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apartment of Commerce PRIVATE SEWAGE SYSTEM Coun St. Croix {uilding Division INSPECTION REPORT Sanitary Permit No: 299057 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: House, Kenneth L. & Ga le I Star Prairie, Town of 038 - 1037 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 9(, .L� c.� Z.. 4-11 L- 08.31.18.158M TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic T„�, / Benchmark Dosin g Alt. BM Aeration Bldg. Sewer 9- es3 y4 , g / Holding SVHt Inlet J TANK SETBACK INFORMATION St/Fit Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic SQ / 5 . Dt Bottom AM— Dosing Header /Man. T 7 Aeration Dist. Pipe Holding Bot. System Fin G rade PUMP /SIPHON INFORMATION Manufacturer IAp6 nd St Cover f- GPM 7 Model Number TDH Lift Friction Loss System Head r DH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO / BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: 50 UNIT Model Number: ILA 40 Lj ON— DISTRIBUTION SYSTEM 7 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At rade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bedlrrench Edges Topsoil 0 Yes ® xx No � Yes � No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2192 Cabin Lane�r Prairie, WI 54026 (SE 1/4 SE 1/4 8 T31 R1 8W) metes & bounds Lot Parcel No: 08.31.18.158M 1.) Alt BM Description 2.) Bldg sewer length = �� - amount of cover = Plan revision Required? rv� Yes o Use other side for additional information. D Date Insepct Sign Cart. No. SBD -6710 (R.3/97) ate � 1 al IL I I -- t- d County Sanitary Permit Application ST. CR OI X COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordi PLANNING & ZONING DEPARTMENT Personal information you provide may be used for secorx4djjp CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road Hudson, WI 54016 -7710 ( 715)386-4680 Fax (715)386-4686 Attach compl plans for the system on paper not less than 8 - 1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application n 1. App lication Information - Please Print all Information lion: roperty Owner Name V 1/4 1/4, Sec O 3 ' N. R I C X E (or W roperty Owner's Mailing Address of Number B XC lock Number 1 car O� S't OI OUN�'/ E ? �ity State I Zip Code P NG & bdivision Name or CSM Number 1 of Building- (check one) ❑ Village Dwe ` s ( (Town of 1 or 2 Family ng - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned ( t e/L Nearest Road 1. Type of Permit: (Check only one box on line A. Check box on fine B if applicable) _T -11 arcei Tax Number(s) 1 40 00 A) 1 1.0 Repair , 1 Reconnection .bNon- plumbing ❑ Rejuvenation p� Permit Number Date Issued B) State Sanitary Permit was previously issued G% f � L;?7 IV. Type of POWT System: (Check all that apply) / �VL �ZC 'Vi f" '{ -✓iL.L b� ` c' /'S II�q��LL�i4�?Cl� 13 ❑ �ound Non - pressurized In- ground Mound 2 24 in. suitable soil ❑Mounds 24 in. suitable soil ❑ A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating (/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. P Rate 6. System Elevation 7. Final Grade Required Proposed 11 (Gals. /day /sq (Mi a � / � Elevation �h. (oGut �ny� - ds . Tgfnk Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons an Concrete structed glass Tanks Tanks ❑ ❑ 13 13 0 ❑ i. F(wponVibility Statement ❑ ❑ the undersigned, assume responsibility for repaidreconnercdWrejuvenat onAnsta#ation of non - plumbing for the POWTS shown on the attached plans. A is to required for terraMt r r o the installation of non-plumbing sanitation sys bee's Name ) PI bees Si ature stamps): /MP No. 113usiness Phone Number r� Q 537 `lf5_a Io- S 13 S bees Address (Street. City State, Tap Code) toct L Cou "Use On Disapproved Sanitary Permit Fee Date Issued Issuing Agent ( ) PI Owner Given Initial Adverse Determination X. Conditions Of Approval /Reasons for Disapproval: SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. >'K 2. All setbaQk requirements must be maintained i as per applicable code /ordinances C-l", o 1 0 J P A i fo 6 7 � O S 9' � � 4 d � � C Q 2 IA c ct 4 o t � � N v m l u / f V a v, ?! r6 AV `l Or o S G d 'Y > a� aft � o e _ (/1 O - u, c D � z T z �� z 0�o m ° �° m 0 x O C/) m O N �o L mmi C/, -h . NN � m _< 0 w, 0 �7) CA 1v ° po O co m n � O m n Lol l L% v o F N W ; r,,, r - �K °� D G7 m z N o m 0;0 m X Q O zD z o C Z N C Z r --q v 65 oo � � N � O m m C C/) Q c dMMIP Cl) n C11 i z X uo z O to 0 O m o — W — -n � z0 m Z IQ = m 'Tl CD ° � 3mm vim°: m I v m a m D 8� °m mm �sfDS? g�� (/r O V T m _ N fD O C/) 'O N c D) (p `� y o` ,� O ' (D . N 0 (D y N O Ei D 0 O a < --q i� 0 5 ,z 2 m ( ro p _ = at R v, - n N- O Q 2 S 0 ry N D j O =. N @ 1 D�j 3� `G � 3 9 y (D cc y N DI c. Cr �. V m N p w y ID CL b n{ O CD = •< �, ,o = o m .. ? v c j O Q y C N Z a a , m o �� > ;o ne 0 (p m z� Z CD O (� A c O CD CD m CD W :3 COP (D PD p ❑ ❑ El �. _ (D a ] ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ; tj � L Ai 5e Mailing Address L$/ S - -_ AA5!2yrC> L` sT, ' 4t Z ' 01 Property Address LA'Ai c (Verification required from Planning & Zoning Department for new construction.) City /State — I S O MIYU�, 6 V-1� Parcel Identification Number 3 / a3-7 -/a - O p - LEGAL - DESCRIPTION Property Location 57 '/a , �J G '/4 , Sec. , T �1 N R W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # c Warranty ed # J / / 3 Q t3' , Volumc / $ , Pagc # Lv Z Spec house yes Lot lines identifiable, no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance P g sP Y responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o f as warranty deed recorded in Register of Deeds Office. Number drooms ./ Z SIGNATURE OF APPLICANTS) DATE 'Any infoirmation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey trap if reference is made in the warranty deed. (REV. 08/05) P0VVTS OWNER'S MANUAL. & MANAGEMENT PLAN Page of FILE - CiEIIWpTiON SYSTM TIONS OYYner SBptlo Tank Capacity Perrrdt # GYJv go O NA Septic Teak AAanufat,Ktm3r El NA DOM PAWS s ;' Effluent f�er l�arnrfacduar /✓ ,Q� of = 3 •,: ri it Mode< 4 ZED mss' a.rttA ftaber of FacRty Units NfA= Ptanp Tank Capacty aerated flow (average) Pump Tank b O NA Design flow (peek?. «x 1.5) Purnp-piw� 9 gwmw a IAA SON Appfcadon Raea Ci -NA Standard lnfluettit/EfAuent - Moen► awWage` ProU Unit Fats, Od & Grease (FOG) :9 0 mg/L, a SwxWrarsi fftw O - Peat: Fftw - Slodwenfical Oxygen Demand (BODj 5220 n X D RIA 0 Mechanical Aeration 0 Wedand Total ceded Scads ITSSi 11. so © Other. a NA . Noolmnical Oxygen grand WOgj : gso nV& .: KSM © - in-�d (gravity) 0 fpre ed) Toth SursperMed SaNrfs ti°5$) 530 mg/r_ O A, ll,.AvGrada_ Fecal Coliform (geometrio meaty S10 OW00ad E3 Ddp4Jrw p Other. Effluent Particle Size =dkL 0 NA NA Odler. 0 NA odw. _ ©'.NA 'Vannes typical for domestic vasnramr and septic tank effluent' Q NA . !/I11NtENANC __ _SCHEDULE S�erarbe -[want _ Seim" T� geaiwT .. _ irapect of tank(s) Ax't `oi�oe wjerr_. �. morttbtal S ) ❑ NA PratKr out corrtenls of tsnik(s) When oond* ell . and stun equals one drill III) of lank voitme fl NA inspect dispersal CON(a) At least am evetys D. $ vwW) D NA Clean e�fAuerrt fitter At : least orecs.every: - jr D NA kispect pun*. pv�P cols & alarm At least once every: E3 n+onfhlsl i] NA Fkrsh laterals and 'tesE At least orloe every O NA Orlrw: - : At ,least onosaeMery: .. p Q NA Oil - D NA MAINZ EN/11i10E HW I RUCTUM apeckin I of tanks and diepersal cals alwn0 be ntads by an irAWdrai tarrying dins 6f to iallodirfp _ °er'�ri� neater PI iNaamr.PhunbW.Raegriated Ss+Mar. -POWM Mf alp 4con i POW .Alairrt*m, Saatags Servicing Operator. Tank inspeadons must include a visual inspection of the tan (a) to ice vWV any rnlssig or broken hardware. identity any tracks or•(safks, measure the Vakwo of conrtbined skidge and scum and to chock for -any back-up or pondig.af s nt. -owths ground surface. The tlisparsal oeN(s! shah be viattaih/ irapeaasd - ebeoic the efflnwut lsvals iE the observation pies an pd to Bieck r ck fw ty! P )g ` of efffuent on the gr+o ind surf=&'^ The porrrNng _af arfRuaii[ oa the ground surface awl Or l o a idling cod l k I "iQ'requires tine imrnedlets notifiretion.of the local regulstoW autho t . When the con *kmd arxurtnidiort of sludge and eaten In - my tank equals on*4" W or room of the tank vvoiat % #* entire oarnt+ants of the tank a" be fjffj avail by a MWWQB Ssrvfr5ig OQWMW 'std dtspc sw . of in astmrdence -witfa chapter NR , 113, Wlscoridn Adq*dW w l_v9 Code::- AN other services, inckmd'sg but not I ft to the "n* ft of affluent lNtw% medtanicel or prssatrimsd catganerM6 pretreatment units, and any se! v! d at intervals of st 2 n" die,; - sheN be pertonned by a cartHisd POW'fS Msinlaber_ A servV* report Ai N_es provided to the local reptrtatory-authwhy within 10 depot conwisdon of art)r service_twent.... START W AND OPE Pap JI-of for now construction, prior to use of ibe purrs c' - d OaaMOR tat for the presence o(jubdii pwduoW -qr +otl" that mat► irrrpede the tteatvimft proosea aimW d 01 tiw . dkrperaal cww. if hwh coiar eictralions are detected have the tae crts Of the t MI*IG) remov -ed by a swage ser+ k*q VPeraeor prior W use. Symmn mart up shall not occur wim 'sill as irhmen at the idAbrodi►s surtace.. . . Du*w power' ontageMS pump tanks easy 1M dww aoiraaf Icjglrhni m isvals. When power is restored the maiii, raig eat iiRi be. �edad tb the N 11 1 ei in ores ltirg 'dam ovedo 1 'ij ddind "and may resiik in tliei 6edarpi ar :anicfsog dlraclyeige of of kew_t To avoki lids situation have the oa�iifisnls tsf V w •pump Mat rarwved •bit a Sg3tags Servicing Operator prior to rsmoriog. power to the afik,errt puRrp ar oontact.a ft — m* r cr POWYS irtt*w to aaeist in crcanm* IF 0.1 trcg the - pump m m & to rasters normal levels within pump taedc. Do not drive or park vehicles over tanks and dir+Parsai.cals. Do M* drive or park aver, or odmwiwdisotrb or oonnpac4 the,area w1119 18 feet dawn slope of any mounderiwgrads-soll A 1 –ption area. Reduction or 1 S a m tin - of the fallowing f00 *8 waste traler,so+laan w kepr�cve the pwfwmanos and. pmioft Vw Ma:of ift POWYS: a 01 aby b wiper IS- ells butts; aordanas aaltan law sw�trey da0 NMIra; dead fles; a dlepsrar � fa foundation drain (sump pump) water; fiult and vagrea6le F m alk go! gaeoRnet _ hobiaides< (treat" sate a or, oil p og: - paindnng prodcrcter pesBoidaty sarnitwnaW 1 - i i P rcr and wager sofomnar brine. VYlran the PCWTS fails tea is parrrcarregtht lsirea orb pf service ticsloft Pis a steps d" l taloeo to howim. *0 low rproem is _Pnoperlf► and satayr abaadcnsd in oompiarMCeE w�l:. rpl Lb rn W_1$3 1Nieoq i AdeNniStratM Qodre_ • ' Ar p41 q; to tanlae_and pits d" be 0 c a - necosd and alwaloned pipe openings mmftd.- • Thew to te`of all tanks and pits shah In remrwad and properly diapomW of by a Saptage Servkdng Opor4itw. • After punVbiq < 611 tanks and phe shall - be ex=vated'and rannromsd or theft covers removad and the veil epaoe Iftd veld► ad% gravel or another kart solid nwamial. MKIMIGE 1 M PLAN If Im PPOWi'S loft - aM cant be ralp d a the Sol -rrnaaeUras heft 'beem – or m a m t b4 Behan, tor pr+mdde a coda sanp(1, 1 I A suitable nrpiacement ores has been evaluated and may be udited for the beartion of a aoc ; ,alnsorptiorc aysoaci ft+s:ariis ahor bs Adbcstepd fhelrr +Siwrbarcos and ooarpactieer and noCbe Trilriit8erl icpon by sequined senbaoiJrcrn god p autil.'peroposs4 *MU )MAW MW w�rq�lis._ Evsilas to pnocO 'the Will z repair In -tire used for a rnsvr soil and sloe evaluation ip.eetabielr :aaR+eas replacarrcent area Pa an �sirw r . comply vrhh the raise to art that tine. - . .. - . © A _ suita*_ .rrrplsoetrcetrt ,arse . is rot available _due ` toy Emil ok ai-dlcr: we irritations. Bserkcq' advaricnis in - POMFTs UctmkW a holdir.M tent mt�be knstaNsd as a Ise( t!selxt � 1W faced POVVTS. IT The alts has not been - evaluated to identify a suitable r6plsaemarrt `arse. - Upon failure of the faO%IM a loll and 8110 must bs_perfianned to`boata a auttable eepI w ilt areal :# no rsplaoemant area is avaAebis a_lKAdkQ table be lrestarsd as *IBM: rasa - 1e replete tbs felted POWYS. Macnd and at�greds sn�,a m;A c aysleais mw bs r000ns�no sd it piece- fo/owlnp i" of tlte..birauunait at the '' _ rMllCe ?atiyeaurt+ees. Rao iF a n Yse.iQ. U ; : c «WARtM16» :SEP+Iit:. ^W AIMAD QTEER.? 7#MMr TAIIRS YAY CON1`AM iEtIAAL AMDNOR MStfFF7t IT OXYO11. no !mil _. °OPM A SEPM PUW OR OTIf. TMANSIM TAM UN AMY tMlCflYBTiIIIIIMS. DEATH MAY MM XT. •OF;A _,MR9C LffKMIIIE.WTUNOMAWAT.ANK -MAY. BE =MMNLT OR ADDITIONA COMMMMS Name ; t Name :Phorr SWTASE SQi K=13 2LM A MRAP 1 LOI'.AI. pL39tilATbRY AAITHOAl1'Y ism S r Phone •• phone S MO aoauama was in mm pft m wo dmWih, roman 0&== i 1 3 IdIN CO •na ti JWIL (Z & (M. VWsconein A& 6 cone. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: S ' /4, S 1 /4, Section _ ; Town 2:)_L_ Range I � W, Town of Pru r `, St. Croix County isconsin ty Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the req uirements of Comm. 84.25 q , and it (they) appear(s) to be functioning properly. '- recent date of service -a,8 ' Yf42oo Did flow back-occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: ldzo L Construction: Prefab Concrete �� Steel Other Manufacturer (if known): Age of Tank (if known): 4-3 (Licensed Plumber Signature) (Print Name) (Tit e) (License Number) W/MPRS (Date) Form to be completed by licensed plumber (s. 145.06 Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) � m m � O � y C m 00 , c 3 m m � _■ O n CL o y y G pr — O O 7 CL -• M CO) c -� a C 3 m O . CL 0 o m C > ? m O — � � 3 r 'O o � � t'1 a 3 b O .04 VL /GV /GVIV iv. ii rnn Lj/VVJ /VV4 • Conveyanm cxempt from the rce because Grtinn 77 xrn f %) / , ,. /.. r QUIT CLAI DEED r:;� ��COME 29b REGISTER'S OFFICE ST. CROIX CO., WI Reed fat Per -Crd qull�talms to - JAN 14 1994 C yN at 8:30 A. ' M 0� r� the following described real estate I tta►atxs� n S7: L'i� 67/ - Stale of Wisconsin; County, , RV nN To AttiCle of t 1 Tax Parcel No: Com 15 at a point � feet t of Idle SO111fmst comer of 1t SR1thE ast qLm ter Of $�jmst fxter then ce ust to i tl,a + wes " t lixle Nbrd� of Itiatiee r>r trb� asst; thm:e Nor 150 feet; 15D feet; thanes Fast t the Smudnmst 9�� Of Safhoast gt�ter; d South at right ate, line of abu� p ofi t of b�rr�g, tgpt� with a t ajW rW to extend fmm the Fast ixsrdL5es to the txBU mew hcrated a == fixst parties lad. f, ty Deed #252906 Cawar - i% at the Southeast corner of the Southeast gmrter of the Sakhsast Ott ( P T r4-u a (311) [kth, of Rangy p�te (18) West, q` �' ( ) of iffy xt feet, tore 1+�t Five t><tttici d Fifty (556) feet, time South Ow Df lath Ch-_ , dx fifty (150) Five hnched fifty (550) feet to Place of stb'ect to Mec o �(l feet, t of Fast be�lmu� � t of . I ' uy-a tAPT This 1 Vy1 homestead properly. (Is) !ys not) Dated this �� day of ya ' 19 - 02. (SEAL) (SEAL) (SEAL) /" (SEAL) z4� WML -, AUTHENTICATION ACKNOWLEDGMENT Slgnature(s STATE OF WISCONSIN ,,7'T G'41 Apr. as. County. outhenllcated this —day of 1B Personally came before me this day of L/hh��� — .19 IhA ahevB n%m 4 CaN AiN CBS 64MM w Aw41 Maleq pelupo jo podAl aq pinoVY Alloedeo Aue ul oulu0lo /uee,ad to YauweN, ('Aiu6soaou lou aie uollejldxe ele c 'I 11)''1uoug 61 uolsslwwoo Ayy 4 'pa6pglMouMo6 jo pafeallueg gq Anw sa,nleuBjq) �gf's(il�'AlunoO ollgnQ AjeION AS Q31ddtl0 SVM 1Nannk#ISNI SIH.L 'awa8 641 aOpoll 0UN36 pug luewnilsul 9ulo6eio1 a4� alnaaxe o A ----- uosJed 841 oq 01 UMOUy ow of 1's1e13 'a1M �90'9pL 4 Ag Daz� l0u 11) NISNOOSIM =1O lode 31V1Sld3ew3W :3llll r . 02/24/2010 10:11 Fax IA 002/004 s► -�ytn J�rpy3 .9 rnZ•3nc3 -04 �" s'o 1�7C C►+ -3H� r�aNr.O■ m HOtiO4••9 r a �MM A O E 'p H zn y�o� " mnCrQ+7�XM�C x; x1 >C x ? fn a 0 p HNC �OMM tv M0-y3 co n"�O� UOxz`AM G 7yCh0 O Oa p �Q¢ � o rom Lnr y ozy� �tnr O D Sf 0 W v a H O H O H CyJ U] �". -4 tti CO) ¢ J H Sy m C fA r {' < C CO M ZI CA ;o ;t • [x7 yC b� c] O O �v G - b 1 A w�� R) of 01 —� �'� � mz pp �+ �A W W W - +tn 16 - o N CL rL m CD % D C� - ■• �� CO, 3 � n W m co %.D J F-� - �-+ � p i� ;a GD OD w . 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N (p O D1 m 0 O j (D a N m 3 7 m �' o CD ;w O ti ° y a c N n °c CL O- p N 0 o CD p A � V fA b9 N O O O CL Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 299057 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: House, Kenneth L. & Gayle I Star Prairie, Town of 038 - 1037 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range/Map No: 08.31.18.158M TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 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 Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L jBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia I 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 B ed/Trench Center Bed/Trench Edges Topsoil Q Yes ® No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2192 Cabin Lane Star Prairie, WI 54026 (SE 1/4 SE 1/4 8 T31 RI 8W) metes & bounds Lot Parcel No: 08.31.18.158M 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes FS No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Wiscu siri Department of Industry, Count Laborand Human Relations PRIVATE SEWAGE SYSTEM § T. CROIX Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) SanitatyPe(0 MP_: GENERAL INFORMATION G yy U Permit Holder's Name: (]Sikj( ❑�lillag� wn of: State Plan ID No.: H OUSE, KEN 5�1 R L'KAl . 3 i • 18. 15 3 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel o. ��(( 1 (��`�- 1037 -10 -000 to( 1 1 01• i� v ex TANK INFORMATION ELEVATION DATA A9700375 joi_q TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (U aav Benchmar "' c Q 1011.2— �• Dosing $ CqJ` Aeration Bldg. Sewer Holding St/ Ht Inlet H TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom 1 I J I �a Dosing NA Header / Man. ` Aeration Zo1 Ic NA Dist. Pipe 1 '7 /Q Holding Bot. System /G"). 3 - 7 PUMP/ SIPHON INFORMATION Final Grade " Manufacturer Demand Model Number Ct & 37.16GPM TDH Lift ID. Friction System TDH /;,.* Ft oss Head Forcemain Length - 7& Dia. �, Dist. To Well SOIL ABSORPTION SYSTEM BE TRENCH Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 11 1MENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE / STREAM LEA( NG Manufacturer: - - -- INFORMATION Type O OR UNI T Model Nu r: System: Yh6ph6 (O C7 — C OR UNI DISTRIBUTION SYSTEM T° 14 ?r/M Header/ Mxifold Distribution Pipe(s) x Hole Size x Hole Spacing - Vi rt To Ai Length Dia- Length a ° Dia. I Spacing 3 — L 1 /4 1 4 Q N SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over a Depth Over xx Depth Of 4?7Seded/Sodded xx Mulched Bed /Trench Center �t a Bed /Trench Edges Topsoil s ❑ No Yes ❑ No I COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 8.31.18.158M,SE,SE 2192 CABf0 l� 0/_ V0; bb r-i•ia S 4 /l/ rla wtw Plan revisidh ❑ Yes ) ' No Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No f I ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: t � � a E E m mom§ t � E * e a h 4 V iscons i n SANITARY PERMIT APPLICATION 201 EWas n n P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) forthe system, on paper not less County than 8 112 x 11 inches in size. STS Sa Permit Number • See reverse side for instructions for completing this application State ��� S,-7 The information you provide may be used by other government agency programs C] Check i evision to previous appli cation (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N S C7 -.109 a- — Property Owner Name Property Location 1 <� S�1/4 G 1/4, S tr T ! , N, R / (orjt Property Owner's Mailing Address Lot Number Block Number rT City, State Zip Code Phone Number Subdivision Name or CSM Number u�w h- �. S- J-71V ( > lr,o C s -a Cdr/ z � lJd c 7 r - .0.�7 II. TYPE BUILDING: (check one) E] State Owned 0 !t Nearest Road C] ' I age Public 1 or 2 Family Dwelling - No. of bedrooms own OF Sr.* III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © .3 b l">' — —10 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection-of 5, ❑ Repair of an _____System ________System__ ___________ Tank Only______________ ExistingSystem ___ _____Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 2 vr�mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation : CA�D .S .tG' S 54t. S Feet o/. ' Feet Capacit VII. TANK in allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or HeIdTffJTaTrk }�- /Ott' / G./t'�� e'r i 9 , El El El 1:1 1:1 Lift Pump Tank `i S?� .- GfJ` AV 1 ❑ 1 ❑ 1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number: Plumber's A( dress ( St r eet, City, e) 41 VL) , City, State, Zip Code): 4 IX. COUNTY/ DEPARTMENT USE ONL ❑ Disapproved Sanit Permit Fee (Includes Groundwater ate Issue Quing g ent Signature (No Stamps) P Surcharge Fee) Approved ❑ Owner Given Initial C Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety 8 Buildings Division, Owner, Plumber • t INSTRUCTIONS 1- A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II_ Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County / Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce August 14, 1997 15837 USH 63 Route 8, Box 8072 Hayward WI 54843 WILSON PLUMBING 410 HWY 46 AMERY WI 54001 RE: PLAN 597 -20925 FEE RECEIVED: 60.00 REVISION TO PLAN S97 -20706 HOUSE, KEN SE,SE,8,31,18W TOWN OF STAR PRAIRIE COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, roy G. nsky Wastewat Specialist Seni Section of Private Sewage (715) 726 -2544 Friday's 5453R/ 1 SBD -7997 (R.11/96) OPTIONAL WORKSHEET I. MOUND SYSTEM 11. IN- GROUND PRESSURE SYSTEM Continued- Wastewater Load, Total Daily • Flow = 3 66 gal. 10. Force Main: Use s. ILHR 83. 15 (3) (c) Minimum Dosing Rate ■ 32 Y gpm. Adm. Code and PROVIDE A DETAILED Diameter = in. LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor = �• ft. System Head = 2.5 ft. 3. Landslope = 0 % 3 > 0 Vertical Lift = _Ll_ ft. 4. Distance from Dose Chamber to Friction Loss IC 1; 1O -a2-- ft. Distribution System = .. -t � _fL ft. TDH a , / ft. S. Elevation Difference Between 12. Pump Selection: Pump and Distribution System a -1:_ ft. Pump will discharge at least gpm 6. Absorption Area Sizing: at / /- ft. total dynamic head. Area Required = 14. /t. Pump model and manuf'acct�� 20 L �t • Bed or Trench Length (8) _ ft. Bed or Trench Width (A) a ft. 13. Dose Volume: Trench Spacing (C) ■ ft. 10 Times Void Volume of 7. Mound Height: Distribution Lines a Fill Depth (D) fL / Daily Wastewater Volume + Fill Depth Downslope (E) a ZZ - it. (• 7 4 Doses In 24 hrL ■ gal. Bed or Trench Depth (F) ft. Backflow - gal. Cap and Topsoil Depth (G) s ft. Minimum Dose ■ gal. Cap and Topsoil Depth (H) = ft. 14. Dose Chamber: 8. Mound Length: J# Volume = Szn gal. End Slope (K) a ft. f Total Mound Length (L) = ft. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: � 1. Wastewater Load. Total Daily Flow ■ gal. Upslope Correction Factor a - t 7.2- __ 2 � � Use s. ILHR 83.15 (3) (c) , Wis. Upslope Width (1) ■ ft. $% Adm. Code and PROVIDE DETAILED Downslope Correction Factor = y LIST OF SIZING ON PLANS. Downslope Width (1) = ft. 7, q J* 2. Required Septic Tank Capacity = gal. Total Mound Width (W) = c • 2 -fL , 3 i 3. Percolation Rate ■ min./in. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83 Natural Soil a +,� _ gaL/p.ft./dsy and PROVIDE A DETAILED LIST OF Basal Area Required a 94. ft. SIZING ON PLANS. Basal Area Available a s4. fL t7� Required Area = 14. ft. 11. If Standard Tables from Chapter ILHR 83 -7 (, f x,/O = 360 , Length = ft. are used, Indicate Table Ile 10 b' V,.3 J Width = ft. 12. For the Distribution Network, Use Numbers S -14 In Section 11. �?' Number of Trenches • Og" Trench Spacing = __ ft. 11. IN- GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Fatter • ft. Lateral Length ■ ft. 2. Landslope ■ % Number of laterals ■ .� 3. Percolation Rate ■ min./in. Lateral Spacing • In. 4. Proposed System Elevation = ft. Distance from SMewall to Pipe = In. S. Wastewater Load. Total Dail Flow: gal. System Elevation ■ ft. Use s. ILHR 83.15 (3)(c), Wis Adm. Code and PROVIDE A DETAILED IV. SYSTEM -IN -FILL yy (Tl 5 LIST OF SIZING ON'PLANS.. _ Fill in All Items from Sect ( V Required Sepik Tank Capacity ■ gsl. ' G. Absorption Area Sizktg: V. SEPTIC TANK Percolation Rate a min./in. 1. Capacity ■ I SM. Area Required = sq. ft. 2. Manufacturer. System Length • ft. 3. Show Site Constructed Tank Details on Plan System Width a h. 7. Distribution Pipe Sizing: 1 VI. DOSING TANK Hole Sire a in. 1. Capacity a _ $M• Hole Spacing ■ 1 /0 _ 'R. 7W 2. Manufacturer. Lateral Length - A. 3. Pump Manufacturer: Lateral Sirt: in. 4. Pump Model; L.serral Spacing -- -�_- tl. S. Operating Head- ft. Ui%lancr Irons Sklrwali •Irr 1 G. • Flow Rate a gpm. X. Distribution Pipe Dhaiwrlls Rate: 7. Show Site Constructed Tank Details on Plans Number of I lash: Pat Pipr I low Per Pipe VII. IIOI.DING TANK 9. • Manifold 51r I. Capacily ■ PL Type to noj r and) 2. Mrtalacturer: Length = 3. Show Site Constructed Tank Details on Plans Diameter = _? In. -9M ALL INFORMATION ON PLANS- k rill sT AlileLi c.00c( /Ii.v 4=709 'AA/A ,� � ►��- ,.� P.O.W.T.S. o �.1 >:�s Conditionally /-:� <�, APPROVED DI! N OF DEPARTMENT ANID BUI'LDING3 LL E CO ESPON CE Uvao car S sue, • .,� ' � b I 09 Straw, Marsh Hay, Or ` Synthetic Covering Distribution Pipe r ; C and S H 111 la G 911, Topsoi Owl F 3 � 1 . $ D I o t Slope Forca Main Plowed Layer /_7 So of Aggregate .20"" / f o cross Section of a Mound System Using l► Bed For The Absorption Area — ..-- F � � B ( T3 ?VAO F .T Ft. 1' ma A�� Ft. GFt. I Y Z B q.2- - Ft. 6 H ,�sr, Ft. 7, r Signed: £ L✓ I X /. Ft. • 1 _ � g z License #: Yy► /� G ? p'�' S' y J S. Ft. i Date: 8'�l /J�� ��,3 W `_— � �= Ft' 0 e l� ft��rs e- • Alternate Position of Force Main L i J Observation Pips 'i Fos'a Main Pipe Bed of Ai " -2&i" ,Aggregate . r . -.— assrvation Distsibution , j ... = S,p . p�aansnt Mar �^ J `plan View of Monied Using a S" For - the �bsorpt oa 71roa r Pogo Perfereted Pi WO 0 LNJ View • PertaeNd W C P PVC Pipe NWm Lecetad On Netto"4 a Are 94wif r $peced ! a •� PI C gor Mdw ! PVC MWasid Pipe AMNeet• Position Of Oisaie!•atian force 610% Phu Lett title mwwd Be Not To End Cop Ead Co Distribution Pipe Lay P ?Q Ft. i R 1 S X ,c Inches aims Hole Diameter Inch Sim. Lateral ! �/,,,_ Inch(es� ��° d: p Manif " '' •Inches License Nuiaber: old • Oats: S' 05 7 Force Main I nches _ o f. holes /pipe. 7 Invert Elevation of LateralsRA&t• ;a , • ' 7 2 0 •) 2 5 SEPTIC TANK & PUMP CNAMbL I,K UJJ Jj • 1 WEATHER PROOF ' 4 CI VENT PIPE 12" MIN. ABOVE GRADE JUNCTION BOX APPROVED - 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK 6 4 �' CI RISER WARNING LABEL FINISHED GRADE 6" MIN. ���.4" MIN. ABOVE G E ** 18" IN . 6" MAX. Il 1 INLET �. GAS , , WATER TIGHT SEALS TIGHTS � A SEAL APPROVED BAF FLE LM JOINTS W/ Cl " — PIPE 3 s ONTO CI PIPE s i ON SOLID SOIL 3' ONTO j C RISER EXIT SOLID FT. OFF PERMITTED ONL) SOIL PUMP OFF ELEV. D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD ` SPECIFICATIONS S97-209 SEPTIC / DOSE ' NUMBER DOSES • PER DAY: „_,.,,...._ • TANK MANUFACTURER: � � %P.st. -1 . SEPTIC GAL' DOSE VOLUME FLOWBADC1K q �, GAL* TANK SIZES DOSE ��..— � � j--- pZ�,pgM MANUFACTURER: . I I s-T - C(c CAPACITIES: A 2 J' , INCHES = 3�? GAL• MODEL NUMBER: B a 2 INCHES = GAL • SWITCH TYPE: � t'ca_ INCHES = GAL. FACTURER •� �'' PUMP MANU a� S'i ' ap �_ INCHES = 6 GAL • MODEL NV �� : j,,,t �, �., SWITCH 3 z � PM PUMP g ALARM WIRID AS PER ILHR 16. Z3 WAC REQUIRED DISCORGE.RATE , G .TRIBJTION PIPE FEET E BETWEEN PUMP OFF AND DIS _ IFFERED FEET VERTICAL D FEET 1. �3 t MINIMUM NET�IORK SUPPLY PRESSURFT/ 100 • FT. • FNICTIOH FACT�i • _ • FEET i s, �3 FORCEMAIN X /. � DYNAMIC HEAD . + � FEET TOTAL "— DIMENSIONS OF PUMP TANK: LEITH -*=—•; WtD INTER NAL S fee / • 06 y=QtiID . E DKgERs .3�� DATE: SIGNED: ,cd, HEpp CA cu RVE 4 ,/a -1 9 I 3 S/6 o , .t0 e t 1 7. t 1 t0 t /7 / Go 70 00 Wolas 10 30 40 60 1 2 ' - ao 0 FLOW PER MIN E G WMMBNN — ir AMo 12 t 4 3/16 a " LIM FElt WTM 72 273 ij2 ;s � 4S 70 ..._. 20 6.16 25 95 ..,. 3• FACTORY FOR SPECIAL APPLICATIONS � wactim a CONSULT t4 Jolt for duplex systems. aro �e and p wd fbat are availat 4vw with an aiafm � for d.WW SOems, are available watt Of � v a ftw knot"oyda ootr�• =1 � di,nosxlanM V WW*bW. 1. N�MOtslAoNaOM� ' 39 IM • 4/8 H.P. 2. alnoMo�°k s all fnOdels' �� tlon .MMiq 4.tdE� + �� P) or 3. _ 4. Z' ��� o0 N a OXOO ad"w- s w Nl IaAeAN �M°Ns'Pb1 Atdo 0.4 1or137 4 5: �J•PM�.podUR 'fOr w�IMlYf�ooAn ^a wMrd•in Four(4) Aub t or 13 7 3 o r 4 3 S � �1Wswodm 0s• p0{ Z30 t rloa 4 7 Z or 2 3 0 Gomm • L enCewOi "owl r•�' An r1O OM � �p w "www M Oe � as OL'°�Ca��`' t�� Mooed AtOwwPd� aOa � D {� ' oondib s rem � ° W kft For unuww MAt PUMP co. yr' •fr1.'3', ' 5 L•f't �( 1 +. • v iv t.'� •i \:,fit � �;•, ` ACA }T PSI i .VlIIRE MESH. \ .001 ' GTH: 110" ", ,�•,�i �$� ��, ♦ i r�� ={ / fQThi: 93 , ,p .,•��,Ir'r; ► = �'Co VEF� 5' BELOW INLET: 57" ' • t.HEIGHT: X73 "' MANHOLE: 24" I.D. r1 r a 'g FOR TYSEAL OR •, ,; � •1.1�: ^wi•Nct�rr�le:aii:. �sx• BAFF ;.; s INLET. ►ND: -01.1. LES: T ) t P.V.Ci `MEETS WI.'.D+I.I.H.R. AND •1�7�1 ,,.;;wf , , `+ MN . M.P.C,A.,SPECIFICATIONS • �� �;� •1 11 ' ' �, �� .�.� r . 19.65 GAUINCH •� (SEPTIC) 1000 GAL. 9.94 GAL/INCH (PUMP) 500 GAL. :WEI UNDS 120 !t .12,40 O. r MODEL WCT 10001500 Combination Tank�� RL 2 (Hy 11 W75"715)647.2311 0 , Wtscorain 6epartment of Commerce SOIL AND SITE EVALUATION p age —L o f Division *of $afety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code durouu of Integrated Services County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must , include, but not limited to: vertical and horizontal refer -(BM), direction and percent slope, scale or dimensions, north arrow, x4itlu and distance to nearest road. parcel LD. # APPLICANT INFORMATION - PI rint iI>MfA •.s tion. Reviewed by Date Personal Intonation you provide may be used fo ry purposes (Privacy Law, s. 15.04',(1) (m)). Prope er P pertyLocation f ! Vt. Lot 1/4 1/4,S T ,N.R Property Owners Mailing Address of # B or CSM# ' 70NINC3QFFiCI: State Zip Code ` ❑ City Village Town Nearest Road City � n Z 7 h'► s"S"/ ❑ New Construction Use: j o Residential / Number of bedrooms Addition to existing building [� Replacement ❑Public or commercial - Describe: Code derived daily flow � ._ 9Pd Recommended design loading rate f bed. g�trench, gpd/tt� required bed, ft ft Maximum design loading rate r bed, gi�.�l�tre� gPd* Absorption area eq . Recommended infiltration surface elevation(s) $ � ft (as referred to site plan benchmark) Additional desigNsite nsiderations - y Flood plain elevation, if applicable /�`' ft Parent material S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill H 9 Tank U = Unsuitable for system ❑ S ®U ®S ❑ U ❑ S U CIS ®U [Is ® U SOIL DESCRIPTION REPORT Structure GPD /ft2 Horizon Depth Dominant Color Mottles Texture Consistence Boundary Rooms BF Trench , Boring # p Gr. Sz. Sh. in. Munsell Du. Sz. Cont. Color Ground 13 elev. _ Alp I/ 9790 ft. Depth to limiting ; factor Remarks: Boring # 7• S�' r Ground 1 elev. Depth to limiting factor ,2'L„ in. Remarks , Telephone Np, CST Na ( ease P nt) r Sig ture CST Number Address ep s� s _ 3 • Mottles Ou. sz. Cont Color IIN • �� r ���'�w�i71.7."� � -:- was . - I �r PE. A B i g • .. • Mot ®® Il Ou. Sz. Cont. Color � 1 1 �, � •�/t�' �-�o �' 3 � � �s,/z. �.� �- Ste% stc �, �..� //1�- � /SGt� l �'/8' k ., s ! � ST Sri' f�,�ic" . ��Ll c,,� o� h, .v ssw g ,� � =�.r.1 /��'- ,�'�;.� �,� - �...� /ado �,�� -(/ ir� �o � � S �� �� ��� 8� /� /. �_ - -� � � ,� I /'7 1/' ,y 3 '�is 8' 3�' �;,, ,,a' - lat /,a,� ,� � ���� .: / _ . _ '� L X ' CIt r� 0 wiscpnso Department of Commerce PRIVATE SEWAGE SYSTEM Count S r Safety�nd Buildings Division T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarfl.: Personal information you provice may be used for secondary purposes (Privacy L , s.15. (1)(m)]. HBMi Idek [ �liiX P tRT of: State Plan ID No.: CST 111IBM Elev.: Insp. BM Elev.: BM Description: Parcel TY5%Q- ;1037 - 10 - 000 TANK INFORMATION ELEVATION DATA A970 277 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration L Bldg. Sewer Holding -- - St /pbf Inlet TANK SETBACK INFORMATION St/ Ht Outlet 11 TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet Air -- ""- Septic >50 NA Dt Bottom Dosing NA Header/ Man. Aeration— NA Dist. Pipe Hol Bot. System PUMP / SIB INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Fi �3 Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM S- 60 63 BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT L DISTRIBUTION SYSTEM � r .,;a Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Y' 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: STAR PRARIE 8.31.18.158M,SE,SE 2192 CABIN LANE c<YI t' p a-' C / J Z ( T !`1 Gj -r' �:. -�. LC' f -.-r /� .i.. -.-4 7 (0�.. , tr— - • Cf - � . �'/` , F j '�C...l !A- �C:.: _ S6 ' - C _ e - vim- ay ��r v \ s'• C Plan revision required? ❑ Yei' ❑ No - Use other side for additional information. BD -671D (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH F SANITARY PERMIT NUMBER: 1 Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System- 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ST (3,-01':l0_ • See reverse side for instructions for completing this application State sanitary Permit Number Fq The information rvi m hr v rm Y� e you provide de ay be used by other government agency program S ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location t cZ &-1 i4 S F 1/4, 5 Tr T /, N, R J fE (or)dV Property Owner's Mailing Address Lot Number Block Number City, State I Zip Code Phone Number Subdivision Name or CSM Number II. T YPE OF BUILDING: (check one) ❑ State Owned ❑ it� Nearest Road Public or 2 Family Dwelling - No. of bedrooms ❑ VII age wn OF .. P Q-&-4 J- 111 BUILDING USE (If buildingtypeispublic ,checkalithatapply) Parcel TaxNumber(s) 1 ❑ Apartment/ Condo — O — / 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. 'Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 2IJgMound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp_ Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation va 1 .2-M a S / . 'Z S, " Feet Capacity VII. TANK in Ca allo g Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete con Steel glass Plastic App New Exist in structed Tanks Tanks Septic Tank or Holding Tank yL �ez v e j - ,,.,Lr ❑ Lift Pump Tank /Siphon Chamber I I j 4 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSWNo.: Business Phone Number: ,� � - i.✓� ��d�, � � w � � 3 8' � � /.r =s 6P arm Plumber's Address (Street, City, State, Zip Code): IXJ S d 1q oU IX. COUNTY / DEPARTMENT USE ONL ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D atelssued ssuing Agent Signature (No Stamps)_ Approved Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety B Buildings Division, Owner, Plumber k INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. t 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. ( 3_ All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained_ The septic tank(s) must be pumped by a licensed pumper whenever . s necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /orexisting tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. " Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; Q soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. E . kr �r 4 Wisconsin Department of Commerce t,j( SOIL AND SITE EVALUATION ;'DiAsion of Safety and Buildings v Page of Bureau of Integrated Services ,dance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not 1 1/2 x ] 1 inches: in.s'*e. Plan must County include, but not limited to: vertical an ntaI r point (BM), - and u percent slope, scale or dimensions, ,row, a @nd disfanc to nearest road. Parcel I.D. # r ii O APPLICANT INFORMATIO lea��d at all Finai0ori. Reviewed by Date Personal infomnation you provide may be r second (Privacy L'aw; . 15.04 (1) (m)). Prope ner 3 INGQpp� -\ Property Location u' Govt. Lot 1 /4 114,S T N,R , (or4 Property Owner's Mailing Address r i 7 Lot # Block# I Subd. Name or CSM# 3 yr City State Zip Code Phone Number ❑ City El Village Town Nearest Road �''► /''t 4 �S`/ ❑ New Construction Use: _0 Residential / Number of bedrooms Addition to existing building [� Replacement ❑ Public or commercial - Describe: Code derived daily flow , ? r-40 gpd Recommended design loading rate bed, gpd/fF trench, gpd/ft Absorption area requiredbed, ft ft Maximum design loading rate bed, gpd/ft _,,�4__ trench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design /site considerations Parent material - li Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ s ®u ®s ❑ u [Is 0 u 1 ❑ s ®u I ❑ s E EIS z0 u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots * w in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench SK Ground _ s elev. Depth to limiting factor , 36 in. Remarks: Boring # / .� Ground 1 7. S iC elev. Depth to limiting factor ._ in. Remarks: CST Nam (P ease P nt)� i Signature ' Telephone No. Address Date CST Number L SOIL DESCRIPTION REPORT , PROPERTY OWNER Page PARCEL I.D.# Boling # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 3 , a-s ll 3 Ground elev. O 5 5 �L S 7, Depth to limiting factgr Remarks: Boring # 13 Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. ' Depth to limiting , factor in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Z 9 , 5 �3IAI - 1</84,J P1r k aC! ST A - 9G' i - .'OPTIONAL WORKSHEET 1. M9UND SYS I EM II. IN-GROUND PRESSURE SYSTEM - Continued - --4 1. Wastewater Load, Total Daily Flow= 3 00 gal. 10. Force Main: Use s. ILHR 83.15 (3) (C) Minimum Dosing Rate - gpm. Adm. Code and PROVIDE A DETAILED Diameter in. LIST OF SIZING ON PLANS. 11. Total Dynamic Head: 2. Depth to Limiting Factor = ft. System Head = 2.5 ft. 3. Landslope = % Vertical Lift = ft. 4. Distance from Dose Chamber to Friction Loss= Ufa ft. a ) i_3 Distribution System = _.L0 ft. TDH = ft. 15 - 0 5. Elevation Difference Between 12. Pump Selection: Pump and Distribution System = 1,0 - ft. Pump will ischarge at least- gpm 6. Absorption Area Sizing: at ft. total dynamic head. Area Required = sq. ft. Pump model and manufactt rer, G Ue Bed or Twtd4Length (B) _ _��_ ft. Bed or T4eaeh-Width (A) ■ ,6_ ft. 13. Dose Volume: 10 yl>-' O '�Z�Y =.3,w /V Trench Spacing (C) _ ft. 10 Times Void Volume of 7. Mound Height: Distribution Lines = gal. Fill Depth (D) _ ft. Daily Wastewater Volume T Fill Depth Downslope (E) = ft. 4 Doses In 24 hrs. _ gal. Bed or Trench Depth (F) = rft. Backflow - �� gal. Cap and Topsoil Depth (G) = ft. Minimum Dose = Sd gal. Cap and Topsoil Depth (H) _ _.l.tZ ft. 14. Dose Chamber: 8. Mound Length: Volume = ' gal. End Slope (K) _ ft. Total Mound Length (L) = ft. 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: 1. Wastewater Load, Total Daily Flow = gal. Upslope Correction Factor= . 7� Use s. ILHR 83.15 (3) (c) , Wis. Upslope Width (1) = ft. Adm. Code and PROVIDE DETAILED Downslope Correction Factor = LIST OF SIZING ON PLANS. Downslope Width (1) _ _ af. y ft. 2. Required Septic Tank Capacity = gal. Total Mound Width (W) _ .__ ft. 3. Percolation Rate = min. /in. 10. Basal Area: 4. Absorption Area Sizint: Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83 Natural Soil = - 'J gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required = � sq. h. SIZING ON PLANS. Basal Area Available - /43 sq. ft. Required Area = sq. ft. 11. If Standard Tables from Chapter ILHR 83 �� Length = ft. are used, Indicate Table # -,��== -- width = ft. 12. For the Distribution Network, Use Numbers 5 -14 1 Section 11. Number of Trenches = Trench Spacing = ft. 11. IN- GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor = ft. Lateral Length - ft. 2. Landslope = % Number of Laterals = 3. Percolation Rate = min./in. Lateral Spacing = in. 4. Proposed System Elevation = ft. Distance from Sidewall to Pipe = in. S. Wastewater Load, Total Daily Flow: gal. System Elevation = ft. Use s. ILHR 83. 15 (3) (c) , wig . Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. Fill in All Items from Section 111 `. Required Septic Tank Capacity= gal. 9 �� 0 0 O o 6. Absorption Area Sizing: V. SEPTIC TANK Percolation Rate = min. /in. 1. Capacity = gal. Area Required = sq. ft. 2. Manufacturer: System Length = ft. 3. Show Site Constructed Tank Details on Plan System Width = ft. 7. Distribution Pipe Sizinx: 1 VI. DOSING TANK Hole Siie = in. 1. Capacity = gal. Hole Spacing Y6 #,-imw 2. Manufacturer: L.dcod Length . _ rl. 3. Pump Manulaclurer: L.oleral Siic _/ _ in. 4. Pump Model: I.alvr.d spacing a it. 5. Operating Head= ft. Ui,t.utce Irom %idew.dl 10 Pipe in. (v. flow Rate= gpm. 8. Distribution Pipe Discharge Rate: 4--7 7. Show Site Constructed Tank Details on Plans Number of I loles Pee Pili low Per Pipe gpm. 15S VII. IIOI.UING 'l ANK 9. Manilold SI /10 1. Capacity - gal. I ype en1 • • or end) 2. Manulaclurer: Length = . 11. 3. Show Site Consvucted Tank Details on Plans Diameter = _ �_ in. -SHOW ALL INFORMATION ON PLANS- _ DIIHR SBD -6761 (R.03/32) �a�11 t,,no� /H.v ss�d9 Conditi a. o lly APPROVED Of 4-EE EPA sr� of Enr AND ME WtW JUL 18 1997 " - 7 7 1 ! & BLOGS. DIV. G RESP JI to of S I r t" �<%Krii7 S y'D.11 r3i° CIS'' I'E/.•nAI T�-+f� �IU•b c-c'�'' �0 4 PVL qd (.w4 , 3 w 3' Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe A5'Tm c3 3 mid-Lm Sand H G coma" Topsoil F 3 $ D F Slope orce Main Plowed Layer Bed of Aggregate Cross Section of a Mound System Using D Ft. 4 Bed For The Absorption Area $ F F�Ft. AFt. GAFt. j Signed: y�Ft. License #: � / G .� �� J = Ft. I Date �i w Ft. _ Alternate Position of Force Main S9 7 2-n wy t A 6 L J Obs Pipe A Forc Hain W - - -- - - - - -= Distribution Pipe LBed of Aggregate Observation i pi pexmanent Marker ' s :. plasi ViView o! Mound Using a sod Poi the 7ltisosptiioa Are ` PAg of. Perforated Mpe Detail n vi )Perforated Ettd Cop PVC Pipe Nob Located on Bottom, J Are Equally Spaced J e* Q PVC Force Mohr � PVC ' Manifold Pipe Alternate Position Of Distrip•dion Force Main Pipe Lost Hole Should Be Most To End Cop End Cap Distribution Pipe Layout P 520 Ft. R S X '/ Inches Y fiches 2 Hole Diameter _ A Inch Signed " i Inch es . Lateral � ) M License Number: _�� G� �' Manifold = 3nches Force Main " Inches Date: —�— of holes /pi pe_ ; 0, - 7 Invert Elevation of Lateralsff.A t. S97.-20706 SEPTIC TANK PUMP C,HAMbLR UKUi� " MIN. ABOVE 4" CI VENT PIPE 12 GRADE WEATHER PROOF APPROVED JUNCTION BOX 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER W/ PADLOCK C FRESH AIR INTAKE 4" CI RISER WARNING LABEL FINISHED GRADE 6" MIN. MIN. ABOVE G ADE ** 18" IN 6 MAX. +s INLET GAS- ,\ WATER TIGHT SEALS ""j'" TIGHT t � SEAL \ A PROVED BAFFLE _}� ,. JOINTS W/ CI 4" B ON PIPE 3 ' ONTO CI PIPE SOLID SOIL 3' ONTO V ;7' C ' ** RISER EXIT SOLID OFF PERMITTED ONLS SOIL PUMP OFF ELEV . FT • D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER T ANK CONCRETE PAD ' SPECIFICATIONS SEPTIC / DOSE c NUMBER DOSES PER DAY: TANK MANUFACTURER: � � /,-��ra - .r -- . SE PTIC �� GAL. DOSE VOLUME INCLUD _.. GAL. D OSE _ � GAL �. C �� CAPACITIES: A = � INCHES •, 3- ._.��._ MANUFACTUR _ MANU GA L, RM fd� ALA -- B 2 INCHES - �,._ MODEL NUMBER: SWITCH TYPE: C - INCHES PUMP MANUFACTURER : _ 2 0 M Y_ INCHES = ?S G AL. MODEL NUMBER SWITCH TYPE: .•��� c 3 Z _ PM PUMP 6 ALARM WIRING AS PER I LHR 16. 23 WAC REQUIRED DISCH6RGE RATE W' STRIBUTION PIPE . . ,�/- FEET 2.5 FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND D FEET 1.'i3 + MINIMUM NETWORK SUPPLY PRESSURfT�100•FT. FRICTION FACTOR••_• FEETi ,�+3 + 5;6 FEET FORCEMAIN X — TOTAL DYNAMIC HEAD -Z , . WIDTH ; DIAMETER • INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ,,,.I C � . DEPT . S, LI DD I - LICENSE NUMBER: l- si°d� DATE: SIGNED: - �- a ' c,/n t t' � 4 s'•� 3 7/8 6 1/4 HEAD CAPACITY CURVE 4 5/8 - I ' MODEL "98" e , m ` 6 O 4 - 10 \ 1 112 2 5 0 40 50 60 70 so 80 J.S. GJILLONS 10 20 30 LITERS 1 240 p FLOW PER MINUTE TOTAL DYNA rAr- V#I PER IIAW R EMUENT AND DEWATER•10 12 CAPACITY ' NEAO uNITE1MIN I FEET METERS GALS LTRS 5 1.52 72 273 A 3/ 10 3.05 61 231 15 4.57 5 -- 20 6.10 25 95 5 95 Lock V• A 23 aka t CONSULT FACTORY FOR SPECIAL APPLIC�ATIIONrS��b� for controlling single • 'Variable level float Electrical alternators, for duplex systems, are available and • and three phase s *eI are available for ved piggybec supplied with an alarm. DoublS • Mechanical alternators, for duplex systems, are available with or variable level controls. without alarm switches. O�NOE 1. InlEgrai woM 6p6rrbd 2 0� °M �' � �� 1ra.ia�bN i�e�. 1 vgbklN Iwd ftd ewrA or douW pWo Standard all models . Wei ht 39 - % H-P- 2 R bfM0477. 6 3. Med►an1ea eiwnela 104m or 10-0075. A11erRek T -Pak'. 9S Serles Sim X ee FM0712. for am reol dN of EMetrieel 4. S a a (4) M Vohs -Ph �e — 5. ccn wAw 10-0225 wed u a oCI aelMbr. DENY d up l e% (3) M9S 115 1 Auto 9.4 1 or 1& 7 4 4 b 6 6. Four (4))110 J4'W MIGUOn box. IOr YIN5r1)Q16 COIM� Ot wked•in 11S 1 4.7 1or 187 "— ppS 230 1 Auto 3 or 4 8 5 ewnpwx or dupNn p6t �, 10-0002• E98 2 1 Non 4.7 2 or 2 a 6 7. TWO M h*'J-PW- Tor*WAAP ooeWO@*M a $Pke. L{ AM U1Malla4en d egriAl . p deMeas i A wow N,a,ra be doR• a a ae•11n.a eaRh4Wf SWW. F Ik1p514; IioaRsed 000leiM AM E10101 0"d sd* OOdj sU014d w f o llowe d h on mealth Ael Mgdwrhcd A,ft Fgippaek V'IEM• ewe FMp�/ 9 oi' (" N Coa lam) as ooagtl•RN SN.tr and M..hh Aar tor, FMiift A1wr0 P•dwp.• FM0M RESERVE POWERED DESIGN + ' For unusual conditions a reserve safety �w is engineered into � design or every �� pump• 4k Ky MM s quw>rd.. .�� M►01 �LM �,.�, /939' FAX �o PUMP !D.. f p-j• � / X1 �' Y' � � +CAPTIONS O � I 1 H�'5000 ) e. i . ' : VlJIRE�MESH: 1 110" �'r SI l t S' fi 9^ � •, .� Wt p� '* `,r � s s�Nir ,..:5. IDTH 93„ #i 'k'x{ tt "t 1 of �K•'iYa �fi�c� y�; °. . tf } Nif + ;; ib 51.,1s ►�, i F•r �,� drtM `C�VEfi OW INLET: 57 ^ :s5 BE - t MANHOLE: 24" I.D. n • s y*� u�^ /� t r7 ) .. - -- L , ••. •''.• � t �,INL�� � '`,, �, ;B PFOR TYSEAL OR ri t INLET•,AND U BAFFLES: P.V.C. MEET3WI D.I.I.H.R. AND {,�, �;,;') M' Cr•A „SPECIFICATIONS 19.65 GAUINCH,(SEPTIC) 1000 GAL. 9.94 GAIJINCH (PUMP) 500 GAL. • � � . ,WEI , HT:�1 `.,Y,r ' � a f� r ..M, { i Y , F � .e�+s`aa. Yx z _+'' r} .�' �•+[ , . fF' . ,f � � �•..�e s f m a (� MODEL WCT-1500 11 10001500 Combination Tank Y ODCRETE Rt. 2 (Hy 11 Malden Rock. W1547504715)647-2311 /� .,... STC -105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER tr_ ✓% �IrSP MAILING ADDRESS 1 L9 MCal k2 V, JUJ�. PROPERTY ADDRESS OP/ 4 7,:2 La ,b I (� l (location of septic system) Please obtain from the Planning Dept. CITY /STATE Jla e. 2a 1 R e. / PROPERTY LOCATION 1/4, 1/4, Section T N -R W S Ci TOWN OF , ST. CROIX COUNTY, WI SUBDIVISION P 1 Z Cc� I Y1 ne, LOT NUMBER CERTIFIED SURVEY MAP 'VOLUME , PAGE ;15/ , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (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 K? 4QLLQ'e— Location of property 1/4 1/4, Section I T N -R W S Township Mailing address Address of site ;2 l o"Z Coy ID I Y1 Q h P Subdivision name Lot no. Other homes on property? Yes _k,- ,- ' No Previous owner of property j 61 Lg•P Total size of property _ (� Total size of parcel Date parcel was created Are all corners and lot lines identifiable? i/ Yes No d huh � Is this property being developed for (spec house) ? Yes e No y`� Volume Ji» and Page Number - -19e as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. 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 Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. Jfegg -Plnd that I (we) presently ' own t4 ..proposgd s ite for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. -T / k'0 7 gnature of/Applicant Co -App icant � Sh 7 31? P7 Date of Sig ature Date of Siqnature r I� " DOCUMENT NO. STATE BAR OF WISCONS v FOAM 3_-1962 rmis SPACE REtERVEO FOR RECORDING DATA QUIT CLAIM DEED Oa k s ._.._ REGISTER'S OFFICE CtI�R�, ,r/ J /74iK s �'" /� ► Q� ST. tom( CO., WI iru..[r ii ss1� fte' fier Pecc^d q uit-claims to JAN 14 1994 ma d Dnd6 the following described real estate in �' �R O /./' County, State of Wisconsin: RETURN TO Tax Parcel No: Article of ageHteit 421►1110 Camlarug at a point 5% feet West of the Southeast t=ails of the Southeast gxitcber of Southeast qumter of section Fit, TuAiftp Nffhx r" a North of Italtge luuba Ei*►teen west; there North 150 feet; thence west to die west line of said Southeast quetcter of Southeast Warts; dwice South at right a ks, 150 feet; thane Fast to the point of begimitg, I g its ,ath a roaA y rift tO extant fran the Fast line of abase discribed pretdses to the trail now lacatied aamss first parties lard. Rmra Dead #2529% Grnmra ang at Southeast cc of file Southeast gmts Southeast of the So quarts (SEA) of Sectiat Figit (8) ThcdnP M rtY'ate (31) rDrth, of Fagg B*Ibam (18) West, bane North Ore knied fifty (1YJ) feet, tht3re West Fiw hutted Fifty (550) feet, thence Smith Cne hued fifty (150) feet, tiara Fast Pipe h r dyed fifty ( 550) feet to place of begirinurg stbject to ti..lectric ad Pbll lute ea9autelt of recmd. 7 This S homestead property. (is) pA not) a y ice,. t9 Dated this day of (SEAL) (SEAL) Ctt~ (SEAL) / (SEAL) l i AUTHENTICATION ACKNOWLEDGMENT Signature(s STATE OF WISCONSIN ss. 71 County. authenticated thi day of 19 Personally came before me this v day of 1191- above named A TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the per w 01110=0 the authorized by § 706.06, Wis. Slats.) foregoing instrument and acknowledge the same THIS INSTRUMENT WAS DRAFTED By -- rte y " 1 motary Public 2 County iriv (Signatures may be authenticated or acknowledged Both my Comm,ss—or a rm:ne nt / ., (if 461, ate expiration are not necessary *ate NTF 0023 'Names c parsers signing in any capac»y should Cr typed or prmtlat De+"+ —v,1