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HomeMy WebLinkAbout020-1098-00-000 cn O 3 d o d ~1 z 02.0 C~) M. c tD tD w C O. Q H NO Z 0. o W 'w W O 1.3 M n O (D n 7 0 O W "d xC~" I O) M H N OM SI a~ a v (D CD rf C r O O. N IW 0 0 CD T lam-' Po y C4 000 H ° z co m rn N ° a_ ~y czo b 3 5 :2 tv "wA fl: • d -00 'O -00 43- CD P- rC C3 9 -_I _ O N ZD _ O N G C/1 C=~' Ul N U1 a . z ~ 9 ~ 3 a. ~ O D N o N j ;u CD d 'NO 7 C' CD d y U7 1 wO $ i z 0 Z CD Z 0 J 0 p D n~ v "IFA 0 CD O H H CD N rt o N It~1 coo m aQ ~d co O Z ' Q c CND w 3 a H n o NN 7y I" 3 cn z = tII A Z 0 06 N O ~s Q m w ~ t74 w ~o zt z 0 o o " co N I 3 ~ CD A o I 3 a CD v c z a N O N N 3 I s a I a ~ N A d I O ti O O O CD V 2) r d ~ ~O CD O O '69 0 DEPARTMENT Il INDUSTRY, INSPECTION REPORT FOR k' 1 FETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 79694 BUREAU OF PLUMBING MADISON, WI 53707 U~+ CONVENTIONAL ❑ALTERNATIVE SPlanLD.N"n,be (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 8601447 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER. INSPECTION DATE Church of Latter Day Saints P. 0. Box 354, River Falls WI 54022 BENCH MARK (P-.., reference p-1) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST HEF PT. ELEV SE NW, Section 33, T29N-R19W, Town of Hudson, Lot# 2, Otlo N,p- of Plumber. JMPIMPRSW No.. Coun,y SanitaryPermit Number Roger Timm 3224 St. Croix 83800 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV WARNING LABEL LOCKING COVER PROVIDED PROVIDED ❑YES LI NO [:]YES LINO BEDDING. ~VENT J 7IHIGH WATER NUMBER OF ROAD. PROPERTY WELL BUILDING. VENT -10 I FRESH ALARM FEET FROM LINE AIR INLET ❑YES ❑YES LINO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMIPHON MANUF AC TIIREH WARNING LABEL JLOCKING COVER PROVIDED. PROVIDED ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF JPHOPFHTY WELL BUILDING (VENT TO FHE SH FEET FROM LINE AIR INLET (DIFFERENCE BETWEEN PUMP ON AND OFF) ❑YES LINO INEAREST-~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of lowin LENGTH IDIANIF Tr MArI HIAE AND tianHKwa P g FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: - ATERIAL' JINS1111. OIA API TS LIQUID BED/TRENCH WIDTH LENGTH TOENCHES DISTR. PIPE SPACIN(I MCOVER DEPTH DIMENSIONS PIT (;HAVEL DEPTH FILL DEPTH UlSili PIPE f1V STR PINUMBER OF PROPERTY WELL BUILVENT TO FRESH BELOW PIPES ABOVE COVER FEV INLI . END PIPES FEET FROM ALINE - AIH INLET NEAREST - MOUNDS EM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES LINO SOIL COVER TEXTURE jP11WAN1 NT MARKERS (IBS[ HVAI IHN WI 115 _ ❑YES LINO ❑YES _ LINO CENTER EDGES DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED DEPTH OF T 0 P S 0 f L 1'"'T-1YES 1:1 NO 1""), 'E' YES ONO YES ❑YES LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH LENGTH NO. OF LATERAL SPAC I N(; THAVLL DEPTH BELOW PIP[ FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL IN_n_TI sTB I:ISTH PIPE 5ISTF0BIJ 11ON PIPE MAT[ HIAI & MAHKIN(, ELEV. ELEV. DIA ELEV. PIPES DIA ELEVATION AND I DISTRIBUTION 1 INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECTL Y COVER MATERIAL pEPTIS(Al I_ If T CORRESPONDS TO APPRUVID _ ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL. BUILDING FEET FROM LINE ❑YES NO ❑YES NO NEAREST _ Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE TITLE DILHR SBD 6710 (R. 01/82) DEP.ARTI'lli OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 769 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, Will 53707 BUREAU OF PLUMBING i ❑CONVENTIONAL ❑ALTERNATIVE State Plan L D. Number: ssigned) Holding Tank 1:1 In-Ground Pressure ❑ Mound 17 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN'. REF. PT. ELEV.: CST REF. PT. ELEV.. Name of Plumber: MP/MPRSW No. Cnunry' Sanitary Permit Number 1 7 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER -a PROVIDED. PROVIDED 0" (.rfJ L!/F YES ❑NO ❑YES FIND BEDDING: VENT DIA.: VENT MATT IGH WATER NUMBER OF ROAD'. PROPERTY WELL: BUILDING. VENT TO FRESH ALARM FEET FROM LINE. LAIR INLET'. ❑YES ❑NO ❑YES ❑NO N_EAREST DOSING CHAMBER: MANUFACTURER . BEDDING'. LIQUID CAPACIT P P MODEL PUMP: SIPHON MANUF ACTUHEH WARNING LABEL LOCKING COVER PROVIDED PROVIDED YES ❑NO pl/ YES ❑NO YES ❑NO GALLONS PER CYC PUMP AND CONTROLS OPERATIONAL NUMBER OF ~'HOPEHTV WELL BUILDI Y VENT TO FRESH (DIFFERENCE BETWEEN PUMP ON AND OFF) FEET FROM LINE AIR INLET ❑YES ❑NO NEAREST-). SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth Of plowing DIANE rEH MATE HInE AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NO OF DISTH PIPE SPACING COVTEERH A L INSIDE E =PITS LIQUID DIMENSIONS BENCHES ninI' PIT DEPTH. GF LOW POEPTIi FILL DEPTH DI H. PIPE DISTH PIPE DISTR. PIPE MATERIAL NO DISTIL NUMBER OF WELL BUILDING. VE BELOW PIPES ABOVE COVER EIE v.INLE I E ELLEEV V. END PIPES AI NR ITNLET. TO FRESH FEET FROM NEAREST----_-_~ MOUND SYSTEM: Mound site plowed perpendicular to slope a Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PFHMANE NT MAHKEHS OBSERVATION WELLS ❑ ❑ DEPTH OVER TRENCH BED DEPTH OVER T YES NO ❑ YES ❑ NO C ENTER RENCH HEU DEPTH OF TOPSOIL EDGES SODDED SEE UFD MULCHED ❑YES. ❑NO ❑YES DNO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRNO.EOFNCHES EELEV~ SPACING GRAVEL 6EP7H HE LOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD E MANIFOLD MATE E L E V ELEV HIAL NO UISTH DISTR. PIPE UISTNIBU iION PIPE MATERIAL & MAgKING ELEVATION AND DIA PIPES DIA DISTRIBU TION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHRECTI V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO _ ❑YES ❑NO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Reverse Side Retain in county file for audit. . SIGNATURE. TITLE: DILHR SBD 6710 (R. 01/82) SANITARY PERMIT APPLICATION COUNT EZ ~_j ILHR In accord with ILHR 83.05, Wis. Adm. Code ' STATE SANITARY PERMIT -Attach complete plans to the county copy d 3 Q 0 ( y py only) for the system, on paper not less than 8/ x 11 inches in size. `STATE PLAN I.D. NUMBER D -See reverse side for instructions for completing this application. odw 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO P ERTY OW NE ,/r ~f P OPERTY LOCATION L .J'G5 ~ dr. 4 S T2 , N, R (or~ PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ,o. laic 36 el ~t& 6~1~ Zz `2 o TLa C TY, STATE ZIP CODE PHONE NUMqBE~R/~ L-i CITY NEAR ST ROAD, LAKE OR LANDMARK I, it/ f~ ro-A IS v2Z /t/ # 0 VILLAGE : 50 +e II. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family OR X Public (Specify): cA rue_ III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a.54 New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in #2) 1. a. XConventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Seepage Bed b. ❑ Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet). Z 6 2 q 75 2 4 Feet Private ❑ Joint ❑ Public rMCK VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION 4xanks isting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App structed Septic Tank or Holding Tank 4 ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber 2.10L> ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plu er's Name (Print): / Plumber's Signature: ( o Stamps) MP/MPRS "o.: Business Phone Number: I fn /Y'A -3 272,3-41$4 Plumb 's Ad ress (Street, City, State, Zip Code): Name of De ig r )2 S D - 5r-in &.qceqs~bc, VIII. SOIL TEST INFORMATION Certified CI Tester (CST) Name CST CST's ADD ESS Street, Cit Zip ode) Phone Number: Lo I alvdi 4 dZZ < Z~ -7 IX. COUNTY/DEPARTMENT USE ONLY X❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (N tamps) Approved ❑ Owner Given Initial Surccharge Fee o Adverse Determination 4'~~ X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owners name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if .project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 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; dosing or pumping chambers; 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. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. T`ie groundwater bill Ground)Nater included the creation of surcharges (fees) for a number of regulated practices which Wiscori'$jn's _ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried O'easure is used in your building is returned ,to the groundwater through your soil absorption system or the disposal site used by yoLrr holding tank pumper. The Monies collected through these surc"rrarges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- ~(t water, groundwater contamination investigations and establishment of standards. Groundwater, k it's worth protecting. 4RD-6398 (RM/86) 3/~• FL. 42f• f i I - 0 G- EL.92 WWAJL- PM a-~Ylc~GT.~_.O _ COW ' ~ ~ - - - N WPLJC. AT L1.rT12 ' EL. q'mo T•(P, 6eF- G F-1 ~ - - _GoNr1E~ 1 sweat PeR - - _ ~ I= =~c_-4"G.t:= U If 4.0. 000 1 Irv 251-0" G.0. `7NV. EL'a91~.0' Ir 1 o. ao Ex{•1r.so . - - I QI k5- N~EvV U I t~ I N El F t2 E 923..6' = loo' o.{ \ ' G LL~ C T T GRAOE AT 01)11.01 i ~~-3 C-L. 922.5' 1TYPIGAL . A LI HT Fbt.E I ' 1YP TfG-9'l1.Pj' ~ TG- El. 41.8' I 921. e'er 1.IMI OF SODOING Q~ 8/G- E1..921.3' ~I "-TTCIZ- ~)A~ dz5.&l C++-JR-C4 +t„P4A,P-L 1W1" a&jtq, zz., ia,ato CONSU WALT M[fTtKIM C ASSOC., TRICAL. CONtssuITtNO MECHANICAL-[LECT111CAL tNO1Nt[11f ~ n IAY CtA{itESW13CONS1E►IET S~70t Y^ T[l[►NONE (7131 033-1201 r CHURCH OF JESUS CHRIST OF LATTER DAY SAINTS HUDSON,WISCONSIN REC,5IVEp APR 18 1986 C,cUate D PLUMBING ^ / Gws " rY4 ~vREgU coeq w cD? a see t3A~c ties INDEX 11 ~gg6 wN vTOSPECIFICATION ~S,~EK1N ~rpov Ue ~°j F 1e / C 8°oK'' PAGES Kett -4 GANICTS DRAWINGS so"o SITE PLAN-CONTOURS SD-1 SITE PLAN ME-1 DETAILS ME-2 • aAI~O° 'Lr a° ROBERT L.°a n, A m STRAAVALDSO D-0605 P EAU A m IS. 'a50 9® Ram 90 L ' 2~ Acril 1?35 02 710 SANITARY SE,~A'~E SY57EM5 GENERAL 1.1. Description: A. Includes But Not Limited To - 1. Furnish and install sanitary sewage system complete as shown on Drawings. Begin sewer pipe within 5 feet of point at which it enters building and connect to serving sewer system. 2. Pay necessary fees to governing agency of sewer system. PRODUCTS 2.1. Material: A. Cast Iron Soil Pipe & Fittings - 1. Meet requirements of ASTM A 74-81. "Specifications for Cast Iron Soil Pipe i Fittings". 2. Joint Material - a. 50:: oakum and 50% lead, well calked. b. Rubber gaskets meeting requirements of ASTM C 564-70 (1982), "Specification for Rubber Gaskets for Cast Iron Soil Pipe and Fittings", and compatible with pipe used. B. No-hub cast iron soil pipe and fittings. 1.. Meet requirements of ASTM A74-81, Specifications for cast iron soil pipe and fittings, except those related to hubs. 2. Connector couplings shall be composed of neoprene gaskets with stainless steel drawbands. EXECUTION 3.1. Performance: A. Install materials in accordance with Manufacturer's instruc- tions. B. Provide depression under bell of each joint to maintain even bearing of sewer pipe. C. Use jacks to make-up gasketed joints. D. No-hub pipe and fittings. 1. Use torque wrench to obtain proper tension on draw bands. Butt ends of pipe against centering flange of coupling. 3.2. Field Quality Control: A. Failure to install joints properly shall be cause for rejection and replacement of piping system. Sewerage & Drainage Section 02 700 t t , . 14 `larch 1935 02 745 SEPTIC TANKS GENERAL 1.1~. Description: A. Includes But Not Limited To 1. Labor, materials, and equipment necessary for complete installation of disposal system as described in Contract Documents. 2. Installation of reinforcing steel. B. Related Work Specified Elsewhere - 1. Plumbing lines within 5 feet of the outside building line specified in Section 15 405. 2. Furnishing of reinforcing steel specified in Section 05 030. 1.2. Quality Assurance: A. Requirements Of Regulatory Agencies - 1. Install in accord with laws, rules, and regulations of authorities having jurisdiction and in accordance with Contract Documents. PRODUCTS 2.1. Material= A. Sewer Pipe - 1. Meet Requirements of ASTM C 700-78a. "Specifications for Vitrified Clay Pipe, Extra Strength. Standard Strength, i Perforated". Joints ASTM C 425-77 (1982). "Specification for Compression Joints for Vitrified _Clay Pipe and Fit- tings", Type 1. or schedule 40 P.V.C. plastic pipe (ASTM-D2665) with solvent cemented joints. B. Lubricant Sealer - 1. Dennis Chemical Co., St Louis, Missouri 2. Equal as approved by Architect prior to bidding.. C. Drainage Tiles - 1. The perforated pipe may be PVC plastic sewer pipe conforming to ASTM D-2729 or ABS plastic pipe conforming to ASTM D-2751, both with strength reduction allowed for perforation. D. Covering for Open Tile Joints - 1. 30 lb asphalt saturated wool felt. E. Backfill Around Drainage Field Tile - 1. As specified in Contract Documents. EXECUTION 3.1. Performance: A. Follow instructions for concrete under Division 03 and for plumbing under Division 15 General. Sewerage i Drainage 02/49 Section 02 700 1. Septic Tank a) Septic tanks shall be constructed of WATERTIGHT concrete. The tanks shall be provided with the necessary inlet and outlet tees or baffles, and connections for cast iron pipe. The inlet invert shall be at least 2 inches above the outlet invert. A vented inlet tee or baffle shall extend 9 inches below the liquid line, and extend 6" above the liquid line, keeping a minimum of two inch clearance at the top of the tank. The tanks shall either be of monolithic construction below the liquid line or joints below the liquid line shall be interlocking V-notch, shiplap, or tongue and groove. Cast iron pipe will be used at the inlets and outlets of the septic tank as prescribed by codes. b) The distance between the top of the tank and the liquid line shall be approximately 20% of the liquid depth. c) Tanks shall be provided with a 24 inch minimum diameter manhole. All septic tanks shall be provided with access holes, 6 inch minimum diameter, over the inlet and outlet baffles or tees. Suitable plugs with handles shall be provided for the access holes. The manhole shall have a suitable cover with handles. d) The contractor must excavate, place tanks and properly backfill at the locations and elevations as shown on drawings. Backfilling around septic tanks shall be made in 18 inch layers, thoroughly compacted in a manner which will not produce undue strain on the tank. Settlement of backfill may be done with the use of water, provided the material is thoroughly wetted from the bottom up, and the tank is first filled with water to prevent floating. The inlet and outlet shall be sealed with temporary plugs until connections are made to the inlet and outlet lines. e) The top of the installed tank will require a riser to be installed over the manhole. The contractor shall install an approved covered riser which will provide access to the tank not more than 6 inches below finished grade. See drawings for physical size and capacity of tanks. f) Tanks shall be state approved as manufactured by Skaw Precast or Huffcut. 2. Effluent Tank a) See drawings for capacity and size. Tanks are to be state approved as manufactured by Skaw Precast or Huffcut. I I 3. Effluent Pumps and Control a) Each pump shall be capable of delivering 30 GPM @ 5' head. The unit shall be a submersible, 1/4 H.P., recessed impeller, 115V/60/1 with controls as listed below. Pumps by Myers, Goulds and Hydromatic are acceptable. b) Sealed float type mercury switches shall be furnished to control sump level and alarm signal. The mercury tube switches shall be sealed in a solid polyurethane float for corrosion and shock resistance. The support wire shall have a heavy Neoprene jacket. A weight shall be attached to cord above the float to hold switch in place in sump. Weight shall be above the float to effectively prevent sharp bends in the cord when the float operates. The float switches shall hang in the sump supported only by the cord. Three float switches shall be used to control level. One for pump turn-on and one for pump turn-off. A third switch shall be provided with alarm. All level switches shall be adjustable for level setting. c) Control panel shall have a NEMA weatherproof enclosure. A lock hasp shall be provided on door. A circuit breaker shall be provided for each pump and a magnetic starter with overload protection. The control circuit shall be 120 volt AC with a separate fused disconnect switch. H-O-A switches and run lights shall be supplied for each pump. Terminal strip shall be provided for connecting pump and control wires. Additional terminals shall be provided to connect alarm. Pumps and controls are to be furnished as packaged unit by single manufacturer. 4. Backfill Around Drainage Field Tile: a) The contractor shall excavate to the length and in the direction specified for the sub-surface field as determined by soil percolation tests. Excavation or construction of drainfields will not be allowed when the moisture content of the soil is greater than the plastic limit. The gravel shall be placed in the bed and the perforated pipe laid level. The pipe shall then be covered with gravel and the bed backfilled as shown on the attached drawing. The gravel shall be clean and may vary in size from 1/2 inch to 1-1/2 inches, with not more than 5% fines below the 1/2 inch size. Gravel to be used must meet the approval of the Project Engineer. The drainfield shall have two inches of gravel above the pipe and 6 inches below the pipe. Gravel shall be placed the full width of the bed. Where directed by the Project Engineer, the contractor shall install additional gravel depth below the pipe. The top of the gravel shall be covered with fiberglass mesh. Backfill with native material. D' L H R Safety and Buildings Division --7--1 PLAN APPROVAL Bureau of Plumbing P.O Box 7969 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Ilan Idw~lihc3(iun '~u. C,allun Pc,r Da% (,cr - 51 a D _K R~ PRIORITY PLAN REVIEW ONLY - _ t C ` e p 7 L1 11,1n Kevwv~ , I ee K~ a i~k,d w Petitir~n f w V,iri,ln<c IE,e Kec. ti Project Name Project Location - Street No. or Legal Description C/ `unty ❑ City ❑ Village Town of:~ - 4 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. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS ('f') (2) (3a) (3b) (4a) (4b) (6) (7) ✓ This approval will expire two years he date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and/or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By. RECE~VEC~ / JUNE 19 1 ~,~s - OFFICE James Sargent y f ~F' Bureau Director ~ If Questions Plans Approved By: Da;e A prov d: Contact cc: -Private Sewag Consultant ❑ Plumbing Consultant ❑ Environmental Healt County ❑ Local PI ❑ Facilities Need Analysis Section ❑ U -SSWMP ❑ Plumber ❑ Department of Agriculture DILHR-SBD-6099 (R. 01/85) ❑ Owner ❑ Other 4 State of Wisconsin Department of Industry, Labor and Human Relations June 30 1986 SAFETY & BUILDINGS DIVISION Bureau of Plumbing 201 East Washington Avenue P.O. Box 7969 Madison, WI 53707 Charles M. Jones, P.F.R. Church of Latter Day Saints 9100 Purdue Road, Suite loo Indianapolis, IN 46268 Petition No. 86-01447-P Dear Mr. Jones: Re. Church of Latter Day Saints - Residence Private Sewage System SE, t, 33, 29,1 Hudson, St. Croix County, WI The petition for a variance requested to section ILHR 83.15 (5) (b) of the Wisconsin Administrative Code was considered on May 29, 1986. The petition has been conditionally approved. The condition being -tMt an alarm system be incorporated into the duplex alternating controls wihith would be activated in the event of pump failure, sioultat tsly switc4ing the remaining pump to dosing on each cycle. The rule requires that there be a o -day holding capacity above the high water alarm switch in pump tanks. The variance requested was to use duplex alternating pins in lieu of the one-day holding capacity. 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. Sincerely, Julie H. Peterson, Acting Chief Section of Private Sewage JHP:KS 3541v cc Leroy Jansky Private Sewage Consultant Distract 6, Chippewa Falls Harold C. Barber, Zoning Administrator - St. Croix County AR-SBD-6423 (N. 04/81) SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) Detach And Return STATE OF WISCONSIN DILHR Upper DIVISION OF SAFETY & BUILDINGS • Portion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Correspondence P.O. BOX 7969 MADISON, WI 53707 66 DATE: 4.,./ 1 r' f U t PROJECT: 8 `u ,rc ? o Letter .1G y S, ~5, 4t 9~F~~1 c9 l ~ 1 ~1 tru SUIP '16' .,5uL1ritE:Jy L' GiX r/.k). Uox 44/, 1Art.ut j 7 PLAN ID. # DETACH HERE Ut' PROJECT NAME PLAN ID. # This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Fee Received is $ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. ❑ Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20'• beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. SBD 6678 (R. 08/83) (PIb 100a) (Wis Stats. S. 145.02) STATE OF WISCONSIN DILH De'ach And Return Upper DIVISION OF SAFETY & BUILDINGS Po'r`tion Of This Form With BUREAU OF PLUMBING 201 E. WASHINGTON AVE. RM 141 Any Return Corresponde $ P.O. BOX 7969 MADISON, W153707 'f~ 6N-2ss-391s DATE: PROJECT: V 3/tI JI`c,p j g 0 .719 86' 1,i"kur cii # LdLtL-'r bd,;~ Ji 7r.t5 I t 1 Z t s':~~sfal~ LLu. Jt. i.,ro'ix iti t .1 . L~)l 5i:f`'cu: PLAN ID.# _ DETACH HERE PROJECT NAME i,rlurLit :)y Ll1l LL t t11 y A! Li G::) PLAN ID. This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ i '!U Fee Received is $ ❑ Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. ❑ Plans being returned. ❑ Overpayment-Refund forthcoming. ❑ Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance.- I. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy) specifically noted. A Petition For Modification signed by county, owner and ❑ Plans not clear, legible or permanent. / notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks private sewage system to buildings, lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course, swimming pools, water service piping, all weather ser- and manufacturer if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local II. Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for installing holding tank. Statement from and notarized. (1 copy) county or soil boring and percolation test data on ❑ County onsite required. (1 copy) ❑ Design calculations. 115 completed by CST, showing that a soil absorption system ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons pumped per cycle. III. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 20' beyond edge ❑ Construction details and cross section of,soil absorption of trench before side slopes begin.) system. ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. SRD 6678_R. 08/83) (P1b 100a) (Wis Stats. S. 145.02) 4, STATE iLM OF WISCONSIN D R Detach And Return Upper DIVISION OF SAFETY & BUILDINGS BUREAU OF PLUMBING POrtiQn Of This Form W` 201 E. WASHINGTON AVE. RM 141 Any Return Gorrespo nc : P.O. BOX 7M ;:o MADISON, W153707 2~ so8,sss-3815 DATE: '/y* PROJECT: 04/18/86 Churc3, of Latter Day Saints SE, NW 3133,29,19W Hudson Malt Hestek n & Associates, Ltd. 5t. Croix WI P.G. Box 447, 7u4 Souti't Barstow Street Eau Claire, WI 64702-0447 PLAN ID. 8b-G1447 p DETACH HERE PROJECT NAME Church of Latter Day Saitits PLAN ID.# 86-01447 p This is to acknowledge receipt of your plans and specifications for the above-indicated project. Preliminary review indicates the required fee is $ Sr-lr' Fee Received is $ 155.00 Plan accepted for review. ❑ Underpayment- Please submit additional fee. Plans will be held in abeyance. t Plans being returned. ❑ Overpayment-Refund forthcoming. Additional information required. SEE BELOW. ❑ No fee has been remitted. Plans will be held in abeyance. 1. Plan Submission ❑ Soil boring and percolation test data on 115 completed ❑ Additional information shall be submitted in duplicate unless by Certified Soil Tester. (1 copy)' specifically noted. Petition For Modification signed by county, owner and ❑ ;Plans not clear, legible or permanent. notarized. (1 copy) ❑ All information submitted shall be signed, dated and sealed or ❑ Complete data relative to anticipated use of building. a stamped in accord with Section ILHR 83.08 (2) (a) Wisconsin ❑ Deed restriction required. (1 copy) Administrative Code. ❑ Affidavit enclosed. ❑ Condominium declaration. (1 copy) ❑ Plot plan showing location of land parcel (distance from nearest road intersection, etc.), lot size and all distances from IV. 'Holding Tanks private sewage' system to buildings, -lot lines, well, water- ❑ Holding tank profile showing vent, manhole, alarm, course; swimming pools, water service piping, all weather ser- and manufacturer. if state approved. Complete vice road, etc. Show benchmark with permanent elevation. construction details if site constructed. ❑ Holding tank agreement signed by owner and local' IL ~ Pressure Distribution Systems (Mound or Inground Pressure) unit of government (sample enclosed). ❑ Application for Use of an Alternative System signed by owner ❑ Reason for, installing holding tank. Statement from and notarized. (1 copy}- co Le , , county or soil boring and percolation test data on '~..Qu&4 onsite requir2d (I C03 ❑ Des n calculations. 115 completed by CST, showing that a soil absorption system :-Soil boring and percolation test data on 115 completed by cannot be installed' on the land parcel. Certified Soil Tester. (1 copy) ❑ Affidavit for all-weather service road (enclosed). ❑ Cross section 'of system. ❑ Pipe lateral layout. ❑ Plan view of system. V. Dosing Information ❑ Verification fo Exception Status Form by county. (1 copy) ❑ Cawations for total dynamic head and gallons pumped per cycle. ' 111. Private Sewage Systems ❑ Size, length and depth of force main. ❑ Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate (GPM). ❑ Location of area suitable for replacement system- provide soil ❑ Cross section of dosing tank showing pump(s) or siphon(s). data. ❑ Construction details of septic, holding or dose tank if site ` VI. Systems in Fill (Fill must be placed prior to plan submission.) constructed, or tank manufacturer if state approved. ❑ Total area. filled (fill to extend 20° beyond edge ❑ Construction details and cross section of soil absorption of trench before side slopes begin.): system: ❑ Depth and type of fill. ❑ Copy of signed onsite report by county or district staff. 1b. 1-A Wisconsin Departmon try, erg G`adw§, D I LHR Labor & Leroy Ansky P.S.C. Safety \ ldings Dy ion\` 13 Spruce Street Bu of PI Chippewa Falls, WI 54729 (715) 723-8786- ti PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT o c? Name of Premises C ~uRC!-fit Otz I-4mg Dl.\-{ SAdN T'S CSM V (o Vista SE. Nw. 33 2.a► 14 yJ NDSa~ S-r !)C Location Township cRo County Maste, P'arMw/Soil Tester _t[zAi.1C~s 4~ . o6.OE 1 yqU -5, Address 113 w. W41.NuAT 51% ~%vdn'5" " Sr Wt SyozZ 0wnerCt*ARcA 0r- c.AT'1'*P DAB`( 5A tyt-c Address 4106 Pu213 uL& iQUy &,,,t~ 1 OUP lexpi t44~buSr Sanitary Permit Plan I.D. No. a. QI 4q7 - P Type of Inspection _S >t -S Persons Present at Site _F-O6DEN s T . NEC.-So A . Type of Building: Public ClAkkP-C4 ❑ Single Family or Duplex BRIEF, FACTUAL COMMENTS AND SKETCH: eaA ~I (SYR~ N ~~13 _ p 5r j t1 "(}IVI- I r- Y- I A, co~ C40 A&L 1# LL- - i j _4t4 - - _ i 'LIA C_ _ 1 t_ j L i1. M t I- SEE ATTACHED DISCUSSED WITH PLUMBER/CST SIGNATURE DATE OF INSPECTION b Siyn re of Inspecto Inspector Local Inspector Plumber or Responsible Pe U )I LH R-SBD-6799 IN. 5/82) G N N RC o►= ~ A`c-r'~2. L~A'~( SA 1 ~,•r s S><, NM►, 33,29, \cjVJ('. H1.npsoN ST•CRo\c Go., WI S`(STLi'M f~ccA SrgKG{~ I13Y caT, OT3 SIR PLACE - scA~E 1:lop Mel►T T-2. CRY cST 63ms \ STAtE µw%f 3S s~z/ec. INVUSTRY, ILL DEPARTM.jENT OF REPORT ON SOIL BORINGS AND SAFETY & BU INQUS DIVIS . LAND PERCOLATION TESTS (115) P.O. BOX 37 HUMANUMAN RELATIONS 1 / MADISON, WI 5370. + (H63.090) & Chapter 145.045) LOCATIOff--. SECTION: TOWNSHIP/#AlFldielP~rL: LOT NO.:BLK. NO.: SUBDIVISION NAME: SE . 1/4 NW~ 33 /T29 N/R19 W HUDSON 2 - CSM, V.6, P. 1510 COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS: St. Croix Latter Day Saints Church 9100 Purdue Rd. Suite 100, Indianapolis, In. 46268 USE NO. BEDRMS : COMMERCIAL DESCRIPTION: DATES OBSERVATIONS MADE ❑Residence PROFILE DESCRIPTIONS: PER OLATION TESTS: No N/A Church ®New ❑Replace Nov. 20, 1985 Nova 20, 1985 RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND• IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S ~U ❑ S XDU 72'x100' Conventional Bed 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: CLASS I Floodplain, indicate Floodplain elevation: N/A 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.) B- 1 96 918.9 NONE >96 18, Bl 1 Topsoil; 18, Bn 1; 60, Bn s & gr. B- 2 97 919.3 NONE > 97 14, Bl 1 Topsoil; 19, Bn 1; 64, Bn s & gr. B- 3 102 918.1 NONE -102 12, B1 1 Topsoil; 17, Bn 1; 73, Bn s & gr. 4 102 918.0 NONE >102 17, Bl 1 Topsoil; 19, Bn 1; 66, Bn s & gr. B- B- 5 116 919.1 NONE >116 12, Bl 1 Topsoil; 18, Bn l; 86, Bn s & gr. 6 114 917.5 NONE :-''114 12, Bl 1 Topsoil; 12, Bn 1; 90, Bn s & gr. B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER O PER INCH P_ l 46 NONE 10 4 3/8 4 1/4 4 1/8 2.4 P_ 2 50 NONE 5 2 3/8 2 1/4 2 1/4 2.2 P- 3 50 NONE 5 3 1/2 3 7/16 3 7/16 1.5 P__ 4 83 NONE 5 6 6 6 1.0 P- 5 71 NONE 10 1 3/8 1 3/8 1 1/4 8,0 P- 6 48 NONE 10 3 1/2 3 1/2 3 1/2 2.9 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. 915.0 - ORIGINAL SYSTEM ELEVATION 912.5 - ALTERNATE LEGEND ~ P 1,ufR-01~E` IFOtND . 13.1 BORING OR PEXCOLATION TEST LOCATION. 8 r _BMHMR { n BEN K 0 CSC $ APE. Z X 3 6 4 - ro\ c9 19477 °o P.4 11/0 f i:N 0 8 i .30 9. 71' f _ r E 40,7-4 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 WERE COMPLETED ON: FRANCIS H. OGDEN Nov. 20, 1985 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): 113 W. WALNUT ST., RIVER FALLS, WI. 54022 CST 0565 I(Z CST GNA URE: iliS?° t 0B 2° ? 0' 0 nal a-i " :"pv _ocai ritY, Proper w`ner and ~o=~ TeateP. m. e"CTI OI -313 W Y 34-111M(-, TANK nNLY IF ALL THE _ TIC X Fit i H z y r S T C - 105 rr, a y SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County z 1 OWNER/BUYER~~IcttrGl1 ~`~~./~~1~l^/ © G-'~ ~~71r✓ H ROUTE/BOX NU BER l/_~e- Fire Number CITY/STATE ZIP PROPERTY LOCATION:,AIL , Section, T Z~N, RW, Town of t.(,c✓ St. Croix County, Subdivision TL Q Lot number Z 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. H I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- b 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.. yke- 0-1,~•-e~ SIGNED DATE ~I 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. 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 u.NGli vt G!~ ai~/!S Location of Property ;4 111 IJ 1y, Section , T N ~ - R W Township Gr?/ - - Mailing Address voe :3 3 C/ V -;f <0,F2 Address of Site / 1 ~ e w 35 ~ 1. /,v~ 61 Subdivision Name Lot Number Previous Owner of property a ~re .~tJ L6 Total Size of Parcel /r. ~ J:> Date Parcel was Created n~ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No X Volume 2 and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cehtiby that a.Qt ~statements on this boAm ane hue to the best ob my (ocuc) knowtedge; that I (we) am (a&e) the owneA(.6) ob the pnopeAty duCAibed in this .in6oAmation banm, by viAtue ob a waAAanty deed %ecohded in the Obb.ice ob the County Reg.c,sten ob Deeds as Document No. oo / ; and that I (We) pne/sentty own the pnopoded site bon the sewage di~spozs ~sys em (ot I (we) have obtained an easement, to nun with the above desCtubed pnopenty, bon the construction ob said .system, and the same has been duty tecotcded in the Obbiee ob the County RegisteA ob Deeds , as Document No. / (,D 7/ . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) l ~ DATE SIGNED DATE SIGNED .At . Parcel 020-1098-00-000 02/05/2007 08:55 AM PAGE 1OF1 Alt. Parcel 33.29.19.393C 020 - TOWN OF HUDSON Current Xi ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RE:526-7722 22ND FL L D S CHURCH TAX DIV O - L D S CHURCH TAX DIV, RE:526-7722 22ND FL 50 E NORTH TEMPLE SALT LAKE CITY UT 84150 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 545 STAGECi;~5 SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 10.330 Plat: N/A-NOT AVAILABLE SEC 33 T29N R19W SE NW LOT 2 OF C.S.M. Block/Condo Bldg: 6/1510 CHURCH BUILDING/PARKING LOT SCHOOL Tract(s): (Sec-Twn-Rng 401/4 1601/4) 33-29N-19W SE NW Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 708/462 2006 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/25/1995 Description Class Acres Land Improve Total State Reason OTHER X4 10.330 0 0 0 NO Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 OTST aged 9 'Ton .-+,mI;m- AZZ W u0sal0 ~1aeW Aq paldeap juawn.l3sut s141 A a 4 I 910hS 'IM NoscinH a m I hhE X08 'Ef '21'a 1 0110 'd.Hd3SOf OS 93011 '3~1 ana MOM zb*Lss 4213NM0 ,80'06' ,9h'h8 0..~9I44 I ONINNI~J38 , LA C' ,06 d01NIOd (n I i ICI Zoe IZ I D o to °e S\ W r c 4y O~ ~r I b ID I m yb\ z 1.1 I 0 K . o~CA C) Ch Im I H IN r•1<4~ O\ I I K 4'e~~ Ir I s I 1'0 N ':I'S 6Z£'t0E 6•~\ Iy I IN p S32iOt/ Z6'9 ~o I A T lOl 109£ 08 l 0 N I W m o 1334 NI TWOS Z I _ _ a6eae8 I ° v 0 X. I 0 A `Q asnoy o ; l~ Z IV.n ,9h'£h I r -0 ,6£•£Oh ILh'£8l m 3.. ILO'99 m i99'LS9 3i0£oLBN to Z I N r I ~ 0 N I Z 33111WW0OP CNINOZ Ow / I 106 ONtNNtlU SNIIYd 3AISN3H3Y4W03, 3iOSo69S A1N(lO:) mob, •1S ~ 00.09 5861 E T 2111W 1 11iNN00 ,0 fJt 1IA I 1 I1 ? M (I3AOHddd N Z 5ss~~I~dw I= v, 0 In 1 d A ca m 0 1 r call., x .11, :E 1w N r' m N 19 u, Im f7 I Z x 1 Ip m b 'd'S 9EL'09h I z n s3wov CE 101 Ir m z Z 101 a Z m 2 m 10 I C '17 x 00'05 s lost ,00'fi8L uL0i6£oLBN c >i ~00'h£s ~a3Hinos 1.dM-d0-1HOla A 3N1'1 Ca r-- 4 S d N y l 0 3 1 J. y 1 d N n s0 N'v2 a311V1dNN L Melt! 'N6L1 NISNOOSIM A!Nno:) X10210 '1S 'Nos(m d0 NPAOl I £E NOI103S 'A LN 'N6Z1. N01103S d0 h/ LMS 3F-Il d0 h/ L3N '80D b/I N 3HJ. aNV h/ 1MN 3H1 d0 h/ l3S 3H1. NI 431VO01 dVW A3.ANnS a31d11213O 10 44.4 6