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W o o 'm - o o CD m m( 3 c o v'� O c O C � N. n_3 d N � N.n 3 0) (D y cn C4 >> O Q CL 7 � O Q d V Ol O C 0) V (O C 0) N N C ( N N c N O T O W0)0) O0 Na) w03 N ' N C X N C O X (D co O Cn -4 3 m @ V 3 3 @ NO M CD K NO =ti N Q O O O CD ( A O O 0 n O 0 N U, N 5 I Wisconsin okartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430260 0 GENERAL INFORMATION (ATTACH TO PERMIT) A tate Plan ID o: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 3 2Y= Thw s- X Permit Holder's Name: City Village X Township Parcel Tax No: Wylie, Evelyn I Springfield Townshi 034 - 1030 -10 -000 CST BM Elev: Insp. BM Elev: I BM Description: Section/Town /Range/Map No: c3D I aU •b CST fa 14.29.15.209A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` ^ Benchmark a f Dosing L( Lk Alt. BM Aeration 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 /00 r r 2-5 Dt Bottom f Dosing i Header /Man. 30 Aeration Dist. Pipe � 3- M4b ID ' , 20 Holding Bot. System f �- 00 Final Grade of PUMP /SIPHON INFORMATION G w a f — ao Manufacturer Demand St Cbver GPM Model Number (S 2 'P& A,111, ,� •c7 / 1 0' ° H Lift , Friction Loss Head DH Ft v� 1. 1 System S. 05 - T G_ - �.� • �'trG/ S O Forcemain Length f Dia., Dist. to Well 1 — 0 *> SOIL ABSORPTION SYSTEM BEDITRENCH Width ► Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. DIMENSIONS ' (Z ' SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACH anufacturer. INFORMATION Type Of System: f / I CHAMB T c ICD ] lop 1 �D �— DISTRIBUTION SYSTEM Header/Mani I N Distribution r u — x Hole Size k x Hole Spacing 4 Vent to Air Intake Pipe(s) Length Dia Z Length /I S • 7 Dia Spacing 51 SOIL COVER x Pressure Systems Only xx Mou Or A t - Grade Systems Only Depth Over Depth Over xx Depth of odded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 77 91 Yes N No 0 Yes ® No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: D / � l ?3 Inspection #2: 7 P dW 4 �� Location: 984 County Highway W Glen wQ� C J �ity, WI 54013 (NE 1/4 NE 1/4 29N 15W) NA Lot Parcel No: 14.29.15.209A 1.) Alt BM Description = �" /� NNOM.tal�lfir� 2.) Bldg sewer length -amount fcover = _ Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) ' ` `– D _(�„ � S nsepctors ignature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S N Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) COII S (608)266 -3151 Department of Commerce Sanitary Permit Application State Plan LD. Number W 24� in accord with Comm 83.21, Wis. Aden Code, personal information you provide Privacy ...,.....t * s - `, may be used for secondary purposes acy law, s15.04(lxm) Project Address (if 1. Application Information -Please Print All Info matiolt S �/1'1 {-eS fC�Lx� �C1Z v— Pr Owner's Name Parcel # Lot # Block # Property Owner's Mailing Property location d oLQ ''J a W � ' /,, ' /., Section City, State ,- ` Zip Pbone Number CYt �0� W� O�7 T N' R Z' o �) 11. Type of Building (check all that pply) (! L_ Subdivision Name CSM Number *f or 2 Family Dwelling - Number of Bedrooms -- ❑ Public /Commercial - Describe U ! El State Owned - Describe Use �QU z ❑City_❑ Village ownship of / t'C 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' New System Replacement System [3 Treatment/Holding Tank Replacement Only El Other Modification to Existing System ❑ . El Permit Renewal El Permit Revision list Previous Permit Number and Date Issued B ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner 1Y.'jype of POWTS System Check all that appl #M on - Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Motmd < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized Dn -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Dkip line ❑ Crravel -less Pi El other (explain) V. Dispers Area Information: Ism S Design Flow (gpd) Design Soil Applicati f) Dispersal Area Req ' (sf) Dispersal Area Proposed (sf) System Elevation CL ,.3 ? 0 QDD /S�oD /Ml r VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Talcs Tanks Sept D ©D /ODD / lam- • / At Aerobic Treatment Unit (� (�g Dining Chamber L se <. O V11. Responsibility Statement - 1, the undersW ed, assumtXesp.4.flity for imtailatton of the POWTS shown on the attached plans. 2 Plutt�'s Name (Print) Pllwwns t MP/MPRS Number Business Phone Number / IMP L- S��z 39 6 y 7(S 43tl 26 vso Plumber's Address (Street, City, State, Zip Vlll. unt /De artment Use Onl Sanitary Permit Fee (includes Groundwater Da Issued Lllssuing Agent SiknaWre (N s) proved ❑ Disapproved Surcharge Fee) ¢j ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons f Disapproval kh ,n oft d, ,mot �,wt, ROW c ' , zG -u � �a c� 2- � U 3 Attach complete plans (to the County only) for the system on paper not hiss thin 81/2 x i l inches in size SBD -6398 (R. 01/03) a — �' ��- 'N•�•14 t Lo I / K :'wt sst i•R•s � L I `1L i Z 4 7 Q � at 2" TECS� ESYS$� Put 6,� ED .. I? D Ot DJ✓. owe _ 1 12.0 •' � O v. � u � CA,•., rt— ' ` 4eA, Nw: w, rlLaww.. PJ�S:ON Q ��3..�, C�v -S-ac� �u. ►- C.� +W i 07/28/2003 11:16 FAX 7152352592 T L SINZ PLUMBING INC Safetyan�Buldings 4003 N KINNEY COULEE RD _; LA CROSSE WI 54601 -1831 TDD 0: (6081264 -8777 \ *1sconsin www.co mme w.wi s onsi n.gov www.wisoon9in.gov Department of Commerce • Jim Doyle, Governor Cory L. Nettles, Secretary June 25, 2003 CUST ID No. 139462 ATTN.• Rod Elsinger TODD L SINZ ZONING OFFICE _ T L SINZ PLUMBING INC ST CROIX COUNTY � arl,,•L �t e— E5609 708TH AVE 1101 CARMICHAEL RD 0 MENOMONIE WI 547515520 HUDSON WI 4016 CONDITIONAL APPROVAL ©,� PLAN APPROVAL EXPIRES: 06/25 /2005 Identi�cati0nl�lumbers Transaction ID No. 883244 SITE- Site ID No. 661162 Evelyn Wiley Residence Pleiise refer,.:to %both identifieati°on.numbers,' 984 County Hwy W above, in all cca dence•witli.•the;agency - Town of Springfield, 54013 St Croix County NEl /4, NE1 /4, S14, T29N, R15W FOR: De scription: Replacement 3BR Mound Object Type: PO System Regulated Object ID No.: 909670 The submittal described• above has been reviewed for conforinnance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. Thn 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: General Approval Requirements; • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01101). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minim of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 8128 • 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. Stat • Comm 83.22(7) 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. 07/28/2003 11:17 FAX 7152352592 T L SINZ PLUMBING INC Z003 TODD L S1N7 Page 2 06/25/2003 Owner Responsibilities: • Comm 8352 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plaa>iader s. Comm 83.54(1). , • Comm 83.52(2) A, POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 8355 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. 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due S 0.00 De nnis R Sorenson Wastewater Specialist, Field Operations V 7633 (608)785-9336, Mondays 7:OOAM- 3:45PM dsoTenson@commcrcc.statc.wi.us I Y ' Evelyn Wiley - Mound Transaction # ? - y y Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD- 10691 -P (01/01) Pressure Distribution, SBD - 10706 -P (01 /01) Location: NE 1/4, NE 1/4, Sec. 14, T 29 N, R 15 W Town: Springfield County: St. Croix PRIVATE SEWAGE SY a T EM Date: June 27, 2003 Cond oQj 1 Owner: Evelyn Wiley . r : Address: 984 CTHW W Glenw d City, WI 54013 Plumber: Tod Sinz vRRESPONDENCE Signature: License # 439462 Attachments: 6748 -Plan Approval Application SBD -8330 page 1: cover pG��' \ /�� 2: design criteria & calculations RECEIVED 11 3: plot plan JUN 2 0 2003 4: system cross section 11 5: plan view, lateral detail S � & B L S AWN! 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 x Design Criteria Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg /L Anticipated septic tank effluent 30 mg /L < TSS < 150mg /L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg /L 3 Bedrooms x 100 gal /bedroom /day x 1.5 A-s-o gallons /day hydraulic load Desi n culations In situ designed loading rate gallons /sq. ft, per day Dept to estimated high ground water in. Depth to bedrock in. Cross slope at system S' S� _ % \ �t Z. Force main leng ft. of in. Manifold /header length lyA ft. of — in. Drain -back °•`t gallons Lateral length @ ° g ,- } ft. of in. Lateral elevation \ ok•a ft. @ bottom of lateral Lateral hole size s �s z in. @ S'5 in. ( Z •9 3 �s' ft.) Spacing 3 8 holes /lateral g holes total Lateral volume gallons Total lateral discharge rate Z -0 gallons /minute @ 3 '�� ft. head Network pressure compensation losses ' 0' ft. '�- °•S � Elevation difference t 0 . 0 ft. Friction loss \ •9 z ft. @ gallons /minute "Dotal dynamic head 4 ft. Pump /s*on 4"4- gpm @ 1 z ft. of head Manufacturer Model # 2- Dose volume Zo. U} gallons Lift/siphon tank 6 u gallons Septic tank gallons Effluent filter Measurement pump on and off in. I iei @t alarm from tank bottom - 4 •7- in. Reserve capacity 3 �� gallons specs caIcs yes Page 2 - of w Cr 1 k o Zo 4v I see F / L s.� °� o K� zttil3 -• � I C�a�� Sao z•� N o ndit i Ot' ' �+` s ii � '1i \1`.i"/�!� �N e' u (QJZ ,7'L � {�iV' �' S'fy ' ` �rf 0✓R�'� -� + W RC , 0S � M �; Uwonr ( C4! `Z4.� Q •�¢o� ( 1 s.�,c. `9 oC't o•,.� — l 1 t.5 " � 0 - ri Ql\ v-.: w.. cXa.�"?J�S: pv, 4 � •-¢.� C w,r }aoQ.. �.- L i�+ W ol C, k / V V ` I j r C 1 C 4- (- \-i 0v% J � �•Z 14,Z� NI-1 E SEWAGE SYSTEM Co nd ition ally SAHTY AND ,`�.s E6P C , L td LD'._.i i E N I � la ,� 4 6b \1 qp,<60:�� o� - " \ 1. h nn TyYhNy \ � W �VOI'�L (� `V VN \VO.- S /3L 101 K �RT,SEVIfAGE IYSIEM CondWna lly A r uv P m R L : (VISION OF SAFETY AND BUILW CGS S o g SEE CORRESPOND _." ;�r-j- t L >'C WEATNERPROOp LOCKING +covER JLNcT ch l�JA/r�N /NG 4 1A6E4 41�IC1C DNC.OVVlCT --1 � GIG6 3 �� nL) NDIgSUROED SAIL. 24" T.O.�I 4 V � r�uwua� . lo%" r ( 4 STF f�Z Ks ELT o►+S VlIAGE �" j Z . • rally C>cp P ualP i eo•��e�- ` OND I b S C P T �E c��E CORRESt' ENC S P C C I F I C AT I Oki S ' e," � TA",.S MAWUFACTUR R C: (JUMDCR OF DOSES: TA►JK SIZE ; 1 � 6"O \\ GALL0WS DOSE VOLUME AARM MAUUFACTuKLR: S7 \'- �,�,, IAJCLUOING 6ACKFL0W: MOOCL WUJhbCR: 1 ° �� `� CAPACITIES: A= WCHCS OK 3 SWITCH TyPC; � 4 "� "`b Z. �3•S , r�MP /'1AWU FACT URCR: G °¢� \¢v C•iUCnES OH MODAL WUMDCR: ,� Z ` Om � INC HE S GR - SW�%H TYPE, " uOTE' PUMP AWO ALARM ARi 73 6C MIWIMUM DISCHARGE RATE 2o'b GPI „, IN5TALLC0 0Q SEPARATE �CRTICAL DIFFLKEWCf DCTWCCW PUMP OFF A►JO DISTRIbUTIOW PIPC,. FEET + MirJIMUM WETWORK SUPPLY PREiSUKE , , , , , , , 3 ' S FACT} �•81� c9 .5 5:��. + FEET OF FORCC MAIN X `_ ` F � Iooi[FRICTIOU FACTOR. �•�Z FEET — TOTAL DtJWAMIL HEAP FECr IQTERIJAL DIMLW6J OW I�T �g 31O � � Of TAAJK, LELJC.TH _______.__; ;LIQUID pCPT H �Ao.0 6 0. "TAL DYNAMIC HEAd /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N MODEL 152/153 -- w w MODEL- 152 153 50 + Feet j Meters c i. Liters Gol -iters 153 5 1 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 0 15 4.6 53 201 61 231 a 44 167 j 52 197 30 r t�— a 8 25 7.6 34 1 .29 42 59 r 30 9'' 73 87 a 20 , 35 0.7 -- -- 2� a 2 r 1 1 - - 4 T — - - 0 Loc'� V„,ve 3n 0 F 014508 0 2 40 60 80 100 GALLONS ZO-to LITERS -- 6 4 0 80 160 240 320 .-► -4 FLOW PER MINUTE - -- — - -i- CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing panels available, o e • Electrical alternators, for duplex systems, are available and supplied with e an alarm -- L_ Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. 1 1 Sealed Qwik -Box available for`outdoor installations. See FM1420. 1 O ver 130 °F. (54 °C) special quotation required. 1521153 Series 1521153 MODELS Control Selection — r Model - Volts-Ph 1 Mode Amps Simplex Duplex — N152___115 1 T N on 8.5 1 1 2or3 _ - BN15 . 2 115 1 1 Auto 8.5 Included — 2or3 - - _ -__ -- I ' sK2064 E 230 1 Non 4.3 1 I 2 or 3----- - - - - -- —L BE 152_ 23_0 1 1 Au to 4.3 Includ 1 2 or 3 I N153 115 1 Non 10.5 1 2or3 BNts3 11s t Auto ta.5 Included 2or3 SELECTION GUIDE E 153 _ _2 _ 1 Non 5.3 1 2 or 3 BE 1 53 230 i Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level Float switch. Refer to FM0477. o CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA), or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Louisville, KY 40256 -0347 Manufacturers of, Z SHIP TO: 3649 Cane Run Road Louisville, KY 40211.1961 p 4 ii r - (502) 778 -2731 - 1(800) 928 -PUMP Qvaurr PIM S NCE /9�9 http: / /www.zoeller.com F AX (5 774.3 © Copyright 2000 Zoeller Co. All rights reserved. r System Management � Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop Plumbing, 715 -235 -2644. or the with the adsorption system or an others stem components, the installing lumber, T.L. Sm p P gP Y Y Y P St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small Darticles Qf the same density as water,p pump tank or compartment to allow a dose to e accumu ate , a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9, Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulch may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 3y�5 2. If necessary, the septic tank must be pumped t remove solids d scum; pumping is required if the combined scum p �d s m solids volue equals one third of the tank volume. U! � (�.� V _ a J (mod Yv?�o 3. When the septic tank is pumped, any6olids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterl in ns are r cep p 1i ed lumber should be notified if effluent is consistently ponded in the ads orption c 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompan\ their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. I f the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 1 I . Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 I ORIGINAL' 1769 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 — Division of Safety and Buildings in accordance with Comm 85, Wis. ode County Certified Soil Testing D Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must St. Croix Include, but not limited to: vertical and horizontal reference point (BM), direction and I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest d. Parcel - 1030 -10 -000 Please print all information. — ----- viewed D e Personal information you provide may be used fprsoeorda`ry purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Wiley, Evelyn Govt. Lot NE 114 NE 1/4 S 14 T 29 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# A 984 CTHW W City State Zip ' Code - Phone Number "� City �j Village MIJI Town Nearest Road Glenwood City WI 5403 715- 265 - 4237 Springfield CTHW W New Construction Use: ilej Residential 1 Number of bedrooms 3 Code derived design flow rate 450 GPD ✓' Replacement Public or commercial - Describe Parent material loess Flood plain elevation, if applicable NA General comments and recommendations: install 4' x 112.5' rock cell mound on 100.0 contour as upslope edge of rock w/ 0.5' sand fill FT] Boring # _j! Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 34 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 ! 0 -8 10YR 3/2 - sil 2 m sbk mvfr cs if .5 .8 2 8 -34 7.5YR 4/4 - sil 3 m sbk mvfr cs if .5 8 3 34 -38 7.5YR 4/4 f2d 10YR 6/2 sil 3 m sbk mvfr cs if .5 .8 4 38 -48 10YR 4/4 f3d 7.5YR 5/3,4/6 sil 0 m mvfr - - 0 2 massive gy si coats 9 -18 associated w/ fine roots Boring # —.a Boring ✓i Pit Ground Surface elev. 99.0 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon j 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 1 0 - 10YR 312 - sil 2 m sbk mvfr cs 1f /m .5 .8 2 9 -34 7.5YR 4/4 - sit 3 m sbk mvfr cs 1m i 5 .8 3 34 -45 7.5YR 4/4 f2p 7.5YR 4/6,5/3 sil 2 m sbk mvfr gs if .5 .8 i 4 45 -50 10YR 4/4 c2d 7.5YR 4/6,5/3 sil 0 m mvfr - - 0 .2 f3p 7.5YR 5/8,5/3 vertical root redoximorphic features w/ classic dark centers 11 -16" ' Effluent #1 = BOD 30 _< 220 mg /L and TSS >30 150 mg /L * Eff uen # = BOD < 30 mg /L and TSS < 30 mgL CST Name (Please Print) Signatu CST Number Hen F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/21/2003 715 233 - 0398 i ' J r - Property Owner Wiley, Evelyn Parcel ID # 034 - 1030 -10 -000 Page 2 of 3 _ F3 ] Boring # _j Boring I/, Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' __ in. Munsell Qu. Sz. Cont. coW Gr. Sz. Sh. 'Eff#1 *Eff#2 s 1 ! 0 -11 10YR 3/2 - sil 2 m sbk mvfr cs 1f /m .5 .8 2 11 -30 7.5YR 4/4 - sil 3 m sbk mvfr cs 1m 5 .8 3 ! 30 -40 7.5YR 4/4 sil 2 m sbk mvfr gs if .5 .8 — l - 4 40 -45 10YR 4/4 c2d 7.5YR 4/6,5/3 sil 0 m mvfr - - 0 1 .2 massive gy si coats on peds 12 -18 somewht diffuse; suspect a remnant E- horizon diffused through field cultivation here Boring # --I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' _ - – in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I ❑ Boring # J Boring i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 i I i ' 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 -8330 (R.07 /00) Certified Soil Testing O ,.4- 1 °Z to - oao '� Alts - `N ti • t4 -2q'• is A 4 k$� i c 'L 4•v i 11 � I IL (LD Gi —� • I At U I Z� i _ 07/06/2003 22:11 7152357914 HERITAGE BUILDERS PAGE 03 07/01/2003 15 :42 PAZ 7152332302 T L SINZ P1t,1W1N5j jNS la 008 8T CROIX COMM s8K c TAM mAvfrmqAx AORSBMw'T AND OWNMMUP CSRTtPi'CATICIN PORM Lvedy -1 Mailii+g Address 'ICT'"i Lt]t.+U�1� ,�` ��� v�� Property Addt+ass �i �Tj (Var;.l7icatiao requited ffm P a inn bepsrtrn.t for civstatc Pat d Identification 14=ber O 3 /0 3 0 - (� — o a -tog A Prerpcaty L0cad N V1 t/•, Sec. A., TAY- AX056 0 To w4 of ` pk ,EM CarNf ed Survey Map # _, . 'Volume , Page N Wam mty Deed N � �_ �� volume —��� Pty N 3 . Spec ba= fl yea no Le times ide[tcr W'D Q YN MMM AM iWaper use atyd md IN piewa fslim+a to hawe wastes. Pmpce ondm of p ow do n pde bait wVc%y *am y am or sooa�mt; if tr.eaa by a Dwood VWWW. w1�at You pus tab t0 syssa cr m am ago aw flmadoa of the wptlo VMk as a bums nt 6MV to *6 wsstc dbpodi a7� "Tw psvpeay awma aptcs to submit tp M CtotY Zoom a eeetStfnatiat+ forsa, sled by *a nwacr and by a msse�Ptaaab4s, ioart�eytbsn ptum� saas+riteed ptaaa'b�e or a lioonsed y ,�p mr �iyigs tb (1) Liss oe•aeias ar#s4evYatm'dlsPea sir° is to proper opar as ng amx9 ion andlor (2) after ioipOCdion "aQ PUMP�i « '), +Optic taa1G b less ton 1l9 tali of slau'14e. y p,, tiw tmdesiped tbrc rand Me above =quite ==%and area ft msim+de "POW* sffw l s "%M a'th 00 VU hI6 aed tl►o of 1�att� �. Aatti of Wiaaowto. a � EoRt1Q, iaeraia. as sd byr the Dtpaeessent oCCoeQmaetae Dew �� dot 7� septic sys'seos ?ns beam maiatalaed mtat be eatt¢+ic3ed syed zetaateb! to ette St- soix amw ZonfAC Otltoe.rMLla 30 dyat of abe MM ya•c expt tion date_ Bt A OF APP VATS I (we) cert *a all snatsmaatts as mis seem are aw co the vase of nW (00 kw*edV- so (ate) Asa aweKRs) o! the n7 daecthod abum by vimta of t wattaa y decd ratotdod in R6918tor Or DeMda Office. OF "T Dl�� 5 A rrtrrr• • �.� �• Any infbrmtttto6 shat is mi *�epaesanted mLL,Y result l0 tbC 6toltary pCMft b tawolod by drt Z 21AS luvartu)m rr dads vAgl tkW apptie*tioo: ■ "anapod WInsory deed &*M tbt Ryisesr or Deeds e$Aaa IL tm of Qae oa.%mod smv4y map if m annee is mdo in *0 asar"M deed 08/25 /2003 08: 21 FAX 7 T L SINZ PLUMBING INC Q002 _ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANIC This is to certify that I have inspected the septic tank presently serving the residence located at: �,�'A, - .11 -1 of Sec. T _N. R W, Towns of 5PP-1 ��T� (�- � St. Croix County, Wisconsin _ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appe&r9 to be functioning proper Last time serviced Did flow back occur from absorption system? Yes No k (if no, skip next line allons minutes Approximate volume or length of time: g Capacity: bOd s Other Construction: Prefab Concrete Steel Manufacturer (if known) : AL[ /�✓�r" {i'� �L G�cr .Age of Ta (if own) %orb L, .f r.v z- (Sign re) Name) please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, W13CQn8in Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding axis septic tank Condition, I certify that the tank, to the best of my kn edge, ill conform to the requirements of ILHR 63, Wis. Adm. Code (exec for i ection opening over outlet b fle) . Name d 0 L ! I✓�' Signazure MP /MFRS D Q ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This i to certify that I have inspected the septic tank presently serving the �V�� �� residence )I located at: _%, , � Sec. T Z�_N, R Town of S�� l N AT w ! t , St. Croix County, Wisconsin. 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 Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer MR. 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: 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 Signature MP /MPRS 07/06/2003 22:11 7152257914 HERITAGE BUILDERS PAGE - t w DOCUMENT NO. STATE SAS Ow WISCONSIN ro" 2 — Is" ••.... QUIT CLAIM DEED J� ��� 1136pox-M9 S32900 Ir: 1 5. 27 S C Fl: L _ ........ ------------ ------ ---------- ------ . ........ - ------------- AUG -- - - - ---------- I quit'al-ims to ........ —.— ..... r-t qt3o A. rJ -------------------- -------- -- ---- -- ------------- 1--- -------- -----------------._. •........._._._....__._........ ----------- .......... -- ....... ........... ....... ....... .......• - -.°---------------------- -.7 At* state of wisc—Ai.. ...... .. st� rig A/ 0 OP 4= S4 5 V 6 Av Sr Tax P*r,.d No: ------ ------- ------- ' , 7 prover%Y. ig NOV) Dated this ------ ---- day air --------- - --- ---- - ------ ---------- -------- ---- ---- -- -- --- -- ------- — --------- ------------- ............ - --------- ---------------- Or W18CONSIN ------------------ --- --- -------------------------------- ........ ------ -A L-4114 "— ------- C A# ra ------- -------- vm came b-fare -------- day of ----------------------- 4 111-- Thy authenticAted this ------ -4AY at.. ------ the above x0med -- -------- --------------- ------------ -- -l— -------------- -------------- ----------- ------------------------ ----------- ------------ I ----------------- -------- BAR Or wisr-omaiN -------- ------- . ........ ------ ------- ** ----------- b - 0 - 0 - s - ----------------- to W.0 the I ", took lbe Wis. ataim.) Rho serve. TNia mok ----------- ---------- — ............ jp8*y=UN4KP4T Was 0 -------- — ---------- * -------- RvDert C. Win- --------------- No A S O e mm ------ mg y be sclk—W!edged- Both lit --------- I (stirnatur do Ate not V%ecmaarv.) a.4. Stock PAW, 'w I NGFIELD PLAT T -29 -N • R -15 -W - 1 0 111 gO ..v �� .. .. s ters) GLENWOOD PAGE 56 See Page 112 For Additional Names. '00 E 2900 3000 3100_ 3200 3300 i Ban & F o w o ktty JO �1 Steven raid A l l M Fi !y COO s�v '�, & 156 er a &Mona 1 Anni. 4 0 7 g e r z z g a 40 t° 3 29 Lames ° u -.6 :n p 102 Dmo4 2U ►. Aaoo wry LagOn 000 vaJF00 rahm '° u Julie jn;- u , 6U y No 3z Leroy p o E t do Ma y „ ° Seim I 00 80 &Donna o � ' , o Micha el �°*°c"°° b B 92 Thomas Allan Rott N 3 U& Gloria IGer E 0 I= Gardner & Ma ayne Marian e Udd'.�a 9 us Otto 0 i� 0 159 nom 202 24 40_ �n_o �Finde S 4 110th AVE I B Ro bert qavid Some �� 3O R rockett F 80 79 " 64 140 20 I �' � p 20 20 k Cf) Q °8 m O Bruce & Donald Richard ir Troy & n Leroy & Don ° o Di Johnson McLau - r& Fornst Ram w F Sew Haines N b m 40 80 37 zs 69 120 1 9 240 111 w O A G&P cv s 11 v oo c^ Robert P io Wayne Dennk v U N aS &Pamela �'i at w thyCu � w I '9 35 via M�►O U�s rr x " a � �Y 40 �A & met PaNh& 1 Harold N C q: ", F c L la LEN H b b erer & I` x Larson eenenda8 T Jarvis Brandt GP ' V � 7 c P ovich � 3 � o � oftman Lij 4N) 48 " 40 40 c on AV k 40 5 I > oo I W nGNa aul & SAVE 16 H err & Hen & ani {' tt ua Chua To Yang Farms N cCar- Lewis H ang 40 ang Inc 67 sen 39 40 1 o z Edward & I q v DDe L � Jew 6 u ~ warm & 3 S o Joseph & Don lla k W " B wo T — James & I chm 80ehlo Str z 3 224 Harold 1 � Villmian Carlo s & Ruth Steven 0- O & Betty Chong T Farms vasqu McCarthy & Rebecca p Brandt DB Her Inc mist S &K U ° 160 Nyhus 120 etal 1 60 � 4 Lyons 120 $ N N Y f James 318 S ven 2 120 on i P Duane Barry a$ 37 S R Fern Clo o Ihrke M c""' on 90th , Mary I o 28 90th AVE _� 4 0 40 73 4s 9 s 7 d 40 4o AVE 12 Robert E - Brian & I Z � deS James Thomu d Bruce Tsuefu & Karen Eric mond & Susan v 'Debra Z rust Mahoney n smhia� Peterson ya DHfG1 / J & Marie Nelson Maho- I () 120 Scott ao 79 39 174 " 400 Mi}1O° G &G 40 r� c 39 ney 40 Q a & Jack g, H &D Lockerby Thomas Icon 21 � e Smith cy P Utirhad O Ol & Nancy Betty na.ia 23 & I Doan- / Nyhus M,nn L ' I ' P Bakke 00 Bloom 80 85th Colburn 39 sunare. Quam Adam al N ney 120 e� 4 0 R 75 AVE 160 100 4 Marshall 3s z iw Mt Smith D & ao ' � & Jo hnson IC?ahl David &Lesley & Mary S Hardwood as m 0 3S M.& [ gcE 2 Ronald e eC t dals Larson 6o Mahoney Corn E Mavis o c c +0 �J Fortune &Kay 120 Bo ti m es > E I > Lindahl o u, r H„, o°naM °1S a, Hugh Debban Lee Leona J �° Bob f « u o 159 o • rK- & Shar- C o & Diana Ica Mary & K-1 , u a j go � � SPid.— ,, M.5 ma 159 K d � McGee Bunn Heath 3 H o: 1 h7ebi° 40 t'q,n by 4o y 80 Cum' 3t .~a 80 fiC: VE � 80th AVE N a i, �e Charles urdes C o Bonnie _o — " ( N William I G Mandehr ,E 1 1 I Wok- Hoppe Bonnie � 0 o OMean E �` o Krueger to 29 as ».,man 4o 60 a alters V ^ 40 �' 80 40 40 f ° 60 40 OI 9 y " v & aver, e ]8 9 J ulianne rederick I U) I Smith plement •4 -C Do June a oo E a D onal d Finder u .� Lenertz �� ,g U v c� Co 109 Q U O 4o n V 3 V L W 7 oh 80 I w 0 127 12 °' tai 4o Lois Leroy �l E Gerald l 00 -0 m E � Danov_ �� N s Johnson :r °� sow / o �� 78 rl 3a I 9 4 Robert 72nd 4 Dale p S (5 �I Y l ON �I 3 Snyder AVE & Kim ° v o Y c o Z QJ Z ° a ° N etal Heimke / a e11 ,.0. A4 50 '� 40 3 �rd xa v 2X 34 _ 36 40 a r O 4 Mabel & Richard 10 t AVE v NN O0 Thompson Eleanor 20 Hagen Ger ald C J. 40 Trust 207 Mousel „ 35 cb61 04 ° C I � ° M e 0 120 156 K S�tene 42 00 1% 1 c l q 5 .-,U 6. c D Ellef Mary 3 Keith & f & Ma h 13 6 Phea- son SStenzel Kr mcrey Erickso o o 0 o S 168 c James & R E wait- t 2 Mark .. r~ Alic > & rust hi�llipJ f n:aa H 451z I Grady wed p� 4 ° dbom 40 0 4t 3y to 39 20r`�r" ammo_s 60th AVE CADY PAGE 24 d `'ate j t V 1.1- i c u w ' 1 i i DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 El CONVENTIONAL EX ALTERNATIVE I State Plan I.D. Number: ❑ Holding Tank ❑ In- Ground Pressure FX Mound (Ifg4V j569 NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE Robi Gl ?.i.e R. R. 1, Box 190, Gtenwood City, W1 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.: NF NE, Section 14, T29 -R1 5W, Town ob SpA ngiietid Name of Plumber : MP /MPRSW No, . County: Sanitary Permit Number: L .fie J. M ena i 6219 St. cu ix 54914 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER /� (J 'l O PROVIDED: PROVIDED �� Y RYES ❑NO DYES Il�,1NO BEDDING: VENT DIA.: VENT MATLL. HIGH WATER NUMBElfi ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET` LINE: J AIR INLET: DYES ❑NO 1:1 NO NEAREST.: 00 f /O —/ / L-7 DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: �( DYES ONO 0YES ❑NO DYES ONO GALLON PER CYCLE: PUMP AND CONTROL OPERATIONAL NUMBER OF PROPERTY WELL BUILDING VENTTOFRESH (DIFFERENCE BETWEEN FEET FF40M LINfi 0 �� �� Ala Ipl T PUMP ON AND OFF) 1 �d YES 1:1 NO 11FAREST �( SOIL ABSORPTION SYSTEM. Check the soil moisture at t depth of plowing ' FORC LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN S Z ��) the soil is dry enough to continue.) V CONVENTIONAL SYSTE �l�.. WIDTH: I LENGTH. NO. OF DISTR. PIPE SP C V '.INSIDE CIA .- #PITS. LIQUID . +�yg€�pyrH TRENCHES E AL:1 DEPTH: �IAAI�N�tt�AtS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MA RI NO DISTR NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV. INLET ELEV. END. P ES FEET FOhII LINE: AIR INLET: I N E AREN MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS zSX ES ONO — NE S ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED. SEEDED. MULCHED: CENTER EDGES. / / 11 /' d ❑YES O YES ❑NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: ' Illuuu WIDTH. LENGTH: NO. OF LATERAL SPACIN : GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER: 7 / TRENCHES: ' � `¢C' :. MANIFOLD PUMP (( MANIFOLD DISTR. PIPE ANIFO LD MATERIAL N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.. ELE DIA I I ELEV. PIPES. PIA.: / kx H LE SIZE 1 HOLE SPACING DRILLED CORRECTLY. COVER MATERI L VERTICAL LIFT CORRESPONDS TO APPROVED Go t( PLANS: ES ❑N YES ONO PERMANENT MARKERS: OBSERVATION WELLS: PR PERTY WE BUILDING: FEET FRO COMMENTS: NUMBeR O& _'. LINE: YES ❑ NO YES ❑ NO Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE. DILHR SBD 6710 (R. 01/82) Wisco APPLICATION FOR SANITARY PERMIT n �DILHR (PLB 67) C OUNTY - DEPRRTmEnT oc UNIFORM SANITARY PERMIT # - InoUSTRV, LR6oR 6 HUMRRRELRTIons — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. —See reverse side for instructions for completing this application, PLEASE PRINT PROPERTY OWNER MAILING ADDRESS /' ' / 71/Lc� D C PR PERTY L CATION / CITY: /� ,,` 1 /4 �(J�1 /4, S N, R E ( TOWN O �p lloo �/ �`Z T' LOT NUMBER 111LOCKNUMBER SUBDIVISION NAM ST ROAD, LAKE OR LAN MARK ST TE PLAN I.D. NUMBER 7 Y �a --3s� TYPE OF BUILDING OR USE SERVED r (!:Ibr 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy Alternate System 17'2. f J> ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Ppleb. Site Steel Fiberglass Plastic Gallons Tanks oncrete Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: ` IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Z 411 Lift Pump /Siphon Chamber Manufacturer: S PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Nam of P (Print): Signature: M /MPRSW No.: Phone Number: 4ff Plu er's Address: Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: I F : Date: Disapproved / / iJ /—Q�/ {�( El Owner Given Initial Ca /tD� (Q� o� a ( A� Approved Adverse Determination % I'M asbn for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. , Department of Industry, Labor and Human Relations ""S`°"m" Division of Safety & Buildings DILHR Bureau of Plumbing OEWiRTiT1E ov ,.: , , "� � P.O. Box 7969 irK3t STRV,LRBOR6**ATW4 \RELRTIOf15 Madison, WI 53707 Tel. (608) 266 -3815 l i i <? A u � �GF � IN ALL CORRESPONDENCE _n 49A, ir 1 L7 REFER TO PLAN �� IDENTIFICATION NO. E OF PROJECT co PRIVATE SEWAGE ONLY - E] GENERAL PLUMBING PLANS Fee Received: LO A1ION 2 Priority Plan Review Only ITY OR TOWN j COUNTY f r � Examinatio of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wher required inspections are to be made. Win- In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. Sincerely, For P*valt Sewage Systems Only: r;� This approval is valid for two Sarg t, the l Bureau Dire or sanftrypenit R IE DAT cc: DPS S:Uff) Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services oun Other DILHR SBD -6099 (R. 05/82) M� I.y Y. [Y') 1 r 4 i i P i i i t H . z H 9 ST C- 105 r H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County z d OWNER /BUYER g bet -t - _LVE (yYlY // e ROUTE /BOX NUMBER Fire Number CITY /STATE C Q 1 ZnWd0 d LG21 ZIP 6i- PROPERTY LOCATION: j x , Az4f_k- Section T,�'!ZN, R�W, Town of St. Croix County, Subdivision Lot number I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_ y be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly . maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H o I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- b ment of Natural Resources. Certification form must be completed 1� and returned to.the St. Croix County Zoning Office within 30 days v! of the three year expiration date. SIGNED DATE �1 St. Croix County Zoning Office P.O. Box 98• Hammond WI 54015 715- 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. � r APPLICATION FOR SANITARY PERMIT ST C- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contracto,i:,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property _ L _0 r - � _j- V 42 - •//L ��11 2, Location of Property ' G ', Section = f �_ , T � N - R _L _ W Township Mailing Address ' ��" C3 n C.t?C GE�O /.3 T Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel 9. 7 Cj erC_ Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes_ No Volume and Page Number 9 as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. -------------------------------------------- PROPFRTy OWNER CERTIFICATION I (We) eent%by that aU statements on this 6o4m aAe tru to the b ebt o6 my (ouA) knowledge; that I (we) am (a&e) the ownen o6 the pnopenty d"nibed in thi.6 4.n4onmation bo&m, by viAtue of a wa&&anty deed neconded in the 0jjice of the County Reg" ten o4 Deeds as Document No. 9!5y 3� and that I (we) pnesentty own the pnoposed site bon the sewage poa system (on I (we) have obtained an easement, to nun with the above deseA bed pnopenty, 4on the eonstAuetion ob said system, and the same has been duty neconded in the 06jice o6 the County Regtizten o6 Deeds, as Document No. ). SIGNATURE OF OWNER SIGNATURE CO -0 (IF APPLICABLE) DATE SIGNED DATE SIGNED y Olt { sttlt' iAllisr ore of ` ill ' ar t a" bdi . dwim � ,isbseestts {( csi+�Mtw, VIA loai ©t�L`i a, �tm ,#a►wluh►p 29 F' t''t"�c^�txt�tt o 3 , x ;�: . asi;to p� o Yesdsr st. M laa�reh t Iii b+ tbw a voovwmw at tbf we �t tv = P tb* "M of 1 19 , t rich t3J. " 1986. r spacial, rla� be applied Beet to intereet oil the uW*W baisom at the raf "3 II r'Xls sii w3fhMSt "perm of hf apm priseipal at My time Mi t ;`` . ei�+�tt et Mp prepayteee�t, this ceatssct fA West be lwrtsd as in dt!` f ` - tr i6 ior�oet aE , sad interest (and in suh car sceraiag isterest fmo . 4P6mwjPd) is'ieas dM the an osat that said iodskodasss mould have bees bad , ' „ d +ebew; pmrided that amtbly psysaeats shalt be costianed in the evert � !M!Mfos tM promises being tbaeea�tter excluded h*wtm. NaOaf tba Purchaser is satisn" with the tale as slaw by the 1�v t4 post of a t m two widence. u title evidasce is Aa pedme price in pNd. 5 t U �1 i011 tilts► pow ai s at Are Peo/betr os C alb SO U_ It t ....:s. b t 5 �. �, '�• #� Il�lt La t11R �d tiNCifiN, Y wwwo MORAP"I"m Old 4101101 bew Old clwt of wd OVA : j ~SM MW by tom, are OAK wN bear air k *We �( MPP. to tha evertr AN e�#Ie,. of thb CecegBt #II " to the beaefi #td'aw4 of Yeadot asi - at+ 06111W 44 00 Prwperty the t! md qP1 � Hele R. IIrata�t el a , id STATE OF St« 5n Pesaooally Trrut: 1 "w lie az a. d This imstg6mm wa4 dratted • '._�� to ae koo to GM, GILBZRT 8 GWIN going i Su�FAMM n 54016 (digum"M my be 6@60*WgIled at aahwwledW. Both i u ate aet wowwrrs.) Notary Pobiic.:, o KerMtsyd pdatart•sipdt is our capacity SbXI&# ber of pigged below their r R DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 ( IAM & Chapter 145.045) LOCATION: SECTION: T WNSH1 /MUNICIPALITY: LO :BLK.N SUBDIVISION AME: A10/ 1/ W/4 t / NJR15jE (o r�.< <, .c UNTY: R'S BUYER'S N ME MAILING ADDRESS: 0 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER IALDE CRIPTION: I PROFILE SCRIP NS: STS: esidence ❑ New P<'Place J ! RATING: S= Site suitable for system U= Site unsuitable for system / CON� VENTIONA MOUN • �� IN— OUND -PRE: SSTEM- IN- FILLHO TANKS RECOMMENDED E���TEM:( optional) SS ) S S 20 S If Percolation Tests are NOT required DESIGN RATE: 9 I If any portion of the tested area is in the � n under s.H63.09(5)(b), indicate: Floodplain, indi cate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE., AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED 1 EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B, =P 6 1 7 / .9 zuzu 35 B- B- B- I PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. P RIOD ERIOD2 R PERJNCH P _ / p 8 d 0. / P- O p Lat 30 y P P -_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION t t , a , t � I _ `.l'� 4 � "may � ! j € ♦ i ; r �� �,4 4---- 1' EEE ( t i ( / } ) 1 1 7- I i I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accdr r wst"Ti fhe proce res 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 Ipri TESTS WER COMP ETED ON: eKfi a_ r or /0 //6 C ADD RES :� CERT FI ATION NUMBER: PHONE NUMBER(optionaq: Q �i / CS7 SI UR DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ulLW'SBU -6J96 (R. 02/b2) -- OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete an(] accurate sail test, your report must include: 1. Com�ilete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement systerra; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT RASED ON SOIL CONDITIONS; 6. PLEASE rise the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; B. Make sfire your benchmark and vertical elevation reference paint are clearly shown, and are permanent; S. Comps ete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the information {such as flood plain, elevation} does riot aptly, place N.A. in the appropi iate box; 31. Signs the farm and place: your current address and your certification nurriher; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols I St - StorEd (otter 10 ") BR - Brairock cote Cobh1e 43 - 10 SS - Sandstone gr __ Gravel (under 3 ") LS --- Limeston e S _. Sand HGW - High Gior.ntlo�ater cs - Coarse Same Peac - Percolation €l=ate tried s -- Medium Sand W -- Wo,11 Is Fine Sand Bldg - Building Is - Loamy Sand - Greater Than � sl Sandy Learn < - -- Less Thar, 'l Lewin Bra - Brown x __ sit - Srlt Laam BI Black s -.. Silt G -- Gray *cI - Clay Loam Y - yellow sci Sa ndy Clay Loam R - Red sicl Silty Clay Loam mot - Mottles sc Sanely Clay w/ - witll sic - Silty Clay fff few, fine, faint r c -- Clay cc common, cmrse P1 Peat rnm - Many, medium rn - Mtuck d - distinct. p - prorninent HWL - High water lcvel, Six general soil textures surface ~ltiwk� r for liquid waste disposal BM - Bench Mari: VRP - Vertical Refer,>nce Point TO THE OWNER: ' This soil Celt report is The fil'st :;tc *p in securing a sanitary permit. The county or °ne Department relay request ve'�rific.ation of 01is soil test iii the tittle pri --or uo peen - it issuance, A compl v: ,stet of plans for the privatlx sysl:e n and a penilil: application mum be sCS, }mitr ed to the trpp rOj:=Jaie vocal authority in order to t_h a #n a ocmm6t. Tho Sanitary petmil must [w t,,x, ai inn )nd, posted D ±ior to ill c S. - of a,ey <rc> +ls'ts'ucfron. A fjk ST. CROI X COUNTY WI SC NSI N ` l f ol t yf T ZONING OFFICE if 796 -2239 (HAMMOND) 425 -8363 (RIVER FALLS) HAMMOND, WI 54015 June 18, 1984 Divizion o6 3a4ety and Building Bureau o6 RLumb.ing P. 0. Box 7969 Madison, Wl 53707 Dean Si4: An oneite .inve,eti,gation bon the Robert Wytie pnopeaty .I'ocated at the NE-4 o6 the NE% 06 Section 14, T29N -R15W, Town o6 Sphing6.ietd, St. Cno.ix County, neveaked eu,i.,tabxe aoV-6 at a depth o6 35 .inches, betaw which sea.eonabte high ground water was noted. Th-iz elite .dhoutd be eu:i.tabxe Son a mound system. Shoutd you have any qum ione, pxe"e 6eee 6nee to contact this o66.ice. S.ince.tLet y, Thomas C. Ne.Laon Assiztant Zoning Adin.inibt atop , TCN:mj r WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY b BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. C�Lo -ix Location NE 1/4, NE 1/4, Sec. 14 T 29 N, R 15 *XW) W Town i`kN Spn i-ng6.i.ekd Street Address Lot No. Block Subdivision Landowner's Name: Roben,t Wyeie- The application for this site is for: ❑ new construction use. H replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: ❑ to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numb i sued to you.) ❑ one of the applications needing a quota number. The quota number assigned to this application is - ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. ❑ for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed :;oil criteria established by the department. ❑ for an application on file prior to February 1, 1980. ❑ for a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: W ❑ a failing conventional soil absorption system. ❑ a holding tank that was installed and in use prior to February 1, 1980. RXI a privy that was installed and in use,prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the lot meets the criteria for a conventional private sewage system, check here.n I certify that the above information is true and accurate to the best of m knowledge. Name Thomas, C. Ne" on Si County Official Title A,66,i6;tant Zoning Adm.i.vue.thaton Date June 18, 1984 DILHR -SBO -6158 (R 12182) STATE bF WISCONSIN- DW1*9NT bF INDUSmRY, LABOR 6 HUMAN RELATIONS DIVISION OF SAFETY 6 BUILDINGS - BUREAU OF PLUMBING P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township /X44UAV*4 *V X " NE NE kis 14 T 29 N/R 15 gJ("XW S 4iyt Aietd St. cko'ix Street Address: Subdivision: County: Landowners Name: Mailing Address: RAW Wy t'e. R. R. 1, Box 190, Gkenwood City, W1 I (We), the undersigned, hereby make application for an alternative system on the above- described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persona to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further.agree to either personally or by my agent contact the proper county offioial to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and furthgr agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR -SBD -6413 (N. 05/81) My Commission Expires: Department of Industry, Labor and Human Relations 1a5COf.W Division of Safety & Buildings 1�� DILHR Bureau of Plumbing �� OEf�ip TfflEflT a P.O. Box 7969 - If10U5TRV ,LgBORi6lKXBAf1AELA710f15 Madison, WI 53707 Tel. (608) 266 -3815 IN ALL CORRESPONDENCE > REFER TO PLAN k I IDENTIFICATION NO. NAME PF PROJECT c 1 -�. -'� i s c c `RPRIVATE SEWAGE L - ❑ GENERAL PLUMBING PLANS Fee Received: LO�ATJO ( � — Priority Plan Review Only CITY-O CITY T WN OUN Examination of plumbing plans and specifications for this project has been completed. In accord with Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of when required inspections are to be made. T A tga- A-Aseat Ret hegwR withiR two years from this date, In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the city, village, township or county in which this installation is to be made. Failure to obtain local permits will automatically void this approval. For PMvateSewape T� ap"Mm is Vn •fr two Sincerely, Ndh;. is ��yeersrtx-N'iri f VaW unM d2t6 of the inft r it W VW" l� James Sarg�t s;'r "t"'n .fit 4 • fh`' �+ Bureau Dire or R EW DAT cc: DPS Owner H & R & Rec. San. Section Local PI Plumber Bur. of Health Fac. & Services Count Other DILHR SBD -6099 (R. 05/82) I A,= ►FTIONAL WORKS!'f'I:T 3 _ t lvZ MOUND SYSTEM �e 11. IN•GROUND PRESSURE SYSTEM-Continued- 1. Wastewater Load, Total Dally Flow: gal. 10. Force Main: fOn t, Minimum Dosing Rate= •--- -- Use section H 63.15 13) (c), Wis. Diameter= _ Adm. Code and PROVIDE A DETAILED 11. Total Dynamic Head: LIST OF SIZING ON PLANS. 2 ,?5" System Head = S ft, r , 2. Depth to Limiting Factor = �- Vertical Lift = ft % 3. Landslope = Friction Loss= 4�ft T.. 4. Distance from Dose Chamber to ��- ft Distribution System = _biG ft. TDri = r: t 5. Elevation Difference Between �i 12. Pump Selection: y , Pump and Distribution System = --a- ft• Pump will discharge at least gpnt at ft. total dynamic head. r - 6. Absorption Area Sizing: Area Required = sq. ft. Pum odel and anufa furor: i Bed or Trench Length 407 ft. _ --y- -- 13• Dose Volume: Bed or Trench Width (A) ) = ft. ' Trench Spacing (C) _ ft. 10 Times Void Volume of Distribution Lines= gal• 7. Mound Height: _ � • ft. Daily Wastewater Volume+ Fill Depth (D) Fell Depth Downslope (E) _ ft D oses 24 hrs. _ gal Bed or Trench Depth (F) = ft' $ Minimum Dose gat.. r Cap and Topsoil Depth (G) _ ft 14. ,Dose Chamber: Cap and Topsoil Depth (H) a1`v Volume 8. Mound Length: End Slope (K) _ �.� ft. t d IVATE SEWAGE Total Mound Length (L) _ _� ft. Ifi. • CONINENTIONAL PR SYSTEM' `� 9. Mound Width: 1 . Wastewater Load, Total Dally Flow r�� Use section H 63 .13 t3) EIS Wist fx ~ t i. Upslope Correction Factor Adm, Code and PROVIDE DETAILED::, Upslope Width (J) _ ft. LIST OF SIZING ON PLANS. s Downslope Correction Factor = gad x ' Downslope Width (L) = f ft. 2. Required Septic Tank Capaelty • ` Total Mound Width (W) _ - ft. 3. Percolation Rate 4. Absorption Area Sizing: 10. Basal Area: - Refer to Table 2 in chapter H 63 Infiltrative Capacity of " Natural Soil = gal• /sq,ft. /day and PROVIDE A DETAILED LIST OF Basal Area Required = - sq. ft. SIZING ON PLANS. , Basal Area Available = sq. ft. Required Area sq. ft. Length i. if Standard Tables from Chapter Width tt�' , H 63 are Used, Indicate Table No' Number of Trenches 12, For the Distribution Network, Use Numbers 5 -14 in Section 11. Trench Spacing r Distribution, System: 1 ' It. IN- GROUND PRESSURE SYSTEM Lateral Length 1. Depth to Limiting Factor = ,_ ft.' Number of Laterals = 2. Landslope =' • r s ` min. /in. Lateral Spacing 3, Percolation Rats = r � Distance from Sidewall to Pr 4, Proposed System Elevation = LZ ft. System Elevation S. Wastewater Load, Total Daily Flow' L fal• Use section H 63.15 (3) (c), Wis. IV. SYSTEM -IN - FILL Adm. Code and PROVIDE A DETAILED •Fill. in All Items from Section til LIST OF SIZING ON PLANS. Required Septic Tank Capacity dU gal. V. SEPTIC TANK 6. Absorption Area Sizing: �v 1. Capacity Percolation Rate a min. /In.` (bu.0 Area Required = t 5 sq. ft. 5 -4- 2 Manufacturer: ' R System Length = �� ___._ ft. 3. Show Site C Tank Details on Plan a System Width = -' ft' VI ,DOSING TANK �IJ� 7. Distribution Pipe Sizing: t ' ,Ca acity = a(. , Hole Size = in. 1. P -►�►%� .�; g Hole Spaciril 3 ( 2. Manufacturer: _ ,a`.,�• - "'r = Pump Manuf.rcturar: z Lalcarl Length r� /�L in 5� 4. Pump Model: 3z ' �"', S. Oporatinpt Head ■ - •-*_._' L.,Icr,rl Spacinµ Distance U'ont Sidewall•lo Pipe _._cia bt. 6. Flaw Raton s tt. uisirtbution Pipe ukcharge Ratr: 7• . Show Site Constructed Tank'aafalls on Plans ). .fi 4 Number ul I lulu~ Per Pipe I low Pet 1 - Kttrn• VII. HO ING TANK ,W 1• Capacity =, q, Maniloid tilling: ,� r I ype (cenlel or end) . ,yZ� 2 Manufacturer: Length - ,ltlr 3. Show :Site Constructed Tank Details on Ptaas ...r.•� Diameter < in. z SHOW ALL INFORMATION ON PLANS -. DILHRSBD -6761 (R.03182) t h F 9 �1 M , I a- � Y p` o 'f V i a Ik W ~ i 1 0 i J a � o, e J I V [R' 4 2 tit c_^s, \ a u ` n i r 1 Fvd vs au) V a E n � I Q s �z 4 z.3 ; z 7,1 o o�cf r!'li4NN Z '7 SG Page ._: Of Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H G Topsoil = =_ = -- =- F E �� D 3 % Slope. -bed Of % 2 i Force Main Plowed 2 A �e gaie From Pump Layer D Ft. E� E _ 1-3 Ft. Cross Section Of A Mound System Using F Ft. A Bed For The Absorption Area G I Ft. A Ft. H _ /�5� Ft. Signed: �/ B Ft. � License Number: K Ft. Date: Ft. Alternate Position Ft. of W Ft, Force Main - r L Observation Pipe —..,, mom - -- --------------- - - - - -- qijA ---------------- - - - - -- --------------------- - __________________ __ I Force Main W° — l - - - - - -- — - - - - -- N 2 1 " Distribution Bed Of 2 — 2 '2 Pipe Aggregate i I Observation Pipe Permanent Markers I Plan View Of Mound Using A Bed For The Absorption Area i PAGE OF PUMP CHAMBER CROSS SECTION AI SPECIFICATIONS -VEUT CAP 'I'LL. VLU'r PIPE _ WEATHER PROO APPROVED LOCKING JUUCTIOU BOX MANHOLE COVER 25' FRCM DLOR, WINDOW OR F SH WMIU. I AIR INTAKE GRADE ' `i� MIIJ. 18" A I ki. • COWDUIT PROVIDE I - - -- — `Q If I L6_ T AIRTIGHT SEAL I I f I API=K0VL U JGINT A ,l ( I' I APPROVED JOINT W/C.t. PIPE. , Iii W/C.I. PIPE EXTEMDIHG 3' I (� ALARM EXTENDING 3` 0►170 SUI.ID .�.,! - ( II ONTO SOLID SOIL a Ow c ( I ` I PUMP — ti 0 f j "' , {fit D CONCRETE BLOCK e . RISER EXIT PERMITTED OML4 IF TAIUK MANUFACTURiFR HAS SUCH APPROVAL SPEC.IFICATIOUS iEPTIC AND ) OSE TAIJKS MAIJUFACTURER: Ciu-' PIUC,As'o' )UMBER OF DOSES: / PER DAy TAUK :,IZfL : GALLOMS DOSE VOLUME: GALLOAIS ALAR MAMUFACTURER: _ s' J CAPACITIES: A= 11JCHES OR 300 CALLOUS MODEL ►DUMBER: _ B- Z INCHES OR 1/S' GALLONS SWITCH TSPE: — r3 /! C ( INCHES OR CALLOUS PIIMI' MAIkJIIFACIIIREK: U ����___/0 AUCHESOR Zs� C- ALLOUS ^1C)I MUMBE.R: iJpTE. PUMP AND ALARM ARE TO BE 5WVIC TYPE: 6 IAJSYALLED ON SEPARATE CIRCUITS PUMP DISCHARGE RATE .S GPM •. VERTICAL. DIFFERENCE BE rWEEAI PUMP OFF AIJD`DISTRIBUTIOIJ PIPE:.._ FEET 4 0 X5 6 + MIMIMUM NETWORK SUPPLY PRESSURE , . . . . . . . . . • 2 . 5 FEET + A FEET OF FORCE MAIM X z,:S L F j loo pr N FRICTIO FAtTOR_. 2' / ! L,FEET = TOTAL D`JMAMIC. HEAD It2f, FEET IM T ERIJAL DIMEIDSIOAIS OF TAIJK: LEM&TH ^14 ;WIDTH ; DEPTH y1 LACEMSE DUMBER: _ P 1 DKTE: IL_L_T. J0/4 i :eatures Pum Im eel r is recessed Powerful 4/10 HP Motor is Rotary Shaft Seal has carbon Micro Switch (SS4 A) has per - - Tornado" type — operates oil filled for good insulation and and ceramic faces for positive manent magnet on switch arm for completely out of volute passage lubrication of bearings and seal. seal. Body is stationary, prevents activating switch. 'ivingg full opening for flow of Overload protection built -in, has string or trash from winding ASS Plastic Operating Switch liquids and solids. no starting switch or relay on seaL (SS4 A) has steel follower molded Motor Housing is heavy cast mechanism. Switch Housing (SS4 A) is Into top for activieft switch magnet. iron, epoxy coated. Stator is Thrust Washers and Sleeve completely sealed from sump pressed in for perfect alignment, Bearings are oil lubricated for liquid, easily removed for best heat transfer. smooth operation, long pump life. replacement of needed. Dimensions Performance Curve �C c . Accessories Performance Table Feet 2 4 6 8 10 12 14 16 18 20 22 Total Mead Meters .61 1.22 1.83 2.44 3.05 3.66 4,21 4.9 5.49 6.10 6.11 Gallons Per Hour 3,600 3,60 3,450 3,300 3.1� 2,9� 2,550 2,250 1,800 1,300 660 Liters Per Hour 13,625 13,625 13,058 12,490 11,923 10,916 9,652 8,516 6,813 4,911 2,498 ®o Performance Capabiliti ❑ ❑ ❑ Capacities to 60 GPM 227 LPM Heads to 24 feet 7.32 meters Pump Down Range * 4 to 41 inches 101.6 to 114.3 mm Solid Handling Capability s /4 inch dia. solids 19.1 mm dia. solids Liquids Handled Fresh, drainage effluent waste water Intermittent Liquid Temp. 15VF 66 Motor via HP Electrical 115/230 V., 12.0 imps, 14, 60 Hertz Discharge lid inch 1 38.1 aim *Automatic Model. (MWWW acv vmianta "wa , Winch). myem­ pe Myers Co., Division of McNeil Corporation Ashland, OH 44808 (419) 2891144 Telex 98 -7443 113 Oil TOTAL HEAD IN FEET rn C) 00 O N. P 0) 00 O N A M M O N -P- O © O N O D a o o 00 won = rn 0 ° -� o � Q � -'a C) a om a N 00 m �7 Ole o o (.n rn ch ..d ° o m C� rn _ ° N Q O • rn ° O V O O 0 N W .p (In 0) V 00 CO —` O TOTAL HEAD IN METERS r�