-GPM 7-> "O GF'M MIN. 8.O -rAok SP>FGS • VERTICAL DIFFERENCE DETWEEM PUMP OFF WD DISTRIBUTIOW PIPE.. FEET 1 I of y~ `IL + MIWIMUM NETWORK SUPPLY PRES5URE . . . . . . 2.5 FEET EACkv, P H- FEET t0A I S~ Z 14 S FEET OF FORCE MAIN X 2 • 9 F~o fr FRICTIOW FACTOR.. ' Z TOTAL DyQAMIG HEAD = t4' 7 FEET 70 D UN~ AL D1MEWSIOWS OF TAIJK: L TH N ;WIDTH 77 ;LIQUID DEPTH yq TNT.ERIJ ONSITE SEWAGE SYSTEM SIGAIED: LICENSE IJUMBER: DATE:-- copjil. i® v c DF PAR T M~-=N T OF I~40IJSTR . LABOR AND 1!- U ii-\ RELATIONS N OF S 1 SEE CORRES ENCE S90- 40")5 W HEAD/ LL ~i 116 l CAPACITY 3110 - 105 CURVE- 30 1 - 95 26 90 26 85 I~ I MODEL EFFLUENT 24 80 and Q 75 MODEL 169 DEWATERING = 22 165 i U 20 65- Q Z 16 - ~ 55 It 18 50 MODEL 163 MODEL 14 45 166 f 12 40- - - - 35 10 MODEL 30 137,139 MODEL SEWAGE and 6 2s ' DEWATERING B 20 MODEL 15 EL 161 i 4 • 7 10 ¢QU W MODEL 5 53, 55, U. 2 lt! i-u W It 57, 59 I GALLONS 10 1 30 40 50 80 70 80 90 100 110 80 ! 24 - LITERS 0 6o 160 240 320 400 75 22 FLOW PER MINUTE j 70 20 66 16 60- - - MODEL - - 295 LU 16 55 - ! V 50 - - - Q 14 MODEL 294 - - Z p. 12 40- r - - - - - J MODEL I FQ 35 - 10 293 Q 30 MODEL f' 284 - 6 ~ MODEL 6 20- 262 + - i 4 15 10OO. MODEL - - _ - - _ - _ 2 5 267, 268 0 ' 3280 Ow Mures Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 '130 140 150 160 170 160 190 P0. Box IM? / Louisvilk Kelfucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 778-2731 FLOW PER MINUTE "13r Cast Iron Series "139" Bronze Series * HEAD CAPACITY UNITS/MIN Feet Meters Gal. Urs, 1 • Automatic or Non Automatic. 5 .52 104 394 10 3.04 79 300 I ( • '/2 H.P., 1 Ph., 115V, 200-208V or 230V. 15 4.57 64 242 • Y? H.P., 3 Ph., 200-208V or 230V. 20 6.10 36 136 • Non-clogging vortex impeller design. 2s 7.62 6 30i ' • Passes 5/a inch solids (sphere). Lock Valve: 26 • 1!h" NPT discharge. Canadian Standards • Float operated, submersible (Nema 6) mech- U~ listed SA Assoc Approval anical switch. available • Automatic reset thermal overload protection. 137 Serbs SC-2225 • Stainless steel screws, bolts, guard, handle and 139 Serb: se-1115 arm and seal assembly. 'Bronze motor and pump housing, switch NOTE: No UL listing for 200-206V/1 Ph case, base and impeller. pumps. Mercury float switches are available for non-automatic models. ST. CROIX COUNTY 1 ;r WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 December 12, 1989 Division of. Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the John Schuna property, located NW4 of the SW,- of Section 1, T28N-R19W, Town of Troy, St. Croix County, revealed suitable soils at a depth of 2.1 feet below which seasonable high ground water was noted. This site should be suitable for a mound. Should you have any questions, please feel free to contact this office. Sincerely, Thomas C. Nelson Zoning Administrator cj i