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030-2103-20-000
Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578924 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: Hendricks, Edward M. & Lori L. I St. Joseph, Town of 030-2103-20-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 16t,% — L;5 36.30.19.834 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATIOkJ BS HI F,,ss LEV. 1 i rv. Septic Benchmark r / Dosing L Alt.BM pry a �J� u CAD✓w Bldg.Sew r , Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent Airy In ROAD Dt Inlet r� Septic $� /3 _ Dt Bottom Dosing � l � 1,3 / � [ Header/Man. d Aeration Dist. Pipe Holding Bot.System 7,35 ,g. PUMP/SIPHON INFORMATION Final Grade Z - 7 16Z • 7 Manufacturer / Demand St Cover Do ~ I Z•y,3/ ?;_.c17 Model Number `(' V-'\ I c, �^-� o d r� /-'r �,o✓� !r l�`t / `�� 8 TDH Lift` fL P Friction Loss o System Hei//L TDH I 1 � �f/j r 1.1 Forcemain Length Dia. i( Dist.to well SOIL ABSORPTION SYSTEM �5 – 7— G /K.4 G /Ol•7 BEDITRENCH Width f Length f I No.Of Trenches IT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer: �Z /�/Q INFORMATION CHAMBER OR f" Type Of Systerq:, c �� 139 ,� A I� UNIT Model Number: a(/ DISTRIBUTION SYSTEM pJ ° — /1 7 Header/Manifol it Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Di �Spacing SO v Dia ILength_ a SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Dept of xx Seeded/ odded xx ulched Bed/Trench Center + / G Bed/Trench Edges Topsoil Yes No Yes o No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1286 89th Street-New Richmond,WI 54017(NE 1/4 NE 1/4 36 T30N R19W) Dur jing&Lewis Lot 2 arcel No: 36.30.19.834 1.)Alt BM Description= 1 u� ��✓��-- "'a,,je (A'151 2.)Bldg sewer length= / % I t � 6c- - � amount of cover=vX�s�' �' Ru—" C' vow �- �e,r;��e 3��- 6j Plan revision Required? ❑ Yes No �Use other side for additional informati n. Date Insepctor's ignatur Cert.No. SBD-6710(R.3/97) � County Services Division St.Croix ' Washington Ave Sanitary Permit Number(to be filled in by Co.) Box 7162 Madison,WI 53707-7162 Permit Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit /V* is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to project Address(if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy SAME Law,s. 15.04 1)(m),Stats, # - f 17 I. Application Informat' -Please Print All Information cJ`I Property Owner's Name i Parcel# Edward&Lois Hendricks 030-2103-20-000 Property Owner's Mailing Address Property Location 1286 89'"Street Govt.Lot City,State Zip Code Phone Number NE 1/4,NE 1/4, Section 36 New Richmond,WI 54017 circle one) T30N R19Eo1 II.Type of Building(check all that apply) # ® 1 or 2 Family Dwelling-Number of Bedrooms 2 Subdivision Name burning&Lewis ❑Public/Commercial-Describe Use Block# ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of 00, Town of St.Joseph III.T ype of Permit: Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date I uueed Before Expiration Plumber Owner IV.Type of POWTS S stem/Com onent/Device: (Check all that apply) ®Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound?24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank Other 5ispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Treatm t Area Information: Design Flow(gpd) Design Soil Application Dispersal Area Required(sfl/ Dispersal Area Proposed(so Elevation ` 600 Rate(gpdsf) 857 ✓ 900 97.86' 0.7 k� J VI.Tank Info Capacity in o Gallons Total #of Manufacturer �� c Y . 6 a; � Gallons Units ��. / o New Tanks Existing Tanks �• /e 1 • Un 6-5 w C7 0. Septic or Holding Tank 1250 1250 1 Wieser Concrete Gt/` ® ❑ ❑ ❑ ❑ Dosing Chamber 750 750 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plu s S' ature �' 223760 RS Number Business Phone Number John Se hmitt 223760 715-760-0486 Plumber's Address(Street,City,State,Zip Code) 616 150`h Ave. Somerset,WI 54025 VIII oun /De artment Use Only Approved rove Permit Fee Date,Issued L, Issui Agent Sign r e Given Reasod for Denial $ H75 '�� Z$ �✓ IX.Condl6iY&WMEMeasons for Disapproval 3� tS�tw.. �� oJ� atcQ-�- rJ� 1��G •� Z_O 1.' siptietank,effluent filter and dispersal ceB•must all be services fmaintained as per management plan provided by plumber. 1 ft 2 !(s11 snttc,fagitlrements must be ipaiM3ird. `d0d6%ordinailce:l. I a (.�f 9"�� �.a.�'a�r /nom. .�• rJ, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R03/14) PLOT PLAN N Project Name: Hendricks Replacement Septic System Legal Description: NE1 14,NE1l4,S36,T30N,R19W P.I.D: 030-2103-20-000 Subdivision Name: DURNING&LEWIS Lot#: 2 SCALE:1"=40' Township: ST.JOSEPH Parcel Size: 4.26 Acres County: ST.CROIX System Elevation: T1=98.15' Existing 75'Infiltrator Hi Cap.Trench Slope: 4% T2=98.15' Existing 75'Infiltrator Hi Cap.Trench BM1 Elevation: 84.90' Bottom of Pump Chamber T3=97.86'Proposed 90'EZ Flow Trench BM2 Elevation: T4=97.86'Proposed 90'EZ Flow Trench Backhoe Pits: _ 4 inch Sch 40-ASTM D2665 NOTE:See page 14 for a complete plot of the parcel. 14 inch 3034 - ASTM D3034 ail V) _T mm O HBO INN 53 c yoD PC ,ran 5i,K/7p_C,4 571: Tti iC I 214 fae i� Page 2 r O p y � CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Hendricks 4 Bedroom Replacement Septic System Owners Name: Edward & Lori Hendricks Owner's Address 1286 89th Street New Richmond, WI 54017 Legal Description: NE1/4, NE1/4, S36, T30N, R19W i Township St. Joseph County: St. Croix Subdivision Name: Durning & Lewis Lot Number: 2 Block Number Parcel I.D. Number 030-2103-20-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic& Dose Tank Specifications Page 4 Effluent Filter Information Page 5 Dose Tank Cross Section Page 6 Pump Information &Curve Page 7 System Sizing &Cross Section Page 8 EZ Flow Information Page 9 INFILTRATOR Chamber Specs Page 10 & 11 Management and contingency plan Page 12 Septic Tank Maintenance Agreement Page 13 Warranty Deed Page 14 CSM Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 4/26/2015 Phone Number: 715-760-0486 Signature: In Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) PLOT PLAN N Project Name: Hendricks Replacement Septic System Legal Description: NE1/4,NE1/4,S36,T30N,R19W P.I.D: 030-2103-20-000 Subdivision Name: DURNING&LEWIS Lot#: 2 SCALE:7"=40' Township: ST.JOSEPH Parcel Size: 4.26 Acres County: ST.CROIX System Elevation: T1=98.15' Existing 75'Infiltrator Hi Cap.Trench Slope: 4%, T2=98.15 Existing 75'Infiltrator Hi Cap.Trench A BM1 Elevation: 84.90' Bottom of Pump Chamber T3=97.86'Proposed 90'EZ Flow Trench BM2 Elevation: T4=97.86'Proposed 90'EZ Flow Trench Backhoe Pits: 4 inch Sch 40-AS TM D2665 NOTE:See page 14 for a complete plot of the parcel. 14 inch 3034 - ASTM D3034 ail r Z 's r33 o S 63 \ \ S E�X/ST,tj d 2-5-0/-7 3G s:•. j C 6400 Sir►1/l hCH S'Ti=—d�C1 IN, v � Tti �' lcI 2l�► l Page 2 an-NLIOGZVA :31U 99te-5Z2-009 OIOZ 'Nv 03SIAMI Z \ :anod-isod :31vo moz �,avnNvr :31v(] osc�s w. 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Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter(end opposite of the cap)to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap&on the side of the filter). Always install the filters in a position where they can be easily serviced. "Always use caution when starting threads to avoid cross threading**. Plumb force main into the 2"sch 80 PVC union. **We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface**. For best performance, if a check valve is installed it should only be after the outlet of the filter. SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks(600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a"pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4"cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Note that in cold conditions the filter cap may be difficult to remove. Keep the filter in a warm area or pour warm water over the cap before removing. Once the filter is installed in the tank it maintains a stable temperature and removing the cap will not be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove%" plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 allen. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range(3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13, 2005 Page 4 SEPTIC TANK_8•' PUMP CAAMBER CROSS SECTION AND SPECIFICATIONS G r V\6 4" Cl VENT PIPE 12" MIN. ABOVE GRADE E WEATHER PROOF ' >_ 25 ' FROM,DOOR, WINDOW- OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 FINISHED GRADE 4" Cl, RISER WARNING LABEL 6" MIN. ABOVE GRADE •}�. -4" MIN, 18.'! I N. 6" MAX. INLET WATER TIGHT SEALS GAS- f TIGHT : 4" BAFFLE _.._./ A SEAL } APPROVED CI PIPE - --- i ALM JOINTS W/ Cl PIPE 31 ONTO SOLID TO __ON SOLID SOIL SOIL PUMP OFF ELEV . FT. Off-- - t RISER EXIT D PERMITTED ONLY IF.TANK . MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS dft SEPTIC / DOSE TANK MANUFACTURER: /.?-.Sc)/ $U WW501-NUMBER 'D"OSES PER DAY: _, ,,� • TANK SIZES: SEPTIC �_ GAL. DOSE VOLUME INCLUDING DOSE -�T s-b GAL. FLOWBACK: Igo . GAL., ALARM MANUFACTURER: S APACITIES: A = 2t7INCHES = �O7.�JGAL. • MODEL NUMBER. SWITCH TYPE: ( r B = 2 INCHES = r GAL. PUMP MANUFACTURER: l� C 2 INCHES = _GAL. MODEL' NUMBER: _GU tf SWITCH TYPE: D = INCHES = ft '-GAL. REQUIRED DISCHARGE RATE L. GPM PUMP 6 ALARM WIRING AS PER ILHR' 16 . 23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . !s FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . � . ^ 2 .5 FEET + FEET FORCEMAIN X _FT/100 FT. - FRICTION FACTOR ' . EET TOTAL DYNAMIC' HEAD = 3 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH 9�; DIAMETER LIQUID DEPTH J~1 � SIGNED: _ LICENSE NUMBER: a�o.537 DATE: — 7� 1/88 a . Page 5 MODEL : : 5 MODEL 3872 . . Submersible Effluent Pump Submersible Sewage Pump • °a Eif Iwn1 Pump r 1 4 r ww 't �1 NERDS FEET NEFEAS FEET W in S +20 MODEL: 3885 MODEL:8872 7 >a � ,00 a b w r 00 = 0 •, w eo +o * 00 40 S E » SD + i i s 70 D 00 10 20 70 t0 10 00 70 O,i.SFN 0 0 2 1 0 0 p T2 K 1S m51t CAPACITY CAPACITY Pump Specifications Features and Benefits Pump Specifications Features and Benefits +/z HP *Glass filled,thermoplastic vortex '/s through 1'/2 HP •All models feature silicon carbide Up to 75 GPM impeller with stainless steel Up to 130 GPM mechanical seal faces for superior Maximum head to 18' insert and pump out vanes for Maximum head to 123' abrasive resistance and extra Discharge size 2"NPT mechanical seal protection. Discharge size 2"NPT long life. Solids:2"maximum •Rugged glass-filled thermoplastic Solids:1/4"maximum •Cast iron semi-open non-clog Motor casing and base desi n provides Motor impeller with pump-out vanes All motors feature ball superior strength an corrosion All motors feature ball for mechanical seal protection. resistance. bearing construction. bearing construction. •Rugged cast iron volute type casing •Cast iron motor housing for Available in Single and adaptable for slide rail systems. Single phase: efficient heat transfer,strength Three Phase 115 200, *Corrosion resistant threaded Materials of Construction and durability. 230,460,and 575V . Cast iron • All single base models stainless steel shaft. Corrosion resistant threaded g p. •Motor is full submerged in high Thermoplastic stainless steel shaft. have capacitor start motors. y g 9 Stainless steel quality oil for lubrication •Available in automatic and manual Materials of Construction and efficient heat transfer. models. Cast iron •Optional silicon bronze impeller •CSA listed models available. Stainless steel available. •CSA listed models available. ®Underwriters Laboratories A#Models are designed for continuous operation and feature stainless steel hardware. Page 6 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Edward & Lori Hendricks Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ftZ Soil Application Rate 0.7 gpd/ftZ 600.0 gpd Design Flow_ 1 0.7 1 Soil Application Rate_ F-57 EISA= 171.4 Feet of EZ Flow trenches 90 I feet long each 2 No.of Cells 9 Per Cell 3 ft Cell Width 18 Total No of 1203H 90 ft Cell Length 450 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 101 ft Observation Pipe with approved cap or vent _.__.w. Soil Backfill ■ 36 inch Geotextile Fabric 12 Inch O II Q Slotted and Anchored Vent/Observation Pipe with Cap 97.86 ft Infiltrative Surface >36 inch 94.86 ft Limiting Factor r■r®■■■we■•■■r■■r■rrr■■r■rr■■■rrrrr■rr■arr■rrr■■r■r■rr■re■■•■■■■ Plumber/Designer Signature: License#: MPRS 223760 Date: April 26, 2015 Page 7 Wisconsin Department of Commerce,Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow(GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84,Wisconsin Admin.Code,and Chapters 145 and 160,Wisconsin sizing can be used in Wisconsin, resulting in a 40% smaller Statutes. All sites must meet the Site&Soil Conditions&Locations &Isolation distances as noted in local regulations. drainfield. The approved products are 1203H(3-12" bundles with pipe in cen- 6. Place EZflow bundle(s)in the EZflow configuration approved ter bundle in 5'or 10'lengths)and 1203HP(3-12"bundles with pipe by system design permit specified for the particular site.The in each bundle in 5'or 10'lengths. top or center-most bundles containing pipe are joined end to A single pipe bundle contains a four inch perforated pipe surround- end with an internal pipe coupler.Any additional aggregate ed by EPS aggregate and is held together with polyethylene net- only bundles that may be required,should be butted against ting.A single aggregate bundle contains aggregate only and is held the other aggregate-only bundles and do not require any together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filter fabric pre-manu- • EZflow®Bundles factured in between the netting and aggregate. The fabric • EZflow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • EZflow Internal Pipe Couplers sure the the GEO is positiioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing. Installation Instructions 8. The EZflow Drainfield Systems should be installed in a level The instructions for installation of EZflow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom)and should follow the contour of the ground surface defined in chapters Comm 82 through 84,Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code,and Chapters 145 and 160,Wisconsin Statutes,as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing,con- figuration,and layout for the EZflow systems,stake or mark 9.The trench top shall be graded such that water will not pond. with paint the location of trenches and lines. Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10.EZflow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZflow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed EZf7(nv assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however,that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of 6"of soil cover as bottom of product. recommended by manufacturer. 4. When installed in a trench, the trench should be dug to a 1203H-GEO width of 36 inches. This not only saves labor in excavation, Geotextiie but also provides better load-bearing capacity after backfill- Barrier Material ing is complete. 12" r, JOA1(PN'IFR BUM)LFS WI'I}f wnRt+a. vws cxwrLwu Tup ro EZ,flow �a Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. Ez DOES IT. F: 1-866-279-9203 Oakland,TN 38060 Ring Industrial.com 1044-101008 ©2006 Ring Industrial Group,LP Page 8 - _ I 0 w = w 118nw Cc a � 143 C � CO C\l !f tj 2 ca C3 .-• �, rn3T oc ca O U O N O L .J -2o D U O O O � (n 2 =S Z3 .. L L Z+-0 co x c --� U L O N -C = 3 � •-. L 0. 3 0 O = cn cNn c"cn ♦ N U E a r V �p • N 0 o 0 • $ L 'C M loom W c � u a co a � • o W um U o o c Z= th C_ $i b J r � Pa_ge,� POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Edward&Lori Hendricks Tank Manufacturer: Week's C. P. r NA Permit# I~ Septic P Dose 1:Holding Volume: 1250 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete r NA Number of Bedrooms: 4 rr i_ Septic f" Dose I_Holding Volume: 750 gal Number of Public Facility Units: v A Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s)to Serivice Pad: ft Design (peak) Flow=estimated x 1.5: 600 gallday Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate:_0.7_ gal/day/ft2 horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: SIM/TECH r NA Fats,Oils&Grease(FOG) 530 mg/L Effluent Filter Model: STF-100 Biochemical Oxygen Demand(BOD5) 5220mg/L NA Pump Manufacturer: Gould NA Total Suspended Solids(TSS) 5150mg/L Pump Model: EPO 311 L '- High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L ry NA Mechanical Aeration Peat Filter r✓NA Total Suspended Solids(TSS) 5150mg/L r' Disinfection I"`I Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other: Biochemical Oxygen Demand(BOD5) s30mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L WNA r/In-Ground(gravity) r In-Ground(pressure) NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r- Mound Maximum Effluent Particle Size: %a in dia. rNA Drip-Line r Other: Other: r t Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third('/)of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once every: 3 years) (Maximum 3 years) I- NA month(s) Inspect dispersal cell(s) At least once every: 1.1 Vii/ year(s) (Maximum 3 years) r NA r month(s) Clean effluent filter At least once every: 1.1 r✓ year(s) r NA month(s) Inspect pump, pump controls&alarm At least once every: 1.1 ✓ year(s) NA month(s) At least once every: year(s) NA month(s) At least once every: r year(s) NA After 5 years alternate drain fields f-° mont S annually At least once every: ✓ year(s) F NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber;Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface.The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third('/)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,Wisconsin Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components, petreatment units, and any servicing at intervals of 512 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page 10 Page of START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels.When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers;disinfectants;fat;foundation drain (sump pump)discharge;fruit and vegetable peelings;gasoline;grease; herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: •All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. •The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. •After pumping,all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken,to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells.Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area.Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name:Owners Choice Name:St.Croix County Zoning Phone: Phone:715-386-4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1), (2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. Pie ll) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Edward & Lori Hendricks Mailing address 1286 89th Street Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State New Richmond, WI Parcel Identification Number 030-2 103_20-000 LEGAL DESCRIPTION Property Location NE /4, NE '�4,Sec. 36 ,T 30 N R 19 W,Town of St. Joseph Subdivision Plat: DUrning & Lewis Addition Lot# 2 Certified Survey Map# Volume ,Page# Warranty Deed# (before 2007)Volume ,Page# Spec house❑yeslao Lot lines identifiable DyesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS. 383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth„herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on is form are true to the best of my/our knowledge. i/we am/are the owner(s)of the property described above,by virtue of a anty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) Page 12 bT abed Willi , 4 � % All a•ows UIL r , r r r s .l1i ! ,� t a� a� a• s Y 11• Nix ail- • a 6 • �,',�4t � � y� 1,i r�� .,r ':�l�t '�gi', ''��•{'r�'y'/'�J'. 2•d seT'ON NOMni zz AdUN3D W%S:a 656T'02•adi 4' Wisconsin Department of Industry, *SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of safety 8 Buildings in accord with ILHR 83.05,Wis.Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include,but St. Croix not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCEL I.D.# dimensioned,north arrow,and location and distance to nearest road, 030-2013-10 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION James Durnin GOVT.LOT NE v4 NE 1/4,5 36 T 30 ,N,R 1 Igor)W PROPERTY OWNER':S MAILING ADDRESS LOT# BLOCK* SUBD.NAME OR CSM# 7217 Courtly Rd. 2 na Durning & Lewis Addn. CITY,STATE ZIP CODE PHONE NUMBER ❑C11Y ❑VILLAGE JUOWN NEAREST ROAD Woodbury, m. 55125 1612) 739-5208 1 St. Joseph I Cty. Rd."A" 1:4 New Construction Use[xl Residential/Number of bedrooms [ j Addition to existing building L j Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed,gpdm2—. —trench,gpd/it2 Absorption area required 643 bed,ft2 563 trench,ft2 Maximum design loading rate--7—bed,gpd/ft2 _R trench,gpd/ft2 Recommended infiltration surface elevation(s) 98.15 ft (as referred to site plan benchmark) Additional design/site considerations na Parent material stream terrace Flood plain elevation,if applicablena ft S=Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S Ell ❑S f3u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring# Horizon in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trertdl 1 1 0-10 10 r 2 none csb V*'."-4111 2 10-30 1 r4 4 none sil lcsbk mfr aw if .2 .3 Ground 3 30-90 7.5 r4 6 none cos osa ml na na .7 .8 elev. 102.4 ft. Depth to WA limiting factor +90" Remarks: Boring# 1 0-12 10 r3 2 none sil lcsbk mfr aw ltn .2 .3 2 glg 2 -3 0 4 4 mfr •2 Ground 3 32-84 7.5 r4 4 none sl 2csbk mfr - .5 .6 1 %n elev. 101.8 ft. �. \ D �. Depth to limiting in 17 factor +84" ST CROIX Remarks: `S' zd�tNO �' CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 �1 Address: 1554 200WAve.,New Ri nd I 54017 Signature: i '/ Date: 5-13-97 CST Number: m02298 CPS PROPERTY OWNER James Durnina SOIL DESCRIPTION REPORT Page-2�of--3-- PARCEL I.D.a 030-2013-10 Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence BwxWy Roots GPD/ft in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trerch 3 1 0-8 10 r3 2 ,.h 2 8-28 10 r4 4 non Ground 3 28-45 10 r4/4 none sl 2csbk mvfr aw na .5 .6 elev. 10la ft. 4 45-84 7.5 r4 6 none cos 0SQ M1 na ria .7 1 .8 Depth to limiting � $tO factor Lle Remarks: Boring# 1 10-12 10 r3 2 4 2 12-23 10 r4/4 none sicl lcsbk mfr qw if .2 .3 Ground 3 23-41 .5 elev. 4 41-82 7.5 r4 6 none cos 0scr ml na na .7 .8 101.7 ft. Depth to 17- 964 limiting factor +8211 9Z Remarks: Boring# 1 10-11— 10y-r312 none sil, 2msbk Mfr if .5i .6 5 2 11-18 10 r4 4 none sil 2msbk mfr if .5 .6 Ground 3 18-30 7.5 r4 4 none sl 2csbk mvfr Crw na .5 .6 elev. 4 30-84 7.5 r4 6 none cos 0SQ ml na na .7 ' .8 100.7 ft. llimihng factor r +8411 6 Remarks: Boring# Ground elev. ft. Depth to limiting factor ------- Remarks: SBD-6330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel James Durnin g 1554 200th Ave. CSTM2298 NEkNEk S36-T30N-R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715)246-6200 1 lot #2-Durning & Lewis Addn. N 1"=40' EM.= top of k" pvc pipe C el. 100, Alt. BM.= nail in Elm tree C el. 102.10' b2. 15 � � �oI � r 0 2,76 ' 7, 0 III Gary L. Steel 5-13-97 L � omo aEc O w m �'a 3 % `o `c m L a a �. m o c a w m L rn a m � H�'Sm v W d a m m m a m cE d b .2F t�L3° co o o F- d m m LL 0 LL M S J K 7 U V J K K v V J ❑ u W N N CD a� m a. yap, . a 0 0 G i fry r CV c°S Q � C ao N � J m � G 4 4 w a � � a a N f"Y h y CD O O t� O C h O O N N N d d tl i I O Z � C Z LL LL c c O 3 a I 3 o a�i c H C rn W zt E E Y d 0 Z 00 Z o — N Z w am �(D C. M 1-- Z w C d N C C N . 'O L O Z d - ffi 75 Q w O D C O a 2 d c c . to F r �' E U) y v (D 3 w cc r> N Cu . 7 Y ;O R C �1 .= N N .C.. O O cy N ; R to 5 y 47 C L N c N a L t O C c c O �U:°. c v O O N a w Z H Z o N Z I N J LO N R c (V �n .. O R � U CL a LO C y N I 2 v O D d N 0 N N fA O rr rr p o E O O 5 a Z • R LO fA J V y rn rn } AV U) o 00 O O w 7 M w m N C a zz co N N N d a } (n Q to 3 R H c C� ° i O V 7 d j N 00 W R t) a$$ M a N N N N O O (U Y O C O C'7 W y U CO U y 7 r N M' C� Y C (U C N O R .O o co in 2 m co O Z Y cn CCS v� d € a EL CL m d a E c c o m o M ~ O 6v m 4 0 � � Y C i o UY 3 N c� N i Y N C w OO ~ N 0.2 (0 m y Z o V D5 h T CL C N f0 N � C LO 'O 'D O 04 O d Z a) M 0 .0 \ 0 m O 3 T E O N C Y 7 f6 C L y c y LL .o 1p O 0 3 c'C 0 m >> N L f f� d Q> L W C C 0 3 ` v a� Z N _O UJ E Z p Z of m CO M W d m M H Z c o i O Z a C U T 7 w U) C N O O z z w N Z c E N t _ F 41 C N m O a a m c E y N �w 0 N N o o WSJ N r O � •� U 000 as 0 CD m IL IL IL N a g (D N C U) Z rn rn N N J U y 0) rn } Z to �i lA o Co CD N W O O . 0 E Cl) 7 0 co d CO p m m co N 0 �1 d 41 Q � Q O c i O 3 j N OD O Cl) W N t LL O O \ N O L O O_ O N Y O C co m �1 N O O O 0 0 C C 0 O O 1-1 O' M C O w N lO L c O O M U) 2 co 0 Z c Y � (n �i a CL m .� m a r i E ` c c L A Q 2 0 (n c°� oad. 3L 03. :av -oao 3 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT-- Owner NA ,.A � � � c, c e Address A ee � w City /State A s +.,. ' txsl - ,S'C1 / — f � 3fAo uy� Legal Description: -«v� Lot Block Subdivision/CSM # aio3 ''/, A�L Sec. �, T �S -R_Z2W, Town of - SEPTIC TANK -- DOSE CHAMBER -- HOLDING TA `IN +ORMATION: Tank man"acer :z r Size ST/PC �� / 7Sa Setback from: House Well tj p/I, Pump mane ,' Model raj // L Alarm location 5-�- -� f �,• �, / a r 77 -- - - (HOLDING TANKS y) Setbacks: Service ro Vent to fresh air ' e Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: , o + Width 3 f _Length 7 S Number of Trenches Setback from: House �_ Well_ P/L ZW_ Vent to fresh air intake 176 ELEVATIONS Description of benchmark %o- 0 %Z (LO) Elevation AW Description of alternate benchmark - p4;p I✓(,,,,, �r Elevation ®;?• r Building Sewer ST/HT Inlet ST Outlets ��' PC Inlet PC Bottom -11-17- Header/Manifold 0 ' - Top of ST/PC Manhole Cover Distribution Lines (�) `� 9 , 9� S1 (�) Q 9. IV ( ) Bottom of System (�) _ 21, 15 (,4 9` $ , /5 ( ) Final Grade (l) / 0 ,� ' Date of installation C ///?/ ? Permit number State plan number Plumber's signature License number Date //2/ Inspector -, complctc plot plan NOTICE Picase provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate.benchmark; if applicable. PLAN VIEW I r 0 v~ a ..� ` INDICATE NORTH ARROW f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338986 Permit Holder's Name: ❑ City ❑ Village N Town of: State Plan ID No.: HENDRICKS, EDWARD ST. JOSEPH CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 030- 2103 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( Benchma la2_ /o 1 6z f O Dosing MA, 15M Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Air Intake Septic >tic) � NA Dosing 5_0 f > qo r 5 - 0 NA Header/ Man. ' 30 Aeration NA Dist. Pipe } S2_ p �. G � Holding Bot. System a PUMP/ SIPHON INFORMATION � Final Grade Manufacturer Cs2.�'�`� Demand Model Number 690 3 it L._ GPM TDH Lift FFriction System TDH Ft Loss Forcemain Length Dia. -Head Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O 35 t S0, 7 �— OR UNIT Model Number: System: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Q-�� Dia. Length ia. 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 3 / � — Bed / Trench Edges Topsoil ❑ Yes [] No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) R +�= m ZE + LOCATION: ST. J EPH 36 1286 89TH STREET Lin 5 �„c� r.� C4, � ���.�� ��A� "" '� A11�"Q�10 ,.Ar� •� i. _ � ti :,'.l.t•..,ip, eta >' "" -tea 7 _ Plan revision required? ' ❑ Yes 4No Use other side for additional information. SBD -6710 (R.3/97) 1`K - L� �2C 1 Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i e r e f E m E 3` e # f E �m a� ee f a a E i E { { e 3 E E E E E 9 i s x 0 , v i E � e 4 i J 9 } E .® e e.. e e aea e a w� e. e e m r m f B � h s s c i j t � � 3 } Safety and Buildings Division 2 W. Was hing to n Avenu Visconsin SANITARY PERMIT APPLICATION p O Box 7302 De gto e e Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code p Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the sy g ; ,o QE ss county than 8112 x 11 inches in size. -'� sit • See reverse side for instructions for completing this a �ilcZ' State Sanitary Per N ber 3 3 Personal information you provide may be used for secondary purpose -f' heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. Tate Plan I.D. Number 1. APPLICATION INFORMATION - PL AS PRIN Pro rt Owner Na j, t r L atib 1/4 i , S T O, N, R' E (or)� Propert Owner' ailing Ad ess J\ g N 11Afr Block Number .. AJ 79' 4 t, ate Zip Code Phone Number Ion Name or �S Number Y F BUILDING: (check one) ❑ State Owned ❑ it Nearest Road ❑ village n Public 1 or 2 Family Dwelling - No. of bedrooms Town OF S"C - A I II. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 1 ❑ Apartment/ Condo — Q O 1 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. VNew 2 ❑ Replacement 3_ Q Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an ______System __ ^ __ - __System - _TankOnly______________ Existing System ________ ExistingSyrstem B) fid A Sanitary Permit was previously issued. Permit Number Date Issued (a V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 (Seepage Trenc l ku 22 E] In- Ground Pressure t 42 ❑ Pit Privy 13 Seepage Pit C? 3 77 C_ 43 ❑ Vault Privy 14 E] System-In-Fill x 7 , A 3 7 (o ,. LJ b 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. (Gais/day /sq. ft.) (Min. /inch) Elevation L0 3, 1 9 , ~�— . 7 Feet I Mi jo Feet Capacit II. A in gallo Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks eptic Ta or NWldiag.Iaflk K 1 ❑ ❑ ❑ ❑ rift Pump T iphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VI L RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ration of the onsite sewage system shown on the attached plans. Plumber's Name: (Prin Plu ber's Si natu No Stamps) MP /MPRSW No.: Business Phone Number: rs Plumber's Address tree City, State, Zip Code): V Q- ` IX. COUNTY / DEPARTMEN USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes groundwater at I ssued ks gent Si nature o Staffs) proved [I Owner Given Initial Surcharge Fee) Ff�(Z I Sa( Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS .1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be maintained. the septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc J, 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 tathe county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------- - - - - -- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. O. S U i� c � ,L✓7`� 5 +11A = `jo r i 1 SEPTIC TANK &•',PUMP CWBER CROSS SECTION AND SPECIFICATIONS aO G aid 4" CI VENT PIPE 12" MIN. ABOVE GRADE £ WEATHER PROOF' 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE- WITH CONDUIT MANHOLE COVER FINISHED GRADE 4" Cl RISER W/ PADLOCK 6 WARNING LABEL 6 MIN. ABOVE G ADE — } — __� --4" MIN.. 18" IN. 6" MAX. i INLET WATER TIGHT SEALS GAS• TIGHT1 4" BAFFLE A SEAL APPROVED i CI PIPE -J- ALM JOINTS 41/ CI B i PIPE 3 ONTO SOLODTO __T_ , ON SOLI SOIL C SOIL PUMP OFF ELEV . FT. Off dc�t RISER EXIT �- -�- D PERMITTED ONLY IF. TANK . MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE II ,,' wA TANK MANUFACTURER: /�rD ��U O-WNU MBER'DOSES PER DAY: _ TANK SIZES SEPTIC b GAL. DOSE VOLUME INCLUDING rl DOSE gd GAL. FLOWBACK: /9 GAL. ALARM ACTM$ER: MOD L S� APACITIES: A = • Oc71NCHES = 5.4 GAL. E NUMBER: SWITCH TYPE: B = 2 INCHES = 2,2,( GAL. PUMP MANUFACTURER: �l� C = L INCHES = O, GAL. MODEL NUMBER: lf� / SWITCH TYPE: D = _-b- INCHES = REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . .%. 2.5 FEET + 4 FEET FORCEMAIN X _V_FT /100 FT. ' FRICTION FACTOR FEET T.OTAL DYNAMIC HEAD J FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH �°� DIAMETER LIQUID DEPTH J t` y SIGNED: _ LICENSE NUMBER: �� DATE: - l� 1/88 low � \ . . > |; - _� C) . |; Z � ■j \ \ / \ � � m n |' . E } { ° ° �} E o . cr � | f 7 7 [ C % ± f ° c . « CL % ( 2 / - , (D � t� � ■ ( $ 7 9 !4 2 \ e , . . !■ 2 § � i ] | � \ � | |t � W f( _ / � S !| 7 F a r- a » C. m § Q c . a / Dk R , x 6 0 3 ƒ - / \ /.. - , n = -• 3 p 0� c f ? m 2 -.0 7 § (D . a r g ® . f R C k $ :& �k0�m $ k / CD . o o ■� 0) k g 3 $ e IT N =01 �A2$ O GO (a 3 CD - 0 � -4 � O R � . 7 CA) x CD � a G = $ 6 �k- | _ ƒ F ¥ f { C / ] . . w r \ $ Invert 41" 0 f � . = � .. c .( . �. . . . . MODEL 3885 MODEL WE03 H through 1 Submersible Effluent Pump Submersible Sewage Pump • 1 '' .: Effluent Pum4 6, ' a I L 4 fe METERS FEET METERS FEET w 130 8 120 MODEL: 3885 ] MODEL: 3872 110 20 C7 ao 100 6 C] 90 5 15 T C] ]0 C 4 a 20 R = 10 50 # 40 2 5 " so 1 20 e 10 0 0 0 10 20 30 40 50 60 70 U.S. GPM 0 0 0 2 4 6 8 10 12 14 16 MW r'_1 2 ao 4o so fio ]o ao lao no l20 "o wo u.aGPM CAPACITY " CAPACITY 20 Pump Specifications Features and Benefits Pump Specifications Features and Benefits 1 /Z HP *Glass filled, thermoplastic vortex 1 /3 through 1 HP •AII models feature silicon carbide Up to 75 GPM impeller with stainless steel Up to 130 GPM mechanical seal faces for superior Maximum head to 18' insert and pump out vanes for Maximum head to 123' abrasive resistance and extra Discharge size 2" NPT mechanical seal protection. Discharge size 2" NPT long life. Rugged glass - filled thermoplastic Solids: 3 / 4" maximum Solids: 2" maximum Cast iron semi -open non -clog Motor casing and base design provides Motor impeller with pump -out vanes superior strength and corrosion All motors feature ball All motors feature ball for mechanical seal protection. resistance. bearing onstruction. Rugged cast iron volute bearing construction. g R gg type casing Single phase: 115V •Cast iron motor housing for Available in Single and adaptable for slide rail systems. Materials of Construction efficient heat transfer, strength Three Phase 115, 200, • Corrosion resistant threaded and durability. 230 460 and 575V. Cast iron • > stainless steel shaft. Corrosion resistant threaded All single phase models Thermoplastic stainless steel shaft. have capacitor start motors. Motor is fully submerged in high Stainless steel • quality oil for lubrication Available in automatic and manual Materials of Construction and efficient heat transfer. models. Cast iron • Optional silicon bronze impeller •CSA listed models available. Stainless steel available. • CSA listed models available. S Underwriters Laboratories All Models are designed for continuous operation and feature stainless steel hardware. r , �V `�; Safety and Buildings Division SCOnSln SANITARY PERMIT APPLICATION 2 1 B W Washington Avenue Department of Commerce In accord with tLHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. S t ` • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application ►Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prope ner Name Property Location �V�Qf- .Q v4 AfIg 1/4, S T �, N, R 1�'E (o % Propert Owner's M ling Addre Lot Nu er Bloclyluu ber r v I �/ Ci y, St to Zip Code P mber ubdi ion Name or CSM N ber ( c c II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t� Neare t Road ❑ vll age Public j 1 or 2 Family Dwelling- No. of bedrooms iiar OF 111. BUILDIN USE: (If building type is public, check all that apply) Flaircel Tax O Numbers) .i /_ 36 • 1-9 • TS 1 E] Apartment/ Condo � 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„ Ip( New 2. ❑ Replacement 3, E] Replacementof 4. E] Reconnection of 5. [] Repair of an System ________System _____________Tank Only______________ Existing System _______- Existing 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12)K Seepage Trench 22 ❑ In- Ground Pressure C a � 3 -7 42 [] Pit Privy 13 El Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill �; j A , s y 3�•�$'S • VI. ABSORPTION SYSTEM INFORMATIO '703.2 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Systefn Elev. 7. Final Grade (0&0 R uiy8q. ft.) Pro posed (sq. ft.) (Gals/d�y /sq. ft.) (Mi n. /i � 1 � Elevation ,� C C — 7�� Feet /164 6 Feet Capacit VII. TANK in Ca allon g Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks ptic Ta r t'leFd+ng�artk•" /�5 ,� ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I I I I I ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Sig tur ( Sta s) MP /MPRSW No.: Business Phone Number: C `tcs t Plumber's Address ( treet 'ty, te, ip Code): M ew I , ki, t IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Age Signa r No Sta¢ps) Approved ❑ Owner Given Initial Surcharge Fee) 9 Adverse Determination �� G X. CONDITIONS OF APPROVAL / REASONS F - D �L 7 a r C 6_fTb SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1 INSTRUCTIONS ' I- A sanitary permit is valid for two (2) years. 2. Your sanitary permit may renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contacgp r 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: 1. Property owners name.and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information_ Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans'and specifications not than - 81/2 x 11 inches must be submitted tb {he county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora 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. i f v cg� Y�( p 3( ( T ( 3o ll1 � °I� L .S QJ � LOl 7N o� a2; $et ST_ 7 5 ' r .� Gk /a rba.be is Qacb 17.7 r � 3 0-)La.os37 - -9 70 _1 o l3ncl r ooVY% srz r x (&XA i - ., � �} !f c 2 ,\ 8 5 !! « � 5 \ � � . !| % � §o ( k � ^ 2 TMM E g_. d\ } CD cr !� { / 10 \ a $ 2 ' 0 @ C �\ } 6 |; §\ 3 q ■ !a | § !■ 2 « a ¢ § J1) ■ i� i| f) Z# m «§ |» , , . . $ ¢ ;e co q a o 7 k [ / § ¥ « | 9 R 6- 0 % , x m C CD R 2 =�� m | X q § = J K p 0- ,Z c 2 2 2 n � � � c CD k - 0 cc oz U r / R K k % ° 4 - _ o 0 7 0 / RA (2�� k ::r k�\ co k % } k 3 U�� 7 q��� @ 0) x = �. q , C� { $ m 0 w 9 = ¥ :/� | = / ƒ Invert 4 y $ k ƒ [ ® w ) J | � �� 4 , Wisconsin Department of Industry ' SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations bivision of Safety 8 Buildings 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030 - 2013 -10 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION James Durning GOVT. LOT NE 1/4 NE 1/4,S 36 T 30 N,R 19 Hqor) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # 7217 Courtly Rd. 2 na Durning & Lewis Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ jjiOWN NEAREST ROAD Woodbury, M. 55125 (612) 739 -5208 1 St. Joseph Cty. Rd. "A" J:4 New Construction Use [x] Residential/ Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate -7 - bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 98.15 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I ® S ❑ U EIS ❑ U ®S ❑ U ® S ❑ U Ns ❑ U ❑ S [3 11 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -10 10 r3 2 none sil lcsbk mfr aw 2f .2 .3 2 10 -30 10 r4 4 none sil lcsbk mfr CIV if .2 .3 Ground 3 30 -90 7.5 r4 6 none cos osa ml na na .7 .8 elev. 102 ft. Depth to limiting factor +90" Remarks: Boring # 1 0 -12 10 r3 2 none sil lcsbk mfr qw lm .2 .3 2 12 -32 10 r4 4 none sil lcsbk mfr c1w if .2 •..3 Ground 3 32 -84 7.5 r4 4 none sl 2csbk mfr .5 .6 10 ft. Depth to limiting $ ; factor +84" ;:.��, ST CROIX CE Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 � [ -�� Address: 1554 200W Ave., New Ri nd I 54017 Signature: 5 -13 -97 CST Number: m02298 PROPERTY OWNER James Durning SOIL DESCRIPTION REPORT Page Af ' PARCEL I.D. # 030 - 2013 -10 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -8 10 r3 2 none sil 2 2 8 -28 10 r4 4 none sil 1 sbk mfr Ground 3 28 -45 10 r4/4 none sl 2csbk mvfr Crw na .5 .6 elev. 101 _ ft. 4 45 -84 7.5 r4 6 none cos osa ml na na 07 .8 Depth to limiting factor +8 Remarks: Boring # 1 0 -12 10 r3 2 none sit 2mar mfr .5 .6 2 12 -23 10 r4/4 none sicl lcsbk mfr 9w if .2 .3 Ground 3 23 -41 7.5 r4 4 n n .4 .5 elev. 4 41 -82 7.5 r4 6 none cos oscr ml na na .7 .8 10 ft. Depth to limiting factor +82 Remarks: Boring # 1 none si 2ms k mfr if .5 .6 2 11 -18 10 r4 4 none sit 2msbk mfr qw if .5 .6 Ground 3 18 -30 7.5 r4 4 none sl 2csbk mvfr C1w na .5 .6 elev. 4 30 -84 7.5 r4 6 none cos OSQ ml na na .7 ' .8 1 00.7 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel James Durning 1554 200th Ave. CSTM2298 NE4NE4 S36- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 1 lot #2- Durning & Lewis Addn. N 1 =40' BM.= top of 211 pvc pipe C el. 100' Alt. BM.= nail in Elm tree @ el. 102.10' S -3 10 III Gary L. Steel 5 -13 -97 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P*1 t - ►o iIA S Mailing Address ��- +► Drr� �T O a `/�! t 4 01 �c Property Address a O (Verification required from Planning Department for new construction) L City /State VA':n"` N" "OM (Parcel Identification Number 7, 1`o3 LEGAL DESCRIPTION Property Location ' /a, 6 ' /., Sec. _ ' T N -R W, Town of Subdivision t _% , Lot # �! . Certified Survey Map # , Volume , Page # Warranty Deed # �° ®Z'�o� , Volume �� . Page # , i Spec house ❑ yes )(,no Lot lines identifiable yes ❑ no r SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste d isposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplgmber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. _4:25 c 1" zzy 99 SIGNATURE OF APPLICANT 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 � - VOL 1423FAc-E 57 SH STAIE BAR OF 'is I1CONSIN F 2 -1998 R REGISTER OF DEEM ument mbier !' ED ST. CROIX CO., WI This Deed, made between Earl L. Mielke, marricd _ RECE,VED FOR RECORD Grtntor, and 04 -30 -1999 9:30 M Edh_ard M. Hendrick and Lori 1.. _Hendric s tud wi as survi marit pro ►ARRA4ITY DEED ur EYE* 1 I __ — _ - -- CERT COPY FEE: Grantee. C F E E. fEE: 254.70 Grantor, for a valaable consideration, conveys and warrants to Grantee RECORDING FEE: 10.00 the following described real estate in St. Cro ix C-nnty. State of Wisconsin (The PAGES: I 'Property'" i s Rct.ording Area _ Harm and Return Address + r ...... _ -. a ,, . flit p.ng V 2rl. 03rk 41 363 i ti;'G3s�3 : 1h•154602.1668 030 - .103 -20 Park!. Idenntication Number 1 E'EN) Tr,n is not home +toad property. Lot" Durning and Lewis Addition to the Town of SL Joseph, TOCrTHER WITH AND SUBJECT TO PROPOSED JOINT DRiVFWA x WITH LOT 3 OF SAID ADDITION. 1 _ I i Exceptions o warranties: Easements, restrictions and rights -of .Nay of rcuxd. if any. Dated this _ day of April, 1999. e AUTHENTICATION ACKNO)%� LEDGME Signature(:) Earl L. Mielke, a :Harried m'ut, SI'A TE. OF N ISCV'.)E\ i 1 i ss. authenticated this :fay of April, 1999. —� Pcr"�rally :s ;ne hrti re me till', day of � — --- - - - - -- — hc ahest named o TITLE. `LEM131-'R ST_ I h RAR OF \`; ISC('`SIN __ __ __ ^.c r.nov. n t. ^< the per':nn(,) .{h ill not, c\.rcuted the tort_ ,, ;r -mcni aild he s.tme. authorized by § ' Wts S'.,(s.) ! Attorney I:ristina Ogland Nc tary Pu a ,late �; •; r,in _ _ Hudson, W1 54016 \h Con slon 1> , :. arxnt. (If nut, late evl• ite)n date 1Ster,.aures aay he authenticate.! ,;r acknowledged. Both a• n' Rete :. 1 f • • \amts f pen; ,tzning in aR1 eapactry ,hruld hr n it J •. r prn;eJ he! u ; rlr ,Ign.ta res w ARRA \TV nFF.D iNFORMA7.CN:R<,- 75;C%ALSCOMPAT4Y FGNDDU:AC.WI 70 ` -`2G71 • S 38 a 4 p47 : �, ; is, 8 � 1 1 g 1 fig�m - e 5 E I IL Y , . , a.► ,,,, f ` I N M gll !ri■ ■sWww uW ■ ■ ■w Y .fie y I Id : Hal R iSS B5 8i • (LF i Vii.. p':; c .�• ' t . p Y � .'h�f3;,'.,+�.. a'd 9ZT'ON NOSafH TZ ANMM30 W*S:6 6561'0Z' add w DATA P ROCF$SiNQ w ti I fJ Ld v t7Q =,r � P- IFPl C D Ask Oct {{ p Ir m � !M a b �- Wiwi L l ca IN m j m m VbM � ~ mom'` '� tq M$ ! IN g ; r " Za p to j ISO wry 1 01- N E ar,...•EES ' O �YMMr+r'+R "r�.y 1^ TO „L+ • ,T,�, .. . NOSQf1H TE A8nlW33. ,.,..Wd T : T ;-666T ' P DERRICK CONSTRUCTION Fax :715- 246 -4948 Jun 9 '99 16 :53 P.01/05 FAX TRANSMISSION q G TEVIE: DATE: . PLEASE DELIVER TO: DERRICK cO MPANY: Z ►.�� CONSTRUCTION ( - FAX NUMBER: THESE PAGES ARE FROM: Residential Commercial TOTAL # OF PAGES INCLUDING COVER SHEET: Remodeling IF YOU DO NOT RECEIVE ALL OF THESE PAGES, PLEASE CALL (715)246 -2320 AS SOON AS POSSIBLE. THANK YOU! 1505 Hwy, 65 P.O, 5ox A ADDITIONAL NOTES: New Richmond, WI 54017 (715) 246 -2320 FAX: (715) 246 -4948 ,i DERRICK CONSTRUCTION Fax:715- 246 -4948 Jun 9 '99 16:54 P.04/05 EROSION CONTROL PLAN CHECKLIST Check (V) appropriate boxes below, and complete the site diagram with necessary information. Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. X ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. ❑ X Location of storm sewer inle . 0 Location of existing and proposed buildings and paved areas. X The disturbed area on the lo:. Approximate gradient and di of slopes before grading operations. Approximate gradient and drection of slopes after final grading operations. ❑ )< Overland runoff (sheet flow) -mming onto the site from adjacent areas. Erosion Control Practices ❑ X Location of temporary soil storage piles. Note- Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s), Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10 -foot wide vegetative strips) that will pre- vent eroded soil from leaving the site. ❑ Location of sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specifically required by code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas_ Overland runoff (sheet flow) from adjacent areas greater than 10, 000 sq. ft. should also be diverted around disturbed areas. ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ Location of practices that will control erosion in areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices - should nQ be installed in perennial streams (streams with year -round flow.) ❑ Location of other planned practices not already noted. �c Indicate management strategy by checking (J) the appropriate box: c Q le = o Management Strategies ❑ Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). Indicate re- vegetation method: Seed Sod ❑ Other n Expected date of permanent re- vegetation: C) Q Re- vegetation responsibility of: Builder © Owner /Buyer Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? Yes ❑ NoX ❑ X Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. ❑ Trapping sediment during dewatering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. X Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). - All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. - All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. - Access drives will be maintained throughout construction- - All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan preparation, refer to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW- Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/266 -3558. Erosion Control for Home Builders (GW0001) can be ordered through Cooperative Extension Publications, 608/262 -3346 or the Department of Commerce, 608/267 -2423. � f�rc. 181 -s° �G. go• C , 7 C3 � r IL rn w 0^ 11— 7 17 R z6v, ©m• a }> DERRICK CONSTRUCTION Fax :715- 246 -4948 Jun 9 '99 1653 P.02l05 'Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20& 21 of the Wisconsin Uniform Dwelling ode soil erosion control g e trel infermz- tion needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is p rovided to assist in meetin this requirement. Instructions: 1- Complete this Ian b fill p p y In requested Information, completing the site diagram and marking (r) appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 1 inch = feet EROSION CONTROL PLAN LEGEND PROPERTY i LINE i _ EXISTING DRAINAGE I - TD TEMPORARY DIVERSION FINISHED DRAINAGE LIMITS OF GRADING SILT i FENCE STRAW E. BALES fw GRAVEL VEGETATI } O SPECIFICATION _ I I TREE - i PRESERVATION STOCKPILED SOIL I . j Please indicate north by completing the arrow below. I —N— I PROJECT LOCATION 4 cr I -L, l/LA ra-4-i [V1V � "WE S BUILDER V�'�Tf'�y►C - C.4�S�''i�► -`► ` \at.1 OWNER t!''�S G' WORKSHEET COMPLETED BY S DATE (O A