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HomeMy WebLinkAbout020-1353-52-000 /* , • Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 370234 Permit Holder's Name: ❑City ❑Village ❑ Town of: State Plan ID No.: 1 Cernohous, Jeff Hudson Township CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.: iOD j) d IN441 I id 11 y (rd <� 020 - 1353 -52 -000 TANK INFORMATION ( ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic A y ,' t IOW � : Benchmark , $ / /G ci Dosing P � Alt. BM S 60 95" 75 11111111111k III Bldg. Sewer d l/, 0 "S- Holding St/ Ht Inlet 0 11.70 ces p,P' TANK SETBACK INFORMATION StLHt- .Outlet TANK TO P/ L WELL BLDG. VAir entto Intake ROAD at i A 5ae et Septic ,• - ' CO S � " /5-' NA Dt Bottom (2 ' i� � 0 4 /� q- �/ Dosing ?j' ( .... ± L 2.' Z NA Header /Man. 2, 3 f43 1 - -.-- - - ---- NA Dist. Pipe * Z. 3P '9A 3 7- Ho dl ing Bot. System 3 . ) f 7, 7. S PUMP / SIPHON INFORMATION o wer I ' Final Grade Manufacturer G d , i i J --' 3 Demand St cover 0 3• JAL ° ?z , .f Model Number �. a-5 3q,..-pciPM �i Bpi /, U 14,4 7s 7-5 TDH Lift Friction S stem TDH I�. Loss .3 Head 2 Z2 ,� Ft Forcemain Length j 7 ' Dia. 2 " Dist. To Well SOl ABSORPTION SYSTEM ■� y �� / TRENCH Width Length N.. O Trenches • No. Of Pits Inside > . Liquid De: h 7,' E N I N 3 , „ D IMEN I • �` _�— Manufacturer: SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHI P'� INFORMATION Type O C - BER M - " 41, - r: System: yik ±Z`7" "7102 r © • RUNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) / / /� I x Hole Size x Hole Spacing Vent To Air Intake Length / / Dia. z/I Length 36 Dia. (�/ Spacing 4 1 /A r/ �� ' ` SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges [ Topsoil ❑ Yegi1 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepan ie , r on rese t, _etc.) Inspection #1: /zo /ad Inspection }: Location: r e`('n I-iiU fw-- Hudson, W1 5 16 (SE 1/4 NW 1/4 36 T29N R19W) - 36.29.19.2052 Cottonwood Ridge -Lot 52 1.) Alt BM Description =. ,../' 4m , (..tiv S• a e iv- NQu.,ai 2.) Bldg sewer length = 4 ' - amount of cover =S' r t �P� - f` °� area 3.) contour =4/. 6 : iG ,--7. y. sda ci t'ece 66h. Lldft c- Plan revision ( re required? 6 0 Y es No Q ❑ Use other side for additional inform tion. elm I, � � G � ( 76, ", SBD -6710 (R.3/97) Dat- Inspecto ignature Cert. No. • f ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: �m mo d® �oa € I i $ _ II _ E v 1 } { %., 1 �� ; 1 1 ; Ti; ; _ _� L „1. 1_ _ I 1 a ,, ..,,,_,,,..„._ _ T .,,,,_ ..._ 1 rair 1 I ; H i ; r 1 a Mai Nam 1 Ni kA l k .0111111.1 ail iiii 4-- 111: :' \ Ili a 1 11111 Rium. - - 0 ri .. - r 1 miti , - Aso_ 1 . aim . _ i a ... „,i irdli,,h/i �� mo w_ Ilribmr,6 ---f d mai I Fr_ I 11111 , _ ,,,„_,_ __I 1 Ell �_ lic • _ i 1 I a 4_, 1_4_ i II 111 ate._ _....�.. _ , .....,.. ,... {.. _ .... .......... �_.. _»..... - a..._. - _..... - _ _ ,.1., _..... „t , + 1 mi 1 - 1,_ 1 , , , /„.„„,,,,,,,, „,_ 2 g 4 ¢ 1 ii ii 1 , f is 1 _, _ __,.,_ ____, , 4-4„ -+,-4, , , , , , , im, i 1 1 1 1 4_ 1 IN . II m L H C�a F I� r 1 ,,. J r Vre Safety and Buildings Division SANITARY PERMIT APPLICATION 2D1 W Washington Avenue sconsin P 0 Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707-7162 • Attach complete plans (to the county copy only) for the system, on paper not less County . . than 8 in x 11 inches in size. i' TG Ycx i lC • See reverse side for instructions for complet this application State Sanitary Permit Number `�3 tip —rAA a . 3 U Z 3 7 Personal information you provide may be used for secondary purpos ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan Review Transaction Number L. APPLICATION INFORMATION PLEASE -*j--" TALL INFORMATION 3(Y ?2( Property Owner Name Property Location 4 T , N, R E (Or) ge Cc Cey>D,41,/, so -1/4 S s 2 � /P Property Owner's Mailing Adelress l Number Lot Numbe Block Number 4 /63•r T'� -e,o 7 -V c d/ 4 2 City, State Zip Code Phone Number Subdivision Name or CSM Number /4 A u Y2 ( ) G a - ' - 1I: P • F B ILDING: (check one) ❑ State Owned ■ Ityy ■ Village Nearest Road ❑ Public is,1 or 2 Family Dwelling - No. of bedrooms 4 / own OFty A s ' , . ✓ 1 d Gib k ,v *- Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) do,) 3 2 9 (9. Z GSZ ozo- 13c -1-4 -2 4 1 ❑ Apartment / 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 box on line A. Check box on line B, if applicable) • A) 1. A 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ystem System Tank Only Existing System Existing System - B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 [Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure / �\ 42 ❑ Pit Privy 13 ❑ Seepage Pit (P K 6 3 J 43 ❑ Vault Privy 140 System -In -Fill C,es- A / G 96.6 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area ' 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed Q ✓ (sq. ft.) (Gals/day/sq. . Min. /inch) ,./ Elevation 6 a' 0 ✓ 4'd d ✓ 5" 7 r ( I. Z AM-.- 7 7 - G Feet f 1 meet Capacity VII.. FORMATION in gallon Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Exper. Gallons Tanks Concrete glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank X 40 d 4210 D / f�/ 0 , 5 . 7 C ylJ a ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber, Y 0 roe / A rd .0G Si s,41 Eik. ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: o Stamps) PRSW No.: Business Phone Number: 41 ' 1 /r 6c AS .Scl. dllle., /.4+ ^ 2.279Cg 7eS —Fr ‘--q, / Plumber's Address (Street, ( City, S Zip Code): r• IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Pernik Fee (IncludesGroundwater Date Issued Issuing ent Si nature (No Stamps) Ij Approved ❑ Owner Given Initial Surcharge Fee) / �I `` Adverse Determination '' 3 Z - . ao 4/( -700 ,,.,_ X. CONDITIONS F APPROVAL R ( ((( CO O S O A O L/ /REASONS FOR DISAPPROVAL mi 4 ; *1 k rr (s` 44, el aa..r'e•', tst it s Se ." 1 Y 3 - o a,s p i - x, 10 - 0-1Q/c2 SBD -6398 (R.12/99) 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 a 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 and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe 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 on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 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; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ' a Safety and Buildings .. miri 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 IsconsIn www.commerce.state.wi.us Department of Commerce , a Tommy G. Thompson, Governor p ' , r Brenda J. Blanchard, Secretary May 12, 2000 r ti� CUST ID No.691727 € A ATTIC• POWTS INSPECTOR t ARTHUR L. WEGERER y ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Ideztifcaticin Numbers PLAN APPROVAL EXPIRES: 05/12/2002 Transaction ID No. 314821 Site ID No. 191509 SITE• Please re to both identification numbers, Site ID: 191509, Jeff Cernohous Proposed Residence above, in all correspondence with the agency. St. Croix County, Town of Hudson SE1 /4, SW1 /4, S36, T29N, R19W Subdivision: Cttonwood Ridge - lot 52 FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 661792 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a potential for a law suit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. r - • ARTHUR L. WEGERER Page 2 5/12/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 05/02/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim @commerce.state.wi.us WOW 63 T'1TL�. s L i • . Page \ of b MOUND SYSTEM • FOR A y BEDROOM RESIDENCE LOCATED IN. THE SE OF THE S>• 1/4 OF SECTION 3 b ,TZ N, R lq W, TOWN OF , ST- C-12.01X COUNTY, WISCONSIN. LoT SZ p� CDTS -\S INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PA GE 4 of 6 DISTRIBUTION PIPE LAYOUT • PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPA RED FOR C-EizivotU S 4. 6 3S "ilzekfro L Ctzat_E` N , p�yw y-1N Ss Li �Z f .ta. '.T.S• t In ditionally r P ROVED ART MM OF COMMERCE C as t S+ Y D BUILDINGS L • 4 4 v PREPARED BY , 110 �) R '= �'ONDENCE WEGE =D ER SQ = L. . TES S NG AND . osIs DES2GlV SSi�VICE �F� RECEILJEO BOX 74 421 N. MAIN ST. RIVE? FALLS. NI 54022 '� C r—o 16J 1 AgTHUR I ? /� y/ 715 - 425 -0 E(iF.fif_R } III MAY ". 2 2400 Y W 4n15P E{191ti'GRl'N. SAFETY vi - Z9 -Qd . JOB NO. - PLOT PLAN Scale 1 "= SO' Page Z of •� \ So' # P � , 8j / I . / U, Yyr - zisr 7 - - Pf= l7 rJ R6E \L' i41 LP re v W16 il 1. 1 \S„ P V C Nsv % Ttt s �RR . t bM 13f , • X00' OF iv i ' Z` QV Q 1 —, m i N nUtla 41,.6 G �: p11 OF Zea qiIIP ELq °_ i s rn spi el-co _ 1 NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. (9 required) 3. Install 4" observation pipes with approved caps. ( 2. required) 4. Septic tank to be Zoo /80o gallon capacity manufactured by W I1.bk) t ∎) Pjazcsksr, Luc_ 5 . Bench Mark %Mtki - Lst.. Lb() O ow ILL 'FOP LAIL " , 3M Li-Z.– et ,wo.n' 1 zpt lloc '2 ll 6. Divert surface water around mound to prevent ponding at the uphill side. - Page Of b Approved Synthetic Covering, Ft -1 C.3; Distribution Pipe Medium Sand Topsoil 0.0000. F " ; Elev. . ( /AA `I1//1Iillite S % Slope Bed Of 2 2 %2 Force Main Plowed Aggregate From Pump Layer 0 \.0 Ft. Cross Section Of A Mound System Using E \..4 Ft. A Bed For The Absorption Area F o•8 Ft. G Ft. A Ft. H 1.5 Ft. Linear Loading Rate = C . S GpD /LN FT B b 3 Ft. Design Loading Rate= 0,(1 .GPD /SQ FT I 1to Ft. J Ft. K 1) Ft . Alternate Position L Ft. of Force Main W SZ Ft. L 1 Observation Pipe -- A I _ - f yy c j -- -' Force Main Distribution Bed Of %"— 2 %; 2 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page a Of 6 Perforated Pipe Detoil 0 End View Perforated ..,}7 End Cap 1 PVC Pipe Install permanent marker a °` at end of each lateral Holes Located On Bottom, Are Equally Spaced • � S 1 PV C Forte Moin PVC Manifold Pipe Distri ution Pipe Last Hole Should Be I , Next To End Cop End Cap P ` Ft. Distribution Pipe Layout s y Ft. X 'fib Inches Y 118 Inches Hole Diameter 1 4 finch Lateral " ;PAL Inch(es) Manifold " Z Inches Force Main " Inches # of holes /pipe % Invert Elevation of Laterals 92 r Ft. BX1.11= GP+''1 Place 1st hole 24 from center of manifold with succeeding holes at -{$ intervals. Last hole to be next to the end cap. • Combination Septic :Tank arid PUMP CHAMBER CROSS SECTION AND SPECIFICATIOIJS ' PAGE S OF 6 i C • /'1 VEIJT CAP WEATHER Pit00f • i 1 JUIJCTIOLI 80X 4 VENT PIPE , ,A.- APPROVED LOCKING 10' FROM DOOR, MANHOLE COVER wt1 wIIJDOW OR FRESH ' T-- wARtulIJG LaOE[ A�INTAKE 1 ' i r „.. cokipulT 5 -x . J 1 _ . •', 4, �I I ? � GR11Di I 'i' MIA1 L' IB'Miu. ' "I:::2 I8 "MIN. - -- - `— 4____ INLET ) /A-t PROVIDE e...1 Y ---- — ____ .i____, _ —_— ►zRsttr e+� r'` 7 AIRTIGHT SEAL I ! ! a RPFLSS -r I \ \/� Approved � I I Approved joint w/• Tank construction �� joint w/ PVC pipe shall comply with - ALARM PVC pipe ILHP 83.15 and 83.20 Js II V C I au I 8. 5 LLEY. FL PuMP �I OFF CONCRETE 7 �Lev.83 -00. elocRH 1 ti: 7 -2 /3 . -X- RISER EXIT PERMITTED OIJLy IF TANK MAUUFACTURER HAS SUCH APPROVAL SEDOIN =FD BCDO I Nt; SEPTIC F SPECIFICATIOLIS DOSE TAIJKS MANUFACTURER: P\ `bk ) kI V T INUtABER OF DOSES:_ / `9 PER DAy TAJJK SIZE: \-0t l8 GALLONS DOSE VOLUME r ALARM MANUFACTURCR: '---- ZTIZ.O sL[ST leg INCLUDING BAGKFLOW: lb GALLON: MODEL ►DUMBER: \O\ lt) CAPACITIES: A= \ 900,0 IAlCHCS OR GALLONS SWITCH TsPC: 1`'1E1“8 8 = _ Z IAICHES'oR " 2-1 Ega.LONS PUMP MANUFACTURER: .100k--pS C= 8 IULHES OR \b8 . . 3-- )1 E' (1S GALLONS MODEL NUMBER: � 0= I INCHES ` R 1I 5 GALLONS SWITCH TYPE: JJOTE: PUMP AUO ALARM ARE TO ISE MJlJIMUM DISCHARGE RATE Y GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AIJO.DI5TRIBUTION PIPE.. N.3S FEET f MINIMUM NETWORK SUPPLY PRESSURE 2.50 FEET + \Q 0 FEET OF FORCE MAIN X _ _ F7 Oo,LFRICTIOU FALTOR.. _ FEET TOTAL DAJAMIC HEAD - 1a'Sq, FEET As per manufacturer Lads gal /in. Liquid depth 38 n m? N=.�zFO iuc�cvv - _or ' • Goulds 1 Submersible ,,t.....„,.„... . r� -p MODE 5 EPO4 �� _ ., ` EP05 • APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent wi uses: dry without damage to heat transfer. • Motor Cover: Thermoplas- components. tic cover with integral handle • Farms Motor Av ailabl for automatic and and float switch attachment • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Heavy duty sump 115 or 230 V, 60 e 0. 4 1550 models include Mechanical • Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. • Bearings: Upper and lower • EPO5 Sin phase: 0.5 HP, FE ATURES heavy duty 9 SPECIFICATIONS h ea du ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design 3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SA Canadian Standards Association ,"-' • Total heads: up to 24 feet. with three prong grounding _ • Discharge size: 1 1 /2 NPT. • plug. Optional 20 foot ■ EPO5 Impeller Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). • Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 - I l • Capable of running 1.15.„4--- dry without damage to 9 - 30 ---__: .-► 5 GPM components. I �` 'a_; c "1 Pump: EPO5 8 - j ... - 7 25 FT .04,.-] • Solids handling capability: o 25 /a maximum. w - • • Capacities: up to 60 GPM. s 6 - 20 1 q.S9 • Total heads: up to 31 feet. m I \ i 1 I • Discharge size: 1 NPT. z 5 - • Mechanical seal: carbon- c 15 3 "' `l rotary/ceramic- stationary, a 4 - / EP053 BUNA -N elastomers. o i • Temperature: I- 3 - 10 I _ 1 04°F (40 °C) continuous 1 EPO4' 140 °F (60 °C) intermittent. 2 - -' 1- 5- •`. 0 - 00 10 20 30 40 50 GPM • I 1 1 1 1 1 1 ' 0 2 4 6 8 10 12 m /h CAPACITY © 1995 Goulds Pumps, Inc. • Effective May. 1995 3 . Wisconsin Department of Commerce SOIL AND SITE Division of Safety and Buildings �. - ..- -•... Page 1 of S Bureau of Integrated Services in accordance,m6 s, 1LHR 88 p9 Adm. Code / . Attach complete site plan on paper not less than 8 1/2 x 11 inch,as.insize. PI n,•�n 4`,County include, but not limited to: vertical and horizontal reference poiM direction tend \ S'-k' • C--Y t X _ percent slope, scale or dimensions, north arrow, and location ind distarl#a,to nearest road. rcel I.D. # rr' APPLICANT INFORMATION - Please print all in4forrhation . -f� --. 41 ed by Date Personal information you provide may be used for secondary purposes (PNvacy LaN,Ceivi *Q4� 1 m)) : , a l 7 7 / 111 ,, Property Owner Property, L eatioyyt 1111 � 1 t Richard S-�-ou+ jw,, r Q vt: Loft gE 1 /4$ w 1/4,S 36 r TZ ,N,R IC( E (ore Property Owner's Mailing Address o Block# Subd. Name or CSM# I S53 Awca - Th. 52 C3+ Inwood P,dce ❑ City City State Zip Code Phone Number ❑ Village g Town Nearest Ro 41.A.dSon I W 1 15' - - IU LLo 1( 115 )59 -(c131 0 udt 1 C-1-/ f d NJ .New Construction Use: f..fiesidential / Number of bedrooms 3- Li Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow LO C)O gpd Recommended design loading rate • y bed, gpd /ft • Ir trench, gpd /ft Absorption area required f bed, ft /ZGY trench, ft 2 Maximum design loading rate •y bed, gpd /ft . trench, gpd /ft Recommended infiltration surface elevation(s) 9E. 30 ft (as referred to site plan benchmark) Additional design /site considerations Cop - f7hir elev 97. 30 Parent material ( ...�1 1 act Ct.) O UT wash Flood plain elevation, if applicable 1AJL. 992.0 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S [e-t, E 1 ❑ U ❑ S 119-0* ❑ S R'0 ❑ s E hj ❑ S E'0 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 3 l I p y r 3 /�- --- L, S \ m. m �-S t 1 2 2B , - t3 lOyr LOP rnS `U' S9 MI cs . -- .1 . $ Ground 5 43 -(.06 1 Dyr 3/q CZp "1. 5 y ryI ( a SiI 1 mabk me--c; c-S -- Np . NP elev. Depth to limiting , factor 43 in. ' Remarks: Boring # 1 v -Lp 10 yr 3/1 St. I mabk ►rr - Cr CS 1 .Iry . y .5 Z 2 . -24 17 I r`Il 4 LS irr9 rnI cs - .1 . $ 3 Z 10 yr 314 C24) 1.5yr `-f1tio S1t \ MO T m r C 5 i, ; @ Ground VS. (0G 4-5.',, elev. 7 5 1 Depth to limiting factor Z'-f in. Remarks: CST Name (Please Print) ? Signature Telephone No. 4 - a,,„ 5 c men _ - 47��Ir► — L 2ef I Address Date CST Number Lkc6 Ceder 51-. I`i 5 omerse4 4 lA)1 5yo25 `i-15 -99 25?)309 1 'r SOIL DESCRIPTION REPORT ? PROPERTY OWNER SIC, c 1 + Page 2 of PARCEL I.D.# Boring # H orizon Depth Dominant Color Mottles Structure G D /ft 9 Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench - 3 0 -$ to 3 // ` SC i•�hk mfr �� I V • y ' 5 2 7 -24 1©yr yl4 -- L-S ( ( cS - G •'t- '�' Gev round 3 243 I b yr 3 /`f (2.p 1.6-yr �!/(o 6 . 1 mabk -- - Ls — g7zoft. Depth to limiting factor 24 in. Remarks: Boring # Ground elev. - - ft. Depth to - limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ........................... Ground elev. ft. Depth to — limiting factor in. Remarks: Boring # .......................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) r e- 3 4-.3 S1 �v�f ea-Fk,r.,wnod 42 :141 i a Irv. 13ev\l elf-v• loo .0 TO of / "$'Pon pipe. s6 sc N Sy Alton P tea. 9r 30 t ,eU. 9730 h bL QI pint. ST CROIX •OUNTY SEPTIC TANK MAINTEN • NCE AGREEMENT A OWNERSHIP CERTIF CATION FORM Owner/Buyer 7e f F C e Yti ahoets Mailing Address 4 ./4 3.5 Tv cA to,) r ,`1-- ■ .e- ,J p h .c) . '"S5' - Property Address ' > ' .Aratior +rd !� 3 i ii a �' . 1-4/ (Verification required from Planning D for new construction) •• ( 1 4: r 1 City /State / ,,■ Parcel Identification Number 6.2 D /10 P — ?o -0 LEGAL DESCRIPTION Property Location Sc Vs, SA r/., Sec. 34 , T :2* N -R / W, Town of / 4 .4i . Subdivision G a Z` '-t) 1-.Jo a d f : o9 - e--- , Lot # -- 5--- . Certified Survey Map # , Volume , Page # . Warranty Deed # /6' 6 / . Volume / 4 1 1 5- S , Page # ( 2 . Spec house ❑ yes EL no Lot lines identifiable ayes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the ivaste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed umper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pump' . : (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to .. intain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the De.: ... nt of Natural Resources, State of Wisconsin. Certification stating that your septic system has . . maintained must be completed and returned to the St. Croix County Zoning Office within 30 da , of the three -- exp ti < te. / / s / .2.174, 0' ' r «A • '' i F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all ment o is on this form are true to thei best of my (our) knowledge. I (we) am (are) the owner(s) of roper r j ribed abov .y j•'e of a warranty deed recorded in Register of Deeds Office. A • ' i APPLICANT DATE *** *** Any information that is mis represented mry result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' ' • A 4 • VW 1 - 55PAGE 122 10 STATE BAR OF WISCONSIN FORM Z - 1998 7 IE. 1. COCO 1 - la KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number _ RECEIVED FOR RECORD ThisDeed, rnade between _RICHARD and 09-08-1999 9:30 AM JANET 2.. STOUT,- tu-Lsband-ancl___ wi , VARRANTY DEB) EXEMT - , Grantor, CERT COPY FEE: COPY FEE: at141.1ffERE.Y.__J ,_CERICILLOU-S. and KRISTI_IL TRANSFER FEE: 161.70 _ _husband and_ wife , RECODINE FEE: 10.00 PAGES: 1 , Grantee. Grantor, for a valuable consideration, conveys and warrants to Gtaritee the-following described real estate in ,_ ,,, Croi x County, Stare of WiSLUI Lot 52, Plat of Cottonwood Ridge, Town of Name and Return ijddress Hudson, St. Croix County, Wisconsin. E41"tge- J Q . LP 6.4 (.1_ 020-1108-70-00 Parcel Identification Number (PIM This is not homestead property. (ts) cis not) Exceptions to warranties: easements restri_c_ticins„ rights-of-way and covenants of record. Dated this lst day of Se-ptclaber , 1999'L • • Richard. 0. Stout (SEAL) Janet P. Stout . _ (SEAL) __________ (SEALY _ (SEAL) AUTHENTICATION- ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. • a (k-- 410-4- 7 a - Parcel Identification Number (PIN) This is not homestead properly. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 1st -day of St=pteITLbe*r 1-9-9-9 • Richard O. Stout (SEAL) Janet P. Stout {SEAL,) *�� .� (SEAL) — . (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix Cotmty. authenticated this -day of Personally came before me this 1 St day of September 1999 _ , the atx>ve named Richard O. Stout and Janet P. -St-out - - TITLE: MEMBER STAI EBAR OF WISCONSIN _ • _ .- _. to (If not. ttte 40,own to o ' _ Y the fomBoing authorized by §706.06. Wis. Stats.) and ac� ' •' . , BAST THIS 'INSTRUMENT WAS - DRAFTS -0$Y - - -- - - - Janet P. Stout . 1353 Awatukce Tr. _.. 4 0l b Notar ' ublic, State of .fa onset Hudson, Wi. My smmissio is permanent. (If not, state expiration date: a O (Signatures may be authenticated or cknowledged. Both are nor v ( _ __ ) necessary) Names of persons signing -inany capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin legal Blank Go.. Inc. WARRANTY DEED - TORN, - No. 2 - 1998 Mlwaukee. 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