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HomeMy WebLinkAbout040-1020-30-000 o (4 O m a C7 r~ 0 00 3 `+1 a o o 0 CD 1 d ' y^ 3 r• ~ O 0 0= N Z O(0 (n A A cC • 0 (0 :7 N a) C CP CD N -4 CD - (D 0 -P, CO N W N W ~n z C o p b O r (D p: ( j o o 0 CD CD - b (D CA C fD (P p o O v C-4 3 N T O C !r PPP ~ H N ~ p~ rs. (D H U> [ D CD 0 b N m cn CD a N N n C~ c CD c~ D cD oo O m 9 3 ° O o m 4- Pd 0 0 H ON O ` CD F~ ; , n H rt r CD 00 00 con o c (D ~o 'op C) Ln Q O O O Z o C7 r, I C 1-p ~ ~ ~ ~ < w Z O .3 . . . D Q. 0 Q O ;T CD !rl I Ul H ~ Q m C. CD C3,\ 00 N 7v m C) cn d. 7 O ~ U) D D o N O Z O n h • ci a O O CD ~ H ~ ~1 ri 4- c F'• w N' n 0 CL 3 ry rh z = Z m A 0 rt A Z o O v ,n o' (n N 00 m N) (D M CL z 3 o o fT cn j ~ I ~ A CD w ~ m n CD CL o - o=i c m ~ z a 0 CD N y A. A S A A 4 N A I O O a A 00 b w~ CD OQ a EA O w O `L O b p CD y O CL Al Parcel 040-1020-30-000 01/24/2006 03:17 PM PAGE 1 OF 1 Alt. Parcel 04.28.19.64G 040 - TOWN OF TROY Current X 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 O - CONNOR, MAUREEN D MAUREEN D CONNOR 516 FRANCES AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 516 FRANCES AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.600 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W 3.6AC IN SE SE LOT 3 OF Block/Condo Bldg: CSM IN VOL I PAGE 140 ORD Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1017/92 QC 07/23/1997 753/37 07/23/1997 695/617 2005 SUMMARY Bill Fair Market Value: Assessed with: 102164 342,800 Valuations: Last Changed: 07/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.600 63,500 266,400 329,900 NO Totals for 2005: General Property 3.600 63,500 266,400 329,900 Woodland 0.000 0 0 Totals for 2004: General Property 3.600 63,500 266,400 329,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 310 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R W 4 . ADDRESS f ' `f ST. CROIX COUNTY, WISCONSIN SUBDIVISION J LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J ~ SAS ` /A4 G a f ~ y Ri 40514 Pop sew s~~~tc 3 r3~ Jl'" INDICATE NORTH ARROW t~,i'~-rl.U!t h]f i~ ,rte. ~ ;•"F" c „ ff ' /G~ titOrS j- Joie 7' BENCHMARK: Describe the vertical reference point used G[)1:1 I S/,1? Elevation of vertical reference point: ~G 0 Proposed slope at site: t ^.lf- ' I rri~' ~~GL p / ~ uG SEPTIC TANK: Manufacturer Nc7";t/t C(,,'s~ Liquid Capacity: Number of rings u-&&d: ^ Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: a Number of feet from nearest Road: Front,©Side,O Rear, o feet From nearest property line Front, 0Side ,ORear, 0 feet Number of feet from: well J 0 building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: ~4-Liquid Capacity: Pump Model Pump/S±p+fari Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: / Lo Alarm Switch Type: A Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft Number of feet from well: r Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: 3 Length: rtf Number of Lines: Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of.seeVage pit elevation: Area Built: Has either a dr ox O or distribution box O been used on any of the above soil - absorbtior sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet fromxrl~arest property line: Front, O Side, O Rear, O Ft. `f Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: HOMESITE SEPTIC PLUMBING GO. RT. 3O'NEIL RD.: HUDSON, WIS. 54016 ROBERT ULBRICHT WIS. MASTER PLUMBER LIC. O 3/84 :mj MINN. INSTALLER & DESIGNER LIC. NO 0 00163 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL 12 ALTERNATIVE S'alePlanI.D N~mder (If assigned) ❑ Holding Tank ❑ In-Ground Pressure J-k Mound 85-06493 NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE L d Jim & arol n Shell R. R. 1 Frances Ave., Hudson, WI _ f~- BENCH MARK IPer manent reference P-0 DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. IT ELEV E SE Section 4 T29N-R19W Town of Troy Nornr n! Plumher. MP/MPR SW N,, Cn,~~~iy Sanitary Perini: Number 3307 St. Croix _ 69684 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIOUID CAPACITY TANK IN F F TANY )U L' FV (WARNING LABEL LOCKING COVER ^ PRROVj1DED. PROVIDED ! i„. _ rt_ ~LJ ~b YES ENO ❑YES NO BEDDING'. VVCENT MATE HIGH WATER NUMBt :~{,/F PROPERTY WELL. BUILDING VENT TO FRESH A yy ALARM LINE AIR IN ET ❑YES NO L_JYES L 'NO NEAREST-- I'•:/ DOSING CHAMBER: MANUFACT~HEH BEDUIN, LIOUII) APAC:I TY PUMP M(1()EI .)..1P cli r.tAN( 'r.71~HEH WARNING LABEL LOCKING COVER L J f PROVIDED. PROVIDED'. J' YES ❑NO DYES ❑NOIYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPERTV JVVFLL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN i FEET FROM NFII , } } AIR INLET PUMP ON AND OFF) II~YES _JNO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ~Inv~ rE H 41Ar1 F{IAI AND MAHKIN(I 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 n,TH hIP .IA(I )~EII D~ -PI `s LIOUID THE NCIIfs MA rE HIaE PIT DEPTH DIMENSIONS -HAVE(.IDPES EPTH FILL DEPT H OISTH PIPE DISTH PIPE DI vlr_ M NO I)ISTH NUMBER OF PROPERTY WELL BUILDIN, VENT TO FR ESH ~HE LOW ABOVE COVER FIEV INIIT ELEV END PIP S E P FE ET FROM LINE AIRINLET. I A _ NEAREST _ --r► MOUND SYSTEM: 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- iJYES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE Inlnra %l +nHKEf+s of;sEl<vnnoNwELLs J t _ YES ❑NO _©YES ❑NO DEPTH OVER TRENCH BED DEPTH OVFIT TRENCH HFD DE PTH ()F I()PSI)IL ()I)Df I) JEEDf I) MULCHED CENTER EDGES _ f ❑YES 9NO YES L_JNO ,❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: I~~ WIDTH LENL;TH NO. OF LATERAL SPACING (;RAVEL DEPTH HF LOW PIP: FILL DFPTH ABOVE COVER I7 BED/TRENCH TRENCHES I DIMENSIONS > J _ 2a " 1 1,5 MANIFOLD PUMP MANIFOLD DISTR. PIPE IMAN11OLD MATERIAL NO DISTH OISTH PIPE DISTHIBU IION PIPE MATEHIAL & MARKING ELF V. ELEV. DIA 'I T , PIPES / DIA I , ELEVATION AND DISTRIBUTION d VERTICAL HOLE SIZE HOLE SPACING DRILLED COHH FCll Y COVER MATEf{IAL LIFTCORHESPO N DS TO APPROVED PLANS I YES ❑NO -2``` __J YES ❑NO COMMENTS: PERMANENT MARKERS. OBSERVATION WELLS. NUMBER OF PR OPERTV WELL. BUILDING. FEET FROM LINES r OYES ❑NO YES ❑NO LNEAREST-- 14 4 c4, Sketch System on ?(0 ( T ' ain in ounty file for audit. Reverse Side. p sIC N t- TITLE f7/'~/g7~ D I L H R SBD6710 (R. 01/82) ~.a wlsconsln APPLICATION FOR SANITARY PERMIT COUNTY ~ DILHR s OEPRRTm EfIT OF (PLB 67) UNIFORM SANITARY PERMIT # ~ IfIOUSTRY,LR90R6 MUTRn RELRTIOfIs -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS PROPERTY LOCATION 1 /4SF1 /4, S T N, R r/ E (o W TOWN O ~ip0y LOT NYBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, STATE PLAN I.D. NUMBER S~-I /-/YO f s iPj CAS r9~-e 5-- C~ <o TYPE OF BUILDING OR USE SERVED X1 or 2 Family Number of Bedrooms. ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement ys em ❑ Revision ❑ Privy Alternate System U Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity tcx sb 0 C- ~~ZJ Lift Pump/Siphon Chamber AICGO 75-0 ~ X Manufacturer: 6,4_;ct0 TIF 'f,e 1'41'0 0C• PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): -2-6. 6 37 376e Private Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. --nikir' On Name of Plum4QW6 Signature- MP-/MPRSW No.: phone Number: wak~QT RD.: HUOSOCHWIS. 54016 RT. 3 O'NEIL Plumber's Addres d ) WIS. MAShR PLUMBER LIC. NO. 33 Name of Designer: TALLER & DESIGNER LIC. N0.0(1663 COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: El Disapproved t ` El Owner Given Initial i G7 X Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. ILHR PLAN APPROVAL Safety and Buildings Division Bureau of Plumbing P.O Box 7969 El General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266-3815 Plan Identification No. 14c, IV\ e 3 111 , fc C- Gallons Per Day 0, Ne-i f L' f,4 C PRIORITY PLAN REVIEW ONLY Plan Review Fee Received $ & e, Petition For Variance Fee Rec. Project Name 1 Project Location - Street No. or Legal Description ❑ City ❑ Villa County ge X Town of: 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 he made. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g 1"his 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. IV FOR PRIVATE SEWAGE PLANS: (1) (2) (3a) (3b) (4ak~ 4b) (6) (7) 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 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: James Sargent Bureau Director If Questions Plans Approved By: ti Date Approved: Contact zrlva~teewage Consultant ❑ Plumbing Consultant ❑ Environmental Health County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW-SSWMP ❑ Plumber Department of Agriculture Owner i iK ')BI) 60nv ;R. (11 85 F-1 Other PROJ-F,,CT SIIEET - S7(l G.o r X Ca-,, 'W NER : ►~M Cf~~C'D y S~f~~~ w i S A DDRESS : ni ~iP/3ill G E f oL7 /(J~ U,014A) G(~ /.S 11 SI`L';; i",OC 1TION; LO* CsAj l ~r~/~ U~'•Cvl~'S - d~, G/7 r PROJ MT DESCRIPTION: bGU~U~iPS ?,~,tl,(~iVOwi,V iy 13 ov - ff ~Io~tE wed A- U o ~~P c S ~>9 So~i/~t Sj 7-V o TEv 7 ~r,~ Sys 7'~'~ t , so;/s A ~,o SS c f L~~rES ro~~ /3. P, 4 7- y s to of S~t't~~ ~i ~0 as Eio~os ~o~e S y S Tom, y s ,0 11) D S01 'G 1'AG7~ 1. PLOT PLAN VIE~VS r `tG 2. MOUND CROSS S1sr"71 i_0?? & SYSTEI'7 P !1';T III?'i s rAG-{. -7). PIPE LATERAL l-j4.` 0l ' PAGE 4. DOSING OR S IPH(', ~~T C l !1MBER CROSS OITS PAG j 5. PUMP PER F ORr' .i?; SPECS OR ~7'ITC ;'T SP ;C RECEIVED • ~~F' ~ 1U~3 p>_UMBING BUREAU -)LUI,IBER : S IT JI.`,T': R or D}! ft HOMESITE SEPTIC PLUMBING CO. `i. 3 O'NEIL RD., HUDSON- WIS. 54016 [!rip,1F;Uf_ SEPW, i'i_UplMW, ROBERT ULBRICHT RI 30'NEIL RD.. HUDSON: WIS. ;YTS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ROBERT ULBRICHT MINN1 WTALLJ R & DESIGNER LIC. NO. 00663 ItfS MAS)J-R PLUMBER I-IC. NO, 3307 M P.R.S. Pn11NN. IN31Al tF-R & DESIGNER LIC. NO. OU663 DATE,:- 06493 S -r_-G ITATUR ~ ? o 0 ~w bo sm 1 m J a ~a ~r . Q ~ 1 J I a PLUMBING BUREAU / PLUMBING DEP_AR,7MENT OF INDUSTRY, LABOR AND KU'r~°a RELATIONS C S ~c 0 DIVI OF :VY AND UILDI~.a~ SEE CORRESPONDENCE L ' rn O -o ~ K N A C W~ (1\3 n n1 n ^ Q ~ , u b 0 x Page - Of - Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand ~G Topsoil H _ 3 E p b % Slope / Bed Of zy. Force Main Plowed Aggregate Layer g D Ft. PT NS E 3 Ft. AND ,Up;;~vr6 '1~ection Of A Mound System Using t LA~30R U"'WGS F • 7S Ft. OF INDUSIR~Y AND A Bed For The Absorption Area DEPARTP~~D'wptVi OF SAF G Ft. ONDENCE A Ft. H S Ft. igne EE, CORRESP B ~7 Ft. License Number: K /0 Ft. Date: L &7 Ft. a Ft. Alternate Position T /L Ft. of 850634-" Force Main W Z Ft. L •~VM Observation Pipe J B _ : ~.~t ~ : El 01 P~.U1 ING URCAU Imo'--------------------- A W ~o - - - .i Distribution Bed Of 2 Pipe Aggregate I Observation Pipe Permanent Markers y1' PvC."~ srEEC Olt-es . . 54. 303q Plan View Of Mound Using A Bed For The Absorption Area Page _ Of - G~sT ~/o% sET up kl'G-k T Perforated Pipe Detail UACUST oN End View )Perforated End Cap PVC Pipe 1 ee ~~o oe Holes Located On Bottom, S Are Equally Spaced / S x RGCCE(VED 5 P 3 0 1985 e P PLUMBING BUREAU Manifold d Pipe 30 ' e Alternate Position Of Distribution Pi p Force Main SLol~ED ~owvcv~}~PDS e I- Last L- Hole Should Be_J F'oiP G~EE7F Next To End Cop ~ ;T/GNU End Cap Distribution Pipe La9,out P 23 Ft. PLUMBING R X 30 Inche8 . 0 9 3 ~ F l"vDl1SZRY, ~ A 1 j pMGS ~E~TION~ Y Z/ Inches EO,~ Sgt~tEtT QS4 Hole Diameter OF 'AV r Inch Lateral / Inch(es) License Z~-QNDENGE ~.E Manifold Z Inches Date: Force Main 3 Inches # of holes/pipe /0 Invert Elevation of Laterals 76-' FFt. a)iSTPi t3vTroA-~ ~iPE ~I'Se~AP,V PATE a.S t ye kD f AT E0,[s S Ti "-I h? &-7 D D 1'S ~s . PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ---VEQT CAP 11"C.I. VEtJT PIPE WF-ATHEft. PROOF APPROVED LOCKING JUIJCTIOQ BOX MANHOLE COVER :N 25' FROM DOOR, WIIJDOW OR FRESH 12'MIU. - rA.JR INTAKE/ I GRADE `i'MI1.1. 9 7- ~ I 18" M I iJ . CONDUIT-- PLO F ~E~• PR 1r~ &I L E T w§ c FCI I I I I t~ ~ HUMAN I~EIAT►d III v PC IvP ,101iJ?S APPROVED JOIIJT A o LABOR AND INGS I III W/ P lNDUST`Y, ND BUILD I I WIC.I. PIPE RMENT DF SAFETY. EXTENDIUG 3' DEPA pIUIS10N .A II ALARM EXTENIDIIJG 3' ` ONTO SOLID SOIL OIJTO SOLID SOIL I B I I 3.5 CORRES 0 11 > Lc o no.~ I i o Q d c S E 9Z.v _ S ( E L C. V. FT. N AD PUMP I OFF FsECEiVED - i S c~lEv. ~3o rrdM D P 198 or- ThNK= 7/.33 PLUMBING BUREAU . CONCRETE BLOCK:RISER EXIT PERMITTED GULU IF TAUV MAIJUFACTURER HAS SUCH A PR 8500A6 SEPTIC E SPECIFICATIOIJS (13-0 DOSE W%~ SEIe GQ t C6"" TAIJKS MAIJUFACTURER; COv I.lUM,BER OF DOSES: ~ PER DAy r~ TAtJK SIZE: /5 0 GALLOMS DOSE VOLUME /J' 0 0~p• f V060 vol. ALARM MAIJUFACTURER: Ggu~~ /1I~Y/e~1 de- INCLUDING 6ACKFLOW:c- GALLONS MODEL QUMBER: G U' CAPACITIES: A= 25'1 IIJCHESOR ' GALLONS SWITCH TYPE: Gfzpe~ /Cl0'97- • B= Q~ INCHES OR 3S 6 GALLONS PUMP /1AIJUFACTURER: ZoE~~E~ _2_~T C= 0* WCHES OR GALLONS t~~E~2 _ i1- Hp D=~e INCHESOR GALLONS MODEL HUMBER. 20 VV SWITCH TYPE: -f lc)AT5 ~ MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OPF AND DISTRIBUTION PIPE,. //,6 FEET + MIMIMUM NETWORK SUPPLY PRESSURE , , . . . . . . . . . 2,S FEET } 30 FEET OF FORCE MAIN X 02 FTIOOFLFRICT1o►J FACTOR.. -32- FEET TOTAL D~3MAMIC HEAD = 7~a- FEET ROUA)p Dih~rT 3 s INTERNAL DIME.MSIOQS OF TAQK: - _;WIDTN --1--;LIQUID DEPTH A SIGUE D. _ LICEUSE IJUMBER: DATE: PA&E S T 17 H HEAD CAPAC.ITY CURVE CC ¢100, - 30 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING - SERIES 15,3-55-57-59 97 137-139 163 _ 165 28 M T GAL ;LTRS LTRS GA LTRS LTR GAL 9 L' RS 90 1.:2I 43n 163 248 1047, 394 231 61 31 3 216 as` Soo 231 61 . X31 EFFLUENT AND DEWATERING r~ 34 129 , - " 4.57 72 163 64,; 242 227 60+ 27 26 - SEWAGE AND DEWATERING 6.10 104 38, 136 223 60 227 85. 2 - - - 7.62 30 216 59 "%23 9.14 206 58 20 24 80 v~ 12.19 172 55 12-16 15.24 125 51 f J1 i 5.. \ ;k0 18.29 57 43 7,:1 22 t._... 30 ' ~,.4 21.34 \ 24.38 14: ~3 Lock Valve: 19' 24.5 26 66" 87 70 MODEL\\ MODEL 20 `6' 163 ` 165 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE \ SEWAGE AND DEWATERING \ SERIES 267 268 282 284 293 18 \ M LTRS LTr S GAL` LTRS LTRS LTRS \ 1.52 408 38 130 492 661 3.05 227 27995 360 598 ~ 55 - - 7, 16- 4.57 76 16 3 . ; 63 238 511 '0 . 6.10 30 125 4C1- 7.62 288 \ A 14 ..AA' - ~ 9.14 163 ~ -774 ?92 45. 10.67 60: z 1 z.;. ~ ~4 12.19 46 1S " \ 13.72 ^28 ; 06 - 124A0 V ► 15.24 12~ _45 s3 v MODEL Lock Valve e' 21 2635' 3J \ 1 293- 10__ 30 MODELS ell. 5 137 139 2 nou 6 20 MODEL Z~ ~ 284 4 15; ' MODEL Fs c;F R=CS MODEL 10 268 282 _ 1 0 2 MODELS 5 53, 55, - MODEL MODEL BING BU 57, 59 97 2S7 S ~GALS~~ V 10 ' 20 30x, 40 50 6J 70 ; 80. 90 ,100 110 120 ,`130 140 50` 160 1 t) 180E 190 ry ° LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of OfLLfi4' O. P.O. Box 16347 Louisville, Kentucky 40216 qp (502) 778-2731 Qua[/TY PUMPS ~NCE ~~iJcJ 8 C ouaT y Co d'y Pff 65' /of 3 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS \ MADISON, WI 53707 (H63.09(1) & Chapter 145.045) r el LOCATION:, SECTION: TOWNSFiIPIMkjfdt$tftiPc~{TY: LOT NO.: BLK. NO.: SUBDIVISION NAME: ss '/a '/a T29 N/R 19 E (a W Tipay _ 3 ~s~-► -~yo 17o~.~gs. COUNTY: OWNER'S 'S NAME: MAILING ADDRESS: S / Gcoi' ' ls~/'D L AvC; aD.t' 1(~74• -3 ~/y~~aw Cyi s . USE DATES OBSERVATIONS MADE NO. BEDRMS,: COMMERCIAL DESCRIPTION PROFILE DESCRIPTIONS: PER OLATION TESTS: Residence 3 N/4 ❑New Replace 16"'/. Z Z _1W POSfPQJE~ RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANI': RECOMMENDED SYSTEM: (optional) El S E DS DU OS Mu ❑S DU DS ~U IMo~~o o,~~y• If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s.H63.09(5) (b), indicate: v Floodplain, indicate Floodplain elevation: / 0,Ce- AoJACE~~` A e11y7-1J9 S/ s{Fy, PROFILE DESCRIPTIONS /N DE-C j'4A L ~ { . BORING TOTAI DEPTH TO GROUNDWATER CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) /7' f/ Si / ~1 ' L J . Sy 11 L Aj . Z B- 3• ~ 9 Q 3. 3. 25~ ,rt,• %.f,~i Sil,vD ~ ~S .5-2, /g,v. S/'/ wET w A/"S f/ c t- 0 'yelll1v ,Yo fs , fi r y(o ~ 3s . N'_33 1re4C{ LitiE /0 0,--- 3. r2. r i f ' C;N. Si/ I 16 QN • /3 oG~EJ' f' )j Jr' N . w 3.3 /7 /o 13AJ /S33 • /o C / wEfi Nods • Ar 3• yL ' ~ 3• 3 ~ o,v ca l ~ z r3 S ' Rc~ . /7 -o N0+S Sil.7$'/3N. , 58• R-4, S vz' (3.3. 512 3J 5,4A)1~D /ux 1 jF It T• 0K'• M T- /3AJ y, a . 0 ~ S D 3. ~y lft~_t vfv5E- sl No 0 3.15 'J a.wvf s A PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WAT LEVEL-INCHES RATE MINUTES ( NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RIOD 2 PERIOD 3 PER INCH I - i P- P_ r/t' oLA^' J h~4SE- of TEST P- s z- G Si E / 5 P- c c ~O 2/,S'~v bCrJw P=O rvi S~HEJ s i 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. t SYSTEM ELEVATION F- T-- - -i-- - - - - - I - L- I i I i I ~ i I I I ~ 1- ~ I I I I _I ( 1.. • I I i i I i i 46Y F r _ 1 ~ 1 t I I I I I i I j ' i I ~ i i i i 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 hest of my knowledge and belief. NAME (print): HOME$ITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON:: RT. 3 O'NEIL RD., HUDSON, WIS. 54016 A~ C 7l _2 2- - l Q d ` ADDRESS: ~ROBE `I t~f ~f T CE 111 IFICATION NUMBER: PIIONE NUMB ER(optional): WIS. MASTER PLUMBER LIC. NO. 3307 KRR.S. _0 1- y 1 3P/ M d ' CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. j' DILHR-SBD-6395 (R. 02/82) OVER o~ 3 10A 6:F DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 P.O. BOX 76 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPMr0TTrCtP*t{TY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sr 1/ '/a /T N/R I 7E (o TAE' oy 3 cs~-, -/5'o Uo1°, ys - f' t~ COUNTY: WNER'S)'HHYEWS NAME: MAILING ADDRESS: 150 ST • Ct,oi x ;'t 00e/ 3 fyvDSo,v USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: New Replace PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence A 1 1) ❑ 0CT• 2 Z- eY /V 4 t RATING: S= Site suitable for system U= Site unsuitable for system r--MA1,: ENTNAIEIAU YSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) s a s ou ❑ s ou o s au ~o~~~ If Percolation Tests are NOT required ~DESSIGNN RATE: I If any portion of the tested area is in the under s.H63.09(5)(b), indicate: CD• /N .AFloodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r i /,vc T o Ev~v~.v B- ~i~ L✓%yESTe.JE ~fr~Fc7u~Ep . /.3,~. 'u1~ ls, B- NOi t 13 o pE Lf &,i}3 Z, G' *Vsk 114 B a. . s . N r q-- t ~S. ce s sg KE- A 5' TZ B- B- SU~fACE' c'i-'af'T/a, 3 PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD1 PERIOD2 PERIOD3 PER INCH P- P- Z- 1 30 / L 2-- P- P- 2 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 horn 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 .,ercen! of land slope. 13070M 0-f 6qQ SYSTEM ELEVATION ( Pcckss~N~ `v f/ p ,Cr ) G,f r'6w'+1 w. V'6 eT-5 = 6.6-C, FT T_ T_ t)l~~ AC) E E . 3 Et E ; f s _ c. s i t...-...... i I _ i 7 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:: tinhAENTE IC PLUMBING CO. SEPr /CP - 017,5 ADDRESS: RT. 3O'NEILRD., HUDSON: WIS. 5401 CERTIFICATION NUMBER: PHONE NUMBER (optional): ROBERT ULBRICHT S--0 2 y p y 3 WIS. MA CST SIGNATURE MINN. IN3TALL1ER & DESIGNER LIC. NO. 00663 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - 4 use Iv~~A3{PAUM P, S!l tom 11 TA B a x,k1?~. i..,' i`_K S E S1 d,, :,,,t 1.1E a.# w~._ I Bs~' )-D i ~b ~ Ig Via.. i. a t ? " ~ , .•~Iel .Iris sz7v „~,1 ,s£; a{ I e e`, ~ . . , .h. ~~d s,,a tint} r t. f•'t f is~ ~~=1€ r~i .;ii , _E..,`,f It E6=F,~, `-i,t~r 9s9 and .,a L' ,I iC.fi t; E,,=a.ty ~ ter!., S' a€~<.,a ~~~;a as T(' date" can , ',wf. a4:i= lliood plain' p icola! lon tes, r. _ " ss(= o[)I Imss= - =ti`,~ ,aEr~f. zit ,good ,a€[ , f .,i,,._ r d4, , ;1i7f, r uz'-. the ippropt i,iie L i - fit a x Ppr~ i f i t LTF ya `'ll Ott - CC - rn ai,. fiRS~ ,~'g"3~t a ti r st ~ i z,, e• ,a. ~ • , 3 ".a t.r, ~T ~3i:~ .>?7S, .r ;t, =av r. T=,_ nfi-2Valrt= ,bet Ol pl;I S too lhr• I, i.. r sc„~ 't,e , .~t,a. ' F7 =;:rs~c.,~r . _ , t ~i~•il=~s~i=?~ . w P~G-F 3 o f ~ REPORT ON SOIL BORiN&S PERCOLATION TESTS IIS PLor PLAN PRo--Ec i r. D. DArE ) T - I Y ~5 ,y~p~- w ~ s syor ~ MO MESITE TESTING CO. vn 3, O'NLIL ROAD BOB UlJ;1,'jL't., A AUG.B:iONt WIS...... 54016 CST SS o2 Ye2 r, Sc,4 4r PROPOSED HOUSE MUST LIE 2~- Fr" at lotE FROM .41-1- nr5r ^ee.45. PRo POSE D WELL M vsr Li E 50F, r o,e MOPE' F'411 T£ST ~q~PE~4S, • = eAce/yo£ Plr3 Q = "/571W 6- wEG,- X ~E~G /OCg~"/ONf ~ = f fA,~~ f} v9 E~PED o,Q S~OdEL jo,~E S • ` f/oe/Z . 8 M ~/£~tjJ~/COIL ,PEfE~PtiiJfF PO%JT' T °~a ~Xi sTiv C~- LEGEND 64-1//fr0w o~ var. &,,C Pr. /oa o ~T 1 I ~ 1 f 3 /ao.~~►. O 8S - X33 3 5~ 20 E~cistwy l3, /32- . , yy xe 5 uRfA~~ t T. ~ QX f,P,4DE : /o 2 G 75- s v/f,4 Ale- lV,Q dl-~s ~ 5' ` ~ENf ~X • ;25-, 13 y2 lVg4 407" 0 I H STC - 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d OWNER / S_U' L c7 c~ ROUTE/BOX NUMBER Fire Number CITY/STATE 11OPS64--, '/D/ 'LIP PROPERTY LOCATION: 56 ~4, Section, T ZY N, R W, t Town of St. Croix County, Subdivision Lot number J ~10-f` 6F-5- I'S- 6 ,17 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 i 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 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ro 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. SIGNED DATE 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/contractpr,("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 SE S~ ly, SectionT 2 ° N - R W Township Troy Mailing Address &0T yi(~/9it1 GQ S •Q~ ^ /f V Subdivision Name Z/O zl&p . 6 6/7 Lot Number 3 CL , Previous Owner of Property Total Size of Parcel `3 d f .4a-e S Date Parcel was Created Are all corners and lot lines identifiable? / Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION 3 I (We) eentti,6y that at t 6tatement6 on thi.6 6onm ane tAu.e t the but o6 my (oun) knowt-edge; that I (we) am (ane) the ownen(6) o6 the pnop y duc i.bed in .this .in6o4mati,on 6o4m, by viAtue o6 a wa vmn ty deed neeonded n the 06 6.iee o6 the County RegiA teA o6 Deed6 a6 Document No . and that I (we) peedentf-y own the ptopo6ed Aite bon the 6ewaga po6 6y6tem (on 1 (we) have obtained an easement, to nun with the above des eh ibed pnopeAty, bon the con6tAaction o6 6aid 6y6.tem, and the Game had been duty neeonded in the 066ice o6 the County Reg,i,a.ten o6 Deed6, as Document No. JAI SIG ArTURE OF OWNER SIGNATURE OF,CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED