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HomeMy WebLinkAbout040-1230-30-000 s e tment of Commerce Coun 'safetyarid D B tidi Division PRIVATE SEWAGE SYSTEM ty Wisco St. Croix INSPECTION REPORT Sanitary Permit No: 395117 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: Vnak, Christopher I Troy Township 040 - 1230 -30 -000 CST BM Elev: Ins p. BM Elev: BM Description: eml TANK INFORMATION ELEVATION DATA ��z "�Z — Op TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM 1.30 170, Aeration Bldg. Sewer P"W4 04 3. 20 Holding St/Ht Inlet Lot (O �OS TANK SETBACK INFORMATION St/Ht Outlet (o •S1� �S, 3 TANK TO P/L WE BLDG. Vent to Air Intake ROAD Dt Inlet Septic ``''�� �� Dt Bottom 'fC Dosing I Header an. 7 Aeration Dist. Pipe �'y 3v Holding . Bot. System Final Grade PUMP /SIPHON INFORMATION �'�' ,30 —� Manufa urer Demand 7ov7er GJ(py a— GPM Model Number TDH Lift Fricti ed5s System Head TDH Ft Forcemain Dia. SOIL ABSORPTION SYSTEM 00`L 7 BED/TRENCH Width Length/00 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 t Q'�U - 2 c" ? SETBACK SYSTEM TO J P /L BLDG WELL• LAKE/STREAM LEACHING Magttf�furer. INFORMATION CHAMBER O Ty f System: � .... � ( Es t UNIT Model Number: DISTRIBUTION SYSTEM S, /L Header /Manifold Distribution x Hole Size Ven x Hole Spacing t to it Intake N Pipe(s) _ / T / Length DiaA_ Length Dia Spacing f0l/ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth O Bed/Trench Center ��j Bed/Trench Edges Topsoil of xx Seeded /Sodded xx Mulched Yes �� No [] Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:Qb /O ' /_!PL Inspection Location: 348 Soo Line Road Hudson, WI 54016 (NE 1/4 SW 1/4 16 T28N R19W) 162819113,3 Glover Station Addrk IV Lot 61 1.) Alt BM Description i A. , L g 2.) Bldg sewer length = S �� i} 2� tp. �f � 30 > , () Cqe a > s. - amount of cover = OK Plan revision Required? ] Yes ] No 5 — � additional in�prm �jO ��hg�r side for additatio 0 ' 610 1 3 7 SQwC '% des A, Date sepctor's nature Cart. No. 87 R 9 � r � I �� M �` I t Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395117 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: Vnak, Christopher I Troy Township 040- 1230 -30 -000 CST BM Elev: / Insp. BM Elev: BM Description: Section/Town /Range /Map No: 991-- Uo I * 9 S7 -36 CST gw► I 16.28.19.1133 TANK INFORMATION ELEVATION DATA j�,�sG� 53 C9) P,1 = ?•�'2 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' ^ I - LSD Benchmark Dosing Alt. BM Aeration Bldg. Sewer 3•ql Holding St/Ht Inlet (o•l° TANK SETBACK INFORMATION St/Ht Outlet -s TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > t � I Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding / " , >4 Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover M Model Numb TDH Lift riction Loss System Head T Ft Forcemain ength Dia. Dist. to Well SOIL ABSORPTION SYSTEM 2 3' z a6 CI T R NCH idth Leripth ), No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 7> J L SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufac INFORMATION CHAMBER OR �vf!f�✓ , S ca�lt! Type Of S UNIT _ Model Numb_gr:_ DISTRIBUTION SYSTEM (y �, . P(L- Header /Manifold rf Distribution x Hole Size [x Hole Spacing Vent to Air Intake `� ` Pipe 7 � Length Dia Len th 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 0 Yes [P No [&� Yes 0 No C MENTS (Ind d cod giscrepe ies, p rsons present, etc.) Inspection #1: / / 1 Inspection #2: -- Location: 348 Soo Line Road Hudson, WI 54016 (NE 1/4 SW 1/4 1 W ffvr,, / A 111.1 1.) Alt BM Description =ToP e71 e • � +r• �� `` � 7 • �o A. �' �o U 2.) Bldg sewer length = S-0.10 S) I� - am ount of cover = 2) `0 g S ,,r 'k Planision Required? Yes No Use they sid additional informatioq. Et SBD -6710 (R.3/37) "�� `1� Date Insepctors Signature Cert. No. Safety and Buildings Division Coun '6 1 201 W. Washington Ave., P.O. Box 7162 �q c/ Madison, WI 53707 - 7162 Site Fddress isconsin Departm of Commerce —43 Sop IL,, Sanitary Permit Application Sanitary Permit 1�_ii lber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 3 '7_5�// 7 may be used for secondary purposes Privacy Law, s15.04(1�(m) Check if Revis ic n I. Application Information - Please Print All Information State, Plan I.D. '. u.: Property Owner's Parcel Number A. Prop 1 er's Mailm Addr'eX 2 Property Locatio,_ C ta _jj Z r rriber,_ Z Code Phone Number Lot Nu Subdivision Nan i'o j Aw H. f M&4 4 q kts k AT VP6 0 �t apply) pet F(,Ls At lo,,,,, % 0 1'ranfli y Dwe!!I��ig_,,, f Bedrooms Elvi 0 ri � rci [J Public/Co bi� ' Use ❑ State Owned Nearest Road 56plb 6 III. Type of Permit: (Check only one box online A (numbering scheme for internal use). Complete line B i Jllcl­r :_) A. I )( New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County mc. System I I Tank Only I Existing System B • ❑ Check if Sanitary Permit Previously Issued I Permit Number Date 'd IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) 44 %�Nnn - Pressurized In-Ground 21 ❑ Mound 47 11 Sand Filter 50 ❑ C onstructed iani ? 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ D-ip Line 45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ 0 her V. Dispersal/Treatment Area Information: 5 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate S stein �:ior ;7od Al I . Wm.�- in, Require Proposed Rate(Gals (Min./Inch) Ina/ L i 'ys', L .4 V1. Tank Info "Capaity in Total Number j 6Manfa re. 3 Gallons Gallons of Tanks Concrete Cons: qt cd '11-1s New Existing I Tanks Tanks Septic or Holdin Tank Dosing Climber Vd Z�T /" i!�V VII. Responsibility Statement- 1, the undersigned, asstrme rtspo ability for installation of the POWTS shown on the a i:: _led Pitinf,er's Name (print) Plumber' ignatuW MPAW4MNumber Bas i P,. Plumber's Addrest (Street, City, State, Zip C L VIM Count epartment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is,. Ao, LSi2 t t Surcharge Fee) ps, ❑ Owner Given Initial Adverse Determination __0 Z 0 0 IX. Conditions of Approval/Reasons for Disapproval ���� eleVdZ X Aof e� >7 6 OLO 0 ► 1, 4, ' per Attach complete Plans (to the County only) for the system on paper not less than 8112 x 11't �es In sii SBD-6398 (R. 05101) 01/09/1995 00:20 7152737753 NELSON PLUMBING PAGE 01 U7 /23/01 LION 16:19 FAX 716 986 4846 ST CRI CO ZONING I0001 P < �+R�sH /#&n I S� uu I R -D 4P t o w Aj 1, �! a c i Zp? �� xP 0 H �kr 0 r c 0 U a� a) IJ@AUI — ► co —` —� C _ X > C -- - I co — — O - U) U _ 7C) T Co X CO C Q O UO -0 � j LD r � N U co T 71ffi M 0 V) C O j ? O (� G N it O Q) o � U co J — cn O O ! U7 CJ � - Q = :3 � � � o X -- i Cb U J cz LL C) p) X U L > C I �! T�Ti i o. JJO2 c}n U) C� D - -� 0 ® _ o jL 7 - 0 X, X, C, 11 U 1 , I- Q O ✓J) I I C U CD _ G V M l r L E W CZ v i m Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations "Division of Safety t£ Buikfings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inch,,.e Ian must include, but not limited to vertical and horizontal reference point (BM), c*io� P° o scale or PARCEL I.D. # dimensioned, north arrow, and location and distance toga aFo . APPLICANT INFORMATION— PLEASE PRINT / NFOR� TION D DATE ♦ 4y PROPERTY OWNER: I PAOPE ATION C, B'�l E 17�T1J►J \ S _ r j E 1/4 SW 1/4,S I T ,N,R 1 E( W PROPERTY OWNERS MAILING ADDRESS 1 i � �, K # SUBD. NAME OR CSM # -- 11 O A4. M S T_- �,� 8 G Lp\) L Sfafi W RD 1710N CITY, STATE ZIP CODE PMH1 ER CI ILLAGE ®TOWN NEAREST ROAD B l u A '.( Soo t DI New Construction Use. p j Residerifial / Number of be I ) AddhtiQn to e xisting building I ) Replacement ( ) Public or commercial describe Code derived daily flow 4S gpd Recommended design loading rate - bed, gpolit ° . S trench, gpdfit Absorption area required - bed, 111 9th 0 trench, ft Maximum design loading rate o _ y bed, gpd/fl 0 ' _ S trench, gpd /ft2 Recommended infiltration surface elevation(s) sEIE rJOjia ON P"cGe 3 ft (as referred to site plan benchmark) Additional design/ site considerations �` w'1 M � O 3 ��v e-we , etcA�! S A 6 0' , % `c{-Peu W w Parent material S t CTJ %ftm ejY nV eR '-%k it s Flood plain elevation, if appGicable N •A • ft r s u = Suitable for system COM►wnONAL MOUND IN-GROUND PRESSURE AT -GRADE SWMA �a FILL HOLDING TANK = Unsuitable for stem S❑ U S ❑ U [as ❑ U WS ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsisWtce Bounclary Roots GPD/ftz rein in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Lo jt o -LO 10m 3! C o• S 4.6 s >:w` 2 • to -ZS l0 `1 (2 3 1 J — S i I Z �s bk �� cS — 0.5 a• Ground 3 - `�- S YtZ �l6 — 31 Vol Yn �V_ elev, oi - ft. 3 -62 \(m V_ Si 1 ZM S�k w jF _ S o Depth to 5 61_: tZ)4 V_ q ly limiting facto r U Remarks: Boring # � • 0 - 1oHCc 3 /2. S1I Z'F561rt Wh'�. �g _ v•5 ?0 -l� ,� Z�sbh o.so.6 .s 3 - �•S `t ft y!6 csbk ►�hv��. �•y o. S Ground elev. Cpyv S Qb�fL Depth to limiting factor 7 - 1 - 0 Remarks: T Name - - Please Print Phone: Arthur L. We erer 715- 425 -0165 Address: Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Sgnature: Date: CST Number: ci -30Z- 68 3-Z 3 -q5 M00576 i PROPERTY OWNER T3`f t'f — 5 C*Q ( SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D. # ' Boring # Horizon Depth Dominant Color NIotUds Texture Structure Consistence Boundary Roots GPD/ft t A in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. Bed Trench cOQL O`llZ 3 LZ Si 1 2 sdk wt� ►. Ct.`, v,5 0. 6 , -ZQ \u -313 _ S • 1 2 s o. r, S Ground 3 - - S `iR Y/6 S ) hvJ S yr CS — �•�( O.S elev. a6zj,ft. y qzsb - Xo �t2 3l6 Depth to S • S$—'13 0) `f, R- Y l .. O S 1�f — u •7 •`. 0 . 43 limiting factor Remarks: Boring # 2 a •Z. S �b — Sl I Z `Fs v►� �M G o . S o. 6 ,� Ground 3 2 S -�l 7- S IZ 3 l — S Z-rn S b>� wi 5r `�.. t.�, n , S o• 6 01 69-S ft. �o •s ��tz 3l — sl 1 �Sbh yvt'�t" - 0 •v o.S Depth to limiting factor Remarks: Boring # f<y:r;; 1 o -a 101 \Z 3 tZ — S t'l Z +��,. C — �•S �t,�KQ X113 — S 1 Z 'ES b k 1�ri `F �. — n S:: Ground elev. C1 6S•1 ft. Depth to limiting factor ` Remarks: Boring # KS nit 1 -3 �- 4 5 v >= t�►v S ctp UN Ground �` ft. Depth to 3 OF Z•UU S L.. limiting factor -77 Remarks: SBD- 8330(8.05/92) PLOT PLAN Pa 3 of 3 SCALE 1 "= L(0 ' V33.�Lp' 1 zo' U)nul1Y � � 0 � 0 eLgS9`! \ N\ - %V1 L L.0.ua.C6 Z' w E}L \ \ o Z \-RA tv P1 QE 3 � �i � T1 R L Vt*L 96y 4 1 J�0 � 1 J i Lor � 30' tn -g6a s I 1 NOTE: House to be at least 25' from trenches. Well to be at least 50' from trenches. NOTE, TO INSTALLER: Place trenches 24" deep at the downslope edge. Determine trench elevations at the time of construction. 1 3V -302 _ 68 a 3 — Z3 _9 5 ( 715 ) 42.5 -M 65 T100576 T CST Signature Date Signed Telephone No. CS # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 labor'and Human Relations Division of safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code . COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVI ED BY DATE EW PROPERTY OWNER: PROPERTY LOCATION C. M- t34 E F11~ �j 1��1J \ S S C L Z t - N Z 1/4 SW 1 /4,S It T Z8 ,N.R 19 E( W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # - 11 1 0 N • wt AM % 7-, 68 1 — GWU C12. Sm W L) - 1211 ft bI CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD RLUI. v- Po-L5 -ij -S (1LZ. (71S) L IU- I Soc 1..,WZ RAkU [S(1 New Constnlction Use.pd Residential I Number of bedrooms 3 [ 1 Addik� to eirsting building [ 1 Replacement [ ] Public or commercial describe Code derived daily flow 4S0 gpd Recommended design loading rate bed, gp(W ° . S trench, gpdAt Absorption area required - bed, ft 'go O trench, ft Mha)amu m design loading rate o"q _ bed, WW - L S trench, 9010 Recommended infilliation surface elevations) See MQTe oN Pt't6E` 3 ft (as referred lo site plan WchfnaN Adutitional desitpt / SIB ax>siderations `Z�� Qti'1�'t Q 3 'cam ��,+ tteS.C.1� S 'K Parent material S ICM SM114 $JT uV M '5 ' 11-L 14 s Rood plain elevation, if applicable N - . ft S = SUMe for system COM►eMNAL MOUND "MAID PRESSURE AT•GWE SYSTEM FILL I HOLDING TANK U = Unsuitable to ®S ❑U 0S. ❑U us ❑U [4S ❑U ❑S ®U ❑S ®U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consislonce Bourifty Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mach [ 3_t0 toI2 31Z sit Z w► V' cLV o. S o. 2 to - ZS LO�(R3l� — Sil Z �sbk �� C-S — o•S o. b Ground 3 Zs- - KtZ �l16 - S 1^► S�{rt 1rn � H cS 0 •`I o� S elev. q - 4 ft. Depth to 5 6Z 1D t04 R Y 1 y - S O St 0 1 n • 8 limiting factor� Remarks: Boring # 6.1 1py(Z 3/Z S1� Z�sb1 wt`Fj,. S 7` 5 cS _ o.S' a.6 3 Z S4 Y14 — S1 l � Sbk k�v`F4 _ a04 Ground elev. C>,w S - kS Depth Q`6� ft to limiting faclor Remarks: TName.— Please Prat Arthur L. We erer Phone 715 - 425 - 0165 - Addres e erer Soil Testing & Design Service -P.O. Box 74 Rive Falls,WI 54022 t Signature: Date: CST Number: -30Z- 68 3 - -1-3 -95 M00576 PROPERTY OWNER Q`t t�! — Ct �-TZ SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmrdary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTrench ( z) `O`-t cZ 3 L i 1 Z s t,k 'At - R i. Cu Oz. z g -zo m w-t.R --31 — s 1 2'(L dk Y., - Ground 3 lk Z v V4 cS - o•V o•S elev. o , 5 Q. b a 6?.1 ft. y 44Z `'tR - 3 S 1 � Z in sbk \M L� Depth to S S$ - •'13 L(,1 `1. tZ- Y IV O s ol 1 '''1 I — 7 U • `d limiting factor y 73 Remarks: Boring # 5 L ` Z `FSb w► 'FF� C $ o . S ; o. 1 ( -9 tk3 2 3 [1 1 0 9 2 1 , — 3 Z S ,y - 7-s4 vt -31V 3 Z.t,1 S brt ►*7 `El- oR t. — o . S I o • 6 Ground elev. �lZ � o � . S L1 �t 3 ! s I 1 C S'D ►rt 4. - o . � 0.5 O M-s ft. Depth to limiting factor 7 ZO Remarks: Boring # o Vz 3 c z S o• b u `-t Q 4r l3 - S 1�1 Z s dk 1M `��- �. - v • s o, b 3Z�o �•s'I2 Ground elev. x 65.1 ft. Depth to limiting factor z 1o'' Remarks: Boring # v l S d ON Ground elev. 2\4 - «v ft. Depth to OF- - "O U S L limiting factor - T - 1 7771 Remarks: SBD- 8330(R.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 4o 1 - Z-CS' UnctY T 1 � � 0 \ 0 \ C %-'I — (EL 9 L18 . %Z coo ' � '� ��e s --�' \ � •� � �M - fit. �► S�. 3 6 aN g2 1 i a.3 LSL 96 `! � -y s 1�'L C1 S 1 NOTE: House to be at least 25' from trenches. Well to be at least 50' from trenches. NOTE TO INSTALLER: Place trenches 24" deep at the downslope edge. Determine trench elevations at the time of construction. 9 3oZ _ 6a 9 5 ( 7 _4 2S- Sl_Ln5 TRI 0 5 7 6 C # W F CDEFcER E3 C3 I i_ TEST I PAGr P.D. 801 74 421 N. MAIN ST. AND RIVEF FALLS. W1 54022 F I? E S I CG" E3 E FR V I C E 715- 425 -0165 ATTN: ' G �'� DATE SUBJECT: WE ARE ENCLOSING THE FOLLOWING ITEMS: NO. OF COPIES DESCRIPTION 1 O '�'— [ 61 nJ `Pc �-- 6tIj L `, Y D }_ SENT TO YOU FOR THE FOLLOWING REASONS: ❑ FOR APPROVAL ❑ APPROVED AS SUBMITTED [] INFORMATION DESIRED ['FOR YOUR USE ❑ .APPROVED AS NOT ❑ RETURN COPIES ❑ NOT APPROVED ❑ FOR REVIEW AND COMMENT ❑ WEGERER SOIL TESTING AND DESIGN SERVICE Combination Sept�:ic:Tank and PUMP CHAMBER CRO55 SECTION AND SPECIFICATIONS - VEUT CAP WEATHER PKOOF • JU►JCTIOIJ DOX ti`C.I. VEMT PIPC APPROVED LOCKING ZQ' FROM QOOIC, Mti>JHOLE COYER wlV WAAtJII.JG LP.6E� �8P 10.1 'PIPE ',l�R IM TA FRESH K E avzDUIr A�tuK � w!r'rtR�lsttl' ZrsP 1 IB'MIi1. PROVIDE 18�1'tlfl.\ ---- - - - - -- i ., I -'- -- Pi Il`!LE T /� 16-)D AIRTIGNT SEAL i I L' A . I III APPROVED JOIiJT. Z APPROVED JOIIJ PtB�L Ft� }Z I I I I W/C.T, ? W�C.I. PIPC�R Tank construction I it shall comply with . 11 ALARM TLH ;3.15 and 33.20 ° I • I I vu C, I I I PUMP � OFF D COrJCRETE DLOCK 3 • APPS•: RISER EXIT PE.KMI"T1'EA 01JL'J IF TAWK MAUUFACTURER HA5 SUCH APPROVAL BEpOtNG SEPTIC F SPECIFICATIOUS DOSE + TAWK5 M AQUFACTURCR, C- � 1 , 4zs�-_7t ( 32j UUMbER OF DOSES: PER Dxtl TAk1K SIZE : J v ! - GALLOWS DOSE VOLUME ALARM MAWUFACTURCR: SS ��- �� SLIMeI i�C�UDIUG 6ACKFLOW:� GALLONS l Q L N CAPACITIES: A �ZWCHC5 OF, !_S GALLOU5 moor-L NUMBER: � 2 3WtTCH 77PL: ��Z�� 6= Z IuCHES'OR ��LLOUS PUMP MAUUFACTURCR: �� —S C= IUCHES OR Z�LALLOUS �j �� J MODEL NUMDER. [! D=�iNr-HES OR _21� 73LLOQS . SWITCH TYPE: WTE: PUMP AMD ALA ARE To OL MI1.(IMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREIUCF DETWCCU PUMP OFF AQ0..015TRiBUTIOU PIPE.. EET + MINIMUM NETWORK SUPPLY PRESSURE � � FEET + _3.0— FE OF FORC MIN X T✓_ L Y0 fLFKICTiOW FACToR.. c `" FEET TOTAL OyQAMIC HEAD = FEET As per,manufacturer. 16 ,1 gal /in. f o V Al �f M E40 Series �® 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to W 30 W U- H 25 8 E Z Q 20 6 J h 15 Q H — -- — 4 O 10 ~ 2 5 0 L 0 O 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.I.A. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerMuyer C Men— Mailing Address Property Address ' )06 ► Y1 ©0.� (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIJPTION Property Location A]& 1 /4, 5 Sec. T 9T-Rj__/W, Town of Subdivision 6 0 U 6k )4A D A !O �-�ff �`�D , Loy # Certified Survey Map # )_ // Volume , Page # Warranty Deed # t' >�^/� , Volume - Page # / 2.. Spec house ❑ yes )9„no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Pro per maintenance; consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the o ner and by a masterplumber, journeyman plumber, restricted plumber or a licensedpumper 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 null o sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system w j =- the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stafpg that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da s of e three \V,5_ ate. SI NAT OF APPLICA T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the ope described above, by virtue of a warranty deed recorded in Register of Deeds Office. r E � /� D1 / SI A OF APPLICA T DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) YO v Septic Tank Capacity (gal) z �d Soil Absorption Component Size (ft) Type of Wastewater Domestic Table 2: Soil Absorption 4thponent - Limits of Reliable Operation eptic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the J . Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 06 Nis rJ 275/' 6�7 Cov rvI 3 - YO 3 ` Voi. 1605PAGE442 STATE BAR OF WISCONSIN FORM I - 1999 Es�1s 1 O 17 WARRANTY DEED KATHLEEN H. WALSH Documem Number REGISTER OF DEEDS ST. CROIX CO., WI r This Deed, made between Dennis R. & Sandra C. Schultz kECE.VED FOR RE CORD Revocable Trust, Dennis R. Schu tz an ra C. Schultz, Trustees, bot with u power of or encum rancing, 0 - :c 2001 9:30 AM WARRANTY DEED Grantor, and Christopher J Vnak and Julie B. Vnak, husband and wife EXE"PT N as marital survivors p CGF :" FEEFr: property CERT FEE: " TRkFER FEE: 240.00 RECORDING FEE: 10.00 Grantee. F'P.6ES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area LOT SIXTY EIGHT (68), GLOVER STATION FOURTH ADDITION, Name and Return Address TOWN OF TROY. It CROIX VALLEY WME SERVICES, W- Together with easement over part of Lot 45, PO BOX 750109 N.MMNST. Glover Station Second Addition as described RIVER FA" WI 54022 in Volume 1471, page 152, as document AJ�z number 613906. 040- 1230. 30-000 Parcel Identification Num her (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. NrJ (is no[) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, and rights -of -way of record. Dated this 15th day of January 2001 5 is R. & Vdra C C. Schul Revocable Trust • Dennis R. Schultz, Trustee ' ( • * Sandra C.Sciultz, Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. ST.CROIK County ) authenticated this _day of Personally came before me this 15th day of January , 2001 the above named Dennis R. Schultz and Sandra C. Schultz TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the �eYSoiy`�s�'Vritq executed the foregoing insir ent a acknXtd4 e II?�'t;gme• authorized by § 706.06, W is. Stats.) wYltClC4 + � Y THIS INSTRUMENT WAS DRAFTED BY Pamela A. Sko rll@ � '1 Steven B. Go1T, Attorney at law Notary Public, Ste O f W i SCdnT, n River Falls, Wisconsin 54022 My Commission "IS ojt, state expiration date: rc (Signatures may be authenticated or acknowledged. Both a not necessary.) March 17 - 2002 ) ' Names of persons signing in any capacity must be typed or printed below their signature. C Ftnto main Vrgtassionals company, Fond du Lac. wt STATE BAR OF WISCONSIN 800- e552021 WARRANTY DEED FORM No.I .1999 r CD Ji i p i; q r l l 2 5 y o ,( 0 NOn + � d0 p V N j 9 O 3 Q °oaao <O �' �Q z3 � �V /. �6{ � ��� < yJy+� {J !x•1.7 � �� w F»• Iej' I R I = 4 � \ � i g q �O� J ;�N� gg�Q 0 0 �p w o H O1 j , j �, � '^ j ' r � ' ���� >Oy � �M ZZZZ3333��� ^y� gpp-M � ifl P 7 ��T�TT... 1 c in't��ci � �t r \ d. }}yS . 61yy Syz 'At . amumin 'a > ' 0 co w OD I ZN r � r ��� � •�• -•.. �� �� � �� L i v art l,A «w�w, W I LLI [ I i T o t J t 1 ,aum .n LU t j V1i \ \ sS t t t ! ! .. » ......................... / ?rose. . in F— Yt ' j br ? � ��\ � ti 3 � �� _�•��• � 8� / � Q 3 s 33 fl 333 l 3 s 33 33Y3 3 333 ) W)WY \ ,, LLI L, af» k L Q �.�� ` � J \ pgNS ggqpqpqpq NS FNSNN SSS = SSSS °� �� 6l� aa \ \ \ \� \ j ,�`� f373,3f))3fi � 33 ggzz......sgqzzzzzszszsszzz 1 l � .�� )3 � b � pagzpggqqpqqpzzzzssqzzasazz Y Y r Q1 H : 3���gS�O� rN , �te Oki 8 h-N — — ..... x • • C e i i r/l AS 3H1 .10 f/1 w 311 A 3M7 153M zK � ti� ��� `�� � �,��f�f �/ ��s- ��) � . 0 : c a, o tv , � m � R ; ■ � # C a: 6 � 2 T ■ � } A Q! $ ( [ ° 7 \- < _ k 5 �_ E - 3 ¥ 00 0, / ■ @ £ § ƒ ( ? k 2 $ � , _ &; § x /32 c J! /§t ■ E E / 8 r r w © 2 @ ! > 2 % & � m e :!� � R @� 2 i 2 �_ _ = 8 ° O -4 Z ® z W k C % � ox o r CO) / } ic & & - o } 0 0 0 \ ro i o Oro � § § _ } £ § » ƒ 0 $ E v v i m D e_ @ Im \ / % � 2 { \ m z < / £o \%) 0 \ 7 § 2 � [ @ C / k / m z § 2 @ 6 w CO a + w f 0 k 0 .. } m ■ » g E § / 2 0 ; m � E § CD CL z ( / 4 Ek CD < 2{ CL G $ \ ` Cb ; \ � 7 . � . � t 0 » G t \ _o # 0 CL �4 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395117 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 Holders Name: City Village X Township Parcel Tax No: Vnak, Christopher I Troy Township 040 - 1230 -30 -000 CST BM Elev: I =*90 BM Desc ription: Sectionrrown /Range /Map No: qS�- UP CST g1M� 1 16.28.19.1133 TANK INFORMATION ELEVATION DATA jvb.tsG. T.53 (A.) g9 = TZ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P Benchmark -A-1 (4 I Dosing Alt. BM t.� Aeration Bldg. Sewer 3.41 Holding St/Ht Inlet b•I� TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > I �2 / Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover M Model Numb TDH Lift riction Loss System Head j1111 Ft Forcemain ength Dia. Dist. to Well SOIL ABSORPTION SYSTEM z 3' X GfilliCTRFENCH7 Width eqgt h )'� No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM � r SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manuuf INFORMATION CHAMBER OR (l t�o�Fsr Type Of System: _ I UNIT Model Number:_ DISTRIBUTION SYSTEM Header/Manifold rl Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe Len 9 th � Dia � Len th Dia Spacing tjp0 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 Bedrrrench Center Bedrrrench Edges Topsoil 0 Yes A No Ej Yes [N No C��Nclq�code c(Lscrepe ies, p rsons present, etc.) Inspection #1:// �L Inspection #2: -- Location: 348 Soo Line Road Hudson, WI 54016 (NE 1/4 SW 1/4 1 W Glo 1.) Alt BM Description e� �su�J 4 hh-+0+ I S e&/' 2.) Bldg sewer length = Sb. Y7 1) I( tO " = - amount of cover = .2) �'s = g � & ' ° Plan�ision Required? 0 Yes [] No Use thers id informatio _ SBD -6710 (R.3/97)T - ����` Date Insepctors Signature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395117 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: Village X Township Parcel Tax No: City Vnak, Christopher Troy Township 040 - 1230 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI S ELEV. Septic ^ �L I s 0 Bench mark • 3�0 Dosing w Alt. BM , Aeration Bldg. Sewer Holding St/Ht Inlet O TANK SETBACK INFORMATION St/Ht Outlet (o •Sb 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 Manufa urer Demand t Cover GPM Model Number TDH Lift I F s System Head TDH Ft Forcemain L Dia. SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 t 3 SETBACK SYSTEM TO P/L BLDG WELL- LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ... ( t . UNIT Model Number: t DISTRIBUTION SYSTEM { S- /L Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake 6t Pipe(s) Length gt Dia_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Ovetj'"` Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ICI Yes [ No [] Yes 1�� No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0 D Inspection Location: 348 Soo Line Road Hudson, WI 54016 (NE 1/4 SW 1/4 16 T28N R19W) 16281,9113 Station Addrt IV Lot 6 1.) Alt BM Description �-��'-^ t " s i 1 Ci T 2.) Bldg sewer length = S V � �� �p. �f� g' 30 > ("0' -c� - amount of cover = 31 A - -(w': �'� - -T } �• L � `� - Plan revision Required? Yes No -8710 (Ride 7} _ or addi infprm -tiop. �- - -- — - - -- - - -- S¢�,.C/ w tQ.t� Date Insepctor's Signature Cert. No. 496 t r ----- '' �� --- D�.3�91 ------------ - - - - -- 201 W Safety and Buildings Division County C �(It 8 t' W �, W. Washington Ave., P.O. Box 7162 .5� eonsin Madison, WI 53707 - 7162 Site address Department of Commerce Sanitary Permit Application Saniary Permit N it;,ber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 3111 may be used for secondary purposes Privacy Law, s;15.04(1 m) ❑ Check if Rei islcn I. Application Information - Please Print All Information State Plan I.D. ?- -umber Property Owner:� V Parcel Number /6. ZA (9 to - ? Prop l ,' per's Mailin Add Property Locatio .�, C ,Mate l � � Zip Code Phone Number Lot Number 3 t,,,k _lh ;uoc w(.0 Subdivision- — c �. :; Co u X II. gE o we k t B edroo ms ✓ ok- per f,�,,S Ski(Or„i,�tr ❑Cir,, o I^�amily Dwell_$,� Use f Bedrooms _ ❑Village__ .i 17, El blic /Co ci Pu r — - - �ow nship ❑ State Owned Nearest Road sda Ltn�� JZp M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B L , liea A. 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use. Sys m nIssued nk Onl Existin S stem B • ❑ Check if Sanitary Permit PreviouslPerm it Number fV, Type of Permit: (Check all that apply) (numbering scheme is for internal use) 44 *" - pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 5o ❑ C onstrucled an:, 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Dt Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ 0 her V. Dis ersal/Treatment Area Information: 5 / G D esign Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate S s / tem ;: cior Requir s� Proposed Ra[e(Gals � ' /Dys/ t.) (Min. /Inch) 6� o- VI. Tank Info Capa ty in Total Number Manufac re Prefai Si_ i Gallons Gallons of Tanks Concrete Cons_t , d i I New Existing Mo Tanks Tanks Septic or Holding Tank - -- - - Z5a Dosing Chamber P P Y fined, assume res o ibili for Installation of the POWTS shown on the a ted h :.. - VII. Res onsiblilit Statement - I the undersi p t 1 Pl is Name - - (Print) Plumber' ignamre MPRrfPR'SNumber Ba <_ ; •: - , . -. A lulis Addre (Street, City, State, Zip C LLB VIII. Count /De artment Use Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss.. Ao:,, ,.e Surcharge Fee) ❑ Owner Given Initial Adverse . Determination _� Z 4-s 0O 7 4 1X. Conditions of Approval/Reasons for Disapproval 'J t/ .. l 5ys)1 e ' Xa.ay "f eX7(ew� > r 4v �C th5{zt// r ✓ J{(UW Or9r`na,l y' ✓��, �/ av d Se r /� 1 .fie Mar�.1,� ta�G°Ckre �5 VPCOGt1/vt �"st,T`i01�- S. Attach complete Plans (to the Count? only) for the stem on — sy paper not less than 81!2 x 11 . aches in sc,c SBD -6398 (R. 05101) 01/09/1995 00:20 7152737753 NELSON PLUMBING PAGE 01 0723/01 MON 18:16 tAa 716 See 4880 ST CRI CO ZONING 0601 plof P(-4tj � H - RAfHNelL l A1 6x 5 { o I lo' t uu I cj Z" 9 m