Loading...
HomeMy WebLinkAbout030-1011-30-000 r tr (D EA C) EA O 6F) �O 50 c a r. 3 N m N X a E� c m=om Uso "D d I 'T ' t O 0 CD CD •C C 0 N E 3 2 G a cc 0 O — E L �_ > m (n m ° - E 3 L O7LL N C O 2 ago c (D $ CD �m �� ° 'ma�E O U Cti 00 C V N `p a = Y O Ny E. @ w O U y Co m °' E C A O a a) i EG of E o mN`— o (n 0 oo0y� z oa z �c z avi c c> LL c L L a y n d j LL C `U- G LL C O f � N � A 0 Em o (D :3 o �E E A N m > Lo Q 'nN �_ N E Q U ni E Q C N Nd O O m 0 m O 0 N Q N N N O W E E E O O O LL Z � E a m a m a m M H c G c C7 0 6 O Z d' C U c U r O p N O ' V m z a r c m m (D U v � > _ m } O O C N O N 7 m U V 7 C N n N N a (n L O 7 L O .0 CD cn = c a U U N c _@ O o zmz o a.zz z N Of co z c v c c c O Q` o c O o Q` > N Q �p O d U J O W d N W t d 4) N_ D O d a ro G G G G1 G a A) u CL CLI 0 0 0 z c 0 0 0 0 0 0 0 ry 4i O. O. m N 0 Q. m m G. d CL N m _0 c 0 5 r U N In CL U d Z m rn rn } :3 O o } r r O r r N N 0 0 0 — N O N — O N N r Z C:> 0 rn E i`n � v d o o o o o i co m m O ���1 N O 'O yr y g .21 Z 412 cu U 'O 4 : Q ?- J3 a Q n `a" o O C O N C Q E. N C N C +'' O O O O 1 0 E N O O O O O~ E U o G U 0 0 m m s. r ' a 0 N m m n m v m N N CO C7 t ' o 00 n z a M W X ' O N M t N_ `? = � O �_ pp : E E �v 7 �' 0 0 U) = N N z N m z " Ln > Cl) O '� N1 m F' - m M 0 z N z �e ,a a d o m a CL �, y ° r'' m a A v a 0 n 0 0 w v O N CO3 c w o h. N � b Wj O C I o c I'. w i j i v C d V oLD �m I N C 0 , 2 6.0 a, o E y CD N aa) I o c a z o Q I W m 'm LL c w } O N N N -0 y O E Q N L CL N I O 7 II N I 6 , w E � a M c�'n o I o Z .0 . 03 w m z U c o I ca N z _ m E N L M •� O L : N O c O Q N z s z �) d : I N I O O CL C d �J U ro N aA z 1- I- I- 2 2 - O 0 0 0 0 Z d C m a = I j a I M J V O o o � g N j C> 0 't� c,, m) 4 M y y CS) O N M e- I (� 10 �j C � ul C +. O 3 c p a C E CQ O O d O O C O 'It 00 � L L a E O - N N y Q '- O C C� C O O t0 M CD C: 0 0 O j C O N 0 0 a C N C3 m O ar �+I O N "7 Q O .0 Cl) • O ''i' O O (n co O z N z 0 (n GC i Rl Vi a; m pd, 3 at n ti a • c�3 a m `try i t� 3 t A c a o in v " COMMERCIAL TESTING LABORATORY, INC. f 514 Main Street, P.O. Box 526 f Colfax, Wisconsin 54730 �4A f 715 - 962 .3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.1 24487/01 PAGE 1 ST. CROIX COUNTY REPORT PATE: 6/22/92 COURTHOUSE DATE RECEI ED1 6/18/92 HUDSON, WI 5 016 ATTN1 THOMAS C. NELSON (q OWNER: Joanne Swenson �• /' LOCATION: 615 Old Milt Rd., Hudson COLLECTOR: M. Jenkins DATE COLLECTED: 6 -17 -92 TIME COLLECTED: 2:30pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED:6 -18 -92 TIME ANALYZEDII2:00pm COLIFORM: 0 /100 ml INTERPRETATIONI BacterioLogicatly SAFE NITRATE —N: 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Conform Bacteria /100 ml Nitrate- Nitrogen, mg/L LAB TECHNICIAN: Pam Gave °F .WDEPEpO fN, � WI Approved Lab No. 19 A � V I A° < Means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 r w I i ST. CROIX COUNTY ZONING OFFICE �ropLL St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix county Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion p-t this form iq essential &Q V= #fig property can Dg located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING - - - - -- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE:, $25.00 (Determines if system is properly functioning at, of inspection) {' PROPERTY OWNER'S NAME: �O G� t�ine I o • �I 0 /� ( cQ tR t . ADDRESS � t � I CITY Legal Description 1/4 of the 1/4 of Section , T N -R Town of Lot Number Subdivision: FIRE ER _.LCK BOX DER _ Color of hou i lj -C a,. Y yQ c� -- se. Realty sign by house ? so, list firm: f S'� h f d -R-I i X c, v (c c �cQ f i s o PLEASE INCLUDE, IF AT ALL POSSIBLE, A KAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the I I test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this i is the case lease p make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number to 40 (2� REPORT TO BE SENT TO : v w C w oa g P, c � .ta s w CLOSING DATE: I Z S z Signature Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 136 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: CRC Health Corporation I St. Joseph, Town of 030 - 1011 -30 -000 CST BM Elev: Ins BM Elev: BM Descri tion: d J Section/Town /Ran a /Ma No: Insp. / p . 16 f J t 9 p (� 03.29.19.55D TANK INFORMATION ELEVATION DATA kfv .,-,.c _ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben hmark 6VIA t 3. (, r A53 C9 166 Dosing ,, G Alt. BM Aeration J Bldg. Sewer Holding St/Ht inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing x 5 Header /Man. 1 7, Aeration lJ fit. �j�1� -7. Holding �� �� '� �� �� � f S t-• tl- S Final Grade -^-- PUMP/SIPHON INFORMATION �, ��,('• Manufacturer Demand St C er r GPM v— 157-77 g` _ Model Number xt 5 I N TDH Lift Friction Loss d' Sys m Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �� — ___, SETBACK SYSTEM TO t n LDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM T t to Air Intake Pipe(s) Header /Manifold _ q ELength ribution x Hole Size` \\ Length Dia Dia Spacing SOIL COVER 6 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 Yes [] No s Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: I I Location: 615 Old Mill Road Hudson, WI 54016 (SW 114 SE 114 3 T29N R19W) metes & b nds Lot Parcel No: 03.29.19.55D 1.) Alt BM Description = ~V t �•Y �' ► 'by �,JO ar / CUd �C ( C 2.) Bldg sewer length = 1 J fir' i 5 � • [�° - amount of cover = Plan revision Required? Yes No �� Use other side for additional information. %._ _�__� L SBD - 6710 (R.3/97) Date Insepcto s Sign re Cert. No. Y Sanitary Application Sanita Permit A lication ST. CROIX COUNTY WISCONSIN 1 In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING &ZONING DEPARTMENT Personal information you provide may be used for seconcloW ST. CROIX COUNTY GOVERNMENT CENTER [Privacy aw. S. 15.04(1)(m)j X 1101 Carmichael Road y Hudson, WI 54016- (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # 013 ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: Property Owner Name ,/ 1/4 .54-)1/4, Sec 116 a G. 2 � 0 2008 .2�' N, R i 9 Z* jr W Property Owner's Mailing Address Lot Number Block Number C ST, CROIX COUNTY NINE FF10E City, State Zip Code Phone Numer .j6 -(dZS Subdivision Name or CSM Number 95'01' 262 - x ° 44- 11 Type of Building: (check one) 03ity ❑Village own of ❑ 1 2 Family Dwelling - No. of Bedrooms: --r— (� Public /Commercial (describe use):C0#? &*yj ❑ State -owned Nearest ark 11. Type of Permit: (Check only one box on line A. Check box on li e B if applicable) Our'` �' Parcel Tax Number(s) A) 1.10 Repair 2. ❑ Reconnection 3. ❑Non- plumbing 4. ❑Rejuvenation I Sanitation 1 030 — ld // 30 _<Z�D B) / Permit Number Date Issued Q State Sanitary Permit was previously issued 3 83 " © .3� Q �� � 2 0 . IV T of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound Z 24 in. suitable soil ❑ Mounds 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1, Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade 33 9 Required "u Proposed t '*.g (Gals. /day /sq.ft.) (Min. /inch) X � ; Elevation VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ 13 C1 h� cst` ❑ ❑ ❑ ❑ VII. Responsibility Statement i, the undersigned, assume responsKworfothe r rep it /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift re in tallation of non-plumbing sanitation system. EPiumber's ame pant Plumbe ' Signat ur s : �1MPRS No. Busines Phone Number 5 Z - 7 !Q ddress (Street, City, S Zip Code) . ouny Use Only d Sanitary Permit Fee D e I ued Iss gent Signa (No s ps) Approved O In i verse ��� �� 11 �g IX. Conditions of Approval /Reasons for Disapproval: I M 4 a^j fe / evae iker.�e,r5 o& /� C Fn, � P.+'l.� v l , G,. X. Jr �� b,vt� r�l... or j,,1c5�- S 5 k 5 y U dcs r ' , 5 wo rk- W0,5 (' M� a1� a � S�' rdaaQ,. Rev: 8/05 i tip CiYistci'ng EX�S�In�r !� �° Pu.,� cfjL,..r ber s- "�'ce,•nw:n ,��Pssn4.3o39� ._,. �.. f7 ° t � E36•.hafcd �.►''s&nq // ltouJcepih yc c�n kle-- ea^eSfer . �,•� (/ E,riS�J � � • 2 � N q�iRSC � I V� D �i�' Pi'opo5edce��es�G,+�e. �• `� t'- lcSEt�m "7 kok. " di.5flib A " A'i j dk .�esie%n� 7 -S% jrav ;�ydsf 'Ecssferr�" d:5,4e � �'XIS�in� di ✓c5ra► -� da. -Qd�'. d,'spe�sa/ cell ✓es. � �c .p- D / cl KOa.� ]COPY s: 0 P f� � EX�SElnS - m Esb•.na�cd .� ",1s.xM• G � +'n z�aba / / .4 -��o �loused"ih�yckc/"7I��dCc +� C/ gre4seraP �eSic%+►eQ � �- ��rav;�yd ;s '�axEe.•.r° // CX�'s�H� �;vtsivt -t da.QJ�. Qi .5 C /Sa / cell �c �O a.e( w C N s i s N I n 1 I 1 I P.. _! •. �! I 1 I I I I I I 11 OO s _ I J I N N I � s I I ; — . i�•I ' F I i < I 1 0 0 OD X W P r Z W m N� DSm m - i OC �0 OZy 0;u m c 0M (A0M O m M� ca n 0 v C M e c) � D U) I 1 c� 0 0 - p —I I I o 0 � M X K - -� - - -- -- -- F m D 1 _ C7 m N -1 M I D I - Cn �g �! z cnNa) 0 �D crr ��o�� N Z I r r o Y M ACE SOILS MHER NINCIET E DR = 1' D Ll \ � ALE:3 4" REV N0. ATE: m PROJECT: ? ?? DRAWN BY:SWT A LOCATION: ? ?? � z W3716 US HWY10. MAIDEN ROCK, WI 54750 DATE: 10/29/08 ° 715- 248 -7767 800- 325 -8456 FILE: custom boxes 2008 ACE Solis custom dist box I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ���� OWNERSHIP CERTIFICATION FORM Owner��+er 6'e e- t/ea�� Mailing Address z 0 Y , 20 0 5 - 61 1 2-7 J Property Address &/S 0 %/ IV;// eoae� (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 030 / °//-30- Coo LEGAL DESCRIPTION Property Location 5 e- ) t/a , 15�-3 I /a , Sec. � , T 1F — N R Town of .5e. Subdivision 4A ,Lot # . �/. 702 &e-/-eAc-/ . ,Volume- — , Page # Warranty Deed # , Volume , Page # Spec house no Lot lines identifiable SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num of bedroo Xt&AffJ OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS SERVICE CONTRACT The proper operation and maintenance of the components listed below will significantly influence the performance and life expectancy of the POWTS (Private Onsite Wastewater Treatment System). This agreement authorizes A.C.E. Soil & Site Evaluations, L.L.C. personnel (Service Provider) or their representative access to the POWTS components during regular business hours to perform regular inspections and routine maintenance of those components. It is herby agreed by and between Owner and Service Provider that in consideration of the payments provided for herein, Service Provider will provide a manufacturer trained and State licensed inspector to perform periodic inspections of the POWTS components as set forth below. Service Provider will prepare a written inspection report after each inspection containing any recommendations for the operation, maintenance, and or repair of the POWTS deemed appropriate by the Service Provider. A copy of the report will be provided to Owner and the appropriate Governmental Unit. Service Provider will supply additional services, parts, or labor only after authorization by purchaser. This agreement does not assume any responsibilities or obligations that are normally the responsibilities and obligations of the Owner and does not cover any costs associated with operation, maintenance and or repair of the POWTS. In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property, or incidental economic loss due to equipment failure for any reason whatsoever. This agreement will be automatically renewed each year unless amended or cancelled by either party with 30 days written notice. This agreement may be cancelled by Purchaser only if replaced by a service contract with another service provider authorized to inspect and maintain the specific POWTS components in question. Purchaser agrees to pay Service Provider the sum of $ 12L.00 pe r inspection. Two (2) inspections will be completed per calendar year with inspection fees billed at the time of inspection. Any additional fees for effluent quality testing (if needed) will be approved by POWTS owner prior to sample collection and submittal to lab. POWTS DESCRIPTION: Two existing Conventional POWTS serving the "Burkwood Residence'. POWTS LOCATION: 615 Old Mill Road, SW' /4 SW' /4, Sec. 3, Tn. of St. Joseph, St. Croix Co., WI. Parcel # 030 - 1011 -30 -000 Owner name and address: CRC Health Corporation 204000 Stevens Creek Blvd. Cuperti , CA 950 / /A/`P`/ r signs ) (Date) Service Provider: A.C.E Site Evaluations, L.L.C. J s K. Th mpson 40 Paulso ake Road sceola, 5 ice ProAder signature) (Date) Instrument Drafted By: James K. Thompson ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the �,Pc ,���Gz� --, �-► rye located at: S cc� ' /a, SeJ ' /a, Section 3 , Town 29 N, Range 19 W, Town of ��_ �S , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service Did flow back occur from absorption system? Yes No-)C (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Ma urer (if known): l z e �.► of Ta k (if known): l�(''nor�n �e icensed Plumber Signature) (Print Name) (Title) (License Number) Z&P/MPRS ,r/!t: (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING TANK 7 This is to certify that I have inspected the septic tank presently serving the CPC ,��a L�,o -, ze*W#Pee� located at: 6o ' /4, 540 1 /4, Section 3 , Town 2-F N, Range /�F W, Town of ��. � , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 24e)3 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete X Steel Other Manufacturer (if known): u); esei Fart , f Tank (if known): o?��cacs - inS�c al 15 icensed Plumber Signature) (Print Name) (Title) (License Number) /MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) I I {IIIII {N�l 41{�I 111�! Ilia{ {�I {l ! { {l IlII�! { {II IIII * 8 8 1 5 1 1 1 STATE BAR OF WISCONSIN FORM 2 - 2000 Document Number WARRANTY DEED KATHLEEN H. WALSH This Deed, made between Herbert E. Blaisdell and Lisetta M. REGISTER Of DEEDS Blaisdell, husband and wife ST. CROIX CO., WI RECEIVED FOR RECORD 09/17/2008 10:15AM Grantor, and CRC Wisconsin RD, LLC WARRANTY DEED EXEMPT II REC FEE: 11.00 TRANS FEE; 1296.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: PART OF THE SOUTHWEST QUARTER OF THE SOUTHEAST QUARTER (SW 114 OF SE 1/4) OF SECTION THREE (3), Recording Area r 1 TOWNSHIP TWENTY NINE (29) NORTH, RANGE NINETEEN (19) Name and Return Address WEST, TOWN OF ST. JOSEPH, DESCRIBED AS FOLLOWS lJ l}THHN�Ec N/t iNCK Commencing at the Southeast corner of said Southwest Quarter of the Southeast Quarter; thence West on the South line 478.37 feet (recorded c< NErtLro 6k outa, 2AIC,. as 486.5 feet); thence N30 0 40'00 "W 633.00 feet to the point of A�i0 40 6 S>�r•tre��� a Q-� e-604, 5i_u.tL GM beginning; thence continuing N30*40'00 "W 264,80 feet; thence L CUPE1211110 " 9 O / N59 "E 283.50 feet; thence 530 "E 264.80 feet; thence Gg� S59 0 20'00 "W 283.50 feet to the point of beginning. 0304011- 30-000 Parcel Identification Number (PIN) This is not homestead property, 4w) (is not) Exceptions to Warranties: easements, restrictions, and rights of way of record, if any. Dated this 5+ day of September 2008 * * Herbert E. Blaisdell 4� n * * Lisetta M. Blaisdell AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. t'd „ PIERCE County } authetitica f ih l day of Personally came before me this S day of �� „ , Sepotember 2008 the above named �1 - Herbert E. Blaisdell and Lisetta M. Blaisdell TITC;E: Mfi`jt•StATE BAR OF WISCONSIN CHARLERE A. LARSON to me known to be the person(s) who executed the foregoing � authorized by § 706.06, Wis. Stats.) " 01 "I PU instrume d acknowI dged Pe same. State Of wisco"In THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles - Attorney at Law Notary Public, State of Wi River Falls, WI 54022 My Commission is p rtn nt. (If not, state expiration date: (Signatures maybe authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 2000 INFO-PRO (800 )655 -2021 www.infoproformS.com loll NON - RESIDENTIAL CONVENTIONAL POWTS EVALUATION BURKWOOD RESIDENCE Community Based Residential Facility INDEX AND TITLE SHEET Project: Burkwood Residence - Community Based Residential Facility Contact: Herb BleiSdell Address: 615 Old Mill Road Hudson, WI 54016 Site Address: 615 Old Mill Road, Hudson WI 54016 Legal Description 9 SW1 4 E1 /4, Sec. 3.,T.29N.�„ R.19W Tn of St Joseph, St. Croix County, WI. Subdivision: Na existin 1.72 acne parcel Lot No.: Ne Parcel ID Number: 030 -1011 -30-000 Plan Transaction Number. Unassigned Index and title sheet Page 1 Daily flow calculations Page. Summary & Management recommendation Page 4 Wastewater flow calculations Page 5 Site Plan Page 6 Attached soil evaluation repo Pa e 7 Designer: Jam es K. Thompson Credential Number: 30021 Signature: Phone: (715) 248 -7767 Date: April 23. 2008 T000 '1dA3 31IS V 110S 3 0 V b9LL 8bZ Sit YVA WtT QnnzicZiun \ P� ,) ` Burkhardt, Inc. Daily FLOW Calculations JOR DESCRIPTION, Evaluation of existing pOWTS (Private Onsitc Wastewater Treatment System) serving Community Based Residential Facility. The Eastern most dispersal cell is a dose - conventional system consisting of 7 trenches using high capacity Infiltrator \` "Sidewinder" chambers. The cell was designed to accept all and only bath and toilet wastes, totaling 1,800.00 gallons 4 a ' per day design flow. The cell is currently receiving 1,647.40 Gpd as installed. The Western most dispersal cell is a gravity flow conventional system that consists of 4 trenches also using high 0)' capacity Infiltrator "Sidewinder" chambers. This cell was designed to accept all and only kitchen and laundry wastes, totaling 1,026.00 gallons per day estimated flow. The cell is currently receiving 531.01 Gpd as installed. The soil evaluation report on record at the St_ Croix County 'Zoning Dep't. indicates that sandy soils are present that will accept 0.7 gpd/sq.ft. The soil evaluation that was completed as part of this system inspection indicates that sewage effluent should not be applied to these soils at a rate exceeding 0.5 gpd/sq.ft. WA01TRWATF.R >FISM- AS DESIGNED AND INSTALLED FD APRIL—u-2001, Estimated wastewater Flow 2.226.1)0 Cod 1 31 (28 bed spaces) (35 gal, bed space) = 980.00 Gpd ✓4 �h '' / (7 employees al shifts) (13 gal./employee) = 78.00 Gpd (28 Residents)(3 meaWdayx4 gal. /meal) = 336.00 Gpd (15 laundry cycles)(46 gal. /cycle) = 690.00 Gpd Wisc. Dcp'taULo� n. "fudge factor" = t e? nn r 1d Estimated Waktewat ; Flow = 2,226.00 Gpd DESIGN WASTM MAW ELASRIV ClIgg isT,UD / Estimated Wastewater Flow (29 bed spaces) (65 gal, bed space) = 1,885.00 Gpd (10 employees all shifts) (13 gal. /employee) - t30_ M (,nd Estimated wastewater flow = 2,015.00 Gpd WACTFWATF,R El -AY9 AS !QRSFRVRD 4 /1tUflA _ 4/21 Total Observed Wastewater Flow' Total Observed Wastewater flow (�$�LGn,rl aRer wnchin�+� machinr rrnlan�+n -V r , Observed Wastewater Flow to East cel W6.19 Gpd offer wishing machtn,. rMnlanamente Observed Wastewater Flow to West cel 631.01 [:Dd aAr washing rt j) EASTERN DISIRIBUTION CELT ABSORPTION AREA SIZING: 1. Installed Dispersal cell area: 2,6tU On SQ a ('I trenches )(12 chambers per trench )(31.0 sq.ft. EISA) = 2,604.00 sq. ft. EISA as installed Number of trenches 7 Q 17 Inflltratne " charnhe carh a 84 rhwmhrr. inefaltnd trench width (A) _340' trench length (B) 720,11 trench spacing o.ao An center Total area tw i,wAllad s2 r►n , wide V 72 AT tong 2. Infiltrative capacity of soil at system elev.: 05 g%p /se ft 3. Required dispersal cell area: 3,294 R A 1,647.40 Gpd design flow / 0.5 Gpd = 3,294.80 sq. ft. req'd. 3,394.80/31.0 sq.ft. EISA per "Sidewinder" High capacity Infiltrator chambers = 106.29 chambers req'd. Pg. 2 of 7 Z00 'IdA9 UTS V 110S 3 0 d t9LL 8tZ 2% YVd 60:tT 900Z/£Z /t0 Burkhardt, Inc. wily Flows Calculations JOB I)ESCRIPM& Evaluation of existing POWTS.(Private Onsite Wastewater Treatment System) serving Community Based Residential Facility. The Eastern most dispersal cell is a dose - conventional system consisting of 7 trenches using high capacity infiltrator "Sidewinder" chambers, The cell was designed to accept all and only bath and toilet wastes, totaling 1,800.00 gallons per day design flow. The cell is currently receiving 1,647.40 Gpd as installed. to The Western most dispersal cell is a gravity flow conventional system that consists 4 Y of trenches also using high ®IA+ capacity Infiltrator "Sidewinder" chambers. This cell was designed to accept all and only kitchen and laundry wastes, totaling 1,026.00 gallons per day estimated flow. The cell is currently receiving 531.01 Gpd as installed. The soil evaluation report on record at the St_ Croix County Zoning Dep't. indicates that sandy soils are present that will accept 0.7 gpd/sq.ft. The soil evaluation that was completed a9 part of this system inspection indicates that sewage efTluent should not be applied to these soils at a rate exceeding 0.5 gpd/sgA. Estimated wastewater Flow� -nom (28 bed spaces) (35 gal. bed space) = 980.00 Gpd rj / (7 employees all shifts) (13 gal. /employee) = 78.00 Gpd (28 Residents)(3 tneals/dayx4 gal. /meal) = 336.00 Gpd (IS laundry cycles)(46 gal. /cycle) = 690.00 Gpd Wise. D 't aflc "fudge factor" = ta? nn r. Es timated Wa$tewat Flow = 2,226.00 Gpd l� l DRSIM WASTF,WATF.R RI AW R��i AN l`IIRRII'NT�A,� / )Estimated Wastewater Plow 1.2fi, _ho rtut (29 bed spaces) (65 gal. bed space) = 1,88S.00 Gpd (10 employees all shifts) (13 gal. /employee) _ t �n.� on end Estimated wastewater flow = 2,01 5.00 Gpd WAR:EVWATFR FT OW,AS (jRSFRVFT) 4/10100 4/21 Total Observed Wastewater Flow - j 21.84!` Jul mine tn�)y�ij manhinn r�n1A •momic /I Total Observed Wastewater Flow : ( 1 - 4y l w,^.. ^.t:rl atker washing macbjnt rZplacgetnents -.4 Observed Wastewater flow to East cel t 'tt6 9 f�AAjer )UA- .h ruplacements � Observed Wastewater Flow to West ee l 1. 531 -(11 [:ndaft r washing machine renlACe►nenis 4b Cr L. P,,ASTI,RN DISIEURIt tTION CELL . ABSORPTION AREA SIZING; 1. Installed Dispersal cell am: 2,6na n� nom;. (7 trenchesx 12 chambers per trenchx31.0 %ft. EISA) = 2,604.00 sq. R. EISA as installed Number of trenches 7Q I1 10filfratne "CiAihmd A - ham rr rA h a Ad gh 'rictAnPA trench width (A) inn trench length (B) 72 nn trench spacing 0.M,* n�trr. Towl area to i+tatAllad _AZAn'.i wide Y 92 -A0 (nn� 2. lnftltrtttive capacity of soil at system elev.; 0 t /c ft 3. Required dispersal cell area 't, 9d.Sn &n ft 1,647.40 Gpd design flow / 0.5 Gpd - 3,294.80 sq. ft. req'd. 3,394.80/31.0 sq.ft. EISA per "Sidewinder" High capacity Infiltrator chambers = 10629 chambers mq'd. pg. 2 of 7 Z00z ' IVAS a1IS V 1105 3 3 d t9LL M 2% XVd 60 :tT 8002 /cZ /t0 Y SEPTIC TANK CAPACITY CALCULATIONS: 1. Design wastewater flow - 1,800.00 gpd 2. Minimum required capacity: (1,647.60) + (11.61 x 3' x 21.97) + (46.77 x 21.97) = 3,438.95 *(Requires a three year maintenance cycle) 1,64740 gpd/ 75 gpd - 21.97 gpd person equivalency 3. Existing S.T. Capacity & Manufacturer: Existing R,MMM I n_ctgel ce tic tanker nng i nrp;t rr. nrdt 4. Zabel A -100 effluent filter installed in Zabel filter basin located immediately beyond outlet of existing septic tank, DOSE CHAMBER CAPACITY & DOSE VOLUME CALCULATIONS: Manufacturer & Capacity: Wi s -r Concrete Wlfk^A- tR !S I MM" A SR Q4$ 1;n, = 3 ,nnc 4 -1 an Control Panel: Saptronies 6,1211 W/ dulilme altnrnwnr, alarm, r110rnt .nc"Ir 01-1'rtrie - !iii. nnnact 6 And event covin Existing duplex Goulds 3887 WS05SP effluent pumps. Sizing; A) Additional holding capacity: 1 000 Rot B) Alarm setting: 2 n(l" = 1 17 RA gal C) Dose volume + flow back: J R MM" = I,Orsn a (1,647.40 gal. /5 doses per day) + (.163X70') = 329.48 + 1 1.41 340.89 gal, max. dose volume D) Reserve storage: - 7n7 2u oai TOTAL: 5l .()N' _ AAi Pump specifications: afternia dsilllex , mps installed Manufacturer: �s Model number: ZRR7_ WOMSRF Min. discharge rate required: -Ma WFSTFRN DISTRIRITTION CELL ABSORPTION AREA SIZING: 1. Installed Dispersal Cell area: - J.3-s6 An sa ft (4 trenchesX19 chambers per tmnchX31.0 sq.ft. EISA) = 2,356.00 sq. ft. as installed Number of trenches AA 121 f tra or "Aidewi APr" rl .,,a, n 76 t h e h ..0 trench width (A) 2 R3R3' trench length (B) 114 Ml• trench spacing var� i,_able acing t ei nou l$etp ar=gil wviatin bz allt total area required variahie width x i 14 0 ' S ne 2. Infiltrative capacity of soil at system elev.: 0.5„gpd/sa ft 3. Required dispersal cell area: t ntt7 wjto ft. 531.01 Gpd design flow / O.S Gpd = 1,062.02 sq, ft. req'd. 1,062.02/31.0 sq.f1. EISA per "Sidewinder" High capacity Infiltrator chambers = 34.26 chambers req'd. SEPTIC TANK CAPACITY CALCULATIONS: I. Design wastewater flow = 1,539.00 gpd 2. Minimum required cspacity : „3,2.1.3 4a , line (531.01) + (1 l .61 x 3 * x 7.08) + (46.77 x 7.08) = 1,108.74 *(Requires a three year maintenance cycle) 531 A 1 gpd / 75 gpd = 7.08 gpd person equivalency 3. Existing S.T capacity & manufa Tntal r nnarity — 2,5h{l, 0_rl gallons 'twn lucid We-tern �.� mt 11 78 gallon Wa ,te Sntic, ank installs' in ---ricA 4. Zabel A -100 effluent filter installed at outlet of both septic tanks. GREASE IN'T'ERCEPTOR: Capacity: _EXiSY_�nIA gallon Cnnc tt Ci a 1nt r Hint install rt to rnllt all anti nnly kiMhan uy :t.,: (Grease Interceptor sized in accordance with Comm, 434(5), (29 -seat capaeiryx3 meals per dayXI,25 appliance factor) = 108.75 gal. calculated capacity or 1,000 gal. minimum capacity required by code. Pg. 3 of 7 coo Q� " t dAS UIS V '1I0S 9 1 v CALL At7 CT1. vv AA:WT onn7 /e7 /*A SCIMMAI2Y� Z9 As per facility director Herb Blaisdell, the resident population du rins t he duration of this evaluation has been 27.49 residents and 10 employees per day_ Residents currently generat l,�17.3ggpd of wastewater, or 62.47 gpd/resident,� .,• Stall' Is asswned to contribute It _30 r�ii� as per code. Ain ere a a to 29 residents will result in an anticipated f3 �incrcase in daily wastewater flaw o if'ttsra The existing POWTS serving this facility was designed and installed to accommodate 28 residents and 7 employees anticipated to generate 2.226.00 gpd. Observed actual wastewater flow generated by l-49,residents and ten employees is 1,847.30 gpd and is less than the system was designed to accommodate. The daily wastewater load generated by 29 residents and 10 employees will also fall p4er the wastewater flow that the system was deli ed to accommodate. �J 4 `�-- i,��; `- / � i�, w ,� � . / `��! . �' �', f — ::, `-) � � P 4•� � t��a��rs.,. f %ate...,' 4t It should be noted that both of the existing dispersal cells an, exhibiting indications of partial failure. This is due in part f to unequal water distribution throughout the dispersal trenches. The wastewater flow within the pastern dispersal cell is concentrated to trenches 1 — 4, while the wastewater flow within the Westtrn dispersal cell is concentrated to trenches 1 �! & 2 (see attached site plan). This has resulted in the soils within the affected trenches receiving too much wastewater, 1 leading to hydraulic lailure. The remaining trenches appear to have received very little use and should readily absorbed applied wastewater, ,t The following suggestions and recommendations indicate items that must be addressed to bring the POWTS into Code compliance and managetnent practices that should be employed in an attempt to prevent complete system failure. Cadt defieienciecr 1. All manhole covers must be provided with functioning locking devices. 2. Seal electrical openings in pump chamber manhole and inside electrical control panel. 3. Provide surface access to existing effluent filter basin. Eastern Disnrr nl Cell- j 1. Monitor wastewater flow from facility, /yl�ili � ^�✓ >r1 CtFc�. � �� �'- ✓ ►"� �y�. Re- adjust pomp control floats to comply with maximum dose volumes as required by code,��'�'' �3,, Replace existing distribution valve on cast distribution cell and replace existing distribution box/header configuration to accommodate uniform wastewater flow to all trenches. 4. Divert all wastewater flow away from trenches 1 to trenches 5, 6 & 7 by use of new distribution valve. l' � I t 5. Monitor trenches 1-4 annually to detemtine condition of bio -mat and remediation of hydraulic failure. 6. Monitor trenches 5 -8 monthly to determine hydraulic capacity and prevent over use that will result in trench }` failure. 7. Alternate wastewater flow between trench groups 1 .4 and 5 - on an annual basis_ 8. Clean effluent filter annually. 9. tad: puu>p ehtrmtstir 3nnGal t 1' tern n nerenl Cell- Y� 1 / f7ivett all wastewater flow away from trenches 1 -2 to trenches 3 � by use of new distribution valve.�� 2. Monitor trenches t & 2 annually to determine condition of bio -mat and correction of hydraulic failure. 3. Monitor trenches 5 & 8 monthly to determine hydraulic capacity and prevent over use that will result in trench Z/" j,� .45 failure, 4. A tCmww was S. C - lAI"A filters 8_nn I IlU _ �.. 6. Pump out contents of grease interceptor annually or as needed. ;� • `�'� 7. Puwp.Autlortte� tanks anllyally. 4 Pg. 4of7 I � I .J �� b00Q� ' IdA3 B,LIS V 'IIOS 3 0 V 69LL M 9% YV.4 nT:tT Qnn2 /e7 /cn As per faciliry director Herb Blaisdell the resident population Burin �tuhe uration of this evaluation ha$ been 27.49 residents and l0 enployees per day_ Residents currently generat 1,gpd of wastewater, or 62.47 gpd/resident Statl' is assu,rted to contribute 130 gallons er a as per co c. A ino 29 residents will result 1 n n n anticipated increase in daily wastewater flaw a rb The existing POWTS serving this facility was designed rind installed to accommodate 28 residents and 7 employees ` anticipated to generate 2.226.00 gpd. Observed actual wastewater flow generated by T?-Q residents and ten employees } is 1,847.30 gpd and is less than the system was designed to accommodate. The daily wastewater load generated by 29 residents and 10 employoes will also fall p4er the wastewater flow tliat the system was deal ed to accomm da te. :/9�� = 2 9 iZ .q5 It should be noted that bode of the existing dispersal cells are exhibiting indications or partial fai 6 p This is due in part to unequal water distribution throughout the dispersal trenches. The wastewater flow within the Eastern dispersal cell is concentrated to trenches I - 4, while the wastewater flow within the Western dispersal cell is concentrated to trenches i j & 2 (see attached site plan). This has resulted in the soils within the affected trenches receiving too much wastewater, ( leading to hydraulic failure. The remaining trenches appear to have received very little use and should readily absorbed applied wastewater. Ruggectinnc shnd ]2P.cnmmendatkinng- The following suggestions and recommendations indicate items that must be addressed to bring the POWTS into Code 4 4 compliance: and rnanage rnent practices that should be employed in an attempt to prevent complete system failure. Cade defirienri r• 1. All manhole covers must be provided with functioning locking devices. 2. Seal electrical upvninbs in pump chamber manhole and inside electrical control panel. 3. Provide surface access to existing effluent fitter basin. L/ 'S�°' eel a� >a <tern [li�� real f III• ,y► f 2 1 . ci Monitor wastewater flow from facility ( alt -4br rlvw �tzt� a k'. 2 Re- adjust pump control floats to comply with maximum dose volumes as required by code. Replace existing distribution valve on cast distribution cell and replace existing istribution box/header configuration to accommodate uniform wastewater flow to all trenches. E 4. Divert all wastewater flow away from trenches 1-4 to trenches 5, 6 & 7 by use of now distribution valve. j 5. Monitor trenches 1-4 annually to determine condition of bio -mat and remediation of hydraulic failure. 6. Monitor trenches 5-8 mondily to determine hydraulic capacity and prevent over use that will result in trench X_ failure. 7. Alternate wastewater flow between trench groups 1 ­4 and 3 -8 on an annual basis_ 8. Clean effluent filter annually. 9 . ' ann ally. L, a[ Coll- fJivert ell wastewater flow away from trenches 1 -2 to trenches 3 4 by use of new distribution valve. 2. Monitor trenches 1 & 2 annually to determine condition of bio -mat and correction of hydraulic failure, 3. Monitor trenches S & 8 monthly to determine hydraulic capacity and prevent over use that will result in trench�(� failure. 4. Ali S. 6. Pump out contents of grease interceptor annually or as needed. 3�� 45 ?. P ,'� � e , �0 l Pg. 4 o(7 6� tf b00� ' IVAS 31I9 V 1I05 a 0 d t9LL 8bZ 9% YVA AT:6T QAAZir.ZilA ,:�,: i .�.. 'i�... .•. .� };:;.1 ';,r'.:. +4A,j,: ywa:;. :t�i),� ° `5;:i:�?Yj••;i'��; "'111'k�.,Y ,_\y:.: •;�.�riy..FR,r., •�;;,.,i�g,�;,�K�; W. 0 u o d I�es>tdenee.% a 1 -'V Wij Total Daily Water Flow-, Water Meter ReadiBPa: D&M 41 Timt: F.lansed , rime: Meter sding-, Tatat Flow in Crllons 24 Hour Flow 4/09109 n 4 :00 pm Jtduul inxtallation 837,970 Na Na 4/10/08 ® 2:30 pm 22.50 961,030 1,999,08 2,131.35 4 Q ):IS pm 94,75 869,620 81590.00 2,175.83 4 /15/08 t, 12:00 pm Z2 7S 140.00 871,700 (by Blaisdale) 2,080.00 � 12,669,08 1,..194.29 2,1 4/16/08 Q 1 :45 pm 25.75 873,870 �` 2,170.00 2,022,52 4/18/01© 5:15 pm 51.50 878,180 4,310.00 2,008.34 4/21/08 Qa 1:15 pm CU, 143.25 192,880 4 .700,00 11,180.00 1.638.82 1,947.30 1, 1'ottats; 285.25 24.910 23,849.08 2.006.58 Ott t, Eastern Cell Flow Rate - Shower & Toilet Wastes 6t DUnIeY PUMP kvent Counter ReadinQs- Event Quatar Rtadinea: DOW volume - Elapsed time - 24 Hots avc done Date: Pumo #1 Pump #2 tots! talloos hour!: volume - callou 4/10/08 fe 230 pm .310 339 4/14108 Q 1 :15 pm 324 342 7,426.44 94.75 1 4 /108 ® 1AS pm 326 343 3,182.76 48.50 1,574,97 4118/08 (fit 5 :15 pm 328 345 4,243.68 51.50 1,977.64 4/21/08 a 1:15 pm 329 347 3...111, Z am 1 Tatalst 9 9 18 -W 262.75 1.647.40 Western Cell Flow Rate • Laundry & Kitehen Wastes Date dr Time: Metered Flow Dose volume - Elapsed time - 24 Hour totalcallona: noum__ _ volume 4/10/08 ® 2 :30 pin 1,999,08 No Na Nu 4/14/08 Q 1:15 pm 8,590.00 7,426,44 94.75 294.73 4115108 Q 12:00 pm 21080,00 No Na No J 4/16108 ghI A5pin 2,170.00 3,182.76 48,50 528,12 4/18/08 ® 5 :00 pm 4,310.00 4,243,68 51.50 30,91 4!21108 @ I: IS pm 4.700.00 3.182.76 am 333.50 Totals: 23,849.08 18,035.64 262.95 $31.01 SUMMARY h IGa Ions: Elspsed time: 24 lit, gyp,; Total flow to east cell 41 10/08.4/2 1/08: 18,035.64 262.75 1,647.40 Total flow to wtxtall 4 /10108. Jo 5.813,44 6Z 2,73 I" Tourl Meicrcd WSW Flow 4109/08 - 4/21/08: 23,949.08 pitons total now = 2,178,41 gallons Avenge daily flow PA, S of 6 500 ' 1VA3 UI5 '8 7II05 a 3 d b9Ll 8bZ 9% Xd,3 OT:bT 8002/t;Z/60 �6an �o» c d .i�- �u•rd ----�. /= NirJSu./c d.,rfi!/ria,Fj'o� -1 G'X /'fin E7��S,,E�►n9 Ft�S4:�_q t/ �tiust 4 G t �E1_S%14", r A. // C�ti d's,arisa/,�. N wtsf crq ' d, s pt�sa / Oda in saSalle a v Qpr-"I t O /cl 900 'IVA3 311S V 'II09 3 0 V LOLL M 5TL %V,d OT : tT SOOZ /£Z /b0 2115 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (8M), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 030 - 101 -30 -000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Burkwood Residence - Herb Blaisdale Govt. Lot SW 1/4 SE 1/4 S 3 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 615 Old Mill Roa Na Na Non - platted 1,72 Acre Parcel City State Zip Code Phone Number __j City J Village a Town Nearest Road Hudson WI 54016 1 (715) 386 -6125 St.Joseph I Old Mill Road _ I New Construction Use: J Residential / Number of bedrooms Code derived design flow rate GPD t/ Replacement 16 Public or commercial - Describe: - Rehabilitation Center Parent material Glacial outwash Flood plain elevation, if applicable Na General comments and recommendations: Soil evaluation completed to verify soil characteristics and suitability of existing dispersal cell for continued use. Daily flow to be determined by metering actual flow. FT] Boring # I Boring f/ Pit Ground Surface elev. 96.11 ft. Depth to limiting factor 108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDlfl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 1 0-6 1Oyt2 /2 none sil 2fsbk mvfr cs 2fm,1c 0.6 0.8 2 6 -16 1Oyr3/2 none sil 2fsbk mfr cs 2fm,1c 0.6 1.0 3 16 -30 7.5yr4/6 none sic[ 2fsbk mfr cw 2fm,1c 0.4 0.6 4 30-49 7.5yr4/6 none gr Is Osg ml aw 1 f 0.7 1.6 5 49 -51 1 Oyr4 /4 none Ifs 1 csbk mvfr aw 1 fm 0.5 1.0 6 51 -108 10yr4 /6 none o, m & f Osg ml - - 0.5 1.0 Horizon #5 contains mixed cos, ms, fs & Ifs. Loading rate reduced to reflect reduced permiability associated with textural changes. ' Effluent #1 = BOD 30 < 220 mg/L and TS >30 < 150 g/L ent #2 = BOD < W mg /L and TSS < 30 mg /L CST Name (Please Print) ignature: CST Number James K. Thomps 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 1 54020 4/8/2008 715- 248 -7767 y o- Fsbruar7 1 1`969 �. 1tr. Orville - Carlson Hilltop Rost ire Burkhardt Wisconsin row mr. carisons At the meeting �+f;ttre 8t. Croix County Ford of A pssr a oft . Febrt� &V7 10 1869. The board voted to grant you perdaaion to band . on to Your present buildift as ym requested in your appeal. There Is one restriction that suet be set and adhered to . It is as fool a z '*THAT MKT ,, 'Tloff OF T14IS BUILDI?IC RUT BF, )'TARTO off JUNE 1o, 1 9h9 c�� � � lt1�tU�'�T WILL EM RgVOMM . -� was In favor of requesting that the addition that is being added to the roost else U ooul d be added to the acre side #qd YO could most the set back requirements so well as haw s good looldag structure. They then voted, to l+s►t 7rru k uildiae plaanad so that you sight get stslrted woos , 00" 3.uate oft Your ventur�o. Tours Harald 0. Ham, Zoning A&Ani" stogy► . Ga Sevart Carlson Rasa Harmon Carl "mmoson file F St. Paul — 6334558 Mr. and Mrs. Orville Carlson Hudson — DU. 6-2222 c#dUap ft"" 0#"w 24 Hour Nursing Care Route 2 HUDSON, WISCONSIN 1-22-69 1 am in favor of the new addition to Hilltop Nursing Home as shown on the - plans I understand the new ruling for 100 ft. set back, siam I t L ell > p"r State of Wisconsin � DEPARTMENT OF HEALTH AND SOCIAL SERVICES sir DIVISION OF HEALTH j s MAIL ADDRESS: P. O. BOX 309 October 24, 196$ MADISON, W15CONSIN 53701 IN REPLY PLEASE REFER TO: SECTION OF PLUMBING AND RELATED SERVICES .. Wheeler Tank Manufacturing Company 274 Atwater Street St.. Paul, Minnesota Dear Mr. Wheeler: Re: Hil Nursing Home Hudson St. Croix County This is to confirm our telephone conversation of October 23, 1968. We-.are.returning two copies of your 11,810 gallon capacity steel septic tank stamped "Approved ". Approval of the design of a private sewage disposal system by the Department of Health and Social Services, Division of Health, does not indicate any liability for the construction or continued operation of said system. Yours very truly, W. R.'Koenig, P.E. Chief Thomas E. Devereaux Plan Approval TED:pr Enclosures cc: Mr. Loren Crain Mr. Orville Carlson Mr.. W. K. Tift Mr. Harold BarberL.-'' Mr. Donald Kinyon Hospital & Related Services 7T,;'~ 1� o - r� � T w 1S A'�i�?tova.c� /oIAS P1b 60 NAME OF BUSINESS fl -R 5tr.+ C' l-- �or'►kE IICV LOCATION I-Z T street or highway city or township county OWNER CYRUILLe 0_^'RL.50K1 Mailing address ST �+.m�c. I"1�Nrv• ARCHITECT OR ENGINEER Address PLUMBER MR. Lormep C7gA'q Address 91! 2,v0 sr. Mu 1, Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition If addition to existing building attach detailed memo for each. O Restaurant or dining room . . . . Seating capacity (10 sq.ft. /person) O Motel O Hotel O Cottages Number of unitst Rselar Housokeeping 2 persons /unit 4 persona /unit TOTAL NUMBER OF UNITS �O or cocktail lounge . . . . . Seating capacity (10.sq.ft. /person) OC) Nursing or retirement home . . • Number of bads p J �( `) Mobile horse park . . . . . . Number of units - dependent - nondependent {) Service station . . . .. . . . Number of care served (daily) O School Number of classrooms Meals served Yee No Showers provided Yes_ No {) Factory or office building . . . Number of persons (total all shifts) {) Residence . .. Number of bedrooms Other specify 2. © Lr" F) o G C_ S 2. Indicate whether or not the following facilities are connected: Food waste grinder . . . Yes k No Dishwasher . Yes K 'No Automatic clothes washer Yes K d. NO 3. FiU in the appropriate Information for the following as indioatedt Septic tRak capacity planned Normal septic tank capacity required 50,E increase for F'aTG or Alf Total septic tank capacity required 1 o Percolation test results - ATTACH FEPCOLATION TEST FZMFC SHFM Seepage trench bottom area planned width , linear feet , depth i Seepage pit planned , outside diameter depth below inlet depth Seepage trench bottca area required low width , linear feet Seepage pit required , outside diameter , depth below inlet, Signt3 a of perso'n" completing form: STATE BOARD OF HEALTH, PLUMBING DIVISION P. 0. Box 309, Kadison, Wisconsin 53701 Address Approved: Date / 0 Date OCT 8 19 THIS APPROVAL IS BASED ON STATE PLUMB ING CODE REQIJiREiri:NfS AND DOES NOT EXErIPT THE INSTALLATION Ff;O ^,1 CITY, VIL :AGE., T0N, CR COUNTY REGULATIONS nR pfPMIT REGL'IIIUALNTS. ti AM T i° ono e 1210 ( y C+] H C.] H CC+�Ji m a - - - - - - - ►� C] trJ C/) HO O W o M t+9 M H 1- d F-I Cn > rµ o of r - - - - - `` 4a b �q- :d H • ° C3 1 0 , tzj C ►� m d .. y .. ►� I o a W N o y w O C� W H N H F' 'o°� a A Iv _ �°, Co c+ °o � m t' CD t PO US rzr �n e e e • q .. • t;J H O F� tx; H H zz z g a e q O N C r _ - x� vi '+D v, H m ►3 c O mo H M c n H to -- H t■J "r. m A q C k 'Z I'b l7 e► _ _ W fi7 C, H p - ! c+ Fs- O N C H w C O L V =J ] "� 0 ti y y e x y C!] v r d Cn a i - x (r xc� \ A� Cn H m a ol CA � � o� b - - - cn r 0 M c En W C+, o > - b - 70 .. W CD y y O A4 G n ° h Q M1 H cn O N� H 9 _ - t rey & ro 0 x q q `. \ x 7 \\ c o v O y ,c-- a x° 0 -+ i I. G m w L �+ v v v v m Q) .0 L L v •'4 L () H O -C L C 14 3 ro - O v -4 L m w +) G G 1+ O 3 c''1 G O v G -4 a w O G G a •rC •ra ro m m a) v •rC > •rC r-C a) O D, m •rC v 0 L .0 O 8 v ca v G X G L 1+ v 0 cc v v .- cC v .c -C m u •rC >, -4 v r•4 _4 H c0 a a x m r-c - 0 E .a rd - L o. O ro w co G u E 0 .0 m a m v o co ++ co v v o v 3 v .0 a L to 14 v .. > 4 v $4 > 1a m r-+ w 0. ro � � v a) o v v U ra ..O CO $4 1•i 'ty o a co v a (U .O v w a) m G -L, L G v w v v G �+ L H > u L a co m p v C '0 L m v a cc v> W a .0 m r+ c0 bO O •rC CO CO v .-c L c0 v - G 3 W v M H 'r7 Cd G L M v ro -4 v $4 14 ro •r+ v r-+ v ro m G w 1+ m ro w -4 -4 a) >, CO 604 � L c0 u v 0 v 0 0 -4 r-4 m ro v X G H G Cn G E � N 14 O 41 W . 41 v .0 .0 O •rl v 3 n m •rl o •r4 v G L w v r 4 o 4 a W a 41 v u L v 3 3 1+ c0 H •r+ G .n v L L W W v G O m G G O o m v H H •-4 L ro 9, L a "a ro u v > •.4 v c0 •rc ro w L L m r4 v ••a ro .0 C O r4 O v a (u > m ro E v O O N G v .0 3 v v v a 0 ca m U) H •r G V) o r0 to G w w a v .-+ to a L bO v m H W E U v .0 ro v W •H G m> v ro x m co r4 m m v 1+ W m m r p. v w v L Q) 1. w m Cd .0 G •14 v i i ^ v o a co 0. v d L ro O ro L 1+ .0 w 1+ v m >, a E v m v DO 0 v U L L G 4+ .0 r-+ O o 14 v J•J v v L 1+ r-+ v L • C G w v G G co m L m ,i u x 0 0 > L ro O w v 9, m G L •r4 O v •.� -H -4 v .0 a) v L u w m 0 w ed L 3 0 ro .0 1+ v -4 1+ W > L L G x aJ W a C H 3 -C v L c0 1+ E G ' 4 W m •rl x v 0 +C G O v m r4 L v Tl G G > v v •H v rl u •r4 L a m v w v v v x .O w 3 0 •r4 W v L P 3 v .0 v m C 0 m .0 .0 E m 1J > b0 +J 3 0 0 •rC a m L L cd O m m G E•C a G v L w O v E v m •ra O r-i r-i 1+ a O v cd 0 3 m w cd m G •a m .4 u 1 awJ Xj O L 1+ G 1+ '-+ v m v v O w 6•+ G cd 7 yi Ca E v E ro bO 1a v v> v n a 1+ 7 w v U .0 H m G G d cc m G •r4 3 v L .O cd 4 v W U U O o E u 00 v v cd L G U •r4 •r1 E O G w G a) > w W u .. w o v rC v O •.c > 0 v G N •cc fYt 44 0 w w� O d� 00 G' o G v .0 ro m G G ro -A r4 v L •rl >, O E O L u •rl I •rl .0 v u m v v L W 1+ $4 v w ro 'b v d 1 0 3 .-4 v .-4 L o v 60 x v to v bO v > O L x 3 L v L CO W 14 rd • -Z CV .7 -4 •,4 r-C O G u 3 .0 > a ed E 0 •rC ro r-4 Q co •ra v v 14 1+ L rd v '0 $4 O L 44 $3 L L O v w m v •r+ aJ G tl) 0 0 > 3 ro o G 3 0 a) .0 v 1 14 N C v 60 L r+ m > 0) Cn .+ u L > O m v 14 w 0 m cd a v to .0 r-+ v L L O v 14 a co 1+ m O ro 1J >, .. v 0 v v v x 4) X. O v G > v v w O v m O t] > L L r-+ cd c m w •rc -4 > L w G x v> v 'v x u a v m v++ v o to u v L O m cd v 0) 14 O m v u cd a L 0) .. G v 00 > $4 v > r-c u> E G u C L w "a ro $4 U v L Cd 1+ •rd M 44 0 0 0 a) > L w () O $4 44 1•C L . O •r1 a cd G 3 G a) •• v r-1 q 0W0 w w .o H H i v w -H 0) v O v O v L 1+ O -C Cd m -A 3 w L rd p 1+ m a > a L C> 0+ N U m 1+ O O O It ro •r •M v m 3 r-1 m •rl G L cd v w O ro ca N 1.4 .. m ro r-c CV —4 3 44 > a) v • 4 v w w Cd C w ro 3 L w L co v v a� 4 -4 m m v O .0 aJ r-4 cd u 3 v U ,C $4 R to 0 O r-4 H w tV G G w 'a v L J v .0 u v v r4 ('. L v O G -A .0 v L 'O x o u C w o 0 0 G •r+ v G> m a •C E G o "q -Li L V4 O v to F r 1 L Cl) O v m •rC o w C v •ri cd m L -rt •rc v to a .0 .0 .L C o L m U -A L > E 1+ L x G 3 v a L v C ^ W 3 a L ro .c a) u v v u 0 60-4 o .0 a• L •rC 0 - O CC .n C ,� L r m y .0 m y 1+ D O cd 3 u v O L m m w 0 W v V4 m m L 3 bO a -4 W u a v cd M y > L •rc Al- 14 m y 1+ O .0 v O> w L 01 a) v G v ro L G v m L ,C 1+ .0 L v v L 0 w L O v cd - 4 00 w - r 4 W •0 •r) a .0 m G ••a .0 W m W L v W r"C O of go 0 0 v >, m y •d L m cd v 0 L •rC 3 'L7 v L v . 0 a X m ) .0 >, cd e O .0 G v .0 •-C r-C ro L N ro .c v G G O ,,c G X L •C L L W 3 u 44 1+ E , ( Cs C L -0 ra w a) u m > •rc m •r+ •r4 H O L v v u to 1+ 1+ rd co 0 v O -r-,-4 a 0 r- -H v v H >-, -4 C r4 0 w W r i v v L G O v m v w v cd w .0 L w a 4•J 0 3 •rl w r4 o •rl ro .O v O m v L G 1+ W ro —4 L 1.i m L O Pa u 1 0 'O L L m m w 7 v .0 I> cd L o 14 p. Cd •r+ 0 7 14 C,4 Cd G C v ro .4 w v a v v G 7 1a .0 � >, 0) ..0 u cd a) ra m o b0 0 E -4 a Co a 3 L 1.0 'C aa) w O 1-4 O H 0 L = L v w •rl .0 m L v •r4 H m G o u v L a) O L v G W a) .0 v rC a) a ro E-+ a >, :3 'O aJ G-C E G ra C W L O E •r1 w CO E O m u > L W 6 •C w W 3 CIO m 1 v v G *+ u O 14 - 4 a) cd G L O 3 G G G •rt L •• v 0 G r-1 v C• m G O w v r-4 v a 3 a) cd L v m 44 H w .c •H m O u I •,q .0 L •r) cr1 JC v G w o -4 b0 v G .c v v w CV 3 0 0 O U 1w •rl .0 : Cd w v 1 . m L CO x L C O m 0 Z G O r-+ u •H 0 •0 S u p X 00 a) .0 w m C 3 bO v v w a v L G v L• 44 m C 14 L —4 -4 ,-.c W r a a v JJ Cd Q w v m "A v cc v G •r+ w G m I co L 1+ L O v v co v r-4 m t-4 •r1 r-i a v w A m y G L v U v v v cd o ., r-+ 0 .0 w v G>C a •ra m v o a G aJ W r. G - 0 v v W m u .0 u E E E o 1+ m w L cd v m w v U C x o cd m CU •r) Cd cd r-+ u H v •ra O m L 0 v v a v v CO m •rc G ro L r-i v -4 •ri bO -4 v L v ra > x 1+ - 1+ 1a 1+ > .0 r4 G G r-c m -4 C '0 d v to C' W IA .,4 4-) v m m 1+ G ro G •r+ o v a •rc L a a O v o L -4 ra W W O ro v 4J G P W C r-+ -0 L v v •r+ C' w O co m 1+ G U O v u to > O o v 4J a r-+ v L m m a) w Cd � m � m - - o m 0. 0 co i i w 0)i o r •r CO o (n T� 0 u a., r A 41 ai m 0 bO , ; o ro m O m E 3 bo w 3 E 'v 1v+ u E 3 o v G m v 'o v" U Z v W r--4 m ii "4 X v E a) O W .0 v v m O G v w L (. L v .0 4-1 L 1+ a) G .0 O v v v 0 v 0 v ra U L H 1+ H O C m C •rC H v L m Co m CO L O L v G a L 0 L v L C L L U .0 G v r-c • 4 q r-1 O 0. W L O b 14 O w 0 v m m v Cd G a w •14 u Cd to X L m ro H L •rl x w •-- r C cd •• O O o G v rC .0 v x L a) L 1+ v o u G 1+ L cy O 3 Cd E • r) w aJ N O q r•+ Cd �CC •r+ W L G .-a w v v a 0 •rd G v v w •-I U w w v 3 L c .-4 1+ .0 •rC Q v FC w L a G H v G H a) E H L v m H "0 G H G W G m O O L L O .0 (1) G v to m 0 1+ O ro x ro L kw G c cd •rC O v Cd •.•C v v .0 cd -rc 00 .0 m O P v "a G •r4 O L •r1 •r) to v co ro L L ^ L m 60 W 1+ L 0 L v •rl .. L G O L ., L .% O w O .0 L .. v .-. v a i. E 14 m 0 w 'r+ o 0 0 O 1-1 L Cd ^ ro •rC ro a m m Cd ro L L L p m m .0 u .A o O a G b C v N u O Q v W a %.0 1+ ) 0 cd - v L - — a) m r•+ ... cd v v v d) .• w v v •rd 14 O m v •rc W > .0 1J v .0 m •rl O +,J v O L -4 H - 0 m w A Cd L O s v 4J c L a r. w G w b 1> >, A o v v C ca v v u o G p •o u a ov X 4 aJ (n bba m V. v m 8 o P+ 3 w 3� '' G G v ro ' C .0 C v 3 .c E E E m m L ,n ro ro O .n m H - N M v v v v 71 APPLICATION FOR SANITARY PERMIT for INSTALLATION OF A SEPTIC TANK (Sec. 144.03, Wis. Stat.) A. OWNER OF PRCPE'RTY N � S `� Address (�reet�it��p Code) - Z � &u� / / �� B. LOCATIC CF PROP ARTY �T ERE SEPTIC TA14K IS TO BE INSTALLiT'D Check 1. _City Mail dress Count one: 2. Village �I _ i �� 3. own i C. INSTALLER Give License number held: Wisconsin restricted Licensed .` � n � Sewer / lumber Services Name /} Address D. °PC FICATICNS OF S�7TIC TANK Size in gallons: (check one) 1. 1,000 Gal. 5. 4,000 Gal. _ 2. 1,500 Gal. 6. + 5,000 Gal. 3. 2,000 Gal. 7. _ If over 5,000 Gal., give cavity. 4. 4 3, 000 Gal. Materials: 1. Prefab concrete 2. -- Poured Concrete 3. -teel E. TYPE OF OCCUPANCY l. Family residence 3./±Commercial establishment 2. Multiple family residence 4. Industrial establishment F. APPROXIMATE NUMBER OF PERSCNS SERVED DAILY /// G. PERCOLATION TEST MADr, 1. Yes 2. No Date f /l to By whom ( To be completed by County Clerk) Date application is filed and fee paid Permit issued (date) Permit Number County Clerk f, Percolat Rate Minimum Absorption Area in Square Feet per Bedroom Minutes Required Normal With With With Both For Water to Fall Plumbing Garbage Automatic Grinder and One Inch Fixtures Grinder Washer Automatic Washer 2 5 65 75 85 3 60 75 85 100 4 7 85 95 115 5 75 90 105 125 5 - 10 100 120 135 165 10- 15 115 140 160 190 15- 30 150 180 205 250 30- 45 180 215 245 300 45- 60 200 240 275 330 60- 90 240 290 325 400 ,s; c �-'� �� ��-,� r / Z � / �� � �� ��� � j �- ��� 1 I � �` I �, ' ... .. . �� �_ _. �. �_.. ... C r �- (�,, \0 _.__ _ _ V �I ', 7 I l i I _ _ _ ... -- -- -- t t i -' '� t 0 __ l V W O U' i Z _Z N N 3 0 e � ti o Q a 'O E V o `{- E o �. �0 O % .� 44 +C Ol N V d 0 1 O W D W N W W J v s i s' i i i, -40- I W I u 0 0 z z L _ � o N 3 c �o ti �o o Q a •� c o V o v O O N d �y N •� 0 o W Uzm 0 W N ' W Y 0 J v 0 I i I Kore,�Tt - lt VOI H k0f o t= £3 1 5 /fn & Plb 60 ! NAME OF BUSINESS +�f t tdL oi� I� u R 5 t �.+ c, ( —� a rr►�= T - LOCATION jZ T 2 ' ra sou 5 C- o f street or highway city or township county OWNER 01WI .t .t:. C�'�t. Sow Mailing address ST• ?.m...� f"1 , r•► a• ARCHITECT OR ENGINEER Address PLUMBER M7t, Lcmeij C iaAiQ Address 4 I I p_ sr• L. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition Y If addition existing building attach detailed memo for each. () Restaurant or dining room . . . . Seating capacity (10 sq.ft. /person) O Motel O Hotel O Cottages Number of units; Rear Housek9oping 2 persons/unit 4 persons /unit TOTAL NUMBER OF UNITS ( ) / Bar or cocktail lounge . . . . . Seating capacity (10 aq.ft. /person) tk7 Nursing or retirement home Number of beds gJ /( �) Mobile home park ... . . . . . Number of units - dependent - nondependent () Service station . . . Number of cars served (daily) ()- School .. ..-Number of classrooms Meads served Yes" No�� Showers provided Yes No w O Factory or office building Nurber of persons (total all shifts) O Residence Number of bedrooms K Other - specify Z 0 e- r '1 PL - 0 @ a 2. Indicate whether or not the following facilities are connecteds Food .waste grindjjr . . Yes X No Dishwasher . . . . . . . Yes �[ - No Automatic clothes washer Yes ; 3. Fill in the appropriate information for the following as indioateds a re� i am t u d Sep it d capacity 1 S p tank capacity planned Normal septic tank pax y req SOS inoreaze for >FgG or Aid Total septic tank capacity roqutred -I Scz o Percolation test results - ATTP.OH P$FCOLAT TEST FW SIrEXT Seepage trench bottom area planned width , linear feet , depth Seepage pit planned outside diameter depth below inlet depth Seepage trench bottca area required , (000 ; .width linear feet Seepage pit required outside diameter , depth below inlet Si -u e of persc completing form: STATE BOARD OF HEALTH, PLUMBING DIVISION </ J P. 0. Box 309, l adison, Wisconsin 53701 Address: ` ? Approved: Date / a 8 G& Date OCT 8 1968 THIS ATPI2{IVAL 1S PP ED ON STATE PLUMB ING CODE RECD RUAi MS A ?;D DOES NOT EXEMPT THE INSTALLATION FROM CITY, YIL• CAGE, TO'ANSHIP OR COUNTY REGUU.TIONS OP. POIN11Ii REQUIRLMENTS. i State of Wisconsin 1'V ��l isconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH DISTRICT 7 OFFICE STATE OFFICE BUILDING 718 WEST CLAIREMONT AVENUE EAU CLAIRE. WISCONSIN 54701 PHONE (715) 834 -2931 May 20, 1968 Mr. Harold Barber St. Croix County Zoning Administrator St. Croix County Courthouse Annex Hudson, 4isconsin 5016 Dear Mr. Barber: Re: Hill Top Nursing Home Burkhardt, Kisconsin St. Croix County Fir. Orville Carlson, owner Enclosed is a copy of septic tank and disposal system size for above building. I understand they are trying to come up with some other method of sewage disposal. As yet, have not received any approval. Sincerely, Donald K. Kinyon District 7 Plumbing Supervisor /vas cc: (1) Central Office (2) Tom Knoble H & R S r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER f :Q ADDRESS Cs `S SUBDIVISION / CSM# !` LOT SECTION 3 T 4 N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lee . . M INDICATE NORTH ,ARROW" Provide setback and elevation information on reverse of this -form. Provide 2 dimensions to center of septic ,tank manhole cover. 8a o BENCHMARK: �t /W44, 40a,�p ��J T l oo- O 'ALTERNATE 'BM: SEPTIC TANK f PUMP CHAMBER / HOLDING.TANK INFORMATION U anufacturer: Liq C apacity: apacity: Se ack from: Well • house . Other Q — Pump: Manufacturer Model# Size Float s eratio n Gal lons/Cycle: Alarm Loca ion �J f :SOIL ABSORPTION SYSTEM Width: 9th Number of trenches Distance & Direction to nearest prop. line: 4 Setback from: well: House Other �J ELEVATIONS Building Sewer ST let: ST outlet PC inlet PC bottom Pump Off J Header/Manifold Bottom system •^' Existing Grade Final grade DATE of INSTALLATION: / 1 y' PLUMBER ON JOB: 2 �J LICENSE NUMBER: 2Z6 3 1 .� V ' INSPECTOR:_ 3/9 3 : j t v � o _ a N < o Own R � m l N PL I LU 0 � V f- y G 0 o Ile m lb N Site/ / k -•t It z G d Zk e �� f� SN 4 tv N 1 ,4N.� N 7r- } w o � b v - f 7 SC�P c f U q �- 13 .v. r Df Cl ff' T� o sy5 �. 3 '( 1 ` 10 a a ct 'r VL �(� _._ �•�� tJh TiO;J � Y CONTOOp GG ���4��'� ) Of f � C � 941 ,y 3 � U I�jl N t. •. ----• • lo -- � I i I '� I 3 � q �,o � � {X 1 I I i • � ; � / (/u�Qsiv is � � I I I I � • { � � � I � c' ' ° � I. ICI /��l I0 SOf- t C 9 I I t I c06 �� �o�' ro, 2 �I t I �t' � I i ! �� -4''► I � � q PPp °vEU oNf5 � �,v�� 8 o � ' --� o IZ cry STiv G- oZ Nt 0 S 1 s�pT /e r sTiN�' 7,�,<1/ <S , r/N �zU { s ySrfM (/993) i e,45 T Lo r hfi s r - Y,&v ew, �A 7 D, o = 134c,��ve p 1 T-5 / 9q, Q „�„ &44k 1 = Tor of STCEL Dr��ST I 6i.. sep r c M / tf 4o FA d` 2 - - I c -,P L_&c& 44oj' s tTE Sanitary Permit Application Safety & Buildings Division ° in accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 I seonsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not (Privacy Law, s. 15.04(I)(m)] state owned. Attach com lete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x i I inches in size. County /- State Sanitary Permit Number ❑ Check if revision to previous application State Plan . D. Number I. Application Information - Please Print all Information Location: Property Owner Name 54j&t,1QSB��) �� � N IS A- _ � - Property Location 2 9 /tGJ/ 1 i •(ijjd`�' J0 1/4 s 6 1/4, S✓ T R E o W operty Owner's Mailing Address - Lot Number Block Number le 15 6/P Ail %/9 /r�,�- - SOS �, e� /$4 City, State Zip C e ;,. _ Phonc'Number Subdiv' ion Name or CSM Number YV 745 NA II Type of Building: (check one) — = �� ❑ City ❑ 1 or 2 Family Dwelling - No. of Bedr i ptr ❑ Village r- �. Public /Commercial (describe use ` QffX, J osep Town of 5T ❑ State -owned III Type of Permit: (Check only o bok.om line B if applicable)' Nearest Road ocd A , /1 A) 1. ❑ New System 41tern eplacement 3. " Replacement of 4. Addition to Parcel Tax Number(s) Tank Only Ex istin S stem - 3D •/0/1 • A9 - 000 B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued I I o 3 IV. Type of POWT System: (Check all that apply) - tto )d Non-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -gra n Aerobf Treat ent Unit ❑ Rec' cu ling ❑ Other: V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate(Gals. /day /sq. ft.) Min. /inch) S Elevation < S3 `l 1 12 -85 - - 7 c (.Z� ) �iAN s X4 N.4A,- VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass / New Existing crete structed Tanks I T anks go Oe4 /QOV �v SCP 3 Nola " >g ❑ ❑ ❑ ❑ VII Responsibility Statement 1, the undersigned, ass ume res on ibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumb Ign ' ' at u ( oo stamps): P/MPRS No. Business Phone Number �a B� 2T �C L B�iccl�- z2� 7!5- 32P� •� /�'S Plumber's Address (Street, City, State, Zip Code) 0 5S o e v.2; 6 I ?P • 11 p r g o VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signatu a (No stamps) Approved ❑ Owner Given Initial Adverse rcharge Fee) Determination U.2ffill IX. Conditions of Approval /Reasons or Disapproval: P1-6/ .,►..., k ' .Q o, �P a -CRd 4� -+�i4 t�y� -tMp. r - b ct(S4QAA- U .nt.x►"� i x� c» S SBD -6398 (R. 07/00) l Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 ,► N`Visconsin www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 27, 2000 CUST ID No.226375 ATTN: POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT �. '`:.. �� f C✓ ROIX COUNTY SPIA 655 O'NEIL RD 1"101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL - Identification Numbers PLAN APPROVAL EXPIRES: 11/27/2002 Tra saction ID No. 447928 cet3 ' go�x Site 1D No. 201873 ztar,� P ase refer to both identification numbers, SITE: v� oF�;�E a ove, in all correspondence with the agency. Site ID: 201873, BURKHARDT RESIDE . , c ST CROIX County, Town of SAINT JOSEPH; .5 lJhp SW1 /4, SE1 /4, S3, T29N, R19W FOR: Object Type: POWT System Regulated Object ID No.: 770606 CONVENTIONAL HIGH CAPACITY SIDEWINDER 1539 GPD i iie submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • The grave ess system ll s components must be installed in accordance with the manufacturer's printed instructions, coin p the plan approval, and ch. Comm 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to c inspection by authorized representatives of the Department, which may include local inspectors. All p ermits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sinc ly, DATE RECEIVED 11/02/2000 I FEE REQUIRED $ 275.00 FEE RECEIVED $ 275.00 J ES B QUINLAN , POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (608)266-3937, 7:00 AM 3:30 PM MON / FRI JQUINLAN@COMMERCE.STATE. WI.US WiSMART�eode,,;7633 cc: JO ANN CHRISTENSEN i r Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 /'� n 4 *is COT o n s / I TDD rc .stat e.wi.us /S B 264 -8777 w ww.cornrnerce.state.wi.us/SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 10, 2000 CUST ID No. 226375 'f DATE RECEIVED 11/02/2000 j FEE REQUIRED $ 275.00 ROBERT W ULBRICHT ' FEE RECEIVED $ 275.00 655 O'NEIL RD k BALANCE DUE $ 0.00 HUDSON WI 54016 WiSMART code: 7633 RE: REQUEST FOR ADDITIONAL INFORMATION Transaction ID No. 447928 SITE: Site ID: 201873, BURKHARDT RESIDENCE ST CROIX County, Town of SAINT JOSEPH; 615 OLD MILL RD SW1 /4, SE1 /4, S3, T29N, R19W FOR: Object Type: POWT System Regulated Object ID No.: 770606 NONPRESSURIZED IN- GROUND INFILTRATOR/ PUBLIC 191 GPD The submittal described above has been placed on HOLD and the review and approval is pending subject to receipt of the ADDITIONAL INFORMATION and/or revised plans requested by this letter. Upon receipt of the additional information and/or revised plans, the plans will be reviewed for compliance to applicable Wisconsin Administrative Codes and Wisconsin Statutes. The following must be corrected/revised and accompany the resubmittal: • System design will have to be based on the Design Wastewater Flow, which is explained on page 9 of 28 in the Conventional Component Manual. Send your resubmittal into the address listed above, unless otherwise noted, and the department will review the resubmittal within 5 working days of receipt date. A copy of this letter is to accompany the resubmittal. If the above requested information and/or plans are not received within 30 days of the date of this correspondence, this submittal will be returned denied. No fees will be refunded, and a new fee, application form, and submittal of plans /specifications will be required should you desire to continue with this project. Sincere y, d l ES B QUINLAN , POWTS PLAN REVIEWER Integrated Services (608)266-3937, 7:00 AM 3:30 PM MON / FRI JQUINLAN @COMMERCE. STATE. WI.US cc: ZONING OFFICE ST CROIX COUNTY SPIA 1� Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 4 TDD #: (608) 264 -8777 I scores n www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 27, 2000 CUST ID No.226375 /, YTN.- POWTS INSPECTOR r - ` G OFFICE ROBERT W ULBRICHT - S OIX COUNTY SPIA 655 O'NEIL RD 1 ;��Q� 1 ARMICHAEL RD HUDSON WI 54016 L ` ON WI 54016 RE: CONDITIONAL APPROVAL�,NiN;;ot =F'tC� c.•, Identification Numbers PLAN APPROVAL EXPIRES: 11127/2'092 y �� Transaction ID No. 447928 Site ID No. 201873 SITE: Please refer e to both identification numbrs,: Site ID: 201873, BURKHARDT RESIDENCE above, in all correspondence with the agency- ST CROIX County, Town of SAINT JOSEPH; 615 OLD MILL RD SW1 /4, SE1 /4, S3, T29N, R19W FOR: Object Type: POWT System Regulated Object ID No.: 770606 CONVENTIONAL HIGH CAPACITY SIDEWINDER 1539 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and ch. Comm 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sinc liBQUINLAN, - DATE RECEIVED 11/02/2000 FEE REQUIRED $ 275.00 FEE RECEIVED $ 275.00 J ES POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (608)266-3937, 7:00 AM 3:30 PM MON / FRI JQUINLAN @COMMERCE. STATE. WLUS WiSMART "'7533,; cc: JO ANN CHRISTENSEN • . , 01-BRICI - IT & ASSOCIATES CO. 655 O'Neil Road - Hudson, WI 54016 neg..Destgners of Fnglneering Systems ti 715- 386 -8185 R nvate Sewage Consultants NOV 16 2000 �f � I s NDEX SAFM& B OGS DIV PLAN ID # 7 7 / q Z 3 DATE Oct. 30, 2000 Joann Christensen dba 'OWNER Burkhart Residence PHONE 715 - 386 -6125 ,%DDRESS 615 Old Mill Rd. Hudson, Wis. 54016 LEGAL DESCRIP'T'ION PIN 030 - 1011 -30 -000. SW1 /4, SE1 /4, A3, T29N, R19W. TOWN OF St. Joseph COUNTY St. Croix CSTM Robert Ulbricht 22637 5 LOCAL AUTHORITY/ SUPERVISION St. Croix Cty. Zoning Dept. PROJECT DESCRIPTIO This is a nursing 1/2 way home for a maximum of 28 patients /residents. The existing IGP system (1983) is beginning to reject the daily wasteloadg,(established by licensed pumper) of 2800 gal /day. Per discussions and approval from Leroy Jansky (Wis. Dept. Commerce) we propose to divert approximately half of the daily wastelead into a new replacement system (high capacity Infiltrator trench system).. Kitchen wastes and clothes machine wastes shall be seperate from the toliet /bath wastes. There will be two seperate building sewers. One going into the existing 10,000 gal. septic tank (the toliet /bath wastes) and then into the existing 1983 IGP treatment cell. The other building sewer (serving kitchen and clothes washers) enters an existing approved grease interceptor and then downstream into two new 1280 gal. septic tanks (Midwestern Precast Inc.). Two new septic tanks shall each have approved Zabel fliters (modelA -100) with approved locking above ground man ole /service covers. SIZING per Comm.Table A- 83.43.1: r Dining hall (kitchen wastes with dishwaser and /or foodwaste grinder WITH NO TOLIET WASTE FACTOR ADD is 4 gal /meal. Or, for 28 resients eating three meals/ day= 336 ga /day. Clothes washing machine wastes (established per Amanda Co.) is 46 gal /load, or for 15 loads daily estimated wasteflow 588gal /day Total estimated daily wasteflow into the new system= 1026 gal TOTAL DESIGN WASTEFLOW (1026 gal.x 1.5) = 1539 day Pg.l INFILTRATOR SIZING WORKSHEET l# Pg.2 SYSTEM PLOT PLAN VIEWS Pg -3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. , Pg.4 to of It If of Pg• 5 ZABEL FILTER & MANAGEMENT PLANS. �o'`���� S ���'''�•,, ROBERT W. _ ULD'.11CHT (1 01168 ICE / DIVISION OF SAFETY ' G 6WL0i4GS SEE CORRESPONDENCE 1 m � N N W o= I 1� z PD DO N , N �� �o��� , � I 10 l �01 IQ ,vuRs4v li t o AO o,Qop B oys o . • -- � r r d �srv6- _ Q p s�P o C4� . AP 4 41 13 J ` ,cupric T ST iNC i eqS T L o T G i:v Ts 1. ,��„ ► To s1 &EL ST s i�p 7 M/ t+ eo V (a �/�(9, = S _ i on- o IoM 0 GZrD AP ,O T u1 /9/V40tP v ti 7- P U.v iff -� ---� �► - -- - - TiPE.v C7T axe A PFp- ouep Cvo SS SEC T101,j O F TI'6 W l d It 31• &V 5 a, Fr To T Y e... s 7- 7`41 .v �"��` � U,v �NSpEcT�ov P,�,e, • Alin/ • / z ' � Iff M a y CD T� G AP Iff opfrovA L y 1 ?/,Si') (- /N Z- 7 , 4 77o S y I h/ly-A e4igl1 of / '' 14 Ul��L , 3 " 6 'a Go.vG w W A 3 5 Q, FT T To Ti i L A'Al 2 , iff ., _ 4 q3. D ?W' F 7- 1 F - 1. � M i TiP lell reD - rlr Eve< ,� S yS TAM i�v, S1 1.0 Pg. 6 Continued. - POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS 5T. co U.0 7 y * Governmental authority/ inspectors: 3 * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: R0&5P 7 — d 7— /t fllf 5' 2- 2- c►3 ' * Licensed service / inspection agent other than installer: 11;r-7- 1 a- �t� C ? 5 �4 &$I G'4� A?5 ' r4wKS To 4U&'y * Electrician, for pump, electric controls, wiring units: --------- ...._ --- IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveting, etc.) across the mound area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. i r 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (lea!tkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion reventive can lead to failure. Compaction or heavy P ) P Y traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: (effluent level inspection pipes), __ _ fer flushin and eleanin the lat ewe The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualibied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. F ;d wnnsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings , ., In accordance with Comm 85, Wis. Adm. Code - • County :5;r. C Atlach complete site plan on paper riot less than 8 1/2 x 11 Inches in size. Plan must Include, bill riot limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. A3 Q • 104 1- O percent slope scale or dimensions, north arrow, and location and distance to nearest road. 3 Please print a1tlntorniafiih�: R viewed by Dale Personal information you provide may 1) ' 04 seconds purposes (P cy Lew, s. 15.04 (r) (m)). 20 Prro Owner - n A. Property Location �j a '/EA" �L /� � G Gam- Govt Lot S� 1!4 S� 1114 S T 2 / N R Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# &i.5 a1-0 , ,�� • � ; � ,�� City State Zi Code Pt�glber (� City [] Village ,®Town Nearest Road 11 11 �!>�So -+� Cv/. S Q , ic" x 5 sT' 3 E P tf--- Div ✓y: /l. . E] New Construction Use: ❑ Residenlla ® f e)1, s Code derived design flow / le GPD K nepiacement 0- Public or commercial - Describe: y V f Y 1Vt7, Y1A - Parent material 0r74,),} Flood Plain elevation it applicable N fl. General comments and recommendations: -�7 Sys ❑ Boring # ❑ Boring } / EI-.Pif Ground surface elev. ft. Depth to limiting factor /�� In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ttt in. Munsell Qu. Sz Cont. Co lor Gr. Sz. Sh. I •Ef1#1 0 E11#2 / o SOY 3/ Sz- lfsAe ' C5 Z , y . ca 3 S 7• SYW, ;6 S. D . S cs . 7 z. :J 0 ,21 4 2— r ❑ 2 Boring # ❑ Boring 5 a > Q f4 Pit Ground surface elev. / h. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 0'/3 /0 YX 2 G S J, �, v R S z f .7 i. Z. 13 • Z/ /p YX 34 L s 1 /G11 f 'W v1 is • 7 A Z 3 -11.16 /09 s/6 s D r j �.Q . 7 �. Z cr cJ `t2•b 31.E -,( Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ' 0-1/ �eicti7- Signatur CST Number � Ad Dale Evaluation Conducted Telephone Number Af �m � iPEsiO�,vc> 5 o t) yL ( A4, e- y q 7Z:: r e 13 Property Owner Parcel ID # 03 O Aoff 3 0 v v Page Z of [3] Boring Boring # ❑ t� pit Ground surface elev. � It. Depth to limiting factor ? / 3 Z In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 o - ? 16Y 213 S z,w She m vf,e z of , S • � 7 7-2-3 0, S de cS 1-2- �,,,� q�•. sue ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eft #2 i a Boring # ❑ Boring ❑ Pit Ground surface elev. fl. Depth to Nmiting factor {n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. sno eaio fa cmo► A) 4 •vU ,e p e Si , W'4 S A010 s Ae S� 5 � ly c 0/ `/yi// kV qr o r � 13 E .. t i sP,�ivU , oo l I _ /3AC,�lOe pl rt'S •► t -- Z o 30 Of I ti-eAr L� e f 07 yST , ' I Qy , y p� s ;a .v7 I yy 7r �' i 11.411 D ( O I A. 05 �- ion ,- ,oQ . --TAJT e S-77, S°o S / Sys r, e /lv a4 7104 -7 I f 19�fO - U rdv -p�t.- °t Uo 1 ST. CROIX- G0UN.TY ZONING OFFICE CERTIFICATION STATEMENT w FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the s/ residence located at: Sw 1/4, S 1/4, Sec. - T 2/ N, R_�Y_W, Town. of S� OS Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 5 47 - • ' � � Did flow back occur from absorption system? Yes No /` (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: ?0 SA�e. X Construction: Prefab Concrete Steel Other Manufacurer (if known): / Age of Tank (if known) : (Signature) (Name) Please Print (Title) (License Number) (Date) Farm to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) b or sanitary ermit Certification: _ 1 Plumber er (applying f p ) In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best 'of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name � .� S D4P /MPRS 1140 7 S _J"�� g 5/88 ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT ...._ r f / AND 3gt0 tLl�" S OWNERSHIP CERTIFICATION FORM Owner /Buyer lT � �JL�'�s ©�l( U�tI�� b fI 4z, Mailing Address 60l5 O/Q /l� � �7"VQSD�V s�f /4�-' Property Address .S/1f- (Verification required from Planning Department for new construction} City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 54) '/., S� 1 /,, Sec. 3 , T "� ` N -R l j W, Town of s r r Subdivision _ N14 , Lot # Certified Survey Map # ti/� , Volume , Page # Warranty Deed # (t3 9 15 / Volume I S� Page e # 2 Z Spec house O yes kno Lot lines identifrable yes O no SYS'T'EM MAINTENANCE Imptoper use and maintenanceof 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 waste disposal system. i The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastet plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification slating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three yea iration date. 5 /4 o AIONA APPLICAN "r DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to tlue best of my (our) knowledge. I (we) Am (are) the ownet(s) of W TT IGNATURE y �descrlbeddy virtue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT DATE * * * * ** Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with tills 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 Wisconsin Department of Industry SOIL AND SITE VALUATION page of Labor and Human Relations Division of Safety and Buildings in accordant i Ff Wis. Attach complete site plan on paper not less than 8 112 x 11 Inches f 8! Pla frr ty �• Include, but not limited to: vertical and horizontal reference point (lirectfo�` percent slope, scale or dimensions, north arrow, and location and Wnce to nearest road. c Lb. # ST C APPLICANT INFORMATION - Please print all infor ' n. ' X I wed by Date Personal information you provide may be used for secondary purposes (Privy Lgw,� 15.t it�OFSG ' •� Property Owner 1'O At upi G t� e i srevseru "` % i T#B1ock# f,3v�Kwvo� iPESi� sw�-vSO.v 114 S� 1/4,S 3 T z � ,iv,R �� E (or) w Property Owner's Mailing Address Subd. Name or CSM# &1 OLD Mi LL RC ' City State Zip Code Phone Number Nearest Road► ° e 0 0S0 AJ ' s;( 01 & ( 7! S ) 3810 '( (1-5 1 ID City ❑ Village Ul - Town ❑ New Construction Use: 9 g ❑_, R sidential /Number of bedrooms Addition to existing building ❑ Replacement M � u R� ; L;' Public or commercial - Describe: y LrJ/} G L.- T oTA L- * 7 Code derived daily flow 2 90V gpd SCJ ra Recommended design loading rate —gy bed, gpd/fl trench, gpd/ft Absorption area required _bed, tt - rench, it Maximum design loading rate ` I bed, gpd /ft gpd/fl Recommended infiltration surface elevation(s) •S'�- ��- ' 3 ft (as referred to site plan benchmark) Additional design /site considerations A/&ft'W S will S�R UE" o•(�L y X'1*44 ' IWI - Parent material Flood plain elevation, if applicable 41� it S = Suitable for system CConvve tional , Mown In-Ground Pressure AT- Gr ade System in Fill Holding Tank U = Unsuitable for system L'� S❑ U U 5 E3 U l� U ❑ U Dl U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 5Z 11fS z •X/ /oY,�y s�L z fs6,� IM 7,e s ice- • s Ground 3 ] • 5 7.SVIV 516 e S 7 q� 2 •/p iD Y� -s /G S . a S G�.� — .7 .8 Depth to limiting g2 factor 7 In. Remarks: Boring # i3 /0Y/ 2 2 f • 7 • g 1 ,3 3 Ai -10 10 Yle 5x&_ 4rz� - ze Ground ©G elev. 8q.a� s Depth to . to V limiting 0 H factor 7 f, 6n. Remarks: CST Name (Please Print) Signature Telephone No. ROge �t� ' 1cGIT 7 /S- M - S> IP-5 Address Date CST Number As soc i ates A P2 (L S' t V C ! q - 2 43 75 Private Sewage Consultants 855 O'Neil Rd. Hudson, Wis. 54018 ,A GiG tJS�� SE�r1 *e_ �r,/✓C� �,e. ��p�X • . 20 �s. 6 AE5,Au.0s (A1,4x,',o&1 k�A4 . !y" / - aF c /oar *s IN 72-_-,1-/ s /%�K �Ui¢ s Tom .: ? � �rrti►f ���/ Gr�.¢ �j- ' r'/, y � G � - � -1 s, �ol,�� j3vtfew rao p PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of ' 3 PARCEL,.,., ®• /� /� • �� �� Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench z •�3 /a VX 31 -5 l f M 4 " 6e C � i f • `f ' . 5 • ¢ Ground 7•S Y / U SL e lev. ft. •Y ?s yx y/ s L fa dv r Depth to limiting 9.2 O 1 factor � in. 3.2 i, Remarks: Boring # layA 2 Z .8 .� Ground /d S • �. O �— • 7 G elev. !� Depth to limiting factor �� in. 7L Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots D/ 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: SBDW -8330 (R. 08/95) S�'Zl�ll� --- C ©/t1 ���(/U t>�J� ' ..� /�w� -2G�s �• c''�� . / d� - / 10,4 ,9 X 15 - 1o'40f 04P IWIL P4? cavra G � S D3 v siv G- Aar ES i COG y v s � v O A)s� C C, IT MAJ 6 c�pTiG 7, G p TAN -G- 0 o s ysrE.4 ti - 45 4o T �.Vc� sysT cleV*77OW-5 /ate c� 8 = B4e*'Aap, p t T -T Top o STCE4- stpric ele , = ler, 0 ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer f V' &;MS7�, g z%e& S f_ �� !9" U46 . Mailing Address Property Address (Verification required from Planning Department for new construction) City /Stan' _y��'> / ' Parcel Identification Number 03� • ��1�' �� ' �� LEGAL DESCRIPTION Property Location 5 '/,, y4, Sec. 3 , T 2 �' ` N -R l / W, Town of S � • ` �- 5 �' Subdivision , Lot # Certified Survey Map # , Volume , Page # 513 570 /o6 4" e Warranty Deed # _ <�T6, j:7 , Volume //b ,Page # / Spec house ❑ yes Kno Lot lines identifiableX yes ❑ no SYS'T'EM 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 waste 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, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/w e, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staling that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. /1 1144160 S _ I ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (out) knowledge. I (we) em (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Af NATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in die 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 t '� Oc�CUMENT NO. W ARRANTY DEED TNIS SIA E RESE poll RECORD +N6 DATA N 8'. STATE BAR OF WISCONSIN FOW1 2- 198 S i 13570 P _ RtL4IS t L" GFFIC r ` 4G97 VOL pA;E Chem -Med Management Group, nc., a innesota ST. CROIX CO., W1 ;f Corporation,..... - . .... ... -- ..... MAR 1 1994 - - f � _... . .. -- ---- ....... • - -• - -. 10:15 A. M —ntieys and warrants to - ._S- iiten. son- _Hea1tY�- 52CV1C2S,_11C., �h1� .a. Minnesota _.Corperation.,... -... ...._---- .......... -------- - - - - -- lae��te►of peens - .... .............. ... .. .. ..... - ....... - .. .. ..._.. _ .. -._ - ..... ... ....... . .. f -•�i .... _ ... i '"TURN .. kU' =tt 2�A ii CMI _._ . - PA r,t k y t� • i the following desc_ibed real estate in .._......St.._ Cr.c)lx ...............County, p State of Wisconsin: �' Z� • (9 . �S-U Tax Parcel No: ... --------------- ....... 7 0 30— Ittl —30 [.0- s�p Part of the SW1 /4 of the SE1 /4 of Section 3, Township 29 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Commencing at the SE corner of said SW1 /4 of the SE1 /4; thence West on the South line, 478.37 feet (recorded as 486.5 feet); thence North 30 degrees 40 minutes 00 seconds West, 633.0 feet, to the POINT OF BEGINNING; thence continuing North 30 degrees 40 minutes 00 second West, 264.80 feet; thence North 59 degrees 20 minutes 00 seconds East, 283.50 feet; thence South 30 degrees 40 minutes 00 seconds East, 264.80 feet; thence South 59 degrees 20 minutes OC seconds West, 283.50 a feet to the POINT OF BEGINNING. of that certain land (This deed is given in fulfillment contract rded between the parties hereto dated December 31, 198$, recorded January 17, 1989, as Doc. No. 444678, Book 831, page 612, in the office of the Register of Deeds for St. Croix County, Wisconsin.) (This deed is being re- recorded to correct the legal description in the previously,,.;" k This _ .._is._.A.QC------- homestead property. recorded deed.) Ir t Kj4X(is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. t Dated this - .. ..... 24'M ------ - - - - - -- day�of .._F __ . -. _ . 19. 94 -,. Chem -Med O agemen , (S EA G oup, IncEX7 ; i � REGISTER'S OFFICE M F M U . _ L) -- - - SEAL) By : - If�'41. R�c'dlbrRrioorq n Patrick Cronin, President `DEC 2 9 19�•e ' -. (SEAL) By :- _. (SEAL) - - a �f Steven _ -T.. -- Muellerl.ei.le, Vice - .�' -- -- -- -- -� President l !i EI�f�OMM AOHN049LEDCiMSNT Minnesota Signatures) -- ----- -- -- - - --- STATE OF 1VtE6AIQE1(A( I ' Z - •- W ashington > iCf4XJVl�)�r�4 -Co me this a l day of authenticated this -------- day of------ -- --------- ---- - -- 19 ...... Personally ame before 19:- 9 --.-.- 4 the abo ma+ ",� John- _P. tk rnin Steven ... '---------------•----•-------•-------------•---- •---- •---- •--------- •---- - - - - -- - -- s TITLE: MEMBER STATE BAR OF WISCONSIN .............. - -• (If not, .- •--- -•--- •-- --- - --- -• --- ---... ---•- -- t j authorized by § 705.08, Wis. Stats.l to me known to be the person* ........... who executed the il foregoing instrument and N bli nowledge the sa 1 THIS INSTRUMENT WAS DRAFTEO BY .� ...... r-is_tina. Ogland_ ________. WiS Notary Puc .. ':�[.i. -. .0 o t un y, M�'' ttorneX..at Law �Jl�s (Signatures may be authenticated or acknowledged. Both M Commis ' ion are not necessary.) date: - ) P ; *Name* of persons ei=ninI, in any capacity should be typed or printed below their siYnaturn. ' WARRANTY DEED STATE BAR OF WISCONSIN Milwaukee Legal 8!s Co .Inc. FORM No. t — 1998 Milwaukee. Wisconsin ;. a r..' .e'•. r I 1 - I V III IIJQ II Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 383936 0 " GENERAL INFORMATION (ATTACH TO PERMIT) late Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, 05.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Blaisdell, Herb /A" "Bu_V*kA4 l (LCSt &jc& St. Joseph Township 030- 1011 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: SectioNTown/Range/Map No: t50 .0 (Sb . O' C 3� , u I 03.29.19.55D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 15 7 / &J Benchmark 3.0 03.o tab `. t �� Dosing Alt. BM Aeration Bldg. Sewer 1 Holding St/Ht Inlet tr � t TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L Vv ELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' S70 r �S — :39 Dt Bottom Dosing / / r Header /Man. 4 3 Z Aeration Dist. Pipe Holding Bot. System _ PUMP /SIPHON INFORF Final Grade Manufacturer � Manufacturer Deemand St Cover L C M Model Number o � - C Ins � �.. �• 3a q 3 _�z.' TDH Lift Friction Loss System Head TDH Ft q• Sa °13, 5 z 0 Forcemain Length I Dia. j DIst.toWeR 3.a2 t l�,co SOIL 6W RPTION SYSTEM I RENCH idth r Length No. Of T nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME S SETBACK SYSTEM TO JPIL JBLDG IWELL LAKE /STREAM LEACHING Manuf vyrgr. S`� INFORMATION CHAMBER OR lI'tt Type Of System: r / / UNIT Model Number. DISTRIBUTION SYSTE' 9 Q 1 Header/ anifo C D dribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Len Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded ulched Bed/Trench Center Bed/Trench Edges Topsoil Fo�j Yes Fal r No 0 Yes Fx_j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: ­ 7 - - r — Location: 615 Old Mill Road Hudson, WI 54016 (SW 1/4 SE 1/4 3 T29N R19W) NA Lot ` r r -�— Parcel No: 03.29.19.55D 1.) Alt BM Description = IrrlA 5-) 2 t"' 30 O " 2.) Bldg sewer length /Q / - amount of cover A - ` ,CD � Cs� -riu➢, Plan revision Required? Yes X No � 1 Use other side for additional int>rmation. SBD - 6710 (R.3197) � ate is Insepci ols ignature Cert. No. G r_XA l �� = X03, g cr L e Uv� r elk-- L • 5 qo 4v '5- r A— /��; Is n t, 12 � 1584 PAGE 221 , o STATE BAR OF WISCONSIN FORM 7 - 1998 6.38151 4 KATHLEEN H. WALSH " r WARRANTY DEED REGISTER OF DEEDS DocumentNumbe` ST. CROIX CO., WI This Deed, made between Christensen Health Services, jar—, a RECEIVED FOR RECORD Minnesota Corporation, f/ Swenson Health Services, Inc.. -- 02 -07 -2001 9:30 AM WARRANTY DEED Grantor, and Her bert E. Blaisdell and Lisetta M Blaisdell, husband and EXEMPT N wife, holding as survivorship marital property CERT COPY FEE. COPY FEE: TRANSFER FEE: 1050.00 _ — RECORDING FEE: 10.00 -- -- - -- PAGES: I Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Retur Address 1, Part of the SW 1/4 of the SE 1/4 of Section 3- 29 -19, Town of St. Joseph, St. Thomas A. McCormack Croix County, Wisconsin described as follows: Commencing at the SE corner of L A l F.'; s7P 2 said SW 1/4 of SE 1/4; thence West on the South line, 478.37 feet (recorded as t lire S _:t9� }tF,:,4C 486.5 feet); thence N30 0 40'00 "W, 633.0 feet to the Point of Beginning; thence B8 { Wi X4003 continuing N30 40'00 "W, 264.80 feet; thence N59 20'00 "E, 283.50 feet; thence S30 * 40'00"E, 264.80 feet; thence S59 20'00"W, 283.50 feet to the point of 030- 1011 -30 beginning. Parcel.1dent� cation Number (PIN) This is not homestead property. Exceptions to warranties: Easements and restrictions of record. Dated this 1st day of February 2001 CHRISTENSEN HEALTH SERVICES, C. AUTHENTICATION ACKNOWLEDGMENT STATE OF ( )) r ) i Signature(s) ) ss. _ 5 - Cyr o t X County. ) Personally came before me this day of authenticated this day of �e O. 1 2001 the above named TITLE: MEMBER STATE BAR OF WISCONSIN .... to me known to be the person(s) who executed the foregoing (If not, . N�g st ent and acknowledge the same. , t authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED SS,:'X ;�•� W: Q'.. J r I Thomas A. McCormack 6 is u 12. C 17 ! Pyt B aldwin, WI 54002 a Notary Public, State of (Signatures may be authenticated or acknowledged. srediot MY Commission is pelTnanen . no , s e exprra on e: necessary.) %< ... —12- o - 5 .) ' Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF W ISCONSIN WARRANTY DEED FORM No. 2.1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800655.2021 0 An '}7 Sanitary Permit Application safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Wisconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach corn lete lans (to the count ' co onl ) for the s stem, on a er not less than 8 -1/2 x 11 inches in size. County C� C 10 �/ State Sanio Per i Number 11 Check if revision to previous application State ��Z D. N mbeer 1. Application Information - Please Print all Information Location: Property Owner Name J ,r d// / Property Location n &IA /J11f l 5, 9'e l! 13W, 7 0 ,0T 'K 50 114 s fl /4, S 1 I Q ,N, R 7 E or W Property Owner's Mailing Address Lot Number Block Number CQ c 5 o/O Al� // J ' ---- - City, State Zip Code Phone Number Subdivision Name or CSM Number /> ap50A, 0/. SyaI ( 7/s ) 3 8to • &12.5 II Type of Building: (check one) ❑ City ❑ 1 or 2 Family Dwelling – No. of Bedrooms: ❑ Village Public /Commercial (describe use): Ya. QJ/� — 1Ul��6, )et S � � KTown of IWL- ❑ State -owned s S P III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road eP A) I. ❑ New System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System 1 d Q • `d // — D ' d O O ' B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV Type of POWT System: (Check all that apply) ` . Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line r ❑ t- a . Treatment Unit ❑ Recirculating ❑ Other: S S O V Dis ersal/Treatmen Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade ,Y'j) Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 9a . a e Elevation CJ t/ 1ST /,s ©Q 7 g`J.$D --� �/0 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing ? ?, crete structed Tanks Tanks i�8/ ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume res on ibility for installation ofthe POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): ,- MP /MPRS No. Business Phone Number �ZDa & r 2Ilhlf/�4 3 - 7 s 7/5. 3Fb-(F /o Plumber's Address (Street, City, State, Zip Code) 6 ,5 0 "N_et'L /�� fjll l�S�1J Gt' /S • S �lDi� VIII County/Department Use Only • Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ip ng Agent Signature (No stamps) Approved • Owner Given Initial Adverse Surc rge Fee) Determination I s Z S 2� Zt>a I IX. Conditions of Approval /Reasons for Disapproval: 'k Ark 5 s tnr�> s�' tnrcna au,+�o «• �-, YtcJA cego 4 ��,r"d4ae S ,�� I t SBD -6398 (R. 07/00) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM count SajotV and Buiidings Division y t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar PermitNo.: 3 Personal Information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). Permit Holders Name: ❑ City ❑ Vi la [] wn o : State Plan ID No.: JoAnn, Christensen St. oseph Township c f } 9 2 $� CST BM Elev... Insp. BM Elev.: BM Description: o Parcel Tax No.: 030 - 1011 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. v oAD Septi w - %&W P• - ?IV Benchmark 3.0 ID "r-A E lam` ? �2g'a . BM Z Aeration Bldg. Sewer Holding G / Ht Inlet I 1� O 7 -S4 ' TANK SETBACK INFORMATION V ` / Ht Outlet $.Ta- 1511 TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic <:. -- NA Do"% NA Header /Man. Aeration NA Dist. Pipe (p, Z Y ��' Z z Holding _.- Bot. System 5 �`B Dlr.' 9 f 9 3­75 3 1 � /S PUMP/ SIPHON INFORMATION Final Grade q ' s 3. /f gv.yy ?G.3z Manufacturer - - emand St cover Mode! Num er GP G - r TD Lift Friction em TDH Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED(/TRENC Width f Length No. PIT No. Of Pits Inside Dia. Liquid Depth IM ! N 3 I(� N IM I N SYSTEM TO P / L BLDG WELL LAKE/STREAM L M actur r: SETBACK AMBE INFORMATION System: Z s 7S�(� M o� Num er: er DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size I x Hoe Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 1 c,� SOIL -COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mul7ched Bed/ Trench Center Bed /Trench Edges Topsoil Q Yes ❑ No ❑Yeo COMM ENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Oq / I o / o l Ins ection #2: / Location: 615 Old Mill Road, Hudson, W1 54016 SW 1/4 SE 1/4 3 T29N R19W) - 032919855D 1.) Alt BM Description= .�ca.� Atrow �e (e2Je 5y,5{tom 2.) Bldg sewer length= e�� `s � 5 {aged 4^e en4 sy s fems tv, s -Ak . - amount of cover = Cave f a� Ae 0l. ZQ� / k a C� ac�- ► � /p / 1 -53 /i*S G�C/P fh 53�t��if Ok %�l�ivr� Ldl�Y h� OThG/ I00 KkAPLY Plan revision required? ❑ / Yes Q No ! v l •rte Use other side for additional information. p t (o SBD -6710 (R.3197) Date Inspector's Signature Cert. No •M e� N b� cuti J ° o D 5- - o— M M 1 D s,� O y" VC Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ®sevnsin Pal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Personal } Department of Commerce (Submit completed form to county if not (Privacy Law. s. 15.04(I)(m)] state owned. Attach com lets plans (to the county coRy only) for the system, on paper not less than 8 - 1/2 x I I inches in size. County C A �/ State Sanitta Permit Number ❑ Check if revision to previous application State Plan I. D. Number .7 �1 1L 6P32- V ,? I. Application Information - Please Prin all Information Location: Property Owner Name e / ,� p / /�j ,�e o., Property Location a K � Sd �! �VF /� " ' �T /K S� SW 1!4 S �l /4, S 3 1 ,N, R I E (,, W Property Owner's Mailing Address Lot Number Block Number ca 5 ow XJ City, State Zip Code Phone Number Subdivision Name or CSM Number If 0OSo.tJ sya/6- ( � /S ) 3 8!0 • �l ZS II Type of Building: (check one) ❑ City ❑ 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village )k Public/Commercial (describe use): y� pJi} —Public/Commercial 6�Town of L3 State -owned $ T. `T S >� P III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) I. ❑ New System 2. Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) stem Tank Only Existing S stem d 0 - 10 11 - 3 0 ' 0 g) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV Type of POWT System: (Check all that apply) * Non-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line i ❑ t- a Q Acrollic Treatment Unit ❑ Recirculating ❑ Other: V Dis ersaVrrestmenl Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) O e Elevation (J V 15 /SO 1 .-7 1 1_� y. So ---, 59 -50 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing ?• ?• crete structed Tanks Tanks �0� �dfi0 >G OiY ❑ ❑ Nt ❑ ❑ VII Responsibility Statement 1, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans. Plumber's Name (prin kalkewl Plum er's Signature (no stamps): P/MPRS No. Business Phone Number rzoa�nr Zz� 3 s 7 3 Plumber's Address (Street, City, State, Zip Code) Ce $ S ) ' NZ i L �� • /� v�So. Gam / • S �O� VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ip ng c r gent Si ature (No stamps) Approved ❑ Owner Given Initial Adverse Sur Fee) 6 ,tl(` /,','^,, Determination ZS • � ZW IX. Conditions of Approval !Reasons for Disapproval: tk11 soo�cjr -s w�s� n v� ( � caa�1 a't�c c�4►n&4ccs s • Q� �� �,� Limo .k -4 �„ cB• � � 1 '' V nn a-( tnl� hti0 t(C� �� ry w•tvuua- e.� r�c,s+µ n�ect.i u� . SBD -6398 (R. 07/00) o `,—• ycu Gor 1 5 s C,94� : / "= 3 �. I /A; lt4 i14 1 a - - - -- /so 60vtTro,,) s 3 0 AlAr 1 Y4 / 7y29 tiDU. Z7, ( �7 .. O 13114 / 00 - y /� Exrs Ti�u (r 0' S � _______ o S• JA -==mo -� _ .. -(Z� - - °- ��� I _ . _.._. Vp 5' - - 4Z7-- — Z-07 4 . 0 q� ��o 67 1.e 0, D (/0 Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 ` TDD #: (608) 264 -8777 r r Iscons n www.commerc .wis ons www.wisconsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary April 11, 2001 CUST ID No.226375 ATTN: POWTS Inspector ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/11/2003 Identification Numbers Transaction ID No. 632498 SITE: Site ID No. 201873 BURKHARDT RESIDENCE — GROUP HOME Please refer to both identification numbers, - ST CROIX COUNTY, TOWN OF SAINT JOSEPH above, in all correspondence with the agency. SW1/4, SE1/4, S3, T29N, R19W; 615 OLD MILL RD FOR: DESCRIPTION: REPLACEMENT NON - PRESSURIZED IN- GROUND SYSTEM / 1800 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 786570 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. On page 5, the management plan must reference a non - pressurized in- ground dispersal component, not a mound system. 2. Concerning this bound volume, there are actually 11 pages, some of which are not numbered or suitably referenced in the table of contents as specified in the approved "In- Ground Soil Absorption Component Manual For Private Onsite Wastewater Treatment Systems" (Version Z.0) SBD- 10705 -P (N.Ol /Ol). 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. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. ORIGINAL ROBERT W ULBRICHT Page 2 4111101 Sincerely DATE RECEIVED 03/29/2001 FEE REQUIRED $ 225.00 FEE RECEIVED $ 225.00 P G L BALANCE DUE $ 0.00 POWTS PLAN RE WER II , INTEGRATED SERVICES (608)266-2889, M - F, 0700 - 1530 HRS PEPAGEL @COMMERCE. STATE. WI.0 S WRTrd " 73 cc: HERB BLAISDELL ULDnIC & ASSOCIAT ES co. 655 O'Neil Road • F ludson, WI 54016 Reg- Vesigners of Engineering Systems 715 -386 -8185 Private Sewage Consu►lanls PROJECT INDEX PLAN ID # 2 DATE March24, 2001 OWNER Herb Blaisdell dba "Burkhardt i0 Residence' �O 715 - 386 - 6125 ADDRESS Burkhardt Residence, 61 '3son, Wi . 54016 LEGAL DESCRIPTION PIN 030 -101 30 -� Rr O 4l� SWl /4, SE1 /4, Sec.3, T29N, R19c° fi F o TOWN Of St. Joseph Asti U St Croix CSITI Rob ert Ulbr CST226375 tiC'F LOCAL AU'THORI'TY/ SUPERVISION St. Croix Cty.• Zoning Dept. PROJEC DESCRIPTION! A replacement system for an existing resident group living home (1/2 way type facility), for up to 28 residents and 7 staff employees. This system shall be treating only the wasteflow from toliets and bathes. All the wasteflow from the Kitchen and clothes washing machines is being seperately treated by a proposed new state plan (refer to state approved plan No.447928 - Nov.2,2000- a copy enclosed). Total documented daily wasteflow for entire residence,as measured daily by licensed pumper service is a maximum of 2800 gallons. The existing failed IGP system from 1983 shall be abandoned but left intact for future re -use via a valve system. The IGP system, per soil test of March 2, 2001, and per previous soil exam by Leroy Jansky (Dept. Commerce -see enclosed state report) veries that existing 1983 system is in code compliant soils. As indicated on March 2, 2001 soil evaluation report, the sizing of this proposed new inground non - presurized trench type system, and per Code Table 83.43 -1 (with interpolation using hotel rm. waste sizing factors), the total estimated daily waste- flow is 1001 gals. but the enclosed proposed new system shall be designed using a "Design Wasteflow" of 1800 gals. daily. This determination was arrived at after consultation with Dept. Commerce Wastewater Specialist Leroy Jansky, and after consultation with Plan Reviewer Peter Pagel. Table 83.43 -1 allows for a daily wasteflow of 69 gals per room (2 persons) for hotel toliet/ bath wastes. Thus, per individual, a daily flow rate of 35 gals. was used. Per " Inground Soil Absorption Component Manual SBD- 10705 -P (n0 /01), the design wasteflow of 1800 gals. shall be dosed using the existing code compliant 3000 gal. precast pump chamber (1983 - Wieser Concrete Co. Maiden Rock, Wis.) Existing dual alternating O Q (OVER) Ulbticht & Associates Private Sewage Consultants Pg.l INFILTRATOR SIZING WORKSHEET 655 O'Neil Rd. Hudson, Wis. 54016 ,SZS �� Pg.2 SYSTEM PLOT PLAN t o Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P 4 it it .r g. OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS 2 / c� Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. 3 i The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /O1. pumps shall be re -used. The existing watertight code compliant steel septic tank (8000 gals.) shall be reused. However, per 83.44(2) (c) a new exterior Zabel filter system shall be installed (Zabel model No. A100, suitable for daily wasteflows up to 3000 gals.), filter encased in code compliant seperate vault (Zoeller model #170 - 0011). Y `^ oa � �```' - l► 1. CNN » Sn Q m v1 Page 3 Soil Appli cation Rates for Leachin g Chambers Assigned Sizing Credit Manufacturer and Product Name Model Actual Open Assigned Soil Application Assigned Soil Contact name Bottom Area Rates for per Table 83.44 -1 Application Rates for w /phone # per Chamber or -2, Wis. Adm. Code Sizing Credit per Product A pproval Hancor Enviro Hi 17.7 ft 0.2 gals /ft /day 0.35 gals/f /day Frank Daly Chamber Capacity 0.3 gals /ft /day 0.5 gals/ft /day 419424 -8305 0.4 gals /ft /day 0.7 gals /ft /day 0.5 or 0.6 gals /ft /day 0.9 gals /ft /day 0.7 gals /ft /day 1.2 gals /ft /day Enviro Standard 17.7 ft 0.2 gals /ft /day 0.27 gaWfe/day Chamber Unit 0.3 gaWf /day 0.4 gals/ft /day 0.4 gals/ft /day 0.54 gals/ft (day 0.5 or 0.6 gals /ft /day 0.68 gals/f /day 0.7 gals /ft /day 0.95 gals /ft /day Infiltrator Systems High Capacity 17.14 ft 0.2 gals/f /day 0.35 ga1s/ft /day Inc Sidewinder 0.3 gals/ft 0.5 gals/f /day Mike Monfeli 0.4 gals/ft /day 0.7 gals/f?/day 262- 238 -0908 0.5 or 0.6 ga1s/ft /day 0.9 gals/f /day 0.7 gals/ft/day 1.2 gals/11 /day Equalizer 36 EQ 36 15.28 ft 0.2 gals/f /day 0.27 gals /ft/day 0.3 gals/ft2 0.4 gals /ft /day 0.4 gals /ft /day 0.54 gals /ft /day 0.5 or 0.6 gals/ft/day 0.68 gals /ft /day 0.7 gals/ft /day 0.95 gals/ft /day BioDiffuser 17.7 • PSA, INC 16" High 0.2 gals/ft /day 0.35 galslft /day Dick Bachelder Capacity 0.3 gals/ft/day 0.5 gals /ft /day 800 -598 -2614 0.4 gals/ft /day 0.7 gals/if/day 0.5 or 0.6 gals/ft /day 0.9 gals/fl/day 0.7 gals/ft/day 1.2 gaWft /day Standard Unit 14" High 17.7 ft 0.2 gals/R /day 0.35 gals /ft/day 0.3 gals /ft /day 0.5 gals /ft /day 0.4 gals/ft /day 0.7 gals/ft /day 0.5 or 0.6 gals /ft /day 0.9 gals/ft /day 0.7 gals /ft %day 1.2 gals/ft /day j i r r I kv T' o - . s CAI . / - 30 � I INSY4 /14 I a 3 0 .vlr I 12 ' � 4 I ,VDU, Z7, yET P 13ASE�'gel S 13 0 000, z� 3 ��7g 1 w 0 �o to��FS'�J�°°" r t do o r- A I B 114 / V ° 57E J a� D k �' ica, /00 0 u - 5b . L o j i il�Q d y I i i I � `� I �hll I �'►� I I I � I � � �� 1. I i I I I I v1 I `p � N I I � I I I I I o I + I I l ° I ° i i° � I m i I I I I l i I I I `I► I 'IN I I °a I _ o LIJ y � o I I I II j I I I I I l I I I I I i I I I I Io I oI IoI I w lol I C I l I I I I d I I l i I I I I i i I I I C � l ,l El 7p \ m v e9e., Za 0 I 7 �0,0 e 4) 4 ?e /3 Iff N 5 0 YX 4A CAo SS SEC T10A) o W5 1A) - 'lN � ro y► ,,, cAPAc, ry w i sQ FT. VlA00 s � c�ifclr j/ �,1� Sic Tr'o.+J 116 7 iff he I 'er A yNt 1,15 - 7 0 OVER: See Reverse Side for Vent/ Observation Pipe Details. p oaf 7 F An observation pipe may serve as a combination observation/vent pipe providing it terminates in the same manner as required for vent pipes. See Figure 6. � "I Vent cape Return bend Cap 12" min. 12" min. Final grade,, Aggregate Islribution lateral System elevation Figure 6— Vent and combination observation/vent pipes Leaching chamber tops are at or below the -original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate ' systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance �t 4inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. , ' Water tight cap Top of r� 4" min. dla. �` leaching Repair couplings chamber _Slot 6" min. min. 4" min. Infiltrative surface water Closet Collar Har(3/8" min, dia.) Figure 5 - Observation pipes Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4 inches. • , OWNER's MAINTAINCE OF SEPTIC SYSTEM ' POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS sTce * Governmental authority/ inspectors: AE77 -- 3 dC0 * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: R 013 x - 72 - NiiPie?4 �I/J.PS' 3 ? 5 r * Licensed service / inspection agent other than installer: 3 a * Electrician, for pump, electric controls, wiring units: 73 3 6 IMPORTANT OWNER MAINTENANCE REQUIREMENTS G S C�RR� 1. Winter traffic (sledding, shove ring, etc.) across t mound area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of/�� gals. daily. ' 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, e allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone t0 maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is " necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out- The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualibied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. 2eff&-Z- FiG1--Ex�io�c -74�-410-0 3 t ZabeITM A100 Series Commercial & Residential Effluent Filter �!�► Product Specification 1, Product Name: ZabelTmAl00 Commercial & Residential Effluent Filter, U.S. Patent: 4,710,295 2. Model Numbers: A100 Case & Cartridge; A101 Cartridge Only; A100 -HIP Case & Cartridge; A101 -HIP Cartrid Only 3. Applications: Apartments, trailer parks, schools, churches, shopping centers an ns and community treatment plants; Single and Multi- family homes d offices; Septic dump stations 4. Performance Specification 4.1. Model A100: 3,000 gpd 4.2. Model A100 -HIP: 4,500 gpd 4.3. Multiple filters may be installed in manifolds to handle larger flows. Use a Zabel Flow FC100 to set the effluent flow to predetermined limits. Control Plate Model 4.4. TSS: Reductions in TSS within six months of installation - 50 to 90 percent. The higher the pre - filtered TSS the greater the percentage of reduction. 4.5. BOD5: Reduction in BODS within six months of installation - 20 to 45 percent i of the wastewater. P s dependent on the make -up 5. Materials: All materials are non - corrosive. Case & Lid - PVC; Filter discs - Polystyrene; Rods - Poly ethylene; Nuts - Nylon. A100 -HIP rods and nuts are stainless steel. an outlet access opening at least 16 6. New System Installation: Center the top of the 12 inch Filter Case under inches in diameter. PVC solvent weld the bell coupling to the 4 inch Schedule 40 PVC exit pipe of th required by local code. The PVC outlet pipe should extend at least 18 inches beyond the outside face of the tank wall. If required to meet depth requirements, install a ZabelT"" Extension Reducer and 4-inch Schedule 40 e tank as Pipe to the bottom of the filter case. A riser to grade is recommended. High performance double stack (Model. A100 -HIP) filters and multiple filters installed in manifolds will require additional support and access. 7. Existing System Installation: The filter may be installed in an existing septic tank if an outlet access opening already exists and the filter can be installed without damaging the existing tank. If a 4 -inch Schedule 40 PVC pipe does not extend into the tank, the filter can be installed utilizing a plumbing flange. If the existing tank cannot be used, the filter can be installed using a ZabeITM' Container Assembly Model CA100 or ZeusTM Basin System. ting septic 8. Service: A professional onsite service company should perform all onsite system service. 9. Service Method: Grasp the filter handle and pull the filter cartridge upward. A Zabel" 36" T- Handle is available if required to reach filters more than 12 inches below grade. Hose off the cartridge into the tank and reinsert into the case. If required, the filter may be disassembled for further cleaning. 10. Service Frequency: The filter requires cleaning when the septic tank is normally inspected an required by local regulation. The A100s are designed to slough most normal solids off the inside of the vertical disc dam walls and back into the tank when the effluent flow is in a resting state. Installation of pumped as an effluent filter may increase the frequency of service if the homeowner discharges materials that are harmful to the system. 11. Warranty: The A100s are warranted to be free from defects in material and workmanship for the life of the original purchaser. Zabel'sTM liability is limited to repair or replacement of the part and in no event s be liable for any consequential damages of any kind. hall ZabelTm 12. Dimensions: A 100 16" 1/169' ' • 12" - A100 -HIP 12» 26 „ .596.16 inz 1,857.6 in 198 1/16" 1,018.08 in 2,908.8 in z 297 a n " 47 N f� 6( PUMPS 19 ,7J '. va[ /TY SECTION: 3.20.150 sN�E �4. FM1547 ` " 0699 9 Product information ' ® Supersedes presented here reflects /� conditions at time of L O 1097 Publication. Consult factory b� ;r�` regarding discrepancies or MAIL T0: P.O. BOX 16347 • Louisville, KY 40256 -0347 VISIt inconsistencies. our web Site: SHIP TO. 3649 Cane Run Road • Louisville, KY 40211 -1961 http.-#www.zoe11er.com (502) 778 -2731 - 1 (800) 928 -PUMP • FAX (502) 774 -3624 ZOELLER ONOSITE WASTEWATER P RODUCTS SOBLLLrB S"77C SYSM N ACCBSSOB/ES Zoeller Container Assembly P/N 170-0011 �.L7r y Installing the Zoeller Filter `° CR�� in Existing On -Site Systems There are two ways to retrofit the Zoeller Filter in existing septic systems, low dosing systems or aerobic on -site wastewater systems. The first method is to expose the existing tank at the outlet end, remove the access lid and replace the existing outlet tee with a new Zoeller Filter. However, in some existing tanks it is very labor intensive or impossible to do because of the location or design of the existing tank. The alternative to installing the Zoeller Filter in the existing tank is to install it outside the tank between the tank outlet and the distribution system in the Zoeller 170 -0011 Container Assembly. The installation is very quick and simple and provides the same protection to the distribution system (lateral fields, STEP systems, mound systems, trickle systems, etc.) that is provided by installing the filter in the existing tank. The container assembly comes complete including the Filter Container, Adjustable Riser, Riser Lid, Lid Screws, Schedule 35 and Schedule Zoeller 170 -0011 Container Assembly 40 pipe seals and sealant. Filter Container, Adjustable Riser and Riser Lid — 11 5 /i6 III — I I BOLT DOWN —III GROUND I I I I l l l i RISER RISER LID LEVEL FILTER — I SEALANT SEPTIC TANK '�iroel � - - OUTLET ADAPTER eo — III — I I SCH. 40 PVC S I I+F) 11 — I I I — I I T _ e I I — I I I � I I I I I I I I _ I I I I I _ I vies. -- _ —____ - -- `FILTER CONTAINER 8K7683 A typical Container Assembly installation is shown above and the dimensions of the Fil C Riser and Riser lid are shown to the right. sK1ass „ ,ir rn twaxa p —. __... - -------------- - - ALL ZOELLER ON -SITE WASTEWATER PRODUCTS MUST BE INSTALLED IN ACCORDANCE WITH LOCAL AND /OR STATE PLUMBING AND /OR HEALTH DEPARTMENT CODES. Distributed by: a © Copyright 1999 Zoeller Co. All rights reserved. PLIMP CHAMBER CROSS SECTION AND SPECIFICATIONS b P E > /O ' - 7 1- 0 �csi vDocJ, - DOOR 7 w VENT CAP ( i VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 12 "MIU. ! f I w - / 4 AAA , 06 IA13 7.SQ V j1 - /O n/ GRADE I > I Y "MIN. CONDUIT -- q3, 00 ��,� ---- - - - - -- �IEPfr ov X11 PROVIDE INLET - -- J,�,_,.. *.. - - - - -- AIRTIGHT SEAL I I I nncc I II APPROVED JOINT A 51 vG K I I APPROVED JOINTS %,J/ PIPE a1 J4 I II W/ PIPE EXTENDIMC, 3' 6� I I ALARM EXTENDING 3' ONTO SOLID SOIL 9 g,'�� I 11 ONTO SOLID SOIL 54.40 Poc I 5C4 . g v PMc � I I I ON Q �o C I ELEV, � I FT. PUMP - -� SE o 1 � � OFF 2/ 3 /Q D � , /clDiPE eF SANK 'gEDO/ti � BLOCK S�tv� �c % vfi t io d T w � RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL 3PECIF(CAT10MS DOSE T/ TANKS MANUFACTURER: 2 I.IUMBER OF DOSES: PER DAy TAA1K SIZE: 3 � GALLONS D051 to ALARM MANUFACTURER: G�I91�L AIr O INCLUDING BACKFLOW: 3�� GALLONS MODEL NUMBER: -D' V L ' CAPACITIES: A = Z INCITES OR GALLONS ,0� SWITCH TYPE: � — B= / y INCHES OR _L L_ GALLONS U} l PUMP MANUFACTURER OvL/, Cp �9 C= 61 INCHES OR 3 Q GALLONS � MODEL NUMBER: 1/� D= /2 INCHES OR & GALLONS �� SWI TCH T`JPE: /' / ysy,� < F49 - 5 NOTE: PUMP AND ALARM ARE TO BE I,iG1� 1 MINIMUM DISCHARGE RATE ZS GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET -rAok SP,E + MINIMUM NETWORK SUPPLY PRESSUR FEET E� AC- + .100 FEET OF FORCE MA X J 11 - 6F /00 FT.F RICTIOM FAC.TOR..1_:L FEET' — TOTAL DYNAMIC. HEAD = 2-0 FEET `f V It INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ? ;LIQUID DEPTH ,rIEV +7/'OA,) Or AY 7reld /3 x (�Pi� �i, h, P - SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a licensdd service pumper. C- Submersible Sewa Pump 3 88 7 AVAILABLE CERTIFICATIONS ,. ETL LISTED SUBMERSIBLE PUMP CLASS I AND 1I DIV 2 AND LT1 CLASS III DIV, 1 AND 2 `I V ETL TESTING LABORATORIES, INC. CORTLAND, NEW YORK 13045 G1086131480 CANADIAN STANDARD ASSOCIATION SA u APPLICATIONS • Three phase: % -1 HP, FEATURES • Homes 208/230 - 460 V, 60 Hz, 1750 Motor: Fully submerged RPM; 1 HP 208/230 -460 V, Impeller: Cast iron — semi- in high grade turbine oil for • Farms lubrication and efficient open, non -clog with pump •Trailer courts 60 Hz, 3500 RPM. • Motels Overload protection heat transfer. must be out vanes for mechanical seal ht ran for continuous • Schools provided in starter unit. protection. Balanced for smooth D es i gned operation. operation. All ratings are Sewage systems Shaft: Threaded 400 series within the working • Hospitals stainless steel. Casing: Cast iron volute type limits of the motor. I • Industry • Bearings: Ball bearings, for maximum efficiency. • Dewatering upper and lower. Adaptable for slide rail systems. Bearings: Upper and Anywhere waste or drainage • Power cord: 15 foot Mechanical Seal: Ceramic lower heavy duty ball bearings must be disposed of quickly, standard (optional lengths vs. carbon sealing faces, construction. available). stainless steel metal parts, Power Cable: Severe duty quietly and efficiently. Single phase: ' /3 -' /2 HP, BUNA -N elastomers. rated, oil and water resistant. SPECIFICATIONS 16/3 SJTO with 3 -prong Shaft: Corrosion resistant Epoxy seal on motor end plug; /4 and 1 HP, 14/3 stainless steel. Threaded Provides secondary moisture Pump: STO with bare leads. Three design. Locknut on three barrier in case of outer phase. / 1 HP 14/4 STO jacket damage and to prevent ' I;I •Solids handling capabilities: with bare leads. On CSA Phase models to guard against oil wicking. 2" maximum. component damage on • Capacities: up to 180 GPM. listed models, 20 foot length accidental reverse rotation. 0 -Ring: Assures positive • Total heads: up to 49 feet TDH. SJTW or STW are standard. sealing against contaminants • Discharge size: Flanged BF or and oil leakage. BHF units have 2" NPT threaded companion flange METERS FEET as standard. Optional 3" NPT 77 77 TM M77 F7M 77r threaded comp g anion flan a 16 t „ M 3887 j available and must be ordered SIZE2'SOLIDS or I ' separately. (Order No. Al 14 t • Mechanical seal: carbon- a0 ' 1, t < I r i' rotary/ceramic stationary, 300 12 series stainless steel metal 1 parts, BUNA -N elastomers. ° 10 • Temperature: 160 F = 30 r I I I (71 ° C) maximum. s { • Fasteners: 300 series o I I 1 ' ` I' stainless steel *Capable of running ge to s 20 ' f� + }f , t j t + i i • � dry without dams + , I , r r,. components. 4 1 r E } 10 I Motor: 1 2 I I t: •Single phase:' /3 -' /2 HP, 115 V { .i , or 230 V, 60 Hz, 1750 RPM; o o I , : 11 I } iL L t 4 -1 HP 230 V, 60 Hz, 1750 0 20 40 60 80 100 120 140 180 GPM RPM;1 HP, 230 V, 60 Hz, I 3500 RPM. Built - in overload o 10 - - -- -- — - - - i with automatic reset. 20 30 40 m CAPACITY I i I 14 V ll I r4 Wisconsin Department of v nmerce ,� SOIL EVALUATION REPORT Page of Division of Safety and Bu duios ^ I t fn a&r4ance with Comm 85, Wis. Adm. Code Attach complete site pla on�paper not Igs P - 1 x 11 inches in size. Plan must County 5' T, Goo/ include, but not limited to`:.vertical and ho�i Verence point (BM), direction and Parcel I.D. percent slope, scale or dir"nsions, nor , and location and distance to nearest road. ' �� �� 3 ow Ple sQ print all Information Reviewed by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner r, Property Location Govt. Lot SU 1 /4 E 1 /4 S T N R�/ E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# &1S ©gyp /-v/// ,�ep City State Zip Code Phone Number [j City E] Village ,j Town Nearest Road 17 4�71. 1 SWI ( ? /S 3A6 - �0 /,2!5 ST 1' 0S E p tf-- 694 ✓�i /� . E] New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow irate GPD .Replacement QL Public or commercial - Describe: yZ 1404Y 1tJ/X 5'1A - Parent material � Plain elevation if applicable N ft. General comments and recommendations: r �/ z�� •P�r� -ter` slisT. �SDGif �7&- 7 1iE"r i314A, 4 OWLY ❑ Boring # ❑ Boring 9 y /0 / F ft --Pit Ground surface elev. . Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 / o 10Ye 311 Sz- / f s /41 �P Z • l /d Yl 3/ S/G 2 fs , e z - s7 3 S 7• Syt'�s n1n S. D- S c Boring # ❑ Boring S 3 a ' D Ej Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 / 0-/3 / L S ,lam x /ht v /P S z -1 . 7 A z 13 • 2./ io ye 3/ G S kf" f 4" 1/ � 7 Z. 3 10 M s /.� -5. 0. L ii� At Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg /L CST Name (Please Print) o'so r ZO ? � T Signatur 2 Z 6o 3 7 S Address /� O ! Date Evaluation Conducted Telephone Number CUSS D,u €iL �'£�. y�jJ�,fDJ Lt1 /.SfO /�, lvtt" l- 0 7IS•3P6 f leo M It "44 S S A �• 1014 i C 13 �^ 03 0 /O // O 0 Z 3 Property Owner Parcel ID # Page of Boring ! � 9 Borm # Pit Ground surface elev. �� it. Depth to limiting factor Z 1 -31 in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 o - -7 1 o ye 21 S C 2,,w sA� M v7,e 'ts z of , -S 7 . 2,3 7.5 ye yl s, o , �,e e5s — 7 1- 2- 3.13 1 s/ d' • 7 A Z F-1 Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor )n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -6330 (R -6100) !� ,)��' ✓I/L'� T7 /� ' � 5 A" l • 4 A- -. w Go7 . y Td 13 I IWSY X1-4 ! a (:;eA pl - rs 30 AtAkr L 2' I s ys T • [ yy 7y2�' t O LP /COD `� -0 0'00' S 7', i3 � � •� ----� Exi�sTiN(r � °° ,5 rim ' 0 4 d c SD /OD ' S y s T 5 Az 1 r ` �� 7 °jam S7E6 L a GOP Wisconsin Department of Industry, PLB -1 INSPECTION REPORT Labor & Human Relations l/ Safety & Buildings Division ZQD IPe ��cQC Bureau of Plumbing Name of remises Date Plan I.D. No. : f I F. 0E3�$ Street- oun y ary i S kA,3 SE G-3, 7-.�.= P R 19 UJ Iw P• • lj"') >s. P4 ST. c.R0I - / as r� Plumber & HrM Name dress !✓V E o ff"- - ?> A (- (,:t , —AQ*M;%M 4 umber Abmwts Add ress C (C o wner Add D2 Al- -}TA L L C:FraT�'�. c�3S . } r�'C _ � ;?._�.__...._ v bra +� , PE .�+'..:4,* e, f...: -.r ,�s.s�„4r- Y... t..�; ..G�/,�lr ,j ..w..�,w,�„�,�,,,,,, 13 E. Spru Sr 06wa. Fails, Wl 54729 23- 87&6.. D iscussed with igna ure )See Attached. a DILHR - SBD - 6192 (8,10/82) Si gnature o is . P4UFRb" O te as pe s Inspector Local Inspector Plumber or Responsibl Party 0 er 7 . h AS BUILT SANITARY SYSTEM REPORT OWNER �o.�Q /( /YA 11 TOWNSHIP - � R o •ti ADDRESS a i'7 , GCJ/S ST. CROIX COUNTY, WISCO SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of H63 R OW EVER THING WITHIN 100 FEET OF SYSTEM i J -- J — ' r Q) __ __. __ eel V rn i n n � V' m N e eo) r U C p o 3 I di a e Ho th Arrow SC BENCHMARK: (Permanent reference Point) Describe: Ce/1Yer of o of z-oe Nlonho% C'enfe,v Elevation of vertical reference point: /40 , 0 Slope at site: SEPTIC TANK: Manufacturer: ��/� Liquid Capacity: e000 ,�Po/. Number of rings on cover Tans- manhole cover elevation: tiA Tank Inlet Elevation: / Tank Outlet El evation: & G/ o1 , Ex s�"i'.29 Y p ,'C. ct r� PUMP CHAMBER Manufacturer: Z4-1;e 'sel - s Number of gallons X000 Number of gal. for a cycle gallons; total capacity o f — distribution lines gallon: size of pumps head; gallon per minute / horsepower 0 ,4/ ; bran name of pump and model number are ; Type of warning � YP g device HOLDING TANK: Manufacturer Number of gallon Elevation of manhole cover Type of warning dev' e SEEPAGE PIT SIZE: Number ot pits feet diameter feet liquid depth seepage pit in_et nine - elevation bottom of seepage pit e evattion W14 feet. SEEPAGE BED SIZE: number of lines _/_ width lengt file depth SEEPAGE TRENCH: width W length PERCOLATION RATE - AREA REQUIRED ,�.Ijffy tr A S BUILT qV50 INSPECTOR DATED -J� 7 `J,5- PLUMBER ON JOB n LICENSE N UMBER Q 3 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS I VI • LA@dR & HUMANrRELAT ONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOit 7969 BUREAU -0F PLUMBING MADISON,'WI 63707 QCONVENTIONAL JaALTERNATIVE Sun Plan I.D. Nurrlbs, III frtpned) ' ❑ Holding Tank ( In- Ground Pressure ❑ Mound 3 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Willow River Care Center R. R. 2 , .Hudson, WI S 2 7 BENCH MARK (PS - 4.ent r04nnce pond DESCRIBE IF DIFFERENT FROM PLAN: REF. PT, ELEV.: CST REF. PT. ELEV. SW SE Section 3, T29N -R19W, St. Joseph Township -- � Nw . of Plumbs, M► K Co n1Y: O i/MY UTIt NunNNr: Everett Boldt 4489 St. Croix 34817 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV- TANK OUT LE T E LE V.: ARNING LABEL LOCKING COVER PROVIDED: PROVIDED: 3O OYES ONO ❑YES ONO BEDDING: VENT OIA.: VENT MATL. NUMBER OF ROAD: f ROPERTY ELL: IB UILDING; V NT O SH LARM: FEET FROM LINE: AIR INLET. OYES ONO ❑YE ❑NO NEAREST DOSING CHAMBER: r MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER 3 U g PROVIDED: Pl§OV DEO: �R tip e/1.5 OYES NO OZr� V DYES ONO I OVES ONO GALLONS PER CYCLE: PUMA L OPERATIONAL NUMBER OF PROPERTY w Ll a aaN v N (DIFFERENCE BETWEEN FEET FROM LINf� �� AIR I LET ❑NO NEAREST . PUMP ON AND OFF) YES ST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH UTAME TEH MATERIAL 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 VENTIONAL SYSTEM: WIDTH LENGTH N OISTR. PIPC SP/yCING INSIU IA SPITS LIQUID BED /TRENCH A THEN HES / AJ�,ft1Al: PIT DEPTH DIMENSIONS 'T /l _5— GRAVE DEPTH FILL DEPTH IIiS J I F DIS R. PIPE IS 1 MATERIAL NO. R. NUMBER OF WELL: BUILDING: VENT TO FRESH BELOW PIPE BUV COVER ELEV INLET ELEV.ENO PIPE FEET FROM LINE. AIR INLET * :1 Cv� f NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope C k the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: ou s stems ake certain that it ON REVERSE SIDE. SHOW ELEVA is t Iteria for medium sand. TIONS MEASURED. ❑ YES ❑ OI OVER TEXTURE PERMANENT MARKE IS : OBSERVATION WELLS I / /I* *,- / 1 DYES ONO I OYES ONO DEPTH OVER TRENCH /BED DEP144OVER T IBED EPT OF TOPSOIL SOUDED SEEDED MULCHED CENTER ED OYES ONO I DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATERAL SPACING /TRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: BED /TRENCH TRENCHES: DIMENSIONS W&W D PUM MANI OLO DISTR. PIPE MANiF OLD MA ERIAL NQ 01STH UIS R. 1 1STRIBUII N PIPE MATERIAL & MARKING ELEVATION AND ELEV 29 DIA 3 r � ELEV �� PIPE $ DIA_ S V I/O / „ D DISTRIBUTION l INFORMATION HOLE SIIF HOLE SPACING tIILEU nRHfClt -V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED / � t/ PLANS a JNO �' YES ONO 'COMMENTS: PERMANEN OBSERVATION WELLS. NUMBER OF PROPERTY WELL: BUILDING NA FEET FROM LINE , YES I .I O YES E INO NEAREST .5 (o V f I I I I I Sketch System on Retain county file for audit. Reverse Side. .. sIGNAT TI 01 LHR SBD 6710 (R. 01/82) - DEPARTMENT OF; APPLICATION S AFETY &BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HU(CAAN RELATIONS (PL13 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing + -0 Address: W11-1-060 , v'GR. Lig Qom. l:G� Z L aq�.Sa.v Zj 5 540 / �o Property Location: C" or Townshi County: p iTvZ9 NiR / (or) . W f. c/a Se fib S'f. C�pci,c Lot Number: Blk No.: Subdivision Name: Nee re Road, Lake or Landmark: State Plan I.D. Number: f} . C70 AJ 1< / Kq w! o' 1 4- , (If assigned) "c TYPE OF BUILDING Number of Public* ❑ Variance* ❑ Other (specify)* Bedrooms: ❑ 1 or 2 Family * State Approval Required. 14. TOTAL NUMBER PREFAB POURED -IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY QQ O ©n/e, X X Or 37 Uj HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER O O 0 ,V G X X N2W MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New M Replacement ❑ xperimental Seepage Bed El Seepage Pit Al �j Seepage Trench 2„ El Alternative (specify) �^� (.�c -R � .� Pa_ a <x ct t El Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): 'Rr Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for ins tion of the private sewage system shown on the attached plans. Name of Plumber: gna ure. MP /MPRSW No.: Phone Number: Plum dress: NaTgALDesigner: g ill COUNTY /DEPARTMENT USE ONLY �tof g 8Aent: Fee: Date: APPROVED r. Sanitary Permit Number: ® A ❑ DISAPPROVED �f Reason for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the, sanitary permit. DISTRIBUTION: White- County, Canary- Bureau of Plumbing, Pink - Owner, Goldenrod - Plumber DILHR -SBD -6398 (R.07/81) r State of ftfffl to Department of Industry, Labor and Human Relations r f ¢ Aj'Wi l` + W SAFETY & BUILDINGS DIVISION i Bureau of Plumbi < " 20 Eat Washington avenue f P.O. Box 7"9 K"ison Wistonsin 53707 Willow Park Care motto+^ Route 2, Sox 3$5 Hudson, ilia slr 5 Petition Na 83 -013WP ar Sirs: Re Wi llow Fart C+tre Center Alternative Syst" U9IFS. 3 ,v n *l Town , of St. J6 000h, St IF Crdix County, wl The sO4ect Petition for Modification of section h 63.16 (6) (b) and section H 63.113 (�) of "* ViStonsin Administrative Cie *as considere oa April 22, 1"34 It was approved. Tr* rule requires 'that a pump task ha ve a winimm ww day holl4ing capac at*ve UK high >,raW alarm switch and distribution 'latera can tw beri+ed no deepw than Q inches frcw f inal grade. The variame r sttd was to use duplex alt ernating Pis in lieu of the one a lair holding, and to install a lace at ingromad pr essure distribution syste With 66 inch" of fill Over tf)e laterals. All of the data and statements suNtitted in behalf of ttw. petition considered. This app roval is specific to the subject petition and cannot be used for y add modifications. Sin+cer0y Jerome <o p, Chief t Pr n �''� '� R Q �"� � and Platti X*O pE t.ra l cc: L- Troy 3ahsky„ OWS - District 6 Cftiopwa falls a d C. amber., ZA •- St Croix County rett Soldt, P umbe f ` t Department of Industry, Labor &Human Relations Division of Safety & Bldgs. y fiafle O 1 1:6Q?Y> Bureau of Plumbing Platting & Fire Protection - P.O. Box7969 Madison W1.53707 Tel. 608-266 -3815 IN ALL CORRESPONDENCE • �� �� �.•� -,� ����. -�-•. REFER TO PLAN IDENTIFICATION NO. , i - NAME OF PROJECT TYPE OF PROVAL��� Qy STREET AND NO.' CITy OR TOWN CO UNTY STATE 21P OWNER Gentlemen Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- 'pl with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. 'The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require - rnenis of the city, village, township or county in whi ch this installation is to be constructed. Failure to obtain local permits will auto- h matically void this acceptance. For Private SCWKK;e Systems Onfi,'. Sincerely, This approval i:.s valid for two r"ars or , �vi�l t.r_• valid until y c'ate of the Initial tha ex iration p James Sargent - Bureau Director PLANS REVIEWED BY: DATE: cc: DPS-OWS Owner DILHR Local PI Plum H $t R l21 County M . Rep. Bur. of Health Fac. &Services Rec. & Env, Seryw" ` 1�1LHR,Sf3 ©-60$9 (V. 06/80) C. Cl i ' It - 7710 bo 14 I I �^ . ;A!) `n +,, •�� •• ter' I LL sk 74 w ' , IV Ilk 40 49 qc VT ILJ , a k n + • J t I E s 3 • I if HdVJ cl �►.� _+ �-+-- -+� ; , i S K. n l t x- s t. .. t r� F �� PftPJf CT DETAIL DATA ''SKET 3 ,wit? Qi+ 1 1 NESS LQCATION county car' Via. or town�i p _ t�+ x� street �, y LEGAL t3ESI:R I P7 I ON - 4 911 .,: �wi '�"'Mr '..wrpr.f..rr . w... F.. +�.�.�ir•�rr!'..r.- ..:....w.�. �..��.�. -..r. �:.. .T.+i. d4' OWNER ow Lc /T A Mal ling address •2 p x'� , p o ARCHITECT Oft ENGINEER Address y r -° r PLUMBER V / o Address ��-D rria9��J 64 1 11 1, ChaGk,>3�ppropriatss byi'lding u� 4(s) and fill in the information requested opposite r y - ..� y . each usage l isteidc e 5 e f Existing buildirl± New budding Addition If adcliG;oil txistn- building aktaoh di trNei far each: () Drive In restaurant ........ Car spaces �k son) m� �) Kfsstaurant , «.� ............. Seati capacity (10 sq. f . a .p; hing hal Per meal served Toilst woofs Ye ... - No� "'te 1 (� t axe i' ( Cot tagos Numbe r of un T i 2 porsons/un i t r 4 persons /unit T(lT4 NUMBEW' ,)NITS „•.. () Churches .. . .:..... . ... Number of persons Kt teh+eh Yes,,,, f r (fi r or cocJ *t 11 lounge .. , ... e,st ing capacity t.. ()0 Nursing of test home ........ Number of bends 4-'� .. , , , , .. , . Number of unI is �* eppndent (camper fret l�er3 () "lie hoh pafk nnndapranden (mobile hone O petai i stabs .. , ... Number of employees N of custrstq' ft R persQ+�) ; , +E, ame $*rvFce stot -1p ► , , .... , :... t Number of cars served (deli 1X) ; r ( Srl Number of elassrooars i�lsas served Ylss , r, , bowers provided Yes ( or Offi4:0 buf;lding Number of persons (tot F :A Apartments . , .. .. . ► . Number of bed moms ( ) , t (X) p.ther . 4 `. . ..... , ... specify t x �' u`�q ��+M7"�'� G�JrsSd/r',es y"7, ' �fitr 2. Indicate whethor or t the fail l owl ng f a c i l i t i e s are tone ect @d : y? ' Food waste ge~t ds►r , Yep NAa...,. Dlshti4ASh+er Yps, kC No . ` Automatics to Peele + *, A4 tf"t i c c1+_� I ias' was�t+�r No _ 1 No X C th±s r t►a t i fy ) -- 3. Fi l in the ap ►r irialto information for the fpl f�awing as i�ldtc n s'f�e +r au c4 Septic tank capat�ity plan rpd 1600 A AwALa ><,s �"? �;. TEST AND SAI Pa�tetion test res AA N PERCQLA L REPO SHE1*T TT 1APR 1 81983' N RTHE�R 1 1? o': . §d+ M irk A y, k R 7" . +. f r + •.k 20� r µ t • { wo trash + area Riet�ned � I i neaf feet /Y t4 ` °. ,< soopojo iced a rah p I Wined 'ell' , w 1 d t h � feet depth w r� { ; ee rah pit plomnoO F} outside diameter d_V!h be mist depfh '�1�'l 4. See �pprRv ptp -i*r specifi4atigns and dgtai s, S�ignalt4re,lf Rer,sph form STATE NIUISIQN QF HEALTH, PI,4JMO.IRfG SEGTI#I� W i s ca4,t 7 1 s ;x AppIf gy "pd s ' Ad re � W Date , r , t p .0 ? TH 1 S ARP PVU 1$ 109, ON OW FLUMPI ON CQI >S REgy I AfkMENTS A00 FOES NOT EXEMPT TFtE Da to INSTALLAT FROM C I Ty t V KLAG9. TQ�4�H I` i 66NT* PERM I T 44�,U I R.EMENTS AND SNA4 lIQ I I R I E1I I f►Q iiTIiQ THE 1 fiTEN APWAtI11P 1 Hik Q'k t R I O!"1 QP ALTH. I�ER RTMiII�AL E Q . Y. k ? r r t i , , , 6 ,i , fit, , �?? 1 Y ,• 4 � , L z p � D� Ul to P. r ^ a, ; r. , ay ' ED r d Pr . 811 �J � 1'983 W k 1EAU t • X N U • N r tea � � G N • SO MO it All 4'1 `` m • fib Z' I. �s l ���� ,fit♦ fi r ii r Vi to � ,.� `�' • � � -� --.,� O! ,,,,( -fig,. � �. ti, r i k t k r Aar . , ti. •'�' '. � tl � aC.'` A � � 3 F A� Ire �o+ BRA �. F'• �- d ,F� S. , .�_ r _.. 5r _', .� NK w 0 Q • j 0 Hl CEVED r, o° o F ,e K 9 o le - `APR 1310N 1�.dOQ._AL Se i Pl��I111I�ler'�t'C1� 4 I o r T , ^ C A &Q nde 3 E C �r 7''r R a : d If _ _ Sv a Fn c e eL . f o M r o a vo � 9 7. 3 Y7 t � h t� :a fi'G y� � � ,w,� r f 4r s' fit' 41 Z- �7Rtiw� h y � r- 0 13 5 8 MP 4 Sq�� .•w�++N.wl+,.+ «�.rN /� i �• �q/..�IrT_ , f F , .._....:... ,r. wry .......Mr.•���+.r.,t;4,.w,...., nM;;}�1 '' .�:'�< •'3 wd.. 4 � 7 i l�MIS PA A Pe lit ,APR 13 1 , Tit A ' " F fj �►N��! d' Sih 4x (teA f } FA►R K.4•4, Ole ' G✓RSfd ; 4. !. s,� C s4 A 0 / c a rc R 4�•'�- +�- ' - GHQ Arc s 5 �' 4 # 4 A+ ,4 t4 A . 1 . 1 , jr J Lf IQ �A G ¢ 4 I /* TO t� t ( Y 7 n ,,,',� , {• •i, a , 1 t' 1 r ; F � �t �� (~ ,�• � �y�• ASS { �/ Ate`'`` - .•�.,..- ........_...... `. +�u►v�' ' /q � , 0 t46)iw#d )Q Aj va t ov e. aa.t, L U. 'f Aj a� PAGi� P U Aki ;C R SCCTIOW k10 ! Z f Ysi 5 1 f: WEATHRK PKQ ©F A!"IR" LOC F�cM 0,( i +1U1111C��QA) P.►Q1E` --•, �k l� �t �QIA�R @ 1�1TAK E I k Sj +A "+ �. M Mj t � y 1 8 * A I IAA S- S �k� • F - ' 'd r� ; ��� "v—r h ' t NF a r "� ` � '` ,� ;`E � ' "�"� trt � : , it � •, '� , ., � � ; ;� y h I 5 } .� 14f • 'I'' T �Ifr^R.!� �!^ K w.� f ' ; ! } R I }.i it #"r' C IF t",gJK MAN IFAfi IJ fi �,A►PPKQS��F�. �. F ' ;+ c a' . ' �• ;� , .0 r � f:;r�1 �' is � e �,' r, } %4ry t 1 1 rY'� 4 CAT ' t I RrI I�IV / 4114 Akf-T W R, *3i1 Ulf' TAI 41 Zv p1 0 i I� $ ►� ���11�, ¢ y ' ,; ! ° r' Aiil ''."' ,ri q r K:F/ 51ro11 F�# : IE;C�' V T 2 r • y OR CA Jk AL MA0tWAr 7 4 ERA 4 V AL LO ARC TIC► � P1» 1scMA�t,c F 1h „ . 7 1'I AI DI t �t��E EMT l PU AlA 4FF AAl13 !1'I6(RI T k f + MIIUIMUM �1 TWQRK $URPL4 PACt�SL�� F Q 1 FORGE f*A M '� a r , r � Y - + flKIC`TIOM FACT A4 t� •� 1 A 3 0 } i JRAI�AhL Dlf"'l,S fi FR --- r�'e14?�°sYw C t a r/p rF r <7ar3 T T 1 "A_ s P p 00 00,6 I S a On S OL f vet .. CN VI �` � �.A �; "� `•� "�� 1, til)� a � u 1 ..� rt tj t v a A r ' ""- DzPAR T'OF SAFETY & B UILDINGS UILDINGS REPORT 01 SOIL BORINGS AND DIVISION LABOR AND PERCOLATION TESTS ( 115 ) P.O. BOX 7969 HUMAN REL,ATiONS l / MADISON, WI 53707 0-163,090) & Chapter 14:5.045) t LOCATION: C 10 TOWNSH P/ Y: L T NO.:BLK. NO.: SUBDIVISION NAME: w 0 '/4 ITA9H17 ! ► V o .S N /YID COUNTY: WNE.'S B R` NAM MAILING ADDRESS: 7 5 .5"1044 SE DATES OBSERVATIONS MADE . BEDFIMS. : OMM ACIAL D S, IPTION. I, A ION T TS: QRes Idenca ❑New Replace �' lei Cep 4 - '7 - 4 - "7 ('"� � �` m is A [.- P• RATING: S- Site suitable for system U= Site unsuitable for system t' ONVENT L: M UND: �( IN- GROUND- -IN -F LLHOLDING TANK: RECOMMENDED SYSTEM:loptional) IS El U EIS U [I 91 1 M` Ile a U f ' If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the l . under s.H63.09(5)(b), indicate: I Floo indicate Floodplain elevation: t o >< m PRFI DESCRIPTIONS s ING TOTAL P .H T R UN ATER CHARACTER OF SOIL VYf H WICKN SS, COLOR, TEXTURE, AND DEPTH ,• ER OEPf'HVt ELEV � A � TION V 410 TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) !Y 0 /et C. �` &Y 8�► A /t.�»'" :�"► ,w �4 3 '1'ty � M S si s O pf �� ! r /, S N om ' ,•�+ f- �, y� '� rvLaC1. 3 (� "- 8 •M f ca ^ f► ._ 3 B. )7 I Ai 0 e- R a S& w ys A We r, PERCOLATION TESTS 1.Awd AFl4aA , TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER f111IMl1lB AFTERSWELLING INTERVAL -MIN. p t P PER INCH P + I, aQ 4ess P-- I W r OF 9 C, b A bgQ d IC Ill R O OK 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- zontef 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 (and slope. SYSTEM ELEVATION y E , I 1 2 t 1 # I Y 4 }... l J944A � ' S 'f ! _ t . 1 l > t 4 ' F i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: —Y-- ✓e -A-P L - ?•- L'3 ADDRESS r CERTIFICATION NUMBER: IPHONE NUMBERioptionall: Zz �T t TURF: DI S Yl , i al , .R 3 y :iL lit ... � -, ..wr•.....e . �...- s...�+�+w++.+�+- .....,..m. ,..... •--- .......,.�.._ F, 1 4 6 1 4 � : k . r• i l 4. a _ Pre K ale - fe PA I T ^ v IE C AT- GFR Ade ,, T C f 1 M s F FRG e. �- a u Y (014 .7 r _a.�.� t A) e- R W•1 �o�a le, Ve.g- �A IQ et W , S a Q dA a o s ty �' a e A 7 A p G,. i m 4, 0 0 �h° « I Fa u ey e +y I x I t e f l 9� j f V a r 4 ( A L , 1 t `t I m i g i w r kn Ic CI- I ► i 1 v I I 1 , t ! i Wit.. � i � t I � C 1 ► t t + 9 � '� � � � .. ; t ; r� r " F l v- I "4 CAJAMBE kcbtais ' cfit d i k" u vi , 4��AT,1t 1 `lgoo �t 5 FROM I 1E4"AR, f/Mw rE Y. ! i T .� r. , ,air t q :'Rdu I -^ � , '• _ '.. ^'�'T - ' t , i ,° Q d P ' �I;A11 ,. $x 'r�" j ►RpV1tp �tl 1 7i� r t �7 t, d` M1 #rk '^ R ' dS wa tt z J a ,fat M:I {dry l s. � d It OA 4 t x i �J FI'Y t y , _ q g ��rtrt { Y FA CTUK t a+ d;•• k! / rrj 1 s � a < � is t 7 , j f .i 1,� n cJ / .^lc wl ',+ aC% � M F t pyN► ��y�a NN �+ }��rt M1 "` 4 J f • y 3 TNIJK . -'' d �.• rl�t�' d F t 'S fk# f'A.�'} �N'�C : � .. � µµ �•���t 4 `},O Y,' `- -�'C+l {.. s '` i ' ry�4.:Y �� � 1 sr 5• r v M1`ti K efrY � � � "7' 3 ^. ' • � I,p #. r'fr�1' # 1r��ZR " $� r �4•(} -�7{ x f: 8 E �}-� X1 4 4 `�, OM L 14 oNA. d a �1 �1tC IC Rtt ` Qt9C (e { t H Ot r Ir 5f pp!� t . i+ 3 F. . £; rat'Rr Pa " , , e s a, t } MIQ11My�'1 TU11Q�P4 d �1- f-KF§tsl # t ; rQ F�'f Q1= FI;t� M1N X F�,, k'jr , , M1, i T O T A L EMI � A rc�1A�, Ei�l� t�JS1Qt 1& lr�v La t 4 ,+ 2. , k x 9 LAC ,..- - .�I,GA1 D• 1 MSE AtL1NR15F - flAdTE. .w.:. i Wisconsin Department of Industry, PL$ _ INSPECTION REPORT l Labor &Human Relations Safety & Buildings Division Bu -reau of Plumbing, Platting & Fire .Protection Na me of remises Date Plan I. . NO. W: P C Ae �AC, i 3 - 1 Sweet ounty Sanitary Permit 'rJw sw , sE s3 T:zgj0,f249W - Tui . S JOSEN S . CRO1 M aster FIUMDer & virm N ame Aaar N vi Sc 6 A stet✓ _ Rt�a+►N�s,�ATO Md regs u CARU�, Z 3o W _G40 /6 O wner ress t) 014ALQ 14 - J - T - 2 LEVXr10_M bAT A --- - - - - -- - --- -- — PT BS HI FS Ei~ AWK EA6E OF , I 00.W i St te_E N t S,Ot. T -Z g 10.57- g1 5 , #57EM E'uEV&TIO�4. Ica s is T-1 -z. A su PACE KLEvATw T- 0 -Z„ 6 3 L +. � Z . sTP-Q L E 38- Ye owt 6o 0 qNP y c 5 S*MEL MA1AHoLE COVEk 33a WE P� t - S t 4 C.S i y cS wj Fc P I o4A 1a g r Nor 1 1 w- '�. SEASON R1 F-ST LEV t= 5AT, 15 9 100 nil HR Leroy Jansky O.W.S. 729 (715) 723 -8786 Discussed with signature (,-,)See Attached. �46£. L DILHR SBD 6192(N.09/80) Signature of is . PlUiEW 5W Un-we V asW Speci"ist Whi Inspector Yellow -Local Inspector Pink- Plumber or Responsible arty Green- Owner y v lid4: ' . , , . a a a � ! )DA' /1 a Al t y � t 4 r.y " a rY ^Y f „ ti r- S , i a � . r . 4 1 t IAN IM r * MW* • / w.�..... w.- A...., ,..,.�.�...,.( ..A. .A..;IMm.._k X �.._.A. a_.w .�� � .......,.0 /. . -..�� ,•A.'. �,i.r �., .i.� ... �.�i l. ..A.AI /...rw,•.... Al_. �..L,.s..• /w4 .. / ..c.•.� '... /�..► . ,.� ..'� �1► >..........�,. ►.w,_.. ..�/.. ' : .. r .�!,w,. .•I/.�:,�.. ,w.^ ..raC 4s ,(� - .L.r.,R� ..�...Mw. -,,., w ..�+A,..,...R.+ /. / .. / .w• it .I, .. �.. . ,�� .c... _ /.+v .,..�e _ /..►... .a , /...... /,ems. Alt ��1. -/' ,�tw. _•�- .et. _.. a,Iiw.• �..�,.. ... -mow. �� °. .w�. ° �:..- ;.....:. .. �I /.,..a►i ..�..,,.. ,- �._. / � ,IY��tw► .. r. .»� /.w. �.�.,.. � ...�.... _.� ,��i.�.�... .,� f ..tnr,c..t...�.�r .w— M.a.ls �„ ... .it 1 : 1 • • 1 • / • • i .ter sr.T.1s••te T/ 7 7 ., r µ r e r 00131070392MI Rik TfT9 WTI, GOT 0 f1#?Gt(1 i ?�hMh� 44. .- ..- ...r... ...w...:..,...wr + +,.w +. ... ., .•.... ...,.wr,,...,m..... -_• -. ,.:,..«,....,.. w.<.,•. r.. rn-.......- ,.w....a..err.+ww..,..,+�.ss.., ..:e. .. ,.. ..., ..« �... -.. _,.......,...+r + w,+ .:........... .........svwwi.+.�wr•r.r�,v.. - - ..r y 3 Z'.i' k' RN WTI lot - , D i i _ v b t ! L ' • E a S . s w, • y r .. ! 4.:. .a :sue' n ._. w ..... •, yk` ^• 1: ,� y �,. ,1 4 , .. 1 � ,�. ". - .. € 66 I Z" Op CA CA �." i t � i 1 ► I � I�� 4 t I ► 1 I 1 „ I a SIN PV Cl � � ► I I I F I i 1 1 I ► 1 q0 l. , '+..� •• * 'L eo r ♦ - *f Zw r� A� - 1 0 4b TA 4 r� T 4 Sl �. 7t " th (b -c z th a ' i ts y- • = is L .�_ 2 yam: F v o a qo • 2 � rl n IN 14 IL ff !~ a n i• < ! a ,> I` t r i � s E Z A M �`. �, + A 80 nE -411 6 OZ co f it I to 0 tl r , � D { l � b a b' � � � . �'^ ' " L II I �• • ♦ ♦, ; '' ��?{ R° � p � "�� P�� I ♦�♦ t iv i s � i t , Model Pump Features Motor Features Discharge Size -2" NPT Standard. 3" NPT Motor Fully Submerged In OH -Filled optional flange —field interchangeable. Chamber — High grade turbine ' f Semi -Open, Non -Clog Impeller -2 vane surrounds motor for more efficient heat The Model 3882 SumpThing design keyed to shaft, with ejector vanes dissipation, permanent lubrication of can be used for a variety of on backside for further protection of seal bearings and mechanical seal, and for residential, commercial and in- chamber. complete protection against outside dustrial applications because of Series 300 Stainless Steel Fasteners— environment. its rugged and space- saving for corrosion resistance. Bearings, Lower End — Ball bearing for qualities. Series 400 Stainless Steel Shaft —for precision positioning of parts and to Flood and Pollution corrosion resistance. carry thrust loads. Mechanical Seal— Ceramic vs. Carbon Bearings, Upper End — Sleeve bearing Control sealing faces, stainless steel spring, and to carry radial loads. Buna N elastomers. Single Phase Units — Permanently Split Liquid Transfer Rugged Cast Iron Construction Capacitor for reliable start-stop service. I Built -in thermal overload protection S ewage and Wa ste Maximum Temperature- 160°F, with automatic reset, 115 or 230 volt, 60 Removal Easy to Inspect and Clean —Motor Hz operation. De-Watering Section easily removed from casing for Throe Phase Uni — Overload protec- g cleanout and inspection. tion in starter unit, 208/230 or 460 volt, Sump Draining Capable of Running Dry— without dam- 60 Hz operation. age to components. Power Cord — 15' standard cord length. Heavy duty STO cord for water j and oil resistance. Epoxy seal on motor end provides secondary moisture barrier in case of damage to jacketing. Single phase units have 14/3 STO; three phase units 14/4 STO. 115 volt and 230 volt '/z H.P. single phase units are equipped with 3 -prong grounding type plug, 1 14 8 1 H.P. with bare ended leads. I •. 0 GOULDS Liquid passages provide true full diameter solids handling capabilities as advertised. I High efficiency full volute casing. Keyed shaft guards i against damaged compo- j 11. nents on reverse rotation. Quad -ring seal on motor section assures positive sealing against contami- '� Model 3882 available in 1 /2, V4& nants and oil leakage. Epoxy 1 H.P. sizes for 115, 230 volt - seal on power cable acts as single phase; and '/z, 3 /4, 1 H.P. f secondary barrier to liquid for 208/230 volt or 460 volt. 4 intrusion if cable jacketing is three phase 60 Hz operation damaged. Rugged cast iron Approved by Pennsylvania construction. Bureau of Mines" C "pN'��•,, S Heavy -Duty N Non -Clog EVER ETT A. - SOLDT ` Dependable Capacities to 190 GPM = D•0426P Heads to 50 feet. e BA ?.. D41'IN, Wis. 2' Solids Handling Capability Is 2" NPT Discharge ConnectiQn , ���'�.,d���T�' • �`R • . °`�� E T ` (3" Optional) 'Available with a Pennsylvania Bureau of Mines rating for non -face applications. a When specified pump will carry the approval number: BOTE 91. Available in 230 volt single phase and 208/230 or 460 volt three phase only. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. Gallon Per Minute WP0511 Model WP0512 WP0712 WP1012 WPH1012 WP0532 WP0732 WP1032 WPH1032 A.— Series No. 10- WP0534 WP0734 WP1034 WPH1034 RPM No. 1/2 1750 1 3450 Submersible 5 150 170 18 0 190 Sewage 10 126 1 54 168 170 Pumps V 15 94 125 152 150 e so 20 56 90 1 21 1 28 W 3 25 17 4 81 107 c m 30 14 40 8 Certified W ti 35 10 64 Canadian p Standards 12W H 4 43 Association 4 24 `�✓ 50 4 �-- 7W Max. 15'�✓itti Series HP Volt Phase RPM Solids Amps. Wt r W P0511 'h 115 1 1750 2" 9.0 108 W P0512 1 /2 230 1 1750 2" 4.5 1 08 ' W P0532 '12 208/230 3 1750 2" 2.2 108 WP0534 'h 460 3 1 750 2" 1.1 1 WP0712 3 /. 230 1 1750 2" 6.0 110 2WT WP0732 3 /4 208/230 3 1750 2" 3.6 110 ! sok+,:xy. ' W P0734 3 /. 460 3 17502" 1.8 110 WP1012 1 230 1 1750 2" 9.0 114 I W P H 1012 1 230 1 345 2 " 11.0 114 71Y 6W WP1032 1 208/230 3 17 50 2" 4.2 112 W PH 1032 1 2 08 / 230 3 3 2" 7. 112 W 1 4 60 3 17 50 2" 2 .1 112 W PH 1034 1 460 3 3450 2" 3.5 112 'CSA Listing pending. — i 50 i 4 I I «�. 40 r 7tiA € 10 LL l ye , E �J T7 � f cc 30 Z Wp10 S f 3 '•hP W era E P0? Ser / D i WPoS so r / x 10 f i 20 40 60 80 100 120 140 160 180 Capacity— Gallons Per Minute i Q X. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. i w PAOE ..... pF.,,. _ • 1 ' 4 t.. e PUMP'' CHAMBER CR056 SECTION Ak SPE F C —.. -_ VE LIT CAP f t4 VEA1'T PIPE WEATHER. PROOF APPR+C>VED LOCKIN4 - JU KTIOkIt BOX _ MANHOLE COVER 25 FRGM D(--,OR, 12 "M I ►1. v wlAlaow aR F {tE•SH , AI JIUTAKE � GRADE y" MIN. GOIJt?U1T Id'MIN. , r-- _ r N\ r. < IIJLE:T PROV QE AIKTICaHI', sEA1� A!'PRO ✓E is JQIpIT A �t IgJC l41Q�►1i I '""� APPROVED J41AI' W(E.Z. PIPE Au L?� r , �g �► -. `If )I C. PIPE �crENal rJ � 3 _ • � .. 1 FD S it to �c±l'l jl �" 1 T :SOLID S0jf pus,,, s t R1'SER EXIT PERI'llli Ep QI.1l IF TANK MAAIUFACTURE.R ` HAS SUCH 'APFRg $ N .. / A MA►IUFAeT -54e ,v RCocK IJUMBER ©F +/+C PE:t LxA;kt '+4� is 5 —. PKIS DOSE ''VOL.WME. ARM MAi�WEAGTURER:'_� l - A�, p �" -►- CARAt»ITItrS.: i4E3 QR aZ GALLOKJS F MODEL IQUKbF_ c C ES � J r0 " --,-RL H OR a.._ +� SWITCh TRE.' RGuJ2 - f p I,I fHES OR l �444y GALLCUS M F�1.lMf AM4FACT lJKli: K. t� o --- )AICMES OR �'? GALL Q*Ig . �. M()t)EL MUMBER: O 2 MOTLF SWITCH T�JPE:: d�� GUJ4 �- IN9TALLEO ��lM ARA TO 4,E � �. ^ Pl1MP AM AkA „� ,,,•, y �UA D SEPARATE: E.1'ii,C,l.tITS PUMP DISCHARGE #LATE J~C7 GPM av VEKTILAL DIFFERENCE KTW&,:EAl PtjfAP BUFF AIJQ 0I5TR14UT14?N Plt+(�:. � F��,1 -F - M1IUIMUM METWQRK SUPPJ.H PRESSURE Fl�1r'T 4 4 q ! �, � f" - _FEET OF FORGE MAIM X IC /7 F QFTFFUCTIOU RACYgR , --= 6 FEET t , TOTAL DWAMIC HEAD ° FEET cI • IWTERbJAL DIME 1pA1S QF 1AAlK: LENGTH /J�� o� W I Q T H E P T H.� ' C-N; jA 1 -„ to c T , 1 1 i rt. Av I L l zE a t o _ N a; o a �r o — 11 i I N N � ,...E ,� • F _ 4A 1 - LA Q ► 1. - LA e, D A -. r r , r �� r • 1 i s e• '- • • � s � a a .L_./■ %,All:.." .ca'� �! / I�� /���;�������.�.d +�. � ,. ..lL.t.w .�.. ,�.� "/ -� �. ..w / ..rdV ra..ri,.t .� aL <�.n/A.. ,•a,..�.w. a�.s � / _ /� _ , � - ,a...i,e... � , • •.�A... .,...� Gw . w.! . _� it /►..�..t.A.. ./ /,a.i .w.� .�...i ..s•��.,/ /uI._ I_. � i.... �.r.. il�� °........ ,i/Ir ED , .41[_ _ ..... , ...�. -. 1../...i. O r ow . � i.... / /_... /lSiR.■� 1 ;;Ka.�w .AiK_ � ,� " .A.!,�[,+.MR!� � wa°t i� ! .t 4a / /I ,•• .1 � � f ., ' � i /.•L,.,;,.: / , �./..A..'�!�i',.: :..,III /�.! �... � .: ���-� . .....r = - - f ' i a ,.M..Iw — fAMI jol F4 MWF 1 • / • 1 .•erg- •ee+T�.r+r_�- 1 .- e • s ZttflP NA ''s1aT!! < d 6 J sV "lqr,'oq w y� C� y t, s j lus yo SR -11 : >. 77 � �."''",'T" `s�'4 � „',`ciJ'�`�i,�•. 1 � _' g Yom. T + i .... .:, ,.._ .. ._. -, ..... -,. ...4... .,. ,.c;,y .. , • .,, a _:., ....e.'.m R, - .._ .. ...,. ,,........ ...fig_.; ., .... k , , r n L � y h. k « a , , , k s .cam • . _ • r , MUM ToMMENown .11 !. .l•re_ n1' • • •�. x::31! ` � • f �• i is ► • • ...ia..' • �wr._«: I _-I. , ., i , ♦. .•. . ... r' 1 .:___ :' ..L_ w. ,� ... . Af pr WA .w.rlf•t ...s./ ! , IAA , :r I ,// / � ' w /:/rrtl / .� .lr .�.1r6i6.•....... A�...,.trL,�..,..'.'• t� ,.�.wi _a.�.:.r /IL. -,... /a.- :..,.' /,!� t.,,.. ;...., . i /✓..r' q 71 V � s 'L.L.........._ ,,.nr. .�'. . !...I/ �. /AIL' . .•4,w...Ir•A ► ..f WE d" _ 1I rem L.A wu� •..../ � A L.- �. ,e./ 4,.._..•�e ,�.., .� _ .. f 1 ' ..�, �. _ � r , I .�./ /. I I ' / /, /►j► ' f , �i WO /rt 1 r � Z A .. 1 W.. .. ' . •.,' `... A.. /' ,. / red. ' � � . s �' . !w.... _ ' .i1 Department of Industry, Labor & Human Relations Division of Safety & Bldgs. S tate Ot p Wisconsin isconsin 17 Bureau of Plumbing Platting & Fire Protection 6 - ! P.O. Box7969 Madison W1.53707 Tel. 608- 266 -3815 '� to i� INALL CORRESPONDENCE � REFER TO PLAN IDENTIFICATION NO. 1 55 1 Z�� � NAME OF PROJECT TYPE OF PROVAL STREET AND NO. CITY OR TOWN C STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. I e. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. For Private Sewage Systems Only; Sincerely This approval is valid for two years or it will be valid until the expiration date of the initial SBnitaly permit. James.Sargent- Bureau Director PLANS REVIEWED BY: DATE: cc: DPS -OWS Owne DI LHR Local PI Plum r H & R f21 County Rep. Bur. of Health Fac. & Services DILHR S9D - 6099 (N. 06!80) Rec. &Env. Services v�7U.. State of Wisconsin ` Department of Industry, Labor and Human Relations #4wi l 26, M SAFETY & BUILDINGS' DIVISION reaa of Plwsring 201 East W"hingtoe Avila" P-0a Math , itimmosis SV Millow Park rare meter Rout* 2 0 Sore 3 soo Vitamin Ss Petitto* No. "136" Deor Sirs; 94r. Viliow Park cot Center Alt erMrtivo System SN,SI', 3,,29, libt 70110 of St. Joseph SL. Cron arelt , al subject Petition for Alodif lc tion of sect ion h $3. IS (6) (ib) a*t soction " 53..13 (S) of the Wisconsin Administrative Cede was considerso +tee April 221 1963. it was approvoIc -The role ires' that a p %#I* bore a minimum ow day bolting copraci.ty the, hip aster Itlarde switch and distribution laterals can he buirlied dooW than 42 Inches fr" final grado. 'flee variaeee tsd was to use duplex oltweatiag pwws is lion of tMir on doy holding sed to install a repia Amat i ngr'oved presswe distribution s st4ft with isres of fill ov' the laterals. All l of the #at,* state is sd Bitted ib behalf of toe pratitios were . cossidtered. This approval is specific, to the subject petition and c~ be used for any a Mitional modif icatioas. Sincerely. Jerome toepp Chief Section of Private Sao*ge and f4tti aG s!"2P�ral cc: y Sys M - District g, Niprp"s Fall Is old C. UrW. ZA - St. Croix Countf Everett Soldt, Pl DILHRSBD -6423 (N. 04/81) '4 SBD 6678 (9/81) (Plb 100a) ' � • STATE OF WISCONSIN DfLHR Detach And Return Upper DIVISION OF SAFETY & BUILDINGS Portion Of T his Form With 201 OF PLUMBING 201 E. WASHINGTON AVE. RM 178 Any Return Correspond e 8 e P.O. BOX 7969 MADISON, WI 53707 p � RF�EIVE 608- 266 -3815 DATE: II t1 API? ;2,5 ' 8 t: PROJECT: ga © ^ MAC - c. �� �-� �'e ►pK - - CIRO I c c �W \5 , PLAN ID. # 0 act DETACH HERE PROJECT NAME Osxi T �� PLAN ID. # This is to acknowledge receipt of your plans and � s pec i fications for the above indicated project. / Preliminary review indicates the required fee is $ fin Fee Received is $ QGn -nnl I w ❑ Underpayment — Please submit the additional fee. ❑ Overpayment — Refund forthcoming. ,,, ❑ Plan accepted for review. Plans being returned. Elff No fee has been remitted. Plans submitted with no fees will be Additional information required. SEE BELOW. held in abeyance. I. Plan Submission ❑ Complete data relative to anticipated use of bldg. Additional information shall be submitted in duplicate un- ❑ 2 copies of PLB 60 enclosed. less specifically noted. ❑ Deed restriction required 0 copy). .� ❑ Plans not clear, legible or permanent. ❑ Condominium declaration. 0 copy) `ZAII information submitted shall be signed, dated and sealed / r stamped in accord with Section H 63.08(2)(a) Wisconsin Administrative Code. El Affidavit enclosed. IV. Holding Tanks ❑Profile of holding tank showing: vent, manhole alarm and manufacturer if precast. Complete construction details if IL Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ Application for use of an alternative system signed by owner ❑ Holding tank agreement signed by owner and local unit of and notarized. 0 copy) government (sample enclosed). ❑ County onsite required (1 copy). > <Pesign calculations El Reason for installing : holding tank: Soil test or statement for pressurize distribution. ❑ Soil boring & percolation from county (1 copy). test data. Rqqe.J -0 ❑ Plot plan showing, location of holding tank with lateral disc- �ress section of system. ❑Pipe la'teratlayout. ` ances to any building' ' wefts ° W`atk piping, water ❑ Plan view of system. ❑Plot plan. course, lot lines, swimming pools, Wlweather service road, ❑ Verification of Exception Status Form by County. (1 copy) Etc. Provide benchmark with elevation reference point. 111. Private Sewage Disposal Systems V. Lift Pump ❑ Ground slope with 2' contours in entire area of soil absorp- ❑ Calculations for total lift pump discharge, head and gallons tion system extending 25' on all sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main..:: ❑ Location of area suitable for replacement system - provide ❑ Detail & model of pump or autematic siphons'including soil data. size, pump curves, drawdown arad a4erage flow rate GPM. ❑ Plot plan showing, lot size and all lateral distances from ❑ Cross section of lift pump tank showing pump(s) or sewage disposal system to buildings, lot lines, well, water siphon(s). course, swimming pools, water service piping, Etc. Construction detail of septic, holding or lift pump tank if site constructed tank manufacturer if precast. VI. Systems In Fill (Fill mu3trbe placed, or to plan submission) j El Construction detail and cross- section of soil absorption ❑ Total area filled (fill to extend 26'"beyond edge of tren( system. before side slope begin). ❑ Soil boring and percolation test on 115 completed by cer- ❑ Depth and type of fill tified soil tester (1 Copy). El Copy of- onsite report by;9P*ty,gr�distriis' ''staff. k SBD6678 (9/81).(Pt1 100F), j STATI"<p ea `�tnd Return' Ut�er ©fvlslipINts ' BUREAU ! Port Of This f + rtn With 2f11 E. WA; 18 Rtrrror�reptndenGe� r, ' 6t�8�2BB -38tS� �r t PATE' fl5/241$3 PROJECT: A Ali 1 lirsr Farm 4b(g} ; SCI,SEi 3,29 19W' ' EYerett Bolt St. CraiX wi 8,� gain Street x $tltiwirt, �tI4{J132 x PLAN ID 83 -01M x y DE COHERE _ ....._ 1laa' Park >4re Center�ftat�ir„ .5/8 8:4k -�I358 �k " PROJECT NAM PLAIN ID. # hi�# is 'to R lans and sped ati s fvr the'above -indic to 1. T acknowledge rem, pt of your, � Preliminary review "in iicetes the requked'fee Is 260.00 Fee Rewived is 'Underpayment — Please submit the additional fees i..J Overpayment Ret,tie€olttag .rte Plan accepted #or rs ieW. ❑ . 'kik being n4uaad nv No fee has I?een ret +i � f'lant4lu b�nitted with no fees be ❑ , Additional infarms[tesr t f S l t held iti ,abey� �. t 1'lasa Submission ❑ Complete data refa)ata t» 5 i ]Additional tnfortiwattt�n h be'submitted in duplicate vri ❑ 2 copies of PL$ Gil sha s less specift, y nobw 4 bead restriction ,< b Puns not.cieax legible or permanent. D Condominitttn declaratipn l9 copy) [. Alt information sulimittact shall'be signed, dated and 4eali or starrtped in accord with Ii j21(a) WiSConsm k Adtttirustiatee ❑ Af#tdavit IV, NolcittV Tanks r P Z� l rss #iie of` itold1hg tank° alowl s manufacturer If precast, i ll Prsurlxe ltrrbutiori Systems (Mauador In Gtcwnd Pressure site +constructed. t r ,gpPttiaticm fctr tae of an- altexttve system stgntd by.tnemer Q ,W old utg xatk ,mod tttstatsxt3d ( c1+} ' r gt mmetif I ke Rased) ❑ Coht ctsife4,requtre�tl tt calsy) 1 Qesign caiesststior►s „© "Ream fot Irtalling hold tB , per f0 prasse(rgk— ,st}` +hution d Soil Bring &;percofatian from count 1 Y. copy) h teg data._!, ❑ Pkrt; plan showing 'o�rttea Cross eectroti of wysten ❑ Pipe lateral layout. an, s to any building �nnells, vv Qt ❑ P! vtevu A syst"4 ❑ i?lot:ptan course, Iot lines,; swttnrnyilg y. ❑. _et►fte ttion-* fix+ tioi Starts Fmm _, Cr�0 _V (1 _Mk� }, � Etcc Provfid� benchmark witfr�efeva 1 t 1 lkrNote Sewage Disposal systems if.. Lift Pprnls ` Or©und ;Rlpo* with 2' in entire area 01801NIDS Orp- (] C�fcttfatiarrs f€tr tr�'f u t Iran system extending Zw on all sides porr►R P� (� levattclir of permanentzreference point bwohmark) y < r ''iicatton areir's�ti #abit3' lt. systet prdc#e 51�t%1ettt- ,8td+c M dalke. ' 4 : P>p �. lotat plat, �ts1 'Jot s #ze and' ail ltral distances ftaotn lit��411 ' t {3oSal #YSt+ t tab ffw0d11! 1 lot lines, well" " Mar ater . } e �01M ry( �p aWyp �y�/,�� �y.���yy��p #y� �a b � MflMr�1V,�1iR t. i�1( ��. 5{ Y' Y'' �s ' �, f LYt�i:.11�.� - NY�'NR��I:�tY Q Constrtastion clt fetf atf s pttc, holding .or Itft p MP tecllc tf ' site te d Gr te*rnahaa uu°of t xN Vl 1 1 0 ° Ganst Mw rt�ti$n w .tl Ct�t3�$± ion 'tYf sorf� B�K�r1 t ❑filet - ft atsd f pe►tx s alt test "on 4 t e rrptete 'by car t t F ttfftld �`e 1� '1��1' 1 -. pR. '�'1 � 2. � yy J. •. & s'... } s IPO 3 $' F Mb �'ttd a e, �.Fr 4 � yw�ay ,r �dr`r z T •smY` .�'inytr F }, s i�"' � � q ,� 2 t ° +i �'� ,oi a ,� r s � �� a • :(, ,b 'i`'a,, - .ik - IN 'S - 1�. 3 {* irr'� • : a,. F, « i t Y �' c�� '^� 3,'.• ° }2' * � '� A � A }�Y� � � .._ X14 � '' 4 �j S 4, .Y 3.`b *�•. +IM rF: s xv. P < § £ 4" x '. :t'4yt 'v�`•nr< f eT P� ' a o- Y y x ,,¢J , ±'4 of az'C�� tiY s { 4�`' j '�' i" �, s ' " l •Fn' � Yr, �. �; } ��� � *,.2 T "`. ns° � s ,�,'.: ��� m+•r � � w ���`� i' Y R �,. k . g' j 5 y ��a'; � fa' Y � � A c�'� �TM ",� {' '. .,," -, y � ♦ i yr � la c ..y, r :: 4 � t o X�� }`; ,, vE' � e • -:€'�' :>mn r'�'rd � Y- - , f�'3"J fiy , => / g / g � • � �. n..f � ''�; rY :� �°t ,� .i• _ •� r > - r- wkw•- + < ��r'.i'y* �r.. -r. ^ +.' ` .. •,,,r n -- r - •+r`�. C Y r .,,5 x�' Vtlt Ip � F , i+ne � ..�, i .•' �T ..s: t J ' 3 �y.k,._ S - _ .{ ". � �� TC$E ''.r � �) • s � ask `- - � ,i' •y— l G a � J ,�� '� -� <; &', �� a't�'K.:��' � x s C: 'r - '� • y� ; ,. ",� `l �� { ? ; r,'i � � P fx , ay ,y. r x a i�"' h �� n" �'�` R,ta �. +fit r � .•�� ... � � a �s � ar• ,': �r 2 Yg �i[. 7 � :�. �. 'fir � fj '� � S "A 11-'i'�t ;1 t '� T��:. e? •..t 1 ✓ t � iz { rF * fi t# r" V. z W 4 S A P� Of A - rh , g r , ,3='3 A O �.i f3ds' Ott ak f t tj +` q ' 2 [L � r ST ���c "31'x? S T� ✓�A "�FY�6 � - f f O� � $4 hY 1 ra w # t •� f $� � � . �' � sy � - ac .` :( ,� = '3'R'_ +e "e$ � 'k � � .�:4c �'Ss O, 77 F bn - i,s 90 . 90 ,�o w 3g ►t•RIN PRAIRIE T•30N- R.17W: 15�, SEE PAGE 57 SEE PAGE 59 AV K O PO D . M °,y A JE ETT .. [ /3 it ,se MuL /rQ S ncs t rr, /CS , s 't Tiaroe� R� • � O n�a.>R, CQ /O/ eA� l n,c /r l 0 F N � � $ E ma .: C m O �•• < r ,L7,ttrna.r7 y 149 s: .Fb6 ev c inch V 71'$ " v u � H°rzsen C " � • � / `nee � J.Por,a /d C ° ' /7ont,eth �'J Y 7f � - P f s co. Mar .®oe a Nca/ fCar/ (/S.H • Thomas .N Y� Cy /c �r ]' �o�cia S `vSCi R 2Sa5 Cough //n 7 �PPo /dt .Eoy/ red Con ,d,°a Zqo � zto V` O WILLOW o rr / /bo N 1 RUN �� °o• • erk / j RO. c V y R y9 -K"'.11 /Vane. - fl • $ v . /�' h'°.r R _ ,gr,d et I 7 u / /,ny Dcr'os,e/' f1 ` x 4 P"t \e .9 .s. 43 scjh \ V /e •V �i // M '1. C Ord 4 1 .1 •Cou h /,n /N.chaG /S ^ 0 4 + v a V �o u CU Doi/:d -9 Tcrrs d�C Nase� Slone �cF QU e /s9 Pe rGrson S� 4o S •rovu \ Co p La wren e ` Harc A / ✓EN O Zoo 3 fo /LO d RD. P 1 O 1541 6G • L Ly /c T NPP o /dt zzo ~� bcr- Z Louse. r /B� / 9,,d ,v a,s6 s aux • zso FOrr @Sf aSTEFF e yGOr9a- EN zzi B/o/se/' /'� "5/ Co ,FJoys /ro,n a rai',Ko, V rco . 'jO o N e 4N1t OA /� /Y,Ch4e /E N /e5 RD. �9 o /°eterson •`° ' .t.o y/bcrT /'a r. Eo v />_ i Ida • eD a .t /qK eo yoP.t,ns .��^ James Ter-rBae Fszr .s f .Y U zyo .E'a m°rr' t7 LGnns,�' �rr4 /.b �Q S�onah.re <Yes/ey Inc. so Pa}ric Mitch e/, uX c5/oddord bah • FD. Ruth M /bo w 0 ✓ SK/ Q 0 V /09 rv-,17 fh M//fon Si ,e arrow so° } �siZ zoo f Dorothy so ll eo Mac ioo Peterson QC 'V Thomas' � /� V 1� y 'C �, � v`�`e f ijc{{ U U h • L..Burrow �tl F�da. `d zs7os 4 ° /y hV Sohn S t Carnriy >•• Broc,E-P¢h- C7eur�Fmk {,o • ene �2 .r? f/e /en 2O0 W u 4 3 Co. 60 /rr 90 y' J � • ` �G,tsyhty / sy � a.,, 4 ku ku ` �3 4o y� RNER •• m /T9 99 • b a Bo .� U p J� g l Eve /yrs _,Don` /d �F V d E .nc t cl'CO H E. C. Le,.,ke l i / Ma erite hn- '� h IJennrs 4g; vasQ Ma /onry � IQ ^ Emmert /bo Le Ftv�LS 0. 40 > JDn�cs IJorot/�/ Thomas 4 Krvjen� xoo CGnter K .Eus,Ea .r "'l� - t t/Oro /d f'r/bnow �' .� y V y �orsn vnn 70 /r /LO c Pr,;. os vo,y Ps r t p C� /cam�n Do a an J/B os 0 f7nsor7 ° C p� C /bo F Kar -cri Ina/- /zo a/ 5 g Q W g 2e9.e¢ H . Kamm /bo P yo /6 0 ' T fflithur' 1 1 Emmert 0 0 '00 • Ca roy� un Bn/Y/ 2 L. yrfhur L. s / � u �.� Na rrvs to j ///einbuc/E H/dred, zoo v( w =so oberslB, /60 Ed. Lernk • Vie. /s f 1Ii U o 70 Soader -bed 1 z b o r o� Lours /9 f 4 a rse �GrncC o .LO C tl Bo /vo7a 6 /ir>or' �f yiien t F1nmFrt y Q°, D i +; to • � VE/P �omr� a � • ' 40 .. N " r R •L • ` . 90 10 C4J .f 9a NO. Car / h'owa�dC. { b scores/ Larr i � 9 Br<rr`cw Car / R w C �sn Oeh/ka CC v v y ��� � o /bo � � p � •io eo H � � C�� ��tl /zo /.ss x 6J u t o (� rr /bo T v c v o eti, /bo ov "'W6 o X04 �o 40" Th v�^ /bXd4 S Y L. 3 �v ° KenG°� t e (� 0 v h " 0 JJon S arrres Sr/c tl C a h/,Y /am V V k Sn - / hcn ins Lavc/% u j /yQry go aJ Walsh y o s Tal .Landry tlu 'fMaErn c Co,yC A >hur oy /°02 /60 • I ^ UD 2 Pe Orson tea/ 0 5 �d t4 0� f Jrrascn d a 4;0 �fo E E 7Z yQ P /NE L RO. • r rh a N - " L/NE RD. SEE PAGE 3/ cSt c ax Eu �w s /5� rPoe,Efor Ma �o /s Inc .J BERG JOHNSON NEW RICHMOND 0 BARN EQUIP MOTOR PHONE: 246 -4238 % SALES, INC RIVER FALLS P. & D. Silo Unloaders Chevrolet - Buick � ... .. - PHONE: 425-7671 DeKalb Seed Olds - Pontiac Freeport Silos Serving You With Sales & LAKELAND PLANT Service Since 1925 in PHONE• ' 436 -8886 or 386 -3922 MILTON PETERSON New Richmond Now Richmond, Wisconsin 246 -2261 SAND - GRAVEL - READY MIX CONCRETE c Department of Industry, Labor &Human Relations Z $ Division of Safety & Bldgs, S tate of Wisconsin QP Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 .eel 2J9O Tel. 608-266-3815 Vp 0 t IN ALL CORRESPONDENCE REFER TO PLAN IDENTIFICATION NO. NAME OF PROJECT _ TYPE OF APPROVAL \ 5 i c STREET AND NO. _ CITY OR TOWN C STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above - mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In event of the improvements or °''system - h - as - not commenced - within° iwo yefirs "fir8m�hu aci te; "tfiis approval shall - become - v - 61d'and n6wfirpptica'tl thaltt�e - made fo1 a�5pP60ai�Sf Chase "ptal1St18f2fre kV'drk M JTC=Mr M. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require - ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. ms Only: Sincerely, This iS valid for two J aA � yc -s or i; will be valid antil thie expiration date of the initial sanitary permit James Sargent- Bureau Director PLANS REVIEWED BY: , f DATE: cc: DPS -OWS Owner DI LHR Local PI Plumber H & R (2) County 104. Rep. Bur. of Health Fac. & Services DILHR S86 -6099 (N. 06/80) v/ 1 1 .� � 3�jt Rec. & Env. Services