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HomeMy WebLinkAbout040-1084-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division, I ' Sanitary Permit No r INSPECTION REPORT 404920 0 ATTACH TO PERMIT) GENERAL INFORMATION ( 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: Duclos, Gary Troy Township 040- 1084 -20 -000 CST BM Elev: Insp. BM Elev: BM cription: I 5 f (.4 DT' Cwt TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Be mark, v Dosing I ) Alt. BM (Il ' Aeration - Sle wer )" r 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 ttom Dosing Header /Man. Aeration - -- - - -- Dist. Pipe i Holding Y PUMP /SIPHON INFORMATION I r1 �' �' Final Grade Demand t Co er Manufacturer r r, 4 GPM Model Number TDH Lift Friction 49ss System Heasi TpH Ft Fo[cemain Lenq� I Dia. // Dist. to WPll - t L i 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 L CHI Manufacturer: INFORMATION T S stem: CH R OR YP Y i f ,_4:e � . j&1"-'- r _ i ; (., -rte UNIT Model Number r/, real — DISTRIBUTION SYSTEM — Header /Manifold — t 'butior�'1 I x Hole Size I x Hole Spacing Vent to Air Intake ff I Length Dia Len Dia Spacing SOIL COV ., x Pressu Systems Only xx Mound Or At - Grade Systems Only Depth Over ver xx Depth of xx Muiched Bed/Trench Center Bed/Trench Edges To xx Seeded /Sodded psoil Yes No 1'e,7 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 237 Townsvalley Road Hudson, WI 54016 (Unknown 21 T28N R19W) NA Lot Parcel No: 21.28.19.332A 1.) Alt BM Description 2.) Bldg sewer length - > _✓ I r 1 I ir ; G -y �'I i f - amount of cover = j/ 3.) Contour Plan revision Required? Yes o Use other side for additional information. '' �'-' -' Date Insepctor's Signature Cert No SBD -6710 (R.3/97) S '\-- --- Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 1 , Q,0 / *is6oj�"',n Madison, WI 53707 - 7162 Site Address Department of Commerce e/i , S - a-'3� �� Sari itar PP Permit App lication - Sanitary Permit Number �o Zo In accord with Comm 83.21, Win. Adm. Code, personal information youpmvide ❑Check if Revisi In ay be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number 2— Property Owner's Name Parcel Number ( I( . 2 • � . Gd-(14 (9 qv —1 Property Owner's Property Location nn 92 S ' reisi7'.,: SE'� S Td� N. R/% �!J City, State Mp Code Phone' Number Lot Numbe Bloch Number p t , Subdivisi Nam CSM Number Ir � II. Type of Building (check all that ap ❑City ❑ 1 or2 Family Dwelling - Number ❑Village ❑ Public/Commercial - Describe Use Rrownshi p T ❑ State Owned Nearest Road i M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable A. 1 ❑ New 2 ❑ Replacement System 3 b Replacement of 6 ❑ Addition to For County use stem Tank Only Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that appiy)(numbering scheme is for internal use) �'t0�� �� C � 4M bt r l� �Lt PC 44 ❑ Non - Pressurized In -Ground 22 Maud 47 ❑ Sand Filter Co Wetland 22 ❑ Pressurized I*Qvund 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Area Information: Design Ft -d) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min.Anch) Elevation Q Si e a h4 b A24 JIP P VI, auk p Capacity in TWd Number ac r Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New E%bft Tanks Tanks Septic or Holding Tank ;K _ e Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for POWTS shown on the attached plans. Phu 's Name (Print) Signature MP Num J Business Phone Number Plumber's Address (Street, City, StW. Zip ) VIII. Coen /De artment Use Approved ❑ Disapproved Samtary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner en Initial Adverse Determination • I.Z Z ` I%. Conditions of Ap:p= for 4ffisaroved Arlene complete plane (to the s*) fee the I m paper not lets tiros 81/2 nacho m size SB 39 (R. 05101) _ I� PLOT PLAN •Page 3 of -] Scale 1 " = ' FL�v GE M'1 ,? p S ` �� �, - �R- �sT l►� G ri ov N� I ' NZT C R PU P � ��r Z`e l / / Y � , — ' - - w�-L =CS ? -5 0'_ �� 011= F� DU)� �13� — ?Z S - � ���-► `Ti1?�12s - - -- - - - --- NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required).. 3. Septic tank to be 100c_ gallon capacity manufactured by k• / sTI�-100 Sim l T< 4. Bench mark S rMQB Uk- 5. Divert surface water around system to prevent ponding at the uphill side. ' Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �scons►n A _ www.commerce.state.wi.us/sb l , www.wisconsin.gov Department of Commerce Scott McCallum, Governor hilip Edw. Albert, Acting Secretary / C � January 02, 2002 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL. APPROVAL PLAN APPROVAL EXPIRES: 01/02/2004 Identification Numbers Transaction ID No. 699392 SITE: Site ID No. 633571 Duclos, Gary - 237 Townsvalley Rd Please refer to both identification numbers, St. Croix County, Town of Troy above, in all correspondence with the agency. N1/2, SE 1/4, S21, T28N, RI 9W FOR: Description: Three Bedroom Mound System - Maximum Occupancy 5 People or 378 gpd Object Type: POWT System Regulated Object ID No.: 825274 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with portions of the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • 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. • 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 construct ion/instal lation/operation. Owner Responsibilities: • A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The owner shall notify the Register of Deeds office that the system is sized per capita. Per Section Comm 83.22(2)(b)3, Wis. Adm. Code, this fact must be recorded on the deed to the property. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. ARTHUR L WEGERER Page 2 1/2/02 • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ` Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)789-7892, Mon - Fri, 7:15 AM - 4:00 PM WiSMART code: 7633 jswim@commerce.state.wi.us I� r TITLE SHEET Page 1 of 7 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE W/ 5 persons maximum occupancy This plan has been prepared in accordance with portions of the Mound Component Manual SBD- 10691 -P and portions of the Pressure Distribution Manual SBD- 10706 -P and with the requirements in effect at the time of installation in 1992. The existing 1000 gal septic tank will remain in place. The existing syphon tank will be abandoned as per code and replaced with a 750 gal pump tank containing an STF - 100 Sim /Tec effluent filter. The mound component will remain in'place with no modification. LOCATED IN THE 'l Z OF THE 1/4 OF SECTION Z1 ,T ZS N,R 1 W, TOWN. OF ST'• QAZ.OIK COUNTY, WISCONSIN. INDEX PAGE l of 7 TITLE SHEET` PAGE 2 Of 7 SYSTEM MA NAGEiMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR RECEIVED DEC 2 6 2001 cLOS _Z3 TDr�raSV A - L�� . LZOtt'A SAFETY & BLOGS DIV. PREPARED BY P.O.W.T S. I conditionaly R< aF2 !S C3 I L . TEST S nt CS R OVED DES = ' CSM ARV I c: = A P P.j +: DEPARTMENT Of COMMERCE P. O. $0x 7 421 N. Main St. BUILDINGS River Falls, WI 54022 ��`" i I DIVISION O F Y �, P f9 EILSVSORT� ne 715 =425 -0165 ORRES DENCE Fax 715- 425 -6864, SEE C 1 Z - r Mound System Management Plan Page L of 7 Pursuant to Comm 83.54, Wis. Adm. Code 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. 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 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 sludge and scum in the tank exceeds 1/3 the liquid volume of the tank, If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L 8005, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. distribution system is provided with a flushing point at the end of each lat r mended that each lateral be flushed o ac ast once eve en a pressure testis performed should be it ho N • compared to the initial test whe is 'fice clogging has occurred and if orifice cleaning is re ufr ua distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual arid local or state rules pertaining to system maintenance and maintenance reporting. '9 @0 -��jbq E — v. No one should ever enter a septic or pump tank since dangerous gases may be present that could�cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be Immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning -Office at _ - 1 l S - 3 �`6- t-16 60, S'r• L -�LULX The system installer at 115= yZ$- 9qS$ WP�UG The tank manufacturer at pb _3ZS - ELLS L w.� The effluent filter manufacturer at _ ��$— L gQ - 3Lgy SlI^ -1 I TCC The pump manufacturer at r PLOT PLAN Page 3 Scale 1 "= of n �L�v CE .0 M 0 0 Q O �-tST S�ttiC U �b i i .r AN i ! Y M ! L2 a�i Dtstv�za x - Z3'I 1nw�,,sv� 2p r�luul.�� — Gv�l' S3'_. Z_.$ A'_.- �7: O. Y7 :_F�bu1�:- :Z3�� J ?zs- � 1%�?o� -j `il•�.s -�__— _- _ - NOTES: I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required)., 3. Septic tank to be 10. Ob gallon capacity manufactured by 1Nl���Z Cc»vC°_�L �t1S��G��1P - To RE `1SOGnt_ I,vt w, ST�ibq 4. Bench mark • gem Il�moUt S►M et%C . PhLT%M 5. Divert surface water around system to prevent ponding at the uphill side. Page Of -7 Approved Synthetic Covering ASTH C33 Mediun. Sand Distribution Pipe Topsoil _ - - -- - -- H - -- - - ' —�c _l 3 E i W � 6 /o- S lope Di s•tribution Cell of t=orte Main Plowed 2" to 2 % ". Aggregate From Pump Layer (undisturbed D 1.0 Ft Soil - -- E _ Ft. Cross- section of a mound system using F p, Ft. 2 cells for the absorption area G 1.0 Ft. A 3 Ft. y 1.5 Ft. B �.3 Ft. C S Ft. Linear Loading Rate= 3.57GPD /LN F I Z C) Ft. Design Loading Rate= — _.GPD /SQ FT J 8 Ft.. 4 • Zy - h S to 4E e4 C_ - 1 b _ Dvwty 0_e K 10 Ft. _ .. ... Force Main � D 83 Ft. W 4 Ft. L T F" I'L bservation C - (M . c hbr s securely) — w Distribution Cell of 2" to 2- Pipe _ . ag gregate . .. Q gregate . - l Plan view of a mound system usiq 2 cells for the - absorption area Distribution Pipe Layout Pzae 5 of 7 Place the holes at the bottom of the distribution pipes at' equal spacing. Remove all burrs from the pipe and holes. Extend the end of each late -al Up with the use of long tumor 45 fitting to a point within six inches of the final 9:ade. Teminate the ends of the late.als with a valve,:threaded can or . threaded pIU& Provide aces from final grade for the valve; threaded cap .or threaded plus. 7. F 1 cr L C\ s C. r- \4C wC Lateral Manifold Lateral X �Ute lral z Xa Xa z x z x `P Late ral Length — Distribution Line \� LZ'rN N MEW S "• � � Q�� h1�1J F = Ft. Mole Diameter I !Y fnch S l 5 Ft'. Lateral ° ' 1 I IV . Inches) X y0 Inches Manifold n 3 Inches Force Main " Z Inches #of holes /pip Invert Elevation of.LateraTs 6.5 Ft. PUMP CHAMBER CROSS SECTION AMD SPECIFICATIONS ' PAGE OF �] •' VE)WIT CAP `I"C.L VENT PIPE WEATHER pK JUIJCTIOW 80X APPROVED LOCKING MANHOLE � � - 10 FROM DOOR, COVER WITH WARNING LABEL fi WIMDOW OR FRESH IYMILI. I AIR INTAKE I GRADE H' An J. � •�. 18'Mlu. Co1JOUIT �' -- WAIN. v � - - - -- -- N IMLET PROVIDE AIRTIGHT SEAL _ I V APPROVED JOIIJT f - A 3- N$TAL-t- APPROVED JOINT I I S �?v -`TIE bl S Cti P�LGE ALARM e ST ••.� - i 1 oN • i I - - uiv. 3? PUMP ' .� OFF 0 - !=L-tZ\� • CJZ. 00 4 COWCRETE BLOCK RISER EXIT PC1tMITiED ONLY IF TANK MAIJUFACTLIRCR HAS SUCH APPROVAL 1LAD01 S2o1 SPECIFICATIOMS Dose T , 1N l�i�1 COKI--n _ MA�JUFACTURTrR. MUMBER OF DOSES: S -Q) PER OJ►y Ca378 6 PL TANK 5I2L: DSO GALLONS DOSE VOLUME Z ALARM - - P-- 4,YUFACTURi`R: - SZIE-�Io 3L INCLUDING 6ACKYLOW: GALLONS AODEL WUMBSR: I Ol Hlw CAPACITIES: A=' 6. WCHES09 3 �u'� GALL0143 SWITCH TSFC: 5 = - INCHES OR L ' d' L GQLLOLIS PUMP MANUFACTURER: GOV L-k,3 C = y I N CHES OR �' ` GALLO MODEL NUMBER: 3 $� ��V � 0s . is _INCHESOR 3o Z GALLOAIS SWITCH TYPE: - I"�LS'2CuR� 1 wrtqL= -15 -. L/ IJOTE: PUMP AMD ALARM ARE TO BE MIWNAIIM DISCH/kRGE RATE (;PM INSTALLED OM SEPARATE CIRCUITS VERTICAL DtFFEREIJCS BET WE WEE PUMP OFF R PIPE.. 3 FEET t MINIMUM NETWORK SUPPL. PRESSURE ..... , ... , . 3 ZS .FEET r2-- Sal, 3, + 3 O FEET OF FORCE MAIN X , Fy 100 ►tFRICTIOU FACTOR. 3FEET :...•. yam_ Y•: _ _ _ + I TOTAL . Oy AM IC HEAD' = �•- �'�`3_.__=- �_�; -� -- - ~'_• �-. —_ FEET tl As per:Qanufacturer - 2, 0. 2 6 - gal /in. Liquid depth 37 r - Y • �^�.� P�•F���J �v�.v�. �sE � or 7 Goulds Submersible Effluent Pump 38 EPO4 EP05 APPLICATIONS Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Motor: Available for automatic and •Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical RP M, points. • Water transfer - , over built in 230 V, v Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty 9 • Dewaterin RPM, with preset at the factory. rated oil and water resistant. _ automatic reset. ■Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: FEATURES heavy duty ball bearin i 15 V, 60 Hz, 1550 RPM, g Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo construction. • Solids handling capability: automatic reset. plastic Semi - open design /4" maximum. • Power cord: 10 foot AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for mechanical seal rotection. - •.ptal heads: up to 24 feet. -with three prong grounding p o. Canadian StandardsAssociatton discharge size: 1 1 /2" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for improved performance. end in "F" or "AC ".) m rotary/ceramic- stationary, .three prong grounding plug p p BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 0 F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 '- components. I i -► 5GPM Pump: EP05 s ` • Solids handling capability: c 25 i 3/4" maximum. a Capacities: up to 60 GPM. s 20 f • Total heads: up to 31 feet. 2 • Discharge size: 1 NPT. z 5 - — • Mechanical seal: carbon - a 15 rotary/ceramic- stationary, a BUNA -N elastomers 4 EPOS Temperature:. 3 10 r 1040F(400C)continuous _ 3 ^ 140 °F (60 °C) intermittent. 2 u6� r '. 0 0 0 10 . 20 - 30 40 50 GPM i 1 -r - r 0 2 4 6 8 10 `s "" } 12 CAPACITY 1 � ©1995 Goulds Pumps, Inc. Effective 5 May, 199 , 199 12!21/01 FRI 14:27 FAX 715 38E 4687 REGISTER OF DEEDS IjoUi VOL PER CAPITA OCCUPANCY KATHLEEN N. WALSH REGISTER OF DEEDS Document Number Document Title S'; . CRDIX CO. , WI The existing POWTS own ;d by Gary and Marlene RECE10 FOR RECORD I7uclos located in Sect _on 21,1 Town of 12 -20 -2401 f:45 Pig Troy, St-Croix County, Wisconsin (see attached ;iISCELLANEGI& description) was insta -led in 1982 in accordance EXEMPT y with plan approval No. 8200250 dated Feb.15,1,982. �f;?IT COPY FEEe COPY FEE: TRADER FEE; The absorption area is 378 sq, ft, and based on the RECORD -10 FEE: 13.00 code now in effect is )citable for 378 gal /day of ,AGES: 2 effluent. COMM 83.43(3)(x) state;; that the estimated daily RccordingArea flow is assumed to be 1.00 gal /d-ay per bedroom Name and Return Address based on 2 persons per bedroom which is 50 gal /da Gary Duclos per person. The design Flow is then 50 gal. /day X 237 Townsvalley Road 150% = 75 gal /day per person. River Falls, Wz 54022 The mound is code comp:iant for up to 5 persons in the dwelling (378 -75 =5) as per COMM 83,43(3)(b) based on per capita oc(cupancy. 040- 1084 -20- -0 COMM 83.22(2)(a)3 requ: res that when the design Parch[dtntifieation Number (PIN) is not based on the nuiber ,of-bed,rooms in the dwelling, the design condition (per capita occupancy, maximt:m 5 persons) be recorded with the deed to 'tho property, Owner's names OwRarls gn tore no ubscribe an sworn to me Gary A. Duclas Marlene C. Duclos ti Today's date 1Z1M d1 — , Notary Public - ignature i l �l S f� ``ia�t►ttuuf�n. 1 Drafted by: Arthur L. F egerer `f Commission eXDiration i ,a � . 2 zz BA R3ARA L. E81� NC'AAr PuBt,(G M)NNE5'�nv u w ��� �` `���" Wy .anrssan &niuG Jan 3t, 2W5 This information must be completed by : ubmitter: document title, name fie, return addre -g , and PIN (if required). Other information such as the granting clauses, legal. description, etc. r lay be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one G age to your document and Sup to the rccordins fct Wisconsin Statutes, 59.43(2fn) WRDA 2199 J 2 15.3? (2199) — r 12/21/01 FRI 19:28 FAX 718 38{ 4687 REGISTER OF DEEDS 002 t : 1 196 PKE [14 4 DESCRIPTION Warranty deed re:orded in Volume 1213 on Page 131, document number 553212. Lots Two (2), Th -ee (3) and Four (4) of the Certified Survey Map in Volume Foir (4) of Certified Survey Maps, Page 1157, as Document Number 377181, filed in St.Croix County Register of Deeds Office on ipril 20, 1382, being located in Section :twenty -one (21), Township Twenty- eight North (28), Range Nineteen (19) Weat, Town of Troy, Except. Volume 7 of Certified Certified Survey Maps, Page 1944, as Document Number 435385, and Exce?t the S)uth 71,906 acres describers in Warranty Deed in Volume 1085, 'age 316, as Document Number 518610. ST CROIX COUNTY SEPTIC TANK MAINMANCE AGRPBMENT AND OWNP-RSIM CERTIFICATION FORM Owner/Buyer 0 5 Mailing Address D2 '7 y1 S t Property Address 0 l (Verification ccgaitnd trout Plamiog for new coWMCtion) atylStazc 4 rL ltJi Pamr1 Idcutification Numbs LWA.L D SC PTXON Property Location %, 4 Sec. ` _ T Nit W. Town of Sabdivistoa Lot # - C err - ded Satvty Map # volume Wage # Wcy Deed 9 Spay. ovse p yes IIO Lot tiacs ide a i Ale 0 yes p. no — ��� j eoasists of pam�piog oatQtcu +aoucEobaadlevrastes.Pmpa cmWrioctac$=camGrata rctraka�.: a0Q0w�noodo�iby► t�oamodpawpec :Wbfty'aePnti�■mtoQyoi7t9Gari . .�iaQtca�tiad>�atsyt0ai:, .. 'Tr h st>Tunit'to S+e 4abcDep�m�ati��. �9� stapiemit�eSjotp�y,� oaPaetandfiy a ilia °c ' s sal (�Qteonau6oiaa cc�aa6ecdeiFositsyste� Pt adta( -C'f � � kssllna 1t3�Il of�dgo. .��b� ��4.�s«e dre ' od ,�exmQ�c�Cir�eu��.�hQiesomd�ds ��"DOdC�ooaf;mastb�e ���S�eof�vts000siti �. �� d�rc. � ooml�ktedmdremcaoda�est :Cl�vocOo�jrZor�g4tliOC�iu�in3a DATE O�VPSd� ��CA.T�ON 1 (.a�e) oct6ctj� dart all faamt arc taao to dre b«t of mY ( omj largo I (are) am (arc) clue owarx( of try it�tcof: �Y deed t+000xdod in itcgistRx of Roods Otfioc, DATE sssss• iafoao Wfift dM is vmh4cpmscntodmay v=* is afro uaitaty pmWt beiM ttiwolmd by tba Z=Wg DepattmeaL •••• • • ss Iadndc'"M tW *fPtication; a stampod waMW dead firom &C Register of Doods offike a °0PY Of the cwifiod =TcY MP if =f== is trade in ttte wamattty deod i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certi that I have inspected the septic tank presently serving Y the QU residence located at: %, Sec. 9 / , T 9t� N, R 19 W, Town of � , St. Croix County, U pon Wisconsin. U insp ection, I certify t9at I have found the tank and P baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No_)(' (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction :' Prefab Concrete " Steel Other Manufacturer (if known) : Age of Tank (if known): (Signature) (Name) Please Print O PP s X10 ?C � (Title) (License Number) (Da E& Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (exce t for inspection opening over outlet ffle). Name d y2 Sign ure MP MPR 12/21/01 FRI 14:27 FAX 715 38► 4687 REGISTER OF DEEDS — �r� '7 ����• ► VOL j �f)PA E 03 ��5�356 PER CAPITA OCCUPANCY KATHLEEN H. WALSH REGISTER OF DEEMS Document Number Document Title ST. CROIX CO., 'WI The existing POWTS own :d by Gary and Marlene RECEIVED FOR RECORD Duclos located in Sect on 21,T28N, Town of 1 -2001 1:45PK Troy, St.Croix County, Wisconsin (see attached ,ISCELLANEM dascription) was insta. led in 1982 in accordance UE7PT with plan approval No. 8200250 dated Feb.15,1982. PERT COPY FFf: COPY FEE: TF.ANSFER FEE: The absorption area is 378 sq.ft, and based on t'he RECN0110FEE. 13.00 code now in effect is ,suitable for 378 gal /day of ?AGES: 2 effluent. COMM 83,43(3 state,n that the estimated daily RccordingArca flow is assumed to be 100 gal /d.ay per bedroom Name and Return Address based on 2 persons per bedroom which is 50 gal /da Gary Duclos per person. The design flow is then 50 oaf /day X 237 Townsvalley Road 150% = 75 gal /day per person. River Falls, W! 54022 The mound is code comp:iant for up to 5 persons in the dwelling (378 -7S =5) as per COMM 83.43(3)(b) based on per capita occupancy. 0 4 0 - 10 84 - 2 0--000 COMM 83.22(2)(a)3 requ: res that when the design Parcel Ide Number (PIN) is not based on the nuriber ,of - bedrooms in the dwelling, the design condition (per capita occupancy, maximum 5 persons) be recorded with the deed ,-o the property. Owner's names Ow is g Cure tq /&ubscribe t d sworn to me Gary A. Duclos Marlene C. Duclos [�- Today's date Notary Public pignature MCI q s Arthur L. �egerer � v � Commission exz�iration Drafted by: � - . 0 0 ' p1A'gJ. 14 � - tol 3 eS _ q fl�rai nrw B\-- . VIM a0 BARBARA L. ERI 54��?ti. NC 7AAY PUBLIC- A61NNES�t'�ily te �` } ` c�` Nr :arrssanE.pres,an;t,.a05 $ ' I This information must be compieted by: ubmitter: document title. nsme & rctutn addKe, and NN (if required). Other information such as the granting clauses, legs: description, etc. r tay be placed on this Srst page of tnc docura?nt or may be placed on additional pages of the document. Note: Use of this cover page adds one F ige to your document and 52.04 to the recording fce Wisconsin Statutes, 59.43(2m) WRDA J99 ! 4 J .1 /U1 FRI 14:28 FAX 715 381 4647 REGISTER OF DEEDS [?�►U42 DESCRIPTION Warranty deed re:orded in Volume 1213 on Page 131, document number 553212. Lots Two (2), Th -ee (3) and Four (4) of the Certified Survey Map in Volume Fo it (4) of Certified Survey Maps, Page 1157, as D Nu mbe r Do cument _umbe 377181 filed in St.Croix County Regis o o y f Deeds Office on April 20, 1982, being located in Section Twenty -one (21), Township Twenty- eight North (28), Range Nineteen (19) West, Town of Troy, Except. Volume 7 of Certified Certified Survey Maps; Page 1944, as Document Number 435385, and Except the S)uth 71.906 acres described in Warranty need in Volume 1085, ?age 316, as Document Number 518610. a377IS N0,2TN IK GORNER � I SEC. 2!. ALUMINUM • I JY. G40lK CodNTY Foa" MOH. O• �1 - , !�D �NORTN G /N6, SE IK - .Uw I K SEC. L/ I 00 I L7ETA /L �A I 9 � SEE pET,4 /L -- - - - - - -- = I ,20.83= gW N88 41 f` "E 997.66 Al 88 ° 'f� .56E a y o \o. N 8 9°1z '� , z" `\ ! s. LOT w LOT � "� � LO • r , � o t LOT _ ��_ O N E4 5r %* , CORNE.r W (/) I ! ! 4 - T -T'.r" r; ' � , '-) C, dre. Z/. AGavN,VVA ST 4--qp 40 \ \ MaN. FGWNO. CE.uYER Of SEC. z/ • .. -- -- AlSo 4/NE , .POLL ///G /y EADDif/ ,Z, d 33 , 700 SQ FT. , �G. !0 9 A G • /iVCL. /Q1l. o% 53.38 AC. EXCL. .e /K/ 976, 700 .SQ. F T. , ar i . Iv x/98,79 .s.� :sz °w /.�� 7 — — LOT .Y 0 V CU.PYE a4r.4 CaleVE / -,Z � u • V6 3.70 /0 %32 AC. M B.Q.V = Al Oy` °/o ;ZO "E 339 , & SQ. FT. , 99 42 AC. EXCL R✓W , .• 1 u h CC/.e[/E Z 3 y� AlPC = G VI.03 ,e1w CUIQ/iE OA TA Cf/O. = 633.95 I 5 cueve * -5 CuevE °s -� C/yL7 B,Qi(/fi, e N /O • �.Z , lss "�/ � -I Q = /3 06.55'x" d < .Z 9 4 � I QAO. < /997.22 .2A0. = I276•./8 ARC v lfS7• /i ARC emo. = 5 66./6 Cao. = 656+5'3 -- el/O. B,ee/G. - Al 6bi ° 16 Z6�E CNO. B z N /o ° 3G',�9 • K/ n 1 ,v ozozi � A SO4TN JEC. I! ,Z79. 97 �� - 88 ° S7 o3 - W .Z�7o•74� - -- -- � r _ Jpd >NE,lST - T SOUTH Al 38,0/ _ SEC L/. AGdM/ A SEG. 21. 44e.W! /OVUM �. .rr. C.tO /X GOl /,'/YY ST. exo /X COdN a T I I ' A ! r• S• /l40n/ COU,VD. Mn,✓. FpuNO. [� " :� sc.00 � D^ [,� SHEET z OF SHEETS 377181 CZ - D 50RYEY M�9P NO. 1157 P.,4RT OF SECTION 21, TO!/f/NSy /P Z.6 A14OR7 /E'A/t/GE /9 WEST, T.PDY TOW1VSN /P, ST. CPO /X �� 11 COUNT Y, WISCOMS /N. �gGa FILED NM W. APR 201982 -0c � MAN O' COMMELL N / ir WM ►AUS C ° Rgb1K of Deeds / ML 14 crobt cow , CO c9 Wb000to r 4 . 0 0 B URJ� ,vO.eTlt/we.5T CdeNE - _ - -N 88�'✓6 �� E Z /S� OB - - - .,$'EC. Z/• ALUa/ / , Vf/M NORTH Li 'C VW SEC. 2 NORTH .4 GORNZR JEC, t/. ALU.W /NUM �' ` � CRO/X COUntTY MO.�% FO L/NP. u it M ZASE.Y/6✓T row T.lAYZL - AJ P.E'.Y ✓oL. G 3Z, OZ33 I Q , , /i � i .: c^ C �N/t. .VK/�� SEC• Z/• d.7 4? ICA A 11Vj � h �� o♦ �� * \ h PIAIE L ANE N P. JAW a N 88 V 4t S6 E v, Ci 3" LD7 tia O 3 \p y� It A S3Z AW Sa. FT. , v� 0 2 _- P. WZ ST yy loRN4R Si C. L/• BOUTN L/A/E, NW J"y 6EL'. Z / AL!/M /NUM Sr' CRWX `v O /9rt/,tJEO. .PESET F.e4b 1 ' 4 . ��' �� : � .� ./� ._ s_..y; �•' • t� i L E6Z 1VD AAO7 -,C: O / / X,2i� //PO/c/ f' /.�E SET , /•SO Z.O. /L //t/ FT. 7N15 is A SURVEY or rve y PARCEL OF L A.VO OE SC.? /BE'p ` • / /,PON P/PE FOL./NO /A/ Boos 0 4 .931 o /JE EOS, � , PAGE 306, DOCUMENT A10. `� 3 1# " ReIAM SAR FOC/NO 3 / 6 8SG ON F /[E /A! 7&_- 40AClele Ole THE R64;1sr e OF OEED S, cS 7' CRO /X cc COt/,t/rY, N/ /SCONS /.V. SCALE � / /NCH Ec?UALS 500 FEET r1 Volume 4 Page 11 .sVaEr / Of y SNtC I o ir* o 90 � 3 m o d o ' '• CD ID CD � n rr A7 (n Z o a p -1 Z c N p 00 C CD ? .r A 0 w f1 1p N c A 0 Co N O y z o y w o W N ' n C N N 0 D C O c CD CD to W S'i c 0 b'i c 0 ! "� (n z D m a (n G D a CD ca D N a y (a y 0 a y CD C CD CL CL O N N I O D { V a�10l 9 y CD N N a N N a! c K t lam► CL y . -0 7 T T m 0 Z O O g C 000 m e y �I a c N y � I o w D A y o I m A 0 v o °� N 3 oNi 7 � CD i C71 CL z • Y l O =ti D D o D D o c c 0 0 Q. a !r CD m M m a 1 3 1 3 c c o C CD A Z CO I .+ rn N i � i► AG7 aoT ao� m�i a (o I a 1D i z g g m N� m� D v o w a � 5. a � co m CD CL 0 a a >0 a o a x I N cc'� A 2 In N a I I x I �, 0 eno 0 �— o I I ' cc �� N 0 N 0 O � A ti CD ! oro <n <A O CD o 9 CD Parcel #: 040 - 1084 -20 -000 12/27/2005 01:14 PM PAGE 1 OF 1 Alt. Parcel #: 21.28.19.332A 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner GARY A & MARLENE C DUCLOS O - DUCLOS, GARY A & MARLENE C 237 TOWNSVALLEY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 237 TOWNSVALLEY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 29.020 Plat: N/A -NOT AVAILABLE SEC 21 T28N R19W PT NE SE & NW SE PT OF Block/Condo Bldg: N 1/2 SE 1/4 LOT 3 CSM V 4/1157 INCLUDES P333D Tract(s): (Sec- Twn -Rng 401/4 1601/4) 21- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1213/131 WD 07/23/1997 6471533 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 102692 Use Value Assessment Valuations: - Last Changed: 07120/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 71,500 507,100 578,600 NO AGRICULTURAL G4 25.410 3,000 0 3,000 NO Totals for 2005: General Property 30.410 74,500 507,100 581,600 Woodland 0.000 0 0 Totals for 2004: General Property 30.410 74,500 507,100 581,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 208 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1084 -30 -100 12/27/2005 01:14 PM PAGE 1 OF 1 Alt. Parcel #: 21.28.19.333C -10 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner GARY A & MARLENE C DUCLOS O - DUCLOS, GARY A & MARLENE C 237 TOWNSVALLEY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 237 TOWNSVALLEY RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 44.350 Plat: N/A -NOT AVAILABLE SEC 21 T28N R1 9W PT OF NE SE NW SE NE SW Block/Condo Bldg: & SE NW PART OF LOT 2 OF CSM V 4/1157 EXC CSM 7/1944 INCLUDES 3286 -040- 1083 -70 Tract(s): (Sec- Twn -Rng 40 114 160 1/4) EXC AS DESC 1928/650 21- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/17/2002 684394 1928/650 LC 07/23/1997 1213/131 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 102693 Use Value Assessment Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 41.350 6,400 0 6,400 NO UNDEVELOPED G5 1.000 100 0 100 NO OTHER G7 2.000 10,000 37,500 - ® 47,500 NO Totals for 2005: General Property 44.350 16,500 37,500 54,000 Woodland 0.000 0 0 Totals for 2004: General Property 44.350 16,500 37,500 54,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 104 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1083 -80 -000 12/27/2005 01:28 PM PAGE 1 OF 7 r Alt. Parcel #: 21.28.19.328C 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner GARY A & MARLENE C DUCLOS O - DUCLOS, GARY A & MARLENE C 237 TOWNSVALLEY RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal De*cri0orr: Acres:_. -- 1.500 Plat: N/A -NOT AVAILABLE _SEC R19W PT NE SW THAT PART OF Block/Condo Bldg: NE SW KNOW AS PART OF I nT 4 QELS n V 4/1157 INCLUDES P332C, P333A, P334A & Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) P335 21- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/2311997 1213/131 WD 07/23/1997 766/151 2005 SUMMARY Bill M Fair Market Value: Assessed with 102687 Use Value Assessment Valuations Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 30.320 4,700 0 4,700 NO Totals for 2005: General Property 30.320 4,700 0 4,700 Woodland 0.000 0 0 Totals for 2004: General Property 30.320 4,700 0 4,700 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 (PIb tEtEfal 78 9 1� Return olV(Staly iljl:NGS Rtxon O# This Form Wirth ouR9;au al►. ., f 201 E wry x tali *8 hturn. �errsp nl�tertce MAtf(SE3N, w1 x 6t>lit2�$15 �. DAT5: #2/01182 P ROJECT uclos Gary A. - Restd 8 NEy$Ey21 �.. �, r+ Paul Cudd &Sans, Inc. Tn Tro St. Croix WI FEB 1 Ramb Route 5. Uiver Falls WI 548 22 PLAN ID. # �,► 82 -f3U2` ...:8 DETACH HERE e i t P1 3.f1rE: NAME S� Res i d i�Ce . PLAN ID. # 82 -(142 3 This is to, acknowledge receipt of your plans and specifications for the above - indicated projiact.y x a t 'Preliminary review indicates the required fee is -$ - .,,,�i�" Fee Received is $ ' Underpayment -- Pleases ubmit the additional fee. Overpayment — Refund Of , Plan accepted for review. [� Plans bein g returned.. D A dditional � r No fee has -been remitted. Plans submitted with no fees will be information required a held in abeyance.. - a t. Plan Submission ❑ Complete data relaiiVo to 1116 pa ; Q Additional information shall be submitted in duplicate un- ❑ 2 copies of PL8;60 enclosed: VA fiess specifically noted.. - (] Reed restriction n3clurred (1y�',: O`Plans not clear, legible or permanent 0 Condominium decl'aration.`'-(� y� }�� ,,, � �, ] All information submitted shall be signed, dated and sealed or stamped in accord with .Section H 63.08(2)(a) Wisconsin s Administrative Code. ❑Affidavit enclosed. IV. Holding Tanks ❑ Profile of holding tank showing vent; man,, 6 and manufacturer if precast. Complete 6ontiruction detaiis�if ! I. '. Pressurize Distribution Systems (Mound or In Ground Pressure) site constructed. ❑ .Application for use of an alternative system signed by owner 0 Holding tank agreement signed by owner sine local uriWro and notarized. (f;copy) government (sample enclosed) ❑County onshe required (1 copy). D Design calculations 0 eason for installnit hotng rtet for pressurize distribution. El Soil boring &percolation from county (1 copy) test data. ❑ Plot. plan showing kbcfti eraf disc- ❑.Cross section of system, El Pipe lateral layout. ances to any building, welts, water g, water ❑ Plan view of Srystem. ©Plot plan. course, lot 'lines, swimming pools,`ali.vueatttvice road, ❑ Verification of E xceptiori Status Form by County. 0 copy) Etc. Provide benchmark wtYh elevation te#' point..::; <, I I I: Private Sewage Disposal Systems V. Lift Pump Ground slope with 2' contours !n entire area o #soil absorp- ❑ Calculations for total lift pum p di ' bead d gall tion system extending 2W on aH sides. pumped per cycle. ❑ Elevation of permanent reference point (benchmark). ❑ Size, length & depth of force main: Location of area suitable for replacement system - provide [] Detail &model of um or automatic si soil data. pump plans includi size, pump curves, drawdown and average f low,rate GPM, ❑, Piet plank showing lot size and all lateral distances -from ❑ Cross section of lift pump tank shQyrrr> c1m or sewage disposal system to buildings, lot lines, vreH, water siphon(s). course, swimming pools, water senrice piping, Etc. ❑ Construction detail of septic, holding or lift lump tank if " site Constructed or tank mantxFacturer if precast. V1. Systems ln+ill -(Fill must be placed prior % � - , Construction detail and . cross -swxi6 of soil: absorption Ci} Total area filled (fill 'to extend 0' f y of ,r ' systettt. before side slope begin). ❑ Sail boring and pertxyiation test on 1.15 c�mpttitecd by car- ❑.Depth and type of foil. " r R 1 ; 'r.• lifted soil tester (1 Cow). Q f py of onsrte rep rl ' u,r . . g F� dH tt ry � *4 }:i 7 fi z a .� 3 ,•a. �, `.e - - .,� } � r+� 4u f '�� a �';t "Jl � §�5 ' ? e� . s {,�_ � f$ #�.CS' Ri �•`;�.�� ., r+C r �+y i' �4 r r R•� p' r �'x ��_ 4� � S� +.� , r '�11►` pi xG v � - � � `5� -tip€ �� y� '"Mrsr•.z� �"� `^�C _ .. � * t v ?,,. hs� a w'? 'Y� ` a ' T f�J- .- '"�' - ..+"i�•i, `�,. - t e� ads �a e"r �' $ s a. Pf '� .t }�� `� t .. ,xJ- •kr.�.�° r�ar a, ,rs,, # k�x5 ref °. M s , ., yS` 4 _ � 'T ��1 ,j�q•.• a6 A" � '� i .�q . x�� ' t z ' 'a s 1iL& �`. ¢• t t rs x r �3#1' 'r?tSYQ� a" N v ' I F 1 C r i�.�'rilr €I Q �_ �t a 4 `� s:.e�( d _ � l✓ {,�° •" < tie � ; 3 +.r,K•�"�� +. �' `��� aa � f f44'r r� `'�` ?fir � P �� ��•tt+ .` ACSr',� ��" 5 ., ht a rra 4t �`f +t��: 1 �! 'C$£Y3�s - 7k� k �.•a ,it r 7�$ a � M v.; ,r � rb3. x .. .: .bra T `➢� .:c ..t'�' � ^� �:�^, r � #�8L 5 ��.� ,t �� }r'.i `l � Cr 1 .f✓'i�".� #f�' k' + irF• r`;�t'i�3"��I {�t' S;77r,„/,,��'',�_ gM+�•,•' �r"� t!! '��FF f w vas 5 • w P� rLrY�a�:;,�t�$$#�Ij ri§+�"F1 F ��- M n�a' § �t a• F �„T ^"���"� , � r ; r - 'L . �Y 1 { _ s� • t l s"!� ,�'`, t, r > `1� � "�#1�� � � � t+i � y.,. � s� 3 •,�' '���; JQ'' , ii,.t � € �`� zt� rc r t{F nikk3 "4Q `Kf � 1" � �"y�' c �.°� � � j " � - II y $ •,sr. t, rt' r+k3 a� r�# a ,#1,<f ±t{� .�$' Cx: f� s3� C t3�d� t 3 .� ' �� �$ P` 4 r� �' t� t 4_t F� #, f j`t ` f ►,`F#'t� e � _;s'� � - t: } tA° • % 'F ^ a'.' :� ,c�. " { 7,' ` i " � > #, •4: �'Y� i_'- :,r�i.[�, :�p sf�€. ?,#;sL # .�,� .: +''�¢�<'t'�`�,' lE r � r J v� s�� t t � v ~ert N* ,M c . ,,€� .,''n.' � ����� �°��iv. x : �ry t• �'� %. -u: � r s p sr� l��� z AAA, State Of W i sconsin ` epJilFoof In try, Labor and Human Relations FEB 22 1982 , r i ZONING Please Reply to: i \ OFFICE ti SAFETY & BUILDINGS DIVISION Bureau of Plumbing �` Tl E ► ��' P.O. Box 7969 f r r Madison, Wl 53707 J Plan Identification Number L J Re: PRIVATE SEWAGE SYSTEM ONLY—(' el . The Bureau of Plumbing has reviewed plans, site survey information and installation details for the construction of an alternative private sewage system to be installed at the above - mentioned location. The plans and specifications were prepared by and received for approval on The soil and site evaluation was conducted by The site meets the soil and site requirements specified in chapter H 63, Wisconsin Administrative Code, for the use of f � , The proposed system is for a Wastes from the building will discharge to a '°� � gallon capacity septic tank which will discharge to a t ? gallon capacity 4" chamber f6ew which a.paaap#a tag apasi # ^: ; a, -� •- � aktFga�a i i d•e; �— - will discharge through a '"' inch diameter pipe to the soil absorption system. It is of utmost importance that the system be installed in complete accord with the plans and installation details and the conditions of approval contained in this letter. The licensed plumber responsible for the installation shall notify the county inspector when the installation of the system will commence so that the county inspector shall be able to inspect this installation. The installer shall not deviate from this approval and shall follow the directions or orders issued by the appropriate local or state authorities. In accord with ch. 145, Statutes, and ch. H 63, Wis. Adm. Code, the plans and specifications are approved contingent upon compliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep one set of plans bearing the stamp of approval of this department at the construction site. If the installation of this system has not commenced within two years from the date of this letter, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination oversight, construction or any damage that may result in or after installation and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on ch. H 63, Wis. Adm. Code, requirements. It shall be necessary to obtain and fulfill the permit requirements of the county in which this installation is to be constructed. Failure to obtain county permits will automatically void this acceptance. cc: OWS By: County Other Enclosures DI LHR - SBD - 6159 (R. 7/81) mes Sargent, B erector DEAARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BULIDINGS LABOR & HU AN RELATIONS ALTERNATIVE PRIVATE DIVISION P.O. 96X 7969 SEWAGE SYSTEMS BUREAU OF PLUMBING MADISON W153707 ❑ Mound ❑ Pressure Distribution NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: PLAN ID NUMBER: �V -OD: So BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: SEPTIC TANK: MANUFACTURER: 76� ACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: ",?'!''" PROPERTY LINE: WELL: U G: DOSING CHAMBER: MANUFACTURER: LIQUID CAPACITY: PUMP MODEL: PUMP MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: El YES El NO ED YES ❑ NO GALLON PER CYCLE PUMP AND CONTROLS OPERATIONAL: PROPERTY WELL: BUILDING: V O TRESH LINE DIFFERENCE BETW PUMP ON AND OFF EEN Q YES El NO SOIL ABSORPTION SYSTEM: Check the soil moisture at the depth of plowing or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM and furrows thrown upslope: mound systems to make certain that it OF SYSTEM. SHOW El YES NO meets the criteria for medium sand. ELEVATIONS MEASURED. ❑ DISTRIBU S YSTEM:__ ::.:.:.. ' � o WIDTH: LENGTH: NO. OF SPACING CENTER ; <;cr.;�::.:: ���: TH AND MARKING. :...::.; DIAMETER: TRENCHES: TO CENTER: ^•.. : >. ;;. MANIFOLD: PUMP: _ - MANIFOLD PIPE MATERIAL AND MARKING: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL &MARKING: .:....... � >a :.:::. DIA.: __.._-- PIPES: DIA.: HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: DEPTH OF GRAVEL OVER PIPES: VERTICAL LIFT CORRESPONDS TO APPROVED ':>:: �%E:<%7 i�? r•; 1: :'z:::�6:ii1�:: >:'<;!::i::>t >:> .. _._ _. PLANS. ❑ YES ❑ NO ❑ YES ❑ NO SOIL COVER: TEXTURE. DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL: SODDED: I SEEuEM MULCHED: CENTER* EDGES: ❑ YES ❑ NO El YES ❑ NO El YES ❑ NO COMMENTS: i SIGNATURE TITLE: DI LHR -SBD -6227 (R. 05/81) 1