HomeMy WebLinkAbout038-1147-10-100 7.sfisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y
Safety and Buildings Division St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPeermitNo.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 3
Permit Holder's Name: ❑ City []Village ❑ T n of: State Plan ID No.:
Wilson, Burton Star Prairie Township _ U }
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
/ 00 1 /o 038- 1147 -10 -100
TANK INFORMATION ELEVA ION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark1 , 3 13 /03 A c�
Dosing Alt. BM V
A - — Bldg. Sewer 114
Holding - St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet d /7, /� 3. 5
TANK TO P/ L WELL BLDG. AiirIntake ROAD Dt Inlet
Septic y NA Dt Bottom b'I
r
Dosing y / NA Header/ Man.
q -__ - -- - - - - - --- NA Dist. Pipe 4
Holding Bot. System '
y. s
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand St cover d y 3 3
Model Number ku bo, l� °� 3- .yyGPM
e ov 3_ P� a o0
TDH Lift z o' Friction System2 TDH Z 7 Ft D e ✓ 9k PF
Forcemain Length a Dia. 2 " Dist. To Well
0(ICr ,
SOIL ABSORPTION SYSTEM
RED/TRENCH Width i Length r No. Of Tr PIT No. Of Pits Inside Dia. epth
DIMENSIONS - L / t e DIM
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM L N anuacturer:
INFORMATION Type Of CH ER 111 er:
System: M CAA /06/ UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
�. l �
Length Dia. Z Length I S Dia. �_ Spacing J � 13
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.) Inspection #1• /I r / oD Inspection #2: 0 0,
Location: 2168 Shore Drive, New Richmond, WI 54017 (SE 1/4 NE 1/4 17 T3 1N R1 8W) - 17.31.18.615 Wigwam Shores -
Lot 2
1.) Alt BM Description= 7 off'
2.) Bldg sewer length = I Q 1
-amo of cover = -> ( -P
'' 3.) contour = ( SG�I a S • Sz a f ° 3 . 13 = !
'6NO we C! rho/ 44 9
Plan revision required? ❑ Yes F No
Use other side for additional inform tion. !� OT ( 5 Z
SBD -6710 (R.3197) Date Inspector's Signature Cert No.
X
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
NVAsconsin 1 P O Box 7302
Department of Commerce In accord with Comm 83.05, W d .� 1 l .-
P �! Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the syst \ pap e,o, ess` Co t
than 8 112 x 11 inches in size. '`
N CJIE� OK
• See reverse side for instructions for completing this appllc tion Sta%IW,, nitary Permit Numb r
n, QOQ
Personal information ou provide may be used for secondary t
Y P Y ry purposes `' if revision to previous ap Ication
[Privacy Law, s. 15.04 (1) (m)]. gj
S Ian IA. Number
L APPLICATION INFORMATION - PLEASE PRINT ALL F, 0 0 SZ
Property Owner Name roperty Loc
r 1 ,- T , N, R E (o so
Property Owner's Mailing Address Lo Block Number
E ��
City, State Zip Code Phone Number Subdivision Name or CSM Number
E i 1 15 ( 53'P-4 S
11. TYPE F BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
Public 1 or 2 Family Dwelling To - No. of bedrooms Village
_� Town OF
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) I � I , �. ��— / I
1 ❑ Apartment/ Condo — � > D -' O O 40
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. pg 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 21 RMound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure t 42 C] Pit Privy
13 [1 Seepage Pit q� X �� "�-�` 43 ❑ Vault Privy
14 ❑ System -In -Fill C? • 5 Y
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
5_0 Feet O/. Feet
VII. TANK
Cap acity
in g Total # of site
INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Exper.
Plastic
Gallons Tanks concrete glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank r o ❑ ❑ ❑ [:j ❑
Lift Pump Tank /Siphon Chamber g QQ — 3 ❑ 1 ❑ I ❑ 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 Plu e s Signature: (No tamp PRSW No.: Business Phone Number:
17'
Plumber's Address (Street, City, State, Zip Code): i
L o G L vim' d
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Agent Sic nature (No Stamps)
Wpproved ❑ Owner Given Initial Surcharge Fee)
\
Adverse Determination L -OD 'lZ
X. CONDITIONS OF APPROVAL / REASON FOR DISAPPROVAL:
as
SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved 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 system's must be properly maintaine - d. The septic tank(s) must be pumped - b a 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.'
11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
Vlll. 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
_. includ'e the foll6Wing: A) plot plan, drawn to scale or with completedimensions, locattorrl 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 coumy; E) soil test data - a - 1 15 form; am 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 and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
isconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
June 03, 2000
CUST ID No.221741 ATTN: POWTS INSPECTOR
ZONING OFFICE
DONAVIN L SCHMITT ST CROIX COUNTY SPIA
586 VALLEY VIEW TRL 1101 CARMICHAEL RD
SOMERSET WI 54025 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/03/2002 Identification hers
Transaction ID N 20
Site ID No. 193416
SITE: Please refer to both identification numbers,
Site ID: 193416, Bert Wilson above, in all correspondence with the agency.
St. Croix County, Town of Star Prairie
SE1A, NE 1/4, S7, T3 IN, RI 8W
Subdivision: Wigwam Shores - Lot: 2, Block: A r
FOR:
Description: Three Bedroom Mound System
P Y
Object Type: POWT System Regulated Object ID No.: 666718
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force
on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary
permit approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a Ratenti al for a law suit that may delay the effective date of the code so this status may or may not
change.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
DONAVIN L SCHMrr Page 2 6/3/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 05/31/2000
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
&rard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us WSMART code: 7633
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
m TDD #: (608) 264 -8777
VA sconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
June 03, 2000
CUST ID No.221741 ATTN: POWTS INSPECTOR
ZONING OFFICE
DONAVIN L SCHMITT ST CROIX COUNTY SPIA
586 VALLEY VIEW TRL 1101 CARMICHAEL RD
SOMERSET WI 54025 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/03/2002 Identification Numbers
Transaction ID No. 320050
Site ID No. 193416
SITE: Please refer to both identification numbers,
Site ID: 193416, Bert Wilson above, in all correspondence with the agency.
St. Croix County, Town of Star Prairie
SETA, NEIA, S7, T3 IN, RI 8W
Subdivision: Wigwam Shores - Lot: 2, Block: A
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 666718
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall
be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
CAUTION: Wis.stats 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force
on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000.
Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary
permit approval if submitted to the issuing agency on or after July 1, 2000.
Note: There is a potential for a law suit that may delay the effective date of the code so this status may or may not
change.
o
A copy of the approved plans, specifications and this letter shall be o n -site during construction and p en 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.
DONAVIN L SCHMITT Page 2 6/3/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 05/31/2000
At�(O l v FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
erard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM
jswim @commerce.state.wi.us WiSMART code: 7633
MOUNT SYSTEM
for
BERT WILSON 5` �•
SEI 14NE114 S7 T31 R18W
Star Prairie Township
St. Croix County
Page 1 to 4 Soil Evaluation & Survey
Page 5 Work Sheet
Page 6 Plot Plan
Page 7 System Cross Section
Page 8 Pipe Lateral Layout
Page 9 Dosing Chamber
Page 10 Pump Curve
By
D avin L. Schmitt
586 Valley View Trail
Somerset, WI 54025 �O-S,
715- 549 -6651 P � it . r ally
MPRSW 221741 C o 1 0)
May 25 -00
CID MERC 1NG �
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v i xiri W SOIL AND SITE EVALUATIO
Department of Commerce
Di ALUATION
Division at Safety and Buildings Page -._`. , ,
Bureau of Integrated Services in accordance with Comm 133 tig. Wis. Adm. Code of
Attach tiomplete site plan on paper not less than g 1/2 x 11 Inches In site, Plan must Munty
Include, but not limited to: vertical and horizontal rafar8nce point (EM), direction and
percent elope, scale or dimensions, north arrow, and l and distance to nearest road. Parcel I.D. k -�-_ _ - -'-
APPLICANT 1 '�
NT INFORMIIATION - Please print all Information. Reviewed by "` --_ — Date
Personal Information you provide may be used lot seCorulary purposes lPdvacy Law, S. f!i,pq (n) (
Property Owner .. - - -- • . - ._- ___�....( _ --
{ Property Locallun
�. l a 41 t'ti `!- I •![� �r.� Govt, Lot 1/4 1 /4,5 !
T3 ,N,q__ ! C? E (or)
Property Owner's Mailing Address - _ -- Lot 44 - 1 Dirx�; Sulxl. Name Or CSMq J y
f Y, City k r° State Zip Code Phone Nurnbei ��—
1� b I) 1 h b r } ❑ City 0 Vila ® Town N earest Road
5 1 L.. G� d 3`1 ) 3 t 6- 9 1 31-t-_ V_ �C A w; 1 6 111 Q e
❑ No# Construction Use, Residential / Number of bodrxuma -- -. Addition to existing building -
Replacement C3 Public or commercial - Describe:
Code derived dally flow _. .��4 gPd Recomrnendod design loading rate ,1!. .._ bed, gpd/112 V - trench, gpolft
Absorption area required. 2
P 4 � . ft _7.5 -,trench, it ° � S 1 h Maximum ddsic�n loading rate (` � — moo, gpd/f� 1 1 1 trench, ypoltt
Recommended Infiltration surface eievstion(s) .. a te. tl
—_tt (as referred to ails plan bsnghmHrk)
Add111Gnal designlslte rortaiderations , _. �. ,
Parent material � _ _• Fkwd plain olevatlon, If applicable —_ it
S = Suitable for systern Conventional Mound In- Ground r F u r�assure AT- Grade Systern In Fili lioltllnc� Tank
U Unsuitable for system Q s U I9 S F) U [I s DA U Q s H U [] 5 59' U D II U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant C olor Mottl Structure
;;, • n (n. Munseif Texture Consletence Bounder Roots GP /fl
t]u, Sz. Cont. Color y Bed , Trench
p -
_ LID
Ground _.____.._. " `�'r � _ • S
Depth b I S F 5 1C T �,,
limiting y 5
- `� ` 1 { fW '
�-
iaat r � �..�- -•- . � ,
an. ,
Remarks:
Boring #
...... —�_
Lie—
around -35 s �. <<.. �--. —_ S F is c w v _ ,4:.S
alev. Depth to _
limiting
K f tier
in, Remarks:
CST Name (Please Print) Signature A Telephone No.
w
Address - • ..
i 1,4 Date CST Nurn r
v� (} 0 r " +1" i G � � -, :� — bb z) cast 1.
1 .41 �.
II
{ SOIL DESCRIPTION REPORT
PRaPERTYOWNER � '9.�I1it_ ^�_�� � Page Of _3L
PARCEL I.D.1t
Boring # Horizon Depth I Dominant Color Mettles Structure 2
in. Munsell Qu. Sz.
CA C01or Texture t;r, Sz, Sh. Consistence Boundary Roots Bed Trench
!_.. a F .
Ground ..... 6 : .� .-�y 7 y , *� �- t / - -- ... �-�. � � w ► 5 3 k '" c w_ • b
7, `+ N`L F 7, 'c l lr m F. ate_ .�-- , a : .3
Depth t o n {{ r,C —
limiting __� Q•__ - ��J`�7 �'�� Sr�- 1 rV�?IC- IM�► _►.� .J
factor -- —
Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottlas Texture Structure Consistence Boundary Roots
In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
a
tafOlJrld
elev._ _..._ _.__...._....._......._..__._—.....-
Depth to
limiting ,
factor
—in. Remarks:
Boring #
t:
Ground
Depth to
limiting
factor
...In. Remarks:
SOD -8330 (R.9/98)
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Page Of
OPTW)NAL WORKSHCET
II. IN•GRo I ;'4,1 F'ki.%',URf. SYSTLM•Conunued-
1. MOUND SYSTEM
yso 1 grit K1.1w: A; )��l�
R
1. W aStewAte 4 I.cord, Ioul Daily flown s ,inna,m Dosmit Rate = _ pm.
Use s. TLI1R 83.15 (3) (C) - _ ;n.
Adm. Code. and PROVIDE A DETAILED 11 bmeter i
LIS I Of SIZING ON PLANS. Ai It' 11. l ntei :c Head:
.�6. -�.t- Gystcrn m Ikad = 2.5 fl.
1. Depth to Limiting Factor = Vr,IKal Lift = ._? ft•
3. L4ndclope = 7G «l y friction Loss ft.
4. Distance from Dose Chamber to =
ft. IDli
IiNIIIMuitnn 4Yslem =
S. Elevation Difference Between ' n 1 ?• Nu "'I valsrlurn'
Pump and Distribution System = _ ! ft. Pump t will discharge at least gpm
6. Absorption Area Sizing: i at � 1-ft. total dynamic head. i
pump MON and manufacturer: Z d_CLL 2
Area Required = sq. It. SSS
Bed or Trench Length (B) ■ ft.
Bed or Trench Width (A) ■ ft. 13. Dose Volume:
Trench Spacing (C) ■ ft. 10 Times Void Volume of �
7. Mound Height: Distribution Lines= --sue- gal. .
Fill Depth (D) ■ ft. Daily Wastewater Volume +
4 Doses In 24 hrs. ■ )13
gal.
Fill Depth Downslope ■ ft. gal.
'
sod or Trench Depth (F) F) ■ it. Backflow •
Cap and Topsoil Depth (G) ■ ft. Minimum Dose ■ gal.
Cap and Topsoil Depth (H) = ft. 14. Dose Chamber: goo gal. 1
8. Mound Length: Volume ■
End Slope (K) ■ ft, j
Total Mound length (L) ■ ft. 111. CONVEN, ONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. West ew er Load, Total Dally Flow • gal-
Upslope Correction Factor ■ ' Use s. ILHR 83.15 (3) (c) , Wis
Upslope Width (1) ■ ft. Adm. C and PROVIDE DETAILED
Downslope Correction Factor = LIST OF SIkING ON PLANS.
Downslope Width (1) ■ ft. 2. Required Septic Tknk Capacity ■ gal.
Total Mound Width (W) ■
fL 3. Percolation Rate ■ Min./in.
10. Basal Area: 4. Absorption Area Slzf ILHR 83
Infiltrative Capacity of .� Refer to Table in c .
W.h
Natural Soil ■ r O.ft./day and PROVIDE A DIET LE IST OF
Basal Area Required = sq. ft. SIZING ON PLANS.
Basal Area Available = sq. ft. Required Area ■ sq. ft.
Length = ---- -- ft.
ILHR 83
11. If Standard Tables from Chapter Width • ft•
are used, Indicate Table N _ -- Number of Tren es ■
12. For the Distribution Network, Use Numbers 5.14 In Section II. Trench Spacink
11. IN-GROUND PRESSURE SYSTEM / S. Distribution System:
fn.
1. Depth to Limiting factor
ft. Lateral Length= ft•
■ - � Number of Laterals ■
2, Landslops ■ %
3, Percolation Rate ■ �- min./in. Lateral Spacing =
4. Proposed System Elevation = ft. �1stance from In.
Sldewall to Pipe =
S. Wastewater Load, Total Daily Flow: �Q.. gal. System Elevation ■ It.
Use s. ILHR 83.15 (3)(C)', Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEM• L
LIST OF SIZING 0" 'PLANS. a Fill i Item m Section 111
Required Septic Tank Capacity ■ _L�s.. ga l. r .
6. Absorption Area Sizing: V. SEPTIC TANK
Percolation Rats = min. /in. 1. Ca Manufacturer*
Area = �,ASC�as gal.
2. Manufac
Area Required = ft. /t.
f K "S C Cln/Gn L7�
System Length ■ ft. 3. Show Site Constructed Tank Details on Plan
System Width = ft.
7. Distribution Pipe Siting: / VI. DOSING TANK O
in. 1. l apacits = � gal -
Hole Siic •
"file SPar.inx =
It. A1.tnufa.turrr. O
I.elcr.11 Length It. .1. Pump Manul vourer:
1 .rlre.d Sim /'S M. 1. Pump Meld&
1 .rlrl.rl �prlinR - - �r 11. 1. ope -+unt: Htjd= It.
h%t.■pr born ♦idrw.rll In 1'ilu• A 'y _ nr. 1.. 1 1". R.ur : gprn.
I
N. (li�lnbuliorl l'ipr 1)idew.11lc to I*il . Sho% %,tc C nnatru.lcd Tank Detalls on Plans
Nuntl "•r of Ilolr.l'rr 1 .....__
1 low Prr 1 Ithnl. VII. 110 > ,% s.!co%n%itu-.IcdTan
41 Maodold ♦IiinR• 1 gal.. 1 yowl. (11-01..•1 or t."41) )-E=ND son Plans
Islan/rtrr � In
tiHOW ALL INFORM AT ION ON PL ANS -
0111 list %Ills f. it. I IR toIIII:1
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Straw, Marsh Hay, Or
Synthetic Covering
ASTM C-93 -Distribution Pipe
Me,lium Sand
M G
6 Topsoil I F
--�� E D
3
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Slope
Bed Of 2'_ 2'" Force Main Plowed
i Aggregate Layer I
(6 Below Pipe) �
D _L Fi'.
Cross Section Of A Mound System Using F -1'�' FtI ;.
A Bed For The Absorption Area F - ' 7� Ft
G / Ft li.
A_ Ft. H /, 6 Ft'.
I Signed: W6
B A Z_ Ft.
License Number: K /0,S Ft.
Date: –�� -00 - L 6&" Ft.
i J 6, Ft.
I rS Ft.
W A Ft.
L
Observation Pipe—,
-- ------- - - - - -- -------------- - - - - -- T 7Force Main
W ° D Of i – 2 i
1 Pipe Aggregate
. I
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Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
iti
i
t'ettu�ute 1'I�ts Itelnll
End View
�PerforofeCl i
End Cap) PVC Pape
1 ova '
� e Holes Locvted On Bottom,,'
Are Evualty Spaced
P
*� is
* it
tv MANIFO&
oistributtor�
Pipe
Lost Hole Should Be
Next To End Cop
Distribution Pipe Layout P Ft.
FpRG@ ffAiN:
I
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X 34 Inchpt
Y __ Inches
Hole Diameter V4nch
Signed �2 _gnch(es)
License Number: ��� �� �/� Manifold �_ Inches
Date: S 5 7 t!9
Force Main _ I Inches
# of holes /pipe_f&l
Invert Elevation of Laterals ff& Ft.
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• PAGE —L OF
PUMP CHAMBER CROSS SECTION AMU SPECIFICATIONS
VENT CAP
'I "C.I. VENT PIPC WEATHER PROO APPROVED LOCKING
u���� 1'In�1 !►max �MAAIHOLC COVER
1 N .q' / M.u�
*JIMUUW UN / 14L611 I
AIR INTAKE I - T GRADE i y• MIAI.
16' MIAI.
CONDUIT - - - - -- -
10 "MIND. - - - --
�i
PROVIDE i -
MLE T AIRTIGHT SEAL
I I
I I APPROVED JOINTS
APPROVED JOINT A I II W /C.I. PIPE
11 PE I II ALARM ONTO 3'
CXTCNOIN6 3' I 1 ONTO SOLID SOIL
ONTO SOL10 11101 0 I I
I I ON
c I 1
$ I .
LLEV. FT. PUMP J
OFF
' � I
' D I
�L GP-T CONCRETE BLOCK
L oo
• RISER EXIT PERMITTED OWL
IF TANK MANUFACTURER HAS SUCH APPROVAL gEDpl !
SEPTIC € SPCCIFICATIDNJS
DOSE
T ►�K3, MAEIUFACTURCR: .LJE� HUMBER OF DOSES: PER DAy '
� i
TANK 51ZC: GALLONS DOSE VOLUME 12/.
ALAR MAWUFACTUILrR:
INCLUDIN(v BACKFLOW: ' t.ALLONS
CII I
MODELL NUMBER: wI CAPACITIES: A =INCHES OR 1622 GALLONS
SWITCH TUPC: / /CR c U2 y - 8 INCHES OR YllLS. GfLLOUS
PUMP MANUFACTURER: _I U CHES OR LY� GALLO
MODEL NUMBER: 9t -- - D- /I INCHES OR 0.8 GALLON6
SWITCH TYPE: ,CI Es..rr N /C MOTE: PUMP AND ALARM ARE TO 6E j
INSTALLED ON SEPARATE CIRCUITS
MINIMUM DISCIARGE RATE :3� GPM
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND..DISTRIBUTIOM PIPE.. 1 2. FEET
t MINIMUM NETWORK SUPPIS PRESSURE .. . . . .. . . . 2 . 7 5 FEET
♦ _. FE X �
ET OF FORCE MAIN e�- F Yo t FRICT10ki FACTOR.. /',!I FEET
TOTAL DtJWXMIG HLAD = F FEET
/ /G HT
IWTERAI/1L DIMLW6100dt OF TANK: k6•k+E� �iD ;WIDTH -- 2 6LIQUID DEPTH
SIGt`IE 0:
LICEWSE WUM6ER: �� �,Ly� DATE: Bali .��
• PEE ro
I !
HEAD CAPACITY CURVE J
w EFFLUENT MODELS
(A CAUTION Model 185/4185 should
1,0 fin au11In1•IPII ILl IPee Illnll If) (PPI l N I
111 1 111 !
120- -- -- — -- -- - - - - - - - _ - --- —
36 191
34 110_
32 ... 105 -
100 -... -
30 --
95__ -
2B --
186.
26- 85
1186
24- 80- 165.
4165
3 n
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U 20 65 .. _
60 -. .163. --
IB.._ 1163 _ __ __ - -189.
55- 4189
16-
50- --
14., 45 -
I2 -- __ 140, 188.
1140 4188
10 -
30 -- _- - — _
11 � 185,
8 4185 _
25-- ` _
6- 20 -
161,
IS__
4- 1 1
- --
2 - 4161
g _..
3,57
0
U.S. GALLONS 10 2 40 50 60 70 80 90 100 110 120 1 _1 150 160
IItERS 80 160 140 320 400 480 560 640
U FL UW PER MINUTE 009922
TOIAL DYNAMIC HEAD/
LIOW 1 MINDIL
Lt FI 11EN1 AND DEWAILHING
MODEL 53,55, 98 137 140, 161, 163, 165, 185, 186, 188, 189, 191
4140 4161 4163 4165 4185 4186 4188 4189
FT. M. GAL, LTRS. GAL. LTRS. GAL. LTRS. GAL. LTRS. GAL, LTRS. GAL. LTRS. GAL. LTRS. GAL. LTRS. GAL LTRS. GAL. LTRS. GAL. LTRS. CAL. LTRS.
5 1.52 43 163 72 273 9 3 352 91 344 100 379 61 231 61 2 11 __ 58 220 145 549 145 549 a5 170
10 3.05 34 129 61 231 79 299 BI 318 93 352 61 229 61 2 58 220 140 530 110 SJO /S 170
15 4.57 19 72 45 170 64 242 76 2 88 85 322 60 227 61 231 58 220 134 507 135 511 45 170
20 6.10 25 95 36 136 fiB 257 79 299 59 T23 60 217 58 220 128 484 131 496 45 170
25 7.62 _ _ B 30 59 223 70 265 57 216 59 221 5 8 220 122 462 125 473 45 170
30 9.14 49 185 82 235 55 206 58 220 85 322 Si 220 116 439 120 434 45 170
40 12.19 21 79 45 170 46 172 55 206 70 265 58 220 104 J91 109 473 15 170 1
50 15.24 20 76 33 725 50 189 51 193 58 220 90 311 97 387 45 170
60 18.29 15 57 19 148 12 121 58 220 71 269 85 322 45 170
70 21.34 -- _— - -- 23 87 9 }4 52 197 51 193 69 261 45 170
80 24.38 10 J8 45 170 28 106 51 193 45 170
90 27.43 31 117 2 8 34 129 45 170
100 30.48 16 60 17 64 40 151
110 3200 . n 15 ]D 114
1711 In 'R llr 1H
I1t1 3tl a/ IN !B
LOCK VALVE: 19.25' 13 26 46 S6' 66' 86.5 13' 114' 91' 110' 137'
PMA
MEMBER
SUMP O
.V` ARID SEWAGE
PUMP MFRS. ASSN.
Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in s' 01an fnust; r County
include, but not limited to: vertical and horizontal reference point ( direction and S ch b I
percent slope, scale or dimensions, north arrow, and location an distance to nrrest road.
Parcel I. D. # —
C� —
APPLICANT INFORMATION - Please print all i iidrmatid viewed by Date
Personal information you provide may be used for secondary purposes vacy Law, S. 1'5.04(1) (m)). `
Property Owner ppe'O ation _
Ll. W1 ►� �d. C,� � �4�t: ,abut. Lot S r:1/4 M E 1/4,S T ,N,R E (or)
Property Owner's Mailing Address Lot'#, Block #, Subd. Name or CSM#
City 11 5 e State Zip Code Phone Number - Ci` Nearest Road
Co i) ► ►ti u � L � tY ❑ Villa ®Town 2 193
❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building
.J�j Replacement ❑� Public or commercial - Describe:
Code derived daily flow SD gpd Recommended loading design , d /ft 2 I
g g rate I bed gp q trench, gpd /f1
Absorption area required 3 _2 S bed, ft .3 7 5 trench, ft Maximum design loading rate bed, gpd /ft f �"+
i trench, gpd /ft
Recommended infiltration surface elevation(s) 9 � g r ft (as referred to site plan benchmark)
Additional design /site considerations 1
Parent material Q0, G� I '�"`. I Flood plain elevation, if applicable ft
[ EE Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
unsuitable for system ❑ S U S❑ U ❑ s % U ❑ s ® U ❑ s [it u ❑ S KU
SOIL DESCRIPTION REPORT
Borin g # Horizon Depth Dominant Color Mott Texture Consistence Boundary Roots Mottles Structure GPD /ft
j ti< in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Ground 1 3 -1 1 ' 4)j ,.. H`a � arnSbK.
elev.
97 ft. li - 7 .5 1 R.` � �--. -- a....._ d. W_
Depth to `� I S I 9Lq� '_' _.. t SL I FS 1S � 'C ",,�
limiting 3 - * 1 A2 C `f 6 11 .SCE- ��J�.f� �' •—� .Z
factor
A-1 I
Remarks:
Boring #
En A
�ll r
0 .
£;,
Ground - 35 / �-- I '` v - 1 u ►
elev. 5- 5190 C -In Sa L_. 1 FS b fie.. m� %
97 nft. ,
Depth to
limiting
f ctor
Remarks:
CSY Name (Please Print) Signature Telephone No.
t�- 1 -�1
1, ess i Date CST Number
5 No a 6
{J�0.hht. SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground 7,
n tl� - - -- lice.+" a ►►) Val► fv� e- --A
elev.
Depth to f f 7,�j AW 6e.L r Ir-s m��
limiting �. ��! ? ►5`I � G.t.. f �. MF
factor
Remarks:
Boring #
k
L
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
13
Ground
elev.
ft. '
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R.9/98)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM s
T
Owner/Buyer .- al h J r/ 6e /l
Mailing Address W 75 to T r—
Property Address R 1�
v erification required from Planning Department for new construction)
City/State ,(A/ kV i'To N o 1,G,'' Parcel Identification Number U 32 I / Me
LEGAL DESCRIPTION
Property Location %, ' /., Sec. Z 7, T 3 / N - /8 W, Town of
Subdivision Wig boo rn 540 1 e S Lot #
Certified Sarvey Map # Volume . Page #
wacran Deed # .3 V3 �
� h' Volume /'S 1 I . Page # L / 7 8
i
SOM muse 13 yes i5 Lot lines idwUmble ht'' yes O. no
1 J Pa'Usiaand moeofynarse ptiarys= oouldrewltmitsp tobandiewastes.Pmper '
por is of pumping oat 60 Septic tank "a7 tie y , = ac so=4 if ne aded by a R sed PumPa . Wha ym put hft gyd=
anaffect.do-Awfinaf the septic teak a tc+earm0t stage itt &0 waft,disposalsysbam.
{
IU PAY' dyne nwa to smbv* to Crone Zoning Departmed a =ffiwtion foam, signed by tyre . by a
P '7 P dpkmberoratic= wdpmmqervrdfyingalit (1)&eon�dtewastewater ' system
is M ProPet oP=Wwg condition and/or (Z) after kVcc&n and I j iag Crf necetacy), the septic -teak is Less .than 1/3 fia 0
Vwc. Lire tmdcrzigmd have read Ere above requirements and to maintain the '
td fair. Ira+ei4'as set tfre agree pravaft =wW di
System wi& the
by Dq>attment of Commaoe and the Depazimcet of Nadual Resources State of Wisconsin..
sbtiogt$ rat your sepdo system has been mainmined must be
t oompleGod and z+med to the St. «+oix.CauntY Zoning Ofhee 30
dsys of ffiree year expuatim date.
r
6 , 7/�
SIGMTM OF APPLICANT DATE
CERT CA O
# --
I (WO certify that all statements on this form are true to the best of my (our) lmowledge. I (we) am (are) the o s) of
tdue P*WM y 4=zft Qt' abotre, Ky virtue of a warranty deed recorded in Register of Deeds Office.
...
&GNATWE OF APPLICANT DATE
r
ssssss AW infoam ion that is mis- representod may result in the sanitary permit being revoked by the Zoning Department s « «ss
.; •• Include Witt' this applleation: a stamped warranty deed from the Register of Dodds office
# a copy of the certified survey map if reference is made in the warranty deed
• `IU
STATE BAR OF WISCONSIN FORM 1 - 1998 623438
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number
lic-l_ ,1512FAa1478 ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between DIANNE L. LELAND, a s ingle perso 05-22 -2000 10:00 AM
YARRANTY DEED
E"T #
_ Grantor, CERT COPY FEE:
and T. J. JANE R. WILSON a BURTON WILSON, husband and COPT' FEE:
wife TRANSFER FEE: 165.00
RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate In St. Croix County. State of Wisconsin
(the "Property "): Record Area
Name and Return Address
Lot 2, Block A, Wigwam Shores, Star Prairie Township
According to the Plat thereof on file at the Register of
Deeds Office for St. Croix County, Wisconsin located
in the SE -1/4 of Section 17, Township 31 North,
Range 18 West. Together with a non - exclusive
easement over that part of the private road shown as
Tepee Trail on the Plat of Wigwam Shores, more fully 038- 1147 -10 coo
described as follows: Beginning at the North -South s Identification Number (PIN)
This
Town Road, lying Easterly of said Plat, thence Westerly This not homestead propert
on Brave Drive to Tepee Trail, thence Northerly along (is) ) ( (is not)
said Tepee Trail to an Easterly extension of the North
line of said Lot 2, the point of termination of said
Easement.
Together with all appurtenant rights. title and interests.
Grantor warrants that the title to the Properly Is good, indefeasible in fee simple and free and clear of encumbrances except — none.
,q fh
Dated this day of May 2000
P04 �.
�lar+t (.eL4.rd
(SEAL) (SEAL)
DIANNE L. LELAND
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
? f. ( /o/ 7` County.
authenticated this day -Ktrltson Personally came before me this day of
Notary Public May 2000 th above named
State of Wisconsin Dianne L. Leland
TITLE: MEMBER STATE BAR OF WISCONSIN to
Of not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Slats.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY q
Atto rney Barry G. Lundeen �Gr4— fr7� A_
MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. Notary Public, State of Wisconsin
_ 110 Second Street, Hudson, Wisconsin 540 16 My core / lnissi n is p rmanent. ()f not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not my )
necessary.)
' Names or persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Lao Btank Co., Inc.
WARRANTY DEED FORM No. 1 - 11999 Milwaukee. Wis.
STATE BAR OF WISCONSIN FORM I - 1998
WARRANTY DEED
Document Number
This Deed, made between DIANNE L. LELAND, a single perso
Grantor.
and T. J. JANE R. WILSON and BURTON WILSON, husband and
wife
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate In St. Croix County, State of Wisconsin
(the 'Property') Iimordnug /tea
Name and Return Address
Lot 2, Block A, Wigwam Shores, Star Prairie Township v,q
According to the Plat thereof on file at the Register of D p
Deeds Office for St. Croix County, Wisconsin located
in the SE-1/4 of Section 17, Township 31 North,
Range 18 West. Together with a non - exclusive
easement over that part of the private road shown as
Tepee Trail on the Plat of Wigwam Shores, more fully o 1147 -loo
described as follows: Beginning at the North -South Parcel Identifica Number (PIN)
This is not homestead property.
Town Road, lying Easterly of said Plat, thence Westerly (is) (is not)
on Brave Drive to Tepee Trail, thence Northerly along
said Tepee Trail to an Easterly extension of the North
line of said Lot 2, the point of termination of said
Easement.
Together with all appurtenant rights, title and Interests.
Grantor warrants that the title to the Property Is good, Indefeasible In fee simple and free and clear of encumbrances except — none.
Dated this 9 day of May 2000 1 A
Pjal4e. ceu.4d
(SEAL) (SEAL)
. DIANNE L. LELAND
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
SS.
; � 7 -/, County
authenticated this clap �ateS -Khutson Personally came before me this day of
Notary Public
May 2000 ,the above Warned
State of Wisconsin Dianne L. Leland
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by 5706.06, Wis. Scats.) Instrument and acknowledge the same:
THIS INSTRUMENT WAS DRAFTED BY
Attorney Barry C. Lundee
MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. Notary Public, State of Wisconsin
110 Second Street, Hudson, Wisconsin 540 16 My com issi9n is p lrmanent. (If not, slate expiration date:
(Signatures may be authenticated or acknowledged. Both are not a 03 )
necessary.)
I
Y 1
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EAST LINE BLOCK A
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y
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4
a 3 62 �+ 144.50 a 163.10` I. I
.ge _ _ _ 314.5i'
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115,40- 163.11 -
\ ----� I �24 N LOT 4
buy 2y3
/ 101 - 2 163 16 296A-30
2 a 625
305.03'
s , r 196 16 3/ 3 s
3 626 wo ik 361 � `
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COT 3 r<�i► I
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131 163.22
141 4#113 ltOQs N • L.76N 20 r
5
$ �,� 627 N ».r
1 623 290.50 ,
125 Ml� 6�� ��:'�a�t► . = rn LOT 2
c i 63. — h - 296A -10 1 I
630 0 I 276.15 III
163.46
8 q�� 3 17, LOT
i 9,tisg = 296A
9 163.41
N �F
s
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I. SEC. 17 t4 s
1. Nw tiT' :� l a,}• r '1
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