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030-2095-30-000
Wi4cdInsiltnent of commerce PRIVATE SEWAGE SYSTEM county: ,Satety�I Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)I. 384215 Permit Holder's Name: ❑City ❑ Village In Town of: State Plan ID No.: enzel, Katie St. Joseph Townshi CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: l ob : () m 030 - 2095 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION HI FS ELEV. Septic S ? �" 2 SU Benchmark Dosing pi - 7 SD Alt. BM' � — J S, col A Bldg. Sewer - Hold' ( St inlet '1923 (s, TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Air Septic sp I S D Z ( NA Dt Bottom ��' v K;1 Dosing 5 1.4 36 If NA Heade Ael NA Dist. Pipe 2 /p0: S� Holding Bot. Syste QSQ� 3 q� q2 PUMP/ SIPHON INFORMATION 11 Final Grade Manufacturer Demand Model Number -a- ( GPM t/ TDH Lift Friction System TDH Ft �,� , �[� • 3 1 ( - 4 , Zq y� $� Forcemain Length [ p Dia. 3 Dist. To Well ' �, SOIL ABSORPTION SYSTEM I 3t ED Width I Lei gt 1 o. Of= PIT No. Of Pits Insi a Dia. Liquid Depth EN 1 N l OIMEN I SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACH Manu a INFORMATION Type O �, / , /�1 CHA M e r. System: DISTRIBUTION SYSTEM - 7 q Header / Manif Distribution Pipe(s) r/ li I x H i 4Size x Ho �a g Vent To Air Intake al Length —- Dia. Length !a ( Dia. � Spacing 11 / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes C] No COMMENTS: (Include code discrepancies, persons present, et . s ection . o q1 o/ Inspection #2: --f -- Location: 1463 24th Street, Hou Ito n, WI 54082 D'(SE 1/4 NW /4 T3ON OW) - 2 079 Country Side Estates -Lot 3 1.) Alt BM Description = 6 "92, 5► -- /ZO 2.) Bldg sewer length = 2 - amount of cov r = � OYes °r. ( � , , It 3. co = —? r..ea dl� l�. `b S tt>�i n ,A 4% S <.• a p �w�. C�1 Ian revisionrequired� No 3 Use other side for additional Information. 0 S lr SBD -6710 (R.3(97) Date I pector' s gnature Cert No. 446 a s Sanitary Permit Application 3 Safety & Buildings Division 3 / 201 W Washington Ave. In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 . ` � See reverse side for instructions for completing this application Madison, Personal information you proyie(e�tttap for secondary purposes to 7302 county 1 Department of Commerce (Privacy Law, s. IS} (Submit completed form to county if not ., state owned. Attach com lete lans to the coon o n onl for stem, on paoer not less than 8 -12 x 1 I inches in size. ber sion to previous application State Plan I. . Number / t c Z � Court State Q S nary Permrt um bT �r D oZ S t -. _; I. Application Information - Please Print all In rfqation F Location: Property Name ri �� ,, ; � _.�.;� Property Location IC ion SE t 51 ��lX x / l /4, S V TO .N, E or Property Owners Mailing Address f ° ,, DOFF Lot Number Block Number City, State Zip Code )'tioiie A(tlm Subd ivisio o SM Num be " _ -�''• II. Typ of Building: (check one) ❑ city ❑ 1 or 2 Family Dwelling -No. of Bedrooms village ®Town of C3 Public/Commercial (describe use):_ ❑ State -Owne . � Nearest Ro 4� / (r t r n Q Parcel Tax Number(s)30. III. Ty pe of Permit: Check only one box on line A. Check box on line B if applicable) O A) 1. aNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check ail that apply)' `lam • Non - pressurized In- ground Trvfound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day /sq. ft.) (MinJinch) Elevation i ysd ysd 'Ors — a /. a 99- YZ VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks /2S0 /ZS 70 j C1 C3 ❑ ❑ 7S 7sa VIII. Responsibility Statement I, the undersigned, assume res on ibility for installation oL POWTS shown on ched plans. Plumbees Name (print) P�1vr�er's Signature (no stamps): RS Business Phone Number Plumber's Address (Street, City, State, Zip Code) 37 Z IYa ?Z ST Airrt." Gvl S'Y ®o / IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 1 s g Agent (No scamps) Approved ❑ Owner Given Initial Adverse Surch a Fee) db g ' Detemiiiiation 3 ZS • �'� X. Conditions A4R ro,r / i (l - S S` t t� �• i c . vLtb -,elf" U rwo tpi t; Gs� t a-. c�► ' ` — U �� ,�,t„� - �,.r`°t�a.� �-a�t�c� � per. a'p•P -�` c� c-� ( . 14:06 7152686637 GILLE TRUCKING PAGE 02 l ! i I At � �.. ; _ fr o _ _ .�_ .. -- i ! .. ! _ ..I .. ! Z .I V7 i ( i . , .. I .. ., . , �` . �.Ill.�,_ - 1 7 • ��� � �' �o � - � _-:.._ ' .. i ... i .. 1 j _�...A! _� - -- - - •-- i--- - ►.... ... I 1 I 7 1 w { j ! d l I 1 1 I 1 � U F G VTR' 1• G i -� ! /! j IlZ 5 75,0 i I • I $ - 170 ; 1 ! I ; ! a , y I 1 Ii i I� e nsi%,,- )epartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Tabor an&Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x t ' f ches Ih,�§ize must include, but qt rroiX not limited to vertical and horizontal reference point Qn and Q/a.o#,,Wope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distanc est road — 03 — 50 v ` , APPLICANT INFORMATION— PLEASE PRI INFO,IRiNATION Y GATE PROPERTY OWNER: ;`PAO LOCATION 1r ;2 AYA� Vernell A. & Stephen L. Sk 1 d GOVT[. NE 1/4 4 va,S 24 T 30 N,R 20 for) W PROPERTY OWNER':S MA!I_ING ADDRESS LOT BLOCK # SUBD. NAME OR CSM # 149 High St r na csm T CITY, STATE ZIP CODE PHONE NUMB.EA '' ' VILLAGE GOWN NEAREST ROAD New Richmond WI. 54017 (71�' X4'6 : 7 kk New Construction Use Residential I Number of bedrooms (] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd/ft Absorption area required _- bed, ft2 375 trench, 11 Maximum design loading rate ' 5 bed, gpd /ft ._trench, gpd/ft Recommended infiltration surface elevation(s) (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft r S 7=S1 U n ' suit ' abf 0 e ' for tabe system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK s stem 1:15 30 U QIS El U ❑ S ❑ S [ I O Chid S SOIL DESCRIPTION REPORT �cu)co�2_ �� [ ` E � Boring # Horizon Depth I Dominant Color Mottles Texture Structure Consistence Bourxially Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed JTirendrl ....1.,..,, 1 0 -12 10 r3/3 none 1 2msbk mfr cs 2f .5 .6 .5r 2 12-18 10yr4 /3 none sil 2msbk mfr gw If .5 .6 , Ground 3 18 -29 10yr4 /6 none sicl lfsbk mfr gw na 1 .2 .3 2 elev. c2p 7.5yr5 2 99 ft. 4 29 -60 1 / 7.5 r5 8 sicl lfsbk mfr Depth to limiting factor 29" Remarks: Boring # 1 0 -11 10 r3 3 none 1 2 ms -� 2 <' 2 11 -16 10yr4 /3 none sil 2msbk mfr gw if .5 .6 S 3 16 -31 7.5yr4/4 none sicl lfsbk mfr gw na .2 .3 -� Ground c p yr5 2 elev. 4 31 -58 7.5yr4/4 M na na na n 99_,2Q ft. Depth to limiting factor Remarks: CST Name:— Please Print Gary L. Steel Phone 715- 246 -6200 Address: 1554 A00th. Ave. Ne Richmond, WI. 54017 Signature: Date: CST Number: 5 -4 -94 cstm 2298 PROPERTYOWNER V. &S. Skoglund SOIL DESCRIPTION REPORT 2,_f 3 PARCEL I.D. # 030 - 2034 -50 Depth Structur GPD /ft ' Boring # Horizon De Dominant Color Mottles Stt ' P + � !Texture � I Consistence i Baxniary I Roots in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. Bed iTrer& 3 1 0-141 2f 1.5 .6 2 14 -20 10yr4/3 none sil 2msbk mfr gw if 1 .5 ; .6 Ground 3 20 -28 10yr4/6 none sicl 2msbk mfr gw na .4 .5 elev. c p . yr i 97.60 ft. 4 28 -50 10yr4 /6 7.5yr5/8 sicl M na na na np np Depth to limiting factor Remarks: Boring # Ground elev. fE Depth to limiting factor Remarks: Boring # C3 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) )W STEEL'S SOIL SERVICE C Gary L. Steel Vernell A. & Ste n he L. Sko and 1554 200th Ave. gl P CSTM2298 NE 4NW4 S24- T30N -R20W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 f lot #3 N 1 " =40' A BM= top of NE lot stake at el 100' � r 5► l h Jo4J X Ga ry L. Steel 5 -4 -94 l Safety and Buildings cT, MA J CCF4V 4003 N KINNEY COULEE RD '�1 6O LA CROSSE WI 54601 -1831 N visconsin T r (608) 264 - 8777 .us/sb r:c; i 5 �� �? � � www.commerce.state.wi.usisb Department of Commerce - ,��� www.visconsin.gov Scott McCallum, Governor \ Brenda J. Blanchard, Secretary May 25, 2001 CUST ID No.221471 ATTN. POWTS Inspector ZONING OFFICE DENNIS J GILLE ST CROIX COUNTY SPIA 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 APPROVAL CONDITIONAL VAL O PLAN APPROVAL EXPIRES: 05/25/2003 Identification Numbers Transaction ID No. 642506. SITE: Site ID No. 171385 Katie Wenzel Please refer to both identification numbers, St. Croix County, Town of Saint Joseph -150th Ave. L above, in all correspondence with the ag ency, NEIA, NWl /4, S24, T30N, R20E FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 792773 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes in Statutes. e submittal has been CONDITIONALLY APPROVED. The following and Wiscons Statu s The g conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. _ • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • The changes made to this plan on 5/25/01 by this reviewer were acknowledged and approved by the e ' �� 1 ,.� designer. .'�. Note: The well must be a minimum of 25 feet from the tank and a minim of 50 feet from the mo ea. O CE the specifications n 11 be on -site durin construction an to �' approved roved P fans � P ecifi ons d this letter sha s a g inspection by authorized representatives of the Department, which may include local inspectors. mut A copy of e e ,` required by the state or the local municipality shall be obtained prior to commencement of Y GAS construction /installation/operation. i OB d 97 i a DENNIS J GILLE Page 2 5/25/01 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. Sincerely, FEE REQUIRED $ 175.00 !!oG . _ FEE RECEIVED $ 175.00 _ BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608- 789 -7892 Mon - Fri 7:15 AM to 4:30 PM WiSM.ART:cozi+. 7' jswirn@commerce.state.wi.us I ' Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 *isconsin TDD #: (608) 264 -87 www.commerce.state.wi.us /sb sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary May 25, 2001 CUST ID No.221471 ATTN: POWTS Inspector ZONING OFFICE DENNIS J GILLE ST CROIX COUNTY SPIA 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/25/2003 Identification Numbers Transaction ID No. 642506. SITE• Site ID No. 171385 Katie Wenzel Please refer to both identification numbers, St. Croix County, Town of Saint Joseph - 150th Ave. above, in all correspondence with agenc enc NE1 /4, NW1 /4, S24, T30N, R20E FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 792773 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. _ • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • The changes made to this plan on 5/25/01 by this reviewer were acknowledged and approved by the system designer. Note: The well must be a minimum of 25 feet from the tank and a minim of 50 feet from the mound area. 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. DENNIS J GILLE Page 2 5/25/01 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. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services 608- 789 -7892 Mon - Fri 7:15 AM to 4:30 PM WS�NIT 7433 jswirn@commerce.state.wi.us k ' MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Re {�: ntia Applicant',, INDEX AND TITLE PAGE Project Name: KATIE WENZEL Owner's Name: KATIE WENZEL Owner's Address: 408 GOLFVIEW LANE AMERY WI. 54001 Legal Description: NE NW S 24 T 30 NR 20 E D Of `,OW1MER Township: ST. JOSEPH P pEP County: ST. CROIX pEtJ Subdivision Name: SEE CO Lot Number: 3 Block Number: Parcel I.D. Number: 030 - 2095 - 30-000 Plan Transaction No.: Page 1 Index and title RECEIN Page 2 Data entry MAY - g 20�� Page 3 Mound drawings = Page 4 Lateral and dose tank Page 5 Pump specifications WOW Page 6 Management plan Page 7 System and m 'ntenance specifications 8 A r eh S -/o Designer: DENNIS GILLE License Number: 221471 Date: May 2, 20 Q/,01 Phone Number: 715 - 268 -6637 Signature: �/�i/ 1�1 v4 f S,. a'vy #�VIo I Mound and Pressure Distribution Component Design Df�sigi 'u''c �s'"`•ee Site Information R Residential or Commercial Design (R or C) Onfice Note: 300.00 Estimated Wastewater Flow (gpd) Sand fill (D) aameters 1.50 Peaking Factor (e.g. 1.5 = 150 %) calculations 118 = 0.125 5/32 = 0.156 assume a Table 83• 450.00 Design Flow (gpd) 3116 = 0.188 5.00 Site Slope ( %) 443 in-situ SON 7/32 = 0.219 Contour Line Elevation ft ,p treatment for fecal ( ) / a•75 ' coHform of <= 36 114 = 0.250 28.00 Depth to Limiting Factor (in) inches. 9/32 = 0.281 0.50 In -situ Soil Application Rate (gpd /ft2) 5116 = 0.313 Distribution Cell Information 113. 001 Dispersal Cell Length Along Contour (ft) 3.98 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the hij hest point in the distribution Y Pressure Disribution Information network? Enter Y or N C Center or End Manifold (C or E) 2.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 1.75 Orifice Spacing (ft) 3.52 ft /orifice Orifice Density 3.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 89= Pump ank Elevation p (ft)96.5 Enter Y or N 6.50 System Head (ft) x 1.3 36.70 Forcemain Drainback (gal) 11.58 Vertical Lift (ft) 181.88 5x Void Volume (gal) 0.77 Friction Loss (ft) 218.58 Minimum Dose Volume (gal) 18.85 Total Dynamic Head (ft) 52.73 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 1.00 1.00 1.25 x 1.25 1.50 x x 1.50 x 2.00 x 2.00 x X 3.00 x 3.00 x Treatment Tank Information Gallons/Inch Calculator era} 1250.001 Septic Tank Capacity (gal) 1000.00 Total Tank Capacity (gal) huffcut IManufacturer 40.00 Total Working Liquid Depth (in) 25.00 gal /in (enter result in cell B48) Dose Tank Information 750.001 Dose Tank Capacity (gal) Effluent Filter Information 15.001 Dose Tank Volume (gal /in) Iza I Filter Manufacturer huffcutt Manufacturer ja100 lFilter Model Number Mound Plan View -- . -- . -- 1/6B J Pipe K A W 1. �. . . . . . . . . . . B . . . . . . L Mound Component Dimensions A ft E 10.39 in H 1.00 ft K A7.80 ft B 1 F 10.00 in z 7.76 ft L ft D 8.00 i a l j G 0.50 ft J 5.22 ft W ft 450.00 (ft Dispersal Cell Area 1327.06 (ft) Basal Area Available 3.98 (gpd /ft) Linear Loading Rate 18.83 (ft) 1/6B Obs. Pipe Placement Mound Cross Section View 101.ZS f Aggregate Dispersal Area Finished Grade (ft) —► G H 2 99. ` F Dispersal Cell 100.92 (ft) Lateral 't68-2 (ft) —10. — Invert Dispersal Cell 1 Elevation E 4 C to l�ev�tr�r�A— 5.0 % Site Slope 1 ur Shading Key �o Dispersal Cell nt etic Fabn over Q Topsoil Cap See lateral details Subsoil Cap a c page 4 for number of © ASTM C33 Sand / F laterals, size, and f 0 Tilled Layer 0.5 ft Typical Lateral spacing. Laterals are Q5 Aggregate o centered in the AxB �---- A * distribution cell. Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical IL P S 0 = Tu m -up wd ball value or � X-.-- � I�02 I X12 }I Laterals & force main of PVC Sch 40 aleanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter in Orifice Spacing (X) 1.77 ft Lateral Length (P) 55.75 ft Orifices per Lateral 32 Lateral Spacing (S) 2.00 ft Orifice Density 3.52 ft /orifice Lateral Flow Rate 13.18 gpm Manifold Length 2.00 ft System Flow Rate 52.73 gpm Manifold Diameter 2.00 in Total Dynamic Head 18.85 ft Forcemain Velocity 2.39 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Comm Disconnect Electrical as per NEC 300 and ---� 16.28 WAC 4 in. min. _ Tank component is properly vented E-- Alternate outlet location Forcemain diameter huffcut Manufacturer ^r 3 in. Capacityl 750.00 Gallons Volume 15.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 29.43 441.42 C B 2.00 30.00 P u� mp off e levation (ft) C T4 '2+948 Q.6 �t D *6� I5s.5 D 57.83' Total 1 50.00 750.00 Dose tank elevation (ft) WT • 1 -l �d6.9 Alarm Manuafacturer level alarm 4 a ( Ioror ow Alarm Model Number jdvI Pump Manufacturer Izoeller Pump Model Number 140 Pump Must Deliver 52.73 gpm at — 1 - 8 - 8 - 51 ft TDH W HEAD CAF' ACl CURVE TOTAL DYNAMIC HEAD /CAPACITY _ -- G I — s 12 PER MINUTE 3 7/s /4 MODEL :5 '140/4140 EFFLUENT AND DEWATERING , s/a F201' Meters Gel, Ltrs. 14^— 1,52 91 344 3.05 84 318 — + 4.57 76 289 12 1 40, 41 40 6.10 69 257 1 ::/2 - 11 1/2 NPI 35 -- 25 7,62 59 223 10 30 9.14 49 185 30 35 10.87 38 144 I i rT 40 12,19 21 79 a 25- —" 45 13.72 5 19 7 L. Lock Valve: 46' _ -- ' 5/ '6 9K1624A QJ 4 w 0 10 _.. n U.S. GALLONS 10 20 3f. 40 50 60 70 80 40 00 110 is ;! �_.. _.. LITERS 80 160 240 320 400 0 , '• -'1,' �� O FLOW PER MINUTES 010940 +%e 11 112 NPf CONSULT FACTORY F(W SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with an alarm. I. ' • Mechanical alternators, for duplex;: yltems , are available with orwithout °` - - .... 1r . -, 7 . ,I... .,. alarms, • Control alarm systems are availrab 1a gar 1 phase pumps used in simplex a , 1 t r .... , 1... system. See FM0732. '_1 SK16M • Variable level control switches are .ilrailable for controlling single phase systems. • Double piggyback variable level llo 31: switches are available for variable SELECTION GUIDE level long cycle controls. 1. Single piggyback variable level float switch or double piggyback variable level • Sealed Qwlk - Box available for oit;loor installations. See FM1420. float switch. Refer to FM0477. • Over 130'F. (54'C.) special quct�liican required. 2. Mechanical alternator M -Pak 10 -0072 or 10 -0075. • Refer to FM0806 far 200' F. applications. 3. See FM0712 far correct model of Electrical Alternator E -Pak. 4. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. 5, Four (4) hale ,1 -Pak, junction box, for watertight connection or wired4r, simplex 140 Series -:K; b i�. 4140 Series - 73 lbs. or 2 pump operation, 10.0002, ............. . ... 14014140 MODELS _ Control Setectlon Model Model Volts -Ph M_o Amps SIT 'ex Duplex _ N140 N4140 115 1 Non 15.0 fIr 1& 2 or 3& 4 CAUTION E140 E414D 1 Non 7.5 1 & 2 a 3 $ 4 All installation of controls, protection devices acrd red" should b e done by _ BN140 BN4140 115 1 Non 15.0 1 '1 2 or 3 & 4 a qualified licensed electriclam Al dectrical and sak ly codes should be BE140 BEA740 230 1 Non 7.5 1 or 1 & 2 or 3 &A._ -- followed including Th most fK t National Electric Code (NEC) and the "* Dauble seal pumps are evailal le vrith optimal lnca Wee sensars. Seal Fail ircrxator Ilght milade in NEMA 1 or NEMA 4X Saliaty and Health Ad ( ""'J' COWN panels. RESERVE POWERED DESIGN For unu sl)aI conditions a re safety factor is en gineered into the design of every Zoeller pump. ANNl . .,i11' . MAIL TO: P.O. BOX 16347 I: Loulsv16e, KY 40256 -0347 Manufbaursrsof. . SNIP T0: 3649 Cane Run Road t LoulavAte, KY 40211 -1961 I Pl/ !O_ (502) 778 -2731' 1(800) 926 -PUMP ljaQUrrP�MW sacE 199" FAX (502) 774 -3624 — I — Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Se ptic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil conpaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/LTSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is peformed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6199) or SBD- 10690 -1 (N.7 /00)) and local or state rules pertaining to system maintence and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintence of this system should be directed to your designer, installer, county zoning office or local health inspector. Mound System Specifications Owner's Namel KATIE WENZEL Designer's Name I DENNIS GILLE System Flow and Load Parameters Design Flow - Peak 450 gpd Estimated Flow - Average 300 gpd Septic Tank Capacity 1250 gal Soil Absorption Component Size 450 ft Type of Wastewater Domestic Maximum Influent Particle Size 1/8 in Maximum BOD5 220 mg /L Maximum TSS 150 mg /L Maximum FOG 30 mg/L Maximum Fecal Coliform 10E6 cfu /100 mL Service Frequenc Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should ins ect once a year and clean once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthl Pressure System Laterals flushed and pressure tested once every 1.5 years Mound Inspect once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted or perforated and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion. Lateral Tum -up Detail Finished Grade . . . ..... .. .. ...... Threaded 6" Diameter Lawn Cleanout Plug Sprinkler Valve Box .. or Ball Valve .. .. .. Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: KATIE WENZEL Page 7 of .05/25/2001 14:06 7152686637 GILLE TRUCKING PAGE 02 . 1 ' h - Yj J. C. _ I :_. I { i ! , 1 I I • I • I � I I � ' ! ! ,•1oR � I I I I i - -.I - I i I I ! I . L L _ 12- 0 750 I ! rT g�&JAT7o , , i I I i I. i .�. ...�.. I + ••i 'I I I I , , , ! ! I I � I I ! , I ! I � I � I I • I %.,f v , */ u.L rni uo: as JVAA 1 10 3tfo 40?3Li ST CRX CO ZONING Q001 vu,aid7epararentoftn�siry. SOIL AND SITE EVALUATION REPORT Page 1 of 3 0abor and Aelatlons nivWan of safety & Suildings in accord with ILHR 83.05, Wis. Adm. Code C Attach complete site plan ern Paper not less than a 112 x 1 . ' c(;es ih:bize ?Plan must include, but not limited to vertical and horir;ontai reference paint ( rill a'nd�.Of,,.ropa, State or P CEL I.D. # dimensioned, north arrow, and location and distant est road, ''�`� _ .. APPLICANT INlrf]RMATICiN PRI tNF4;lihl4' ION f p�IaSY ATE PROPERTY OWNER: � ' ;n :.^ 'PRO LOCATION Vernell A. & SteElk L. Skqcrliuid �: GOV1,TJ NE 114 NK 114,5 24T 30 N,R 20 3dw) PROPERTY OWNER':S MAP.In 3 ADDRESS i LQT BLOCK# SURD. NAME OR CSM # 14Q 141 gb St - _ _ \ � � na C '# CITY, STATE IP CODE PHONE NUfc+I4EfR ° EIVILLAGB OWN KAREST ROAD NOW Rj_MM2aL T .17 (7 I&New Construation l im 61 R / Number of t)edroo (} Addidon to extsting building } Replacement I ) Public or commercial describe Code derived daily Bow _ 4 !'_i0 arid Recommended design loading carte • _ bed, gpd/ft - 6 trench, gpo4 Absorption area required -32!L bed, tt2 3 trench, tt Maximum design loading rate ' S bed. gp lft . _trench, gpdAt Recommended Infiltration surisoe elevation(s) .SC. t 1 1 nP q9--729 (as referred to site plan benchmark) Additional design I site com;ldei'ations na Parent material pitt glacial. drift Flood plain elevation, if applicable na ft .,. S ■ Statat�le for system „ WOMONAL MfAMD W-GROU PRESSURE AT-IMD SYSTEM I�, F&L HO XWG TANK U= UAsudabl6 f System t S 9M U +rte 11 U �] S C ❑ 5 S l�tl ❑ S :RU .wu. SOIL. DESCRIPTION REPORT Depth r)ominantcolor Mottles Structure GPDlft Boring # Horizon Texture CQrtsiseenoe 6atrxlaty Roots in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. 8ed rtllfit s l 1 0 -12 10 r3/3 none 1 2msbk af x — as 2 5 2 12-111 10yr4 /3 none sit 2msbk mEr gw If .5 .6 Ground 3 18 - 29 10yr4/6 none sic Ifsbk mfr 94r na .2 .3 e lev. 0 ft, 4 29 -6.0 10yr4 /6 c 7.5y 572 99 `P 7.5W /B si lfsb Depth to fimtting factor 29 - Remarks, wn n Boring # ! st; t 1 0-11 10 r3 3 none 1 i 24 ' A. 2 11 -16 10yr4 /3 none sil 2msbk mfr 9W 1f .5 .6 3 16 -31 7.5yr4/4 none sici lfsbk mfr gw na .2 j .3 {around C p 7.5yr5/2 elev. 4 31 -513 7.5yr4/4 M na na n a 021 6. Depth to flmBing factor Remarks: CST Name: - Please Print Gaxy L. Steel '" 246 -62 Addreae. 15.54 Xftli. ~ .AVe. Ney Ricbmond, W1. 54017 Soo aturo: _..' Date: CST Numb!: fir' 5 -4 -94 cs 9 pROQF.RTYOWNER V.SS. S1C� ogitlrld SOIL DESCRIPTION REPORT PP�e _? . ,nt 3 PARCELIAt 030- 2034- : .5,11 — f)ept;n ;tom +Want Color j Motlfes Structure i I Roots god /f Boring # Horizon{ Munsell O in. i ra. SZ Cont. color Texture Gr. Sz Sh. l consimnw isamck vy i zr- -°.ms ",. gm 3 M1y - al.. none rnfr aw 2 _5 .6 t 2 14-20 10xr4 /3 note sii 2msbk mfr gar if .5 j .6 Gmimd 20 -2i1 l0yx4/6 none Sic] Mfr gw na .4 .5 elev. c p rl 5yr5/2 T ,60 ft. 4 28 - 5 -0 10yr4/6 7.5yr5 /13 sial M na na na np i np Depth to Wong - factor 2R^ 2 Remarks: —, Boring # i i I Ground eiaar. , ID Nmiting factor - Remarks:.. _._.. Boring # I �x i Grand slay. Depth to IMIng factor Remarks. Boring # ; Ground - e*. ft. Depth to N ng factor �-�- -j I Remarks: — �Bt�.833a(R,06/9� Vol v12tVi rAL za CKI (;U ZONING la 003 STEEL'S SAIL SERVICE Gary L. Steel Vernell A. & Stephen L. Skogl=d 1554 200th Ave. CSTM2298 New Richmond WI 54017 MPRSW 325�t ���� 524- T34N -R2tlW town of St. Joseph (715) 24"200 lot #3 N 1 " =40' top of NE lot stal u. at el 100 rr v"t' , 9. �•� v h � Gary L. Steel 5 -4--94 JUN -08 -2001 09:48 GROSS GIVEN ENG DEPT 1 612 222 3689 P.01i02 75 West Plato Boulevard St. Paul. MN 55107 Gross-Given Mfg- 651-224-4391 "4-224 ae" fax �51- zzz. Fax To: From: Fax: �S 3 0 �b �6 Pages: Phone: Date: 6 ' 0 Re H-D -14f— �..'ts CC: ❑ Urgent O For Review O Please Comment O Please Reply [3 Please Recycle • Comments: G JUN -08 -2001 09:49 GROSS GIVEN ENG DEPT 1 612 222 3689 P.02i02 I� /// I 1 I 1 I i 1 1 . i I I 1 , I � S TOTAL P.02 r a4 /2,9/ 2 001 13:14 7152686637 GILLE TRUCKING PAGE 02/02 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM f Owner/Buyer `� + V V ✓1 z <- Mailing Address y 601r yiello Property Address „ b (Vor .ation required from Planning Department for new construction) City /State 4 ,0Ak - _ Parcel Identification Number E 3o – toy -3 – 0c, o LEGAL DESC 2P7;]? -IAN G / Property Location Nifr r /4, A ' /4, Sec a . T 30 N -R W, Town of Sk.'^4 �o Subdivision CCM vA jv of 1 'f C Lot # Certified Survey Map # , Volume , Page # Warranty Deed # __ _ 5 �` (o 1 , Volume JI Z Page # `° 1 Spec house ❑ yes [}:c�c;u Lot lines identifiable ❑ yes ❑ no SYSTEM M INTED 14CE Improper use and a ntenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out tlte! septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of tti:: 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 masterplumber, journeyrn M. pltumber, restricted plumber or a licensed pumper verifying that (l) the on -site wastewater disposal system is in proper operating cond.it.an and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. 1/we, the undersigned have toad the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by t:h.r. Department of Commerce and the Department.of Natural Resources, State of Wisconsin. Certification stating that your septic syste to has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o� tbPTmc year expir,�t6on r' - r SI ATURE OF APPLICA.NsT DATE OWNER CERT1FjC j joN I (we) certify that a statements on this form are true to the best of my (our) Imowledge. I (we) am (are) the owner(s) of the P5P PPfiy described abov Ib ' e of a warranty deed recorded in Register of Deeds Office. / zi of SI NATURE OF APPLI 14 DATE " " " "" Any information thin: its mis- represented may result in the sanitary permit being revoked by the Zoning Department. """ "+ Include with this applicuttilon: 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 WARRANTY DEED '•' Document Number REGiST�R'S nr'FICE 5T. C ?O!X :;t�., Wt -�+ hctu—. Address APR U 7 1998 8:00 q 3o i .. 7aado ' Parcel I.D. Numb:.r: 030 - 2095 -30 7 Vc and and Stephen L Skoglund conveys and warrants t Katie L. : Vein�el a single pe rson the frollowing described real estate in St. Croix n consin: of 3, ountry Side Estates in the Town of St. Joseph, St. Croix County, Wisconsin. This is not homestead property.'' Ex.:eption to warranties: Easements, restrictions and rights -of -way o: record, if any. r f i Dated this day of April, 1998 _(SEAT,) (SEAL) Ste hen L. Sko glund - Vern-- nd 11l A. Skoglu p b s' _ '>, r AUTHENTICATION TRANSFER X Signature(s) Vernell A. Skoglund and Stephen L. FEE Skoglund authenticated this 2,ol day of April, 1998 d't. 't= Kristina Ugl d TITLE: MEMBER STATE BAR OF WISCONSIN I THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland �- Hudson, WI 54016' a l f r bi U A t b t t� __. __... ........._.._....._............ _._......_ ..__... ..._. ..... __...... _...._.. -IE NEI /4 OF THE NWIA AND IN PART OF THE SECTION 24, T30N, R20W, TOWN OF ST. JOSEPH, �0NSIN. LINE rOao oECICA - 10 T HE P UBLIC EEC 2 ---- --- - - - - -- -- - -- - - - -- SN VA 137.80' — 216.00' — — — 216.00'— P� S89 35'57"W 569.80' s 0 % I / f LOT 2 LOT I 3. � NZ 3.06 ACRES 8 3.15 ACRES 8 3.15 ACRES 133,348 SO. FT. M 137,367 SO. FT M 137,367 SO. FT. 40 W 3 3 0 io o ° 40 8 3 M . O io ° O N 216.00' 216.00' ECTION 24 S 9 57 1295.33 a a 0 CO) O 1 3 n d _ 1 "* 1 ' O M ID 3 i 4 m < _ A L W p y s N O O N C _ O (p 10 CD K) O Ln O fD N O- 3 cr OEM) �-4 W O O N O O C W C CD O ' A 3 5 N A Z O 0 �. c w ky C � to z D a m D rn a T 3 (p 3 0 0� N p _ 00 o N N = O O O C A O C 0 3 '•' v ter • � Z 101 0 0 Z o w n co (0)N00 M ° o o :3 m' M m m (D N CL ty z CD ~-! o o w o n n o N a m j I o C N N (D CD = S W .+ O 3 Z O O0 N -' � co) O A Z CD O N to Ct A Z 7 N n Q O j 3 0 w O S c m M M m O aRL a Z � � A ro 0 r► Z N rn Z 0 C A a CD <_. o 7 N C N _ � o a CD I y I i o 1 I O p. f0 ti ti t v O I � CD Oq N A &9 O o CD b +personal Intormat+on you prowce may De uses Tor seconoary purposes p- rnracy Law, s.1b.U4 (1)(m)]. ------ -" Permit Holder's Name: ❑ City []Village Town of: State Plan ID No.: enzel, Katie St. Joseph Townshi CST BM Elev.; Insp. BM Elev.: SM Description: Parcel Tax No.: 030- 2095 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic Benchmark Dosing Alt. BM 5-. 05 A Bldg. Sewer g0 Hold' St Ht Inlet C (0 1122 TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic Sp I p I 2- '— NA Dt Bottom .O?j Dosing 1 5b " t ` 3 b NA Header / Man. A NA Dist. Pipe 2 t' Holding Bot. System 3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand t over �� r -1 Model Number il; GPM gr / TDH Lift Friction System TDH Ft (� - g 3 1 ' A 24 L oss Head 441 Forcemain Length D Dia. 3 ci Dist. To Well �-. o V__ SOIL ABSORPTION SYSTEM ( 'U. 3 0 -4- + * a PT (13 EDY TWOCH Width I Le' � + o. Of 46 PIT No_ Of Pits nsi a Dia. Liquid Depth N I ` th �a DIMEN I SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH Manu INFORMATION Type Of i]T I �+ CHA M e r. System: ° r ( `�� NIT DISTRIBUTION SYSTEM 4 f 9 Header/Manifold Distribution Pipe(s) 1 ►/ It x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Lengthy Dia. IZ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil 1 ❑ Yes ❑ No (]Yes Q No COMMENTS: (Include code discrepancies, persons present, e Aspection #1: o9 / /gN o/ Inspection #2: — f / ----- (I)Pl wid)CiP"Q Location: 1463 24th Street, Houlton, WI 54082 (SE 1/4 NW 1/4 24 T30N R20W) - 243020796 Country Side Estates -Lot 3 4��5t2> 1.) Alt BM Description = �yn�y� C 2.) Bldg sewer length= 21 1 � JJ - amount of cover = > Ig •r- (c�� 3 contour rx . = S &.Cc -f.lR. 4o �sl � - stets ��. Plan revision required? ❑ Yes No Use other side for additional information. SBO -6710 (R.3/97) Date Inspector's Signature Cert No. 4 P e - 3 a�f S , Sanitary Permit Application 7 �3 L Safety & Buildings Division l! 201 W. Washington Ave. I*LPersonal in accord with Comm 83.21, Wis. Adm. Code CQ »sin See reverse side for instructions for completing this application PO Box 7302 information ou ro ma Judi y for secondary purposes Madison, WI 53707 -7302 Department of Commerce y p . (Privpe`y.Law, s. (Submit completed form to county if not state owned. ,onl for tem nn a er not less than 8 -1/2 x I I inches in size. - - Attach complete Ions to the coon o s , // County State S I P rmit umber sion to, previous application State Plan 1. . Numbcr LOY J _ " a 6 I. Application Information - Please Print all In ation Location: Property O Name ' " Property Location SE i l�S2V T,S'O ,N, 110 E or W Property Owner's Mailing Address ' ,pt=F - Lot Number Block Number y0 9 o l,U,itiu' ZrJ. City, State Zip Code t , 'g np t� Subdivision Name qUCSIV1 Num II. Typ of Building: (check one) ❑ city ❑ 1 or 2 Family Dwelling - No. of Bedrooms _ ❑ Village ❑ Public/Commercial (describe use):_ M Town of ❑ State -Owned /- } Nearest Ro Parcel Tax Number(s)30 + 2O 9.S n ,30 Coo III. Type of Permit: Check only one box on line A. Check box on line B if a licable O A) 1. AR New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Ar . • Non - pressurized In- ground l!vlound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At- de ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Gade r Required Proposed Rate (GalsJday /sq. ft.) (MinJinch) Elevation Y-5 'Y'5_0 1s a /0 97.. y, ' VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks / zsa �zs o ❑ ❑ ❑ o ❑ 7S'd 7So VIII. Responsibility Statement I, the undersigned, assume res on ibility for installation o POWTS shown on ched lans. Plumber's Name (print) P�iu ees Signature (no stamps): RS Business Phone Number Plumber's Address (Strect, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued s g Agent (No stamps) Approved ❑ Owner Given Initial Adverse Surch�ge Feee) I dD ` Determination X. Conditions ro / is 2=1e, � n ur � n r u • u C twt/aO- S S 1FM ,. %0. V\,OV — Ce^uGY�t`(L+n7L a+�dL YV AI AQ nwak t L C ✓�� c (¢ sus �►�- ��Q , `+,. � s do pa, fl Q ��� - --7,�j 14:06 7152686637 GILLE TRUCKING PAGE 02 1 , - i I � I ' POO 4r .. J_ 1 6 J STi -4 T - f i � I i I i 1 � ! I . . +. ! 4. • R J. I -A. z of 79. t -top An It ! � �3�I. ;� y � II L A_ J. VD Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County - Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitant term it No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 370370 Permit Holder's Name: ❑ City ❑ village Z 1XWrX*r State Plan ID No.: Bessac, Ken Richmond Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax N- 026-1075-70-400 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TH Lift Fr iction System TDH Ft Loss ceLength Dia. ti Dizt.Towell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIME_ I N SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu acturer: INFORMATION TYPe O CHAMBER Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 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 xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [I No ❑ Yes ❑ No COMMENTS: Include code discrepancies, p ersons resent, etc.) ( P p P Inspection #1: / / Inspection #2: Location: 1352 140th Street, New Richmond, WI 54017 (SE 1/4 NE 1/4 26 T30N R18W) - 263018395A -Lot 4 1.) Alt BM Description= 2. Bldg ewer length= g - amount of cover = l�V ► 1'— t ' I 3.) contour= Plan revision required? ❑ Yes []No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No. I