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030-2098-70-000
;cousin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and Building Division INSPECTION REPORT Sanitary Permit No: 563815 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)]. City Village X Township Parcel Tax No: Permit Holder's Name: 030-2098-70-000 Galbraith, David J. St. Joseph, Town of CST BM Elev: Insp. BM Elev: BM Description r Section/Town/Range/Map No: 28.30.19.811 TANK INFORMATION EL NATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark C,Z /&6.3,9 X17.05 Dosing a Bldg. Sewer AMVM Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Lti ` eader/Man. $ X45 Aeration Dist. Pipe 7,77 27- le L Holding Bot. System I" IF(. , FinalGrade 5•Z ~61 ~ ! PUMP/SIPHON INFORMATION Manufacturer Demand over O GPM Q / Model Number wl 16 V aWV `Cy 7.73 v fv TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well L SOIL ABSORPTION SYSTEM PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width Length No. Of Trenches DIMENSIONS 3 5 Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer: h~um F/a te INFORMATION Ty__ Of System: ld 7 5 '7 / 5;b ./u / UNIT Model N DISTRIBUTION SYSTEM •ds Header/Man ifold~ ~ventt Airl take / x Hole Size x Hole spacing nt to / Distribution Pipe(sj~ Length Dia "1' Length Dia Spacing Q~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,a Mulched Depth Over Depth Over xx Depth of xx Seeded/Sodded BedlTrench Center' ' 4j Bedrrrench Edges Topsoil es ❑ No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / 28.3. Location: 583 132nd Avenue Somerset, WI 54025 (SE 1/c4~E 1/4 28 TC30N R1 9W) Birch Point Lot Parcel No: 11 9.811 1.) Alt BM Description = vrec'r~ ~a.. J' ( ( 6, j d _:Z c l - amount of cover = X 5 2.) Bldg sewer length = r1inseepctor's ~•`Ga+ lam P rM, Plan revision Required? ❑ Yes No 2 I Use other side for additional informati n. J J ignature Cert. No. SBD-6710 (R.3/97) Date PLOT PLAN N Dave Golbraith Legal Description: SE 1/4, SE1/4, S28,T30N,R19W P.I.D: 030-2098-70-000 Subdivision Name. BIRCH POINT Lot 7 SCALE: I^ = 60' Township: ST. JOSEPH Parcel Size: 3.0 Acres County: ST. CROIX System Elevation: T1=97.15' 4 inch Sch 40 -ASTM D2665 Slope: 0% T2=97.15' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 97.09' Bottom of existing s stemTo of BM2 Elevation: 89.42' Bottom of dose tank. ■ Backhoe Pits: p~, ;~,.IZ~M~ BI P3ZNh l~v Z-3 X(cS' IFu/ST7N Z Lot, 2° IF0 A)C14,c5 TerNCi~cS iy VALvE Q~'iJ1 BSAZ o WELL 3 acD~cOr~ ~X/Sii >~C~ HuvtS E 1000 / sO S/ PL WiT►4 Sir~1TECi~ v v` 5 o wri-I P L County _ Safety and Buildings Division S/ - L~d X 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ' SP CI Madison, WI 53707-7162 State Trction N her Sant rmit Application ti in accordance with SPS 383.21 C , submission of this form to the appropriate govern tal un } is required prior to obtaining rm' ote: Application forms for state-owned POWTS are su d to I ^ dress (if different than mailing address) the Department of Safety P sion ervies. Personal information you provide may be used for sec _ 132,4 purposes in accordance wi v Law, s. 15.04 1 m , Stats. C G ~~g3 f¢V1. Application Informal. lease Print All Info a Property Owner's Name arcel # DA 05 G,4 T H ' 03 6 70 -19Property Owner's Mailing Address j~ Property Location 0p~ cJpeV 3 / 3 z N o / i V C Govt. Lot T Zip Code 'n 7 Phone Number S i y,, > C SectionZ~ city, state S'a m i es 6 / ~L/V T -3 © N; R )~rclE oret) H. Type of Building (check all that apply) Lot # Subdivision Name I 1 or 2 Family Dwelling - Number of Bedrooms I Block # &O-C H Po , ti , ❑ Public/Commercial - Describe Use l ~wke ❑ City of A CSM Number El Village of El State Owned -Describe Use Ig Town of sri T Tos E'p/~/ Z Q,~~ ('e t(6 w Ez III. Type of Permit: (Check onl one box online A. Complete line B if applicable) A. ❑ New System V( Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Chan List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ge of Plumber El Permit Transfer to New 2 2 Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) rea Information: nt A V. Dis rsaUTreTre Des~Flow (gpd) esign Soil Application Rate(' Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation _ q7~1 ~ So 7 v" 7/3 65-0 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units r, j y y New Tanks Existing Tanks L r w j w C7 P, Septic or Holding Tank OO moo 15 r Dosing Chamber 6:5-0 ~ 1 W5 7 T , VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum e J , MP/MPRS Number Business Phone Number 3©14 N) SCH /Ii IT- T MP o 17/-V- 7&0 -o V96 Plumber's Address (Street, City, State, Zip Code) a4ti r 6k Sc i W T S No z 14 :504,16k5,67,_ VIII. Court /De artment Use On Issuing nt Signature Permit Fee Date 7;V3 Approved ❑ D_ prov S Z~ ❑ tven Reason enial (p rt IX. Conditwoeasons for DisaPProval 3/ JIItvS~ Gp 1. Septic tank, effluientfter and dispersal cefl must all be servkes / mainWined as per management plan provided by plumber. C~ 2. AN S 6600k re4ulfbmettts must be makltik*d is per "code tordirl~Ilces: Attach to complete plans for the system and submit to the County only on paper not less than 8 in a 11 inches in size SBD-6398 (R 11/11) 4 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Golbraith 3 Bedroom Septic System Owners Name: Dave Golbraith Owner's Address 583 132nd Ave., 1348 60th Street Somerset, WI 54025 Legal Description: SE1/4, SE1/4, S28, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: Birch Point Lot Number: 7 Block Number 2 Parcel I.D. Number 030-2098-70-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Effluent Filter Information Page 5 & 6 Management and contingency plan Page 7 Septic Tank Maintenance Agreement Page 8 Dose Tank Cross Section Page 9 Bull Run Valve Page10 EZ Flow Information Page 11 Warranty Deed Page 12 CSM Page 13-16 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/25/2013 Phone Number: 715-760-0486 Signature: L~ In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) PLOT PLAN N Dave Golbraith Legal Description: SE 1/4 SEIM, S28,T30N,R19W P.I.D: 030-2098-70-000 Subdivision Name: BIRCH POINT Lot 7 SCALE: V = 60' Township: ST. JOSEPH Parcel Size: 3.0 Acres County: ST. CROIX System Elevation: T1=97.15' 4 inch Sch 40 -ASTM D2665 Slope: 0°/(u T2=97.15' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 97.09' Bottom of existing s stemTo of BM2 Elevation: 89.42' Bottom of dose tank. ■ Backhoe Pits: Q „TZgM~ BI t3itn AvE s ' Z`~ X(oS'~ Eu/ST)N i EZ }Later Z° SX ~7 f~oCt, 1 tA1C14F6J T2cA1C~fc5 $Z VNLV E p~1~C gMt o WELL 3 ~cD'QoOr~ XIS i i N 6 F} d~t5 F 1000/&50 57/PC ITN SIArCC14 STr -100 Alwal) r ti Sow(H P L SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Dave Golbraith 2 No. of Cells 6.5 Per Cell 3 ft Cell Width 13 Total No of 1203H 65 ft Cell Length 325 sq ft EISA Per Cell 3 ft Cell Spacing 650 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-1 Oft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent ~ Soil Backfill 45 in ■ GeoteXtile Fabric 97.2 ft Infiltrative Surface 12 in 0 <94.2 ft Limiting Factor >36 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License MPRS 223760 Date: 25-Jun-13 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page-of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Dave Golbraith Tank Manufacturer: Midwest Precast r NA Permit # E Septic E Dose Holding Volume: 1000 gal DESIGN PARAMETERS Tank Manufacturer: Midwest Precast F NA Number of Bedrooms: 3 r NA E Septic E Dose Holding Volume: 650 al Number of Public Facility Units: IN NA Vertical Distance Tank Bottom (s) to Service Pad:_10 ft Estimated (average) Flow: 300 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 450 gal/day 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: SimfFech F NA Fats, Oils & Grease (FOG) :530 mg/L Effluent Filter Model: STF-100 Biochemical Oxygen Demand (BOD5) 5220mg/L r NA Pump Manufacturer: F NA Total Suspended Solids (TSS) 5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L Ij NA r Mechanical Aeration r Peat Fitter NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r other. Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) s30mg/L Iff NA r In-Ground (gravity) r In-Ground (pressure) NA Fecal Coliform (geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: Ys in dia. 2FAN r Drip-Line r other: Other: Other: F NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third (%3) of tank volume Pump out contents of tank(s) When the high water alarm is activated Inspect condition of tank(s) At least once eve : 3 rear(s) I- (Maximum 3 ears) NA r mor*Xs) Inspect dispersal cell(s) At least once every: 3 rear(s) Maximum 3 ears) r NA s Clean effluent filter At least once eve : 1.5 r year(s) r NA ff-*9s) Inspect pump, pump controls & alarm At least once eve : 1.5 year(s) r Flush laterals and pressure test At least once eve : r year(s) I NA rran#xs) Other: At least once eve : r rear(s) r NA Other: 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) PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS 1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020 Boyne City, M149712 Fax 231-582-7324 Email salesCdgaa-simtech. coin Web wwwgag-simtech.com INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. 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. Noce that in cold cond ilow the Miller cap maybe dWh;rA to mmom Keep #w barb a wart area or pour warm water over the cap beibm mmovkV Once the filter is In Wad in the fiv*N mOtabs a SIMW klnpwahae and mmovft the cap wN not be a pmblem. 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 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 tanks removed by a sePto9a 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: 715-76040486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Chace 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. (Rev. 2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Dave Galbraith Mailing Address 583 132nd Ave., Somerset, WI 54025 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Somerset, WI Parcel Identification Number 030-2098-70-000 LEGAL DESCRIPTION Property Location SE 1/4, SE 1/4 , Sec. 28 , T 30 N R 19 W, Town of St. Joseph Subdivision Plat: Birch Point , Lot # 7 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 17yes0no Lot lines identifiable Elyes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance 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 this form are , e 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 corded in Register of Deeds Office. Number of bedrooms 3 06/25/13 '45-MATURE OF (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 GF PUMP CHAMBER CROSS SECTIOM AIJG SPECIFICAT10kJS VE UT CAP y"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG > 25' FROM DOOR JUMCTION BOX MANHOLE COVER - , WINDOW OR FRESH 12"MIU. AIR INTAKE GRADE I Y" MIN. I ~ ~ ~ le"rrlu. COIJDUIT i8"P11A1. INLET PROVIDE 1 "j" AIRTIGHT SEAL IIf A f ill I I i I ALARM e I 11. f I *APPROVED f I ON JOINTS WITH I ELEV. FT. APPROVED PIPE 3 ' ONTO PUMP ` OFF o SOLID SOIL GOJJCRETE BLOCK RISER EXIT PERMITTED OJJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEGIFICATIOAIS DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAS TANK SIZE: G0 GALLONS DOSE VOLUME ALARM MANUFACTURER: IMCLUDING BACKFLOW: ~'29 GALLONS MODEL 1JUMBEK: A2 f% CAPACITIES: A= D,y! IIJCNES OR ,~LZ GALLOU5 i SWITCH TYPE: 07 OVe- g = 2 INCHES OR . GALLONS PUMP MANUFACTURER: Xo..,(d,!r C= lIIJCHES OR GALLOIJS I MODEL NUMBER: V Ds-7INCHES OR 134; GALLONS i SWITCH TYPE: -e rc MOTE: PUMP AND ALARM ARE TO BE i MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREMCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. _ 111 FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , . , . . , 'I= FEET y + /60 FEET OF FORCE MAIN X AFT,/ !t'dS '1 1 loo fxFRICTIOU FACTOR. FEET TOTAL OtIMAMIC HEAD = l~ QJrFEET I IMTERAIAL DIMENSIOIJJ; OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH SIGIJED: 10✓ 4 4o,&~~ LAPR 01 ICEMSE NUMBER: 7 44a nsTC,4/4? 0--f 41EGERER S':.IL Tfi53ING PAGE ac Gculds tai: o fi Subm®r$fble - ~r • Effluent Pump EP04 3871 EPO 5 APPLXATWI • Feedenerr xio series OF uIIY h ■ MOMr Mewl Cast iron sWlll► designed fOr the 'tftlMka ateaf. prrrle t1lrfJhy Oe fla tollawlnpuan- 'Crp"ofAmino fubrla dcmanddkJant faeQJdentheMlrenlfer, • EM L*N d+S►1NldW damape to heat trawttir. • wd dumbfflty. • Noma component:. ee ewer faerr TturnropI". Firms Rioter. Au tMe ier aattaWk and Itc cover we Wow bs+rdfe • 14"7f 0* sump • FP04 pHeat OA HP, nrararel • ilat "Lle .NO doet tMlfdr a khment ' Waist trrrlafer t t S or V w N, i Soo nail tMle/e ~aalaw. 0~ • atwa ~0 RfiM, but In onind wP.h float Sr+ fib pleemw and ■ Fearer claw Sewn duty @Uk ndk resat. PnW d till b d". MW of are ester M aIgm • EPOi $id n If ph@". 0.3 HP, • EetNer. u per aWtower ~~ac RPM, F1ATURS hftWdufy►eW bearing bolt in overlord W" • 810IIda WON 0epeb by taaftorr►rtyc reset ■ &W Impetfatr; 71r1rma conatrtalori i rrm*nam. • Paw~et lord: 10 foot p~ Nom " Capwmw up to 56 GPM. eta dWd WVM, 159 SJTp "t- PUMP MEMO MOM= for A91EkY LiTfNO 7obrl f►tads. up 21 peL w10t mrar prong Ore 6j.11p mechpnlni reel pr kbft. MaNtarpe Sft: l hr W. plu0.000naf 20 foot ■ Erfts fmppeetfer. nwfnb Mtclnrrical doh errbw- rMo. I W3 &ITW with Diaaffc erMteeed damn for (U Rated model numbers 8 IJ1VA44 kft Om prop Imundrng p;up L,rprorad p~nru. erM In'P 0►'AC.) T {etandrrd an EPOS) ■ CMMf wd NO: Rugpd ~mp~ ro:corranuous tnenMVINec daps p TN'F( 1140'F (N3•cj supwar aft &W k os'ntlltent mmmilan knot. 300 swin MURM PUT • COW of rtrnnkq AMY without dertuge =non rsrpr. • so PURM.- s • > th kndtt apabpky: o r - , 7-- iL ' caped br up in Go GPM. • roW ►rwda: up to 31 ieoc 'irictx,; a c i R:lofianary, I ' BUIM • 04 = toj 14" ~tt0•~ Intatmltoent ~ s I • o oe ro o e re r: rw,, C vas ae„ies ti,m•a rr+a. . Oi-d E9LB-T9G-9S6 4pIT4osneH ueea d9Z:ZT b0 60 Jew American Manufacturing Company Bull Run Valve Page 1 of 3 _ Y - ~ 1 Home About Site Map Order Info Training Videos Contact Data Center Drip Systems watwlftstewatw Controls Products Downloads Design Guidance THE BULL RUNT'" VALVE ~ Q ~ ' WU4TER-TIGHT ~ ACCESS CAP RISER CAP ADAPTER RISER TUBE VALVE DIRECTION HANDLE The Bull Run Valve TM is designed to split flows to septic # OUT PORT fields or systems. In addition to the advantages of longer life and easier installation it is the most public R" OUT PORT health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak-proof and external operating characteristics. The change over from 4 IN PORT one drainage field to another can be accomplished in % less than a minute by simply turning the valve without The Bull Run Valve is available in 4" sch 40 pvc digging or contact with wastewater. and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated periodically to direct effluent to one or the other Field Field Ved No. i No.2 of two septic fields. After removin g the screw cap at the top of the riser tube, the valve handle can be turned with the valve key furnished. Valve Positioned BULL RUN VALVE ad tm 1 _ 2 Complete Valve Kit dwing "ing Odd Years Septic Septic Contains Even Years Tank Tanis 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVCIRISER - 4" BRVKEY28 BULL RUN VALVE KEY 28" ADJUSTABLE TO 28" BRVKEY36 BULL RUN VALVE KEY 36" HIGH POLY RISER http://www.americanonsite.com/american/catalog/brv.html 6/26/2013 E;flow by INFILTRATOR T .0 • Aiw~ dear and 5 • ~rt~~r,~_~:G E~~~ r~.,t,rr:~r ~c~r~.~a, ar,~ "~~~~C~<_,9 - t_7 .r.3,' •a, J C ,C)~ "I "VI dh' • ads EZ INFILTRATOR For technical assistance, installation instructions or customer service, call Infiltrator Systems at 800.689.7759, EZ,17ow by INFILTRATOR Single Pipe Systems Horizontal Systems Vertical Systems Triangular Systems r . INFILTRATOR 7 80,0,889,7759 W VVw'eZfl0wlp.COm WwwAnfSltratorsystems.com For technical assistance, installation instructions or customer service, call Infiltrator Systems at 800.689.7759. 5 J~~ m ~ m~ r e Y . JS D ~ x O 0 N m \ ✓ -x n \ Nw, S 4 ,ZOb ~ I \ O, to ti x o• . X 9 b m \ iDDV w N N W \\I V C7 d 60 OD - X x W N w< -I ? m 487 09ti x m ' ~ : X \ a ~ 9 N {0 S: o N, W m W W W + x DD a f~ e ......i e 0 O 5\\\~ 09b 99 < -4 1 455' z r j _ . . a•V?939-Q--R-- _ Sill ~'~o ~ 1332i1S H10 ' oes - ' 77777.1 579205 ,QL 13?:3 Do 1577 STATE BAR OF WISCONSIN FORM 2 -1tiYb DOCUMENT NO. WARRANTY DEED I _Ericksmith. Ind, a Wisconsin Corporation • - --~iw~- - R 7~t conveys and warrants to Davi J. Galbraith an ST. CROIX CO If #/I 1998 Patrice M Galbraith, husband and wife MAY Y 1p6 for 998 . 10:30 A. M I i the loeowing described real ostale in St. Croix State of Wisconsin: FIETURN TO i Lot 7, Birch Point in the Town of St. DAVID J. ESTREEN Joseph. 304 LOCUST ST. HUDSON, WI 54016 r 30-2098-70-000 Parcel ldanglicatlon Number (PIN): TRANSFER FEE -t Tn.s is not homestead property. (is) (is not) y. E.cepiion to warranties: Easements, restrictions and rights-of-way of record, if any Daledolis day of May 1998 (SEAL) (SEAL) • I: 4 • /~I'• (SEAL) .a. ~y. • Dennis W. Erickson, President AUTHENTICATION ACKNOWLEDGMENT N•N~••••,,•• Signature(s) S'DO OF WISCONSIN ,I CLO "x County. authenticated this day of Personaoy came bebre me this da of 1""j, "al 61-4- 19 f6 to above named TITLE mEfJ6ER STATE BAR OF WISCONSWE * * - pt ' 31, r me 1t wm to be the parson who executed the au'•+orized by § 706.06. Wis. Slats.) } t the ssme. THILi p INSTAWENT WAS c '~~~~l,~A `•w~`G a i Dennis W Erickson BY OF Vy1S I Int •L~1'' n r ~.D ~ ~ r. v. w".wnwnDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page i of 3 Labor and Human Rotations - Division of Safety & Buildings in ~~u R 83.05. Wis. Adm. Code ~y j Y COUNTY Attach complete site plan on paper not less an` t2 x 11 i es I e ;Plan nvig include, butt St . Croix not limited to vertical and horizontal refers M~(B n slope, scale or PARCEL I.D. ft dimensioned, north arrow, and location a cYatartoe tonaear . pending APPLICANT INFORMATION-PLEA E ,P,R T 4LLMF *TI REVIEWED BY DATE PROPERTY OWNER: r 4 f 5~ A-PROPERTY LOCATION Dennis Erickson r GOVT. LOT SE 114 SE 1t4S 28 T 30 N.R 19 for) W PROPERTY OWNERS M UNG ADDRESS LOT # BLOCK 9 SUED. NAME OR CSM s 143 St. Croix Trl.w% 7 nor Birch Point CITY, STATE ZIP CODE P OCI Y []VILLAGE ]MOWN NEAREST ROAD Lakeland, Mn. 55043 (612 436-5211 St. Joseph 60th. St. P*New Construction Use pq Residertial / Number of bedrooms 3 [ J Addition to wdsting building t I Replacement [ I Public orcommerdal describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 - 8 trends, OW Absorption area required 643 bed, ft2 563 trends, ft2 Ma*n m design loading rate • 7 bed, 2 .8 trench, gpdoft2 Recommended infiltration surface elevation(s) 97.15 ft (as referred to silo plans benchmark) Additional desigrs / site considerations na Parent material outwash Flood plain elevation, d applicable nor It U=U loor tem I S U OU au 30S Oil a ®u o ®'u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Ca sir GPD/ft in. Munsell Ou. Sz, Cora! Color Gr. Sz. Sh. Bed tersdt 1 1 -12 10 r3/3 none 1 2c 1 mfr cs 2f _R2 .3 2 2-35 10 r4/4 none sil lfsbk mfr w If .2 . Ground 3 5-80 10 r4 4 none s os v elev. .7 .8 100. 55 It Depth to limiting factor +8011 Remarks: Boring # 1 -10 10 r3 3 none 1 2 s 2 2 0-36 10 r5 4 none .2.3 Grotxxf 3 6-82 10 r4/4 none s os mvfr elev. 100.45 tL NO b limiting factor +82" Remarks: CST Name-44emPrint Gar L. Steel 715-246-6200 1554 200th. Ave., New Richmond, Wi. 54017 signaa,r.: Day: 4-95 CST Ntr<tuberw. PRCIPERTYOtdINEB Dennis Erickson SOIL DESCRIPTION REPORT pap - 2 of .3 . PARCELI.D.#r pending Boring # Horizon Depth I Dominant Color Mottles Ted Structure ~ Bound3y G PD/ft in. i Munsell QL Sz. Cont Cobr Gr. Sz. Sh. Bed iT 3 1 -10 10 r3 3 none 1 2msbk mfr cs 2f .5 .6 Mj/ 2 0-38 10yr5/4 none sil lfsbk mfr gw if .21.3 Ground 3 8-88 10 r4/4 none cos osg mvfr na na .71 .8 elev. I 00.5 lt. Depth b ionng tacbr - 48 Remarks: Boring # 1 0-12 10 r3/3 none 1 2msbk mfr cs 2f .5:: .6 4 2 12-3 10 r5/4 none sil lfsbk mfr . gw if . 2 .3 3 32-8 7.5yr4/6 none cos osg mvfr na na .7 .8 Grouts elev. r .00.4 k Depth 11D knift +80„ Remarks: Boring # 1 0-11 10 r3/3 none 1 2msbk mfr cs 2f .5 .6 5 i 2 11-3 10yr5/4 none sil lfsbk mfr gw if .2 .3 3 32-8 7.5yr4/6 none cos osg ml na na .7 .8 Ground 100 6 tL Depth to ta= 11 +82" Remarks: Boring # Ground elev. ft Depth to limning tactorr , Remarks: s8as3aota.0sre2t STEEL'S SOIL SERVICE Gary L. Steel Dennis Erickson 1554 200th Ave. CSTM2298 SE4sEJ S28-T30N-R19W New Richmond, WI 54017 MPRSW 3254 town of st. Joseph (715) 246-6200 lot *7-Birch Point N 110=401 BM. = top of 211 row survey stake @ el. 1001 ~ . 8 F 17' 2(o t 2 60, tvro 1 Gary L. Steel 9-4-95 I 0 cn O 3-0 n C") m 3 -1 m m y w h v a - c M 3 3 0 a~ cn z N « O' N O ro 3 O <p m Oo Q L j N 1-+ N C- {y L ro ` W N, fan O r0.' N m c0 C rn N Q. = p N j' bD 90 'a -4 O' 3 O N a O ro O O r 7 to (n O O N D C D 0 a io I N CO a ro c 3 CD rn D c I~ am rQ N) ro ~y CL U o cc) (D 3 0 C) r- co ro ?O Cl) r3. (n1 -4 oo N. N C) 3 0 0 N) = C a) CD ro A A O w w n; _ m z ni l z 3 l~ z --I zOy,y y y ro a N na O n o ? !wr • CD @ CD U) C CD 'D N c m c I w m CD z = co i -4 cn z 0 ° N c w CL A ) 7 a. m w a ca O ro z a 3 A O Cn o M co z ro w ~ I D I a a Q I w_ c z c. a N A I H A 'a d0 w H ! O N N O O J A 0 A O 7 ro O 0 y~ ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Address City/State Legal Description: Lot Block Subdivision/CSM # V'f Sec. T.Z0N-RW, Town of 7 c c PIN # 030 -.7 o,7r-7d -eea SEPTIC TANK -DOSE CHAMBER -HOLDING TANK INFORMATION Tank manufacturer J~,, Sul ~s ,v Size ST/PC oDd-Setback from: House JamJ'Well., Pump manufacturer r' i s Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: z o ow Width -,4-_ Length G e Number of Trenches Z Setback from: House /y Well _57 y. p/L _ Vent to fresh air intake s ~4 ELEVATIONS: Description of benchmark Q w e e2 S Description of alternate benchmark Elevation 6 , ° Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC, ottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) Bottom of System O O ( ) Final Grade ( ) Date of installation P' ffTermtt number State plan number Plumber's signature License number ?;7`79" Date Inspector j Complete plot plan or afety °sirt Department of Commerce Safety and Buildings ldings Division PRIVATE SEWAGE SYSTEM County: ST. CROIX INSPECTION REPORT GENERAL WrORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 315833 Permit Holder's Name: ❑ Cit ❑ village Town ot: State Plan ID No.: GALBRAITH, DAVE Sr?. JOSE CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 030-2098-70-000 TANK INFORMATION ELEVATION DATA A9800222 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg Sewer SY' Holding St/.Kt Inlet TANK SETBACK INFORMATION St/ Ht Outlet Verit TANK TO P/ L WELL BLDG. A irIntato ke ROAD Dt Inlet Septic NA Dt Bottom Dosi ng NA Header / Man. Aeration NA Dist. Pipe Z, 1:5 Holding Bot. System `7'0J 00 C_ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand - / (i J Model Number GPM TDH Lift Lriction Syestem TDH Ft f 1~f oss Forcemain I Length Dld~ t' Dist. To Well >,7 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O ,~?%..r.e CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION' ST . JOSEPH 28.30.19,SE,SE 583 132ND AVENUE -~4 [.4 / Z Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. i Visconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. 57 C✓~ • See reverse side for instructions for completing this application State Sanitary Permit Number 3/5, it 33 The information you provide may be used by other government agency programs /Chock it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location Aod:ak 1Z -e- 4-02 1 h W- i r h m2f 114Sj~:- 1/4, 5 .;2 T , N, R If E (orar Property Owner's Mailing Address Lot Number Z_[Bl~ock Number 35 410- = 0 7 City, State Zip Code Phone Number Subdivision Name or CSM Number e r♦ e ( ) A v s r 11. TYPE F BUILDING: (check one) ❑ State Owned ❑ ityy Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Z rows of o s t g,`40 /L 7/ s III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) /32' u 6 343 - ;?a 97-70 -0® 0 1 ❑ 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. 5LNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an System System Tank Only______________ Existing System _________Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21[] Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit X s-7 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation llISQ -5-40 D .r/ at 7• ~S Feet L 3_ Feet VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks ti 'b / AG 1 h? ` -Z1 ❑ ❑ ❑ ❑ ❑ mp an V /Y!I` B ❑ ❑ ❑ ❑ ❑ VIII .RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatur : (No Stamps) MP/MPRSW No.: Business Phone Number: •r4,'4It-L 5-c A* Av?94d 3121 Plumber's Address (Street, City, State, Zip C de): 5'G v IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Iss ing Ag nt Si ture (No Stamps) Approved ❑ Owner Given Initial Surcharge fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SI;D41M (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber PAGV GF PUMP CHAMBER CROSS SECTIOIJ ANG SPECIFICATIOKJS VEMT CAP 4"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG > ?_5' FROM DOOR JUMCTIOM BOX MAMHOLE COVER - , WINDOW OR FRESH 12"MIU. AIR INTAKE I GRADE I ( 'i" MIIJ. ~ CONDUIT 18"MIN. \ 11, INLET PROVIDE I AIRTIGHT SEAL i I I * A ( I \ I I I I I ALARM 6 ~ II I I *APPROVED I om C JOINTS WITH I ELEV. FT. APPROVED PIPE 3' ONTO PUMP OFF D SOLID SOIL COMCRETE BLOCK RISER EXIT PERMITTED OMLy IF TANK MAIJUFACTURE.R HAS SUCH APPROVAL SEPTIC f SPEGIFICATIOUS DOSE TAIJKS MAMUFACTURER: 121'dGJQS fe~~ NUMBER OF DOSES: PER DAy TANK SIZE: Gad GALLONS DOSE VOLUME ALARM MAAIUFACTURER: i t yd'a gun INCLUDIMG BACKFLOW: f 29 GALLONS MODEL IJUMBEK: DZ U CAPACITIES: A= D qt UICHES OR CALLOUS SWITCH TYPE: eve- j B= 2 INCHES OR .2 lK GALLOWS PUMP MANUFACTURER: X-0A (GI S' C=1[IMCHES OR !fif CALLOUS MODEL NUMBEK' y D= 7 INCHES OR 124; GALLOWS SWITCH TYPE: )lh -e x"c MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 3 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWCEu PUMP OFF ARID DISTRIBUTION PIPE.. /A FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , , . ..FEET + ~160 -FEET OF FORCE MAIN X 205 looFxFRICTIOU FACTOR.. L65 FEET TOTAL DyWAMIC HEAD = 1"4 6 FEET I INTERNAL DIMEIJSIONt OF TANK: LEAIGTH ;WIDTH iLIQUID DEPTH SIGUED:- l✓ GI/~t~i~~~. LICEMSE NUMBER:Int"011794a nA-rr ~~•?7 J~~ Safety and Buildings Division *Lonsin SANITARY PERMIT APPLICATION 201 E. Washington Ave. P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. Sr y x • See reverse side for instructions for completing this application State Sanitary Permit Number 31j g33 The information you provide may be used by other government agency programs ❑ 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 RMATI N Property Owner Name Property Location G ! h SF 1/4 SAC 1/4, Sa F T 30 , N, R E (or) Property Owner's Mailing Address Lot Number Block Number 25"7'2 of Off s4 ~ City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned ❑ City Nearest Road Village / Public 1 or 2 Family Dwelling - No. of bedrooms , Town OF 0; n S~ 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 4~©-a-o98 ~7o-oaC~ 1 ❑ 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an Syrstem System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench 22 ❑ In-Ground Pressure / 42 C] Pit Privy 13 E] Seepage Pit c> S X5 7 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq_ -ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 'Q.~6 S S Feet d , G S~Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Exist in Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. structed Tanks Tanks d, i 4 "Awe ore,-,/ & ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P/ PRSW No.: Business Phone Number: 'A/A V;*4 &A 1-405- V e, J 71 4::r - ?X-Z' --*P/ -_7 Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) toApproved E] Owner Given Initial O es/ Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD, (8.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber TO aF Sav. /r Pr Q U~ e°v'J /1^C Gdr C~c F/YIl B 31~ 0 4 ~ h .a a 4 A lo o kst /ale o 6sv s ,'c ? ' ` eX 97. 6 r, yWideonsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety 8 Buildings In apDOfCf h HR 83.05, Wis. Adm. Code COUNTY St. Croix Attach complete site plan on paper not less;han !ik'f/2 x 11 inches iri e. Ian must include, but not limited to vertical and horizontal refers PARCEL I.D. # MA j ?c e" p6int (Bfy)), di on an slope, scale or pending dimensioned, north arrow, and location arld distance to*ne~aresYtq APPLICANT INFORMATION-PLEASE ,P;R6NTSgLL NVFOATI REVIEWED BY DATE PROPERTY OWNER: tf fi'r` ' .5' ROPERTY LOCATION Dennis Erickson GOVT. LOT SE 1/4 SE 1/4,S28 T 30 N,R 19 YXor) W PROPERTY OWNERS MA!I-ING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 143 St. Croix Trl. " ° 7 na Birch Point CITY, STATE ZIP CODE PH ❑CITY ❑VILLAGE ,QTOWN NEAREST ROAD Lakeland, Mn. 55043 (6123 436-5211 St. Joseph 60th. St. P*New Construction Usep] 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/ft2 •8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 97.15 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem giS ❑U as ❑U ]uS ❑U )0 S ❑U ❑S ®U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture structure ConsistenceBotrday Roots GPD/ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed ITmr& 1 -12 10 r3/3 none 1 2c 1 mfr cs n .3 1 2 12-35 10 r4/4 none sil lfsbk mfr w if .2 .3 Ground 3 5-80 10 r4/4 none S os mvfr elev. 100.55 ft. Depth to limiting factor +80" Remarks: Boring # 1 -10 10 r3/3 none 1 2msbk mfr r- R 2f 5 .6 Via., 2 2 0-36 10 r5 4 none • 2. 3 3 6-82 10 r4/4 none s os mvfr n Ground elev. 100.45 ft. Depth to limiting factor +82" Remarks: CST Name-Please Print Gary L. Steel na. 15-246-6200 Address: 1554 200th. Ave., New Richmond, Wi. 54017 Signature: Date: 4-95 CST Number: y STEEL'S SOIL SERVICE Gary L. Steel Dennis Erickson 1554 200th Ave. CSTM2298 SE4SE4 S28-T30N-R19w New Richmond, WI 54017 MPRSW 3254 town of st. Joseph (715) 246-6200 lot #7-Birch Point N 1"=40' BM. = top of 2" row survey stake C el. 100' 17' 2 z l (00. 3 , kqo Gary L. Steel 9-4-95 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Da Vc, G o4 L Lma I [4d Mailing Address 3 S , , AY9 u-j h ► L 1&A r LA Kt, jJA-,-%L s SI 1 V Property Address 13a4 'ed < (Verification required from Planning Department for new construction) City/State Parcel Identification Number 7o - bock LEGAL DESCRIPTION Property Location Sec. ?,8~ T_jQN-R_4_W, Town of S aSeP • Subdivision --y-e- Lot # Certified Survey Map # , Volume, Page # Warranty Deed # S7 C/ At S , Volume 13 0-t•3 , Page # 77 Spec house ❑ yes Er no Lot lines identifiable a-y- es ❑ no 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 systerp can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensed pumper 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 ear 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. 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 } t . z I?r , I'II' c'•. 1.1 r 57940 4 .Q! 139-3 °APE 577 t STATE BAR OF WISCONSIN FORM 2 -19" DOCUMENT No. WARRANTY DEED j -Ericksmith~ Inc. , a Wisconsin Corporation ~~r•7~~,_T,~7S ~•-fi of ~n PC,i1 CRrrOE-- conveys and warrants to David J. Galbraith and ST. C CAI W~ 8K d ~ for tar gaW4 Patrice M Ga ra~*h, husband and wife MAY 161998 10:30 A. M i Re o< j the lot! owing described real estate in St. Croix C.ota> Stale of Wisconsin: RETURN TO Lot 7, Birch Point in the Town of St. DAVID J. ESTREEN Joseph. 304 LOCUST ST. HUDSON, WI 54016 30-2098-70-000 Parcel Identification Number (PIN): TRANSFER $13'QM 11. FEE I This is not homestead property. (is) (is not) y, E.ception to Warranties: Easements, restrictions and rights-of-way of record, if any Oared'his - day of May .1998 (SEAL) (SEAL) % By (SEAL) r W Dennis W. Erickson, President 0 ' AUTHENTICATION ACKNOWLEDGMENT ••IUinaN`~•~,`•, Signature(s) Svt1E OF WISCONSIN ~-Cco;x authant cated this County day 01 .18 Personally came before me th_ day of a 19 L? the above named ENE bL nr1rS` TITLE MEMSER STATE BAR OF WISCONSIN* * ` '*s a me known to be the person who executed the au' ,orized by § 706.06. Wis. Slats.) f• p,~`~ t ackno the same. THi3 INSTRUMENT WAS OR,',,-TEE' 3Y ~'~f7 VG • c x . Dennis_W Erickson %4'OF)000\1 z. ~r1 1117-1-11T{i~~ .L•-~1'!1 r ~a ~ r-. i.. - S \ ~5 p~6 ~ ►oo J ' o x ► .....3, - u S > x / w v 0 0 N m ` i x i nN X CID 10 p n 0 ti \\9 t Qm O5 W ~V c / ► \ `N \ d u W W N ro w N ► D D N w 1 n ; m 0 O X X W \ \ 487' ,09t, x o v a a . a N m ~ X P b L N-~ \ gyp. ► ? IV W N w m t0 Lq W (0 01 O m X\ n d n v. ON S• P U \ O P \1 O 1 O 09b ,99 455' T g - JI --3#4.L 1 ^'-8Z- J3S ~0~ S~3F#~:Q3611~ ~G \ 13391S H10 i oes