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,Labor a sinDep a Ref tofIn use SOIL AND SITE EVALUATION REPORT Page 1 of 3
Division of Safety & Buildings
in acc it l� itl�l� �.�5, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 11 i hewn size. faa ust include, but St. Croix
not limited to vertical and horizontal reference M), dijija4rt�?% of'slop , scale or PARCEL I.D. #
dimensioned, north arrow, and location and dis to nearest road ` ...
°
APPLICANT INFORMATION — PLEASE P �� ALL 1N(�R
�MA�14`pN �_` REVIEWED BY DATE
PROPERTY OWNER: r A. - PRO RTY LOCATION
Jo Ann i Bruce Peterson r te�,GO�T. LOT NE 1/4 SW 1 /4,s 29 T 30 N,R 19 9(or) W
PROPERTY OWNERS MAKING ADDRESS r T # BLOCK# SUED. NAME OR CSM #
#328 Co. Rd. #F 1 [ 2 na Hi hland Hills phase II
CITY, STATE ZIP CODE PHONE NUM ER" "' ❑CITY ❑VILLAGE EUOWN NEAREST ROAD
Hudson, WI. 54016 (715) 386 -5347 St. Joseph I CO. Rd. #E
[x] New Construction Use [ Residential / Number of bedrooms 3 [ ) Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd/ft •5 trench, gpd/ft
Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate .4 bed, gpd/ft .5 trench, gpd/ft
Recommended infiltration surface elevation(s) 101.55 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material glacial till 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 ❑ S ®U as ❑ U ❑ S ®U ❑ S ®U ❑ S f] U ❑ S [2
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxtdafy Roots GPD /�t
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed
1 0 -13 10yr3 /3 none sl 2msbk mfr cs 2f .5 .6
;:�• ,
2 13 - 10yr4/4 none sl lmsbk mvfr gw if .4 .5
Ground 3 31 -65 7.5yr4/4 c p yr
elev.
7.5yr5/8 sl lmsbk mfi na na .4 .5
10 1 . 2 5 ft.
Depth to
limiting
factor
31
Remarks:
Boring #
1 0 -8 10yr3 /3 none sl 2msbk mfr cs 2f 1 .5 .6
2 2 8 -33 10yr4 /4 none sl lmsbk mfr gw if .4 .5
3 33 -40 7.5yr4/4 :none sl 2msbk mfr gw na .5 .6
Ground p yr
elev. 4 40 -55 7.5yr4/4
101 ft, 7.5 r5/8 sl lmsbk mfr na na .4 .5
Depth to
limiting
factor
40"
Remarks:
CST Name _ Please Print Gary L Steel Phone: 715 - 246 - 6200
Address: 1554 0th. Ave. New Richmond, WI. 54017
Signature: Date: CST Number:
C' �� �� 6 -22 -94 cstm 2298
STEEL'S SOIL SERVICE
Gary L. Steel Highland Hills phase II 1554 200th Ave.
CSTM2298 lot #12 New Richmond, WI 54017
MPRSW 3254 NE4 SW4 S29- T30N -R19W (715) 246 -6200
town of St. Joseph
N
1" =40'
BM= top °of SW sot stake at el. 100'
Q1 0 �2
Y
IY
Gary L. Steel
6 -23 -94
ST. CROIX COUNTY ZONING DEPARTMENT
�-- AS BUILT SANITARY REPORT
Owner 9AA/ &7T
Address _ _4
City/State L ,� ;a ,�
Legal Description:
Lot -J � a t Block Q[A Subdivision/CSM # �}i d,a {}7LL � _ Y
'V4 " '�4 - 2 - 4e, Sec. ,U, TAN -RAW, Town of _ S �"', i ffi : &ZI. PIN #
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer &ZEfiE&-r Size ST/PC 601 " Setback from: House JCL Well P/L
Pump manufacturer jC LLB Model / y
Alarm location
Setbacks: Service road Vent to e Water Line
Meter location
ion
SOIL ABSORPTION SYSTEM:
Type of system: oa-mt3 Width 8 Length 5 1 Number o €-Tte;ekes
Setback from: House Well P/L_ Vent to fresh air intake tad
ELEVATIONS:
Description of benchmark ,Tap „2L ,jf 4UG !'1p� G� L Elevation 4:7. 0
Description of alternate benchmark 1On o TR�ti FaRrfpn 5 AF Lo 77�- C Elevation q ,8th
Building Sewer _ ST/HT Inlet 9 3 F9 ST Outlet PC Inlet P3, Y4
PC Bottom Q, D Header/Manifold I -ald 9 Top of ST/PC Manhole Cover
Distribution Lines(
Bottom of System (
Final Grade ( ) /Q L1 ( ) ( )
Date of installation / / permit number State plan number
Plumber's signature License number /7 97 Date 42 /
Inspector
Complete plot plan a
Wisdpnsin Department of Commerce County
PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 315884
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
SCHOUVELLER, JANET ST. JOSEPH
CST BM Elev.: Insp. BM Elev : 7IMPescription: Parcel Tax No.:
030- 2094 -30 -000
TANK INFORMATION ELEVATION DATA AgR00
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic - �� Benchmark
Dosing
CLUB
Aeration Bldg. Sewer '
Holding St/ I Inlet 8'
TANK SETBACK INFORMATION St/ I Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic NA Dt Bottom 3S'
Dosing NA 3>daaer / Man. (7�'
Aeration NA Dist. Pipe '
Holding Bot. System �j�' ,'�$�
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 60/,
Model Number GPM < ° 5 T '
TDH Lift Friction System TDH Ft
Forcemain Length Dia. , i Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuacturer: INFORMATION Type Of CHAMBER Mo Number:
System: OR UNIT
DISTRIBUTION SYSTEM
ft / 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 ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
")I LOCATION: ST. JOSEPH 29.30.19,NE,SW 457 HIGHLAND VIEW
Plan revision required? E] Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
l
NViscon "
SANITARY PERMIT APPLICATION Safety w hni� Divi
s/ 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 8 to x 11 inches in size. F� cy ly
• See reverse side for instructions for completing this application State Sanitary Permit Numb41h
The information you provide may be used by other government agency programs ❑ Check if revi tO p`Fevi'ou on
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Property Owner Name Property Location
— — E-114 SW 1 /4,S Tap ,N,R 1 E( W
Property Owner's Mailing Address Lot Number Block Number
r c D . / 02 N4
City, State Zip Code Phone Number Subdivi ion Name or CSM Number
II. TYPE BUILDING: (check one) ❑ State Owned ./ C] it Nearest Road
El Public 1 or 2 Family Dwelling - No. of bedrooms � K Town OF , el liyw
I11. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 — — .30
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. Lg New 2 ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an
- ------ System - System Tank Only Existing System Existing System
B) [:]A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ;9 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION: I
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
D Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
OO, Feet Feet
Capacit
VII. TANK in Ca gallo Total # Of Prefab. Site Fiber- plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Co" steel lass A
New Existin structed g pp"
Tanks Tanks
S /4110 / — E `S ❑ ❑ ❑ ❑ ❑ ❑
Lift Pump Ta amber OO 1 0 1 ❑ I ❑ I ❑ 1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewaaa shown on the attached plans.
Plumber's Name: (Print PI is Signature: (No t p M PRSW N Business Phone Number:
umber's Address (Street, City, State, Zip Code):
- 5 , O t 6
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater at ssue wing Age t o Stamps)
Approved E] Owner Given Initial Op urcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REA O S FO ISAPPROVAL:
SBD -6398 (R. 11/96) DISTRIBUTION: Odginall to County, One copy T•: saroay a evldir,ys Division. owmer. Prs.bm
Safety and Buildings
Nvisconsin 2226 ROSE ST
LA CROSSE WI 54603 -1905
Tommy G. Thompson, Governor
Department of Comm William J. McCoshen, Secretary
June 27, 1998
CUST ID No.221741 ATTN: POWTS INSPECTOR
DONAVIN L SCHMITT
586 VALLEY VIEW TRL
SOMERSET WI 54025
RE: CONDITIONAL APPROVAL
Identification Numbers
APPROVAL EXPIRES: 06/27/2000
Transaction [D No. 111641
Site ID No. 13124
SITE: Please refer to both identification numbers,
Site ID: 13124 above, in all correspondence with the agency.
St. Croix County, Town of Saint Joseph
NE1/4, SW1 /4, S29, T30N, R19W
JANET SCHOUVELLER
FOR:
Description: Mound
Object Type: POWT System Regulated Object ID No.: 27501
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Adm. Code.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /instal lation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely
e DATE RECEIVED 06/23/1998
FEE REQUIRED $ 180.00
6RARD M SWIM, POWTS PLAN REVIEWER FEE RECEIVED $ 180.00
Integrated Services BALANCE DUE $ 0.00
(608)785-9348, MON - FRI, 7:15 AM - 4:00 PM
JSWIM @COMMERCE.STATE. WI.US
Wisconsin Department of Indfistry, PRIVATE SEWAGE SYSTEM Safety and Buildings Division
Labor and Human Relations REVIEW APPLICAT Bureau of Building Water Systems
Hayward Office La Crosse Office Madison Office Shawano Office Waukesha Office
209 W 1 st Street 2226 Rose Street 201 E. Washington Ave. 1340 E. Green Bay Street 401 Pilot Court, Suite C
Rt 8, Box 8072 LaCrosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188
Hayward, WI 54843 Phone (608) 785 -9334 Madison, WI 53707 Shawano, WI 54166 Phone (414) 548 -8606
Phone (715) 634.4804 Fax (608) 785 -9330 Phone (608) 267 -5119 Phone (715) 524 -3626 Fax (414) 548 -8614
Fax (715) 634 - 5150 Fax (608) 267 - 0592 Fax (715) 524 - 3633
INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this
form together with fees and plans /information. Your submittal must be received at least one working day prior to the appointment at the office
where your review was scheduled. Please call'any of the listed offices if you need help filling out the form or have questions on what information to
sub P PRINT VERY CLEARLY, A sample of a completed form !son the reverse side for your reference.
wrr�r„ i ire
1. APPOINTMENT INFORMATION -If you have scheduled an appointment, fill in the information requested below to save time:
Appointment Date Reviewer Name Plan Identification Number
2. PROJECT INFORMATION If this review is a revision or extension to your existing
plan identification number, provide that number here:
Project No ❑ City ❑ Village Town Of: County
Project Location
GOVT. L AtE 1/4 114,S T N R E (o,YQ
3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED
System Type (check one): System Type I (include new and existing tanks)
Uplo 1,500 gallon septic tank $110.00 /fQ
A ❑ At - Grade 1,501 - 2,500 gallon septic tank ... .......... $120.00
H ❑ Holding Tank 2,501 - 5,000 gallon septic tank $160.00 .. .... .
M C@ Mound 5,001 - 9,000 gallon septic tank .... ..... ..... $200.00 ........
N ❑ Non - Pressurized In- Ground (conventional) 9,001 - 15,000 gallon septic tank . ... ............. $ 300.00 .
P ❑ Pressurized to- Ground Over 15,000 gallon septic tank .................. $ 500.00 ....... .
O Other: U To 1,000 gallon dose chamber
❑ P 9 .......... _... $ 70.00 ..,...,. 7A-
1,001 - 2,000 gallon dose chamber .. ...... S 80.00 ....... .
Building Type (check one): 2,001 - 4,000 gallon dose chamber ..... ... ... $100.00 ........
4,001 - 8,000gallon dose chamber ........ ...... $120.00 ........
D ❑ Dwelling, 1 or 2 Family 8,001 - 12,000 gallon dose chamber $ 140.00 ......
P ❑ Public Building Over 12,000 gallon dose chamber .. ......... -V0ED-
S ❑ State -Owned Building Up To 5,000 gallon holding tank ..... S 6Q,00
5,001 - 10,000 gallon holding tank .............U.0 N $� 019.98: :
Code Derived Daily Flow gpd Over 10,000galIon holding tank $150.00 ....... .
SAFETY § 3 D(iS. DIV.
Check If Replacing Existing System Experimental System (additional onetime fee) . .. ..
Revisions To Approved Plan 2 ........ . ......... S 60.00 ........
Petition For Variance: Setback .................. $100.00 . ...... .
❑ Petition For Variance Site Evaluation .... ... $ 225.00 . ... .
Plumbing $ 225.00
` Revision ..... ...... ..... S 75.00 ........
❑ Groundwater Monitoring Groundwater Monitoring - Per Site $ 60.00 ......
(other than a proposed subdivision)
❑ Site Evaluation in Lieu of
Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring $ 60.00 ....... .
Subtotal. .........
Priority Review: Enter same amount as Subtotal: —
MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: _,.....
5. SUBMITTING PARTY INFORMATION L t
Telephone No. (include area code & extension) Company Name L� Contact Person
( ) 5 s .& ,_S zel.4 10dffA0 �rr
No. & Street Address Or P.O. Box City, To nor Village, State, Zip Code _
5A6 12ALL&X. V 522,
I Aerobic or prepackagecf treatment system fees are calculated based on equivalent size septic tanks and dose chambers
2 Revision fees are not applicable to temporary holding tanks or extensions to existing approvals.
NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually
The information you provide may be used by other government agency programs [Privacy Law, s 15.04 (1) (m)[.
SBDW -6748 (R. 09194) OVER �-�-
,,, L 1 F i 3LiLj S i3 i'�
Mound System
for
Janet Schouveller
RECEIVED
NE1 /4 SWU4 S29 T30 R19W U N 2 3 1999
St. Joseph Township
St. Croix County SAFE -Y & dLDGS. DIV.
Page 1 Work Sheet
Page 2 Soils Report
Page 3 Plot Plan
Page 4 System Cross Section
Page 5 Pipe Lateral Layout
Page 6 Dousing Chamber
Page 7 Pump Curve
1P 0 Vq ;'T.
C
C
Prepared by. Dvp �rs10F �a,$� Rp►Npy
,h
pFE�Y pND
Donavin L. Schmitt ,,�,5 ►�a
586 Valley view Trail ESP ENGE
Somerset, WI 54025 S EE COR
715 -549 -6651
MPRSW 221741
6 -18 -98
SCyoU L [_/� Page��f�
OPTIONAL WORKSHLET
1. MOUND SY5ILhF I1. IN•Gk(ri :r.1) F'kL�',ItRF. SYSTEM -Continued -
((����'//��
1. Wastewatet Lord, total Daily Flow= � gal. 10. I nrte. nta,n:
Use s. ILIIR 83.15 (3) (c) Mollr+um Dosing Rate = J11.1.L Rpm.
Adm. Code and PROVIDE A DETAILED Dometer - - 1n.
LIS I Of SIZING ON PLANS. / �� l 1. Tntei D)nami� Head:
2. ¢ .
Depth Io Limiting Factor = Ww� Sys:em (lead = _2.5 ft.
3. Land0cipe = _ !6 Velt%al Lift = � - ft.
4. Distance from Dose Chamber to Friction Loss = ft.
Distribution System - /DO ft. I D I i = ft.
S. Elevation Difference Between i 12. Pump Selection:
Pump and Distribution System = 2 ft. Pump will discharge at least 3 2 t gpm
6. Absorption Area Sizing. -T at 3a.1:2. ft. total dynamic head. _ 1
Area Required = _3T sq. ft. Pump model and mant&f�t�er: 2d�LLC
Bed or Trench Length (8) _ ft. '7e �• A ! � // `` -----
Bed or Trench Width (A) = ft. q ( 13. Dose Volume:
Trench Spacing (C) ■ - ft. 10 Times Void Volume of /Q? - 16
7. Mound Height: Distribution Lines= -Y�=� gal.
Fill Depth (D) _ �� tt. Daily Wastewater Volume r
Fill Depth Downslope (E) = ft. 4 Doses In 24 hrs. = .L/- gal.
Bed or Trench Depth (F) _ 9 ft. Backflow = gal•
Cap and Topsoil Depth (G) ■ ft. Minimum Dose = gal.
Cap and Topsoil Depth (H) ■ ft. 14. Dose Chamber:
8. Mound Length: � Volume = BDQ gal.
End Slope (K) = S ft.
Total Mound Length (L) = ft. 111. NVENTIONAL PRIVATE SEWAGE SYSTEM
9. Mound Width: 1. Wastewater Load, Total Dally Flow = gal.
Upslope Correction Factor= , 97 s se S. ILHR 83.15 (3) (c) , Wis
Upslope Width (I) ■ ft. dm. Code and PROVIDE DETAILED
Downslope Correction Factor LI OF SIZING ON PLANS.
Downslope Width (1) _ ft.+ y♦ � fo 2. Require optic Tank Capacity ■ gal.
Total Mound Width (W) ■ ft. 3. Percolation to = min./in.
10. Basal Area: 4. Absorption Are (zing:
Infiltrative Capacity of Refer to T e 2 in ILHR 83
t�
Natural Soil ■ -1. gal./sq.ft./day and PROVIDE A TAIL LIST OF
Basal Area Required = 1 /15 sq. ft. SIZING ON PLANS.
Basal Area Available ■ ( AA sq. ft. Required Area ■ sq. ft.
11. If Standard Tables from Chapter ILHR 83 Length = ft.
are used, Indicate Table # Width = ft.
12. For the Distribution Network, Use Numbers 5 -14 in Section 11. Number of T ches =
Trench Spa ng = ft.
11. IN- GROUND PRESSURE SYSTEM 7 / a S. Distribution.
�`
1. Depth to Limiting factor = _�'�' Later Kength ■ ft.
2. Landslope ■ -- T % lll=r of Laterals ■
3, TW19f111110 Ate = 1 1 01 teral Spacing = in.
4. Proposed System Elevation =� -f 00.7 ft. Distance from Sidewall to Pipe = in.
S. Wastewater Load, Total Daily Flow: N so gat. System Elevation • ft.
Use s. ILHR 83.15 (3)(c), Wis.
Adm. Code and PROVIDE A DETAILED IV. SYSTEM-IN-FILL
LIST OF SIZING ON-PLANS. FIII in All Items from Section Ill
Required Septic Tank Capacity = _1 d �O gal.
6. Absorption Area Sizing: V. SEPTIC TANK
lltlijMbom Rate = 1 tr ,,w� 1. Capacity = ,. /000 gal.
Area Required = 3 73 $4. ft. 2. Manufacturer:
System Length = 4/7 ft. 3. Shots Site Constructed Tank Details on Plan
System Width - a ft.
7. Distribution Pipe Siting: �� VI. DOSING TANK j�/�/�
Holc Siic = Ya/ in. 1. l apacity Y
= _ -�Y• gal.
r,
If. 2 61,In Ufat lUfef:
HnIC SpJLmg = �. d t� LLB►
I.Aer.4 Lenµlh � it. 1. Pump Manuf,&:
.areal Sin• _[L+ = in. 1. 1'umt• Model:
1.uclrllp.rtilig It. i. or:•Jtr-l¢Head= ft.
111 \Lllll l• Iron ♦idrw.rll to Pipe 2 ♦ _ u+. 1.. I It+w Rate _ gpm.
ti, bi.uthulion Pipe Diah.n►c Rrte: Sho.. Site C nmtrutted Tank Details on Plans
Numbet ul I lult•� 1'vr 1'ip''
I low I'ct Pqn -�� KPr)), VII. 1101 1WA ". -.�.n.
9. MJndold Svfng' /� gal..
t•n
Iypr (tler or end {
) /wo �1r'+u +r.lurN-
t rngUl __ 11. + •.c 1 ttn.lr�.
Illnot•Ier _ _ u)
SHOW ALL INFORMATION ON PLANS -
11 11R %Ill) 9. 110 1R 111lA '1
1 ,
Wiscon�hi Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Allach complete site plan.on.paper.not less than 8.1/2 x 11 inches in size. Plan must County
in , not limited to: vertical and horizontal reference point (BM), direction and
'' Ss-/,
,p rcet slope; scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information Reviewed by Date
Psrsonal intonnstion you provide may be used for secondary purposes (Privacy Law, 9. 16.04 (1) (m)). y �y
rppq na( Plopeily L ooation
I Govt. Lot N,6; 1/4 .S" 1 /4,S 02? T ,N,R -ON) W
Property Owner's Mailing Address Lot # I Block# I Subd. Name or CSM#
41� Al
ty
w. State Zip Code Phone Number Nearest Road
0�� ( � / _
City ❑Village Town A
19-New Construction User CUResidential / Number of bedrooms — Addition to existing building
"(] Replacethent, i t ❑public or commercial - Describe:
/ft S tre
Code.derived daily flow -- Z� v gpd Recommended design loading rate � /, bed, gpdnch, gpd/ft
, Absorption area required 371' bed, ft 3 trench, ft Maximum design loading rate gy bed, gpd/ft t. 9Pd/it
v i
Recommended infittratlon surface elevation(s) __._ �� �� ft (as referred to site plan benchmark)
tr3 E=L &C eh Coy► L.� Fsfed /rc.t'o�a� ZZ YA' 70 �
Additbnal �eslgNsiteaconsideratl$ns_,IS)
s
Parent mat ?rial Flood plain elevation, if applicable
s Conventional Mound in -Ground Pressure AT -Grade System in Fill `Holding Tank
uM _ u stable rb sys m t p S . WJ u El S ❑ u 1:1 S ®' U El s au ❑ s L�'u � ❑ s" �Nru +
SOIL DESCRIPTION REPORT
Boring # Horizon Depth .. Dominant Color Mottles Consistence Boundary Structure PDIW
in... Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Roots Bed Trench
i
a -aG ~. ---- SL .?,.�s�� war f.✓ :A.
'Qround V111 SL
g
elev.
i
.Depth.to
limiting
fa r .-
n.
FFemarCs
Boring #
Cr
w .
�✓ . s'-
Ground '
n Remarks:
I Signature Telephone No.
CST Name (Please Print) si
°;. Address Date CST Number
ro-9- s o fvs
Q M _ r P � f�� f�� /
�/od 4 Pro�efly C ilrP Q
/y
az
�L� tv s
�d 37' L. ►� �
Y4� �
3 k L
cu r
L;
�� 99 70'
1 41-P Pt
�y.
91P s' Q��/ .e�✓'� v /gay
CS7 DZ/old
Nrl SGv.l \
j
i
{
` - - -
I
I
- -- - -- — -- __� - - --
-- o
' f _
}
i G C
:
I { I DQe GG SST
t � ;
// f y
Tn�'I� � 1 -
_
i
I _ ;
I � :
- I - -- -
- - -
:
t � I
i � I
4 f :
'. w r - _
- - --
S T.e��ta� �ib�unRS�i1P
Page - o
Straw, Marsh Hay, Or
Synthetic Covering
�STi�1 X33 - Distribution Pipe
Medium Sand
_ H _ G
6" Topsoil F
3 � E D
„
b
�— % Slope
Bed Of Z * – 2 % Force Main Plowed
Aggregate Layer
(6" Below Pipe)
D _� Ft.
Cross Section Of A Mound System Using
E Ft.
A Bed For The Absorption Area
F Ft.
G �_ Ft.
A _ Ft. H 1, 5' Ft.
Signed: - ,
BZ Ft.
License Number: jgo K - Ft.
Date: — /j — 9B L Ft.
j ,S Ft.
I 1 1,3 Ft.
W Ft.
L
Observation Pipe
g 01 K
I�--------------------- ~---------------- - - - - -- -
A
W ( ------ T ------------------------------- - - - - -- I Force Main
Distribution Bed Of Z"— 2 2M
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
(� a e or
Perforated Pipe Detail
/
i End View
� Perforotea /
End Cap ) °, PVC Pape
i . eye t
�oO\�`o�c Holes LoGq►ed On Bo►tom,
I � JY/ S Are Equally Spored
Orw IIAN /i
e
Dislribulion rte.
Pipe
Lost Hole Should Be
Next To End Cop
Distribution Pipe Layout P Ft.
r-006 MAIN
S 3
X Inches
r
Y Inches
Hole Diameter Inch
Signed: Lateral 14z Inches)
License Number: 11 /7111 Manifold 11 Inches
Date: Force Main " Z Inches
# of holes /pipe��
Invert Elevation of Lateralsj'D /..,, Ft.
PU! CHAtAE;�R M -c StC`IC,J AFJG �PECIFICl110 "]5
VEP!T CAP
4 "C.I. PIPE WEATHERPROOF APPROVED
F.
JU►JCTIOIJ BOX MAIJHOLE COVE
1
C.p /d-L`
� pr' ��.•n, R. T WWh( )bl .)1 r 1 bll IC�MIi1.
AIR INTAKE I
GRADE
J IB "MIAI.
COIJDUIT --
16 "MIN. �
PROVIDE i �
INLET � AIRTIGHT SEAL
I I APPROVED JOI
APPROVED JOINT A I II W /C.I. PIPE
W/C.I. PIPE I II EXTENDING 3'
EXTENDING 3' ALARM ONTO SOLID SOIL
ONTO SOLID SOIL I II
B I I
I ON .
C I I
AK
ELEO • T. F PUMP OFF
CONCRETE BLO
RISER EXIT PERm ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E , SPEGIFItATIOUS
DOSE K q r , �0 , QUMBER OF DOSES: PER DAH
TANKS MANUFACTURER:
TANK SIZE: Ran GALLONS DOSE VOLUME � q
INCLUDING DACKFLOW: ��� GALLONS
ALARM MANUFACTURER: -----
MODEL LIUMBER: IYA CAPACITIES: A INCHES OR 32L.-Yr GALLONS
SWITCH TYPE: NeR G U 2 %4 B = INCHES OR Y17 GALLONS
PUMP MANUFACTURER: 7 d , p p � �� �L'�� =--- G = �/ INCHES OR /3 � � � I , GALLONS
MODEL NUMBER: D = _LG..- INCHESOR 0 " 92 - °GALLONS
SWITCH TYPE: �� l/ NOTE: PUMP AND ALARM ARE TO BE
37. yy GPM INSTALLED ON SEPARATE CIRCUITS
MINIMUM DISCHARGE RATE
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET /
+ MINIMUM NETWORK SUPPLY P,R9ESSURE - . . 2.5 q FEET
+ ,rao FEET OF FORCE MAIN X [lP�_ F /OO ►LFRlCT10N FACTOR.: FEET
TOTAL D!JWAMIC HEAD = B / FEET
INTtRUAL D IISIOUS OF TANK: •Th''U0 _ ;LIQUID DEPTH 3
SIGNED' J LICENSE NUMBER: 1117 DATE:��
o� 7
v' TOT DYNAMIC MEAD /CAPAC
HEAD *CAPACITY CURVE PER D DEW A
y� EFFLUENT Ai, AN DfWATERINC
MODEL 137.13f1.140a140
MODELS 13711 40/414
.59
I+ r
MODELS 10 /�t.o
F1. toles CoI. Llq. COI. WSW
f 1." 93 Sat N SSG D
12 O �0 346 it m w 341 _
140,4140 q Oar a 242 u 314
S 20 5.1e 39 13e r3 22e
t0 is r.22 a 30 u In t 1/2 - TI 1/2 Wn
So- 30 n4 v >nr
» I A1,1 Sit q Wag _ at i;j
0 w ,1 is w 114
LR. wti 21' 46'
1
t3 E
>t 4
t0
I 1 r
2
S
A 8 C I D I E I F
1371139 4 314 1 7= .81 4 4 1 314 4
U.S. CAL ONS to 20 30 -0 60 6-6. 7o 9,n go 100 110
LITERS 80 100 240 3z0 4 ; 0 4 4 3f4 8 5118 81 15 15114
D rLDw PER W NUTE 4140 4 314 1 8 1 8114
CONSULT FACTORY FOR SPECIAL APPLICATIONS
- Three phase pumps are available in 200/208V or 230V - 1371139 Models. - Variable level control switches are available for controlling single and three
- Electrical alternators, for duplex systems, are available and supplied with phase systems.
an alarm, - Double piggyback variable level float switches are available for variable level
- Mechanical alternators, for duplex systems, are available with or without long cycle controls.
alarm switches. - Long cords are available in lengths of 15 - 25 - 35 - 50 feet. (Maximum 26 length
- Combination starters are available for 3 phase pumps. for 14014140 models @ 115V)
- Control alarm systems are available for 1 phase pumps. - Over 130'F. (WC.) special quotation required.
137 Series - 47 lbs. 139 Series - 51 lbs. 140 Series - 53 lbs. 4140 Series - 73 lbs. ' Refer to FMO806 for 200' F. applications.
single sow Control Selection
Mom Volb.Ph Wk x Duplax CSA UL
M1371139 1% 1 Auld 10.7 1 orl 3S Y Y SELECTION GUIDE
M1371139 115 1 Non 10.7 2 or 2 3 7 3 or 5 3 6 Y r slin
1. Integral float operated 2 pole mechanical swftdl, co exfemal W" required.
10.1 2 - Y 2. Single piggyback variable level float switch or double piggyback variable level
01371139 230 1 Anb 5.8 1 or 13 a - Y llat k switch. Refer to FM0447.
E 113 703 111 in 7 3 or 5 3 6 3, Mechanical ahemator'M -Palk' 100072 a 10.0075.
• t n39 1 5.5 1&$ - Y 4. Cortation $fatter. Refer to FM0514.
1137/139 T° 5.5 ' 2 3 7 3 or5 d 6 Y 5. See FMO712 for correct model of Electrical ANerrmtor'E -Pak'.
J1371139 200.208 3 Non 2.6 234 334or536 Y Y
F1311139 230 3 Non 2.e 2&4 334 or 536 Y Y 8. VeriablefeW control switch 10.0225 used as ail *01 activator. spedfy duplex
G137 460 3 Non 1,4 244 334 or 536 N N (3) or (4) float system.
6139 1 460 3 Non 1.4 234 j 334 or $38 N 7. Four (4) hole "J - Pak', junction box, forwatertightconnectiOnorwired •Insimplex
or 2 pump operation, 100002.
14014140'» MODELS Control Selection LMIa as S. Two (2) hole'J•PW, for Watertight connection or Splice, 104M.
Model Model YokaPh Mods Sbn Duplex SA UL
N140 N4140 115 1 Non 15.0 2or237 3at535 N N
E140 E4140 230 1 Non 7.5 2or237 3or538 N N
90401 BE41401 230 t or , 2
ON140 SN4140 115 1 Non 15.0 2 Cr 2 3 7 3 or 5 3 6 N N CAUTION
W 1 A W vw9 " s"4' .fth fil All installation of controls, protection devices and wiring show be done by
•�
Double col PWMB are avetebte w1h opedW taaiaera wags. Seal Fat Y1diala W &vInl A h NElM I or AMA4X
=*d pnab wrh a qualified Itsed electrician AN elaGtrtai and ad* coda fI10111d be
Pumps must beopelatedin upright powbat. followed including the most recent National Electric Code (NEC) and the
Occupadonal Safety and Health Act (OSHA).
Thu prow uaub nQuve a conooi switch to opaab an external magnabc orcombinauon starter.
For InImmallon on addWonal Zoeller products refer to catalog on Combination starter, FMO514:
Ptppybarkval iablalwaIFbatSwikhes, FVM77: E*ctr AAllomator, FMO486: Mechanical Altema-
lor, FM0495k Alone Pa0ape ,FM0S1t and Sumpl mege Sam. FM0487.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. Box 16341
? d' louiswlk.Ky 402584347 Manuladurersd..
SNP TO: 3649 C
KY
Lo 40271-1961
rNavrlte, 4021 1.196f Qvaurr Pu4•PS SNCE /9.79
PUMP !0 (502) 77 8. 2731 • T (600) 928 -PUMP
FAK(502)774-3624
Wiscoh4in Department of Industry SOIL AND SITE EVALUATION
Labor and Human Relations Page _ of
division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less tha 1 'teas n tt . Plan must County
include, but not limited to: vertical and ho .z I S ' r ' rrnce int (Bl�tj, Pr 'on and s cr af'
percent slope, scale or dimensions, north a And I Stan to Barest road. Parcel I.D. #
_ 3 _ 3
or on
APPLICANT INFORMATION - P e p •,s i
�� I Y .� eddy Date
Personal information you provide may be used f ~ ndary pu o C; 90 1Rc w, s.,i5., (1) (m)). Re
Property Owner ' COUNTv . roperty Location
10 Govt. Lot N,6: stj1 14,S ay T3( ,N,R /57 -Ipr) W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Code Phone Number Nearest Road
X111 052 � ) ZY- 9 El City El Village Town A l a,,o l b ll / _awoo
New Construction use: [Residential / Number of bedrooms_ Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow � gpd Recommended design loading rate e L bed, gpd/ft • s trench, gpd/ft
Absorption area required 371 bed, ft 37S' trench, ft Maximum design loading rate bed, gpd$ - S_ trench, gpd /ft
Recommended infiltration surface elevation(s) _ _A210 , _> i ft (as referred to site plan benchmark)
Additional design/site considerations _.qv 7 e w � L 6c< , d eh CoK 61 L1>1 e sf� / /e'c 1, ��af ZZ Y, ; � /
Parent material G�.�_, . / 4- i // Flood plain elevation, if applicable N� ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
u= unsuitable for system ❑ s R1 u El s ❑ u ❑ s a u I ❑ s au I ❑ S N - U ❑ s PTU
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
9 Texture Consistence Boundary Roots
-• in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
• 1
L I
OS o— D 3/� SQL � 6� ��• � e
Ground 3 6`g s �(� L b P?A i , c
elev.
Depth to
limiting
factor
- FWin.
Remarks:
Boring #
-r
C24 ,ter s� N� �'� �✓ . sr -
Ground
elev.
Depth to
limiting
factor
ae—w in. Remarks:
CST Name (Please Print) Signature Telephone No.
T, S /Sis J-Ys s
Address Date CST Number
SS / S� s S yd.Ir
6L9-e 3 o P,?
P1145 Z�7Z ' 10 e q . 00
B M 7y c 2
All 7o
/Vo{ A proloef y �ihlo Q�
y � 020r
aZ
37' ve
I4'
L � q-p- /oI'
99.70'
414 gel
Qrc -`q -per: �it�� Pi� �G�ZODUB l�r i y;
�
/ e llwrn,� eel, / '� �/ Ile-Y Ille-J 7:,,,,J
L od
Xwn oP SI, J /Vt -1�, �Gv y S �9 T�o•v��9�/ /
" T
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer rT AI E T
Mu111►ig /Wd►'naa
Property Address - L E
(Verification required from Planning Department for new construction)
City /State �/ Dsjjv Parcel Identification Number _ 0,73 Q - -,Z0 91 -30
LEGAL DESCRIPTION
Property Location _& 1 14, JW_ %4, Sec, ,,f,9, T ?D N -R Town of 37.
Subdivision Lot #
Certified Survey Map ,Volume , Page #
Warranty Deed # S26o0 , Volume . 132? , Page # 3 6P
Spec house ❑ yes Cff no Lot lines identifiable 06 yes ❑ 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 system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeymanplumber, 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 Ofd - ice within 30
days of the three year expiration date.
/94E
kGNA4TURdE -r 0 -' FAPPLIC!ANT DATE
OW =R CER, IFICA ON
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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
GNATURE 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
' DRAINAGE
I I
�+ EASEMENT
LOT 2 / N
I
i w '
- -- — ;cv
'� LOT 16
t Z
M 3.29 ACRES 2
143,254 SQ. FT. G
Ir w
ID A
---I w
EL. =951.0 m
\ SE
N89 E 422.94'
m
w
• O
LOT 3 �t
CID -
c
rn
W
�p N
J
I � LOT 12 a
W 3.06 ACRES J L
LOT 4 133,250 SQ. FT.
- -- — O
N
EL. 951.0 2024 • F / // /�
O
4�S• � • RiL� / / / /
LOT 5 /
i
M /
1 / 4
LOT II
,_ I
1G� 3 .22 ACRES Z O
I = 140,096 SQ. FT. g N�
1r N a
V
IZ ° ro 0 O -4
/ DRIVE m
1
' I 16 5
O � \
N N89 04' 13" E 383.84' \ \
cp O, EL= 956.0
� \ S
LOT 6
CD
15 C,
C W� ,� .• \ 7
14 \l.